Displaying emergency patient estimated wait times: a multi-centre, qualitative study of patient, community, paramedic and health administrator perspectives

Background Emergency Departments have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of this study was to gain perspectives from consumer, referrer and health services personnel regarding the concept of emergency wait time visibility. Methods In 2019, 103 semi-structured interviews and one focus group were conducted with emergency medicine patients/families, paramedics, well community members and hospital/paramedic administrators. Nine emergency departments and multiple organisations in Victoria, Australia, contributed data. Transcripts were coded and themes are presented. Results Consumers and paramedics face physical and psychological difficulties when wait times are not visible. Consumers believe about a 2-hour wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times; paramedics want door to off-stretcher times (for all possible transport destinations); with 47/50 consumers and 30/31 paramedics potentially using this information. Twenty-eight of 50 consumers would use times to inform facility or provider choice, 19/50 want information once in the waiting room. During prolonged waits, 1/52 consumers would consider not seeking care. Visibility of approximate waits would better inform decision-making, improve load-spreading, allow planning and access to basic needs and might reduce anxiety. Conclusions Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and whilst waiting for care.

General William Gorgas: outstanding medical administrator

This year marks the 100th anniversary of the death of General William Crawford Gorgas, probably the most famous public health administrator, who first achieved fame for his work in dealing with the epidemic of yellow fever in Cuba in the early 20th century.

Hospital and health administrator level barriers and priorities for National Neonatal Hearing Screening in Pakistan: A thematic analysis

Objectives: To investigate the Barriers and Priorities accorded by hospital and health administrators to neo-natal hearing screening. Methods: This qualitative exploratory descriptive study employing purposive sampling technique was conducted in Islamabad, over a period of 18 months from 1st August 2015 to 31st January 2017. Sample included the stakeholders i.e., Heads of public sector hospitals of Islamabad including Pakistan Institute of Medical Sciences, Capital Hospital, and Federal Government Services Hospital, Islamabad. Study included in depth interviews using a self-structured interview guide and audio recording. Recorded data was transcribed followed by thematic analyses which was manually drawn and verified. Results: The Outcomes from thematic analysis were drawn as Planning, Essential requirements for NNHS, High risk screening, education, Existence of skilled maternal & newborn health workers. Hearing screening equipment//facility instrumentation, Logistic support, Health ministry support and Financial cover are also significant outcomes. Lack of awareness in the public and professionals regarding the importance of early identification of HI, poor health infrastructure, burden on tertiary care and lack of referral top the list of barriers to initiation of NNHS program at hospital administrative level. Conclusion: The Barriers to NNHS identified at Hospital and Health care administrator level include lack of awareness, poor health infrastructure, burden on tertiary care and lack of referrals. Inherent barriers to NNHS cover the spectrum of lack of liaison/ linkages between obstetrics and other departments, deliveries at homes especially in rural areas, poor follow-up, scarcity of technical and adequately trained manpower. Intangible barriers to NNHS comprise lack of health care information system, attitudinal barriers, inadequate fiscal resources, and lack of integrated approach at intra departmental levels. doi: https://doi.org/10.12669/pjms.36.5.1965 How to cite this:Mumtaz N, Saqulain G. Hospital and health administrator level barriers and priorities for National Neonatal Hearing Screening in Pakistan: A thematic analysis. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1965 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Penyelenggaraan Klinik Pengobatan Alternatif dalam Tinjuan Undang-undang Perlindungan Konsumen

Health is a basic right of the people of Indonesia, as stated in Article 28 (h) of the 1945 Constitution. In practice, efforts to improve the well-being in the health sector are not only exercised in modern ways but also with alternative medicine efforts, by using various kinds of unconventional treatment, both medical and treatment products. This paper aims to find out the pattern of legal relations between the parties in the operation of alternative medical clinics without permission. it is found that the establishment of illegal clinics is against the law No. 8 of 1999, thus subject to administrative sanctions in the form of payment up to Rp. 200,000,000.00 (two hundred million rupiah). Furthermore, the trade law has occurred since the consumer decides to seek alternative treatment so that both parties must exercise their respective rights and obligations. It is suggested that consumers should be vigilant in consulting alternative medicine, and it would be better for the Health administrator to conduct surveillance on alternative medicine businesses.

Sir Marc Armand Ruffer, MD: The early years, 1878–1896

A founder of paleopathology, the study of disease in ancient human remains, Sir Marc Armand Ruffer, MD (1859–1917) served in Egypt, from 1896 to 1917, as a public-health administrator, epidemiologist, and pathologist. He was professor of Bacteriology at the Cairo Medical School, President of the Sanitary, Maritime, and Quarantine Council, member of the Indian Plague Commission, and author or co-author of 40 papers in palaeopathology. However, little is known of his early professional life, which encompassed his education, medical training, and research in England and France. The pre-Egyptian period, 1878 to 1896, was a time of extraordinary activity. Acquiring four academic Degrees at Oxford University and clinical experience at the University College Hospital, London (1878–1889), he was the clinical assistant of Louis Pasteur during the anti-rabies campaign (autumn 1889), interim President of the British Institute of Preventive Medicine (1893–1896), and immunology researcher (1890–1895), in London and Paris, under the guidance of Élie Metchnikoff (1845–1916). Ruffer developed the diphtheria antitoxin in Britain. In addition to a dissertation on hydrocephalus, he composed or co-authored 34 papers. A prolific writer, linguist, clinician, and administrator, he explored several medical sub-disciplines before concentrating on palaeopathology.

Round table: Toward a better living with schizophrenia

According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability, which accounts for 1.1% of the total DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). In the World Health Report [The WHO World Health Report: new understanding, new hope, 2001. Geneva]. In addition to the direct burden, there is considerable burden on the relatives who care for the sufferers. The workshop aimed to present and discuss different facets of what could be done for these persons and their families’ members in the light of what has been done in some European countries, which have conducted reforms. The round table will be introduced by presentations from two countries very much involved in psychiatric reforms which will present their attempts and results: first Italy with its emblematic radical deinstitutionalization model setting up a law to close down the psychiatric hospitals. The to-day situation will be presented underlying the huge diversity across Italian provinces and the dramatic lack of resources in some of them. Second the Portuguese reform will be described with a shift of psychiatric care toward general hospitals and its complete integration into health care catchment areas resulting in a increase of out patient acts among them home visits and a decrease of full time hospital admissions. Then a French three-year research program that focused on themes that aims to improve the every day well-being of people living with schizophrenia will be presented. This program aimed to provid new insights on their integration from different angles: information about the disease by doctors at diagnostic annoucement, on internet and actions to take on health administrator training against stigmatisation that could be extended to a larger public. Lastly the program allowed to interviewed face to face up to 67 people: 20 persons with schizophrenia, 20 person with bipolar disorders and 27 close ones to schizophrenic patients. A semi-structured interview collected information on the different aspects of care experiences plus “The Brief Illness Perception Questionnaire” allowed to measure and compare perceptions of the disease. This will allow to present the very positive effects of a program toward family members and patients themselves: “psychoeducation” that is a structured educationnal intervention which provides information and guidelines on how to react with their family member and influences positively the patient’s outcome as the well being of both patient and family members. Each presentation will extensively be discussed with the attendance and followed by some recommandations Key messages Although schizophrenia is a severe disorder much could be done to alleviate the burden on the patients and their family members. Reorganising the care systems trough adequate policies, setting up policies against stigmatisation and providing educational intervention should promote patients and families empowerment.

2547. Prioritizing Antimicrobial Resistance Learning Objectives Through a Modified, Two-Round, One-Day Delphi at a Multidisciplinary Conference

Background Antimicrobial resistance (AMR) is a global public health problem, but the learning needs of the medical profession on this topic are not well understood. The World Health Organization has called for better educational resources on AMR. Thus, we aimed to identify AMR learning objectives for physicians and medical trainees. Methods We designed a modified, two-round Delphi process to build consensus around these objectives, recruiting attendees at a one-day, multidisciplinary, international AMR symposium. Through review of the literature and discussion with experts in AMR, we generated an initial list of 17 objectives. We asked participants to rate the importance of including each objective in an AMR curriculum for physicians on a 5-point Likert scale, which ranged from “do not include” (1) to “very important to include” (5). Consensus for inclusion was predefined as ≥ 80% of participants rating the objective ≥ 4. Results The first round was completed by 30 participants, and the second by 21. Nobody declined to participate, but several people had to leave between rounds. Participants included physicians, researchers, graduate students, and a pharmacist, foundation manager, patient advocate, leader of an international financial institution, health administrator, and biomedical scientist. After the first round, 16 objectives met the consensus criteria, and participants suggested five additional topics. After the second round, 12 objectives met the consensus criteria (see Table 1). Objectives related to treatment of AMR most frequently met consensus criteria. Specific objectives with the highest consensus ratings were related to identifying infections not requiring antibiotics and recognizing the importance of using the narrowest spectrum antibiotic for the shortest period of time. Conclusion We successfully employed a modified, one-day Delphi process at an international, multidisciplinary AMR symposium to build consensus among experts and stakeholders regarding key learning objectives for AMR. This technique may be useful for guideline committees and other taskforces in the Infectious Diseases community. Our generated list may be useful for those developing AMR training materials for medical students and physicians. Disclosures All authors: No reported disclosures.

F. Haass: doctor, scientist, public health administrator, humanist, incorrigible philanthropist and Moscow Holy doctor

The biography of Fyodor Petrovich (Ivanovich) Haaz (Friedrich Joseph Laurentius Haass) (1780 - 1853) - Moscow doctor (1806 - 1853), a German origin, scientist, public health administrator, an outstanding humanist doctor of the first half of the 19th century, a philanthropist, known as the "Holy doctor", is showed in the article. Court Advisor (1811), College Counselor (1826), Knight of the Order of St. Vladimir of the fourth degree (1811), Order of St. Anna of the 2nd degree (181?) of The Russian Impire. A doctor in the army during the Patriotic War of 1812 (from January 1814), head physician of the Moscow Pavlovsk Hospital (1807-1812, 1814-1825), Head of the Moscow Medical Office (1825-1826), one of the founders of the Moscow Eye Hospital (1826), a member of the Moscow Prison Committee and the head doctor of Moscow prisons (1826-1853), the head doctor of the Moscow Catherine Hospital (1840-1844), the founder and head doctor of the Moscow Police (later - Alexander) hospital, popularly called the "Haaz" (1844- 1853). One of the founders of Russian balneology and balneology, who made a great contribution to the development of climatology and meteorology, pioneer in the resorts in the North Caucasus (1809-1810). The creator of lightweight individual shackles, he achieved their introduction at the exile stages to replace the riveting to a common rod for 6-12 convicted. The development of deontology in the 19th century, a science that studies the ethical standards and principles of a doctor’s behavior, as well as certain responsibilities towards the patient, is inextricably linked to the name of Dr. F.P. Haaz [F. Haass]. The life and work of this outstanding humanist physician is a wonderful example of high morality in the fulfillment of his professional duties and genuine nobility in serving the sick and suffering people. The motto of Dr. Haass’ life and professional work was borrowed from the Apostle Paul: “Hurry to do good” (in Galatians (6: 9-10) and in the second letter to The Thessalonians (3:13)). At present, the process of beatification has begun - the canonical process of classifying F. Haass as a blessed Catholic church.