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Metrics in the science of surge.

Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process. With a combination of online discussion through a group e-mail list and in-person discussion at a breakout session of the Academic Emergency Medicine 2006 Consensus Conference, "The Science of Surge," seven consensus statements were generated. These statements emphasize the importance of funded research in the area of surge capacity metrics; the utility of an emergency medicine research registry; the need to make the data available to clinicians, administrators, public health officials, and internal and external systems; the importance of real-time data, data standards, and electronic transmission; seamless integration of data capture into the care process; the value of having data available from a single point of access through which data mining, forecasting, and modeling can be performed; and the basic necessity of a criterion standard metric for quantifying surge capacity. Further consensus work is needed to select a criterion standard metric for quantifying surge capacity. These consensus statements cover the future research needs, the infrastructure needs, and the data that are needed for a state-of-the-art approach to surge and surge capacity.

Consensus↗

Phosphoproteomics in analyzing signaling pathways.

A surprisingly fewer than expected number of genes in the human genome suggests that sophistication of its biologic system is, in part, due to complex regulation of protein activities. The activities of most cellular proteins are regulated by post-translational modifications. One of the most important post-translational modifications is reversible protein phosphorylation, which decorates more than 30% of the proteome and regulates signal transduction pathways under normal conditions as well as in disorders such as diabetes, neurodegenerative diseases, autoimmune diseases and several forms of cancers. This review examines the recent developments in mass spectrometry-based methods for phosphoproteome analysis and its applications for the study of signal transduction pathways. The basic principles of non-mass spectrometry-based methods, such as chemical genetics and flow cytometry-based approaches, are also discussed as well as their specific advantages to signaling studies. Finally, signaling pathways are discussed in the light of large-scale protein interaction studies. The proteomic methods addressed in this review are emerging as some of the essential components in systems biology, which seeks to describe signaling networks through integration of diverse types of data and, in the future, to allow computational simulations of complex biologic pathways in health and disease.

Chromatography, Affinity↗

Allergic rhinitis, asthma, and rhinosinusitis: diseases of the integrated airway.

OBJECTIVE: To review data supporting the integrated airway hypothesis. Allergic rhinitis, rhinosinusitis, and asthma are common conditions associated with significant morbidity and health care costs. A theory has been developed suggesting that these conditions may be manifestations of an inflammatory process within a continuous airway rather than fully separate diseases. Based on this theory, the presence of upper airway symptoms may negatively influence the natural course of lower airway disease. Controlling upper airway inflammation and symptoms among asthma patients may help improve health and economic outcomes. SUMMARY: Further clarifying and understanding the relationship between diseases of the upper and lower respiratory tracts is important because of the prevalence of allergic rhinitis, rhinosinusitis, and asthma and the resulting burden on patients and the health care system. Recent progress in understanding the biology of airway disease has identified inflammation as playing a critical and integrating role in these diseases; however, other important questions remain, including factors that determine the clinical phenotype in allergic airway disorders and optimal treatment approaches. CONCLUSIONS: Several recent studies have suggested that allergic rhinitis, rhinosinusitis, and asthma may be manifestations of a common underlying pathology, but there are many unanswered questions. More studies are needed to better define all the underlying pathologic mechanisms as well as treatments to optimize outcomes for patients with allergic rhinitis, rhinosinusitis, and asthma.

Administration, Intranasal↗

The context of health promotion in the NHS.

In connection with "Working for Patients" health authorities have been asked by the NHS Management Executive how they intend to perform their "core" functions. "Core" tasks for regions include: "monitoring and promoting the health of their populations (including the functions set out in HC(88)64), determining with districts and FPCs, the health needs of their resident populations; collecting and managing information which facilitates this. . ." ". . . District, in close collaboration with FPCs, will retain a key role in ensuring that the health needs of their populations are met; that there are effective services for the prevention and control of diseases and the promotion of health." Amanda Killoran reviews the context of health promotion in the NHS, and indicates the importance of developing nationally integrated programmes of disease prevention and health promotion.

Catchment Area, Health↗

The leadership and executive potential of physicians in an era of managed care systems.

The emergence of managed care signals a need for an expanded role for physicians. Physician executives, trained in management, have the potential to become champions of clinical integrity, negotiators with patient agent organizations, public interpreters of hospital performance data, consultants to the profession, and designers of health care systems. Nonclinically trained administrators have been slow to recognize the unique skills and perspective that physicians bring to the managerial suite. The clash of professional and managerial cultures has often been perceived as precluding a strong working alliance between physician and nonphysician executives. As hospital margins are threatened, decision protocols must not be designed to incorporate teams of leaders who are able to overcome the managerial/clinical divide. The management of this interface will demand the attention of both administration and boards and may require the establishment of new structures in health care organizations.

Leadership↗

Integration of midwives into the Quebec health care system. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

This paper reports on one aspect of the evaluation of the midwifery pilot projects in Quebec: the identification of the professional and organizational factors, as well as the mode of integrating midwives into the maternity care system, that would promote the best outcomes and the autonomy of midwives. The research strategy involved a multiple-case study, in which each midwifery pilot project represented a case. Based on a qualitative approach, the study employed various sources of data: individual interviews and focus groups with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care system during the evaluation. Four main reasons were identified: lack of knowledge about the practice of midwifery on the part of other health care providers; deficiencies in the legal and organizational structure of the pilot projects; competition over professional territories; and gaps between the midwives' and other providers' professional cultures. Recommendations are provided to facilitate the integration of midwives into the health care system.

Attitude of Health Personnel↗

When do developing countries adopt managed care policies and technologies? Part II: Infrastructure, techniques, and reform strategies.

OBJECTIVES: To specify the essential infrastructure elements required to implement managed care techniques successfully in a developing country, once the necessary macroeconomic preconditions for managed care have been met. Also, to describe how managed care techniques can be integrated into health system reform strategies. STUDY DESIGN AND METHODS: Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reform in developing countries. RESULTS: Successful managed care relationships among payers, providers, and patients rely on several essential infrastructure elements: enabling legislation; regulatory mechanisms to administratively correct health and insurance market failures; enforceable contracts; and formal groups or associations of providers. Once these infrastructure elements are in place, a developing country government can consider implementing 1 or more managed care techniques, including payment strategies, demand-side techniques, and utilization management. CONCLUSIONS: Governments in many developing countries can take deliberate steps to accelerate the evolution of certain macroeconomic preconditions--human capital and information systems--and essential infrastructure elements necessary to support managed care techniques. They may then choose to experiment carefully with implementing specific managed care techniques, with consideration given to how the managed care techniques can promote primary care.

Budgets↗

An info-tech disconnect. Even as groups such as Leapfrog push IT as an answer to quality issues, doctors and executives say, 'not so fast'.

The future is now. A new wave of information technology is gaining wide support outside the hospital industry as a solution to medication errors and patient-safety lapses. But in our survey of information system trends, most firms say they aren't operating or launching a physician order-entry system for drugs or treatments. Consultant Steven Roth, left, says recent examples of disasters have warded off many healthcare executives.

Budgets↗

Medical workforce planning in Australia: process, methodology and technical issues.

This article describes the process, methods and technical issues associated with national level planning of the medical workforce in Australia. In Australia, workforce planning is also undertaken for the nursing and allied health workforces using largely similar processes and methods outlined below, with obvious modifications for differences in data sources, structures and practice. In Australia, the focus is also switching to a more integrated planning approach along care group lines, for example emergency care, diabetes care. This approach is still in its infancy and some technical and methodology issues are unresolved. Much of the health workforce planning in Australia is undertaken at the national level through the research team at the National Health Workforce Secretariat, although some work is also undertaken by individual jurisdictional health departments and other stakeholders. Information about the national health workforce agenda and the outcomes of the research and analysis is available through the Health Workforce Australia website at http://www.healthworkforce.health.nsw.gov.au. It should be acknowledged that the main sections of this article have been summarised from the 2003 publication Specialist Medical Workforce Planning In Australia, prepared by the Australian Medical Workforce Advisory Committee and the National Health Workforce Secretariat.

Adult↗

[Health monitoring in a nursery school].

In contrast to the traditional program of health assessment of schoolchildren based on periodic physical examination, the program described in this paper is based on the integration of information and data obtained by observation through the school year from parents, teachers and the school nurse, who coordinates the program. The numbers and the types of problems and the date on which they were identified are compared in an experimental group of 557 kindergarten children and a matched control group of 498 children in whom the traditional program was maintained. For problems of hearing, enuresis, learning and behaviour the number of cases detected was significantly greater in the experimental group than in the control group. Each element of the proposed program is analysed and the advantages of an integrated approach to health assessment of schoolchildren are underlined.

Child↗

[Cost assessment in a fragmented psychiatric treatment system].

While Anglo-American countries increasingly integrate cost-effectiveness-studies into mental health care, in Germany there is still a basic need for empirical data with regard to the cost of care for the mentally ill. This study assesses the total cost of community mental health care of 66 schizophrenic patients prospectively over the course of 12 months. The comprehensive community care of the patients proved to be 43% of the cost of long-term treatment in a state mental hospital. Rehabilitative need, as well as living conditions and gender, showed significant influence on the total cost of community care.

Adolescent↗