Evaluating the Imbalance Between Increasing Hemodialysis Patients and Medical Staff Shortage After the Great East Japan Earthquake: Report From a Hemodialysis Center Near the Fukushima Nuclear Power Plants.

The Great East Japan Earthquake in 2011 caused an unprecedented imbalance between an increasing number of hemodialysis patients and medical staff shortage in the Sousou area, the site of the Fukushima nuclear power plants. In 2014, capacity of our hemodialysis center reached a critical limit due to such an imbalance. We attempted to evaluate the effort of medical staff to clarify to what extent their burden had increased post-disaster. The ratio of total dialysis sessions over total working days of medical staff was determined as an approximate indicator of effort per month. The mean value of each year was compared. Despite fluctuations of the ratio, the mean value did not differ from 2010 to 2013. However, the ratio steadily increased in 2014, and there was a significant increase in the mean value. This proposed indicator of the effort of medical staff appears to reflect what we experienced, although its validity must be carefully examined in future studies.

Nuevas formas de innovar en la gestión sanitaria / No disponible

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Retooling for an aging America: building the healthcare workforce. A white paper regarding implementation of recommendation 4.2 of this Institute of Medicine Report of April 14, 2008, that "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion.".

In Chicago, Illinois, on May 7, 2009, a group of 53 medical educators representing many U.S. certification boards, residency review committees, and medical societies met to review and approve a white paper intended to promote Recommendation 4.2 of the Institute of Medicine report of April 14, 2008, "Retooling for an Aging America: Building the Healthcare Workforce." This recommendation is one of 14 and states: "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion." Background information given included the growing numbers of older adults, review of a 15-year initiative by a section of the American Geriatrics Society (AGS) to include geriatric education in all surgical and some related medical specialties, a recent announcement of 26 elder care competencies to be expected of graduating medical students from association of American Medical Colleges (AAMC) affiliated schools, and the American Board of Medical Specialties (ABMS) approach to 'Reinforcing Geriatric Competencies through Licensure and Certification Examinations." Nine points involved in the implementation of this recommendation received discussion, and approaches to realization were presented. In conclusion, this white paper, which those listed as being in attendance approved, proposes hat all ABMS member boards whose diplomates participate in the care of older adults select the floor competencies enumerated by the AAMC that apply to their specialty and add or subtract those completed during their trainees' initial (intern) year and then define those needed in subsequent years of residency and ultimate practice. This would fulfill the requirements of Recommendation 4.2 above.

Impacto financiero de la emigración de médicos y enfermeras del área Andina: un ejercicio de consolidación de documentos país / Financial impact of emigration of doctors and nurses from the Andean area: an exercise to consolidate country documents

El presente documento consolida los resultados del estimado del costo económico de la emigración de médicos y enfermeras en los últimos años en los países del área andina. Dicho consolidado supuso, inicialmente, la identificación de una metodología que validada para el caso del Perú luego fue aplicada en el conjunto de países señalados. Este texto al igual que los documentos específicos a cada país, aborda el problema específico de la migración internacional de los Recursos Humanos de la Salud (RHUS) en el marco más amplio del actual fenómeno mundial de la globalización de la mano de obra. Las cifras actuales de movilización internacional de la mano de obra evidencian que existe una profunda necesidad de los países más desarrollados por incorporar mano de obra. Ello es así como consecuencia de los cambios en la pirámide demográfica de los países desarrollados donde la cúspide es tan igual o importante que el resto de grupos etarios, requiriendo fuerza laboral joven para atender a una población cada vez de mayor edad ya sea a través de la provisión de los servicios de salud como también a través del aporte previsional a los sistemas de seguridad social públicos. De esta manera, los sistemas de reclutamiento de RHUS aparecen como un mecanismo internacional importante para la captación de los servicios de salud que requieren los países desarrollados, aunque no necesariamente ellos cubren a la totalidad de los migrantes profesionales de la salud. (AU)

Patient dissatisfaction with acute stroke care.

BACKGROUND AND PURPOSE: Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care. METHODS: All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care. RESULTS: The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health). CONCLUSIONS: Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.

A survey of medical staff attitudes to an antibiotic approval and stewardship programme.

BACKGROUND: Antibiotic stewardship programmes (ASPs) are advocated to ensure appropriate antimicrobial use; with short-term evidence they may improve outcomes, limit adverse effects, encourage cost-effectiveness and reduce antibiotic resistance. At Concord Hospital, a 450-bed acute care hospital, we have used a telephone-based ASP for 15 years. There may be differences in attitudes to the ASP by prescribers, which may influence its long-term efficacy. METHOD: A 40-item self-administered questionnaire was sent to 190 junior and 250 specialist medical staff. We aimed to elicit medical staff attitudes to the ASP's utility, educational value, effect on patient care and ease of use. RESULTS: One hundred and sixty-four completed questionnaires were returned. Most (82%, 95% confidence interval (95%CI) 75-87%) clinicians had used the ASP, 98% of whom believed it to be a reasonable system. Most staff (85%, 95%CI 79-90%) believed that seeking approval made teams think carefully about antibiotic choice, agreed it provided helpful advice (91%, 95%CI 85-95%) and that the approval system provided useful advice and was educational (88%, 95%CI 81-92%). The ASP was felt time-consuming and detracting from clinical duties by 33% (95%CI 26-41%), while 10% (95%CI 5.8-15.7%) believed it undervalued intuition and experience. Few (19%, 95%CI 13-25%, P < 0.0001) clinicians believed it infringed their autonomy. The advice given through the ASP was believed by most (89%, 95%CI 81-92%) to improve patient outcomes. CONCLUSION: The ASP was surprisingly well supported by all levels of staff, and reinforced the benefits of maintaining an ASP policy.

The U.S. presidential election and health care workforce policy.

The candidates for the 2008 presidential election have offered a range of proposals that could bring significant changes in health care. Although few are aimed directly at the nurse and physician workforce, nearly all of the proposals have the potential to affect the health care workforce. Furthermore, the success of the proposed initiatives is dependent on a robust nurse and physician workforce. The purpose of this article is to outline the current needs and challenges for the nurse and physician workforce and highlight how candidates' proposals intersect with the adequacy of the health care workforce. Three general themes are highlighted for their implications on the physician and nurse workforce supply, including (a) expansion of health care coverage, (b) workforce investment, and (c) cost control and quality improvement.

Evaluación de la migración de profesionales en salud. Informe final / Evaluation of the migration of health professionals. Final report

La Representación de la Organización Panamericana de la Salud en Bolivia en el marco de sus funciones realizó una convocatoria a fin de ejecutar un estudio sobre la Migración de Recursos Humanos, requiriendo para este objetivo un equipo de profesionales con capacidad de otorgar respuestas claras, evidentes y de calidad, mediante la utilización de las técnicas más adelantadas de muestreo; de esta manera se trató de garantizar un margen de error y nivel de confiabilidad mínimos determinados estadísticamente. En este contexto se realiza el estudio cuali-cuantitativo, utilizando la siguiente metodología: a) Primera etapa: investigación cualitativa de evaluación de la migración de personal de salud y las tendencias de la demanda de personal de salud. b) Segunda etapa: investigación cuantitativa de evaluación de la migración de graduados en medicina, enfermería y auxiliar de enfermería. El objetivo general de la consultoría es el siguiente: Evaluar la migración de médicos, enfermeras y auxiliares de enfermería. Mientras que los objetivos de la investigación son los siguientes: Identificar los volúmenes de migración interna y externa; clasificados por sexo, edad, región, país de destino y procedencia de institución formadora; Identificar los volúmenes del potencial de migración interna y externa; clasificados por sexo, edad, región, país de destino y procedencia de institución formadora e Identificar factores que inciden en la migración. (AU)

NHS workforce issues: implications for future practice.

This analysis of the literature examines the implications of the changes in the National Health Service workforce and the ramifications for multi-professional working practices, patient care and delivery of health services. Changes in medical working practices and education, together with the increasing numbers of doctors, have resulted in proposals for nurses to extend their role and the removal of professional restrictions. Whilst the numbers of nurses in the workforce have marginally increased, the qualified nurse ratio has declined, as has the balance between medical and registered nurses. Few attempts have been made to evaluate these changes in relation to the quality of service and patient outcomes. The changing roles of nurses and their value need to be quantified. Demographic trends, together with international shortages and the lack of educational capacity have also been understated Adequate and accurate workforce information should be regularly collated and analysed.

Los médicos y la industria farmacéutica: una relación de vulnerabilidad vista desde la bioética / The doctors and the pharmaceutical industry: a vulnerability relationship seen from the Bioethics

La prescripción farmacológica en la práctica clínica de nuestro quehacer diario exige que nos enfrentemos a una serie de influencias y responsabilidades, ya que cada decisión recae sobre un ser humano, el paciente, quien recibirá el medicamento y en lo posible sus beneficios. Hoy en día hay un gran número de presiones comerciales para formular uno u otro producto que generan un conflicto de intereses cuando el juicio profesional en relación con su interés primario se ve influenciado indebidamente por un interés secundario como puede ser un beneficio económico o un afán de notoriedad. Presentamos a continuación una aproximación al dilema ético que esta situación conlleva

Whither the drug specialist? The work-force development needs of drug specialist staff and agencies.

Drug specialist staff and agencies have been identified as having a critical role in responding to alcohol and other drug-related harm. This role must be seen in the context of the broad needs of people affected by drug use and the services that they utilize. Unfortunately, as in generic mainstream services, skill development, expertise, organizational structures and resources do not always support the demands of the drug specialist role. In order to develop the drug specialist work-force we must first review the evidence about the factors that influence effective practice. The available research indicates that a range of strategies is required and that these should not only focus on building the capacity of individuals, but also on organizations and systems. Substantial effort in capacity building is required in order to fulfil the expectations created by the title "drug specialist".