Interoperability and HealthGRID.

OBJECTIVES: GRID technology, with initiatives like the GGF, will have the potential to allow both competition and interoperability not only among applications and toolkits, but also among implementations of key services. The pyramid of eHealth interoperability should be achieved from standards in communication and data security, storage and processing, to the policy initiatives, including organizational protocols, financing procedures, and legal framework. The open challenges for GRID use in clinical fields illustrate the potential of the combination of grid technologies with medical routine into a wider interoperable framework. METHODS: The Telemedicine Alliance is a consortium (ESA, WHO and ITU), initiated in 2002, in building a vision for the provision of eHealth to European citizens by 2010. After a survey with more that 50 interviews of experts, interoperability was identified as the main showstopper to eHealth implementation. RESULTS: There are already several groups and organizations contributing to standardization. TM-Alliance is supporting the "e-Health Standardization Coordination Group" (eHSCG). CONCLUSIONS: It is now, in the design and development phase of GRID technology in Health, the right moment to act with the aim of achieving an interoperable and open framework. The Health area should benefit from the initiatives started at the GGF in terms of global architecture and services definitions, as well as from the security and other web services applications developed under the Internet umbrella. There is a risk that existing important results of the standardization efforts in this area are not taken up simply because they are not always known.

Standards for health promotion in hospitals: development and pilot test in nine European countries.

PURPOSE: To describe the process of development of standards for health promotion in hospitals, including pilot study, method and results. DESIGN/METHODOLOGY/APPROACH: A set of standards for health promotion in hospitals was developed by a task force of the International Network of Health Promoting Hospitals, following the recommendations of the ALPHA programme. The standards were pilot tested and assessed qualitatively and quantitatively in 36 hospitals in nine European countries. Subsequently, standards were reviewed by representatives from the piloting hospitals. A self-assessment tool was produced to evaluate whether hospital managers and professionals perceive the standards to be relevant and applicable and whether they are currently met. Participants provided comments from their national health system perspective and rated the standards. FINDINGS: General comments and specific comments were provided for each standard regarding its relevance, applicability and current level of compliance. A total of 35 standards' criteria were assessed and 86 per cent (30/35) were rated > 80 per cent relevant and applicable, while 14 per cent (5/35) were rated > 60 per cent relevant. The degree of current fulfilment of the criteria, however, was low. RESEARCH LIMITATIONS/IMPLICATIONS: While the standards should be applicable to other regions (South America, Africa, Asia) additional testing may be required to adapt them to prevailing health care challenges. PRACTICAL IMPLICATIONS: The pilot test revealed that the standards are applicable and were considered relevant, and showed that current compliance is low. It also showed that there is a clear need to facilitate continuous monitoring and improvement of compliance. The standards are regarded as being public domain, are applicable to other organisations and can be incorporated into existing quality systems. ORIGINALITY/VALUE: Standards are a common tool for quality assurance in health care, but so far have considered health promotion activities only partly, if at all. The standards for health promotion in hospitals developed by WHO fill this important gap.

What are we doing in cardiopulmonary resuscitation training in Europe? An analysis of a survey.

This study has analysed the status of cardiopulmonary resuscitation (CPR) training in Europe in medical schools, cities in the WHO European Healthy Cities network, and hospitals in the WHO European Health Promoting Hospitals network. Three questionnaires tested by a pilot study were sent in 1996-1997: one to medical school deans, one to the WHO Health Promoting Hospitals Network coordinators and one to the focal points of the WHO Healthy Cities Network. The glossary of terms was taken from the Utstein style guidelines. The 392 medical schools returned 168 questionnaires (43%): 167 teach CPR, 165 basic CPR, 136 advanced CPR and 114 both. The 310 hospitals returned 224 questionnaires and 202 were analysed (65%); 154 train physicians, 184 nurses and 110 nursing students. The 509 cities returned 67 questionnaires (13%); 28 train police officers and 36 fire fighters. A total of 120 institutions train paramedics and 82 lay people. The training hours in basic and advanced CPR vary between medical schools and various professional groups trained in hospitals and cities. More time is devoted to training in advanced CPR than in basic CPR and more in theory than practical training. This survey can be an important incentive for European Organisations to identify priorities in their educational efforts.

Medical education in the light of the World Health Organization Health for All strategy and the European Union.

Most governments and health professionals clearly recognize that the education of professionals must be adapted to practice in order to meet the needs of the population and of health systems. The role of medical schools, in a world where specialization is becoming a requirement to practice and is highly regulated, needs to be redefined. Medical schools need to transform their specialist training into a community-oriented, generalist education. In this light, the article analyses the European Union directives on medical education, and the recommendations of the World Health Organization (to meet the challenges of the Health for All Policy) and the World Federation for Medical Education. All are designed to reorient medical education to meet the health needs of the population, to reduce health costs, to ensure quality and to permit the free movement of sufficiently qualified health professionals.

Integrated care: a position paper of the WHO European Office for Integrated Health Care Services.

The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote health and improve management and patient satisfaction by working for quality, accessibility, cost-effectiveness and participation. This position paper outlines the need for Integrated Care from a European perspective, provides a theoretical framework for the meaning of Integrated Care and its strategies and summarizes the programmes of the office that will support countries in the WHO European Region to improve health services.

Teaching critical care in Europe: analysis of a survey.

OBJECTIVE: To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe. DATA SOURCES: Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals in each western country of the European Region of the World Health Organization and to the people responsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionnaires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article. RESULTS: Postgraduate and undergraduate training differ widely in terms of the content of, and disciplines in charge of, the teaching of critical care. Even countries of the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic discipline of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been established in many countries. The topics in medical schools that correspond to critical care medicine do not encompass a distinct body of knowledge and are distributed among more traditional disciplines, most frequently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely between and within countries. The repetition of critical care conditions for which patients receive critical care in several disciplines, as described by the responses, leads us to wonder whether these conditions are really included in the curriculum. CONCLUSIONS: The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.

[Relevancy of the clinical subjects in medical training]. / La pertinencia de las asignaturas clínicas en la formación del médico.

A judgment of the relevance of twelve clinical science courses for preparing the students to the practice of medicine and to the development of the scientific mind, was tested by the Pair Comparison and Equal-Appearing Interval methods. The test groups consisted of medical school faculty members, medical students and physicians. Three groups of clinical sciences, according its relevancy for preparing the students for a career as physicians, were identified Internal Medicine, Pediatrics, Surgery and Public Health, comprised the group of maximum relevancy; History of Medicine, Medicolegal and Radiological studies, formed a group of lowest relevancy. The remainder sciences (Ophthalmology, Obstetrics and Gynecology, Otorhinolaryngology, Dermatology and Psychiatry, formed a middle group. Few differences were found when we considered the relevancy to the development of the scientific mind.