Clin Med
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Editorial Comparative Study
Competition or collaboration? A comparison of health services in the U.K.
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The challenge of generating bed availability is constant in most NHS acute trusts. Building on previous work applying queue theory, this paper now takes operational data from one NHS trust, collected over a period of more than a year, to provide an evidence base and to establish the practical challenges associated with demand variation and managing length of stay. The problem is split into three separate parts. ⋯ Patients who stay for longer than one to two days contribute most significantly to the observed weekly bed availability problem. The problems associated with bed shortages around Christmas time and into the New Year are not simply issues of increased demand. A reduction in discharge capacity is a major contributory factor that results in unnecessary increases in length of stay.
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Tuberculosis (TB) remains a serious infectious disease continuing to cause around 1.8 million deaths annually. The great paradox is that despite the availability of effective treatment for the past 60 years, it continues to spread relentlessly, particularly in sub-Saharan Africa due to the fuelling effect of the HIV/AIDS epidemic. It is no longer a medical epidemic, but an epidemic of injustice. ⋯ It is imperative that the control should be linked to that of HIV which is also closely associated with poverty, poor housing and malnutrition. The historical, social, philosophical and political perspectives that may have influenced the failure of TB control are discussed. Once again, therefore, the question is raised--can TB be brought under control?