Accounting for the transition from inpatient to outpatient surgery

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.     

Working children: the health and safety issue

Recent evidence has emerged that in Britain, like the US, many children below the official minimum school leaving age, are working. In many cases, the work is illegal. Research in the US suggests that many working children risk accidents and other hazards to health. Evidence from Britain on the health and safety aspects of child labour is of a more fragmentary nature, but enough exists to suggest a need for greater vigilance.     

Evaluating school and parent reports of the national student achievement testing system (SIMCE) in Chile: Access,comprehension, and use

This evaluation examined school and parent reports of the national student achievement testing system (SIMCE) in Chile regarding three dimensions: access, comprehension, and use. We conducted phone surveys with a representative sample of directors (N = 375), teachers (N = 1145) and parents (N = 625), and we collected more in-depth data through interviews and focus groups in 16 of these schools. The results indicate that access to the reports is not an obstacle to use for school actors, but it is for parents. While summative ratings of the reports in terms of their clarity and utility were generally very positive, the actual recall and interpretation of even basic information (assessed through case scenarios) was incorrect for a majority of teachers and parents, and reported uses of the information were both intended and unintended in nature. We also found some statistically significant differences regarding comprehension and use among subgroups of our sample. Our findings are especially relevant given the expectations attached to the use of the reports for school improvement on the one hand, and parents’ behavior as critical consumers of education on the other hand.     

The performance of model averaged tail area confidence intervals

We investigate the exact coverage and expected length properties of the model averaged tail area (MATA) confidence interval proposed by Turek and Fletcher, CSDA, 2012, in the context of two nested, normal linear regression models. The simpler model is obtained by applying a single linear constraint on the regression parameter vector of the full model. For given length of response vector and nominal coverage of the MATA confidence interval, we consider all possible models of this type and all possible true parameter values, together with a wide class of design matrices and parameters of interest. Our results show that, while not ideal, MATA confidence intervals perform surprisingly well in our regression scenario, provided that we use the minimum weight within the class of weights that we consider on the simpler model.     

Prevalence of and risk factors associated with cesarean section in Lebanon — A retrospective study based on a sample of 29,270 women

Background

During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues.

Evaluation of a personal safety program with Latino preschoolers

This study evaluated a personal safety educational program designed for Latino families attending preschools in a large metropolis. Seventy-eight children who participated in the Kids Learning About Safety program were compared to 45 control children. Compared with controls, participating children demonstrated enhanced ability to recognize inappropriate touches, learned correct genital terminology, were able to recognize the inappropriateness of touch requests made by "good" people, demonstrated higher levels of personal safety skills, and learned general safety rules. Gains in knowledge were maintained at three-month follow-up testing for all content areas except genital terminology. Although feedback provided by participating families was positive, recruiting participants and maintaining attendance at sessions was difficult. Discussion includes recommendations for future research and engagement of this population.     

Care without coercion – mental health rights,personal recovery and trauma‐informed care

Australian mental health services continue to use involuntary measures in response to consumers' mental distress. Regardless of the intent behind these practices, the experience of being forced to receive treatment, be secluded or restrained is traumatic and can cause further distress and harm. Other parts of the health or social service system have shifted to approaches that emphasise agency, social context, prevention, and rights. Three frameworks currently used in mental health services – human rights, personal recovery, and trauma‐informed – are consistent with a shift away from the use of force. We applied these frameworks to the text of the National Standards for Mental Health Services 2010 to analyse the degree to which it reflects a shift. We also analysed the public text of speakers' notes from the Care Without Coercion Conference 2012 concerning lived experiences of force in mental health services. The analysis highlights force in many aspects of policy. The findings have implications for directions of change, including freedom from violence; support for decision making; access and choice about community and inpatient options; safety and risk management; and greater understanding of current policy frameworks through engagement with people with lived experience about the options and impact of support processes that exclude the use of force.     

THE RATE OF CONVERGENCE IN THE NORMAL APPROXIMATION FOR THE WILCOXON R-ESTIMATOR

We exploit the fact that the Wilcoxon score R-estimator of the slope in a linear regression model minimises Gini's mean difference of the residuals to obtain a Berry-Esseen rate of convergence result for the Wilcoxon R-estimator.