Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research ...infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.
The increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at ...Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashion METHODS: First attendances in the VMRC (September 2016-May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed.
A total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%).
VMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment.
Online communities (OCs) are a virtual organizational form in which knowledge collaboration can occur in unparalleled scale and scope, in ways not heretofore theorized. For example, collaboration can ...occur among people not known to each other, who share different interests and without dialogue. An exploration of this organizational form can fundamentally change how we theorize about knowledge collaboration among members of organizations. We argue that a fundamental characteristic of OCs that affords collaboration is their fluidity. This fluidity engenders a dynamic flow of resources in and out of the community-resources such as passion, time, identity, social disembodiment of ideas, socially ambiguous identities, and temporary convergence. With each resource comes both a negative and positive consequence, creating a tension that fluctuates with changes in the resource. We argue that the fluctuations in tensions can provide an opportunity for knowledge collaboration when the community responds to these tensions in ways that encourage interactions to be generative rather than constrained. After offering numerous examples of such generative responses, we suggest that this form of theorizing-induced by online communities-has implications for theorizing about the more general case of knowledge collaboration in organizations.
National cancer control plans: a global analysis Romero, Yannick; Trapani, Dario; Johnson, Sonali ...
The lancet oncology,
October 2018, 2018-10-00, 20181001, Letnik:
19, Številka:
10
Journal Article
Recenzirano
There is increasing global recognition that national cancer plans are crucial to effectively address the cancer burden and to prioritise and coordinate programmes. We did a global analysis of ...available national cancer-related health plans using a standardised assessment questionnaire to assess their inclusion of elements that characterise an effective cancer plan and, thereby, improve understanding of the strengths and limitations of existing plans. The results show progress in the development of cancer plans, as well as in the inclusion of stakeholders in plan development, but little evidence of their implementation. Areas of continued unmet need include setting of realistic priorities, specification of programmes for cancer management, allocation of appropriate budgets, monitoring and evaluation of plan implementation, promotion of research, and strengthening of information systems. We found that countries with a non-communicable disease (NCD) plan but no national cancer control plan (NCCP) were less likely than countries with an NCCP and NCP plan or an NCCP only to have comprehensive, coherent, or consistent plans. As countries move towards universal health coverage, greater emphasis is needed on developing NCCPs that are evidence based, financed, and implemented to ensure translation into action.
Institutional Work Lawrence, Thomas B; Suddaby, Roy; Leca, Bernard
07/2009
eBook
The 'institutional' approach to organizational research has shown how enduring features of social life - such as marriage and bureaucracy - act as mechanisms of social control. Such approaches have ...traditionally focused attention on the relationships between organizations and the fields in which they operate, providing strong accounts of the processes through which institutions govern action. In contrast, the study of institutional work reorients these traditional concerns, shifting the focus to understanding how action affects institutions. This book sets a research agenda within the field of institutional work by analyzing the ways in which individuals, groups, and organizations work to create, maintain, and disrupt the institutions that structure their lives. Through a series of essays and case studies, it explores the conceptual core of institutional work, identifies institutional work strategies, provides exemplars for future empirical research, and embeds the concept within broader sociological debates and ideas.
Documents and Bureaucracy Hull, Matthew S
Annual review of anthropology,
01/2012, Letnik:
41, Številka:
1
Journal Article
Recenzirano
This review surveys anthropological and other social research on bureaucratic documents. The fundamental insight of this literature is that documents are not simply instruments of bureaucratic ...organizations, but rather are constitutive of bureaucratic rules, ideologies, knowledge, practices, subjectivities, objects, outcomes, even the organizations themselves. It explores the reasons why documents have been late to come under ethnographic scrutiny and the implications for our theoretical understandings of organizations and methods for studying them. The review argues for the great value of the study of paper-mediated documentation to the study of electronic forms, but it also highlights the risk of an exclusive focus on paper, making anthropology marginal to the study of core bureaucratic practices in the manner of earlier anthropology.
IMPORTANCE: Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the ...importance and design of other payment models that include postacute care. OBJECTIVE: To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. DESIGN, SETTING, AND PARTICIPANTS: With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. EXPOSURES: Patient attribution to an ACO in the MSSP. MAIN OUTCOMES AND MEASURES: Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. RESULTS: For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control group, −$106 per beneficiary 95% CI, –$176 to –$35, or −9.0% of the precontract unadjusted mean of $1172; P = .003) that was driven by differential reductions in acute inpatient care, discharges to facilities rather than home (−0.6 percentage points 95% CI, –1.1 to 0.0, or −2.7% of the unadjusted precontract mean of 22.6%; P = .03), and length of SNF stays (−0.60 days per stay 95% CI, –0.99 to –0.22, or −2.2% of the precontract unadjusted mean of 27.07 days; P = .002). Reductions in use of SNFs and length of stay were largely due to within-hospital or within-SNF changes in care specifically for ACO patients. Participation in the MSSP was associated with smaller significant reductions in SNF spending in 2014 for the 2013 ACO cohort (–$27 per beneficiary 95% CI, –$49 to –$6, or –3.3% of the precontract unadjusted mean of $813; P = .01) but not in the 2013 or 2014 cohort’s first year of participation (–$13 per beneficiary 95% CI, –$33 to $6; P = .19; and $4 per beneficiary 95% CI, –$15 to $24; P = .66). Estimates were similar for ACOs with and without financial ties to hospitals. Participation in the MSSP was not associated with significant changes in 30-day readmissions, use of highly rated SNFs, or mortality. CONCLUSIONS AND RELEVANCE: Participation in the MSSP has been associated with significant reductions in postacute spending without ostensible deterioration in quality of care. Spending reductions were more consistent with clinicians working within hospitals and SNFs to influence care for ACO patients than with hospital-wide initiatives by ACOs or use of preferred SNFs.
To improve the completeness of reporting of mobile health (mHealth) interventions, the WHO mHealth Technical Evidence Review Group developed the mHealth evidence reporting and assessment (mERA) ...checklist. The development process for mERA consisted of convening an expert group to recommend an appropriate approach, convening a global expert review panel for checklist development, and pilot testing the checklist. The guiding principle for the development of these criteria was to identify a minimum set of information needed to define what the mHealth intervention is (content), where it is being implemented (context), and how it was implemented (technical features), to support replication of the intervention. This paper presents the resulting 16 item checklist and a detailed explanation and elaboration for each item, with illustrative reporting examples. Through widespread adoption, we expect that the use of these guidelines will standardise the quality of mHealth evidence reporting, and indirectly improve the quality of mHealth evidence.
To identify how US tax-exempt hospitals are progressing in regard to community health needs assessment (CHNA) implementation following the Patient Protection and Affordable Care Act.
We analyzed data ...on more than 1500 tax-exempt hospitals in 2013 to assess patterns in CHNA implementation and to determine whether a hospital's institutional and community characteristics are associated with greater progress.
Our findings show wide variation among hospitals in CHNA implementation. Hospitals operating as part of a health system as well as hospitals participating in a Medicare accountable care organization showed greater progress in CHNA implementation whereas hospitals serving a greater proportion of uninsured showed less progress. We also found that hospitals reporting the highest level of CHNA implementation progress spent more on community health improvement.
Hospitals widely embraced the regulations to perform a CHNA. Less is known about how hospitals are moving forward to improve population health through the implementation of programs to meet identified community needs.
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