Americas Strategic Future: A Blueprint for National Survival in the New Millennium (Contributions in

Recent Titles in Contributions in Military Studies Explorations in Strategy Colin M. Ward America's Strategic Future: A Blueprint for National Survival in the New.
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Indeed, it has been shown that understanding of MDGs among public health professionals was limited 14 , This general lack of information and awareness represents an important challenge. There is an absolute need for more elaborate publicity and awareness about the MDGs among key players if attaining the MDGs is to be a reality But to keep those pledges credible, we must deliver on previous commitments. As reported above, almost countries engaged themselves and provided substantial contributions to the cause. However, these commitments have not been always fully fulfilled.

Engagement by governments and donors in general has been deeply affected by the global economic and financial crisis that has seriously undermined progress towards poverty reduction and MDGs achievement in general, from on. Furthermore, not only governments but also the private sector plays an essential role in the development of the global partnership. Up to now, more than half of the services used for MDGs have been provided by private sources and the role of the private sector is intended to be boosted in the next period. Thus, it is of primary importance that governments and the private sector work together to mobilize more resources to achieve the MDGs and counter the negative effect that the global financial crisis may have on the targets attained and future achievements 35 , Those investments should be sustainable over a long period and predictable, and innovative financing mechanisms might be taken in account Accountability must be an essential part of the framework.

A few studies have underlined the problem of corruption in relation to the use of MDGs resources by governments and other organizations 14 , 18 , 37 , A health care system in a corrupt environment is weak and unstable, and it will be important for the post period to find solutions to address both the health and the governance aspects of the development agenda at the same time. Emerging governance models can allow larger citizen participation, ownership and influence, as well as intersectoral action.

The participation of civil society and its accountability is essential for a strong new policy development and implementation process 30 , 39 , Last but not least, goal measurement is often too narrow, or might not identify a clear means of delivery A lack of scientifically valid data on some MDGs, such as MDGs 5 and 6, did not allow the improvement achieved to be measured adequately or to be compared with a baseline Government reports have sometimes been criticized as false and government-driven, leading to a lack of confidence into the official reporting systems 14 , 18 , 37 , More and better data are definitely needed, especially relating to the poorest and most vulnerable people.

However, even the limited data systems available in some developing countries have allowed the making of assessable investments in education, health, essential infrastructure and environment Indeed, MDGs have not fully addressed the large concept of development included in the Millennium Declaration, which comprises human rights, equity, democracy and governance A post slowdown must be avoided. The Millennium Declaration is still valid and the work should be finalized. To fully address this, the new targets, whatever they will be called, should follow the new political situation and include the emerging countries.

The framework adopted for the MDGs should be adapted to today's needs: The notion of good health is progressing, shifting towards a people-centred approach to create and preserve good health and well-being rather than preventing and treating diseases. Health is now a societal issue of the global community and should be considered as a global good Health systems should be able to adapt to more complex expectations and new health and environmental challenges. New ways are emerging to improve health: In this way, marginalized people can also be integrated in the debate A strong emphasis might be placed on the importance of learning and sharing knowledge and experiences of best practices The post health agenda should also include specific sustainable health-related targets as well as take an all-inclusive approach to preserving people's health for the entire lifespan.

As a first step, the current MDGs targets should be achieved and new targets should be adopted for addressing, e. Equity and education should be considered as the base of health and incorporated in all targets. Indeed, improving people's health and quality of life cannot be achieved by focusing only on the health sector, but requires action to address the wider socioeconomic issues that influence how people live and get sick, including risk factors, services availability and accessibility, etc.

These conditions depend on the distribution of resources and power at local and global levels. Global health diplomacy is nowadays focusing on the development of such a framework, thus incorporating health as a part of all policies or, on the other hand, starting from health to drive policies to protect national security, free trade and economic advancement. Health should be perceived as an investment and not only as a cost 44 , Accountability remains of primary importance.

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On one hand, better data will be required to allow transparency, proper evaluation and improvements. The north—south division is no longer applicable; NCDs such as obesity are affecting all, independently of their country income, with a negative impact not only on human well-being but also on national productivity. Any future health goal must be universally relevant; however, targets and indicators must be adaptable to a country's health priorities and needs and regional differences should be considered 14 , The role of governments internationally and at the local level, including in areas such as health workforce recruitment and supply and production of products for health e.

On one side, low and lower-middle income countries 23 should be able to mobilize local resources and improve in-country productivity as well as bring innovations and solutions that are more suitable for emerging countries. On the other side, rich countries should contribute more to the UN system. These targets should be global social contracts between governances and societies, and the concept of social responsibility, lacking for the MDGs, should be included.

A more efficient partnership among the different agencies could be envisaged, reducing to a few effective organizations the numbers of agencies involved. The dynamic between the actors should change: The private for-profit commercial companies and not-for-profit [e. Bill and Melinda Gates Foundation 49 ] sector is the only one that can afford the huge cost associated with this framework: Moreover, the private sector should not be considered only as a donor but be embedded in the path, taking advantages of the capabilities offered by the sector.

Everyone who has a cause wants a goal: A careful consideration of all aspects in the due time would most probably lead to better definition of the goals. Most of the discussions are focusing on two types of comprehensive goals for health: UHC and access could represent a successful model to achieve health goals and improve people's health at large To achieve UHC, health services and infrastructures as well as coverage with financial risk protection should be guaranteed to everyone Maximizing HALE could be the other health goal.

To achieve this aim, we should be able to ensure that people not only survive but enjoy good health throughout their lifespan 46 , Both goals are linked and interconnected: Debates about post-MDG targets and linkages with SDGs are now on going with in-country and thematic consultations, including, e. Regardless of which overarching targets will be selected, the goals must be translated into measurable indicators; accountability and regular reviews of progress should be easy to perform, to share and to be understood by governments and the general public A multisectoral approach will be essential, integrating the social determinants of health and with a main focus on equity, education and poverty reduction.

The MDGs have focused world attention on the needs of the poorest and driven countries and donors commitments to the achievement of common goals. A post slowdown must be prevented. A new round of goals is now under definition, aiming at fully addressing the large concept of sustainable development included in the Millennium Declaration.

A new framework, an intersectoral approach and strong commitments by governments and donors would be of primary importance to define effective goals and translate them into reality. Globalisation, Equity, Impact, and Action. More papers from this issue can be found at http: The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

National Center for Biotechnology Information , U. Journal List Glob Health Action v. Published online Feb This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract The Millennium Development Goals MDGs are eight international development goals to be achieved by addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership.

Millennium Development Goals, sustainable development, equity, education, accountability, governments, post agenda. Open in a separate window. MDGs achievements and failures To assure an appropriate monitoring and evaluation within and among countries and to conceive suitable policies and interventions, reliable, timely and internationally comparable data on the MDG indicators are of primary importance. Share of poorest quintile in national consumption World Bank Target 2.

Halve, between and , the proportion of people who suffer from hunger 4. Ensure that, by , children everywhere, boys and girls alike, will be able to complete a full course of primary schooling 6. Eliminate gender disparity in primary and secondary education, preferably by , and in all levels of education no later than 9. Only 7 left in stock - order soon. Van Tuyll The Netherlands and World War I: Paperback Hardcover Kindle Edition.

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There's a problem loading this menu right now. Get fast, free shipping with Amazon Prime. Your recently viewed items and featured recommendations. View or edit your browsing history. However, they suggest that this would be followed by a three-year focused programme.

In America, this would replace their traditional fellowship and could include clinical training. During this period of training each resident would be required to focus on one or perhaps two subspecialty areas. There may be organisational challenges to obtaining subsequent clinical experience during subspecialty training although this could be on the basis of supernumerary status which would provide clinical exposure without taking clinicians resident positions, but gaining a sound clinical base prior to starting radiology is entirely possible given the acquiescence of national policies.

Additional clinical experience should follow a structured curriculum individualised for each subspecialty. There is a fundamental requirement to increase the exposure of medical students to imaging taught by radiologists. Presently, the number of radiologists involved in undergraduate training is low. There are a number of initiatives that have been developed in Europe for increasing the teaching of radiology at undergraduate level and these should be further promoted. Teleradiology is now an established method of providing radiological services.

Teleradiology is also established for the provision of radiological services to remote rural communities and for sub-specialist opinions and for specialist case transfers. In the UK it is now used to provide primary reporting services from centres both in Europe and by international providers. With the costs of data transmission decreasing as fast as the costs of computing power, practical opportunities for global teleradiology are rapidly increasing as the cost effectiveness of PACS and digital radiology increases. In our financially constrained world, the clinical losses associated with generalised use of teleradiology may be accepted by governments and health care insurers as a means of cost containment [ 1 ].

However, exchanges of information with referring physicians in conferences or reading rooms are an integral part of delivering a clinical radiological service. It would be a great loss to the profession if radiologists were to be identified by other physicians and patients only as image readers sitting exclusively in front of workstation screens and ceasing to be clinicians [ 1 ].

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The obligation or responsibility or opportunity of a radiologist to go beyond the dictated report and to offer consultant services to his or her clinical colleagues is what allows the specialty to be more than a technical service. This will be even more significant as computer-assisted diagnostic programmes extend to more body parts.

If a radiologist provides nothing more than an observation of abnormal densities, radiology will be minimised or eliminated [ 8 ]. Similarly the role of laboratory medicine was minimised when chemical autoanalyzers provided results cheaply and accurately and the printed values were significant to the referring physician without any interpretation or consultation with a laboratory physician.

With so many technological advances it is not surprising that radiology utilisation of high-cost studies such as CT and MR is expanding rapidly worldwide. This has resulted in a larger and more complex workload. However the number of radiologists worldwide has not increased at the same rate as the number of examinations. Radiologists have only been able to manage this increase by improved workflow and productivity due in part to digital technology. Digital imaging, workstations, speech recognition technology, PACS and ease of communication via the internet have all facilitated workflow.

Teleradiology may increase productivity in some circumstances such as night cover in smaller practices and provision of radiology reporting services to rural communities. It has also been used in some countries to compensate for manpower shortages and when used in a proactive and controlled fashion may help to avoid loosing turf to clinical colleagues. It is not however the ultimate solution to manpower problems which are better resolved by training sufficient radiologists to provide the service within the locality of the clinicians and patients.

Teleradiology must not be allowed to commoditise imaging services and should only be used to support the comprehensive diagnostic service provided by radiologists within groups or local area networks. Radiological societies maintain and radiologists do not publicly disagree that to improve the public perception of the role radiologists play in patient care, closer contact with patients is essential [ 9 ]. Radiological services are essential to the care of patients. To the patients, however, radiological services may seem somewhat inconvenient, mysterious or frightening, or may even be a painful intrusion of their privacy.

The perception is further altered by the fact that patients typically do not choose their radiologist; the referring physician, the health plan or another intermediary usually makes that choice. Often patients and their diagnostic radiologist never meet. This situation substantially alters the service bond between them, actually making the relationship more demanding in a number of ways [ 10 ].

Moreover, nurses, technologists and others are increasingly participating in the performance of imaging examinations. For many patients, radiologists are identified only with the equipment used and not as physicians who play a vital role in the decisions that affect them. The use of technologists, nurses, and physician assistants for intravenous injection of contrast material makes radiologist-patient contact even less common [ 2 ]. Patients believe that the clinician who requested the examination and has received the report is actually the physician who has interpreted the study [ 2 ].

On the other hand, there is widespread agreement that patients prefer to hear the results of imaging examinations from the radiologist at the time of the procedure rather than to hear them later from the referring physician, regardless of the findings [ 11 ]. And in another study it has been shown that radiologists and referring physicians alike tend to support the proposition that, if asked, radiologists should disclose the results of imaging studies to patients [ 12 ]. It seems to be important for the future of the specialty for radiologists to have more contact with patients in the setting of high-cost, high-impact imaging procedures.

The very position of radiology in a variety of hierarchies ranging from political to economic may depend on increased recognition by the public of radiologists as physicians.

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However, results of a survey by Margulis and Sostman [ 2 ] show that more than a half of the injections of contrast medium in radiological practices are performed by non-physicians. Radiologists are often but by no means always present in the facility during performance of the study and radiologists rarely introduce themselves to the patient.

Radiologists should always introduce themselves to patients before any interventional procedure. Primary care is the point of first patient contact and offers continuous comprehensive and coordinated care to populations undifferentiated by gender, disease or organ system. In order for comprehensive care to take place in the primary care setting, the GP often requires access to a wide range of imaging services. This enables the GP to diagnose and treat the more common diseases without recourse to hospital services.

It also empowers the GP to investigate the patient more fully so that, if a transfer to a hospital specialist is required, such referral can, in many cases be for therapeutic care rather than for further investigation. A GP may wish to work up a patient more fully in conjunction with the clinical radiologist, who may be a sub-specialist or a radiologist with special interests, so that the requirement for outpatient referral to specialty services may be avoided or may be a more focussed and constructive consultation.

For such a means of referral to be effective, the radiologist will need to establish preferred investigation pathways with the clinicians to whom ultimately the patients may be referred. Finally, the GP may be able to treat a patient directly with the assistance of the radiologists and some image-guided therapeutic procedures can be undertaken by radiologists directly for GPs on an outpatient, day-case or short-stay basis.

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In the past the workload of departments of radiology was concentrated primarily on supporting the care of hospital patients and on providing imaging services for outpatients attending consultant clinics. The concept that expensive investigation should be limited to clinical specialists is not sustainable. Specialists and GPs should have similar rights to request examinations.

This is particularly highlighted with MRI or CT, where a single examination may avoid the need for an outpatient visit or an invasive procedure, which would cost considerably more. If GPs are undertaking primary diagnosis and management of patients, then clinical radiologists are acting as first-line clinicians and it is entirely reasonable for the radiologist to undertake the most appropriate examination. The radiologist also possesses the knowledge and competence to ensure compliance with all aspects of radiation protection and justification of investigations which is particularly relevant regarding CT.

They should therefore recommend additional examinations where appropriate and manage the imaging diagnostic process in conjunction with the primary care clinician. The value of investigation which does not show an abnormality but reduces uncertainty and provides reassurance to the patient and to the GP, should also not be underestimated by the radiologist [ 13 ].

However, radiological investigations available to GPs must be determined by local radiologists in consultation with their GP colleagues as availability of new, often complex investigations may be limited in some countries and areas. Electronic transfer has also developed rapidly over the last few years and the transmission of images and reports between radiology departments and surrounding GPs is now easily undertaken. Closer working relationships with GPs and a stronger involvement of imaging in primary care will also increase contact of radiologists to their patients and particularly raise public awareness.

There has been a tendency in teaching and large regional hospitals for subspecialty services to pursue the development of satellite departments isolating radiologists from each other. While this may be essential in some clinical situations such as emergency departments, it potentially reduces the interaction between sub-specialist radiologists to the detriment of their wider knowledge and technological development. It may also reinforce the desire for clinicians to set up their own units and encourages the concept of radiologists working in clinical groups rather than providing a comprehensive imaging service.


  • Introduction.
  • The future role of radiology in healthcare.
  • Heideggerian Marxism (European Horizons).
  • Funktionelle Bewegungslehre: Therapeutische Übungen: Instruktion und Analyse (Rehabilitation und Prä.
  • Blade Runner/Ubik/Marsianischer Zeitsturz: 3 Romane in einem Band (German Edition).
  • MDGs achievements and failures.

Radiologists should work towards a single strong well-staffed and funded department which is able to accommodate those clinicians who justifiably need prompt access to expert imaging [ 3 ]. The world of radiology is changing rapidly and radiologists have to be proactive in this process to survive. The subject is now too broad and complex for an individual to remain a comprehensive provider.

As a result radiologists need to group themselves as specialists in particular systems or disease-based areas while finding a mechanism to provide a high-quality service. Radiologists must also be clinicians and understand the clinical features, natural history and treatments of the diseases that they are requested to investigate. Therefore, if radiologists want to add value to the chain of healthcare they need to sub-specialise to a greater or lesser extent according to their working circumstances.

Teleradiology services may be appropriate for small and rural practices as part of an area network especially during nights and weekends and for interaction with GPs and patients. Radiologists must also interact more directly with patients and primary care physicians to provide a comprehensive diagnostic and advisory service prior to the patient entering the secondary care service by managing the investigations of the patients themselves.

This will increase efficiency, clinical effectiveness of the service and speed up the referral process. Radiologists in the teaching hospitals will also need to specialise to a higher degree in order to provide a tertiary referral service, communicate and advise clinical experts and to conduct and drive imaging research as true experts in their field. Approved by the Executive Council National Center for Biotechnology Information , U.

Journal List Insights Imaging v. Published online Jan European Society of Radiology European Society of Radiology , Email: Received Nov 30; Accepted Nov This article has been cited by other articles in PMC. Abstract Rapidly evolving changes in the way that healthcare is administered, coupled with the amazing recent advances within imaging, has necessitated a review of the way in which radiology should be regarded. Radiology, Training, Subspecialisation, Teleradiology, Interventional radiology.

Introduction Radiology has been a distinct medical specialty with unique technical challenges from its inception. The need for change Numerous facilities in clinical services are collectively used by different specialties: Specialisation in radiology One solution has been a gradual increase in the degree of specialisation of radiologists along systems and disease-related specialties, which has been strongly advocated by the ESR in its curriculum.

It now separates radiologists, following training to a core level in all aspects of radiology including all techniques, into two main categories: Radiologists who have additional dedicated training to provide special interests in two or possibly three system-based specialties. Radiologists who have subsequently focussed on one field of radiology which parallels a medical or surgical specialty and who work primarily in that subspecialty in secondary or tertiary referral centres.

Reasons for subspecialisation The argument for subspecialisation is strong and a number of factors should be taken into account. Our field has become so complex that no individual can maintain the level of expertise needed to practice the entire field of radiology.