Academic literature on the topic 'Zimbabwe. Department of Research and Specialist Services'

A collection of facts about a patient’s life and health history of past and present illnesses and treatments is known as medical records. The health professionals were contributing to record the patient’s care. The responsibility in managing daily records that produced by each of department is by the Medical Records Department. It is a department under clinical support services with activities including managing of patient records, patient information production, management of medical reports, and hospital statistics. This article aims to discuss the challenge associated with managing medical records in the organization and how to handle and manage it with the records management as a tool to mitigate risk. Therefore, it is likely to prompt further research by addressing existing gaps towards improving service delivery that can contribute to the body of knowledge in the field of records management and archives generally.

This paper describes the psychiatric consultation-liaison services provided to an Obstetrics and Gynecology Department. Clinical services are provided both by program consultation and by individual inpatient and outpatient referral. Clinical problems in obstetrics and gynecology that result in psychiatric referral are discussed. Research interests which play an important role in the program are described. Educational activities are directed toward ward and clinic staff, undergraduate medical students, residents and the practising specialist. The combination of well articulated consumer requests, interested gynecologists and obstetricians, broadened gynecology residency training objectives, and greater involvement of consultation-liaison psychiatrists suggests a promising future for psychosomatic obstetrics and gynecology.

This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘bottom-up’ local processes as well as ‘top-down’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.

SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).

6614 Background: More patients are experiencing aggressive end-of-life (EOL) care. This is concerning as aggressive EOL care, on a population level, is associated with poor quality care. Specialist palliative care (PC) has been shown to help relieve EOL symptoms, improve patient quality of life, and reduce aggressive EOL care. This study aimed to estimate the impact of the timing of specialist PC, specifically PC delivered at least 3 months prior to death, on a colorectal cancer (CRC) patient’s risk experiencing aggressive care in the last 30 days of life. Methods: A population-based retrospective cohort study of adult patients who died from CRC in Alberta, Canada from 2011-2015. The Alberta Cancer Registry was used to identify the cohort, which was linked to healthcare resource use data in local, provincial, and national databases. Individuals who died < 30 days from CRC diagnosis were excluded. Patients who accessed any of the provinces specialist PC services were deemed exposed to specialist PC (includes PC consult team, intensive PC unit, palliative home care, hospice). Aggressive EOL care was defined as having experienced at least one of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any treatment in the last 14 days of life). Logistic regression was used to model factors (specialist PC timing and clinical characteristics) associated with aggressive EOL care. Results: The cohort comprised 2979 patients. Most patients received specialist PC before death (58%); 60% had ≥1 indicator of aggressive EOL care. Relative to patients who received specialist PC > 3 months before death, patients who received specialist PC < 3 months before death were 1.5 times more likely to experience aggressive EOL care (CI: 1.2-1.9). Patients who received no specialist PC were 2.1 times more likely to experience aggressive EOL care (CI: 1.7-2.8). Short disease duration ( < 1 year from diagnosis to death), younger age at death, living in a rural area, and male sex, were also associated with higher odds of experiencing aggressive EOL care. Conclusions: Specialist PC delivered > 3 months before death reduces a CRC patient’s risk of experiencing aggressive EOL care over PC delivered < 3 months before death.

Sex differences are well documented in chronic disease populations with cardiovascular disease and diabetes. Although recent research has suggested that asthma is more severe in older women compared to men, the extent of this difference remains poorly understood. The objective of this study was to compare rates of asthma-specific health services use (HSU) and medication use, between older women and men with asthma.This population-based cohort study included 209 054 individuals aged ≥66 years with asthma from health administrative data in Ontario, Canada. The primary exposure was sex. Outcomes included asthma-specific HSU (spirometry, emergency department (ED), hospitalisation, physician office and specialist visits) and medication use (asthma controller and reliever prescriptions). Negative binomial regression models adjusted for age, socioeconomic status and comorbidities were used to ascertain outcomes by sex from 2010 to 2016.Compared to men, women had lower rates of spirometry (adjusted relative rate (ARR) 0.87, 95% CI 0.85–0.89) and specialist visits for asthma (ARR 0.93, 95% CI 0.90–0.96), but higher rates of asthma-specific ED (ARR 1.43, 95% CI 1.33–1.53) and physician office visits (ARR 1.03, 95% CI 1.01–1.05). Women also had lower asthma controller (ARR 0.98, 95% CI 0.97–0.99) but higher asthma reliever (ARR 1.03, 95% CI 1.02–1.05) prescription fill rates, compared to men.These findings may indicate poorer disease control, greater asthma severity and poorer access to specialist asthma care in women.

During the mid to late 1990’s a cluster of Livestock Production Programme (LPP) projects, funded by the Department for International Development (DFID) was established in Zimbabwe, as a representative country of southern sub-Saharan Africa, to develop outputs to increase the livestock contribution to the alleviation of poverty. All stakeholders were involved with the projects from the planning stage and participatory on-farm research was a key feature. Several of the projects addressed one of the major constraints to livestock production in arid and semi-arid areas, dry season feeding, the animal species considered being poultry, donkeys (draught power), goats and milking cows. The benefits of these projects can only be realised through effective dissemination to relevant target groups (farmers, extension staff, which because of failing government extension services in several African countries, must include NGOs, churches and local organizations, and policy makers) and development of relevant training materials.

Background NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’. Objectives The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness. Design This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics. Methods A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision. Results Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time. Limitations Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time. Conclusions Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care. Future work Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.

Healthcare professionals (HCPs) in all healthcare facilities including public hospitals in Malaysia need to cooperate to meet the diverse healthcare demands. To date, there has yet detailed research on this collaboration in Malaysia. This study aimed to explore interdisciplinary collaboration in the Medical Department (wards and clinics) of a state hospital. Four focus group discussions (FGDs) were held. A medical specialist, medical officer, nurse manager/charge nurse, staff nurse, senior and junior clinical pharmacists were all present at each FGD. Purposive sampling was used to recruit participants (nomination by heads of department). FGDs were performed in English, but responses in Malay were accepted and translated into English. All FGDs were audio-recorded, transcribed, and analysed thematically. In the theme of role clarity, most participants opined that the doctors led in patient management, while the nurses were in charge of monitoring, ambulating and drug administration. However, some participants were unfamiliar with the role of pharmacists. The majority believed that effective collaboration did exist, but insufficient. Weak communication skills, lack of communication, personnel and time were obstacles to effective collaboration. Regular discussions between different disciplines can encourage interprofessional collaboration. Despite doctors acknowledging pharmacists' Medication Therapy Adherence Clinic (MTAC) services, and nurses' human immunodeficiency virus (HIV) counselling and diabetic education services, some nurses and pharmacists were unaware of each other's services. To avoid conflicting tasks and human resource wastage, each HCP's services should be actively promoted among other HCPs.

An innovative, collaborative model implemented by a UK ambulance service allows patients presenting with a mental health condition to be promptly assisted by a specialist team comprising a paramedic, mental health nurse and police officer. Initial evidence suggests that greater collaboration between emergency services and mental health trusts benefits patients and services: leading to timely assessments, reductions in patient distress levels, and decreasing emergency department overcrowding while providing substantial savings for the NHS. This article explores existing care pathways for patients experiencing acute mental health crisis. Current research from the UK is discussed, and compared with working practices of paramedics internationally. Through reflection of a case study, common difficulties faced in paramedic practice are identified. A multi-agency response to ensure the right care is provided in the right place at the right time is proposed.