tuberculosis (TB) was declared a global emergency by the World Health Organization (WHO) in 1993. 1 The spread of HIV and the emergence of multidrug-resistant TB (MDR-TB) have worsened the impact of TB in terms of morbidity and mortality. 2 As such rapid diagnosis of MDR-TB is a global priority for TB control. The WHO recommends the use of the Xpert® MTB/RIF system as the initial diagnostic test in individuals suspected of having MDR-TB or HIV-associated TB. 3 The information obtained from the test enables quicker decisions about treatment and infection control compared to culture. 4 Since testing is pivotal to healthcare, tests should only be recommended for routine clinical use based on evidence of their clinical performance (i.e. diagnostic accuracy) and clinical effectiveness (i.e. benefits and harms) derived from relevant, high quality primary studies and systematic reviews. Well conducted systematic reviews of relevant, high quality primary research studies are generally considered to be the highest level of evidence. 5
Medical educators are originally medical practitioners that practice medicine, teaching, and research. Not all of them have received formal training in education, not to mention educational research. Therefore, it would be understandable that they approach medical education research usually from the objectivist approach, perceiving the reality as “out there” and wanting to discover it. Medical educationists, on the other hand, are those medical practitioners who received training, and probably certification and degrees in medical education as a social science. Therefore, they assimilate the concepts of social constructivism, and are open to the idea of conducting qualitative research. This explains why in qualitative research is sometimes devalued in medicine, and is considered to be “subjective, biased, and opinion based” (24). Recently, the contribution of qualitative research in evidence-based practice is being recognised in both healthcare systems and medical education research (25).
The acceptability of the PGI, when administered in a postal study of 1746 patients with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer and varicose veins, was found to be low (59%) (Garratt and Ruta, 1999). Similar results were obtained in a population study of 161 people with limiting long-term illness (MacDuff and Russell, 1998). Although unsuitable for self-completion (a simplified version is being developed), the PGI was very acceptable when administered by interview. Results from Garratt and Ruta’s (1999) test-retest reliability study suggested that the PGI was sufficiently reliable for group comparisons, but not for comparing individual patients. Evidence for the validity of the PGI was inclusive, but for patients with low back pain, analgesic use and strength was related to PGI scores. For those with suspected peptic ulcers, the PGI scores were associated with the presence of a family history of ulcer disease, and the scores were associated with GPs’ ratings of symptom severity for those with low back pain and varicose veins. The content validity of the PGI was supported in a community study of patients with atopic dermatology. Ten areas of life included in the PGI assessment, for example, swimming and sleep loss, did not feature at all in the Dermatology Life Quality Index (DLQI), but all ten items in the DLQI appeared in the PGI assessment (Herd et al., 1997). The PGI compared well with the SF-36 in ability to assess responsiveness to change (Garratt and Ruta, 1999). It also compared well, in this respect, with the SF-36 and Euroqol, in a study o f 89 patients with obstructive sleep apnoea, before and after treatment (Jenkinson et al., 1998). There is evidence that the PGI may be more responsive than the SEIQoL because of its focus on health. An effect size of 0.61 was found when comparing scores before and after treatment for low back pain, an intervention which is not thought to be as effective as hip replacement surgery in improving QoL (Ruta and Garratt, 1994).
Linkage of laboratory data with healthcare system administrative data can be used to provide standardized information for people with diabetes on a population basis that can be used to identify deficiencies in care and support quality improvement initiatives. The poten- tial to do so exists throughout Canada and other juris- dictions with universal healthcare systems and/or electronic medical records serving large patient groups. For example, a recent study described the utilization and outcomes of A1C testing among people with dia- betes in eastern Ontario . Although their results were consistent with those reported here, they did not provide information for FN.
Quality review of these time-series studies indicated that a majority of the studies did not rule out the threat that another event could have occurred at the same time as intervention. Reporting of factors related to data collection, the primary outcome, and completeness of the data were generally done in a number of studies. However, only one study provided a justification for the number of data points used or a rationale for the shape of intervention effect (Steele, Eisert, Witter et al. 2005). Six interrupted time-series studies included in this review were analysed inappropriately using statistical methods based on ordinary least squares test (Evans et al. 1998; Durieux et al. 2000; Mullet et al. 2001; Chertow et al. 2001; Adams et al. 2003; Patkar et al. 2006). For example, long time-series studies were analysed using simple square-tests and a regression model (Evans et al. 1998; Durieux et al. 2000). In fact, these tests are inappropriate for analysing interrupted time-series designs partly because these methods assume independ- ence of error, and when events or behaviours are measured over time, they usually correlated with each other resulting in biased standard deviations of the parameter estimates (Ramsay et al. 2004). To provide some protection from this threat to internal validity, an appropriate time-series regression model such as an autoregressive inte- grated moving average (ARIMA) model, which is designed to provide unbiased estimated of error in a series, should be used.
In growth accounting prices usually do not matter much since constant price series can be generated by pricing the output at some base year prices. But as I have mentioned in previous section, for Chinese GDP data there are some arguments about the deflator used in the official statistics. The other issue is that of ”International Comparison”. Prices become important when comparing the output across countries. World Bank ICP (2005) [?] men- tions that PPP based method give different results from exchange rate based methods. Theoretically these differences should not matter much when con- sidering the growth rates of the variables. But to be more precise, we should price each year’s output of both the countries at the base year prices of one of the countries. In this section I do this by generating two hypothetical output series: Indian GDP at Chinese prices (deflator) and Chinese GDP at Indian prices (deflator).
The 24 selected indicators cover several aspects of Ugan- dan public health; including HIV knowledge, counselling, and behaviour (8 indicators), malaria treatment and pre- vention (3), family planning & reproductive health (4), child health (3), nutrition (4) and sanitation (2). The results of the 37 comparisons are summarised as a forest plot (Figure 1). Point estimates, confidence intervals and the results of statistical comparisons are shown in the Appendix (Tables A1 – A8). In Tables A9 and A10 (also in the Appendix), we summarise our comparisons. For 6 indicators (Table A1 and TableA3), we refine the com- parison by making subpopulation comparisons (e.g. men, women, male youths, female youths) resulting in addi- tional comparisons. In total, we assessed 38 comparisons; 1 comparison using a cohort of male youths (Table A3) was eliminated due to the UDHS having insufficient com- parable data, thereby reducing the number of compar- isons to 37. We did not reject equality of the proportions in 21 of 37 (56.8%). The average difference between LQAS and DHS estimates for the 37 comparisons was 0.062 (SD = 0.093; median = 0.039). The average differ- ence among the 21 failures to reject equality of propor- tions was 0.010 (SD = 0.041; median = 0.009); among the 16 rejections, it was 0.130 (SD = 0.010,
The second half of our empirical analysis provides some hope, however, in the potential for medical liability to influence physician behavior. Drawing upon the one type of standard-of- care reform that states have experimented with to date—i.e., locality rule abdications—we investigate the impact of changing the clinical standards of care imposed upon physicians under the law, both in terms of elevated standards and slackened standards. All told, it appears that the relationship between healthcarequality and changes in clinical malpractice standards works in an expansionary direction only. That is, once physicians provide a high level of quality, they may maintain such practices even when the law may loosen its expectations at a later date. In contrast, physicians who provide a quality of care that is below what is expected by the law raise their practice to meet the higher expectations set by the law. Malpractice forces may therefore be effective in elevating the quality floor. This pattern of results is arguably consistent with an interpretation in which informational forces constitute the mechanism of action behind any responsiveness in behavior to legal standards, as hypothesized above and as distinct from traditionally hypothesized fear-of-liability channels. Further work, however, is warranted to tease out the underlying story behind such responses and to distinguish informational mechanisms from traditional fear-based liability mechanisms.
Hospitals are a vital and fundamental part of the society. They are considered as an efficient system of service that provides health and well being to the people of the society. This industry is the largest, extremely competitive, rapidly growing and emerging industry in the services sector of the world. The performance of any organization can be evaluated through the commitment of all employees of the firm. Similarly, the performance of the hospital industry depends upon the performance of its employees. The better performance of hospitals not only help them to treat their patients in a good way but it also assist s them in providing their services at low cost (Humayon, Ansari, Khan, Iqbal, Latif, & Raza, 2018).
Hospitals are vital and fundamental part of the society. They are considered as an efficient system of service that provide health and well being to the people of the society. This industry is the largest, extremely competitive, rapidly growing and emerging industry in the services sector of the world. The performance of any organization can be evaluated through the commitment of all employees of the firm. Similarly, the performance of the hospital industry depends upon the performance of its employees. The better performance of hospitals not only help them to treat their patients in a good way but it also assist them to provide their services at low cost (Humayon et al., 2018). Like many other countries, the hospital industry of Pakistan also faces the biggest challenge of measuring its performance and maintaining its reputation among people. In order to improve the performance of hospitals, Pakistan’s government has taken many steps and strive to implement the concept of Total Quality Management. The philosophy behind the concept of TQM is the art of managing and controlling the magnitude of a quality of product and services entirely. It emphasizes on stakeholders’ engagement, satisfied the needs of customers, improves the financial position of a firm and
Developing measures is perhaps the most complex aspect of quality measurement and improvement, and certainly not something that child health policy experts or advocates need to understand in depth. What is helpful to know is that there is a significant focus on developing ‘evidence-based’ quality measures that rely on rigorous clinical research to identify a structure, process, or outcome that leads to improved health or patient satisfaction. Determining which measures to develop can also be based on a combination of available evidence and expert opinion, particularly when it relates to emerging innovations in healthcare. When a possible measure is identified, it is common to bring together a broad cross-sector of groups – from researchers, government agencies and advocacy organizations to industry interests and professional associations – to assess the body of evidence on a particular treatment or protocol that shows promising results. Once the group agrees to pursue a measure, they work together to reach consensus on the best measurement approach, develop the specifications for the measure, and test the measure.
One potential explanation for this pattern is facility bias, or the assumption by women that they received qualitycare due to the fact that they delivered in a health facility [10, 13]. For example, more careful prob- ing of some indicators of care, such as whether an injec- tion or IV medication was received before birth (i.e., uterotonic for induction or augmentation of labor), or following delivery (i.e., uterotonic for prevention of post- partum hemorrhage) suggests that women did not know the specific indication for the care received, just that an intervention occurred. Validation results for the utero- tonic indicators may reflect more general knowledge women had about having an IV line set, which was standard hospital practice for all women entering the labor and delivery ward, rather than knowledge of which medication was given or why. For example, neither an indicator of whether “an injection or IV medication was received to speed up labor” (i.e., uterotonic induction of labor) or whether “ an injection or IV medication was re- ceived to strengthen labor” (i.e., uterotonic for augmen- tation of labor) met both validation criteria, while a general indicator of receiving an injection or IV medica- tion at some time before the birth of the baby did. Simi- larly, most women correctly reported receipt of a uterotonic within the first few minutes after delivery of the baby, but also falsely reported the receipt of a utero- tonic within the first few minutes after the delivery of
Third, over time and across countries, there are sizable differences in migration patterns, the quality of medical schools, and the attractiveness of practicing medicine in the United States. For U.S. citizens, there have been differences in the motivation to go abroad for medical education and in the quality of the schools attended. We addressed these issues by adjusting our results for time since graduation from medical school. Nonetheless, these are complex forces, and fail- ure to capture them completely creates the po- tential for unknown biases. Future research should more directly address these issues, espe- cially those related to medical school character- istics.
crowded location, and the LTC-CI identifies the activity room as such. People in the dining room are more evenly spaced by virtue of furniture placement, whereas in the activity room, people are more likely to be bunched together within a large space by virtue of their involvement in a common activity. From the vantage point of an individual, this may feel more crowded, even if not unpleasantly so. Even at the low end of crowding, in private and personal spaces, the shower/bath has the highest LTC-CI, but the lowest people count, consistent with the necessary proximity of care providers in these intimate spaces. Consequently, it seems that the LTC-CI is likely to be more sensitive than people counts when evaluating the effects of crowding on the behavior of elders—particularly those with dementia—in long-term care settings.
has recently reported on the state of patient safety in NHS trusts. While offering an encouraging prognosis, this is far from a clean bill of health. The report states that ‘‘The safety culture within trusts is improving … However, trusts are still predominantly reactive in response to patient safety issues and parts of some organisations still operate a blame culture’’ (page 2). Measuring safety climate in healthcare helps to diagnose the underlying safety culture of an organisation or work unit. The prevailing culture influences safety behaviours and outcomes for both health- care workers and patients. Safety climate questionnaires need to achieve as high a standard of measurement as possible so that healthcare managers can use the resulting data to design effective safety management systems and interventions.
Controversy exists among the studies that have examined the impact of interpreter services on visit duration. Certain studies suggest that visits in which interpreters are used are of longer duration than visits for EP patients. In their prospective cohort of 4,146 children presenting to the ED, Hampers and McNulty (2002) found that LEP patients with professional interpreters had significantly longer visits than EP patients (with an adjusted mean differ- ence of 16 minutes). In their prospective study of 285 patients in general medi- cine and family medicine clinics, Kravitz et al. (2000) found that LEP patients who used professional interpreters or bilingual physicians had significantly longer visits than EP patients, with an adjusted mean of 12.2 additional min- utes per visit for Spanish speakers and 7.1 additional minutes per visit for Rus- sian speakers. A study by Drennan (1996) examining staff surveys at a South African psychiatric hospital each time an interpreter was used or needed but not obtained indicated that the one hospital interpreter used (whose training was unspecified) had an average length of interview of “over 30 minutes,” compared with a professional nurse and a staff nurse interpreter, whose aver- age interviews were 18 and 14 minutes, respectively. This study, however, did not perform any statistical tests of significance. In a study comparing patient self-administered bilingual questionnaires with interpreters in women pre- senting to the ED with obstetric and gynecological complaints, Nasr et al. (1993) found that the average completion time for obtaining a medical history was significantly longer in LEP patients with interpreters (mean of 14.6 min- utes) compared with LEP patients who completed the questionnaire. The interpreters included hospital interpreters, family members, or friends, with no analysis by interpreter type.
In a developing country context, given the lack of organized labor markets and the high variability of incomes over time, household consumption, or even expenditure, is generally considered to be a better measure of welfare, and ATP, than income (Technical Note 5). In principle, ATP should indicate welfare prior to payments for healthcare, and so, measurement of ATP by consumption requires an assumption, perhaps strong, that the system of health payments does not affect saving decisions. Household consumption net of expenditures assumed non-discretionary, such as those on food, is often used as a measure of welfare . In relation to the assessment of progressivity, such a measure of ATP is can be problematic, depending upon the objective, if the non-discretionary expenditures are, in fact, sensitive to the system of health finance. For example, the relative tax rate imposed on food would be expected to influence, differentially, household decisions with respect to food spending. Then, the distribution of household consumption net of food expenditure is itself a product of the health finance system and does not provide a benchmark against which to assess the distributional impact of that system. But if the objective is simply to assess the degree of proportionality between health payments and some measure of living standards, then household expenditures gross or net of those on food can be used, as preferred.
Countries applying this rather easy and straightforward screener approach must be aware of the high risk of generating an overestimated, yet imprecise, rate of disability and of its consequences for policy making. The example of Brazil is instructive. In its 2010 census, Brazil included the WG-6 for the first time with the result that an impressive disability rate of 23.9% was estimated, i.e., 45.6 million people were classified as disabled . In the 2000 census, the disability rate had been 14.5%. In 2010, the highest prevalence of disability was seen, with 18.8% of the population claiming vision difficulties, probably because a large proportion of the population in Brazil had no access to an essential assistive device: glasses. As we demonstrate in the present work, however, persons with important difficulties in seeing are expected to have mild to moderate levels of disability, and in the case of Brazil, many might require only a simple public health intervention, such as the provision of glasses. The appropriateness of such high and not further differentiated disability rates can, therefore, be questioned in light of its consequences for intervention planning, policy making and the allocation of health and social resources to meet the needs of persons with different levels of disability.
A third category of literature, however, indicates that quality of care experiences may differ between insured and uninsured patients in the same health facility, depend- ing on the nature of the service provided or the attitude of the service provider. In the Nouna District in Burkina Faso, objective quality of care evaluations by Robyn (PJ), Sauerborn (R) and Bärnighausen (T)  showed that providers were less likely to weigh, take the temperature, perform a physical examination, use a stethoscope, and in- form patients about the diagnosis of their illness, when the patients were enrolled in the community-based insur- ance (CBI). In contrast, CBI enrolment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential socio-demographic characteristics such as patient socio-demographic status, illness symptoms, history of illness and characteristics of care received. The authors, however, found that there was no difference between the enrolled and non-enrolled respondents about the availability of medicines. This study seems to be the opposite to Jehu-Appiah (C), Aryeetey (G), Agyepong (I), Spaan € and Baltussen (R)  who found that both insured and uninsured households had positive perceptions with regards to the technical (object- ive) quality of care, but were negative about providers’ atti- tudes (interpersonal quality of care). The attitude of staff towards insured patients also differs, even in the same health facility. In India, a focus group discussion with staff at ASHWINI hospital found that whereas some patients complain that the nurses in the hospital reproach them for ‘being uninsured’ , some of the staff rather considered the insured patients as a nuisance .