Strengthening care for injured persons in less developed countries: A case study of Ghana and Mexico

In all countries, the priority for reducing road traffic injuries should be prevention. Nonetheless, there are low-cost ways to strengthen the care of injured persons, that will help to lower the toll from road traffic. The purpose of this review was to elucidate ways to accomplish this goal in the context of less developed countries. Studies selected for this review were obtained by Medline review, selecting on key words such as trauma, injury, trauma care, essential health services, and developing country. Articles pertaining to any country and all available years were considered. In addition, the authors utilized articles from the gray literature and journals from Mexico and Ghana that are not Medline referenced. Studies surveyed point to road safety and other forms of injury prevention, as well as prehospital care, as likely priorities for developing countries. Nonetheless, hospital-based improvements can contribute to decreases in mortality and, especially, decreases in disability. For both prehospital and hospital based care, studies revealed several critical weak points to address in: (1) human resources (staffing and training); (2) physical resources (equipment, supplies, and infrastructure); and (3) administration and organization. The ‘essential services’ approach, which has contributed to progress in a variety of fields of international health, needs to be developed for the care of the injured. This would define the trauma treatment services that could realistically be made available to virtually every injured person. It would then address the inputs of human resources, physical resources, and administration necessary to assure these services optimally in the different geographic and socioeconomic environments worldwide. Finally, it would identify and target deficiencies in these inputs that need to be strengthened.     

Utilization of health services by the injured residents in Kumasi, Ghana

The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11,663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (> or =1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.     

Utilization of health services by the injured residents in Kumasi,Ghana

The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11 663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (≥1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.     

Injury care in low- and middle-income countries: identifying potential for change

The epidemiologic, demographic, and socio-political transitions underway in many low- and middle-income countries (LMIC) are associated with a substantial burden of disease due to injuries. LMIC have devoted relatively little attention to the injury problem. This paper argues that whereas prevention remains paramount, improving health care services for injuries will also contribute to reducing the burden. It examines the reasons for the relative inaction in LMIC to date, and contrasts this to high-income countries (HIC) which have seen substantial falls in mortality from improved trauma care systems. Mortality data, although readily available, are the tip of the clinical iceberg and there is a need for better-quality hospital data that can be used to monitor any future improvements. Models of trauma care from HIC are reviewed. It is suggested that the greatest potential for improvement can be achieved if entire trauma systems are improved, including pre-hospital, hospital and rehabilitation care. LMIC may not be able to afford the whole system and improving the most sensitive components of the system may be a better option. Models of trauma care developed in HIC need careful consideration to determine their effectiveness, appropriateness, affordability and equity implications for LMIC. Imports of blueprints from elsewhere are likely to fail; context sensitive and appropriate policies need to be developed locally through a consultative process. Effective working needs to be across disciplines, involving consultation with stakeholders, and requires investment in education, training and equipment. The evidence base for trauma services in LMIC is almost non-existent, highlighting the urgent need for research in these settings.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Laypeople roles at road traffic crash scenes: a systematic review

This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of ‘laypeople’, ‘layman’, ‘layperson’, ‘bystander’, ‘first responder’, ‘lay first responder’, ‘road traffic’, ‘road traffic injury’, ‘crash injury’, ‘crash scene’, ‘emergency’, ‘trauma care’, and ‘prehospital trauma care’ were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.     

Health Care Matters: Supply Chains In and Of the Health Sector

Providing health care involves a complex enterprise, and the trade‐off between quality and cost has been particularly stark compared to other industries. However, a recent focus on health sector supply networks is now producing significant innovations and improvements. This Special Topic Forum illustrates for the academic and practitioner community how health care supply chain research can benefit from our evolving understanding of supply chains and help push that understanding even further. We classify health care supply chain research into two broad categories—supply chain in health care and supply chain of health care—to set an agenda for future research.     

Interpersonal violence in the United Arab Emirates

We aimed to study the anatomical distribution, severity and outcome of hospitalised interpersonal violence-related injured patients in Al-Ain, United Arab Emirates so as to give recommendations regarding the magnitude of this problem, its causes and priorities of prevention. Data were retrieved from Al-Ain Hospital Trauma Registry, which was prospectively collected over three years. There were 75 patients (males = 85.3%) having a mean age of 30 years. Eighty-one percent had blunt trauma. The estimated annual injury hospitalisation of interpersonal violence in Al-Ain city was 6.7 per 100,000 population. Females were significantly more injured by a family member (p = 0.02), at home (p = 0.005), and had more severe injuries (p = 0.003). There was a trend for children less than 18 years old to have more penetrating trauma (p = 0.06) and to be injured by a family member (p = 0.09). There was only one case of woman sexual assault and two cases of child abuse. The mean (SD) hospital stay was 7.87 (14.1) days. Less than 3% (n = 2) were admitted to the intensive care unit with no deaths. In conclusion, the majority of patients in our study had minor injuries. Nevertheless, the psychological impact may be major. This highlights the need to develop suitable mental health services in support of victims of interpersonal violence.     

Seating position and patterns of severely injured body parts among child passengers in motor vehicle crashes: Japan as a distinct case

ABSTRACT

This study describes injury patterns and outcomes related to the seating position of child passengers involved in motor vehicle crashes in Japan. Using data obtained from a national trauma registry database, we compared the occurrence of injuries by body parts, length of hospital stay and in-hospital deaths between front-seating and rear-seating among children. We analysed 166 children aged 0–5 years and 205 children aged 6–12 years. No significant differences were observed between front- and rear-seating for injured body parts, length of hospital stay or in-hospital deaths in the 0–5-year-old victims. Among those aged 6–12 years, rear-seating was associated with a higher incidence of head and chest injuries but the length of stay or in-hospital deaths did not differ. These findings contrast those of previous studies, which found that rear-seating reduces injury risk, possibly attributed to low age-appropriate restraint use among school-aged children in Japan.     

Leveraging Big Data to Develop Supply Chain Management Theory: The Case of Panel Data

Increased data availability is poised to shape both business practice and supply chain management (SCM) research. This article addresses an issue that can arise when trying to use big data to answer academic research questions. This issue is that distilled data often have a panel structure whereby repeated measurements are available on one or more variables for a substantial number of subjects. Thus, to fully leverage the richness of big data for academic research, SCM scholars need an understanding regarding the different types of research questions answerable with panel data. In this article, we devise a framework detailing different types of research questions SCM scholars can answer with panel data. This framework provides a basis to categorize how SCM scholars have examined the services supply chain setting of health care with public data regarding hospital‐level patient satisfaction. We extend prior research by testing a series of three questions not yet examined in this area by fitting a series of structured latent curve models to seven years of hospital‐level patient satisfaction for nearly 4,000 hospitals. The discussion highlights theoretical and methodological challenges SCM scholars are likely to encounter as they use the panel data in their research.     

提高出生人口素质的孕前—围孕保健模式的再讨论

随着人口再生产类型和疾病模式发生根本性的转变,我国政府已对提高出生人口素质和出生缺陷预防给予了高度重视。在过去十年中,随着对孕前保健和出生缺陷一级预防重要性认识的逐步加深,我国出生缺陷预防工作正努力从产前—围产保健模式逐步扩展到孕前—围孕保健模式。尽管如此,近几年的实践表明出生缺陷预防模式的转变依然面临诸多的挑战。对孕前—围孕保健预防模式相关的几个问题进行了讨论,包括计划怀孕的重要性、一级预防应采取何种策略、能力建设和发展。     

Genre and Postemergency Contexts: The Nexus of Strategic Communications

This article explores why organizations choose to enact public relations discourse genres after an emergency situation —organizational crises, disasters, and issues—has been resolved. In the aftermath of emergency situations, we argue that organizational communicators employ discourse messages according to five governing “commitments,” which corporate officials use to shape postemergency messages the way they do. This essay, then, is not so much a retrospective analysis of what happened in selected emergency situations but, rather, is more a prospective explanation about how to use these five governing commitments when anticipating emergencies that could happen. Organizational learning and organizational renewal are addressed accordingly. In this argument we draw upon literature in linguistics, rhetorical theory, and organization studies. Examples of postemergency situations are used to bridge theory and practice to show how what was done retrospectively can be done prospectively to prepare for communication during postemergency contexts.     

Developing the evidence base of patient and public involvement in health and social care research: the case for measuring impact

While patient and public involvement (PPI) in health and social care research has progressed successfully in the last decade, a range of difficulties with the evidence base exist, including poor understanding of the concept of impact, limited theorization and an absence of quantitative impact measurement. In this paper, we argue that a paradigm change towards robust measurement of the impact of involvement in research is needed to complement qualitative explorations. We argue that service users should be collaboratively involved in the conceptualization, theorization and development of instruments to measure PPI impact. We consider the key advantages measurement would bring in strengthening the PPI evidence base through a greater understanding of what works, for whom, in what circumstances and why.     

Purchase Attributes of Wine Consumers with Low Involvement

Abstract

The past decade has seen a dramatic increase in wine consumption. With this increase comes the need to understand how consumers choose wine. Wine consumers have different types of experiences and expectations, and a one bottle fits all method of catering to wine consumers is not an appropriate marketing strategy. Consumer segmentation based upon involvement with wine is critical to understanding buying behaviors. This study used factor analysis and logistic regression to identify the wine novice and what marketing cues they use to purchase wine. The results identified key marketing cues wine novices use to purchase wine and revealed yet another involvement category: the emerging wine learner.     

Burden,pattern and outcomes of road traffic injuries in a rural district of India

Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was <5%. Trauma care was deficient in the district leading to greater number of referrals. Road safety should be given high importance in rural India with a focus on safe roads, safe vehicles and safe people along with trauma care.     

Sensemaking About Business-to-Business Strategies and Relationships: A Commentary on Reid and Plank's Review

ABSTRACT

Weick (1995) describes retrospection as a distinguishing characteristic of sensemaking: “people can know what they are doing only after they have done it” (p. 24) and “how can I know what we did until I see what we produced” (p. 30). While each of us engages in sensemaking implicitly, applying explicit sensemaking tools-such as written retrospection-helps to clarify and deepen our understanding of phenomena. Reid and Plank's business-to-business marketing retrospection of more than 2,500 journals, proceedings, and book references from 1978–1997 serves well as a sensemaking tool. A strength of Reid and Plank's retrospection is its breadth of coverage of topics and sources. Limitations of their review include the lack of coverage of key findings from the cited empirical studies and the failure to develop theoretical propositions on relationships and strategies. By reading Reid and Plank's review, both new and lifelong students of business-to-business marketing will find useful references and insights for improving sensemaking capabilities.     

The algebra of health concerns: implications of consumer perception of health loss,illness and the breakdown of the health system on anxiety

The current and expected future state of the American health care system creates much concern and anxiety at the national and individual level among Americans. This study is in response to the call of the Institute of Medicine to further study the lack of confidence among Americans about their future ability to receive high‐quality health care. This study compares perceived anxiety and its amelioration as a result of three possible health situations: illness with infectious disease, losing one's health and a breakdown of the health care system. This empirical study was conducted within the framework of conjoint analysis. We conducted an experimental design of ideas, identified attributes that increased or reduced anxiety in each of the three health‐related situations and then segmented consumers on the basis of their patterns of reactions to the attributes. We found that the highest anxiety was attributed to the breakdown of the health care system. The segmentation further suggested that the anxiety emerging from the breakdown of society's health care system generated a different extent of anxiety than that which emerged from one's illness or one's loss of own health. The attributes that drove anxiety across the health situations were, surprisingly, charities, one's company, the local hospital and supplemental insurance. Attributes that reduced anxiety differed among segments. The attributes were found to be: close friends, family, distribution of information by authorities and the belief in God. At a practical level, these data and patterns of response allow health care policy makers to enhance the coping ability of patients by understanding the nature of what reduces the anxiety of individual types of patients. The approach in this study provides a person‐centred system for communication and anxiety reduction that can be implemented as part of a public health policy.     

An Integrated Strategic and Tactical Master Surgery Scheduling Approach With Stochastic Resource Demand

This study discusses a master surgery scheduling approach that maximizes hospital revenues while considering the impact on the downstream resources—intensive care units and general patient wards. Demand for these resources is modeled by a stochastic patient path model. I apply an integer programming model to provide the optimal allocation of how many (strategic planning problem) and what (tactical planning problem) operating room (OR) blocks to assign to each medical specialty. I demonstrate further applications of the model, such as the analysis of the value of flexible resources and the simulation of specific resource expansions. The approach is tested with real‐life data from a German university hospital and achieves significant revenue increases.