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Biomedical subjects

Martin McKee

Publications and source records attributed to Martin McKee.

At least 19 recordsLinked to original sources
PubMed2006

Evidence-based policy? The use of mobile phones in hospital.

BACKGROUND: Evidence-based policies have become increasingly accepted in clinical practice. However, policies on many of the non-clinical activities that take place in health care facilities may be less frequently evidence based. METHODS: We carried out a review of literature on safety of mobile phones in hospitals and survey of practice in selected European countries. RESULTS: When first evidence on the dangers of electronic interference associated with mobile phones appeared in the 1990s, hospitals in many countries introduced complete bans on mobile phones. Yet a review of recent evidence suggests that there is no significant risk from using mobile phones in hospitals as long as they are more than a metre away from sensitive equipment, whereas the risk to the most modern equipment is even less. With the technological evolution of mobile phones, the residual risk of interference appears to be minimal and controllable. Although some countries are reluctant to relax regulation, others now limit bans to areas in which sensitive equipment is used and some discourage the use of mobile phones on the grounds of noise exposure. CONCLUSION: With new technology on the doorstep, the potential benefits and risks associated with mobile phones should be examined explicitly in the light of the evidence.

Cell Phone↗
PubMed2006

Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records.

CONTEXT: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. OBJECTIVES: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. DESIGN AND SETTING: Cross-sectional analysis combining nurse survey data with discharge abstracts. PARTICIPANTS: Nurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts. RESULTS: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. CONCLUSIONS: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

Adult↗
PubMed2006

The contribution of health to the economy in the European Union.

Despite increasing recognition of the link between health and economic development in low-income countries, the relationship has to date received scant attention in rich countries. We argue that this lack of attention is not justifiable. While the economic argument for investing in health in rich countries may differ in detail from that in low-income countries, there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in poor, but also in rich countries. Better health increases labour supply and productivity and historically, health has been a major contributor to economic growth. In spite of remaining evidence gaps economic policy-makers also in developed countries should consider investing in health as one (of few) ways by which to achieve their economic objectives.

Developed Countries↗
PubMed2006

A crisis of governance?

BACKGROUND: Contemporary legislative and constitutional developments in the United Kingdom for public health. This article explores these implications. KEY FINDINGS: Examination of the development of parliamentary sovereignty in the United Kingdom shows that, although there is no formal separation of powers, there is a long established convention that legislation should be subject to detailed parliamentary scrutiny, should respect common law, and should be subject to judicial review. This convention has been overturned. Consequently, many recent laws conflict with long-established human rights. Some are unworkable or damaging or both. Public health professionals are being asked to implement poorly thought out laws, against a background of loss of trust. History warns of the danger that public health could be sucked into participation in repressive policies that override the rights of the individual in the apparent interests of the public good. CONCLUSIONS: There is a need for a rebalancing of power in the United Kingdom, both among the three branches of government (executive, legislature, and judiciary) and its constituent parts (England, Scotland, Wales, and Northern Ireland). Constitutional reform is a long-term aim but for now much can be done to hold the executive to account and to be aware of the dangers faced by public health.

Democracy↗
PubMed2006

Impact of joined-up HIV harm reduction and multidrug resistant tuberculosis control programmes in Estonia: System dynamics simulation model.

In Eastern Europe and Central Asia (ECA) the control of tuberculosis, multidrug resistant tuberculosis (MDRTB) and human immunodeficiency virus (HIV) poses important public health challenges. We used system dynamics simulation to determine impact on cumulative HIV/AIDS, tuberculosis and HIV-associated-tuberculosis deaths, over 20 years, of harm-reduction programmes to reduce needle-sharing and injection-frequency amongst injecting drug users (IDUs) and multidrug resistant tuberculosis (MDRTB) control in a population with an explosive HIV epidemic in IDUs and high MDRTB prevalence. We estimate that the number of HIV-associated-deaths will decline by 30% with effective harm-reduction programmes but double if these are ineffective. In our model, effective MDRTB and HIV control reduces cumulative tuberculosis deaths by 54%, cumulative MDRTB deaths 15-fold and cumulative HIV-associated-tuberculosis-deaths 2-fold. Effective MDRTB control, without effective harm-reduction programmes, only reduce tuberculosis deaths by 22%. However, effective harm-reduction programme with a poor MDRTB control reduce cumulative tuberculosis deaths by 34%, MDRTB by 14% and HIV-associated-tuberculosis by 56%. Even with good control programmes for drug sensitive TB, neglecting harm reduction and MDRTB control will result in 50% more tuberculosis-related deaths than if both are effectively addressed. Effective harm-reduction programmes reduces cumulative deaths from tuberculosis more substantively than effective MDRTB control. Our finding have important policy implications for communicable disease policies in post-Soviet countries, which need to substantially change if they are to effectively address the emerging HIV and MDRTB epidemics.

Antitubercular Agents↗
PubMed2006

Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study.

OBJECTIVES: To investigate the association between clinical need and hospital bed supply and utilization in Russia; and, to investigate these associations in areas where traditional Russian tuberculosis health care systems exist and where the directly observed therapy-short course (DOTS) strategy has been implemented. DESIGN: Ecological study using 2002 routine data. MAIN OUTCOME MEASURES: Hospital bed utilization and hospital admissions for patients with tuberculosis in regions that adhere to the traditional Russian method of managing tuberculosis and those where the DOTS strategy has been implemented. RESULTS: The ratio of beds per newly notified case was 0.86. The mean duration of hospital stay per admission was 86 days for non-DOTS regions and 90 days for regions where the DOTS strategy had been implemented. The number of admissions in each region correlated closely with the number of newly registered cases and hospital beds were, on average, occupied for 325 days. In the regions where the DOTS strategy had been implemented bed occupancy was 324 days. CONCLUSIONS: Under the Russian tuberculosis control system, hospital utilization is predominantly determined by supply-side factors, namely the number of tuberculosis dedicated hospital beds, and this system extends across all regions. Implementation of the DOTS strategy in Russia has not led to fundamental structural changes in tuberculosis control systems.

Bed Occupancy↗
PubMed2006

The composition of surrogate and illegal alcohol products in Estonia.

AIM: To identify the composition of illegal and surrogate alcohol products consumed in Estonia. METHODS: The initial source of information was a series of visits made in August 2005 to a soup kitchen in central Tartu, Estonia. Individuals were asked for brief details of their personal circumstances, what they normally drank, and in addition they were asked to bring samples of the substances they usually consumed. In other cases, the substances identified were purchased by the investigators or from informal contacts in north-eastern part of Estonia, an area that is well known for illegal alcohol consumption. Samples were tested for chemical contents. RESULTS: We identified a range of alcohol-containing substances that are consumed, although, not intended for consumption. These comprised medicinal products, aftershaves, illegally produced spirits, and fire-lighting fuel. The medicinal compounds contained, on average, 67% ethanol by volume; the aftershaves contained slightly less. Both were typically pure, with a few containing detectable quantities of isoamyl alcohol. The illegally produced alcohol contained, on average, 43% ethanol by volume, ranging from 32 to 53%. However, many also contained detectable quantities of long chain alcohols. These substances are half the price or less of commercial vodka, with fire lighting fuels especially inexpensive. CONCLUSIONS: There is in Estonia a range of alcohol-containing substances easily available at low cost. Some contain substantially higher concentrations of ethanol than commercial spirits and others also contain toxic long chain alcohols.

Alcohol Drinking↗
PubMed2006

The fragmentary federation: experiences with the decentralized health system in Russia.

The Russian Federation has undergone a process of major constitutional change in the post-communist period, as a strong central government has ceded extensive powers to the regions. This has important implications for the organization of the health care system which, as with other elements of the Soviet system, had previously been highly centralized. Although it is now well-recognized that the powers of the Federal Health Ministry have weakened considerably, the precise scale and nature of the process of decentralization remain imperfectly understood. This paper provides new evidence on the nature of decentralization in the Russian Federation since the breakdown of the USSR, reporting the results of case studies undertaken in six regions of Russia (Samara, Tver, Tula, Chelyabinsk, Sverdlovsk and Moscow oblasts) to describe the organization of health care financing, regulation and delivery. It shows that while there is a common model of health system (with the exception of Samara, where an innovative model was implemented), there are many minor variations. The study confirms the limited scope for action by Federal authorities, but also shows that the power vested in the regional governments is more limited than was previously thought. Instead, the municipalities (rayons) emerge as important bodies, as they own the facilities in which much of the routine health care is delivered and, both directly and indirectly, by virtue of their contributions of insurance premiums for the non-working, provide a substantial amount of health care financing. The study demonstrates the complexity of the Russian health care system and identifies the widespread absence of mechanisms that might be used to bring about much needed change.

Delivery of Health Care↗
PubMed2006

Delivering babies in a time of transition in Tula, Russia.

OBJECTIVE: To investigate the provision of maternal services in the Tula region of Russia, with an emphasis on variations in practice. METHOD: The study was set in Tula Oblast. Data sources included an obstetric information database detailing all Tula deliveries in 2000 (n = 11,123) and structured interviews with the heads of maternity facilities and hospital maternity departments. RESULTS: Caesarean-section rates varied from 3.3-37%; episiotomy from 9-80%; and amniocentesis from 0-51%. As fertility rates fell since the 1980s, increasing numbers of women were hospitalized for 'pathological pregnancy' in an attempt to preserve infrastructure. CONCLUSION: Over-medicalization arises in a system typified by excess capacity and large numbers of specialists. Some practice variations were correlated with characteristics of mothers, but others derive from systems structures such as equipment availability. Improvements in practice will require addressing these structural elements and steering the clinical culture towards evidence-based medicine, rather than simply writing new decrees.

Adult↗