[Reevaluation criteria for health care capacity allocation according to current legislation in Hungary]. / Az egészségügyi kapacitásfelosztás módosításának szempontjai a hatályos törvény alapján.

Act CXXXII of the year 2006 - amended several times - on the development of the health care system requires that health insurance authorities should regularly review utilization of the contracted capacity of professional medical care providers, and the need for change of capacities. The first such analysis should be carried out in 2013, according to the current laws in Hungary. The law lists 16 items, which are the basis for evaluation of the performance of providers. Among them some items are difficult to analyse specifically even for health insurance specialists. This study aims to review aspects of the reevaluation process and their associated concepts. Author wants to provide help for setting up the analysis in practice by going through and analysing the requirements of the law in detail.

Legal responsibility and accountability.

Shifting boundaries in healthcare roles have led to anxiety among some nurses about their legal responsibilities and accountabilities. This is partly because of a lack of education about legal principles that underpin healthcare delivery. This article explains the law in terms of standards of care, duty of care, vicarious liability and indemnity insurance.

Regulation on introducing process of the highly difficult new medical technologies: A survey on the current status of practice guidelines in Japan and overseas.

Since serious problematic cases regarding the technical safety of technically demanding operations were reported in Japan, the Ministry of Health, Labor and Welfare issued new regulations on June 10, 2016 requiring each hospital to check the status of informed consent, skill of surgery team and governance system of the surgical unit, when the highly difficult new medical technologies were introduced to a hospital. In order to firmly establish this new system for highly difficult new medical technologies, it is very important and informative to survey the current situation for guidelines and consensus regarding introduction of medical technology with special skills in Japan and overseas. Based on the survey of questionnaires, document retrieval, and expert interviews, we found that documentation related to the introduction process of highly difficult medical technologies is very rare, and the regulations were mainly issued by academic societies. Moreover, even if such documentation existed, the quality of the regulations is poor and not sufficient enough to perform surgical practice safely. Therefore, for medical practitioners, comprehensive and concrete regulations should be issued by the government or ministry to legally follow in regard to technically demanding operations. A new practice guideline was proposed by our special research group to regulate the introduction process of highly difficult new medical technologies in hospitals in Japan. This guideline, gained understanding from relevant academic societies, provided a comprehensive view on the interpretation of "high difficulty new medical technology" prescribed by the law and show the basic idea at a preliminary examination from the viewpoints of "Surgeon's requirement", "Guidance system", "Medical safety" , and "Informed consent". These efforts will contribute to the improvement of the quality of guidelines regarding "highly difficult new medical technology".

Effect of enhanced feedback to hospitals that are part of an emerging clinical information network on uptake of revised childhood pneumonia treatment policy: study protocol for a cluster randomized trial.

BACKGROUND: The national pneumonia treatment guidelines in Kenya changed in February 2016 but such guideline changes are often characterized by prolonged delays in affecting practice. We designed an enhanced feedback intervention, delivered within an ongoing clinical network that provides a general form of feedback, aimed at improving and sustaining uptake of the revised pneumonia treatment policy. The objective was to determine whether an enhanced feedback intervention will improve correctness of classification and treatment of childhood pneumonia, compared to an existing approach to feedback, after nationwide treatment policy change and within an existing hospital network. METHODS/DESIGN: A pragmatic, cluster randomized trial conducted within a clinical network of 12 Kenyan county referral hospitals providing inpatient pediatric care to children (aged 2-59 months) with acute medical conditions between March and November 2016. The intervention comprised enhanced feedback (monthly written feedback incorporating goal setting, and action planning delivered by a senior clinical coordinator for selected pneumonia indicators) and this was compared to standard feedback (2-monthly written feedback on multiple quality of pediatric care indicators) both delivered within a clinical network promoting clinical leadership linked to mentorship and peer-to-peer support, and improved use of health information on service delivery. The 12 hospitals were randomized to receive either enhanced feedback (n = 6) or standard feedback (n = 6) delivered over a 9-month period following nationwide pneumonia treatment policy change. The primary outcome is the proportion of all admitted patients with pneumonia (fulfilling criteria for treatment with orally administered amoxicillin) who are correctly classified and treated in the first 24 h. The secondary outcome will be measured over the course of the admission as any change in treatment for pneumonia after the first 24 h. DISCUSSION: This trial protocol employs a pragmatic trial design during a period of nationwide change in treatment guidelines to address two high-priority areas within implementation research: promoting adoption of health policies and optimizing effectiveness of feedback. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02817971 . Registered retrospectively on 27 June 2016.

[Comments on the EszCsM (Ministry of Health, Welfare and Family) decree No. 60/2004. (VII. 6.) about the rules of admission of psychiatric patients to mental health facilities and the restraints applicable in their care]. / A pszichiátriai betegek intézeti felvételének es az ellátásuk során alkalmazható korlátozó intézkedéseknek a szabályairól szóló 60/2004. (VII. 6.) ESzCsM rendelet margójára.

The authors compare the human right and medical aspects of the restraints which can be used in care of psychiatric patients. They outline the legislation in force and legislative objectives which were taken into consideration when codifying the ESzCsM (Ministry of Health, Welfare and Family) decree No. 60/2004. (VII. 6.) about the rules of admission of psychiatric patients to mental health facilities and the restraints applicable in care of them. The legal problems of the admission and its connection with the restraints and with the judicial review are summed up. Aspects for interpretation are given for the regulations of the decree which supposedly can prove to be most problematic in practice. Suggestions are made for the standpoints of legislative objectives which may seem necessary in the future.

Mandatory public reporting of healthcare-associated infections in developed countries: how can developing countries follow?

The threat posed by increased transmission of drug-resistant pathogens within healthcare settings and from healthcare settings to the community is very real and alarming. Although the developed world has taken strong steps to curb this menace, there has been little pressure on developing countries to take any corrective action. If the reporting of alarming rates of healthcare-associated infections (HCAIs) from hospitals in India and many other developing countries was made mandatory, it would help to force stakeholders (e.g. healthcare workers, legislators, administrators and policy makers in hospitals) to acknowledge and tackle the problem. This would introduce quality control in a long neglected area of health care, and enable patient empowerment which is practically non-existent in India. Healthcare institutions should commit towards enforcing 'zero tolerance' towards lapses in prevention of HCAIs. Public pressure would force the Indian Government to acknowledge the problem, and to allocate more funds to improve resources and infrastructure; this could substantially elevate the standard of health care given to the average Indian. Despite the numerous challenges, overall public benchmarking of HCAIs is a commendable goal that would go a long way towards tackling this menace in developing countries such as India.

Multi-hospital analysis of antimicrobial usage and resistance trends.

We report a pilot study comparing antimicrobial usage and antimicrobial resistance trends for prominent nosocomial pathogens between 1994-1996. A convenience sample of ten hospitals participated in this retrospective review. We found a large variation in antimicrobial use and resistance trends and that many hospitals did not have data readily available to evaluate drug usage and resistance rates. A significant strong positive correlation was observed between the usage of ceftazidime and the prevalence of ceftazidime resistant Pseudomonas aeruginosa (r = 0.8, p = 0.005) and of ceftazidime resistant Enterobacter species (r = 0.8, p = 0.02). The presence of antibiotic control policies correlated with lower rates of some resistant strains and less antibiotic use. Our findings can be a useful starting point for hospitals that want to systematically measure antimicrobial use and resistance. Hospital laboratories, pharmacies, and infection control departments must work together to develop databases that will facilitate such measurements.

[Quality control in Austrian hospitals--results of evaluation]. / Qualitätssichernde Massnahmen in österreichischen Krankenanstalten. Ergebnisse einer Evaluierungsstudie.

The revision of the federal hospital act (Nov. 11, 1993; BGB1 Nr. 801/93) intends the introduction of an internal quality control as well as comparisons between different hospitals. For the application fo these constitutional requirements, the state governments had to develop laws being the basis for the hospital management to implement quality assurance. To support the introduction of a systematic quality control, the federal ministry of health published a guideline for quality assurance which was made available to all hospitals. Now, a questionnaire in all Austrian hospitals was designed to evaluate the progress and the specific ways of implementations as well as the possible need for action in the future.

[Optimizing the antibiotics policy in the Netherlands. IV. SWAB- guidelines for antimicrobial therapy of adults with sepsis in hospitals. Foundation Antibiotics Policy Work Group]. / Optimaliseren van het antibioticabeleid in Nederland. IV. SWAB-richtlijnen voor antimicrobiële therapie in het ziekenhuis bij volwassenen met sepsis.

The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotic Policy Team) issued guidelines for empirical antimicrobial therapy in the hospital of sepsis in adults. A distinction is made between sepsis in patients with and patients without neutropenia. Patients without neutropenia are subdivided according to the setting where they contracted sepsis: at home, in the hospital or in the intensive-care unit. Because of the diversity in antibiotic spectrum of the different classes of cephalosporins, they can be used in all the categories of sepsis. The use of antibiotics with a very broad spectrum, like carbapenems and piperacillin-tazobactam, or antibiotics which can be applied in infections with microorganisms difficult to treat, like quinolones and glycopeptides, is limited in the empirical treatment of sepsis in order to combat development of resistance. It is crucial to streamline antibiotic therapy as soon as the causative agent of the sepsis is known; this includes choosing an antibiotic with the narrowest possible spectrum.

[Optimizing antibiotics use policy in the Netherlands. I. The Netherlands Antibiotics Policy Foundation (SWAB)]. / Optimaliseren van het antibioticabeleid in Nederland. I. De Stichting Werkgroep Antibioticabeleid (SWAB).

The worldwide problem of antibiotic resistance of bacteria is a point of concern in the Netherlands as well. Responsible use of existing antibiotics was the incentive to establish a foundation, with the acronym SWAB, the primary goal of which is to optimize the use of antibiotics in the Netherlands in order to diminish the development of antibiotic resistance. One of the SWAB projects is the development of national guidelines for the use of antibiotics in hospitals. These guidelines are prepared by a committee of experts and reviewed by external consultants: infectious disease specialists, medical microbiologists and pharmacists. The revised version of the guidelines is submitted for publication in this journal. The SWAB hopes that these guidelines will make the prevention of antibiotic resistance a major factor in the choice of the antibiotic. Streamlining antibiotic therapy is an important tool in this respect.

[Optimization of the antibiotics policy in the Netherlands. II. SWAB guidelines for the antimicrobial therapy of pneumonia in patients at home and as nosocomial infections. The Netherlands Antibiotic Policy Foundation]. / Optimaliseren van het antibioticabeleid in Nederland. II. SWAB-richtlijnen voor antimicrobiële therapie bij thuis opgelopen pneumonie en bij nosocomiale pneumonie.

The Netherlands Antibiotic Policy Foundation issued guidelines for empirical antimicrobial therapy of adult pneumonia patients in hospitals. A distinction is made between pneumonia contracted at home or in hospital because of the differences in micro-organisms and resistance patterns. These two categories are subdivided further with an empirical antibiotic treatment being chosen on the basis of the causative agents to be expected. For instance, pneumonia contracted at home is mostly caused by Streptococcus pneumoniae, to be treated with benzylpenicillin or amoxicillin. With regard to nosocomial pneumonia, treatment varies according to whether a pneumonia has or has not been contracted in the intensive care unit. Combating development of resistance is alloted an important place. Emphasis is laid on 'streamlining' the therapy, i.e. its adjustment (including choosing an antibiotic with the narrowest possible spectrum) once the causative agent is known.

Public reporting of hospital-acquired infections is not associated with improved processes or outcomes.

Most US states have enacted or are considering legislation mandating hospitals to publicly report hospital-acquired infection (HAI) rates. We conducted a survey of infection control professionals and found that state-legislated public reporting of HAIs is not associated with perceived improvements in infection prevention program process measures or HAI rates.

Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records.

The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.