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PubMed1986

Do interns and residents order more tests than attending staff? Results of a house staff strike.

Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of Ontario called a strike of house staff in Ontario's teaching hospitals. The authors obtained data concerning utilization of laboratory tests and radiology procedures during that period and for the same days 2 weeks before and after the strike. During the strike period, the number of tests performed per patient day decreased by only 8.3%. After accounting for proportional changes in emergency and nonemergency admissions, there was no significant change in the number of tests or relative value units performed per patient day as a result of the strike. These results suggest that the volume of tests performed in teaching hospitals is more likely related to the case mix and severity of illness of patients admitted to these institutions than to a pure "teaching effect."

Clinical Laboratory Techniques↗
PubMed2005

The privatization of wine sales in Quebec in 1978 and 1983 to 1984.

BACKGROUND: In 1978, grocery stores in Quebec were allowed to sell domestically produced wine along with wine that was imported and bottled by the Liquor Board in Quebec. This right was extended in 1983 to include imported wine that was bottled by privately owned manufacturers in Quebec. Larger grocery store chains were also allowed to sell wine in 1984. The aim of this study was to evaluate the effects of these policy changes on alcohol sales, primarily on sales of wine and total sales but also on sales of spirits and beer. METHODS: Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used. Canada, with the exception of the province of Quebec, was the control area. All time series were differenced to remove long-term trends. Possible permanent effects of the policy changes on alcohol sales were measured by means of intervention variables. Alcohol sales, in liters of pure alcohol per inhabitant aged 15 and above, were used as the dependent variable. Alcohol prices and the inhabitants' disposable income were used as control variables. RESULTS: Contrary to earlier studies regarding these policy changes in Quebec, the results presented in this study showed a significant and permanent effect of the policy change in 1978. The sale of wine increased by 10%, but the effect was not so large as to affect total sales. Sales of spirits and beer were not significantly affected. In 1983 to 1984, no immediate significant increase in sales of wine was found. CONCLUSIONS: The estimated effect of the policy change in 1978 was modest compared with results presented in most earlier studies regarding the privatization of wine sales in other jurisdictions. One explanation could be that the policy change in Quebec was valid only for a limited number of wines, which accounted for only a fraction of the total alcohol sales market.

Alcoholic Beverages↗
PubMed2001

A global warning.

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Cross-Cultural Comparison↗
PubMed1982

The anaesthetist and industrial action by ancillary workers. Reflections on the 1979 strike.

The author retired from active practice as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as consultant. One of the Editors suggested that the diary could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century, with his considered views culled from the experiences of a professional lifetime. The first essay deals with the effects of the industrial action by hospital ancillary workers in 1979 and considers the special role of the hospital anaesthetist during such disputes.

Allied Health Personnel↗
PubMed1992

Striving for safety: experiences of nurses in a hospital under siege.

The hospital in which this study took place served as a centre for emergencies, critically ill patients and maternity cases during a nurses' strike in 98 hospitals in Alberta, Canada. Nurses at this hospital were not members of the striking union; they belonged to their own independent union and they worked throughout the 19-day siege. Thirty-two nurses at the hospital responded to posters seeking volunteers for telephone interviews. The objective of the research was to discover the perceptions and experiences of nurses coping with extraordinarily heavy workloads arising out of a labour dispute. Interview data were gathered and analysed according to the conventions of grounded theory. Nurses voiced many concerns about the care patients received and they coped as best they could in a process described as 'striving for safety'. Fearing they would make mistakes that would harm their patients, they engaged in two subordinate processes of 'assessing competence' and 'preserving integrity'. Several organizational factors were identified that, if present, contributed to nurses' ability to continue or 'hang in' but if absent, contributed to despair or 'feeling demoralized'. The study was exploratory in nature and thus limited, but several implications for supporting nurses and managing such crises were discussed.

Adaptation, Psychological↗
PubMed2005

Discourse analysis of newspaper coverage of the 2001/2002 Canterbury, New Zealand mental health nurses' strike.

In late 2001 Canterbury, New Zealand mental health nurses undertook a variety of strike actions after stalled industrial negotiations with the local district health board. One response to these actions was the temporary reduction of many of the regions metal health services. Unsurprisingly, the print media responded by publicizing the crisis in mental health services on an almost daily basis. This paper reports on subsequent research into these print media representations of the industrial disputes, identifying themes of juxtaposed but largely deprecatory images of both mental health nursing and of consumers of services. Some professional nursing voices were given print space during the strike; however, these were largely incorporated into existing discourses rather than offering a nursing viewpoint on the strike. We, therefore, conclude by suggesting organizational efforts to focus on ways of ensuring that mental health nurses are seen as a legitimate authority by the media.

Attitude of Health Personnel↗
PubMed2006

Lecturers' unions.

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Attitude of Health Personnel↗
PubMed2006

Neurological complications of prolonged hunger strike.

We investigated neurological findings in 41 prisoners (mean age: 28.6) who participated in a hunger strike between 2000 and 2002. All cases were evaluated using neuropsychological, neuroradiological, and electrophysiological methods. The total duration of fasting ranged from 130 to 324 days (mean 199 days). All cases had 200-600 mg/day thiamine orally for 60-294 days (mean 156) during the hunger strike, and had neurological findings consistent with Wernicke-Korsakoff syndrome. All 41 patients exhibited altered consciousness which lasted from 3 to 31 days. All patients also presented gaze-evoked horizontal nystagmus and truncal ataxia. Paralysis of lateral rectus muscles was found in 14. Amnesia was apparent in all cases. Abnormal nerve conduction study parameters were not found in the patient group, but the amplitude of compound muscle action potential of the median and fibular nerves and sensory nerve action potential amplitude of the sural nerve were lower than the control group, and distal motor latency of the posterior tibial nerve was significantly prolonged as compared with the control group. The latency of visual evoked potential was prolonged in 22 cases. Somatosensory evoked potential (P37) was prolonged but not statistically significant. Our most significant finding was that the effect of hunger was more prominent on the central nervous system than on the neuromuscular system, despite the fact that all patients were taking thiamine. In our opinion, partial recovery of neurological, and neurocognitive signs in prolonged hunger could be a result of permanent neurological injury.

Adult↗
PubMed2001

Impact of a resident strike on emergency department quality indicators at an urban teaching hospital.

OBJECTIVE: To evaluate the indicators of activity and quality within the emergency department (ED) during a resident physicians' strike. METHODS: This was an observational study comparing a strike period (SP) and a non-strike period (NSP) in the ED of a 1,000-bed tertiary care teaching hospital in Barcelona, Spain, with an annual census of 100,000 emergency visits. During a period of nine nonconsecutive days, the resident physicians were on strike. Emergency visits were handled by staff members. Data were compared between all patients treated in the ED during the SP and those treated during the NSP, matched by the weekday. The authors compared lengths of stay (LOSs), rates of use of laboratory tests and radiology procedures, numbers of patient walkouts, patient/physician ratios, emergency hospital admission rates, home discharge rates, unscheduled return rates, and mortality rates. RESULTS: The two groups (SP 2,610 patients and NSP 3,634 patients) were comparable in terms of average daily attendance rate (SP: 290 +/- 12 vs NSP: 302 +/- 21; p = 0.13), elective hospital admission rate, and severity of illness. Statistically significant differences were found in terms of mean total patients' LOS (SP: 206.75 +/- 12.27 vs NSP: 235.10 +/- 27.08 minutes; p < 0.001), number of laboratory tests per patient (SP: 0.30 +/- 0.05 vs NSP: 0.38 +/- 0.04; p < 0.001), and radiographs per patient (SP: 0.78 +/- 0.06 vs NSP: 0.88 +/- 0.09; p = 0.021). CONCLUSIONS: This study demonstrated that replacing residents with staff physicians resulted in fewer laboratory tests ordered, fewer radiographs ordered, and shorter lengths of stays in the ED.

Adult↗