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PubMed1996

Measuring competencies: development of the administrator competency survey.

Competency assessments is critical for nurse managers who must move between and among health care settings. This article reports development of a survey tool to measure administrative competencies to facilitate career movement based on competencies versus traditional structure of education and experience. The study was designed to determine specific competencies that were deductively derived and considered essential for successful leadership in the year 2000. These included eight domains: quality improvement, shared visions, global approach, serving community, mastering change, team learning, managing customer relationships, and managing a diverse workforce. The tool was used to measure nurse administrator competency in a select group. Results identified expertise and targeted priorities for training and improvement.

Adult↗
PubMed1996

Third molar surgical procedures: practices by maxillofacial and oral surgeons in South Africa.

An audit of the treatment procedures routinely adopted by maxillofacial and oral surgeons for the removal of impacted third molars under general anaesthesia was undertaken in South Africa. Most maxillofacial and oral surgeons agree on the method of bone removal, the prescribing of antibiotics, analgesic agents and mouthwashes, the suturing of the incision wound and the post-operative review of patients. The results were compared to a similar study undertaken by Falcon and Roberts (1992) in the UK. With the exception of the method of bone removal, maxillofacial and oral surgeons in both groups share a similar approach to the treatment procedures adopted in the removal of impacted third molars. Some variability, however, existed in both studies with regard to the use of intra-operative local anaesthetic agents, the administration of peri-operative steroids and the use of non-steroidal anti-inflammatory agents.

Adolescent↗
PubMed1998

Health information multitype library reference referral networking: panacea for the '90s.

Librarians are exploring new approaches to information sharing to cope with a rapidly changing environment dominated by budget cuts, information explosion, and globalization of the economy, science, and culture. In 1990, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a pilot project aimed at establishing an effective balance between state-of-the-art information technology and traditional library methods and promoting cooperation among health information professionals by establishing the Health Information Referral Network (HIRN) in the state of Illinois. HIRN's background and development, Internet home page, and networking techniques reviewed in this paper are applicable to multitype libraries and information centers interested in improving information use and the referral process.

Computer Communication Networks↗
PubMed1999

Developing shared understanding through simulation.

In this article relevant key findings of a review of selected published work are used to provide a foundation for a new approach to developing a shared understanding of aspects of health care delivery. The new approach makes use of simulation models. It is hoped that this approach will provide support for improved decision-making and for the development of more appropriate enabling tools.

Community Health Services↗
PubMed1999

Diabetes management: shared care or shared neglect.

Shared care is increasingly being advocated as a way of managing patients with diabetes. While this approach has been supported by clinical trials, the success of shared care in 'real life' is not well established. If health care professionals leave undone what they think is done by others, shared care can become neglected care. Follow up of 200 'shared care' patients who had been referred to the Royal Prince Alfred Diabetes Centre, Sydney, Australia on two or more occasions between October 1995 and September 1998 showed that the majority of specialist recommendations regarding metabolic control (76%), referral to an ophthalmologist (73%) and blood pressure treatment (76%) had been implemented by the primary care physician; however, they were less likely to implement recommendations regarding lipid treatment (55%). The median HbA1c (7.6% vs. 8.4%; P = 0.04), cholesterol (5.6 vs. 6.8 mmol/l; P = 0.0005) and triglyceride (2.0 vs. 2.8 mmol/l; P = 0.05) levels for patients in whom recommendations had been implemented were significantly lower at the time of second referral. Doctors registered with the Diabetes Shared Care Programme and those who wrote longer letters were more likely to implement recommendations than their counterparts (87.2%, versus 70.9%; chi2 = 4.12, 1 df; P = 0.04 and 56 words (inter-quartile range (IQR): 36-71) versus 45 words (IQR: 23-59); P = 0.02, respectively). It therefore appears that diabetes care can be well provided by a shared care approach. However, further monitoring of different shared care models is warranted.

Australia↗
PubMed2006

Shared learning in primary care: participants' views of the benefits of this approach.

This is a study exploring participants' views regarding a series of shared or interprofessional learning sessions carried out in a primary care setting in Bradford, UK. One-hundred-and-twenty-four participants including doctors, practice nurses, nurse practitioners and health visitors attended six expert-led, case-based learning sessions on clinical topics relevant to their work. The evaluation of the sessions is presented, from questionnaire feedback including open responses. Participants had high expectations of shared learning, which was largely met in terms of sharing ideas regarding professional roles and sharing clinical knowledge and skills. Variations between professionals, and between sessions, are noted and discussed. It was concluded that shared or interprofessional learning in the workplace is valued by clinicians, can help improve understanding of professional roles and also enhance clinical learning.

Adult↗
PubMed2004

Every cloud has a silver lining: interpersonal and individual differences determinants of anger-related behaviors.

Two studies examined the effect of status and liking of the anger target on anger behavior and individual differences in anger-related behavior. Participants recalled anger instances in which the anger target was of higher/equal/lower status and/or liked/ unfamiliar/disliked; subsequently, they indicated which behaviors they had displayed. In both studies, anger behaviors could be grouped into behaviors that imply approaching the target (anger-out, assertion, reconciliation) and behaviors that reflect avoidance/anger-in or social sharing. The results demonstrated that approach behaviors more likely occur toward lower status or liked targets; avoidance behaviors and social sharing more likely occur when the target is of higher status or disliked. On an individual differences level, an approach and an avoid/social sharing person class were identified. The findings suggest that anger may motivate prosocial behavior or social sharing, depending on the individual and type of relation with the target. Only few gender differences were found.

Adolescent↗
PubMed1999

State of the nation: therapeutic jurisprudence and the evolution of the right of self-determination in international law.

This article expands the scope of the therapeutic jurisprudence enterprise and applies the concept at a collective global level. The right of self-determination, arguably the most important and certainly the most controversial part of international law, is examined through the lens of therapeutic jurisprudence. By detailing the manner in which nations move towards their goal of statehood, this article opens up dialogue about collective healing, shared memory and alternative approaches to autonomy. The article poses the question of whether groups of people can share in common delusions, forms of folie a gens.

Freedom↗
PubMedDate not supplied

Predictors of sharing drugs among injection drug users in the South Bronx: implications for HIV transmission.

HIV may be transmitted in the process of sharing injected drugs, even if all participants have their own syringes. In an effort to gain understanding of the extent and predictors of drug sharing, data were obtained via personal interviews with 1,024 injection drug users from four neighborhoods in the South Bronx. The relationship between drug-sharing and demographic, sexual, and drug-related variables was first examined in a bivariate analysis, and then via multiple logistic regression. Individuals who split drugs were more likely to be female, have had sex with a casual partner, exchanged sex for drugs or other needs, recently smoked crack cocaine, and shared needles. They were less likely to live or inject at their own home or have used a new needle the last time they injected. In a final logistic model, correlates of drug sharing included trading sex, injecting outside one's home, and using borrowed, rented or shared needles. Despite the lack of significance for gender in the final logistic model, females were at high risk of drug sharing because they constituted the great majority of those who exchanged sex. Continuing research is needed to understand how drug-sharing contributes to the spread of HIV and other infections, as are studies of approaches to reducing drug sharing. Prevention strategists and outreach organizations should be aware of the HIV risks inherent in the widespread practice of drug sharing.

Adult↗
PubMed2002

A phylogenomic approach to bacterial phylogeny: evidence of a core of genes sharing a common history.

It has been claimed that complete genome sequences would clarify phylogenetic relationships between organisms, but up to now, no satisfying approach has been proposed to use efficiently these data. For instance, if the coding of presence or absence of genes in complete genomes gives interesting results, it does not take into account the phylogenetic information contained in sequences and ignores hidden paralogies by using a BLAST reciprocal best hit definition of orthology. In addition, concatenation of sequences of different genes as well as building of consensus trees only consider the few genes that are shared among all organisms. Here we present an attempt to use a supertree method to build the phylogenetic tree of 45 organisms, with special focus on bacterial phylogeny. This led us to perform a phylogenetic study of congruence of tree topologies, which allows the identification of a core of genes supporting similar species phylogeny. We then used this core of genes to infer a tree. This phylogeny presents several differences with the rRNA phylogeny, notably for the position of hyperthermophilic bacteria.

Computational Biology↗
PubMed2006

Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA study.

OBJECTIVES: To compare in terms of efficacy and safety the transulnar to the transradial approach for coronary angiography and angioplasty. BACKGROUND: Opposite to the transradial approach, which is now widely used in catheterization laboratories worldwide, the ulnar artery approach is rarely used for cardiac catheterization. METHODS: Diagnostic coronarography, followed or not by angioplasty, was performed by transulnar or transradial approach, chosen at random. A positive (normal) direct or reverse Allen's test was required before tempting the radial or the ulnar approach, respectively. MACE were recorded till 1-month follow-up. Doppler ultrasound assessment of the forearm vessels was scheduled for all the angioplastied patients. RESULTS: Successful access was obtained in 93.1% of patients in the ulnar group (n = 216), and in 95.5% of patients in the radial group (n = 215), P = NS. One hundred and three and 105 angioplasty procedures were performed in 94 and 95 patients in ulnar and radial group, with success in 95.2% and 96.2% of procedures in ulnar and radial group, respectively (P = NS). Freedom from MACE at 1-month follow-up was observed in 93 patients in both groups (97.8% for ulnar group and 95.8% for radial group), P = NS. Asymptomatic access site artery occlusion occurred in 5.7% of patients after transulnar and in 4.7% of patients after transradial angioplasty. A big forearm hematoma, and a little A-V fistula were observed, each in one patient, in the ulnar group. CONCLUSION: The transulnar approach for diagnostic and therapeutic coronary interventions is a safe and effective alternative to the transradial approach, as both techniques share a high success rate and an extremely low incidence of entry site complications. The transulnar approach has the potential to spare injury to the radial artery in anticipation of its use as a coronary bypass conduit.

Adult↗
PubMed1998

The logic of job-sharing in the provision and delivery of health care.

By definition the practice of job-sharing starts from the premiss that there is a full-time job to be shared by those who want to balance their work with other commitments. In a public sector institution, such as the National Health Service (NHS), where most employees are female, it seems logical to believe that a job-sharing policy would be able to promote equal opportunities, to increase employee job satisfaction and to reduce labour costs. Hence, this paper attempts to discuss the advantages and disadvantages of having a job-sharing policy, and to analyse the reasons for the limited number of job-sharers in the NHS despite the apparent benefits of job-sharing to both the employees and the employer. This study was carried out in 15 NHS Trusts in northern England and Scotland, by the use of questionnaires and interviews, and found that most NHS managers did not see the practice of job-sharing as a major cost-saving opportunity or as a working pattern that would enhance employee satisfaction and commitment. They saw job-sharing as just a routine equal opportunities request which did not deserve such managerial attention or long-term strategic thinking. It is argued in this paper that job-sharing is a potentially useful option against a background of demographic and other social and economic changes which require the development and use of long-term strategic policies. Therefore, it is concluded that, in the NHS, there is a need for a more active and creative approach to job-sharing, rather than the reactive and passive approach that has dominated the practice so far.

Career Mobility↗
PubMed1998

The logic of job-sharing in the provision and delivery of health care.

By definition the practice of job-sharing starts from the premiss that there is a full-time job to be shared by those who want to balance their work with other commitments. In a public sector institution, such as the National Health Service (NHS), where most employees are female, it seems logical to believe that a job-sharing policy would be able to promote equal opportunities, to increase employee job satisfaction and to reduce labour costs. Hence, this paper attempts to discuss the advantages and disadvantages of having a job-sharing policy, and to analyse the reasons for the limited number of job-sharers in the NHS despite the apparent benefits of job-sharing to both the employees and the employer. This study was carried out in 15 NHS Trusts in northern England and Scotland, by the use of questionnaires and interviews, and found that most NHS managers did not see the practice of job-sharing as a major cost-saving opportunity or as a working pattern that would enhance employee satisfaction and commitment. They saw job-sharing as just a routine equal opportunities request which did not deserve such managerial attention or long-term strategic thinking. It is argued in this paper that job-sharing is a potentially useful option against a background of demographic and other social and economic changes which require the development and use of long-term strategic policies. Therefore it is concluded that, in the NHS, there is a need for a more active and creative approach to job-sharing rather than the reactive and passive approach that has dominated the practice so far.

Attitude of Health Personnel↗
PubMed1983

The ecology of infectious and neoplastic disease: a conceptual unification.

The ecology of disease is framed in conceptual terms as the study of the relationships of entities and events in the natural history of disease, a definition allowing it to embrace both the infectious and neoplastic (i.e. chronic, non-infectious) diseases. Those relationships of most conceptual interest and operational relevance are the causal relationships, and thus the ecology of disease properly embraces both epidemiologic and pathologic theory. The classic epidemiologic triad of 'agent-host-environment' is integrated into hierarchical, natural historical frameworks embracing both disease causation and course. Within these ecologic frameworks and based upon discipline-related concepts of causation, it is possible to derive conceptual/operational criteria of causality applicable to both infectious and neoplastic diseases. As approaches to the comprehension of infectious and neoplastic disease share considerable conceptual common ground, it follows that approaches to their control share considerable operational common ground. Indeed, insofar as actions follow ideas, the ecology of disease provides the basis for medical ecology and the planning, conduct and evaluation of overall operational approaches to the control of disease, to include both preventive and therapeutic interventions. From these perspectives, contemporary approaches to the control of neoplastic diseases seem to be derived largely from clinical-pathologic viewpoints of effectual disease process and emphasize non-specific (agent-unrelated) therapeutic interventions. Those general approaches most successful in controlling infectious diseases (i.e. preventive interventions and agent/defect-specific therapeutic interventions) need greater emphasis and application in approaches to controlling neoplastic diseases.

Animals↗
PubMed2005

High throughput screening in agrochemical research.

The demand for new herbicides, insecticides and fungicides led to a steady increase in the number of compounds being tested to find novel market products. To keep pace with the rising workload, high throughput screening (HTS) technologies have been introduced. In agrochemical research miniaturised in vivo tests on whole real target organisms are now possible and are an integral part of the screening cascade. A complementary target based in vitro HTS has also been established in agrochemical research. Target based HTS allows a directed approach towards untouched market shares by novel modes of action. Selection of the best suited targets is the most crucial issue in this approach. Genomic methods thereby deliver many essential genes as candidate targets. Consideration of further criteria such as druggability notably narrows down the number of promising targets. Though target to hit to lead progression still is as in pharmaceutical research a complex and therefore risky process, the implementation of novel bioscience technologies has entailed the transition to an integrated innovative agrochemical research perspective.

Agrochemicals↗
PubMed2003

Priority setting in surgery: improve the process and share the learning.

Surgeons and surgical programs encounter priority-setting challenges every day, such as in regard to purchasing new technologies or managing waiting lists for elective surgery. The purpose of this paper was to explore priority setting in surgery. Traditionally in surgery, priority-setting decisions for new technologies have been based on evidence of effectiveness and cost-effectiveness; and decisions about managing waiting lists for elective surgery have been based on urgency rating scores. The fairness of priority-setting processes in surgical programs should be enhanced to permit all relevant information and values to be considered. The quality of these decisions can be improved by using an approach that captures and shares lessons from each priority-setting experience. The approach we propose in this paper- describe, evaluate, and improve using a leading conceptual framework for priority setting, called "accountability for reasonableness"-can be used by any surgical program to improve its priority setting, share lessons with others, and develop an evidence base for how these important health policy decisions should be made.

Biomedical Technology↗