Influenza surveillance within hospitals: what is the world doing?

Influenza within hospitals is receiving increasing attention as a result of planning for an influenza pandemic and the magnitude and severity of the 2007 influenza season in Australia. This article reviews current approaches to influenza surveillance of admitted patients, as opposed to surveillance of emergency departments, in hospitals internationally. Most examples came from the United States of America and Canada, although systems have been described in the United Kingdom and Japan. In-hospital surveillance of influenza occurs within broader surveillance systems established by national governments, and through other systems established by sub-national governments and individual hospitals. Systems vary in focus, i.e. laboratory confirmed influenza or influenza-like illness, and some are labour intensive while others incorporate differing degrees of automation. The approach to influenza surveillance within hospitals will depend on objectives and available resources, although an automated approach is likely to have greater longevity as labour requirements are reduced.     

A return of the sheepskin to nursing homes and hospitals?

The authors comment on the study conducted by Mistiaen et al. (Ned Tijdschr Geneeskd. 2011;155:A3034) and express their doubts regarding the efficacy of using Australian Medical Sheepskin to prevent sacral pressure ulcers. By their very nature sheepskins are not pleasant to use and their preventive effect is only significant in the very early stages of dermal pressure damage. No mention is made of the far more efficient method of prevention: the air mattress with alternating pressure.     

Incoming and outgoing hospital CEOs: what kind of help do they want?

CEO turnover, although common, is expensive and disruptive for everyone involved. Both incoming and outgoing CEOs would welcome help in making the transition a painless experience. Through a 2005 nationwide survey of 805 current hospital CEOs, the authors obtained comments and suggestions in response to three open-ended questions about specific activities or processes that would help incoming and outgoing CEOs. Mostly, CEOs felt the need for a structured orientation process, succession planning, concrete peer and organizational support, training on recruitment and retention for the board, and an adequate separation package including continued healthcare coverage.     

From universalism to selectivity: is 'appropriateness' the answer?

As health expenditures continue to consume increasingly large proportions of national budgets, ways must be found to assure that money spent on health is used for effective services. Only a small proportion of medical decisions are based on scientific evidence about their outcomes, thus it is not surprising that wide variations exist in clinical practice. In recent years, questions have been raised about how medical decisions are made and the proportion of medical procedures and services that are performed for appropriate reasons. One method that has been developed to quantify the amount of inappropriate use is the so-called 'RAND appropriateness method,' which is based on a structured review of the scientific literature and the collective judgement of an expert panel. Measured by this method, a number of procedures have been shown to have high rates of inappropriate or uncertain use. The challenge is to find ways to eliminate ineffective services and procedures to free resources for those that have been proven effective. Further research is needed to improve the method and to find acceptable ways its findings can be used to promote effective care.     

From 1989 to 2001: what have we learned about the "biological actions of beta-carotene"?

Dr. James Allen Olson helped us to define the role of beta-carotene in human health by categorizing these as "functions, actions and associations." In the last decade, significant research has shown that beta-carotene acts as an antioxidant in biologically relevant systems, affects several aspects of human immune function and higher intake/serum levels are associated with improvements in certain physiological functions such as lung function. The unexpected findings of increased lung cancer in beta-carotene supplemented smokers in the ATBC and CARET intervention studies have resulted in the need for expanded research efforts to define the mechanism(s) of action of beta-carotene. Recent survey data as well as laboratory animal studies continue to find an inverse association between beta-carotene and cancer risk. Because beta-carotene is the major source of vitamin A for the majority of the world's population, it is critical to define the safe levels of intake from foods and supplements.     

Process re-engineering in public hospitals: re-inventing of the wheel?

The purpose of this paper is that of analyzing the hypothesis that, as originally stated by its creators, the reengineering methodology for the improvement of efficiency and productivity, cannot be successfully implemented in Spanish public hospitals, and in fact, the so called experiences do not keep with the basics of such an approach. The technique employed for this study consisted, on one hand, of reviewing and comparing the literature published on this subject and, on the other, on experimentation by means of a case study conducted at a public hospital for the purpose of testing out the outlined hypothesis. The review and comparison of works previously published on this subject revealed that the technique for improving on-the-job efficiency according to the theory-based concepts of the process reengineering approach is not adaptable to public hospitals in Spain. The case study supported this finding, additionally highlighting the fact that in order for any relatively major changes in the working processes at public hospitals to be recommended, a number of organizational and human factors must be taken into consideration as aspects involved regardless of the methodological approach taken. The indiscriminate implementation in public hospital administration of trends currently fashionable in the business administration field may defeat its own purpose if these trends are not previously evaluated prior to being implemented. An assessment must first be made as to their being suited to the intended purpose.     

Productivity-enhancing work innovations: remedies for what ails hospitals?

Prospective pricing, the proliferation of alternative delivery systems, and the demands of third party payers and corporate employers for the containment of health care costs have engendered the keen interest of hospital executives seeking strategies for improving labor productivity. Despite this interest, the relevant literature suggests that few work innovations designed to enhance labor productivity have been implemented in hospitals. This article describes generic versions of four such work innovations--quality circles, union-management committees, autonomous work groups, and gainsharing--and discusses relevant research indicating the types of benefits gained from each and the reasons why some have failed. Each innovation's potential for success in hospitals is evaluated, and suggestions for increasing the effectiveness of each in hospitals is offered.     

Regression to the mean: what does it mean?

To the Editor Johnsson and Berglund's recent article evaluating two interventionsfor high-risk drinking in university freshman could be regardedas a model of appropriately conservative interpretation of experimentalresults (Johnsson and Berglund, 2006). The authors found statisticallysignificant reductions in drinking from baseline to one-yearfollow-up but little evidence of differences     

Graduate programs: what is their contribution to the training of the public health workforce?

OBJECTIVES: To determine characteristics of community health/preventive medicine and community health education graduate programs. METHODS: Forty-eight graduate programs were identified as potential respondents and sent a written survey to complete. RESULTS: Forty programs responded; 82% of programs accredited or applying for accreditation responded. During the 1998-1999 period, 3456 students were enrolled and 773 students graduated from these programs, 91% earning the master of public health (MPH) degree. Two thirds of students were employed while enrolled in these programs. CONCLUSION: Graduate programs train a significant number of public health students, meeting the needs of health professionals with flexible course formats in locations where schools of public health are not available.     

Producing what in the transition? Health messaging and cultural constructions of health in Tonga

This paper asks: what have the health promotion campaigns in Tonga actually produced, and what does this imply for our understanding of the "health transition?" Examination of villagers' responses to health messaging reveals an efflorescence of ideas about health, including a re-conceptualizing of the formal Westernized terminology of health promotion messages into concepts more aligned with traditional Tongan ways of being well. This implies the need for a model of the health transition process in which mutual shifts in understanding must be recognized by all parties, traditional villager and medicalized health professional alike, before new ideas of 'health' are actualized.