Articles: human.
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It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. ⋯ The effectiveness of interventions delivered at hospital level over periods realistically required to achieve change may be influenced by a wide variety of factors at national and local levels. We have demonstrated how dynamic such contexts are, and therefore the need to consider context when interpreting an intervention's effectiveness.
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Can intuition be taught? The way in which faces are recognized, the structure of natural classes, and the architecture of intuition may all be instances of the same process. The conjecture that intuition is a species of recognition memory implies that human intuitive decision making can be enormously enhanced by virtual simulation.
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Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting. The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. ⋯ Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative.
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Internationally there is commitment to work towards eradicating the abuse of older people and to develop services that promote their equality, dignity and human rights. The emphasis on service users is gradually increasing and, along with this, the focus within health and social care policy, service provision and professional practice is shifting. In UK health and social care policy the emphasis on service structure and provision is being replaced by a focus on outcomes for service users, including outcomes which patients themselves evaluate. ⋯ The outcomes framework developed through the research is offered, along with a discussion of the advantages of an outcome-focused approach to care and some of the remaining challenges. A case example is offered to illustrate an outcomes-focused approach. Finally, the paper draws conclusions on how shifting the focus of care delivery from traditional problem-orientated approaches and ritualized practice towards the outcomes of care that individual older people choose and evaluate for themselves offers potential towards eradicating abuse and neglect in formal care settings.