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The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

In recent years, instant messaging platforms like WhatsApp have gained substantial popularity in both academic and practical domains. However, despite this growth, there is a lack of a comprehensive overview of the literature in this field. The primary purpose of this study is to bridge this gap by analyzing a substantial dataset of 12,947 articles retrieved from the Dimensions.ai, database spanning from 2011 to March 2023.

To achieve the authors' objective, the authors employ bibliometric analysis techniques. The authors delve into various bibliometric networks, including citation networks, co-citation networks, collaboration networks, keywords and bibliographic couplings. These methods allow for the uncovering of the social and conceptual structures within the academic discourse surrounding WhatsApp.

The authors' analysis reveals several significant findings. Firstly, the authors observe a remarkable and continuous growth in the number of academic studies dedicated to WhatsApp over time. Notably, two prevalent themes emerge: the impact of coronavirus disease 2019 (COVID-19) and the role of WhatsApp in the realm of social media. Furthermore, the authors' study highlights diverse applications of WhatsApp, including its utilization in education and learning, as a communication tool, in medical education, cyberpsychology, security, psychology and behavioral learning.

This paper contributes to the field by offering a comprehensive overview of the scholarly research landscape related to WhatsApp. The findings not only illuminate the burgeoning interest in WhatsApp among researchers but also provide insights into the diverse domains where WhatsApp is making an impact. The analysis of bibliometric networks offers a unique perspective on the social and conceptual structures within this field, shedding light on emerging trends and influential research. This study thus serves as a valuable resource for scholars, practitioners and policymakers seeking to navigate the evolving landscape of WhatsApp research. The study will also be useful for researchers interested in conducting bibliometric analysis using Dimensions.ai, a free database.

Decree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the effects of the public hospital unions (PHUs), which were a result of Decree Law No. 663, on the efficiency and productivity of public hospitals.

Data envelopment analysis (DEA) and DEA-based Malmquist total factor productivity (TFP) index were used from 2011 to 2016. Raw materials and supply expenses, salaries and fringe benefits, other service costs, general administrative expenses, total number of beds, number of specialists, number of residents, number of general practitioners, number of nurses and midwives and other medical officials were used as input variables. Working capital turnover, number of inpatients, number of outpatients and number of surgical operations for Groups A, B and C were used as output variables.

According to the DEA scores, the percentage of efficient hospitals showed a declining trend from 2011 to 2016. The TFP results also showed a decreasing trend from 2011 to 2016.

Providing administrative and financial autonomy to public hospital managers may cause efficiency and productivity losses, which is contrary to expectations.

This study is the first to reveal the impact of decentralization of public healthcare providers on their performance levels in Turkey.