The quality of skilled birth attendants in Nepal: High aspirations and ground realities.

Background: While Nepal's maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal.

Research priorities for adolescent health in low- and middle-income countries: A mixed-methods synthesis of two separate exercises.

Background: In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda.

Electronic health records and the frequency of diagnostic test orders.

Objectives: To determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings.

Study Design: We analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey.

Methods: We estimated logistic regressions to determine the relationship between EHR utilization and the volume of laboratory and imaging tests ordered in our study population, controlling for age, sex, race, clinic type, payer type, health status, comorbidities, and new patients.

Building hospital management capacity to improve patient flow for cardiac catheterization at a cardiovascular hospital in Egypt.

Background: Quality improvement (QI) has been shown to be effective in improving hospital care in high-income countries, but evidence of its use in low- and middle-income countries has been limited to date. The impact of a QI intervention to reduce patient waiting time and overcrowding for cardiac catheterization-the subset of procedures associated with the most severe bottlenecks in patient flow at the National Heart Institute in Cairo-was investigated.

Methods: A pre-post intervention study was conducted to examine the impact of a new scheduling system on patient waiting time and overcrowdedness for cardiac catheterization.