Evaluation of hospital preparedness for public health emergencies in Sichuan (China)

The aim of this research was to develop a set of reliable, valid preparedness metrics, built around a comprehensive framework for assessing hospital preparedness. This research used a combination of qualitative and quantitative methods which included interview and a Delphi study as well as a survey of hospitals in the Sichuan Province of China. The resultant framework is constructed around the stages of disaster management and includes nine key elements. Factor Analysis identified four contributing factors. The comparison of hospitals' preparedness using these four factors, revealed that tertiary-grade, teaching and general hospitals performed better than secondary-grade, non-teaching and non-general hospitals.

Cross-industry preparedness for Cotton leaf curl disease

Cotton leaf curl disease (CLCuD) is a major biosecurity threat to the Australian cotton industry. This proposal seeks cross-industry investment from the cotton (CRDC) and horticulture (HAL) industries to address the threat of exotic whitefly-transmitted viruses. Testing of silverleaf whitefly, the vector of CLCuD, could provide an alternative, cheaper strategy for early warning disease surveillance compared to surveys for disease symptoms. Control of whitefly-transmitted viruses in Australia and overseas will be reviewed to produce an integrated management package for their control in Australia. This will also involve a workshop with key stakeholders and selected overseas participants, to develop a working party to help formulate this package.

An audit of forest biosecurity arrangements and preparedness in Australia.

Current biosecurity arrangements for plantation forestry are poorly defined, at least relative to other plant-based industries. Serious pest and disease outbreaks in forestry are relatively rare events. Preparedness for rare events is difficult. Part of the difficulty stems from the competing views of managers and stakeholders. This project sought to directly capture alternative views concerning the key objectives of plantation forest biosecurity, alternative strategies for achieving those objectives, and ultimately recommend preferred actions that might be broadly supported by stakeholders. The outcomes from the workshop were used as a basis to draft a list of strategic actions required to improve forest biosecurity in Australia and to be implemented over the next 2-5 years. Research priorities were identified as research to support cost benefit analyses; investigating the effects of changed environmental conditions on forest biosecurity; pathway analysis for functional pest guilds. Integration of this research within a CRC would also permit the effective development and extension of this research as well as providing training urgently required to maintain forest biosecurity and health expertise.

A participatory whole farm modelling approach to understand impacts and increase preparedness to climate change in Australia

This study presents the use of a whole farm model in a participatory modelling research approach to examine the sensitivity of four contrasting case study farms to a likely climate change scenario. The newly generated information was used to support discussions with the participating farmers in the search for options to design more profitable and sustainable farming systems in Queensland Australia. The four case studies contrasted in key systems characteristics: opportunism in decision making, i.e. flexible versus rigid crop rotations; function, i.e. production of livestock or crops; and level of intensification, i.e. dryland versus irrigated agriculture. Tested tactical and strategic changes under a baseline and climate change scenario (CCS) involved changes in the allocation of land between cropping and grazing enterprises, alternative allocations of limited irrigation water across cropping enterprises, and different management rules for planting wheat and sorghum in rainfed cropping. The results show that expected impacts from a likely climate change scenario were evident in the following increasing order: the irrigated cropping farm case study, the cropping and grazing farm, the more opportunistic rainfed cropping farm and the least opportunistic rainfed cropping farm. We concluded that in most cases the participating farmers were operating close to the efficiency frontier (i.e. in the relationship between profits and risks). This indicated that options to adapt to climate change might need to evolve from investments in the development of more innovative cropping and grazing systems and/or transformational changes on existing farming systems. We expect that even though assimilating expected changes in climate seems to be rather intangible and premature for these farmers, as innovations are developed, adaptation is likely to follow quickly. The multiple interactions among farm management components in complex and dynamic farm businesses operating in a variable and changing climate, make the use of whole farm participatory modelling approaches valuable tools to quantify benefits and trade-offs from alternative farming systems designs in the search for improved profitability and resilience.

‘Supra-stewardship’: A Tool for Citizen Participation in European Union Pandemic Preparedness Planning

This article proposes developing the public bioethics aspect of stewardship and applying it to the EU as ‘supra-stewardship’, a tool for opening a discursive space for citizen participation in EU preparedness planning. With this in mind the article highlights some of the contours for engagement on the boundaries of responsibility and the production of governance distortions and failures brought out by attention to framing, distribution, vulnerability and learning. This should help citizens to tackle the complementary expert and public rationalities that undermine their involvement, contribute supplementary knowledge towards governance, and help promote institutional learning by the EU and resilience.

Assisstantship improves medical student preparedness for starting work

Background: The GMC has recommended introducing student assistantships during which final year students, under supervision, undertake most of the responsibilities of a FY1 doctor. The Medical School at Queen’s University Belfast in 2011/12 introduced an assistantship programme. We have evaluated the impact of the assistantship on students’ perception of their preparedness for starting work.
Methods: Students were asked to complete a questionnaire at the beginning of the assistantship. It assessed the students’ perception of their preparedness in five areas: clinical and practical skills, communications skills, teaching and learning, understanding the work environment and team working. After the assistantship they again completed the questionnaire. Comparison of the results allowed an assessment of the impact of the assistantship.
Results: There was a statistically significant improvement in the students' perception of their preparation for 49 of 56 tasks contained within the questionnaire. After the assistantship 81.2% of students felt well prepared for starting work compared with 38.9% before the assistantship. 93.9% agreed that the assistantship had improved their preparedness for starting work.
Conclusions: The assistantship at Queen’s University improves medical students’ perception of their preparedness for starting work. The majority of medical students feel well prepared for starting work after completing the assistantship.

UK medical graduates’ preparedness for practice (P4P): A multi-site qualitative study

Introduction Previous research has demonstrated mixed findings in terms of graduates’ P4P in terms of their knowledge and skills, and interpersonal, systemic and technological aspects (Monrouxe et al. 2014). Few studies have included diverse stakeholders from multiple sites and employing longitudinal methods. We therefore aimed to understand the extent to which UK medical graduates are prepared for practice as Foundation doctors. Methods Cross-sectional qualitative narrative interview and longitudinal audio-diary (LAD) studies with participants from England, Scotland, Wales and Northern Ireland. Study 1 comprised 27 group and 84 individual interviews (n=185) with participants representing different stakeholders (F1s, fully registered trainees, clinical educators, undergraduate/postgraduate deans/foundation programme directors, other healthcare professionals, employers, policy makers, government representatives, and patient/public representatives). Study 2 comprised LADs with 26 F1s over 4-months. Results Participants found it hard initially to conceptualise the term ‘preparedness for practice’. We identified 2187 personal incident narratives (i.e. stories of P4P experiences) across our data: 506 (23%) were classed as ‘prepared’, 730 (33%) as ‘unprepared’ and 951 (44%) as ‘unspecified’. We identified factors that facilitated (e.g. supportive supervisors/colleagues, opportunities for shadowing) and hindered (e.g. unsupportive or disrespectful colleagues, poor organization, understaffing) transitions into and through the Foundation programme. The LADs suggested that trainees felt more confident and competent over time, but that such development was not always linear as challenging circumstances (e.g. new rotations) sometimes made trainees feel unprepared for situations where they had previously indicated preparedness. Conclusion Our findings add to the existing evidence on medical graduates’ P4P in the UK (e.g. Goldacre et al. 2008; Illing et al. 2013). Our findings support the role of assistantships and supportive supervisors for smoothing transitions from student to F1. Further longitudinal and action research studies are now needed to follow students through their final-year assistantships and into their F2 year.

Hospital disaster preparedness in Switzerland.

STUDY OBJECTIVE: Hospital preparedness is an essential component of any developed health care system. However, there is no national legislation in Switzerland. The objective of this inquiry was to establish the geographic distribution, availability and characteristics of hospital preparedness across Switzerland. METHODS: A questionnaire regarding hospital preparedness in 2006 was addressed to all heads responsible for emergency departments (ED). The survey was initiated in 2007 and finalised in 2012. RESULTS: Of the 138 ED, 122 (88%) returned the survey. Eighty nine EDs (82%) had a disaster plan. CONCLUSIONS: Our study identified an insufficient rate of hospitals in which emergency physicians reported a disaster plan. The lack of national or cantonal legislation regulating disaster preparedness may be partially responsible for this.

Investment in preventing and preparing for biological emergencies and disasters: social and economic costs of disasters versus costs of surveillance and response preparedness

Biological emergencies such as the appearance of an exotic transboundary or emerging disease can become disasters. The question that faces Veterinary Services in developing countries is how to balance resources dedicated to active insurance measures, such as border control, surveillance, working with the governments of developing countries, and investing in improving veterinary knowledge and tools, with passive measures, such as contingency funds and vaccine banks. There is strong evidence that the animal health situation in developed countries has improved and is relatively stable. In addition, through trade with other countries, developing countries are becoming part of the international animal health system, the status of which is improving, though with occasional setbacks. However, despite these improvements, the risk of a possible biological disaster still remains, and has increased in recent times because of the threat of bioterrorism. This paper suggests that a model that combines decision tree analysis with epidemiology is required to identify critical points in food chains that should be strengthened to reduce the risk of emergencies and prevent emergencies from becoming disasters.

Improving flood forecasts for better flood preparedness in the UK (and beyond)

This winter (2013/14) coastal storms and an unprecedented amount of rainfall led to significant and widespread flooding across the southern UK. Despite much criticism and blame surrounding the flood events, the Flood Forecasting Centre, a recent development in national-level flood forecasting capabilities for the government and emergency response communities, has received considerable praise. Here we consider how scientific developments and organisational change have led to improvements in the forecasting and flood preparedness seen in this winter's flooding. Although such improvements are admirable, there are many technical and communication challenges that remain for probabilistic flood forecasts to achieve their full potential.

Preparedness for rain during sunny weather: Caribbean environmental sustainability in a nuclear age

Includes bibliography