Money down the drain?

Recent City scandals have left NHS trusts largely unscathed but not unaffected. BCCI's demise highlighted two weaknesses in most trust's approaches to treasury management. Tom Jones explains.     

Will reputational incentives stimulate a reversal of the physician brain drain?

An increased supply of physicians in high income countries both from domestic production and from immigration from low and middle income countries has made medical employment increasingly competitive. This has been heightened by the introduction of reputational incentives, such as public reporting of physicians' outcomes, and the use of other health care professionals, such as nurses. An unanticipated consequence might be a reversal of the 'brain drain', with physicians migrating to low and middle income countries.     

Public toilets down the drain? Why privies are a public health concern

Whether you call it the loo, john, privy, lavatory or toilet, this facility is essential wherever humans gather or live: toilet provision has even been called the barometer of civilization. The modern development of public toilets dates from the late 19th century when sewer systems and water supplies provided hygienic means of dealing with waste, facilitated by public health legislation that also permitted local authorities to provide toilets in town centres. Yet the statutes in the United Kingdom, where the flushing toilet as we know it was invented, never went so far as to require provision of these facilities outside the home. Pressure on resources during the last 20 years has led to many public toilets being closed, for example, 40% of those in London, or to entry charges that reduce accessibility. At the same time an increasingly mobile population has made public toilets even more necessary. Recent public inquiries into public toilet provision in the UK have revealed the impact of the paucity of facilities on the elderly, women, families with young children, ill health that increases the need for toilet use, visitors and poor or homeless members of the community. There has been little attention in public health on the provision of public toilets. With street urination on the increase and less free access to toilets, it is time for public health to recognize a great need and to campaign to turn the tide on public toilet closures, with imaginative planning strategy and associated opportunities to encourage hand washing and other hygiene health promotion.     

Is the medical brain drain beneficial? Evidence from overseas doctors in the UK

The 'beneficial brain drain' hypothesis suggests that skilled migration can be good for a sending country because the incentives it creates for obtaining training increase that country's net supply of skilled labour. Necessary conditions for this hypothesis to work are that the possibility of migration significantly affects decisions to take medical training and that migrants are not strongly screened by the host country. We conducted a survey among overseas doctors in the UK in 2002, which suggested that neither condition is likely to be fulfilled. Apart from the 'beneficial brain drain' argument, the survey findings also cast light on the backgrounds and motives of migrant doctors, and finds evidence that there could, nonetheless, be other benefits to sending countries via routes like remittances and return migration.     

Health workforce imbalances in times of globalization: brain drain or professional mobility?

The health workforce is of strategic importance to the performance of national health systems as well as of international disease control initiatives. The brain drain from rural to urban areas, and from developing to industrialized countries is a long-standing phenomenon in the health professions but has in recent years taken extreme proportions, particularly in Africa. Adopting the wider perspective of health workforce balances, this paper presents an analysis of the underlying mechanisms of health professional migration and possible strategies to reduce its negative impact on health services. The opening up of international borders for goods and labour, a key strategy in the current liberal global economy, is accompanied by a linguistic shift from 'human capital flight' and 'brain drain' to 'professional mobility' or 'brain circulation'. In reality, this mobility is very asymmetrical, to the detriment of less developed countries, which lose not only much-needed human resources, but also considerable investments in education and fiscal income. It is argued that low professional satisfaction and the decreasing social valuation of the health professionals are important determinants of the decreasing attraction of the health professions, which underlies both the push from the exporting countries, as well as the pull from the recipient countries. Solutions should therefore be based on this wider perspective, interrelating health workforce imbalances between, but also within developing and developed countries.     

The role of percutaneous external drainage in the treatment of fluid collections associated with severe acute pancreatitis. What, when and how to drain?

The percutaneous drainage of the fluid collections associated with severe acute pancreatitis mainly in sterile cases is not a commonly accepted method. The aim of the present paper is to analyse the indications, the technic, the limits and results of the percutaneous drainage on the basis of the literature. The percutaneous drainage plays an important role in the treatment of the acute fluid collection, the acute pseudocyst, the pancreas abscess, and the liquified necrosis, accompanying the severe acute pancreatitis. For the septic fluid collections the percutaneous drainage is preferred as the first line treatment. In cases of sterile acute fluid collections and pseudocysts because of its relatively high iatrogenic infection rate the drainage is indicated only if it causes severe complaints. The rules of sterility have to be kept. For successful treatment of liquified necrosis the possible methods are the use of large-bore (20-30F) catheter drainage, sinus tract endoscopy, or laparoscopic assisted necrosectomy. In more than 25% of the cases drainage, along with the conservative treatment, leads to the complete recovery of the patient. In the remaining cases it is helpful in postponing the date of the operation and avoiding early surgery.