Suchergebnisse

Intro -- Foreword -- Foreword -- Preface -- Acknowledgment -- Contents -- Contributors -- Part I: Hospital Transformation and Academic Health Systems -- 1: The New Medical World Order: Not So Flat -- Introduction -- Is the Medical World Flat? -- Two Faces of Medical World -- Summary -- References -- 2: Five Transformative Episodes in the History of the American Hospital -- An Arrogant First Year Medical Student -- What Is a Hospital? -- Episode 1: The Creation of Public Poor Houses in the United States and How They Evolved into Tax-Supported Hospitals -- Episode 2: The Rise of Roman Catholic Hospitals in the United States -- The Origins of Roman Catholic Hospital in the United States -- What Is a Roman Catholic Hospital? -- The Impact of the Expansion of the Market Share of Roman Catholic Hospitals on US Health Care -- Episode 3: The Rise and Fall of the American Jewish Hospital -- The Stuyvesant Pledge and the Colonial Origins of the American Jewish Hospital -- Other Causes for the Creation of American Jewish Hospitals -- The Rise of the American Jewish Hospital -- The Fall of the American Jewish Hospital -- Why Did They Disappear and Does It Matter? -- Episode 4: Litigation and the Desegregation of Southern Hospitals -- Episode 5: Changes in the Relationship of the American Hospital to Undergraduate Medical Education -- Conclusions -- References -- 3: Hospital and Healthcare Transformation over Last Few Decades -- Physician-Hospital Relationship -- From Supply-Driven to Patient-Driven System -- The Core of Value Transformation -- Summary -- References -- 4: Navigating and Rebuilding Academic Health Systems (AHS) -- Introduction -- Health Policy: Regulatory Challenges in Today's Environment -- Healthcare Finance: Financial Modernization, Mergers and Acquisitions, and Cybersecurity -- Building New or Rebuilding Clinical Department as Part of AHS.

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care—from prevention to acute care to rehabilitation. Integration of the various healthcare systems—governmental, non-governmental and military—is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds—trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration—creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030—healthcare and economic milestones—require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders—from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres—both healthcare and economic—can facilitate achieving the 2030 UN SDGs.