scholarly journals Great debate: how clinicians make their views heard in health reform

2009 ◽  
Vol 33 (1) ◽  
pp. 5
Author(s):  
Scott Blackwell ◽  
Kim Gibson ◽  
Shane Combs ◽  
Rowan Davidson ◽  
Carolyn Drummond ◽  
...  
Keyword(s):  
Health Reform ◽  
Best Practice ◽  
Clinical Care ◽  
Best Interests ◽  
Reform Process ◽  
Reform Agenda ◽  
Great Debate ◽  
System 2 ◽  
The Many

PUBLIC HEALTH SYSTEMS in Australia and internationally are faced with the need to implement significant reforms. These reforms are driven by the need to balance the delivery of best practice clinical care with rapidly spiralling cost pressures. With much of the agenda for reform driven by managerial, administrative and even political priorities, clinicians have often felt sidelined from the reform process. Indeed, there is some evidence that clinicians have had decreased enthusiasm for their work in recent years, coinciding with a greater role of nonmedical managers and more restrictions on resources.1 There is a wealth of experience and intelligence within the clinical workforce that can contribute to finding solutions to the many complex issues facing the health system.2 This experience and intelligence is expressed in advice on the clinician?s specific areas of expertise and often within their own environment. This may work against the clinician having an effective impact on the reform agenda at the macro level. In that context, the establishment of a Clinical Senate in Western Australia to inform the health reform process by debating major issues that impact across the system is innovative. The Clinical Senate requires that Senators adopt a broad view, set aside their particular clinical allegiances and debate the issues in the best interests of the community. The Clinical Senate is a forum that allows clinicians to influence statewide-level processes through formally recognised channels. This article examines the rationale, processes and operation of the Clinical Senate in WA as a mechanism for effective clinician input into health reform.

scholarly journals Prognostic gene expression profiling in melanoma: necessary steps to incorporate into clinical practice

2019 ◽  
Vol 6 (4) ◽  
pp. MMT32 ◽  
Author(s):  
Douglas Grossman ◽  
Caroline C Kim ◽  
Rebecca I Hartman ◽  
Elizabeth Berry ◽  
Kelly C Nelson ◽  
...  
Keyword(s):  
Gene Expression ◽  
Gene Expression Profiling ◽  
Expression Profiling ◽  
Best Practice ◽  
Clinical Care ◽  
Prognostic Gene ◽  
Care Guidelines ◽  
Test Usage ◽  
Current Guidelines

Prognostic gene expression profiling (GEP) tests for cutaneous melanoma (CM) are not recommended in current guidelines outside of a clinical trial. However, their use is becoming more prevalent and some practitioners are using GEP tests to guide patient management. Thus, there is an urgent need to bridge this gap between test usage and clinical guideline recommendations by obtaining high-quality evidence to guide us toward best practice use of GEP testing in CM patients. We focus here on the opportunities and uncertainties associated with prognostic GEP testing in CM, review how GEP testing was incorporated into clinical care guidelines for uveal melanoma and breast cancer and discuss the role of clinical trials to determine best use in patients with CM.

scholarly journals A review of community consultation in the development of a multi purpose service in rural and remote Australia

2004 ◽  
Vol 28 (1) ◽  
pp. 97 ◽  
Author(s):  
Angela Durey ◽  
Chris Lockhart
Keyword(s):  
Health Care ◽  
Western Australia ◽  
Health Reform ◽  
Conflicts Of Interest ◽  
Consumer Involvement ◽  
Community Consultation ◽  
Rural And Remote ◽  
Reform Agenda ◽  
Semistructured Interviews

This paper examines the role of community consultation and participation in the process of establishing a Multi Purpose Service (MPS) program in two towns in Western Australia. Information was gathered through written documents and semistructured interviews with individuals who were integral to the process. Consumer involvement in health care is increasing, and while claims of being community driven underpinned the MPS program, our findings suggest otherwise. Conflicts of interest, a lack of representation, and misunderstandings about the meaning of community consultation were present throughout the process of implementation. Moreover, official reports either ignore or downplay these events. We conclude that more attention must be paid to the role of the community in the health reform agenda generally and the MPS program specifically.

Leadership collaboration during health reform: an action learning approach with an interagency group of executives in Tasmania

2012 ◽  
Vol 36 (2) ◽  
pp. 136 ◽  
Author(s):  
Siobhan Harpur
Keyword(s):  
Health Reform ◽  
Action Learning ◽  
Healthcare Services ◽  
Reform Process ◽  
Learning Approach ◽  
State Health ◽  
Executive Leaders ◽  
Reform Agenda ◽  
Healthcare Workforce ◽  
New Knowledge

Objective. To use an action learning approach to encourage a group of executive leaders, responsible for the implementation of a state health reform agenda, to consider the leadership required to drive improvement in healthcare services. Methods. Based on an assertion that knowledge is co-produced and that deliberative and structured conversation can be a mechanism to drive change, an action learning approach was used to facilitate an interagency group of executive leaders, responsible for the implementation of a state health reform agenda, who were encouraged to consider the leadership required to drive improvement in healthcare services. Results. It was difficult to assert how the group contributed specifically to the implementation of the health reform agenda but individuals gained insights and there was informal resolution of institutional tensions and differences. The method may provide new knowledge to the reform process over time. Conclusions. Getting the participants together was challenging, which may reflect the reality of time-poor executives, or a low commitment to giving time to structured and deliberative informal dialogue. Further work is required to test this thesis and the action learning approach with other parts of healthcare workforce.

scholarly journals Agenda-setting in health reform:the role of community

2001 ◽  
Vol 24 (1) ◽  
pp. 161 ◽  
Author(s):  
Rosemary Aldrich ◽  
Gavin Mooney
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Reform ◽  
Community Involvement ◽  
Agenda Setting ◽  
Health Reform ◽  
Health Care Decision ◽  
Reform Agenda ◽  
Care Decision

This paper presents a number of issues surrounding the setting of agendas for health care reform. We argue the needfor increased community involvement, as well as the necessity to wrest health-care decision-making from health careprofessionals, or at least to ensure that such decision-making is informed by community values.We attempt to answer a few questions: who sets the health reform agenda and who should set it, how is the agendaset and why is this critical, when and where is the agenda set, and how should the agenda be set in the future?

scholarly journals Dialysate Sodium—One Size Unlikely to Fit All

2021 ◽  
Vol 1 (2) ◽  
pp. 135-137
Author(s):  
Finnian R. Mc Causland
Keyword(s):  
Clinical Care ◽  
Well Being ◽  
Evidence Base ◽  
Medical Director ◽  
Hemodialysis Unit ◽  
The Many ◽  
Fiscal Considerations ◽  
Dialysate Sodium ◽  
Improve Patient

The role of medical director of a hemodialysis unit has become increasingly complex. Among the many roles it encompasses, the delivery of safe and effective dialysis treatments requires constant review, synthesis, and interpretation of the medical literature. Despite decades of experience with hemodialysis, the evidence base for dialysate prescription is relatively limited, with the choice of dialysate sodium being a prime example. The ask of this exercise was to imagine ourselves as the medical director of a new hemodialysis unit and to consider factors influencing the choice of dialysate sodium. While fiscal considerations are indeed important, one hopes that these align with the delivery of clinical care to improve patient well-being. Therefore, my approach was to focus on exploring the clinical responsibilities of a medical director in the choice of dialysate sodium. As such, after reviewing the evidence to date, my ‘default’ dialysate sodium prescription would be 140 mmol/L, but I would retain the option of individualizing treatment for certain patients until further evidence becomes available.

On Future Directions in Pathology

1982 ◽  
Vol 40 ◽  
pp. 274-277
Author(s):  
Benjamin F. Trump ◽  
Irene K. Berezesky ◽  
Raymond T. Jones
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Clinical Pathology ◽  
Future Directions ◽  
Diagnostic Pathology ◽  
The Past ◽  
Transmission Electron ◽  
Organ Systems ◽  
The Many

The role of electron microscopy and associated techniques is assured in diagnostic pathology. At the present time, most of the progress has been made on tissues examined by transmission electron microscopy (TEM) and correlated with light microscopy (LM) and by cytochemistry using both plastic and paraffin-embedded materials. As mentioned elsewhere in this symposium, this has revolutionized many fields of pathology including diagnostic, anatomic and clinical pathology. It began with the kidney; however, it has now been extended to most other organ systems and to tumor diagnosis in general. The results of the past few years tend to indicate the future directions and needs of this expanding field. Now, in addition to routine EM, pathologists have access to the many newly developed methods and instruments mentioned below which should aid considerably not only in diagnostic pathology but in investigative pathology as well.

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

2011 ◽  
Vol 21 (3) ◽  
pp. 89-99
Author(s):  
Michael F. Vaezi
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Best Practice ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Tools ◽  
Swallowing Function ◽  
Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

The future role of the psychiatrist in Europe – a UEMS perspective

2014 ◽  
Vol 11 (01) ◽  
pp. 35-42
Author(s):  
M. Hermans
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
General Interest ◽  
Future Role ◽  
Personal Opinion ◽  
The Future ◽  
The Subject ◽  
The Many

SummaryThe author presents his personal opinion inviting to discussion on the possible future role of psychiatrists. His view is based upon the many contacts with psychiatrists all over Europe, academicians and everyday professionals, as well as the familiarity with the literature. The list of papers referred to is based upon (1) the general interest concerning the subject when representing ideas also worded elsewhere, (2) the accessibility to psychiatrists and mental health professionals in Germany, (3) being costless downloadable for non-subscribers and (4) for some geographic aspects (e.g. Belgium, Spain, Sweden) and the latest scientific issues, addressing some authors directly.

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