The central laboratory: who needs it?

A central lab can provide substantial savings in personnel and procurement costs while promoting improvements in service. Activities integral to this process are coordinating purchasing, implementing common processes, identifying key facilities, and using a common management information system.     

Training in assessment and appraisal: who needs it?

The aim of this project was to develop a training programme to help consultants supervising postgraduate medical trainees to fulfil their role as Educational Supervisors. A training needs analysis was conducted which revealed that consultants did not appreciate the importance of some of their new duties. This was mainly because of the lack of clear perception of their new roles. Hence training needs to be provided.     

A cancer risk test; who really needs it?

In the Netherlands, people are getting tired of all the health promoting messages. Even so, a new cancer risk test has recently been introduced. The aim of this test is to increase knowledge of cancer risk factors and to achieve a change in lifestyle in order to decrease the incidence of cancer. However, people already know the most important risk factors and lifestyle change proves to be very difficult. It is unknown whether such a test will even reach the high risk groups and whether it will cause people to change their lives. Therefore, it is doubtful whether we really need this test.     

Self-regulation,metacognition and child- and adult-initiated activity: does it matter who initiates the task?

Debate about the balance between child- and adult-initiated activities in early childhood settings is long standing. This article reports a study of 29 children aged 4–5 years in a London state school, on the influences of child- and adult-initiated activities on children's self-regulation and metacognition. Whilst both contexts were supportive, children were significantly more likely to demonstrate self-regulation and metacognition in child-initiated activity. Children's apparent perceptions of adult roles were crucial: in adult-initiated activities children appeared to cede control to adults. At the same time, adults played an important role for children, who were keen to display their knowledge to these significant people. Adults were particularly supportive of children's procedural knowledge. Practical implications include the importance of adult provision of and engagement in child-initiated activity, to afford them opportunities to observe and support children's self-regulation and metacognition and to maximise opportunities for children's autonomy and control.     

Improving vaccine supply and development: who needs what?

Payment for vaccines appears, from recent shortages, to have been inadequate. This paper addresses the roles of various stakeholders in influencing current payment and affecting possible increases. It is argued that the recent problems may have stemmed from undervaluation by government payer-negotiators, by private insurers, and ultimately by consumers themselves. On the supply side, the high profits available to other kinds of drug-firm investments may have inhibited allocation of resources to development of new vaccines, and the low profitability and near-monopoly status of current products may have produced insufficient incentives for producers to protect supply against accidents.     

Preventing surgical fires: who needs to be educated?

BACKGROUND AND CASE STUDY: Surgical fires are rare but preventable. During facial surgery for a 68-year-old man, a fire broke out, resulting in first- and second-degree burns after a nasal cannula ignited in an oxygen-rich environment because of improper draping and tenting. DISCUSSION: Operating room (OR) fires can be prevented if any component of the "fire triangle"-fuels, ignition sources, and oxidizers-is reduced or eliminated. The use of supplemental oxygen in the OR via nasal cannulae, nebulizers, and oxygen cylinders must always considered a potential source of fire. Deficits in knowledge among the surgical team with respect to the prevention and management of surgical fires were apparent. A plan was put into place to improve fire safety education, entailing an educational program that is included in intern and resident orientation. Surgical fire safety training was also put into place for anesthesia and surgical faculty. The anesthesia preoperative evaluation was modified to include an assessment of the patients' ability to tolerate short periods without oxygen. Posters and signs are now displayed in each OR suite. A complete policy review and update ensures that at least two fire drills are performed annually. CONCLUSION: Surgical fires can usually be prevented by educating staff about risk and prevention strategies. Such education should be part of all undergraduate medical, nursing, and other allied health profession education.     

A major trial needs three statisticians: why,how and who?

The statistical and scientific integrity of a major clinical trial is enhanced by having three distinct statistician roles: the Study Statistician, the Data Monitoring Committee (DMC) Statistician and the Independent Statistician. In any specific trial, careful attention should be given for selecting the right people to perform these tasks effectively. It is important that there are good communications amongst all three statisticians (and between each statistician and the other trialists) while preserving all confidentiality as regards interim results. Specifically regarding the Independent Statistician, it seems appropriate that they be truly independent having no other trial involvement than producing interim reports that inform the DMC (and be not employed by a commercial sponsor) but at the same time be fully aware of the trial protocol, objectives, organization and database.     

Engaging with phenomenology: is it more of a challenge than it needs to be?

When seeking to understand the human condition, with all the problems this enterprise poses for traditional scientific research approaches, qualitative research is held to be in some ways superior to rigidly quantitative research. As a result, many beginning health researchers plan to employ a qualitative approach to explore topics that were previously inaccessible via traditional scientific means. However, implementing a qualitative approach is not an easy process and, in many cases, researchers must look long and hard to find material to assist them in developing their research plans. This may be particularly so in phenomenological research. This article examines some of the problems and pitfalls faced by phenomenological researchers new to the approach. Through accounts of personal experience, it highlights some of the areas where phenomenological researchers could be helpful by being less reticent about the process of implementing a phenomenological study.     

Does it matter who owns health facilities?

The rhetoric of governments 'steering not rowing' and of purchaser-provider splits is still part of the language of public sector reform throughout the world, despite some retreat in the National Health Service in the UK. Implementation of separation of purchaser and provider roles has often been associated with suggestions that the private sector is better able to manage hospitals. The evidence for this assertion is mixed, especially when possible quality differences are also considered. This essay suggests that the ownership question is a second-order issue and that policy-makers should ensure that existing public hospitals are funded in a way that encourages efficiency.     

Child obesity: what can be done and who will do it?

Among the measures recommended by the WHO to reduce the risk of obesity and non-communicable disease, the consumption of a diet rich in micronutrients but with a relatively-low energy density features prominently. However, only a small percentage of the UK population (<1) appears to be consuming the recommended diet. Dietary behaviour is strongly influenced by the dietary environment, shaped by food supplies, investment policies and advertising, to create an obesogenic food market. Substantial resources have been invested in food production of a sort that does not promote better health; agriculture and food supply sectors have benefited from decades of public-sector support, but this practice has encouraged the production of meat, dairy, oils and sugar and the withdrawal from sale of fruit, vegetables and fish. The result is an 'obesogenic economy', i.e. a market economy that encourages weight gain, in which children are a prime target. Interventions in the obesogenic market need to be considered and several opportunities are described in the present paper. Recent moves to strengthen national and international food policies aimed to promote healthier behaviour have been undertaken, but they will need political support if they are to be fully implemented. Alliances of public health interests can help to create that political support and promote health-enhancing environments.