Journal of Management and Marketing in Healthcare 1(4)

Effective people management in an ever-changing NHS environment

Editorial
Contract management and monitoring in healthcare

The principles for commissioning in the national and independent healthcare systems are largely similar and much of BUPA’s 60 years’ experience in contracting and provider management of UK healthcare is applicable to the NHS as well. This paper discusses some of BUPA’s current practices in demand and supply analysis, contracting and provider management. The paper provides examples of BUPA’s ongoing work in quality monitoring and improvement, and describes how these are relevant for the NHS. Investment in commissioning competencies, tools and systems has paid off for BUPA, and there are great opportunities for continuously improving customer value in terms of cost, quality and service in both the public and private sectors.

Evolving patient safety strategies: A comprehensive solutions-based approach

The movement toward demonstrable quality and value in medical care is on a fast track because payers, weary of mediocre service, are tying payment to the reliability of excellent outcomes. The challenge for healthcare leaders is increasing as complexity and poor management causes variation in care with extraordinary medical error rates. Highly reliable work environments have specific characteristics. Leaders must embrace values of non-negotiable respect and appropriate accountability. Teamwork training is essential as is ongoing measurement of cultural indices. A linked strategy, structure and execution is necessary. This paper describes the steps to achieve a learning and reliable healthcare culture.

Exploring technological innovation in health systems: Is Canada measuring up?

The societal and economic benefits of technological innovations are indisputable. However, the race for knowledge and talent to develop and commercialise health innovations has never been so fierce. Countries traditionally seen as leaders in health innovation — countries such as the UK — are being challenged by newer players. This study examines how technological innovation is encouraged, and discouraged, in Canada and other selected Organisation for Economic Cooperation and Development (OECD) countries, including the UK, France and the USA. The research uses The Conference Board of Canada’s Innovation Framework as an analytical tool in benchmarking the performance of Canada and other OECD countries in several areas of health innovation, including the innovation environment, and the creation, diffusion, transformation and use of knowledge. The results of this study are discouraging for Canada as it scores poorly in many important areas of technological health innovation. Substantial efforts are needed, and needed now, to revitalise health innovation systems and to refuel the capacity to commercialise health innovations. Action in four key areas is recommended.

Implementation of a hospital-based wellness programme: Do cash incentives promote healthier behaviour?

In 2004, the Florida Hospital Zephyrhills developed an employee-based, volunteer programme known as the Lifestyle Incentives For Employees (LIFE) Plan to encourage weight management, exercise and cessation of tobacco use. The purpose of this study is to: (a) compare the health expenditure costs of 41 employees with continuous enrolment in the LIFE Plan and 32 employees who never enrolled in the LIFE Plan; and (b) describe the Wellsource Personal Wellness Profile data of the 620 LIFE Plan members since the inception of the programme, with emphasis on chronic medical conditions affecting number of sick days and hospital days. The data show a downward trend in the annual healthcare expenditures for LIFE Plan members. For the most commonly reported medical conditions from the profile data, individuals with hypertension, arthritis, back pain and joint pain have more sick days and more hospital days than individuals without these medical conditions. The LIFE Plan shows the possibility of reducing high health insurance costs using an employee-based health programme. By incorporating clear worksite health education messages to encourage behaviour changes that remedy chronic conditions, the longitudinal results are expected to contribute to greater cost reductions in the future.

Non-urgent use of the emergency department: A quantitative evaluation from a patient perspective

The objectives of this study are twofold: to investigate the reasons why patients considered as non-urgent by physicians visit the emergency department, and to explore the relationship between patients’ perceived urgency and the factors in the behavioural model of utilisation. This cross-sectional study develops a survey instrument to assess the predisposing, enabling and need factors affecting patients’ perceived urgency. In order to identify the independent variables associated with the perceptions of urgency, a multiple logistic regression model is used. According to the results, two-thirds of patients perceive their problem as urgent. Level of pain and duration of complaint are found to be significant factors affecting patients’ perceptions. For patients perceiving their problem as non-urgent, the most common reasons for visiting an emergency department include infections, dressings and the like. The findings support the general conclusion that the definition of urgency differs for patients and health professionals. The reasons why patients with non-urgent problems use emergency departments in Turkey include problems attached to primary healthcare facilities, crowded outpatient clinics, difficulty getting outpatient appointments and accessibility problems due to working hours.

Payment by Results as a lever for NHS reforms

Payment by Results (PbR), the English prospective payment system of paying healthcare providers, was introduced to respond to concerns that the previous system of financing was not providing sufficient incentives to NHS service providers to deliver efficiency and productivity. Initially targeted at acute, elective activity, the policy’s ambition included improved access to care, efficiency gains, transparent and fair financing, and facilitating the key reform of choice and plurality. PbR has, by and large, contributed to the implementation and gains derived from these reforms. Much of the emphasis has been on the technical mechanisms of PbR. Little attention has been given to the consequential behavioural responses, and potential perverse incentives that it can create. On balance, it can be seen to have been a helpful tool. This paper will give a clear sense of the strength and limitations of the policy. It will make clear the pragmatic amendments to policy that have been needed to move from a purist Prospective Payments Model to one that seeks to maintain the major policy drivers, but is workable within the NHS. It concludes that even with these changes, PbR can become a powerful lever for reforms in the delivery of healthcare.

Proactive recruitment in local government

New ways of partnership working, new organisational structures, and new role and skill demands are among the challenges facing organisations engaged in commissioning and/or delivering services to local communities. Within this context, local councils have the additional challenges of an ageing workforce, and recruitment and retention difficulties in key service areas and leadership roles. As the pool of appropriately qualified and experienced people shrinks, a competitive market for key professionals has emerged, creating retention problems throughout the UK. Radical changes beyond the scope of individual councils have been required to tackle these shortages and workforce and succession planning have become increasingly important as a result. Supported by national activities, collaboration rather than competition is now occurring to increase supply locally and regionally. Individual employers are also reviewing their existing workforce and creating new pathways to progression in line with new ways of working. Examples of national activities and case studies from social care, environmental health and planning are offered as illustrations of these proactive steps.

The assessment of doctors’ performance: Tools and techniques

There has been increasing organisational and research interest regarding the assessment of the performance of medical practitioners. Much of this progress has already been implemented in both the UK and internationally. This change is being driven both by statutory requirements and by the desire of the profession to improve practice and promote excellence. The process of developing an assessment system is well described. There are several steps including defining the content to be assessed, setting standards, defining the purpose of the assessment, identifying the tools to be used, implementation and making decisions with the results. Many methods of performance assessment have been suggested; some have been extensively evaluated and their psychometric properties are well known. For others, much less data are available. Some of the key steps in designing assessment systems will be described along with a more detailed discussion of selected assessment methods. The effective implementation of performance assessment continues to be a challenge for all those involved in the provision of quality healthcare.

The productive efficiency of blood banks: Using data envelopment and simple ratio analyses to measure the performance of health services

Simple ratio analysis (SRA) and data envelopment analysis (DEA) are widely used in benchmarking to identify organisations with best practice. This study tests the consistency of the two methods by investigating whether they could substitute for each other in performance measurement. To evaluate the relative precision of the two techniques, the paper studies comparative data from 31 second class blood banks in Greece for the year 2003. Optimality is investigated based on four performance outcomes: donor recruitment, blood sufficiency, wasted blood units and transfusion reactions. Comparison of SRA and DEA is employed in pair-wise efficiency scores. Results yield high statistical significance under assumptions of both constant returns to scale and variable returns to scale. The results confirm that the two measuring techniques are closely related and consistent.

RSM Journals have just got a whole lot easier to use, you can now find all of them on one page at http://www.rsmjournals.com. Key link to look for is the Sign In via User Name/Password which is where you type your Athens (you can get one here if you work for a PCT in the North West and view the Getting an NHS Athens Password Flash Video 2.21 min here) password to get access. Alternatively you can go straight to each journal’s individual archive:

• Annals of Clinical Biochemistry
• Clinical Ethics
  
• Clinical Risk
  
• He@lth Information on the Internet
• Health Services Management Research
• International Journal of STD & AIDS
• Journal of Health Services Research & Policy
• Journal of Integrated Care Pathways
• Journal of Medical Biography
• Journal of Medical Screening
• Journal of the Royal Society of Medicine
• Journal of Telemedicine and Telecare
• Laboratory Animals
• Menopause International
• Phlebology
• Tropical Doctor

Editorial. Thomas G. Rundall

Implementing and using care pathways in mental health: Developing an approach for practice. Barrie Green.

Care pathways have been widely used in physical healthcare since the 1980s. Their use provides a range of benefits including more efficient treatment planning, increased use of research evidence, clinical audit, multi-professional teamwork and cost-effectiveness. Their introduction and use in mental health has been less widespread, due to the perceived lack of predictability often associated with mental disorders. However, a number of local, national and international initiatives have promoted their use, integrating either disorder (predictive) or process (benchmark) oriented approaches. Evidence from these indicates that contemporary and future mental health developments can benefit from the wider adoption of care pathways. The involvement of patients, relatives and carers, in addition to a range of emerging technologies and enhanced therapeutics, provides many opportunities to place pathways at the heart of mental health strategies. This paper describes an overview of the approach, highlights a number of models of intervention, and provides an example from the author’s own area of practice. These models relate to an implementation framework for clinicians and managers to use as a guide to challenging stereotypical or outdated organisational behaviours.

Drivers and enablers of change in healthcare: How professions matter. Ellen Kuhlmann.

Governments around the world are under pressure to make services more cost-effective and at the same time improve public safety and the quality of care. Policy makers are pursuing strategies of marketisation and managerialism coupled with consumer involvement. These policies attempt tighter control over care providers by taking away their power. This paper argues for a more dynamic approach regarding the role of the professional in changing healthcare systems. With a focus on the medical profession as the dominant player in healthcare, modernisation processes in the German health system serve as a case study to explore how professional groups matter in the changing governance of healthcare. The case study also highlights the overlapping interests of professionals and institutions. The approach described in this paper moves beyond performance and managerial regimes and brings into view a broader range of driving forces and ‘enabling players’. The paper argues that a greater variety of professional groups may create more sustainable ‘motion’ in power structures than the new managerialist regimes.

Patient choice: Friend or foe? Steve Bojakowski.

The introduction of choice into the NHS has been a major feature of the UK Government’s health policy of the past few years. This paper discusses the limits of choice, emphasising the need for clarity between the NHS and independent sector in making treatment available to those patients who choose to pay for it. The financial limit placed on the NHS, however, is one limit to choice that cannot be overcome. This will be more constrained in the future, due to the slowdown in increases in government spending on the NHS. This slowdown signals a policy shift away from individual choice to a more personal type of care through the introduction of ‘collective’ patient engagement mechanisms, introducing a patient’s ‘voice’ into the development of quality local health services. The paper concludes that how the NHS — and private providers — responds to these challenges will determine whether choice will prove to be a friend or foe.

A strategy for engaging healthcare professionals: Moving from me to we. Kenneth Cohn, Thomas R. Allyn and Robert A. Reid.

The global economic pressures that create dissatisfaction among healthcare providers may be the same forces that will unite physicians, nurses and hospital leaders, and help them work more interdependently. All parties feel squeezed by rising consumer expectations despite stagnant or decreasing reimbursement, rising expenses and staffing shortages. Collaboration, although difficult because of differences in background, outlook and training, can help all parties survive and thrive in the future as it fosters improved care for communities.

The role of the independent sector in improving access to clinical services: A case study of trauma and orthopaedic services. Joe A. Rafferty, Gerry Merchand and Alison Reed.

The role of the independent sector in the provision of clinical services on behalf of the NHS in England is often misunderstood and is perceived by some stakeholders as offering the NHS little more than marginal additional capacity. Indeed, some NHS organisations have been accused of ‘obstructive, disruptive and protectionist behaviours’ towards non-traditional ‘NHS family’ service providers. This paper outlines the development of the independent sector’s role in the provision of clinical healthcare services over recent years. The first part of the paper considers the historical context, including the impact of both the changing role of the state over the past 50 years and the change of government at the end of the last century. Consideration is then given as to the position today, and the impact of current policy drivers for the use of the independent sector in the provision of NHS clinical services. The final part of the paper uses the specialty of orthopaedics, for the purposes of illustration, in order to explore the contribution of the independent sector to the delivery of the last remaining major access target, 18 weeks referral to treatment, and the development of a range of responsive services in the community.

Healthcare ICT in Europe: Understanding trends in adoption and governance. David E. Garets and Jennifer K. Horowitz.

This paper presents information from studies that found a patient-centric focus in the implementation of information communications and technology (ICT) in Europe, the Middle East and Africa. Integrating systems in a multi-vendor environment, implementing an electronic medical record (EMR) and/or its components, and replacing/upgrading/implementing inpatient clinical systems were most frequently identified as top ICT priorities for healthcare organisations. Clinical data repositories, clinical information systems and EMRs were also identified as priorities for the near future. With such a substantial focus on clinical applications, it is critical for clinicians to be involved in the ICT decision-making, implementation and governance processes. Clinicians are most likely to be involved in participating in ICT systems evaluations, exploring innovative ways to use ICT and developing/implementing clinical training programmes. While there is no shortage of applications and technologies to help make patient care safer, more effective and of better quality, there are numerous barriers to the implementation of such technology. The lack of a strategic ICT plan is most likely to be identified as such a barrier. Other barriers include vendors’ inability to deliver products in a timely fashion and lack of staffing resources. As healthcare organisations move forward, it is important that they remember that ICT is a tool to support overall business objectives, and that individuals from all areas of the organisation, particularly senior leadership and clinicians, must be involved throughout the process.

Corporate Manslaughter and Corporate Homicide Act 2007: Implications for healthcare providers. Shaun O’Malley.

This paper considers the implementation of the Corporate Manslaughter and Corporate Homicide Act 2007 (‘the Act’) and its implications specifically for healthcare providers. The paper will describe the main provisions of the Act and provide examples of how the Act may be used by a prosecuting authority. The paper considers the effect that the Act will have upon existing health and safety legislation and concludes that no further obligations have been introduced in addition to those which already exist under health and safety legislation. Healthcare providers should concentrate on their health and safety obligations to which they should already be accustomed rather than being concerned about the consequences of the Act.

Healthcare marketing has five ‘P’s. Steven J. Gray.

This paper will explore the traditional foundation of marketing plans (McCarthy’s four ‘P’s and postulate that healthcare marketing requires an expansion of this foundation to include principles as a fundamental tenet of every healthcare business.

UK policy review. Jonathan Anscombe.

This regular column reviews the upcoming policy trends for 2008/09. After a brief review of developments in 2007, the paper explains that the ‘architectural’ reforms of the last seven years are now largely complete, and the focus of the next year will be on making these reforms work. The Next Stage Review by Lord Darzi will put the focus clearly on the clinical agenda, focusing particularly on long-term conditions and primary and community care. Opportunities for the independent sector are likely to be with strategic health authorities, primary care and hospital trusts rather than a central programme, and should focus on delivering clinical, evidence-based improvements in these areas and advisory services for the implementation of pathways and improving commissioning.

The Specialist Libraries Resource are collections of information aimed at health professionals containing clinical and non-clinical resources. A team of clinicians and information professionals build the collection of materials so that you can rely on the quality and know that information is kept up-to-date. Most of the links within the Libraries provide access to full text documents.

The Content

The Specialist libraries fall into four general categories and overall there is a specialist library for everyone! Thh Specialist Libraries host National Knowledge Weeks - which highlight the best current evidence for selected healthcare topics from Annual Evidence Updates, provide user-friendly summaries written by relevant experts, and links to guidelines, secondary research and primary research. Specialist libraries available are:

Specialist Libraries by Health Condition

• Cancer
• Cardiovascular
• Diabetes
• ENT & Audiology
• Eyes & Vision
• Gastroenterology & Liver Diseases
• Genetic Conditions
• Infection
• Kidney Diseases
• Learning Disabilities
• Mental Health
• Musculoskeletal Diseases
• Neurological Conditions
• Oral Health
• Respiratory
• Skin Disorders
• Stroke
• Trauma & Orthopaedics

Specialist Libraries by Type of Health Service

• Complementary & Alternative Medicine
• Emergency Care
• Health Management
• Palliative & Supportive Care
• Screening
• Surgery, Theatres & Anaesthesia

Specialist Health Libraries for Particular Patient Groups

• Child Health
• Ethnicity & Health
• Later Life
• Women’s Health

Specialist Libraries with a Knowledge Focus

• Knowledge Management
• Patient and Public Involvement

Searching for content in the Specialist Libraries

You can search across the range of specialist libraries by clicking on the Specialist Library link (illustrated to the right) on the NLH homepage.

This will list all the libraries from which you can select the specialist libraries that you want to search and you can run your search in the search box.

The usual range of search operators can be applied to search for precisely the material you are after:

• AND - to make sure the words used appear in the results - this will limit your search results.

• OR - to create an either/or link to expand your search

• NOT - to exclude a word from a search (this will limit your search).

• EXACT PHRASE - by putting your search in “speech marks” you will search for the phrase as you type it. This technique also works with Google and other search engines and is a Fade top tip to find relevant material on the internet.

Advanced Search - Top tip, remember to deselect the resources you don’t want to search this search defaults to searching across the entire NLH.

Saving Search Results

To save results requires you to be logged into Athens (which you can get from the NHS here, providing you work for the NHS). Check the check boxes of the items you want to save and then click the button. Alternatively just click on Save Search Result for individual items.

To retrieve items you’ve saved when you’ve logged in with your Athens password jsut click on the Saved Search Results link in the MY SEARCH section of the page.

This is also where you can find Saved Search Histories, Saved Search Criteria and your Search Profiles.

E-Mailing Search Results

You can e-mail individual search results by clicking on the More Details link. This will then bring up an e-mail form (shown below) which you can mail to yourself or a colleague you think will be interested in the item. It has space for you to add your own message.

Browsing Resources in Specialist Libraries

If you click on any of the blue links to browse a specialist library you will be able to browse content by looking at teh browse tool on the left hand side of the screen. Just click on the plus sign to reveal further lower levels of information and click on the level you want to see. Information will be categorised as:

• Guidance and Pathways
• Evidence
• Reference
• Education/CPD
• Patient Information

If you are looking for a national or international clinical guideline, a protocol or a care pathway it’s worth remembering that Search 2.0 will search the National Library of Guidelines for guidelines published by NICE and professional bodies, both in the UK and around the world.

The Content

• National Library of Guidelines (includes NICE Guidance) - The National Library of Guidelines (the resource formerly known as the Guidelines Finder) indexes over 2000 selected care guidelines available in fulltext format online. These are mainly fom the UK but there are some international guidelines included.

• NICE Guidance (only) -National guidance on the promotion of good health and the prevention and treatment of ill-health, produced by the National Institute for Health and Clinical Excellence (NICE).

• Protocols and Care Pathways Library - The NLH Protocols and Care Pathways Library holds over 250 Integrated Care Pathways (ICPs) submitted by NHS organisations, as well as useful material related to ICP development and appraisal.

• Clinical Knowledge Summaries (search of this service will be available soon) - Provides an up-to-date source of clinical knowledge, incorporating PRODIGY resources, that can help healthcare professional and patients in managing the common conditions generally seen in primary and first-contact care.

• International Guidelines (NEW! Now searchable along with UK Guidelines) - Guidelines from the US National Guidelines Clearing House, New Zealand Guidelines Group - Guidelines Library and Australian National Health and Medical Research Council: Clinical Practice Guidelines

Simple Search

The easiest way to search is to use the search box at the top of the National Library for Health home page (illustrated to the left).

From here you can use the usual linking terms to define your search:

• AND - to make sure the words used appear in the results - this will limit your search results.
• OR - to create an either/or link to expand your search
• NOT - to exclude a word from a search (this will limit your search).
• EXACT PHRASE - by putting your search in “speech marks” you will search for the phrase as you type it. This technique also works with Google and other search engines and is a Fade top tip to find relevant material on the internet.

Limiting Your Search to Particular Resources

If you click on the Guidance (see right) link on the home page of the National Library for Health you’ll be able to select particular resources to search (illustrated below)

Advanced searches

Advanced search allows you to search for keywords in specific fields: Title; Author; Publisher; Date; Any (field); ISBN and ISSN, combine search terms using Boolean operators (and, or, not) and limit your searches by date.

To search just for guidelines, don’t forget to deselect all other resources in the section.

Saving Search Results

To save results requires you to be logged into Athens (which you can get from the NHS here, providing you work for the NHS). Check the check boxes of the items you want to save and then click the button. Alternatively just click on Save Search Result for individual items.

To retrieve items you’ve saved when you’ve logged in with your Athens password jsut click on the Saved Search Results link in the MY SEARCH section of the page.

This is also where you can find Saved Search Histories, Saved Search Criteria and your Search Profiles.

E-Mailing Search Results

You can e-mail individual search results by clicking on the More Details link. This will then bring up an e-mail form (shown below) which you can mail to yourself or a colleague you think will be interested in the item. It has space for you to add your own message.

Today’s post based on the excellent material from the NLH Search 2.0 SHA Representatives group.

When to use them?

Whenever you need ready done quality synthesised reviews of the best available evidence.

The Content

• Bandolier - advice about particular treatments for health professionals and consumers based on primary and secondary research.
• Cochrane Library Database of Systematic Reviews - systematic reviews and protocols for future reviews.
• Database of Abstracts of Reviews of Effects - abstracts of systematic reviews published in places other than the Cochrane Library Database of Systematic Reviews.
• NHS Economic Evaluation Database - structured economic evaluations of health care interventions.
• Health Technology Assessment Database - focussing on prevention and rehabilitation, vaccines, pharmaceuticals and devices, medical and surgical procedures and the systems within which health is protected and maintained.

Searching Evidence Based Reviews

Check the Evidence Based Reviews check box in the search box at the top of the NLH page.

This will allow you to conduct a simple search across all of the evidence based review databases and materials.

As yesterday’s post suggested there are key linking phrases available to allow you to define the relationship between concepts in your search. As a reminder we’ve detailed them again below.

• AND - to make sure the words used appear in the results - this will limit your search results.
• OR - to create an either/or link to expand your search
• NOT - to exclude a word from a search (this will limit your search).
• EXACT PHRASE - by putting your search in “speech marks” you will search for the phrase as you type it. This technique also works with Google and other search engines and is a Fade top tip to find relevant material on the internet.

Searching indivdual or Multiple Evidence Based Reviews Whilst Ignoring Others

If you click on the Evidence Based Reviews Link (as illustrated below)

You will be taken to a specific Evidence Based Reviews Search where you can use the check boxes to select the resources as illustrated below. The usual range of linking terms are available to design your search to bring back optimum results (as detailed above).

Advanced searches can also be run using the same set of parameters as described yesterday.

Saving Search Results

To save results requires you to be logged into Athens (which you can get from the NHS here, providing you work for the NHS). Check the check boxes of the items you want to save and then click the button. Alternatively just click on Save Search Result for individual items.

To retrieve items you’ve saved when you’ve logged in with your Athens password jsut click on the Saved Search Results link in the MY SEARCH section of the page.

This is also where you can find Saved Search Histories, Saved Search Criteria and your Search Profiles.

E-Mailing Search Results

You can e-mail individual search results by clicking on the More Details link. This will then bring up an e-mail form (shown below) which you can mail to yourself or a colleague you think will be interested in the item. It has space for you to add your own message.

OK it’s 7 days to go to the implementation of Search 2.0 the new route to literature searching in the NHS from the National Library for Health. So we thought we dust off the guides from the NLH Search 2.0 SHA Representatives group (this post is from Resource Guide 1: Overview), adapt the guides where we felt we needed to and give you seven days worth of tip off of the goodness to come. Never fear though, if things aren’t as smooth as we hope, the Dialog databases haven’t gone anywhere for the moment (as for the red spot search logo we don’t know the reasons behind it either but any excuse to get in a few minutes practice for this year’s International Talk Like a Pirate Day! Clearly red is the new black!)

Searching the National Library for Health

Currently there are six elements (with a seventh in development) of the library that you can search:

1. Evidence based reviews - synthesising known evidence, these secondary sources e.g. the Cochrane Library should be used when you want a quality review of the best available evidence.
2. Guidance - if you are looking for international, national guidelines or care pathways, start here.
3. Specialist Libraries - offering rapid access to the latest quality evidence by patient group or type of service.
4. Books, Journals and Healthcare Databases (Bibliographic Databases) - use them when you need to search the literature (these will need an Athens password which you can get from the NHS here, providing you work for the service).
5. Images - quality medical images/photos/graphics.
6. For Patients - quality assured information for patients.
7. Drugs Resource - is under development… as soon as we can tell you about it, we will.

Searching the Resources

Easy Search

The search box appears at the top of the National Library for Health page. You can use the check boxes to select the types of resources you want to search.

you can construct your search using the following linking terms:

• AND - to make sure the words used appear in the results - this will limit your search results.
• OR - to create an either/or link to expand your search
• NOT - to exclude a word from a search (this will limit your search).
• EXACT PHRASE - by putting your search in “speech marks” you will search for the phrase as you type it. This technique also works with Google and other search engines and is a Fade top tip to find relevant material on the internet.

Advanced Search

The advanced search option allows you to select from the range of NLH resources for inclusion in your search. It also allows you to limit a search to materials from discrete date ranges and to particular elements of a record.

If you are logged into the library you can search accross the range of journals and e-resources available to you through your Athens password.

Just hit the search button when you’re ready to search.

Search results will be displayed by type in a results bar accross the top of the page.

The added advantage with logging in is you can of course save your search to return to at any point you log-in to NLH.

Saving Search Results

To save results requires you to be logged into Athens (which you can get from the NHS here, providing you work for the NHS). Check the check boxes of the items you want to save and then click the button. Alternatively just click on Save Search Result for individual items.

To retrieve items you’ve saved when you’ve logged in with your Athens password jsut click on the Saved Search Results link in the MY SEARCH section of the page.

This is also where you can find Saved Search Histories, Saved Search Criteria and your Search Profiles.

E-Mailing Search Results

You can e-mail individual search results by clicking on the More Details link. This will then bring up an e-mail form (shown below) which you can mail to yourself or a colleague you think will be interested in the item. It has space for you to add your own message.

In this Issue 

In this issue
Carlos Alvarez-Dardet and John Ashton
J Epidemiol Community Health 2008; 62: 281. [Extract] [Full text] [PDF]

Aphorism of the Month 

“There is more than one way to skin a cat”
JRA
J Epidemiol Community Health 2008; 62: 283. [Extract] [Full text] [PDF]

Speakers Corner 

Welfare regime types and global health: an emerging challenge
Haejoo Chung and Carles Muntaner
J Epidemiol Community Health 2008; 62: 282-283. doi:10.1136/jech.2006.057778 [Extract] [Full text] [PDF]

Public Health Past and Present 

Debates about cervical screening: an historical overview
L Bryder
J Epidemiol Community Health 2008; 62: 284-287. doi:10.1136/jech.2006.059246 [Extract] [Full text] [PDF]

Evidence-based Policy and Practice

Neighbourhood environment as a predictor of television watching among girls
K E MacLeod, G C Gee, P Crawford, and M C Wang
J Epidemiol Community Health 2008; 62: 288-292. doi:10.1136/jech.2007.061424 [Abstract] [Full text] [PDF]

Home ownership and mortality: a register-based follow-up study of 300 000 Finns
M Laaksonen, P Martikainen, E Nihtilä, O Rahkonen, and E Lahelma
J Epidemiol Community Health 2008; 62: 293-297. doi:10.1136/jech.2007.061309 [Abstract] [Full text] [PDF]

Tackling inequalities in health: evaluating the New Deal for Communities initiative
M Stafford, J Nazroo, J M Popay, and M Whitehead
J Epidemiol Community Health 2008; 62: 298-304. doi:10.1136/jech.2006.058628 [Abstract] [Full text] [PDF]

Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis
M F Vescio, B Longo, S Babudieri, G Starnini, S Carbonara, G Rezza, and R Monarca
J Epidemiol Community Health 2008; 62: 305-313. doi:10.1136/jech.2006.051599 [Abstract] [Full text] [PDF]

Using national health weeks to deliver deworming to children: lessons from Mexico
A Flisser, J L Valdespino, L García-García, C Guzman, M T Aguirre, M L Manon, G González-González, and T W Gyorkos
J Epidemiol Community Health 2008; 62: 314-317. doi:10.1136/jech.2007.066423 [Abstract] [Full text] [PDF]

Meaningful differences in maternal smoking behaviour during pregnancy: implications for infant behavioural vulnerability
K E Pickett, C Wood, J Adamson, L DeSouza, and L S Wakschlag
J Epidemiol Community Health 2008; 62: 318-324. doi:10.1136/jech.2006.058768 [Abstract] [Full text] [PDF]

Social inequality in fetal growth: a comparative study of Denmark, Finland, Norway and Sweden in the period 1981–2000
L H Mortensen, F Diderichsen, A Arntzen, M Gissler, S Cnattingius, O Schnor, G Davey-Smith, and A-M Nybo Andersen
J Epidemiol Community Health 2008; 62: 325-331. doi:10.1136/jech.2007.061473 [Abstract] [Full text] [PDF]

Job loss from poor health, smoking and obesity: a national prospective survey in France
F Jusot, M Khlat, T Rochereau, and C Serme
J Epidemiol Community Health 2008; 62: 332-337. doi:10.1136/jech.2007.060772 [Abstract] [Full text] [PDF]

When does work stress hurt? Testing the interaction with socioeconomic position in the Heinz Nixdorf Recall Study
N Wege, N Dragano, R Erbel, K-H Jockel, S Moebus, A Stang, and J Siegrist
J Epidemiol Community Health 2008; 62: 338-341. doi:10.1136/jech.2007.062315 [Abstract] [Full text] [PDF]

Physical activity in older women: associations with area deprivation and with socioeconomic position over the life course: observations in the British Women’s Heart and Health Study
M Hillsdon, D A Lawlor, S Ebrahim, and J N Morris
J Epidemiol Community Health 2008; 62: 344-350. doi:10.1136/jech.2006.058610 [Abstract] [Full text] [PDF]

Research Reports

Childhood socioeconomic circumstances and adult height and leg length in central and eastern Europe
E Webb, D Kuh, A Peasey, A Pajak, S Malyutina, R Kubinova, R Topor-Madry, D Denisova, N Capkova, M Marmot, and M Bobak
J Epidemiol Community Health 2008; 62: 351-357. doi:10.1136/jech.2006.056457 [Abstract] [Full text] [PDF]

Perineal use of talc and risk of ovarian cancer
H Langseth, S E Hankinson, J Siemiatycki, and E Weiderpass
J Epidemiol Community Health 2008; 62: 358-360. doi:10.1136/jech.2006.047894 [Abstract] [Full text] [PDF]

Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions
G Richardson, A Kennedy, D Reeves, P Bower, V Lee, E Middleton, C Gardner, C Gately, and A Rogers
J Epidemiol Community Health 2008; 62: 361-367. doi:10.1136/jech.2006.057430 [Abstract] [Full text] [PDF]

Electronic Pages

Use of surface water in drinking water production associated with municipal Legionnaires’ disease incidence
J W Den Boer, R A Coutinho, E P F Yzerman, and M A B van der Sande
J Epidemiol Community Health 2008; 62: e1. doi:10.1136/jech.2007.061598 [Abstract] [Full text] [PDF]

Recreational values of the natural environment in relation to neighbourhood satisfaction, physical activity, obesity and wellbeing
J Björk, M Albin, P Grahn, H Jacobsson, J Ardö, J Wadbro, P-O Östergren, and E Skärbäck
J Epidemiol Community Health 2008; 62: e2. doi:10.1136/jech.2007.062414 [Abstract] [Full text] [PDF]

Apolipoprotein E polymorphism, life stress and self-reported health among older adults
F Zhang, M Lewis, G Yang, J Iriondo-Perez, Y Zeng, and J Liu
J Epidemiol Community Health 2008; 62: e3. doi:10.1136/jech.2007.063917 [Abstract] [Full text] [PDF]

The changing regional pattern of ischaemic heart disease mortality in southern Europe: still healthy but uneven progress
L Hirte, E Nolte, E Mossialos, and M McKee
J Epidemiol Community Health 2008; 62: e4. doi:10.1136/jech.2007.067637 [Abstract] [Full text] [PDF]

Chernobyl exposure as stressor during pregnancy and hormone levels in adolescent offspring
A C Huizink, M Bartels, R J Rose, L Pulkkinen, C J P Eriksson, and J Kaprio
J Epidemiol Community Health 2008; 62: e5. doi:10.1136/jech.2007.060350 [Abstract] [Full text] [PDF]

Theory and Methods

Measuring the health effects of gender
S P Phillips
J Epidemiol Community Health 2008; 62: 368-371. doi:10.1136/jech.2007.062158 [Abstract] [Full text] [PDF]

Job strain and ischaemic disease: does the inclusion of older employees in the cohort dilute the association? The WOLF Stockholm Study
M Kivimäki, T Theorell, H Westerlund, J Vahtera, and L Alfredsson
J Epidemiol Community Health 2008; 62: 372-374. doi:10.1136/jech.2007.063578 [Abstract] [Full text] [PDF]

Postscript

Placing Health: Neighbourhood Renewal, Health Improvement and Complexity
Ritesh Mistry
J Epidemiol Community Health 2008; 62: 375. doi:10.1136/jech.2007.067439 [Extract] [Full text] [PDF]

New malignancies among cancer survivors: SEER cancer registries, 1973–2000
Rajah Supramaniam
J Epidemiol Community Health 2008; 62: 375-376. doi:10.1136/jech.2007.063560 [Extract] [Full text] [PDF]

Constructive conversations about health: policy and values
Sanjoy Bhattacharya
J Epidemiol Community Health 2008; 62: 376. doi:10.1136/jech.2007.059527 [Extract] [Full text] [PDF]

Correction
J Epidemiol Community Health 2008; 62: 376. [Extract] [Full text] [PDF]

The latest issue of Tobacco Control is now available via your Athens passsword from any North West NHS organisation (If you don’t have an Athens password and are eligible you can get one here). Content in this issue is detailed below:

Editorial

International tobacco control should repudiate Jekyll and Hyde health philanthropy
Simon Chapman
Tobacco Control 2008; 17: 1. doi:10.1136/tc.2007.024562 [Extract] [Full text] [PDF]

News analysis

CZECH REPUBLIC: POTENT SMOKING AND IMPOTENCE CAMPAIGN
Eva Kralikova
Tobacco Control 2008; 17: 2. [Extract] [Full text] [PDF]

SOUTH AFRICA: SNUS “NOT A TOBACCO PRODUCT”
Yussuf Saloojee
Tobacco Control 2008; 17: 2-3. [Extract] [Full text] [PDF]

TURKEY: NEW FEARS, NEW HOPES
Tobacco Control 2008; 17: 3. [Extract] [Full text] [PDF]

JAPAN: REVOLUTION ON THE STREETS
Mark Levin
Tobacco Control 2008; 17: 3-4. [Extract] [Full text] [PDF]

JAPAN: REVOLUTION BESIDE THE STREETS
Tobacco Control 2008; 17: 4. [Extract] [Full text] [PDF]

Tobacco Control 2008; 17: 4. [Extract] [Full text] [PDF]

EUROPE: AGREEMENT ON REDUCING CIGARETTE FIRES
Deborah Arnott and Florence Berteletti
Tobacco Control 2008; 17: 4-5. [Extract] [Full text] [PDF]

SRI LANKA: BAT’S CSR AWARD
Tobacco Control 2008; 17: 5. [Extract] [Full text] [PDF]

WORLD: STRONGER LINE FOR WORLD’S MEDICAL ASSOCIATIONS
Tobacco Control 2008; 17: 5. [Extract] [Full text] [PDF]

UK: BAD NEWS, GOOD PROGRESS
Tobacco Control 2008; 17: 5. [Extract] [Full text] [PDF]

Research papers

Quantitative and qualitative estimates of cross-border tobacco shopping and tobacco smuggling in France
C Ben Lakhdar
Tobacco Control 2008; 17: 12-16. doi:10.1136/tc.2007.020891 [Abstract] [Full text] [PDF]

Relation between newspaper coverage of tobacco issues and smoking attitudes and behaviour among American teens
K Clegg Smith, M A Wakefield, Y Terry-McElrath, F J Chaloupka, B Flay, L Johnston, A Saba, and C Siebel
Tobacco Control 2008; 17: 17-24. doi:10.1136/tc.2007.020495 [Abstract] [Full text] [PDF]

Markers of the denormalisation of smoking and the tobacco industry
S Chapman and B Freeman
Tobacco Control 2008; 17: 25-31. doi:10.1136/tc.2007.021386 [Abstract] [Full text] [PDF]

Smoking in the home and children’s health
S C Hill and L Liang
Tobacco Control 2008; 17: 32-37. doi:10.1136/tc.2007.020990 [Abstract] [Full text] [web only table] [PDF]

Paternal smoking and increased risk of child malnutrition among families in rural Indonesia
C M Best, K Sun, S de Pee, M Sari, M W Bloem, and R D Semba
Tobacco Control 2008; 17: 38-45. doi:10.1136/tc.2007.020875 [Abstract] [Full text] [PDF]

Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey
H-H Yong, R Borland, D Hammond, B Sirirassamee, B Ritthiphakdee, R Awang, M Omar, F Kin, Z bt M Zain, W B Lee, M Siahpush, and G T Fong
Tobacco Control 2008; 17: 46-52. doi:10.1136/tc.2007.021964 [Abstract] [Full text] [PDF]

The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model
D T Levy, S Benjakul, H Ross, and B Ritthiphakdee
Tobacco Control 2008; 17: 53-59. doi:10.1136/tc.2007.022319 [Abstract] [Full text] [PDF]

Crossing geographical, legal and moral boundaries: the Belgian cigarette black market
T Vander Beken, J Janssens, K Verpoest, A Balcaen, and F Vander Laenen
Tobacco Control 2008; 17: 60-65. doi:10.1136/tc.2007.022749 [Abstract] [Full text] [PDF]

Brief report

Tobacco control indicators and lung cancer rates in young adults by state in the United States
A P Polednak
Tobacco Control 2008; 17: 66-69. doi:10.1136/tc.2007.020925 [Abstract] [Full text] [PDF]

Advocacy in action

Survivors of tobacco-related diseases and advocacy for tobacco control
M Mathew, A O Goldstein, and K Hampton
Tobacco Control 2008; 17: 6-11. doi:10.1136/tc.2006.019612 [Abstract] [Full text] [PDF]

Ad Watch

An Argentinean icon as a useful tool to sell BAT’s cigarettes
S Braun, R M Mejía, and R Jaganath
Tobacco Control 2008; 17: 70. doi:10.1136/tc.2007.023143 [Extract] [Full text] [PDF]

Electronic pages

Mapping tobacco industry strategies in South East Asia for action planning and surveillance
F Stillman, M Hoang, R Linton, B Ritthiphakdee, and W Trochim
Tobacco Control 2008; 17: e1. doi:10.1136/tc.2006.017988 [Abstract] [Full text] [PDF]

After the smoke has cleared: evaluation of the impact of a new national smoke-free law in New Zealand
R Edwards, G Thomson, N Wilson, A Waa, C Bullen, D O’Dea, H Gifford, M Glover, M Laugesen, and A Woodward
Tobacco Control 2008; 17: e2. doi:10.1136/tc.2007.020347 [Abstract] [Full text] [PDF]

PostScript

Home smoking policy and environmental tobacco smoke exposure among Koreans in Seoul
S C Hughes, M F Hovell, C R Hofstetter, V L Irvin, H R Park, and H Y Paik
Tobacco Control 2008; 17: 71-72. doi:10.1136/tc.2007.022244 [Extract] [Full text] [PDF]

Miscellanea

Tobacco Control Online: http://tc.bmj.com
Tobacco Control 2008; 17: 37. [Extract] [Full text] [PDF]

Tobacco Control Online: http://tc.bmj.com
Tobacco Control 2008; 17: 45. [Extract] [Full text] [PDF]

The Lighter Side
Tobacco Control 2008; 17: 52. [Extract] [Full text] [PDF]

The Lighter Side
Tobacco Control 2008; 17: 65. [Extract] [Full text] [PDF]

The Lighter Side
Tobacco Control 2008; 17: 72. [Extract] [Full text] [PDF]

If you need any training in using this or any other electronic resource and you work for Liverpool PCT use the contact form below to contact the library.

Journal of Communication in Healthcare is new electronic journal available via your Athens passsword from Liverpool PCT (If you don’t have an Athens password and are eligible you can get one here).  Content in this issue is detailed below:

• Editorial

• The paradigm shift in healthcare — Overcoming challenges in giving patients access to their electronic records

• Alcohol screening and brief intervention by community pharmacists: Benefits and communication methods

• How Blue Cross and Blue Shield of Florida use Personal Health Reports to inform and educate its members

• Using videotaped objective structured clinical examination as a tool for reflection on communication skills

• Educating a new profession: Developing the communication and information management skills of health information specialists

• Engaging patients to understand and improve their experience of attending hospital

• Understanding and defining roles in the pharmacist–patient relationship

• NHS Direct — What challenges has it faced and how have they been overcome?

• Educating older adults to avoid harmful self-medication

If you need any training in using this or any other electronic resource and you work for Liverpool PCT use the contact form below to contact the library.