Should China Expand Its Medical Education Scale? Evidence From Comparative Research

Purpose This study compares doctor staffing level and the scale of medical education in China with those of other countries and proposes policy recommendations for future adjustments to the scale of China's medical education. Design/Approach/Methods This study employs a literature review and descriptive analysis. Findings China had 1.98 medical doctors per 1,000 people in 2018, ranking 85th out of the 193 member-states of the World Health Organization (WHO). In 2017, China had 1.99 practicing doctors per 1,000 people, only ranking above Turkey (1.88) in Organisation for Economic Co-operation and Development (OECD) countries. China had only 10.28 medical graduates per 100,000 people—placing in the bottom third of OECD countries. China's provision of 1.4 medical schools per 10 million people was also significantly lower than the global average (3.9). However, the average number of students enrolled in medical schools (509) in China was significantly higher than the global average (160). Originality/Value Although the scale of admission in undergraduate medical education must be expanded in China, this needs to be achieved while controlling the average number of medical students per school and reducing enrollment in low-quality medical schools. Furthermore, it is necessary to establish new medical schools while improving the operating level of existing ones.

The Future of COVID-19: What Is Next in the Drug Pipeline

Objectives: Development of new and repurposed medicines in response to the COVID-19 pandemic has occurred at an unprecedented rate, resulting in a dynamic pipeline marked by significant challenges and successes. This analysis provides an overview of the vaccines and therapies undergoing clinical evaluation or with recent approval for the treatment and prevention of COVID-19 in global markets. Method(s): For this analysis, COVID-19 pipeline medicines are defined in three categories: vaccines, new treatments and repurposed medicines. GlobalData is the primary data source for this study, in addition to online databases from Health Canada, the US FDA, and the EMA. International markets examined include the US and geographic Europe (excluding Russia and Turkey). Result(s): As of November 2022, the global pipeline contained over 600 therapies and vaccines undergoing Phase I, II, III clinical trials or pre-registration for the prevention and treatment of COVID-19. Preventive and repurposed medicines include antivirals, immunoglobulins, monoclonal antibodies, cellular therapies, and convalescent plasma. In Canada, twelve medicines, including six vaccines, have been approved for COVID-19. The number of global approvals is greater, with approximately 9 vaccines on the market in OECD countries. In addition to pre-exposure preventative therapies, manufacturers are also developing COVID-19 drugs to be used as prophylactic therapy. The analysis identifies new oral antiviral treatments and preventative therapies in the pipeline and under review in various jurisdictions globally. Conclusion(s): This research provides a clearer picture of the characteristics and evolution of the market for new and emerging COVID-19 medicines, which will help policy-makers and other stakeholders understand and anticipate the unique pressures of the COVID-19 pandemic.Copyright © 2023

Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol.

INTRODUCTION: Rheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease. Despite significant cost to the health system and estimates from 2015 indicating both high incidence and prevalence of RHD in South Africa, no cohesive national strategy exists. An updated review of national burden of disease estimates, as well as literature on barriers to care for patients with RHD, will provide crucial information to assist in the development of a national RHD programme. METHODS AND ANALYSIS: Using predefined search terms that capture relevant disease processes from Group A Streptococcal (GAS) infection through to the sequelae of RHD, a search of PubMed, Scopus, ISI Web of Science, Sabinet African Journals, SA Heart and Current and Completed Research databases will be performed. All eligible studies on RHD, acute rheumatic fever and GAS infection published from April 2014 to December 2022 will be included. Vital registration data for the same period from Statistics South Africa will also be collected. A standardised data extraction form will be used to capture results for both quantitative and qualitative analyses. All studies included in burden of disease estimates will undergo quality assessment using standardised tools. Updated estimates on mortality and morbidity as well as a synthesis of work on primary, secondary and tertiary prevention of RHD will be reported. ETHICS AND DISSEMINATION: No ethics clearance is required for this study. Findings will be disseminated in a peer-reviewed journal and submitted to national stakeholders in RHD. PROSPERO REGISTRATION NUMBER: CRD42023392782.

Changes in private health service utilisation and access to the Italian National Health Service between 2006 and 2019: a cross-sectional comparative study.

OBJECTIVES: Previous research highlighted that in the early 2000s a significant share of the Italian population used and paid out of pocket for private healthcare services even when they could potentially have received the same treatments from the National Health Service (NHS). The decrease in public investments in healthcare and the increase in health needs due to the population ageing may have modified the use of private health services and equity of access to the Italian NHS. This study aims to investigate the change in the prevalence of individuals who have fully paid out of pocket for accessing healthcare services in Italy between 2006 and 2019 and the main reasons behind this choice. DESIGN: Cross-sectional comparative study. PARTICIPANTS AND COMPARISON: Two representative samples of the Italian population were collected in 2006 and 2019. OUTCOME MEASURES: Prevalence of access to fully paid out-of-pocket private health services; type of service of the last fully paid out-of-pocket access; main reasons for the last fully paid out-of-pocket access. RESULTS: We found an increase in the prevalence of people who declared having fully paid out of pocket at least one access to health services during their lifetime from 79.0% in 2006 to 91.9% in 2019 (adjusted OR 2.66; 95% CI 1.98 to 3.58). 'To avoid waiting times' was the main reason and it was significantly more frequent in 2019 compared with 2006 (adjusted OR 1.75; 95% CI 1.45 to 2.11). CONCLUSIONS: This comparative study, conducted the year before the outbreak of the COVID-19 pandemic, highlighted an increase in the prevalence of Italian residents who have fully paid out of pocket for access to health services to overcome long waiting times. Our findings may indicate a reduced access and possible worsening of the equity of access to the public and universalistic Italian NHS between 2006 and 2019.

Changes in market organisation due to exogenous shocks – the case of the transformation of the Swedish fashion industry caused by the COVID-19 pandemic

This study aims to provide insights into the transformation of retail caused by the COVID-19 pandemic, using the Swedish fashion industry as an example. In an institutional perspective, combined with Actor-network theory, both new actors and the changing role of existing ones were identified as influencing how the market was organised. An empirical field study of the Swedish fashion industry has illustrated the changes caused to retail by the outbreak of COVID-19, and the subsequent actions taken to limit its spread. Interviews with and observations of retailers' actions contributed to a more in-depth understanding of the changes caused to retail. The study finds that the market was subject to two exogenous shocks: Firstly, that a non-human actor, i.e. the COVID-19 virus, influenced the Swedish fashion market in combination with humans and secondly, that new actors entered the market and influenced its organisation. This has led to a situation where digitalisation has accelerated and experience design has stagnated, and there has also been a re-definition of sustainability. Using an institutional perspective, combined with thick descriptions of the empirical material, this study challenges the existing narrow understanding, i.e., that the actors in the field are barely tied together as supply chains or networks, by including non-human actors in its analysis. This allows us to gain a greater understanding of how a virus and its antagonists have had a major impact on the organisation of the field, in turn having consequences on the trends prominent in the fashion retail industry before the outbreak of COVID-19.

Framework for the evaluation of military health systems.

The organisation of a military health system (MHS) differs from the civilian system due to the role of the armed forces, the unique nature of the supported population and their occupational health requirements. A previously published review of the Military Medical Corps Worldwide Almanac demonstrated the value of a standardised framework for evaluation and comparison of MHSs. This paper proposes such a framework which highlights the unique features of MHSs not covered by health services research of national health systems. These include: national context and summary; organisational structure; firm base facilities, healthcare beneficiaries and medical research; operational capabilities, overseas deployments, collaborations and alliances; personnel including recruitment, training and education; and history and culture. This common framework can help facilitate international collaboration between military medical services including capability development, training exercises and mutual support during military operations. It can also inform national contributions to future editions of the Almanac.

A cross-sectional study factors associated with resilience among medical staff in radiology departments during COVID-19, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVES: This study aims to assess the level of resilience of medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia, during the COVID-19 outbreak and to explore associated factors. SETTING: Medical staff, including nurses, technicians, radiology specialists and physicians, working in radiology departments at government hospitals in Riyadh, Saudi Arabia during the COVID-19 outbreak. DESIGN: A cross-sectional study. PARTICIPANTS: The study was conducted among 375 medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia. The data collection took place from 15 February 2022 to 31 March 2022. RESULTS: The total resilience score was 29.37±6.760 and the scores of each dimension showed that the higher mean score was observed in the domain of 'flexibility', while the lowest was observed in 'maintaining attention under stress'. Pearson's correlation analysis showed that there was a significant negative correlation between resilience and perceived stress (r=-0.498, p<0.001). Finally, based on multiple linear regression analysis, factors affecting resilience among participants are the availability of psychological hotline (available, B=2.604, p<0.050), knowledge of COVID-19 protective measures (part of understanding, B=-5.283, p<0.001), availability of adequate protective materials (partial shortage, B=-2.237, p<0.050), stress (B=-0.837, p<0.001) and education (postgraduate, B=-1.812, p<0.050). CONCLUSIONS: This study sheds light on the level of resilience and the factors that contribute to resilience in radiology medical staff. Moderate levels of resilience call for health administrators to focus on developing strategies that can effectively help cope with workplace adversities.

How temporary organisations manage flexibility in times of crises? Experiences of a Chinese control command in response to COVID‐19

Coordination of the response to the COVID‐19 crisis may be understood as the multimonth management of a temporary organisation instead of classical crisis management. A key question is how to maintain operational flexibility, that is, an organisation's ability to adapt its day‐to‐day functions to accommodate a changing environment. This contribution describes how a control command established by a Chinese municipality in response to COVID‐19 tried to cope with the problems at hand. Based partially upon participatory observation the following aspects are considered: shifting political attention, adapting interaction frequency, changing organisational structures, improvising routines, and altering priorities. [ FROM AUTHOR] Copyright of Journal of Contingencies & Crisis Management is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Barriers to integrating lean construction and integrated project delivery (IPD) on construction megaprojects towards the global integrated delivery (GID) in multinational organisations: lean IPD&GID transformative initiatives

PurposeThe architecture, engineering and construction (AEC) industry encounter substantial risks and challenges in its evolution towards sustainable development. International businesses, multinational AEC organisations, technical professionals, project and portfolio management organisations face global connectivity challenges between business units, especially during the outbreak of novel coronavirus pandemic, to manage construction megaprojects (CMPs). That raises the need to manage global connectivity as a main strategic goal of global organisations. This paper aims to investigate barriers to integrating lean construction (LC) practices and integrated project delivery (IPD) on CMPs towards the global integrated delivery (GID) transformative initiatives and develop future of work (FOW) global initiatives in contemporary multinational AEC organisations.Design/methodology/approachA two-stage quantitative and qualitative research approach is adopted. The qualitative research methodology consists of a literature review to appraise barriers to integrating LeanIPD&GID on CMPs. Barriers are arranged into six-factor clusters (FCs), with a conceptualisation of LeanIPD&GID, GID strategy placements and FOW global initiatives with multiple validations. This analysis also involved semi-structured interviews and focus group techniques. Stage two consisted of an empirical questionnaire survey that shaped the foundation of analysis and findings of 230 respondents from 23 countries with extensive cosmopolitan experience in the construction of megaprojects. The survey examined a set of 28 barriers to integrating LeanIPD&GID on CMPs resulting from a detailed analysis of extant literature after validation. Descriptive and inferential statistical tests were exploited for data analysis, percentage scoring analysis, principal component analysis (PCA) and eigenvalues were used to elaborate on clustered factors.FindingsThe research conceptualised LeanIPD&GID principles and proposed GID strategy placements for LeanIPD&GID transformative initiatives and FOW global initiatives. It concluded that the most significant barriers to integration of LeanIPD&GID on CMPs are "lack of mandatory building information modelling (BIM) and LC industry standards and regulations by governments”, "lack of involvement and support of governments”, "high costs of BIM software licenses”, "resistance of industry to change from traditional working practices” and "high initial investment in staff training costs of BIM”. PCA revealed the most significant FCs are "education and knowledge-related barriers”, "project objectives-related barriers” and "attitude-related barriers”. Awareness of BIM in the Middle East and North Africa (MENA) region is higher than LC and LC awareness is higher than IPD knowledge. Whilst BIM adoption in the MENA region is higher than LC;the second is still taking its first steps, whilst IPD has little implementation. LeanBIM is slightly integrated, whilst LeanIPD integration is almost not present.Originality/valueThe research findings, conclusion and recommendation and proposed GID strategy placements for LeanIPD&GID transformative initiatives to integrating LeanIPD&GID on CMPs. This will allow project key stakeholders to place emphasis on tackling LeanIPD&GID barriers identified in this research and commence GID strategies. The study has provided effective practical strategies for enhancing the integration of LeanIPD&GID transformative initiatives on CMPs.

COVID-19: responding to a pandemic on Operation TORAL.

Operation TORAL was the UK's contribution to NATO's Operation RESOLUTE SUPPORT in Kabul, Afghanistan. Approximately 1000 British troops were deployed in Kabul when the arrival of the COVID-19 pandemic in Afghanistan was declared. This article will describe the challenges faced due to COVID-19 in Kabul.Medical planning considerations, occupational health issues, implementation of behaviour change and operating as part of a multinational organisation are all discussed, with challenges encountered detailed and potential solutions offered. The use of a suggested framework for ensuring the medical estimate process covered all areas relevant to an emerging viral pandemic -the 4Ds and 4Cs approach-proved particularly useful in the early stages of the pandemic in Afghanistan.

Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. OUTCOMES AND ANALYSIS: We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. RESULTS: We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. CONCLUSIONS: Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.

Factors associated with recognition at work among nurses and the impact of recognition at work on health-related quality of life, job satisfaction and psychological health: a single-centre, cross-sectional study in Morocco.

OBJECTIVES: To describe the sociodemographic, occupational and health factors that influence nurses' recognition at work and to examine a recognition pathway model to assess the relationship between recognition at work and health-related quality of life (HRQOL), job satisfaction, anxiety and depression. DESIGN: This is a cross-sectional observational study with prospective data collection based on a self-report questionnaire. SETTING: University hospital centre in Morocco. PARTICIPANTS: The study included 223 nurses with at least 1 year of practice at the bedside in care units. MEASURES: We included the sociodemographic, occupational and health characteristics of each participant. The Fall Amar instrument was used to measure job recognition. HRQOL was measured using the Medical Outcome Study Short Form 12. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Job satisfaction was measured using a rating scale (ranging from 0 to 10). Path analysis was used to examine the nurse recognition pathway model to assess the relationship between nurse recognition at work and key variables. RESULTS: The participation rate in this study was 79.3%. Institutional recognition was significantly correlated with gender, midwifery specialty and normal work schedule: ß=-5.10 (-8.06, -2.14), ß=-5.13 (-8.66, -1.60) and ß=-4.28 (-6.85, -1.71), respectively. Significant correlations were found between recognition from superiors and gender, mental health specialisation and normal work schedule: ß=-5.71 (-9.39, -2.03), ß=-5.96 (-11.17, -0.75) and ß=-4.04(-7.23, -0.85), respectively. Recognition from coworkers was significantly associated with mental health specialisation: ß=-5.09 (-9.16, -1.01). The trajectory analysis model found that supervisor recognition had the best impact on anxiety, job satisfaction and HRQOL. CONCLUSIONS: Recognition from superiors is important in maintaining nurses' psychological health, HRQOL and job satisfaction. Therefore, managers in hospitals should address the issue of recognition at work as a potential personal, professional and organisational lever.

Optimising the organisation of family medicine practice. Selected abstracts from the 94th EGPRN conference, Istanbul, Turkey, 12-15 May 2022

The mission of WONCA Europe is the development of General Pratice / Family Medicine (GP/FM) discipline in Region Europe by addressing the current challenges of health and healthcare. The theme of this meeting is "Optimising the organisation of family medicine practice' to accomplish this vision. When we checked the meaning of "organisation' in the Webster dictionary, the words "forming a business for a particular purpose,' "certain order to be found or used easily' and the "process of planning' emerged and attracted our attention. The crucial discussion describing primary care (PC) organisation was based on the same concepts (if we summarise the words as needs, structure and delivery) after many years.Today the authors consolidated several frameworks and defined: (1) population needs;(2) organisation and structure of PC practices;(3) delivery of PC services and (4) patient and population health outcomes as the four domains and added connecting constructs to link the domains: accessibility, appropriateness, productivity, efficiency, effectiveness, equity and integration. Knowledge about the relationship between structure and process (including the interpersonal and societal exchange/performance of GP/FP) and outcome derives from the organisational, behavioural and healthcare sciences. So we need to partner with interprofessional and multisectoral teams to evaluate detailed research on PC organisation.In EGPRN-Istanbul, we hope we will discuss weaknesses and strengths, opportunities and threats of PC organisation in different conditions and develop many approaches during this meeting under the light of well-planned and applied trials or controlled observational studies, evidence, collaboration and collectivity.

EPH118 Healthcare Systems Sustainability and Resilience: Creating an Index

Objectives: The COVID-19 pandemic has highlighted the need for sustainable and resilient healthcare systems to protect population health. This requires measuring the relative progress of health systems towards becoming more sustainable and resilient. In this research, we design, construct and estimate a country-level healthcare system sustainability and resilience index (HSSRI) that reflects and combines the two dimensions. Method(s): The HSSRI aims to summarise the performance of a health system in the different domains contributing to its sustainability and resilience. These domains are: i) health system governance, ii) health system financing, iii) health system workforce, iv) medicines and technologies, v) health service delivery, vi) population health and social determinants, and vii) environmental sustainability. As part of our analyses, we conduct a rapid evidence assessment to identify indicators reflecting the domains included in the sustainability and resilience dimensions. We assess the domain indicators' suitability by the quantity and quality of the literature supporting their inclusion. The variables in each indicator are extracted from publicly available data sources, such as the OECD, World Bank, and others. The period covered is from 2000 to 2020. Weighted means of the indicators are used to construct the domains' indices in each dimension. We apply a geometric mean to combine the domain indices into one final index. Result(s): The HSSRI is piloted using data from five high-income countries, providing a credible instrument for measuring and reporting healthcare system sustainability and resilience. The results enable policy-makers and stakeholders to observe how different domains of sustainability and resilience have evolved across countries and time. Conclusion(s): The HSSRI will facilitate better understanding and monitoring of the healthcare system's relative weaknesses and strengths, and empower policy-makers to design interventions that improve its resilience and sustainability.Copyright © 2022

Organisational change in a (post-) pandemic world: Rediscovering interests and values

Faced with the existential threat of the COVID-19 pandemic, organisations have been forced, almost universally, into programmes of rapid and radical transformation. In many cases, this has caused a significant rethink in how work should be carried out;in virtually all cases, there will be further major changes ahead for those organisations that survive. In this essay, we consider the implications of the pandemic for the study of organisational change and argue for a shift in the role of interests and values from the periphery to a more central position in our theoretical and practical change management models. Organisations are grappling with how to implement radical changes to respond to their new operating contexts. For scholars, this brings an opportunity to more fully understand the links between values, interests and the dynamics and outcomes of radical change. It is a moment not to let pass. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Re-organising wellbeing: Contexts, critiques and contestations of dominant wellbeing narratives

Wellbeing has emerged as an important discourse of management and organisation. Practices of wellbeing are located in concrete organisational arrangements and shaped by power relations built upon embedded, intersecting inequalities and therefore require critical evaluation. Critical evaluation is essential if we are to reorganise wellbeing to move beyond critique and actively contest dominant wellbeing narratives in order to reshape the contexts in which wellbeing can be fulfilled. The COVID-19 pandemic under which this special issue took shape, provides various examples of how practices continue to be shaped by existing narratives of wellbeing. The pandemic also constituted a far-reaching shock that gave collective pause to consider to the extent to which work is really organised to realise wellbeing and opened up potential to think differently. The seven papers included in the special issue reveal the problematic and uneven way in which wellbeing is pursued and examine possibilities to imagine and realise more radical practices of wellbeing that can counter the way in which ill-being is produced by the organisation of labour. © The Author(s) 2023.

Do South Africa's e-commerce VAT rules measure up to international trends and OECD guidelines?

Orientation: The taxability of e-commerce transactions have been the subject of many studies to protect governments from Value-Added Tax (VAT) erosion, illegal recovery and fraud. Research purpose: This study critically analyses the challenges posed by e-commerce transactions in South Africa's VAT Act . Recommendations are made for amendments to the VAT Act to improve rules to effectively tax e-commerce transactions occurring in South Africa. Motivation for the study: Globally, including in South Africa, enforcing relevant VAT legislation to target output tax collections and input tax credits from e-commerce transactions aptly remains a challenge. Research approach/design and method: By integrating qualitative literature reviews and comparative synthesis, this study employed a comparative legal methodology. VAT levied on e-commerce transactions in South Africa is compared to the Organisation for Economic Co-operation and Development's guidelines as well as New Zealand's and Australia's Goods and Services Tax legislations. Main Findings: While the South African VAT Act aligns with international best practices on the use of intermediaries, there are some differences as detailed in the study. Practical/managerial implications: To align with international trade counterparts, the South African VAT Act should differentiate between business-to-business and business-to-consumer sales. A provision concerning the place of consumption for bundled goods should be included in the VAT Act . The VAT Act should contain a provision that allows bad debts to be claimed on cash sales made instead of total sales made. Contribution/value-add: This study harmonises South African VAT legislation with international best practices within the context of continual advancement of e-commerce transactions.