Extraluminal Bougie-Assisted Endotracheal Tube Exchange Performed by Helicopter Emergency Medical Services.

The transport of intubated patients is a common but high-risk scenario for air medical transport crews. In the case presented, a physician-nurse HEMS crew responded for the interfacility transfer of a patient with severe angioedema who had undergone awake fiberoptic nasotracheal intubation in the referring emergency department. The endotracheal tube had been damaged, however, and could not be adequately secured for transport.

Could knowledge of patient demographics facilitate a personalized approach to radiation therapy patient education?

Introduction: Using patient demographics to tailor cancer patient education processes results in improved patient outcomes. However, there is little information on how to successfully tailor radiation therapy (RT) educational content and delivery. The aim of this quality improvement project was to describe the information preferences of a diverse group of patients undergoing RT and determine if different RT education processes were associated with certain patient demographics.

Pre-radiotherapy pain intensity and health-related quality of life in patients with bone metastases at various vertebral levels.

Purpose: The spine is the most common site of bone metastasis from cancer and can be divided into 5 locational subsections, varying in mobility. The purpose of this research was to determine if the mobility of the metastases-bearing vertebral segment influenced pre-treatment pain intensity or health-related quality of life (HR-QoL) for patients about to receive palliative radiation therapy for painful spine metastasis.

Methods: This study was a retrospective chart review of patients referred to the Palliative Radiation Oncology Program, about to receive radiation therapy for vertebral metastasis between January 2014 and June 2016.

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology.

Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams.

Treating Too Lightly? Radiation Therapists' Experiences of Workplace Violence When Providing Care to Cancer Patients and Their Families.

Introduction: Workplace violence (WPV) is defined as any act in which a person is abused, threatened, intimidated, or assaulted during their employment. Despite an absence of published evidence, radiation therapists (RTs) are considered a "low-risk" profession for WPV. The aim of this research was to determine the incidence, severity, and impact of WPV on RTs perpetrated by patients and/or their caregivers.

Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial.

Background: High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis.

Development of a peer-supported, self-management intervention for people following mental health crisis.

Background: A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs).

Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England.

Background: Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users' needs, this study used qualitative methods to investigate stakeholders' experiences and views of CRTs, and what is important in good quality home-based crisis care.

Method: Semi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11).

Development of a measure of model fidelity for mental health Crisis Resolution Teams.

Background: Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable.

The hierarchy of work pursuits of public health managers.

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted.

The song of the siren: some thoughts on idealization and creativity in Martinů's Julietta.

The authors draw on ideas posited by Segal in her seminal paper 'A psychoanalytic approach to aesthetics' to explore idealization and the creative endeavour as it is imaginatively portrayed in the Poutney/Lazaridis production of Martinů's Julietta, performed by Opera North (2003). The opera is set in a dreamlike world in which confusion proliferates, and Julietta is portrayed as a modern-day siren, luring Mischa, the main character, on to the rocks of psychic withdrawal. It depicts an inner drama where music, narrative and spectacle work together to evoke the main character's struggle which touches on universal themes--the ongoing nature of infantile longings, the pain of loneliness and separation and the fear of madness.

New payment model for rural health services in Mongolia.

This article describes experiences in Mongolia in designing and implementing a new method of payment for rural health services. The new method involves using a formula that allocates 65% of available funding on the basis of risk-adjusted capitation, 20% on the basis of asset costs, 10% on the basis of variations in distance-related costs, and 5% on the basis of satisfactory attainment of quality of care targets. Rural populations have inferior health services in most countries, whether rich or poor.

Does restructuring hospitals result in greater efficiency?--An empirical test using diachronic data.

Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical-divisional (CD), or clinical-institute (CI).

Clinical pathways in 17 European Union countries: a purposive survey.

We undertook a survey of clinical pathways across the 25 European Union countries, Australia. Fifty-one questionnaires were completed by largely self-selected experts from 17 countries. Respondents reported that pathways were important and were becoming increasingly widely used (although the rate of progress was highly variable).

Effects of increased private health insurance on hospital utilisation in Victoria.

The proportion of Victorians and Australians generally with private health insurance (PHI) increased from 31% in 1998 to 45% in 2001. We analysed a dataset containing all hospital separations throughout Victoria to determine whether changes in the level of private health insurance have had any impact on patterns of public and private hospital utilisation in Victoria. Total utilisation of private hospitals grew by 31% from 1998-99 to 2002-03, whereas utilisation of public hospitals increased by 18%.

The effects of increased private health insurance: a review of the evidence.

Private health insurance membership declined steadily between 1984 and 1997, after which major government interventions caused it to increase. We review some of the literature and conclude that the increases in membership were probably associated with a loss of equity and cost-effectiveness for the health care system as a whole. We attempt to explain why the government made the changes and conclude that the main factors were vested interests of those who have benefited and a confusion of objectives.

New general practitioner payment formula in Croatia: is it consistent with worldwide trends?

We describe the history of general practitioner payment in Croatia, and assess the extent to which recent trends are consistent with developments in other countries. We provide a definition of a classification of payment methods, and summarization of the evidence about their merits as described in international literature and an outline of the history of payment methods in Croatia, with emphasis on the changes proposed for 2004. We conclude that the introduction of performance-based payment, as an adjunct to the capitation payments, is consistent with trends in well-managed health systems in other countries.

Community involvement in health in Mongolia: hospital boards and other participatory structures.

Under the Soviet central planning model that operated until 1990, the Mongolian population had little or no involvement in decision-making about health care. As part of overall health sector reform in Mongolia, hospital boards have been established, with significant community representation, to guide strategic and financial management and to assist in developing services according to community needs and expectations. We discuss experiences, and steps taken to resolve initial problems.

A comparison of health insurance in Slovenia and Croatia.

Before Croatia and Slovenia became independent in 1991, they had similar health systems. They have generally taken the same reform path since then, but have also travelled in opposite directions on occasions. Of particular relevance here, both countries established quasi-government agencies to administer a new national scheme of compulsory health insurance in 1993.

Building capacity in the Mongolian health sector: a training methodology based on identified needs assessments.

Mongolian health care is moving from a centrally planned hierarchical basis towards greater decentralisation as part of overall sector wide reform. To identify key needs of health personnel to help to build capacity, we undertook research aimed at assessing priority training areas. The research results indicated gaps and weaknesses in many technical areas, but also significant problems in terms of how Mongolian health organizations function, including rigid structures, isolated management, and little internal communication.

Implementing DRGs in Slovenia: why the Australian variant was selected.

Slovenia is embarking on an ambitious health sector reform program, a small part of which involves implementing the categorization of acute inpatients by DRG for payment purposes. I summarise the leading DRG variants, and describe the process of selecting one of them. I argue that the Slovenian decision to use the Australian DRG variant as a starting point was sensible in terms of cost, speed of implementation, and usefulness of the resultant information.

[Clinical pathways: effective and efficient inpatient treatment].

The new hospital funding system based on a diagnosis-related group (DRG) system and the economic competition involved require large-scale changes in hospital structures and processes. Clinical pathways are multidisciplinary plans of best clinical practice for specified groups of patients with a particular diagnosis that aid the coordination and delivery of high quality care. The clinical pathway originally used in the USA and Australia was aimed at shortening the hospital stay and reducing healthcare costs, which has become an increasingly important issue in medicine.