The Switch From Trivalent to Bivalent Oral Poliovirus Vaccine in the South-East Asia Region.

This analysis describes an innovative and successful approach to risk identification and mitigation in relation to the switch from trivalent to bivalent oral polio vaccine (OPV) in the 11 countries of the World Health Organization's (WHO's) South-East Asia Region (SEAR) in April 2016.The strong commitment of governments and immunization professionals to polio eradication and an exemplary partnership between the WHO, United Nations Children's Fund (UNICEF), and other partners and stakeholders in the region and globally were significant contributors to the success of the OPV switch in the SEAR. Robust national switch plans were developed and country-specific innovations were planned and implemented by the country teams. Close monitoring and tracking of the activities and milestones through dashboards and review meetings were undertaken at the regional level to ensure that implementation time lines were met, barriers identified, and solutions for overcoming challenges were discussed and implemented.The SEAR was the first WHO Region globally to complete the switch and declare the successful withdrawal of trivalent OPV from all countries on 17 May 2016.A number of activities implemented during the switch process are likely to contribute positively to existing immunization practices and to similar initiatives in the future. These activities include better vaccine supply chain management, improved mechanisms for disposal of vaccination-related waste materials, and a closer collaboration with drug regulators, vaccine manufacturers, and the private sector for immunization-related initiatives.

Improving humanitarian health responses for children through nurturing care.

Children are disproportionately impacted by humanitarian disasters, which cause toxic stress. When a crisis overwhelms the capacity of health and social systems to meet the needs of a population, external crisis response teams working in a range of sectors may offer support to save lives and meet the affected populations' basic needs. Gaps have been identified in health sector interventions for children in humanitarian contexts, including lack of routine interventions to protect and promote early child development (ECD). To address this gap and improve the quality of humanitarian responses for girls and boys, the Global Health Cluster, Child Health Task Force, and the Inter-Agency Network for Education in Emergencies held a webinar series on Strengthening Nurturing Care in Humanitarian Response. It concluded that incorporating interventions to support nurturing care for ECD into health responses in acute phase emergencies is lifesaving. In crisis contexts, even simple interventions can be the difference between life and death, and when systematically applied, they can dramatically improve a child's life opportunities as well as national recovery and economic growth.

What has change management in industry got to do with improving patient safety?

BACKGROUND: Healthcare is often in a constant state of change - for political, technological, patient related, and scientific reasons. Yet, for a business where change is the norm, too little time is spent thinking theoretically about how change occurs. One area where change is still needed is in patient safety. METHODS: Presented is an analysis of the literature on change to suggest how this may inform patient safety. RESULTS: No one change approach guarantees success in patient safety. Success very much depends on selecting the best fit change framework and adapting it to local context. Well regarded change models, like that of Kotter, are not well tested within a healthcare context. Those that are, such as Pettigrew, do not specifically address all the issues associated with patient safety. Kotter's phases of change may be applied in a healthcare context to enhance patient safety. CONCLUSION: Kotter's model is well studied in non-healthcare contexts and has potential to be adapted for improving patient safety.

Republished paper: The quest to eliminate intrathecal vincristine errors: a 40-year journey.

BACKGROUND: Intrathecal administration of vincristine is a rare event but catastrophic for the patient, family and clinical team involved. Analysis of this source of harm shows it to be a classic systems error which has proved intractable for nearly 40 years. Failure to learn from history, communicate safety solutions nationally and internationally, create safety agencies which effectively and reliably prevent adverse events, conduct investigations and enquiries which fully reveals how to mitigate system error, develop robust physical design solutions to prevent harm to patients, make effective solutions universal and preparing for the unexpected are all major challenges. CONCLUSIONS: The elimination of rare yet catastrophic errors like this remains one of the tests of whether we can make healthcare safer. In this paper, we discuss why effective learning has been so slow and illustrate lessons for other fields of patient safety.

A multi-center survey on the postpartum mental health of mothers and attachment to their neonates during COVID-19 in Hubei Province of China.

BACKGROUND: There is an emerging literature on the mental health of both pre- and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: As of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days). RESULTS: The period of mother-child separation among the confirmed group (33.9±20.9 days) was significantly longer than that of suspected group (16.7±12.2 days) and control group (10.7±8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5±4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5±4.7) and control (48.8±4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman's ρ =-0.33, 95% CI: -0.095 to -0.538, P=0.005; Subscale score of attachment: Spearman's ρ =-0.40, 95% CI: -0.163 to -0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups. CONCLUSIONS: Decreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.

Digital Approaches to Music-Making for People With Dementia in Response to the COVID-19 Pandemic: Current Practice and Recommendations.

Before COVID-19, dementia singing groups and choirs flourished, providing activity, cognitive stimulation, and social support for thousands of people with dementia in the UK. Interactive music provides one of the most effective psychosocial interventions for people with dementia; it can allay agitation and promote wellbeing. Since COVID-19 has halted the delivery of in-person musical activities, it is important for the welfare of people with dementia and their carers to investigate what alternatives to live music making exist, how these alternatives are delivered and how their accessibility can be expanded. This community case study examines recent practice in online music-making in response to COVID-19 restrictions for people with dementia and their supporters, focusing on a UK context. It documents current opportunities for digital music making, and assesses the barriers and facilitators to their delivery and accessibility. Online searches of video streaming sites and social media documented what music activities were available. Expert practitioners and providers collaborated on this study and supplied input about the sessions they had been delivering, the technological challenges and solutions they had found, and the responses of the participants. Recommendations for best practice were developed and refined in consultation with these collaborators. Over 50 examples of online music activities were identified. In addition to the challenges of digital inclusion and accessibility for some older people, delivering live music online has unique challenges due to audio latency and sound quality. It is necessary to adapt the session to the technology's limitations rather than expect to overcome these challenges. The recommendations highlight the importance of accessibility, digital safety and wellbeing of participants. They also suggest ways to optimize the quality of their musical experience. The pandemic has prompted innovative approaches to deliver activities and interventions in a digital format, and people with dementia and their carers have adapted rapidly. While online music is meeting a clear current need for social connection and cognitive stimulation, it also offers some advantages which remain relevant after COVID-19 restrictions are relaxed. The recommendations of this study are intended to be useful to musicians, dementia care practitioners, and researchers during the pandemic and beyond.

What have we learned about interventions to reduce medical errors?

Medical errors and adverse events are now recognized as major threats to both individual and public health worldwide. This review provides a broad perspective on major effective, established, or promising strategies to reduce medical errors and harm. Initiatives to improve safety can be conceptualized as a "safety onion" with layers of protection, depending on their degree of remove from the patient. Interventions discussed include those applied at the levels of the patient (patient engagement and disclosure), the caregiver (education, teamwork, and checklists), the local workplace (culture and workplace changes), and the system (information technology and incident reporting systems). Promising interventions include forcing functions, computerized prescriber order entry with decision support, checklists, standardized handoffs and simulation training. Many of the interventions described still lack strong evidence of benefit, but this should not hold back implementation. Rather, it should spur innovation accompanied by evaluation and publication to share the results.

What could cognitive capital mean for China's children?

Cognitive capital is an emerging paradigm that captures the criticality of investing in children whilst neural proliferation and development of brain architecture are at their peak. Distinct from financial capital, cognitive capital represents investment in future human potential from interventions in nutrition, health, education, child protection, and social welfare systems that optimize brain development. The return on investment is significant given the plasticity of the developing brain in response to positive stimuli. Investment in brain development results in improved health and well-being, educational outcomes, skills, employment, and quality of life. The inverse is also true. Negative stimuli lead to depreciating cognitive capital, poorer mental and physical health and educational outcomes, and decreased life chances. Cognitive capital could be an organizing framework for China's next phase of development to ensure the building of a prosperous society. Through significant commitment from the government, China has seen remarkable improvements in under-five mortality, literacy rates, access to basic education, life expectancy, and gross domestic product in the past few decades as the result of an expansion of publicly funded social services. Yet, inequities remain within and across communities and regions. In 2015, China had a country ranking of 97 for gross national income per capita, highlighting remaining challenges across the whole population. Cognitive capital relies on a package of forward-looking policies that lead to equitable, efficient, and effective use of existing and future resources. This is consistent with the United Nations Convention on the Rights of the Child. Investments in interventions that maximize optimal brain development in children, realize children's rights, and contribute to future economic growth, defined as "cognitive capital," represent a significant opportunity for improving children's lives, nation-building, and future economic growth in China.

Small bowel obstruction secondary to intestinal schistosomiasis.

Intestinal obstruction caused by chronic schistosomiasis infection is rare, with only 12 previously recorded cases in the literature. We report the first recorded case presenting to a European hospital. A 36-year-old Caucasian man, who was born and lived in the UK, presented with small bowel obstruction. He had visited China and Indonesia 8 years previously. At laparotomy, there was an obstructing inflammatory mass close to the ileocaecal junction and several small bowel strictures. Initially he was thought to have Crohn's disease. However, subsequent histology diagnosed intestinal schistosomiasis.

Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children.

Universal health coverage generates significant health and economic benefits and enables governments to reduce inequity. Where universal health coverage has been implemented well, it can contribute to nation-building. This analysis reviews evidence from Asia and Pacific drawing out determinants of successful systems and barriers to progress with a focus on women and children. Access to healthcare is important for women and children and contributes to early childhood development. Universal health coverage is a political process from the start, and public financing is critical and directly related to more equitable health systems. Closing primary healthcare gaps should be the foundation of universal health coverage reforms. Recommendations for policy for national governments to improve universal health coverage are identified, including countries spending < 3% of gross domestic product in public expenditure on health committing to increasing funding by at least 0.3%/year to reach a minimum expenditure threshold of 3%.

A landscape analysis of universal health coverage for mothers and children in South Asia.

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest.

Improving population health one person at a time? Accountable care organisations: perceptions of population health--a qualitative interview study.

OBJECTIVE: This qualitative interview study explored perceptions of the phrases 'population health', 'public health' and 'community health'. SETTING: Accountable care organisations (ACOs), and public health or similar agencies in different parts of the USA. PARTICIPANTS: Purposive sample of 29 interviewees at four ACOs, and 10 interviewees at six public health or similar agencies. RESULTS: Interviewees working for ACOs most often viewed 'population health' as referring to a defined group of their organisation's patients, though a few applied the phrase to people living in a geographical area. In contrast, interviewees working for public health agencies were more likely to consider 'population health' from a geographical perspective. CONCLUSIONS: Conflating geographical population health with the health of ACOs' patients may divert attention and resources away from organisations that use non-medical means to improve the health of geographical populations. As ACOs battle to control costs of their population of patients, it would be more accurate to consider using a more specific phrase, such as 'population of attributed patients', to refer to ACOs' efforts to care for the health of their defined group of patients.

Accountable care organizations and clinical commissioning groups face an uncertain challenge for improving public health.

UNLABELLED: Accountable Care Organizations (ACOs) in the United States of America (USA) and Clinical Commissioning Groups (CCGs) in the United Kingdom (UK) are newly proposed cross-organisational structures in health services both tasked with a role which includes improving public health. Although there are very significant differences between the UK and USA health systems, there appears to be some similar confusion as to how ACOs and CCGs will regard and address public or population health. This short perspective article gives an overview of ACOs in the USA and CCGs in the UK, with the underlying context of possible public health functions. It concludes by considering the challenges facing both countries and highlighting the opportunity for shared learning. ACKNOWLEDGMENTS: this article was based on a research proposal prepared for the Commonwealth Fund's Harkness Fellowship in Health Care Policy and Practice 2012/2013.