Set National Targets Research Articles

Chronic challenges: picturing chronic disease by the World Health Organization

Chronic diseases are among the leading causes of mortality in the world, the subject of major regional and international efforts to tackle shared risk factors, implement prevention and control measures...

1120 Time to Revascularisation for Chronic Limb Threatening Ischaemia – Audit of a Major UK Vascular Service

Abstract Aim Chronic Limb Threatening Ischaemia (CLTI) is severe peripheral arterial disease where arterial supply is sufficiently compromised to threaten tissue viability. CLTI has a prevalence of 1-2% and carries significant morbidity and mortality. Early revascularisation is essential for tissue preservation. Recent guidance from CQUIN 2022/23 set national targets for time to revascularisation based on VSGBI guidelines. This audit assessed one major vascular centre’s compliance. Method Audit standards were taken from VSGBI Peripheral Arterial Disease Quality Improvement Framework (PAD-QIF 2019). Data from Imperial College Healthcare NHS Trust was collected from February-April 2022 for inpatients and outpatients presenting with new CLTI. The primary outcome was time to revascularisation from referral. Secondary inpatient outcomes included time to referral, specialist reviews, imaging and discussion at MDT. Results 59 inpatients and 33 outpatients were included. 54% of inpatients and 83% of outpatients who were candidates for revascularisation breached targets: 5 days and 14 days respectively. Of those breaching most inpatients were re-vascularised within 6-10 days; whilst for outpatients the majority were re-vascularised within 46-75 days. At the time of data collection 7 outpatients were awaiting revascularisation, all >5 months since CLTI onset. Conclusions A significant portion of patients are breaching revascularisation targets, increasing risk of poor outcomes. In both pathways delays are multi-factorial. Contributing factors for inpatients include delays in pre-surgery optimisation and bed/theatre slot pressures. For outpatients’ pre-assessment, surgical optimisation, MDT discussion and/or investigations all contribute to delays. Implementation of early anaesthetic optimisation or outpatient one-stop clinics could be considered.

Accreditation of higher education in Denmark and European Union: from system to substance?

ABSTRACTThe Bologna Process was an attempt to build and coordinate OECD countries’ higher education systems through, inter alia, strategic public investment. The Lisbon Strategy 2000–2010 was a continuation of the Bologna process that also highlighted the coordination of education and research based on market-based funding models. Similarly, education and institutional accreditations have focused on the relevance criteria for quality of education and define first and foremost relevance as relevant to the labour market. However, education is a national question and must solve tasks for society in general. Relevance as criteria for quality in higher education should not only include employability, it should also refer to other expectations and demands that society ask for. Education is a public good and should, as a publicly funded system, set national targets for education.

Using census data to measure maternal mortality: A review of recent experience.

The Sustainable Development Goals adopted by the United Nations General Assembly in 2015 (United Nations 2015) set national targets for reducing maternal mortality, putting pressure on governments of countries lacking comprehensive statistical systems to find other ways to measure it. One approach tested since the 1990s has been to collect necessary data through national population censuses. This paper reviews maternal mortality data from the 2010 round of censuses for several countries to determine whether the census is useful for monitoring maternal mortality. Data on births, deaths, and pregnancy-related deaths from two censuses for 10 countries was evaluated using standard methods; adjustments were applied to the reported numbers if so indicated. In general, the censuses underreported births moderately and underreported deaths by larger amounts; except in one case, proportions of pregnancy-related deaths appeared plausible. Adjusted estimates of the pregnancy-related mortality ratio (PRMR) were generally higher than estimates from Demographic and Health Survey sibling data or estimates of maternal mortality developed by cross-national studies. Analysis of recent data confirms results of earlier assessments: Census data provides imperfect but still valuable information on maternal mortality. Data requires careful assessment and often adjustment, resulting in estimates with large uncertainty. This paper provides additional evidence as to whether maternal mortality can usefully be measured by population censuses in countries lacking civil registration data.

Strategies to improve recruitment of people with dementia to research studies

Background Low participation in research is one of the key challenges to advancing understanding of dementia, and improving the care and treatment of those who live with this condition. Nurses and nurse researchers play a vital role in recruiting people with dementia to studies, as several countries including the United States and the United Kingdom set national targets and develop initiatives to encourage more people with dementia to take part in research. Aim To highlight the challenges to recruiting people with dementia to studies, and to identify strategies that nurses, and in particular, nurse researchers can use for overcoming them. Our focus is primarily on the role of nurses in recruiting people with dementia to dementia studies, but much of the discussion will apply to other health professionals involved in the recruitment of people with dementia to research more generally. Discussion Challenges discussed include a lack of awareness about research participation opportunities and a suitable study partner. We discuss how the nurses’ role is to ensure that recruitment practices are personalised and responsive to participants’ needs and situation, rather than target driven. The notion of responsible research is used to anchor the discussion. Conclusion Increasing the participation of people with dementia in research is a global priority. Nurses and nurse researchers play an important role in ensuring that people who take part in research have an optimal research experience. Implications for practice: Recruiting people with dementia to research studies is a national priority in many countries. With a greater understanding of the challenges involved and strategies that can be used to overcome them, nurses can have an effective role in the recruitment process and research experience.

Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice.

Background:Couples' voluntary HIV counseling and testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda.Methods:From 1988 to 1994 in Rwanda, pregnant and postpartum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and sexually transmitted infection rates, particularly among HIV-discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were reintroduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the prevention of mother-to-child transmission program expanded to >400 clinics. In 2009, the GoR adopted joint posttest counseling procedures, and in 2010 a quarterly follow-up program for discordant couples was established in government clinics with training and technical assistance. An estimated 80%–90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections.Conclusions:Rwanda is the first African country to have established CVCT as standard of care in antenatal care. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators, and budgets. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections.

The Global Burden of Cardiovascular Diseases: A Challenge to Improve

There are many challenges that need to be overcome to address the global cardiovascular disease epidemic. They include (1) lack of multisectoral action to support reduction of behavioral risk factors and their determinants, (2) weak public health and health care system capacity for forging an accelerated national response, and (3) inefficient use of limited resources. To make progress, countries need to develop and implement multisectoral national action plans guided by the global action plan for prevention and control of noncommunicable diseases, strengthen surveillance and monitoring systems, and set national targets consistent with global voluntary targets, which are to be attained by 2025. In addition, a set of cost-effective preventive and curative interventions need to be prioritized. Further, resources need to be generated and capacity developed to ensure sustainable country-wide implementation of the prioritized interventions. According to WHO estimates, the implementation of a core set of very cost-effective interventions for prevention and control of cardiovascular disease requires about 4 % of current health spending in lower income countries, 2 % in lower middle income countries, and less than 1 % in upper middle income and high income countries.

Rallying United Nations organizations in the fight against noncommunicable diseases

Rallying United Nations organizations in the fight against noncommunicable diseases

Setting targets for universal access to HIV prevention, treatment and care for injecting drug users (IDUs): Towards consensus and improved guidance

Scaling-up access to HIV/AIDS prevention, treatment and care for injecting drug users (IDUs) has been frustrated by the lack of a framework, indicators and agreed targets for interventions specifically targeting IDUs. Major progress in this regard has been achieved with the recent development of a joint Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users and related technical consultations. This guide provides technical guidance to countries on setting ambitious, but achievable national targets for scaling-up towards universal access (UA). The guide has been developed as a collaboration between the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Office on Drugs and Drugs (UNODC), the World Health Organization (WHO) and with national and international expertise and builds on previous UNAIDS guidelines. The guide serves to provide more consistent methods of measuring and comparing countries’ progress towards universal access and offers consensus as to which interventions should be included in a comprehensive package. It provides guidance on defining and estimating denominator populations and proposes a set of indicators to measure coverage, as well as indicative targets or benchmarks against which to measure progress towards UA. The guide moves on from a narrow focus on coverage that neglects other important aspects of access, namely availability and quality of interventions. Finally, the guide encourages country involvement in, and ownership of, what are sometimes perceived as politically motivated coverage targets. Technical consultations, with country experts using the guide to set national targets, suggested a tendency for targets to be proposed that are achievable but fall short of what is required to achieve universal access and have a real impact on HIV/AIDS epidemics. Consensus and improved guidance on achieving universal access needs to be supported by political will, good leadership and, in some countries, remedies to inadequacies in health systems.

Nutritional health project: “putting food on their agenda”

The Health of the Nation set national targets for improving the health of the population and identified five key areas for action, one of which was heart disease. Particular reference is made within the coronary heart disease key area to diet and the need for dietary change if coronary heart disease and stroke targets are to be met. In order to achieve these targets people have to feel comfortable with healthy eating and exercise programmes. The “Putting food on their agenda” project looks at targeting a deprived area in Middlesbrough in the North of England, providing a practical down to earth approach, looking at the problem from the point of view of the people, not the health professionals.