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At least 1,009 records · Page 56Linked to original sources
PubMed2004

[The management strategy of the Brazilian National Network of Human Milk Banks].

The Brazilian National Network of Human Milk Banks (REDEBLH), with its headquarters in the Oswaldo Cruz Foundation in Rio de Janeiro, is experiencing rapid growth. The Network's activity has been acknowledged by the World Health Organization and received the Sasakawa Health Award in 2001 for best public health project. One of the main challenges is to ensure continuing development of competencies to respond to the needs arising from such growth. A new strategy is being pursued to deal with the Network's management issues. This article aims to develop a conceptual framework to contribute to the elaboration of a theoretical framework for new management strategies in the REDEBLH. Using such concepts, the aim is to draw on the typology of networks described in the specialized literature to identify the institutional profile of the REDEBLH. Based on the understanding that it is necessary to identify and understand the processes occurring within networks, and after which to consider management-related issues, the study used a proposal developed for the formation of innovation networks as its analytical tool.

Brazil↗
PubMed1993

Positioning hospitals: a model for regional hospitals.

In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example.

Georgia↗
PubMed2005

Influence of community experiences on first-year medical students' reflective writing.

The purpose of this research was to investigate the usefulness of providing students with community-located experiences as a basis for reflection by observing the degree to which community-located experiences influenced the quality of a reflective writing exercise. Students were prepared for reflection by means of a lecture and a handout on the meaning, function and process of reflection. One hundred and twenty-eight students (66 Afrikaans-speaking, and 62 English-speaking) took part in the study. Initially, most students (71%) who revealed affect prior to the visit reported negative emotional states. For 54% of the students who revealed emotions upon arrival, positive emotional states replaced the negative and this increased to 67% as the visit continued. This represented the most important stage of the personal growth continuum, signifying awareness of perspective 'distortions'. The majority (94.3%) regarded the visit as being important prior to immersing themselves in the theory of primary healthcare. In the questionnaire survey, students were asked for their opinions on the value of reflective writing as a tool for promoting deep learning, as students' attitudes were considered an important determinant of increased uptake of this kind of activity. Reflective writing can be promoted through using a real-world experience as stimulus, and a framework for guiding students' thoughts.

Adult↗
PubMedDate not supplied

Looking at families in nursing research: strategies for study design.

Pediatric nurses have identified the importance of studying children within the context of their families. There have been calls for attention to the family as the focus of study and unit of analysis in nursing research. One of the most important strategies for designing a study that keeps the focus on the family is the maintenance of study integrity. All the strategic choices made by the researcher when developing the research design need to reflect the theoretical premises on which the study is built. Throughout the study design, components of well-constructed family research will demonstrate consistency with the overall conceptual framework.

Child↗
PubMed2005

A performance assessment framework for hospitals: the WHO regional office for Europe PATH project.

OBJECTIVE: The World Health Organization (WHO) Regional Office for Europe launched in 2003 a project aiming to develop and disseminate a flexible and comprehensive tool for the assessment of hospital performance and referred to as the performance assessment tool for quality improvement in hospitals (PATH). This project aims at supporting hospitals in assessing their performance, questioning their own results, and translating them into actions for improvement, by providing hospitals with tools for performance assessment and by enabling collegial support and networking among participating hospitals. METHODS: PATH was developed through a series of four workshops gathering experts representing most valuable experiences on hospital performance assessment worldwide. An extensive review of the literature on hospital performance projects was carried out, more than 100 performance indicators were scrutinized, and a survey was carried out in 20 European countries. RESULTS: Six dimensions were identified for assessing hospital performance: clinical effectiveness, safety, patient centredness, production efficiency, staff orientation and responsive governance. The following outcomes were achieved: (i) definition of the concepts and identification of key dimensions of hospital performance; (ii) design of the architecture of PATH to enhance evidence-based management and quality improvement through performance assessment; (iii) selection of a core and a tailored set of performance indicators with detailed operational definitions; (iv) identification of trade-offs between indicators; (v) elaboration of descriptive sheets for each indicator to support hospitals in interpreting their results; (vi) design of a balanced dashboard; and (vii) strategies for implementation of the PATH framework. CONCLUSION: PATH is currently being pilot implemented in eight countries to refine its framework before further expansion.

Benchmarking↗
PubMed2006

Social identity and self-enactment strategies: adapting to change in professional-manager relationships in the NHS.

Significant variation has been identified concerning the impact of management agendas on health professionals in the National Health Service. While attempts to explain these responses among health professions have identified a range of factors to account for such differences, existing research is still unable to explain the sources of variation that can occur within professional groups. Current approaches to studying professional-management relations either attempt to explain variation between organizational contexts and subgroups at a collective level of analysis or they struggle because of the absence of a theoretical framework capable of integrating social, psychological and contextual elements that can explain the sources and purposes of differentiated individual and group behaviours. In the present study, we argue that if we are to go beyond the mere mapping of broad outcomes, we need to develop an understanding of how the effects of imposed managerial agendas on health professional groups come to evolve and take shape. In particular, this requires us to identify a social psychological process framework that can help explain how initiatives aimed at managerializing roles and responsibilities affect the professional employees' understandings of group membership and their relations with hospital management. By using interview data from a group of 18 hospital doctors and through a comparative grounded analysis we show how a social identity perspective may provide a suitable framework to develop verifiable explanations of this process and its implications for nurse managers.

Career Mobility↗
PubMed2001

Pre-hospital anaesthesia.

Effective management of the airway may have the greatest impact on mortality and morbidity of all pre-hospital interventions. The administration of a pre-hospital anaesthetic may not only facilitate effective management and protection of the airway but may also be fundamental to maintaining adequate ventilation and reducing times to definitive treatment for casualties who are trapped and those with major chest and head injuries. Pre-hospital anaesthesia is a highly skilled technique that requires considerable training and experience. Inappropriate attempts to anaesthetise critically injured casualties may prove fatal if the operator does not have the requisite knowledge, skills and equipment. For those that do, this article provides an operational framework within which pre-hospital anaesthesia can be developed (Box 5).

Anesthesia, General↗
PubMedDate not supplied

Making effective clinical decisions: a framework for nurse practitioners.

Much has been written and researched about the decision-making process. Many agree it is one of the most difficult processes a health professional has to undertake. It is also one of the most important parts of nursing practice. There is increasing evidence that formal decision techniques applied sensibly can improve decision-making (Aitkin, 2003). Nurse practitioners must strive to find ways to improve and enhance their decision-making abilities. This article explores one such framework for decision-making that can be used by both novice and experienced nurses.

Choice Behavior↗
PubMedDate not supplied

Providing patient-centred care in an intensive care unit.

This article examines the provision of patient-centred care in an intensive care unit where patients' autonomy may be compromised. It discusses the Synergy Model as a framework for encouraging nurses to transform a technical and potentially dehumanising environment into a humane and healing place.

Clinical Competence↗
PubMedDate not supplied

Using a model to evaluate nursing education and professional practise.

The concept of evaluation is becoming increasingly ambiguous and a lot of processes may be called evaluation without any clear definitions. A theoretical frame of reference may function as a compass in an evaluation context when collecting, analysing and interpreting data as well as drawing conclusions. The purpose of the present study was to present and discuss the applicability of an educational interaction model for the evaluation of nursing education programs and the professional competence of nurses. The model combines different dimensions in the educational process, using both a student and an educational perspective. It is not uncommon for evaluations to concentrate on one dimension only, which tends to give an insufficient picture of the process of interaction. Examples are provided from nurse students/nurses education and professional practise to show that the relationship between students' abilities and educational factors, in the form of intentional goals and educational frameworks, have an influence on educational outcome.

Attitude of Health Personnel↗
PubMedDate not supplied

Advance directives, best interests and clinical judgement: shifting sands at the end of life.

End-of-life issues for clinical practice present complex ethical, moral and legal dilemmas that have been heightened by advances in medical technology enabling a dying patient to be kept alive for longer than ever before. Respect for patient autonomy and dignity are fundamental ethical components that engage in end-of-life decision-making. A mentally competent individual has the absolute right to refuse medical treatment for any reason and a valid advance directive for the refusal of treatment is binding in the event that the person loses capacity. In the incompetent patient, the withdrawal of life-sustaining treatment is based on the 'best interests' test, developed on a model that takes into account the welfare considerations of the person concerned. It is questioned whether the test should be more subjectively based, and accord greater weight to the wishes that might have been in the mind of the incompetent person approaching the end of life. The Mental Capacity Act 2005 (expected to come into force in 2007) provides a statutory framework for the law relating to advance directives, capacity and best interests. This paper examines contemporary issues surrounding end-of-life decision-making against the backdrop of the existing and proposed legal framework.

Advance Directive Adherence↗
PubMed2005

Investigations on the reaction pattern of photosystem II in leaves from Arabidopsis thaliana wild type plants and mutants with genetically modified lipid content.

The role of digalactosyldiacylglycerol (DGDG) for the functional competence of photosystem II (PS II) has been analyzed in leaves of Arabidopsis thaliana plants where the lipid composition was selectively modified by genetic mutations. Measurements with a newly developed laser flash fluorometer and data evaluation within the framework of an extended "3-quencher" model lead to the following results: (i) the normalized fluorescence transients F(t)/F(0) induced by an actinic laser flash in dark adapted leaves are virtually the same in wild type (WT) and mutants with diminished (about 50%) monogalactosyldiacylglycerol (MGDG) content (mgd1 mutant); (ii) significant changes of the F(t)/F(0) curves are observed in mutants with a severely reduced DGDG content; (iii) in mutants dgd1 and dgd1 dgd2-1 with DGDG contents of 1/15 of the control and below the detection limit, respectively, the probability of the dissipative recombination reaction between P680(+)(*) and Q(A)(-) increases by factors of about two and four, respectively; (iv) the acceptor side reactions are only slightly affected; (v) excitation with actinic laser flash energies above the saturation level of photosynthesis gives rise to elevated carotenoid triplet formation in mutants dgd1 and dgd1 dgd2-1; and (vi) the relationship between DGDG content and functional effect(s) on PS II is strikingly nonlinear. A small fraction of DGDG molecules of the total pool is inferred to be specifically bound to PS II as an essential constituent for its functional competence.

Arabidopsis↗
PubMed2005

A propensity score approach to estimating the cost-effectiveness of medical therapies from observational data.

Health summary measures are commonly used by policy makers to help make decisions on the allocation of societal resources for competing medical treatments. The net monetary benefit is a health summary measure that overcomes the statistical limitations of a popular measure namely, the cost-effectiveness ratio. We introduce a linear model framework to estimate propensity score adjusted net monetary benefit. This method provides less biased estimates in the presence of significant differences in baseline measures and demographic characteristics between treatment groups in quasi-randomized or observational studies. Simulation studies were conducted to better understand the utility of propensity score adjusted estimates of net monetary benefits when important covariates are unobserved. The results indicated that the propensity score adjusted net monetary benefit provides a robust measure of cost-effectiveness in the presence of hidden bias. The methods are illustrated using data from SEER-Medicare for the treatment of bladder cancer.

Aged↗
PubMed2005

The challenges of evidence-based medicine: a philosophical perspective.

Although evidence-based medicine (EBM) has gained prominence in current medical practice and research, it has also had to deal with a number of problems and inconsistencies. For example, how do clinicians reconcile discordant results of randomized trials or how do they apply results of randomized trials to individual patients? In an attempt to examine such problems in a structured way, this essay describes EBM within a philosophical framework of science. Using this approach, some of the problems and challenges faced by EBM can be explained at a more fundamental level. As well, by employing a similar description of the competing alternative research tradition of clinical medicine, this essay not only highlights the philosophical differences between these two modes of medical practice, but suggests that they, in fact, play a de facto complementary role in current clinical medicine.

Biomedical Research↗
PubMed1999

When psychologists work with religious clients: applications of the general principles of ethical conduct.

Psychologists become more effective and relevant when they appreciate that many clients hold religious values and commitments. Greater awareness of religion and religious values in the lives of clients may aid clinicians' efforts to provide more accurate assessments and effective treatment plans. The authors use the American Psychological Association's (1992) "Ethical Principles of Psychologists and Code of Conduct" as a framework to examine many of the ethical issues relevant when psychologists work with religious clients. This article also provides suggestions for ways in which clinicians may obtain the skills needed to offer competent assessments and interventions with religiously committed clients.

Ethics, Professional↗
PubMed2001

The role of CT in the management of adult urinary tract trauma.

Computed tomography (CT) is now the investigation of choice for evaluating haematuria following major abdominal trauma. This pictorial review provides a logical framework for understanding the classification and features of urinary tract injuries, defines the indications and outlines the techniques for CT imaging in upper and lower urinary tract trauma. The use of other competing imaging modalities is also discussed.

Adult↗
PubMed1995

Incommensurability: its implications for the patient/physician relation.

Scientific authority and physician authority are both challenged by Thomas Kuhn's concept of incommensurability. If competing "paradigms" or "world views" cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local or partial incommensurability might provide a framework for understanding the implication of contemporary philosophy of science for medicine. We distinguish four steps in the process of translating medical science into clinical decisions: the doing of the science, the appropriation of the scientific findings by the clinician, the transfer of the findings from the clinician to the patient, and the choice of a treatment regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Clinicians who must use the results of scientific research will inevitably interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicated to the patient. Finally, clinician and patient values must come into play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relativism; some scientific accounts are better than others. However, the challenge of the incommensurabilists shows that further analysis is needed to establish how particular accounts are better or worse.

Biomedical Research↗