Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England.

Background: National responses to healthcare-associated infections vary between high-income countries, but, when analysed for contextual comparability, interventions can be assessed for transferability.

Aim: To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England.

Methods: A longitudinal analysis (2000-2017), comparing epidemiological trends and policy interventions.

Positioning Children's Voice in Clinical Trials Research: A New Model for Planning, Collaboration, and Reflection.

Following the United Nations Convention on the Rights of the Child, there has been considerable growth in research with children about health and services that affect them. Creative methods to engage with children have also been developed. One area where progress has been slower is the inclusion of children's perspectives in qualitative research in the context of clinical trials or feasibility studies.

Community governance in primary health care: towards an international Ideal Type.

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement.

Extending primary care: potential learning from Italy.

Health systems across Europe are under increasing pressure to shift care outside hospitals and into community settings. The emphasis is on providing high-quality, coordinated care for a growing population of older patients and those with long-term conditions. Extended primary care is regarded as the key means of achieving such a shift.

International sources of learning for the organisation of primary care.

This article explores the potential to learn from emerging international models of primary care organisation. It examines a series of exemplars from Southern Europe and Latin America which may help support moves towards a 'new localism' in the public management of primary care. Six lessons for the UK are identified.

The organisation of primary care in Europe: Part 2 Agenda--position paper of the European Forum for Primary Care.

The contemporary models and trends of European organisational developments in primary care, identified in part 1 of this article, are the subject of analysis and discussion. Four main issues are identified in relation to the future protection and progress of primary care, and a series of policy interventions specified. These are directed at international agencies and action.

The organisation of primary care in Europe: part 1 trends--position paper of the European Forum for Primary Care.

Aim: To describe and classify contemporary organisational developments in primary care across Europe.

Method: Ten case studies have been undertaken at local sites which are exemplars of organisational practice nominated by national leaders and international experts. The selection is informed by a comprehensive literature and documentary review, with expert advice from members of the European Forum for Primary Care.

Combined horizontal and vertical integration of care: a goal of practice-based commissioning.

Practice-based commissioning (PBC) in the UK is intended to improve both the vertical and horizontal integration of health care, in order to avoid escalating costs and enhance population health. Vertical integration involves patient pathways to treat named medical conditions that transcend organisational boundaries and connect community-based generalists with largely hospital-sited specialists, whereas horizontal integration involves peer-based and cross-sectoral collaboration to improve overall health. Effective mechanisms are now needed to permit ongoing dialogue between the vertical and horizontal dimensions to ensure that medical and nonmedical care are both used to their best advantage.

Lessons from local engagement in Latin American health systems.

Objectives: To examine the management of recent policies for stronger patient and public involvement in Latin American health systems, identifying common features and describing local practice examples of relevance to the UK.

Context: Participation is a core principle of many contemporary policies for health system reform. In Latin America, as in the UK, it is frequently associated with innovations in primary care services and their organizational developments.

The management of new primary care organizations: an international perspective.

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles.

Transferable learning from international primary care developments.

Alternative approaches to the comparative analysis of international health systems developments are reviewed in relation to the advent of new primary care organizations in countries with parallel 'modernizing' policies. A framework for transferable learning between these is articulated and its design described. This is derived from priorities defined by lead policy and practice representatives in UK primary care.

An evaluation of personal medical services: the times they are a changin'.

The Personal Medical Services (PMS) pilot sites, launched in England in 1997 by the Secretary of State for the then Conservative government, introduced a local contract for primary care, aimed at promoting flexibility, innovation and policy participation. As part of the National Evaluation of PMS, this paper considers the professional and organisational relationships established between service providers working in those PMS sites which specifically set out to address inequalities in access to primary care for vulnerable populations. The introduction of PMS enabled a change of cultural values in primary care, particularly regarding GPs' relationships with nurses and practice staff.

Intraoperative thrombolytic therapy as a treatment of small vessel thrombosis: an experimental study.

Objective: This paper studies the effect of three doses of Streptokinase infused intra-operatively into an animal model of small vessel thrombosis.

Experimental Design: This is a controlled trial of intraoperative infusion of thrombolytic agent into a thrombosed arterial segment compared to no infusion into the contralateral limb.

Experimental Subjects: 19 New Zealand White rabbits were stratified into 3 groups.

Eccrine spiradenoma: a report of malignant transformation.

The authors report the case of a 21-year-old man who had malignant transformation within an eccrine spiradenoma involving the big toe. Although benign eccrine spiradenoma is not an uncommon cutaneous adnexal tumour, malignant change in this tumour is rare. To the authors' knowledge only 16 cases have been reported previously.

Rehabilitation potential of elderly patients with major amputations.

This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%.

Extra-anatomic bypass grafting: a rational approach.

To determine predictors of long-term patency in extra-anatomic bypass grafting, the authors studied retrospectively the charts of 134 patients who underwent bypass grafting (axillofemoral in 17, axillobifemoral in 32 and femorofemoral in 85). Of the study group, 64% were men; the mean age was 65 +/- 12 years (+/- SEM). The indications for grafting were limb salvage (102), claudication (27) and replacement of septic grafts (5), and for using the extra-anatomic route included high risk (83), sepsis (8) and unilateral disease (34).

Confirmation of infection of an aortic graft.

The presentation of an aortic graft infection may be dramatic in the form of an aortoenteric fistula or drainage of pus from the wound. Some cases may be more subtle with presentations of fever of unknown origin. Prior to embarking upon major operative repair for these suspected lesions, it is essential to confirm the presence of infection.

Simple method of intraoperative blood collection and reinfusion during aortic surgery.

The increasing fear of acquired immune deficiency syndrome and other blood-transmissible diseases and increasing blood-bank shortages prompted a study of the safety and feasibility of a commercially available hand-held unit for collecting and reinfusing blood. The device was used on nine patients undergoing aortic surgery and permitted a mean saving of 2.6 units of banked blood.