Why simulation-based team training has not been used effectively and what can be done about it

Advanced medical education simulators are broadly used today to train both technical/procedural and team-based skills. While there is convincing evidence of the benefits of training technical skills, this is not the case for team-based skills. Research on medical expertise could drive the creation of a new regime of simulation-based team training. The new regime includes first the understanding of complex systems such as the hospital and the operating room; then the performance of work-place assessment; thirdly, the deliberate training of weaknesses and team performance skills; and lastly the understanding of the underlying mechanisms of team competence. A new regime of deliberate training proposed by the author, which would need to be evaluated and validated, could elucidate the underlying mechanisms of team competence while providing evidence of the effect of simulation-based team training.     

Special report. Increased violence in hospitals: what can be done about it

Incidents of violent behavior and physical assaults are dramatically increasing throughout the country, often ending up in the health care setting and necessitating enhanced security in hospitals and mental health facilities. In the wake of violence, many security and safety directors are now employing extreme measures from attack dogs to metal detectors to bulletproof glass. This special report details recent violent episodes occurring in health care facilities, examines areas of vulnerability in these institutions, and offers advice on proactive and reactive security measures that are being employed by many security directors.     

Caring for people with AIDS: it can be done

The evolution of care for AIDS patients at the Chikankata Hospital in Southern Zambia, from inpatient to outpatient management, is described. Hospital and community health care of AIDs patients should integrate education, counseling, clinical, nursing, laboratory, pastoral care and administration. Decentralization of primary health car into the wider community is achieved in this way. The ultimate result of community care is re-education of the family and the community so that behavioral change in patterns of sexual intercourse occurs. At Chikankata Hospital the average length of stay of HIV patients has fallen from 32 days in 1987 to 16.2 days in 1988. Numbers of home care patients have increased, as 80% prefer home visits, and most people prefer to die at home. As an example of the powerful effect of community counseling as a result of home care, people are deciding to take action on the issue of ritual cleansing by sexual intercourse, to re-introduce traditional taboos and family authority, and to discuss the effect of alcohol on AIDS. Chikankata Hospital has also started training programs for AIDS health workers from the region, and for local volunteers. Transferable management concepts include the term "normalization" which implies that AIDS is here to stay and future generations must be protected by permanent change in behavior.     

The scientific basis of the "Goals": what can be done now?

Universal dietary goals for the general public cannot be formulated or implented. More appropriate would be guidelines to serve as preventive measures for specific groups, based on genetic endowment, age, sex, and condition. Nutrition education as a component in health education is essential.     

人力资本理论的形成、发展及其现实意义

伴随儿童营养干预评价技术的不断发展,儿童营养干预的效果评价已从单纯的健康效果评价发展至更为综合的总体效益评价。儿童营养干预项目的成本核算已细分出不同的核算方法,成本 – 效果分析中效果评价指标的选择不再局限于单一维度指标,成本 – 效用分析在评估儿童营养干预措施时建立起更为完善的分析框架并引入概率方法进行项目的成本效益估计。成本 – 效益分析因工资收入、医疗花费和生命年赋值的处理得以更全面地估计干预效益。为获得儿童营养干预后人力资本的提升程度,社会学和计量经济学方法也开始被引入,并从营养改善后儿童身高、受教育年限和认知能力的变化进行人力资本预测模型的构建。儿童营养干预的经济学评价研究正呈现出多学科深度融合的发展趋势。     

Falling into the medical poverty trap in Sri Lanka: what can be done?

Sri Lanka's public health care system is free at the point of use and maintains a focus on equity. However, noncommunicable diseases, such as diabetes, are rapidly increasing in prevalence and posing new challenges to the system and to patients and households. In-depth interviews and focus group discussions were conducted in four districts of Sri Lanka to investigate the care-seeking experiences of diabetes patients from households at different income levels. Although health care is free, other direct and indirect costs served as deterrents to care seeking before and after diagnosis, and placed a high burden on households. The need for frequent visits to clinics with appropriate facilities for diagnosis and management of diabetes, often far from rural communities, posed high costs, in particular due to income foregone. Households employed coping strategies, but the need for frequent clinic visits posed repeated costs, which made it difficult for households to recover their economic status. Many patients, especially those from low-income, rural households, could not maintain the management regimen, and their condition deteriorated. There is a need for specialist facilities for the diagnosis and management of diabetes at locations closer to rural areas.