Something to Chew on; Plate-Waste at an Ontario Veteran's Centre.

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes.

Setting up and running a paediatric emergency department in a hospital in Malawi: 15 years on.

Paediatric emergency care is not recognised as a specialty in many countries in Africa but is being practised increasingly. Setting up a paediatric emergency care unit takes time and often involves trial and error. Here we describe the start of the paediatric emergency department in Blantyre, Malawi, a low-income country and how it has continued to evolve over 15 years, in the hope that our experience will inform and assist others who are already developing their own emergency unit or wishing to do so.

Quality management of nuchal translucency ultrasound measurement in Australia.

Background: Nuchal translucency measurement has an established role in first trimester screening. Accurate measurement requires that technical guidelines are followed. Performance can be monitored by auditing the distribution of measurements obtained in a series of cases.

A systematic scoping review of the domains and innovations in secondary uses of digitised health-related data.

Background: Substantial investments are being made in health -information -technology (HIT) based on assumptions that these systems will save costs through increased quality, safety and efficiency of care provision. Whilst -short-term -benefits have often proven difficult to demonstrate, there is increasing interest in achieving benefits in the medium and long term through secondary uses of -HIT-derived data.

Aims: We aimed to describe the range of secondary uses of HIT-derived data in the international literature and identify innovative developments of particular relevance to UK policymakers and managers.

Tightrope walking towards maximising secondary uses of digitised health data: a qualitative study.

Background: Timely progress with attaining benefits from Health Information Technology (HIT) investments requires UK policymakers and others to negotiate challenges in developing structures and processes to catalyse the trustworthy secondary uses of HIT-derived data.

Aims: We aimed to uncover expert insights into perceived barriers and facilitators for maximising safe and secure secondary uses of HIT-derived data in the UK.

Methods: We purposively selected individuals from a range of disciplines in the UK and abroad to participate in a thematically analysed, semi-structured interview study.

Structuring and coding in health care records: a qualitative analysis using diabetes as a case study.

Background: Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management.

The collection and utilisation of patient ethnicity data in general practices and hospitals in the United Kingdom: a qualitative case study.

Background: Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood.

Aims And Objectives: We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups.

Methods: We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK.

A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals.

Aims: To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs) in order to inform future implementations, particularly in acute mental health settings.

Methods: Thematic analysis of interviews with a wide range of clinical, information technology (IT), managerial and other staff at two early adopter mental health National Health Service (NHS) hospitals in London, UK, implementing national EHRs.

Results: We analysed 33 interviews.

Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals.

Objective: To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals.

Materials And Methods: In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems.

Investigating the effectiveness of the Mediterranean diet in pregnant women for the primary prevention of asthma and allergy in high-risk infants: protocol for a pilot randomised controlled trial.

Background: Over recent decades there has been a substantial increase in asthma and allergic disease especially in children. Given the high prevalence, and the associated high disease burden and costs, there is a need to identify effective strategies for the primary prevention of asthma and allergy. A recent systematic review of the literature found strong supportive epidemiological evidence for a protective role of the Mediterranean diet, which now needs to be confirmed through formal experimental studies.

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives.

Background: Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources.

Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals.

Objectives: To evaluate the implementation and adoption of the NHS detailed care records service in "early adopter" hospitals in England.

Design: Theoretically informed, longitudinal qualitative evaluation based on case studies.

Setting: 12 "early adopter" NHS acute hospitals and specialist care settings studied over two and a half years.

The case study approach.

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach.

Anything but engaged: user involvement in the context of a national electronic health record implementation.

Background: The absence of meaningful end user engagement has repeatedly been highlighted as a key factor contributing to 'failed' implementations of electronic health records (EHRs), but achieving this is particularly challenging in the context of national scale initiatives. In 2002, the National Health Service (NHS) embarked on a so-called 'top-down' national implementation strategy aimed at introducing commercial, centrally procured, EHRs into hospitals throughout England.

Objective: We aimed to examine approaches to, and experiences of, user engagement in the context of a large-scale EHR implementation across purposefully selected hospital care providers implementing early versions of nationally procured software.

Auditing ultrasound assessment of fetal nuchal translucency thickness: a review of Australian National Data 2002-2008.

Background: Nuchal translucency (NT) measurement is the ultrasound component of first trimester combined screening for Down syndrome. In 2002, a NT ultrasound education and monitoring program was established in Australia. Between 2002 and 2008, a total of 728,502 NT scans were audited through this process.

Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation.

Objectives: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service.

Design: A mixed methods, longitudinal, multisite, socio-technical case study.

Setting: Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete.

Cancer-related psychosocial research: what are the perspectives of cancer care centre users on participation?

Purpose: To explore the perspectives of cancer care centre users on participation in psychosocial research to inform research design and ethics.

Methods: The study is based on a qualitative research design. Fourteen semistructured interviews were carried in people diagnosed with cancer and carers.

Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.

Problem: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated.

Approach: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies.

Working with Toronto neighbourhoods toward developing indicators of community capacity.

Often the goal of health and social development agencies is to assess communities and work with them to improve community capacity. Particularly for health promoters working in community settings and to ensure consistency in the definition of health promotion, the evaluation of health promotion programmes should be based on strengths and assets, yet existing information for planning and evaluation purposes usually focuses on problems and deficits. A model and definition of community capacity, grounded in community experience and focusing on strengths and assets, was developed following a 4-year, multi-site, qualitative, action research project in four Toronto neighbourhoods.

Rehabilitation and development after childhood cancer: can the need for physical exercise be met?

Clinical and experimental evidence attests to the neurological and psychological benefits of physical exercise. Prescribing exercise for children after cancer has the potential to facilitate recovery, performance and development, with consequent improvement in quality of life and long-term outcome. However, could a school take up the prescription for a child's individual exercise programme? As a preliminary to an intervention study, all primary and secondary schools in two Scottish regions were surveyed.

Population health in Canada: a brief critique.

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions. Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health.