Joint programmes are an alternative model that may aid in improving congenital cardiac surgery outcomes while avoiding the potential resource and accessibility challenges that could result from regionalisation. This study aims to characterise current joint programmes, identify factors that are associated with joint programme success and failure, and gauge attitudes within the profession regarding joint programmes as an alternative.

A multiple choice survey with 23 standard questions for all programmes and additional 42 additional questions for each participant hospital in a joint programme was addressed to paediatric cardiac surgeons in the United States of America. Questions were designed to qualitatively and quantitatively characterise congenital cardiac surgery joint programmes.

Of the 34 unique congenital cardiac surgery programmes identified in this survey, 14 have participated in a joint programme and 50% of those joint programmes existed for more than 10 years. Most joint programmes (86%) participate or participated in a model where the hospital participants are engaged in a “mother–daughter” relationship in both perception and case volume distribution. In three out of four defunct joint programmes, there were case complexity limitations placed on partner institutions, but the now independent partner institutions operate with no limitation on complexity. Most (71%) hospital participants in a joint programme felt that the joint programme produced better outcomes than two separate programmes; however, among those who participate or have participated in a joint programme, only 18% felt that joint programmes were the optimal model for delivery of congenital cardiac surgical care.

No significant relationships.

The systems that help people with mental disorders in Malaysia include hospitals, primary care, traditional and religious systems, schools and colleges, employers, families and other community members.

To better understand collaboration between and within these systems and create a theoretical framework for system development.

A total of 26 focus groups and 27 individual interviews were undertaken with patients, carers, psychiatric hospital staff, primary care and district hospital staff, religious and traditional healers, community leaders, non-governmental organisation workers, and school and college counsellors. Grounded theory methods were used to analyse the data and create a theory of collaboration.

Three themes both defined and enabled collaboration: (a) collaborative behaviours; (b) motivation towards a common goal or value; and (c) autonomy. Three other enablers of collaboration were identified: (d) relatedness (for example trusting, understanding and caring about the other); (e) resources (competence, time, physical resources and opportunities); and (f) motivation for collaboration (weighing up the personal costs versus benefits of acting collaboratively).

The first three themes provided a definition of collaboration in this context: ‘two or more parties working together towards a common goal or value, while maintaining autonomy’. The main barriers to collaboration were lack of autonomy, relatedness, motivation and resources, together with the potential cost of acting collaboratively without reciprocation. Finding ways to change these structural, cultural and organisational features is likely to improve collaboration in this system and improve access to care and outcomes for patients.

Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters.

A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events.

To demonstrate the model’s potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties.

Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities.

The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed.

CarrBG, WalshL, WilliamsJC, PryorJP, BranasCC. A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters. Prehosp Disaster Med.2016;31(4):413–421.

To describe the process adopted to identify, classify, and evaluate legacy of health care planning in the host city of Porto Alegre for the Football World Cup 2014.

There is an emerging interest in the need to demonstrate a sustainable health legacy from mass gatherings investments. Leaving a public health legacy for future host cities and countries is now an important part of planning for these events.

The Ministry of Sports initiated and coordinated the development of projects in the host cities to identify actions, projects, and constructions to be developed to prepare for the World Cup. In Porto Alegre, a common structure was developed by the coordinating team to instruct legacy identification, classification, and evaluation. This structure was based on international documentary analysis (including official reports, policy documents, and web-based resources) and direct communication with recognized experts in the field.

Sixteen total legacies were identified for health surveillance (5) and health services (11). They were classified according to the strategic area, organizations involved, dimension, typology, planned or unplanned, tangible or intangible, territorial coverage, and situation prior to the World Cup. Possible impacts were then assessed as positive, negative, and potentiating, and mitigating actions were indicated.

The project allowed the identification, classification, and development of health legacy, including risk analysis, surveillance, mitigation measures, and provision of emergency medical care. Although the project intended the development of indicators to measure the identified legacies, evaluation was not possible at the time of publication due to time.

WittRR , KotlharMK , MesquitaMO , LimaMADS , MarinSM , DayCB , BandeiraAG , HuttonA . Developing Legacy: Health Planning in the Host City of Porto Alegre for the 2014 Football World Cup. Prehosp Disaster Med. 2015;30(6):613–617.