Evaluating the collection, comparability and findings of six global surgery indicators.

BACKGROUND: In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. METHODS: Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. RESULTS: Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916-2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. CONCLUSION: Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

Medical specialists in Papua New Guinea, 1989: the planned use of doctors and allied health workers.

In 1979 there were 260 doctors, including 60 fully-qualified specialists working in Papua New Guinea, but the results of a nationwide survey indicated that 420 doctors, including 105 specialists, would be required by 1988. This does not appear to be feasible given projected manpower and financial constraints. An alternative plan is being implemented which aims to provide 88 specialist doctors. Other features of the plan include: increasing the number of allied health workers trained by specialist doctors; increasing the number of specialists in general practice; distributing more equitably specialist manpower between base hospitals and provincial hospitals; and continuing to implement the localization policy.

The current status of senior house officer postgraduate education in a single region.

OBJECTIVE: To assess postgraduate education (PGE) for paediatric senior house officers (SHOs) in a single region. METHODS: A survey of all paediatric SHOs in the region was undertaken in the form of a questionnaire and telephone contact. The standard set by the Committee of Postgraduate Medical Deans for SHO education formed the basis for the questionnaire; there should be (i) a designated educational supervisor for each SHO, (ii) regular work appraisal and counselling and (iii) 4 h protected teaching per week. Supplementary questions were asked regarding methods of teaching and study leave. RESULTS: There was a 92% response rate from SHOs and 90% of SHOs contacted had a named educational supervisor. The mean time for protected teaching per week was 2.14 h, although this varied widely between centres. There were many different teaching methods used and 82% of SHOs had no difficulty in obtaining study leave. There was a particular problem for those who were working shifts or cross-covering. CONCLUSIONS: Our study has shown that paediatric SHOs in Wales are reasonably satisfied with their postgraduate education, although there is considerable variation between different units. Several areas have been highlighted which need to be improved if we are to provide SHOs with adequate preparation for the specialist registrar training grade.

Drug information network in the United Kingdom National Health Service.

The drug information network is the United Kingdom National Health Service (NHS) is described. The NHS was reorganized in 1974 resulting in the creation of 14 regions, which were further divided into areas. Drug information services provided within the regions and coordination between regions have evolved into a decentralized national drug information network. In this network, regional centers provide support to their area centers; difficult questions received by area centers may be referred to the regional center. Additionally, some regional centers have become specialized in particular fields. All regional centers have access to data held by other regional centers. Activity is further coordinated by a literature abstracting service in which each regional center has certain responsibilities; a code of practice for drug information pharmacists; production of specialty bulletins; and standardized education and training. Future plans for expanded services are described.