bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Factor in Youth Suicide: The Relative Age Effect
Authors: Thompson Angus H , Barnsley Roger H , Dyck Ronald J
Published: January 2017

Objective:

To determine whether youth in Alberta who had completed suicide were more likely to be younger than their classmates on entering grade 1 (that is, showed a relative age effect).

Method:

Records were obtained for all deaths by suicide by individuals under the age of 20 years in Alberta during the years 1979–1992. The relative age of each of these persons was determined by comparing his or her month of birth to the birth months of the appropriate school-grade cohort.

Results:

A disproportionate number of the subjects were born in the second half of the “school eligibility year,” indicating a higher probability that those who completed suicide were younger than their classmates.

Conclusions:

Previous research indicates that relative age is strongly related to school performance and success in sports. The present study demonstrates that the relative age effect is also a factor in youth suicide. It is suggested that the higher incidence of youth suicide in the group of relatively younger school children may have resulted from poorer school performance, which in turn led to lowered confidence and self esteem. Past research suggests that these conditions may predispose children to hopelessness and depression, which are often thought to be essential components of suicide. Research aimed at neutralizing the negative effects of relative age should have important personal and social consequences.
Clinical Rating of Compliance in Chronic Hemodialysis Patients
Authors: Mai François M , Busby Keith , Bell Robert C
Published: January 2017

Objective:

To develop a clinical rating scale of treatment compliance for use in chronic hemodialysis patients and to test its reliability and validity.

Method:

Forty-eight of 65 patients undergoing hemodialysis treatment at the Ottawa General Hospital during June 1994 met criteria for inclusion and completed the study. Patients underwent a 10–15-minute interview, with 1 of 2 independent clinical interviewers, regarding diet, fluid intake, prescribed medication usage, smoking, alcohol or drug use, and hemodialysis treatment attendance. Following each interview, a predesigned 3-point rating scale evaluating compliance in each of 6 domains (yielding an 18-point total score) to the treatment regimen was completed. Compliance ratings on 10 patients assessed independently by both interviewers were used to establish scale reliability. Criterion validity was assessed by correlating compliance scale scores with 3 biological measures (weight gain [kg], K+ [mmol/l], and PO4 [mmol/l]).

Results:

Reliability between clinical interviewers using the overall compliance scale score (Intraclass correlation coefficient = 0.825) as well as component subscales was high (kappa values, 0.33–1.00). Biological measures of compliance correlated well with each other but poorly with clinical ratings (range 0.01–0.16). Biological measures identified compliance as being poorer than that found with the clinical interview scale.

Conclusions:

The Compliance Rating Scale (CRS) was shown to be reliable but was not well-validated against selected biological measures. Discrepancies between these 2 methods of assessing compliance may be due to differing underlying compliance constructs or patient or interviewer biases. The CRS has value as a patient education tool in that it can be used to instruct patients regarding the benefits of adhering to the treatment regimen.
Characteristics of Problem Gambling in a Canadian Context: A Preliminary Study Using a DSM-IV-Based Questionnaire
Authors: Beaudoin Carole M , Cox Brian J
Published: January 2017

Objective:

To develop a self-report instrument to assess diagnostic criteria and associated features of pathological gambling in order to learn more about the characteristics of individuals who seek treatment for gambling problems in a Canadian setting.

Method:

Fifty-seven adults seeking treatment for gambling problems at the Addictions Foundation of Manitoba were assessed.

Results:

There was substantial variation in the endorsement of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms. Lying to family members or friends and “chasing” previous gambling losses were frequently reported, while more serious consequences (for example, relationship breakup, job losses) were less frequent. DSM-IV ratings were correlated (r = 0.59) with the South Oaks Gambling Screen. Many individuals reported gambling as a way to alleviate dysphoric mood, and 30% reported receiving mental health services in the past. Approximately 50% reported suicidal ideation, although recent suicide attempts were not common.

Conclusion:

These preliminary results of Canadian adults seeking treatment for gambling problems suggest a somewhat different profile from many United States studies, which often rely on older male pathological gamblers. More systematic investigation of the presence of major depression and other psychiatric disorders is warranted. Consistent with demographic data collected at the Addictions Foundation of Manitoba, it appears that video lottery terminals play a major role in the type of problem gambling experience seen in Canadian settings.
Panic Disorder in Schizophrenia
Authors: Labbate Lawrence A , Young P Christopherson , Arana George W
Published: January 2017

Objective:

To determine the frequency of panic attacks and panic disorder inpatients with chronic schizophrenia or schizoaffective disorder.

Method:

Fifty-three male outpatients meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for chronic schizophrenia or schizoaffective disorder were administered sections of the Structured Clinical Interview for DSM-IV (SCID). If panic attacks were reported, patients were queried about treatment and about onset relative to psychotic symptoms.

Results:

Forty-nine patients were sufficiently organized to participate in the evaluation. Twenty-one (43%) experienced panic attacks, and 16 (33%) had current or past panic disorder. Eight (50%) of the 16 with panic disorder had been treated for panic. Substance dependence was not associated with having panic attacks or current or past panic disorder. Patients with paranoid schizophrenia were more likely than patients with schizoaffective or undifferentiated schizophrenia to have experienced panic attacks (57% versus 20%, %2 = 6.0, P < 0.02) or panic disorder (47% versus 10%, χ2 = 6.9, P < 0.01).

Conclusion:

Panic attacks and panic disorder are common in men with schizophrenia or schizoaffective disorder. Panic disorder may be an overlooked comorbid diagnosis in patients with schizophrenia.
Review Board Outcomes for Involuntary Patients in Provincial Psychiatric Hospitals
Authors: Komer William J , O'Reilly Richard L , Cernovsky Zack , Dunbar Sandra
Published: January 2017

Objective:

To identify long-term trends and compare different psychiatric hospitals with regard to outcomes of involuntary certification.

Method:

Data on outcomes of involuntary certification were obtained from the London and St Thomas Psychiatric Hospitals for 1987 to 1997, from the Psychiatric Patient Advocate Office pertaining to 10psychiatric hospitals for 1987 to 1993, and from published data from the North Bay Psychiatric Hospital for 1992 to 1994. Data were compared regarding outcome variables.

Results:

There are variable rates and proportions among the psychiatric hospitals for outcomes of involuntary certification, including patients choosing to withdraw their applications to Review Boards, physicians cancelling involuntary certificates by completing Form 5s, and Review Boards rescinding certificates. Overall, few certificates were rescinded by the Boards, a trend that was even more pronounced in recent years.

Conclusions:

Patients who are in psychiatric hospitals on an involuntary basis are infrequently released from hospital as a result of a Review Board rescinding their certificate.
Micromechanical prediction of damage due to transverse ply cracking under fatigue loading in composite laminates
Authors: Mohammadi Bjian , Rohanifar Milad , Salimi-Majd Davood , Farrokhabadi Amin
Published: January 2017

To predict the matrix microcracking of laminated composites under fatigue loading, a novel energy based model is presented in the framework of micromechanics. For this purpose, strain energy release rate (SERR) of microcracks which had been derived previously for the whole laminate, is developed for a lamina, and then is calculated using a stress transfer-based stiffness reduction method. The advantages of the proposed method include its capability to predict the matrix cracking of general lay-ups based on the local stresses and stiffnesses of each plies separately and not being limited to a special stacking sequence. In order to predict micro-cracking propagation of composites under cyclic loading, the coefficients of the modified Paris law are extracted using the available experimental data of crack density–cycle curves. Then using multi-scale modelling and continuum damage mechanics concept, the proposed algorithm is implemented in ANSYS finite element software, as a new user defined material (Usermat). The static progress of failure on [45/−45]s laminate is simulated and the obtained results are compared with the existing experimental data in a good agreement. Finally, the results of implemented fatigue algorithm for different cross-ply laminates under different stress levels are obtained and compared with the available experimental data.
A methodical approach for the assessment of waste sorting plants
Authors: Feil Alexander , Pretz Thomas , Vitz Philipp , Thoden van Velzen Eggo Ulphard
Published: January 2017

A techno-economical evaluation of the processing result of waste sorting plants should at least provide a realistic assessment of the recovery yields of valuable materials and of the qualities of the obtained products. This practical data is generated by weighing all the output products and sampling these products. Due to the technological complexity of sorting plants, for example, lightweight packaging waste treatments plants and the high expenditures concerning time and costs of sampling with subsequent manual sorting for quality determination, usually only final products undergo such an investigation. Thereby, the transferability of the results depends decisively on the boundary conditions (extent, throughput of the plant, process parameterization). Given that the process is too complex, not all relevant information of the process steps can be determined by sampling. By model calculations and/or adjustment of reasonable assumptions, information concerning weak points in the process can be identified, which can be used for further plant optimization. For the example of the recovery of beverage cartons from co-collected and mechanically recovered mixtures of lightweight packaging waste, a methodical approach for the assessment of processing results will be presented.
Identifying Severity Standards on the Cognitive Test Anxiety Scale: Cut Score Determination Using Latent Class and Cluster Analysis
Authors: Thomas Christopher L. , Cassady Jerrell C. , Finch W. Holmes
Published: January 2017

The purpose of the current examination was to preliminarily suggest severity standards for the recently revised Cognitive Test Anxiety Scale–Second Edition (CTAS-2). Participants responded to the CTAS-2, Motivated Strategies for Learning Questionnaire (MSLQ), and FRIEDBEN Test Anxiety Scale. Using both latent class and cluster analyses, we were able to classify participants as belonging to one of the three distinct cognitive test anxiety profiles—low, moderate, and high. Comparison of the identified test anxiety profiles allowed us to generate a set of severity standards for the CTAS-2 that can be used to differentiate between individuals with differing levels of cognitive test anxiety. The validity of the severity standards was established through group comparisons of test-anxious students on the MSLQ–Text Anxiety, FRIEDBEN–Cognitive Obstruction, FRIEDBEN–Social Derogation, and FRIEDBEN–Physiological Tenseness scales. Discussion concerns the practical implications of establishing CTAS-2 severity standards for educators, student support staff, and learners.
Protective role of silymarin and D-penicillamine against lead-induced liver toxicity and oxidative stress
Authors: Jalali Seyedeh Missagh , Najafzadeh Hossein , Bahmei Sadegh
Published: January 2017

This study was performed to assess hepatotoxicity and alterations in liver antioxidant defence in acute lead (Pb) exposure and the protective effects of silymarin in comparison to D-penicillamine in rats. Forty eight Albino rats were divided in eight groups and received the following treatments in a 10-day experiment – group 1: normal saline as control; group 2: 25-mg/kg Pb acetate, intraperitoneally (IP) for the last 5 days; group 3: 100-mg/kg D-penicillamine, IP for the last 5 days; group 4: 200-mg/kg silymarin, orally for 10 days; and groups 5, 6, 7 and 8: in addition to Pb, they received D-penicillamine, for the last 5 days, silymarin for 10 days, a combination of silymarin for 10 days and D-penicillamine for the last 5 days and silymarin for the last 5 days, respectively. Pb acetate exposure induced significant elevation in serum alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme activities in group 2 compared to control group. Significant reductions in serum total protein and albumin in all Pb-exposed groups and in serum glucose in groups 2, 6 and 8 were also observed. Liver tissue superoxide dismutase and glutathione peroxidase were significantly lower in groups 2 and 8 compared to control group. Silymarin pretreatment and D-penicillamine administration in groups 5, 7 and 8 could significantly lower ALP, ALT and AST and improve liver antioxidant enzymes. Thus, acute Pb exposure induced hepatotoxicity with suppression of liver antioxidant defence system and silymarin, as an antioxidant could alleviate this effect.
Metabolic Rate Changes Proportionally to Circadian Frequency in tau Mutant Syrian Hamsters
Authors: Oklejewicz Malgorzata , Hut Roelof A. , Daan Serge , Loudon Andrew S. I. , Stirland Anne J.
Published: January 2017

The tau mutation in Syrian hamsters (Mesocricetus auratus) is phenotypically expressed in a period of the circadian rhythm of about 20 h in homozygotes (SS) and about 22 h in heterozygotes (S+). The authors investigate whether this well-defined model for variation in circadian period exhibits associated changes in energy metabolism. In hamsters of the three genotypes (SS, S+, and wild type [WT]), oxygen consumption measurements were performed at 28°C (thermoneutral), 18°C, and (after acclimatization) 10°C. After correction for body mass, SS tau mutant hamsters had a higher overall metabolic rate (average oxygen consumption per hour over 24 h) and a higher resting metabolic rate (the lowest 30-min oxygen consumption in the subjective day) than did WT hamsters at all ambient temperatures. S + hamsters were intermediate in both after taking body mass into account. The differences in metabolism among the three genotypes indicate that the increase in metabolic rate was statistically indistinguishable from a proportional increase in circadian frequency. The oxygen consumption totals per circadian cycle (24 h for WT, 22 h for S+, and 20 h for SS mutants) were not statistically different among the genotypes after correcting for body mass. The possible roles of pleiotropic effects, of linkage to genes involved in growth and metabolism, and of early ontogenetic influences are briefly discussed.
Blunted Phase-Shift Responses to Morning Bright Light in Premenstrual Dysphoric Disorder
Authors: Parry Barbara L. , Udell Care , Elliott Jeffrey A. , Berga Sarah L. , Klauber Melville R. , Mostofi Nasim , Le Veau Betina , Gillin J. Christian
Published: January 2017

Patients with premenstrual dysphoric disorder (PMDD) respond therapeutically to sleep deprivation and light therapy. They have blunted circadian rhythms of melatonin. The authors sought to test the hypothesis that these disturbances are a reflection of a disturbance in the underlying circadian pacemaker or, alternatively, that they reflect a disturbance in the input pathways to the clock. To test these hypotheses, after a 2-month diagnostic evaluation, 8 patients who met DSM-IV criteria for PMDD and 5 normal control (NC) subjects underwent two studies to determine whether PMDD subjects showed (1) altered melatonin sensitivity to light suppression (Study 1) and (2) altered phase-shift responses to morning light as a measure of the functional capacity of the underlying pacemaker (Study 2). In both studies, measurements were made during asymptomatic follicular and symptomatic luteal menstrual cycle phases in PMDD patients. The results of Study 1 showed no significant effect of group or menstrual cycle phase on the amount or percentage of suppression of melatonin by light. The results of Study 2 showed that with respect to the variable of offset time, PMDD subjects, when symptomatic, showed a reduced and directionally altered melatonin phase-shift response to a morning bright light stimulus ; in 4 of 5 NC subjects, melatonin offset was advanced by bright morning light, whereas in PMDD subjects, it was delayed (3 subjects) or not shifted (5 subjects) (group effect, p = .045). Study 2 also revealed that area under the curve also changed differentially in PMDD versus NC subjects. In summary, the primary findings from this pilot study suggest that in PMDD there is a maladaptive (directionally altered and blunted) response to light in the symptomatic luteal phase. Because the suppressive effects of light were similar in PMDD and NC subjects, the previously observed low melatonin levels in this disorder do not likely represent a disturbance in pineal reactivity to suprachiasmatic nucleus efferents. Instead, the findings support a possible disturbance in PMDD in the clock itself or its coupling mechanisms.
Complex Effects of Melatonin on Human Circadian Rhythms in Constant Dim Light
Authors: Middleton Benita , Arendt Josephine , Stone Barbara M.
Published: January 2017

In humans, the pineal hormone melatonin can phase shift a number of circadian rhythms (e.g., "fatigue," endogenous melatonin, core body temperature) together with the timing of prolactin secretion. It is uncertain, however, whether melatonin can fully entrain all human circadian rhythms. In this study, the authors investigated the effects of daily melatonin administration on sighted individuals kept in continuous very dim light. A total of 10 normal, healthy males were maintained in two separate groups in partial temporal isolation under constant dim light (< 8 lux) with attenuated sound and ambient temperature variations but with knowledge of clock time for two periods of 30 days. In these circumstances, the majority of individuals free run with a mean period of 24.3 h. In a double-blind, randomized crossover design, subjects received 5 mg melatonin at 20:00 h on Days 1 to 15 (Melatonin 1st) followed by placebo on Days 16 to 30 (Placebo 2nd) or vice versa (Placebo 1st, Melatonin 2nd) during Leg 1 with treatment reversed in Leg 2. The variables measured were melatonin (as 6-sulphatoxymelatonin), rectal temperature, activity, and sleep (actigraphy and logs). In the experiment, 9 of the 10 subjects free ran with Placebo 1st, whereas Melatonin 1st stabilized the sleep-wake cycle to 24 h in 8 of 10 individuals. In addition, 2 individuals showed irregular sleep with this treatment. In some subjects, there was a shortening of the period of the temperature rhythm without synchronization. Melatonin 2nd induced phase advances (5 of 9 subjects), phase delays (2 of 9 subjects), and stabilization (2 of 9 subjects) of the sleep-wake cycle with subsequent synchronization to 24 h in the majority of individuals (7 of 9). Temperature continued to free run in 4 subjects. Maximum phase advances in core temperature were seen when the first melatonin treatment was given approximately 2 h after the temperature acrophase. These results indicate that melatonin was able to phase shift sleep and core temperature but was unable to synchronize core temperature consistently. In the majority of subjects, the sleep-wake cycle could be synchronized.
The Productive Ward Program™
Authors: Van Bogaert Peter , Van heusden Danny , Verspuy Martijn , Wouters Kristien , Slootmans Stijn , Van der Straeten Johnny , Van Aken Paul , White Mark
Published: January 2017

Aim

To investigate the impact of the quality improvement program “Productive Ward – Releasing Time to Care™” using nurses’ and midwives’ reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement.

Background

Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse.

Method

A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014.

Results

Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably.

Conclusion

This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote “quality improvement” as “business as usual.”
AbobotulinumtoxinA (Dysport®) Improves Function According to Goal Attainment in Children With Dynamic Equinus Due to Cerebral Palsy
Authors: Tilton Ann , Russman Barry , Aydin Resa , Dincer Umit , Escobar Raul G. , Kutlay Sehim , Lipczyk Zbigniew , Velez Juan Carlos , Grandoulier Anne-Sophie , Tse Anissa , Picaut Philippe , Delgado Mauricio R.
Published: January 2017

This secondary analysis of a large (n = 241), randomized, double-blind study evaluated the efficacy of 2 doses of abobotulinumtoxinA + standard of care (SOC) versus placebo + SOC in enabling children with dynamic equinus due to cerebral palsy to achieve their functional goals using Goal Attainment Scaling. Most parents/caregivers selected goals targeting aspects of gait improvement as most relevant. Mean (95% confidence interval) Goal Attainment Scaling T scores at week 4 were higher for both abobotulinumtoxinA groups versus placebo (treatment difference vs placebo: 10 U/kg/leg: 5.32 [2.31, 8.32], P = .0006, and 15 U/kg/leg 4.65 [1.59, 7.71], P = .0031). Superiority of both abobotulinumtoxinA doses versus placebo was maintained at week 12. Best goal attainment T scores were higher in the abobotulinumtoxinA groups versus placebo for the common goals of improved walking pattern, decreased falling, decreased tripping, and improved endurance. These findings demonstrate that single injections of abobotulinumtoxinA (10 and 15 U/kg/leg) significantly improved the ability of pediatric cerebral palsy patients to achieve their functional goals.
Risky Mothers and the Normalcy Project
Authors: Frederick Angela
Published: January 2017

Feminist scholars have been critical of the expectations placed upon mothers to accomplish a perfect version of motherhood, but have often failed to interrogate the values about normalcy and disability imbedded in modern mothering ideologies. Mothers with disabilities are well positioned to expose the underlying beliefs about normalcy with which all mothers must contend. Drawing from interviews and focus groups conducted with mothers who have physical and sensory disabilities, I explore Deaf/disabled women’s experiences negotiating the scientific motherhood regime. Illuminating a paradox, I argue these women are labeled “risky mothers” under scientific motherhood, which prizes the management of risk and the prevention of disability. Yet, these mothers are simultaneously rendered invisible by inaccessible and inflexible medical practices, and by a consumer market of expert advice which prescribes that mothers inhabit a typical body. These women’s experiences illuminate the normalcy project as a central tenet of scientific motherhood.
Mediating Agency and Structure in Sociology: What Role for Conversion Factors?
Authors: Hvinden Bjorn , Halvorsen Rune
Published: January 2017

The article argues that the Capability Approach can enrich sociology’s capacity to link human agency and structure in dynamic analyses of social inequality and marginality. While many read the Capability Approach as excessively individualistic, the validity of this view is less obvious if we take into account the key role of conversion processes in this approach. People’s possibilities to convert given resources into valued functionings do not only depend on individual characteristics (e.g. having a physical or mental impairment) but also on the multi-layered structures (e.g. of a physical, attitudinal, social, economic or political nature) they face. Conversion processes can help us to capture the factors hampering or enabling human agency (individual and collective) – and of the transformation of such factors. As an empirical case, the article discusses the efforts of persons with disabilities to combat exclusion and achieve full and effective participation in society on an equal basis with others.
The Spectrum of Infection Control in Home Health Care
Authors: Cecil Connie
Published: January 2017

A home health care agency's infection control program is at the heart of every aspect of its operations, from the human resources/application process to the actual provision of patient care, including the working environment for all of the employees of the agency. Each employee has a part in making the program successful.
Performance Improvement: How to Demonstrate and Document Infection Control Efforts
Authors: Maringer Denise
Published: January 2017

Home health care infection control programs are multifaceted and involve every member of a home care agency. The infection control process involves five key areas: staff education, detailed policy and procedures, documentation of an infection, surveillance of the program, and a quality/performance improvement aspect. As home health care agencies move toward outcome measures, a comprehensive infection control program is key in the prevention of patient complications.
Therapeutic Touch: The Art of Improvisation
Authors: Mary Anne Hanley
Published: January 2017

Abstract: This paper is a comparison of the art and practice of Therapeutic Touch with the art and practice of music through improvisation. It is also an exploration of one person's growth from initial learning to a point in lime where expertise is recognized. Students of Therapeutic Touch are often puzzled by their ability to be effective from the first day yet they have difficulty articulating exactly what it is that they are doing in words that peers, family or friends might understand. The simplicity of energy exchange and the uniqueness of its process can be overwhelming. It is the author's belief that only when the student is able to integrate the new learning of Therapeutic Touch with previous life experience does expertise in the practice of Therapeutic Touch evolve.
Music and Color in the Holistic Healing of Grief
Authors: Baker Helen E.
Published: January 2017

Abstract: The concept of integrating music and color techniques into counseling of the bereaved person is introduced. A brief summary of the nature of physical vibrations in the form of music and color is presented and the process of grieving is summarized. Blocks along the expected grief resolution pathway are delineated. The relationship of blocked emotions to imcomplete grieving is explained and the use of music and color to enhance the expression of feelings is introduced. Specific examples of how sound in the form of music and light in the form of color, can be used as a vehicle for enhancing and condensing the grief process are set forth.
Power versus Participation in Health Service Teams: A Delicate Balance
Authors: Marriott Anne , Harris Irene
Published: January 2017

The purpose of this paper is to critically review the effectiveness of a participative management approach within health service teams. It questions the reality of staff empowerment as an essential product of this approach, and examines the influence of power issues on the degree of empowerment that the organization may allow. The benefits and challenges of staff participation are highlighted, with reference to the manager's role in the participation process. The article concludes by advocating the positive use of power in order to maintain the integrity and effectiveness of a participative management approach.
The Behavioural Outcomes of Quality Improvement Teams: The Role of Team Success and Team Identification
Authors: Irvine D. M. , Leatt P. , Evans M. G. , Baker G. R.
Published: January 2017

This study investigates the relationship between hospital quality improvement (QI) team success and changes in empowerment, ‘organizational commitment, organizational citizenship behaviour’ (OCB) and job behaviour related to QI. Data were collected from administrative staff, healthcare professionals and support staff from four community hospitals. The study involved a field investigation with two data collection points. Structured questionnaires and interviews with hospital management were used to collect data on the study variables. High scores were observed for organizational commitment, OCB and job behaviour related to QI when individuals identified with teams that were successful. Low scores were observed when individuals identified with teams that were unsuccessful. Empowerment was positively related to job behaviour associated with QI. It is concluded that participation on QI teams can lead to organizational learning, resulting in the inculcation of positive ‘extra-role’ and ‘in-role’ job behaviour.
Do Primary Care Physicians or Specialists Provide More Efficient Care?
Authors: Ozcan Y. A. , Jiang H. J. , Pai C.-W.
Published: January 2017

Sinusitis is a common health complaint and expenditures for its treatment are high; thus, it is necessary to promote efficient practice behaviours in managing patient care. This study compares resource utilization between primary care physicians and specialists in the treatment of Medicaid sinusitis patients in Virginia. Physician-level data from Virginia Medicaid claim files for 1993 were analysed. The efficiency frontier, representing the best achievable performance in the use of resources for treating sinusitis, is identified using Data Envelopment Analysis. Resource utilization (primary care physician visits, specialist visits, emergency room usage, prescriptions and laboratory tests) and corresponding costs are compared between generalists and otolaryngologists. It was concluded from this study that there are no discernible differences in technical efficiency between generalists and specialists in the treatment of sinusitis. Nevertheless, otolaryngologists are found to be more costly than generalists in treating sinusitis. Variation in both caseload and patient mix might explain variation in use of resources.
Bringing Canadian Healthcare Closer to Home: The Initial Stages of Change for Senior Managers within the Province of British Columbia
Authors: Preston Diane
Published: January 2017

This paper explores some recent healthcare reforms within the Canadian healthcare sector. As in most countries across the world, healthcare managers in Canada have been faced with the dilemma of how to achieve a balance between equity of provision and expenditure control. This study explores the external and internal pressures for change at the provincial and national levels within Canada. More significantly, it focuses on how the early stages of these changes have resulted in altered work roles and relationships for healthcare managers. A case study of British Columbia is described, where radical changes occurred in the healthcare sector in the mid-1990s. Interviews conducted with a sample of senior healthcare managers in the province illustrate how the restructuring of healthcare impacted upon management roles, structures and communication. The qualitative interview data is intended to provide an important addition to the body of largely quantitative, statistical data that is collected on international health systems on a regular basis. How the findings of the case study can contribute to learning and practice within the health services management arena is discussed.
Measurement of Patient Satisfaction in a Public Hospital in Ankara
Authors: Tengilimoglu D. , Kisa A. , Dziegielewski S. F.
Published: January 2017

This article communicates the results of a patient satisfaction survey administered to 420 adults discharged from a major public hospital in Turkey. The direct measurement of patient satisfaction is a relatively new phenomenon for this country. A system was designed similar to those available in the US and was applied during an exit interview. Three areas of analysis were identified: accessibility and availability of services, perceived quality of patient care and organizational and administrative issues. Relationships and percentages within and among several variables are reported. Overall, most individuals were satisfied with direct patient care, although in some areas this varied significantly and was based on the education level of the respondent. In addition, many customers reported discontentment with organizational and administrative support services. We recommend that hospitals in Turkey adapt routine policies similar to those in the US for conducting these types of evaluations.
An Analytical Framework of Physician Productivity and Variation in Utilization
Authors: Song F. , Rathwell T. , Long A. , Thunhurst C.
Published: January 2017

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.
Planning Health Care for People with HIV Infection and Aids
Authors: McCann Kathryn , Wadsworth Emma , Beck Eduard J.
Published: January 2017

In recent years planners of health services have been urged to design a comprehensive range of services which are responsive to the needs of people with HIV infection and AIDS and those who might be worried about HIV transmission.

Models of care have been tried and tested and pilot services which aim to inform the development of the services scrutinised. Though in general this community care is seen as the preferred option with adequate backup support from acute services. More than anything, there is a recognition that the service must be responsive to local needs. Because patterns of HIV infection and prevalence of AIDS are so variable there is no substitute for the systematic development of timely local knowledge as the basis of local planning.
Forecasting Areawide Hospital Utilization: A Comparison of Five Univariate Time Series Techniques
Authors: Weiss Thomas W. , Ashton Carol M. , Wray Nelda P.
Published: January 2017

Time series analysis is one of the methods health services researchers, managers and planners have to examine and predict utilization over time. The focus of this study is univariate time series techniques, which model the change in a dependent variable over time, using time as the only independent variable. These techniques can be used with administrative healthcare databases, which typically contain reliable, time-specific utilization variables, but may lack adequate numbers of variables needed for behavioral or economic modeling. The inpatient discharge database of the Department of Veterans Affairs, the Patient Treatment File, was used to calculate monthly time series over a six-year period for the nation and across US Census Bureau regions for three hospital utilization indicators: Average length of stay, discharge rate, and multiple stay ratio, a measure of readmissions. The first purpose of this study was to determine the accuracy of forecasting these indicators 24 months into the future using five univariate time series techniques. In almost all cases, techniques were able to forecast the magnitude and direction of future utilization within a 10% mean monthly error. The second purpose of the study was to describe time series of the three hospital utilization indicators. This approach raised several questions concerning Department of Veterans Affairs hospital utilization.
An American Macromanaged Health Care System?
Authors: Weil Thomas P.
Published: January 2017

The implementation of President Clinton's proposed health reform plan that ensures universal access and relatively comprehensive health insurance benefits to over 250 million Americans would have a significant impact on their hospitals, physicians, and other health care providers. With this projected coverage, the 36.7 million Americans now uninsured would demand an additional volume of services. It is doubtful, because of this nation's trade and budget deficits, that any significant increases in expenditures for health will be made available from the public sector. Therefore, providers in the US will need to deliver significantly more care with a minimal increase in total reimbursement. These conclusions are further supported by the experiences of the Canadian and the German macromanaged health care systems that provide considerably more hospital and physician services per person per year than the US at a lesser cost per discharge and percentage of their respective nation's gross domestic product. America may be heading toward macromanaged global budget targets, but for political and other reasons President Clinton's health reform plan will be implemented with a multi-payer, managed competition approach.
Munificent Environments, Management Control, and the Cost of Rural Hospital Care
Authors: Chien Ching Wen , Rohrer James E. , Ludke Robert , Levitz Gary
Published: January 2017

Rural hospitals have been threatened by declining revenues. Control over costs will be necessary to help these hospitals survive. Investigation of the determinants of hospital costs in Iowa reveals that costs are primarily caused by environmental factors, rather than variables over which managers have control. Furthermore, efforts by policy makers to improve hospital efficiency by stimulating competition among hospitals may have been ineffective, since the level of competition was not found to be associated with hospital production costs.
Developing GP Monitoring Systems Guided by a Soft Systems Approach
Authors: Hindle Tony
Published: January 2017

This paper describes a selected aspect of a research project concerned with ‘contracts and competition’ in the recently reformed National Health Service. The particular feature highlighted in this paper is the central role played by the general practitioners in the health service as principal sources of the demands made on provider units (particularly hospitals) and, hence, critical determinants of volumes and costs in contracting. A practical outcome of the research has been the development of GP monitoring systems to be used by provider units particularly in the context of marketing-led referral expectations. The approach used to highlight areas of potential GP contract management and monitoring improvements has been a development of soft systems methodology.
Performance-Related Pay for Health Service Professionals: The Italian Experience
Authors: Adinolfi Paola
Published: January 2017

Italy has significant experience of performance-related pay (PRP) for health service professionals: a system which links part of doctors' remuneration to their productivity dates back to 1938.

This paper reports on a two-year field research, carried out on the Italian National Health Service, which investigates the objectives, design and implementation of PRP, as well as its operation and effectiveness.

First, the evolution of PRP schemes over the latest 25 years is reconstructed, and the range of covert and overt objectives underlying the use of PRP are unravelled. Then, after having highlighted the main structural and cultural factors which negatively affect PRP effectiveness, a critical evaluation of PRP is attempted, drawing on the analysis of both hard performance data and the subjective perceptions of stakeholders. The conclusion is that PRP led to problems and unforeseen consequences in most of the hospitals examined, due to both structural factors, mainly some flaws in PRP design, and cultural constraints, mainly the values of health professionals. However, the case of a Northern Italian hospital proves that, despite the constraining environmental setting, there is still scope for managerial intervention in the implementation process which is sufficient to guarantee PRP effectiveness.

This indicates that the implementation process far outweighs the significance of structural and cultural constraints, and that PRP is a powerful tool at management disposal to increase employees' performance and commitment.
Waiting for Inpatient Hospital Care: Experience at a VA Facility
Authors: Ozminkowski R. J.
Published: January 2017

Inpatient care from hospitals operated by the Department of Veterans Affairs (VA) is offered free of charge to many eligible veterans. Others must make nominal co-payments. As a result, in contrast to the private sector, money prices do not serve as an allocation mechanism for inpatient care. Many VA hospitals must therefore rely on waiting lists as implicit allocation devices. This study examines the effects of waiting at one large VA facility. Using multivariate statistical techniques on survey data from 195 veterans, the influence of factors that determine willingness to wait for VA inpatient care is estimated. The results suggest that willingness to wait depends on the expected benefits of waiting before treatment can be received. The impact of the monetary and non-monetary costs imposed by waiting is small. As VA waiting lists continue to grow, social workers discharge planners and other providers should investigate the tolerance for waiting and incorporate this information into plans for service provision.
Developing a Clinical Information System: An Interpretive Case Analysis within a UK Hospital
Authors: Hackney R. , Dhillon G.
Published: January 2017

This paper seeks to adopt an interpretive case analysis for the study of the development of a clinical information system within a UK hospital. An initial literature review is outlined, which draws attention to the distinction between formal–rational and interpretive perspectives on information technology impacts. A case study is presented where a number of issues are identified which suggest that formal systems analysis techniques do not reflect the organizational realities within the hospital. The paper concludes with a brief discussion of the concerns for systems development, and notes the value of an interpretive perspective in this respect.
Physician Response to a Change in Medicaid Fees
Authors: McKay N. L. , Dorner F. H.
Published: January 2017

This study examines the effects of a change in Medicaid fees on the volume of physician services provided to beneficiaries. The data set includes price and volume at the procedure-level for Medicaid physician services in Texas in 1991, 1993, and 1995. The empirical analysis compares the volume of services provided to Medicaid participants before and after a 1992 change in reimbursement method. The results indicate that, over the period 1991 to 1993, the change in Texas Medicaid physician fees did not have a statistically significant effect on the volume of services provided. When measured over a longer period of time (1991–1995), however, volume increased significantly when price decreased, but, when price increased, there was no significant effect on volume. The results thus provide empirical support for the behavioural offset assumption underlying the switch to Medicare's Resource-Based Relative Value Scale (RBRVS) method of physician payment. A key policy implication is that reduced fees did not lead to a lower volume of physician services provided to Medicaid patients at least over the period of analysis. However, the new Medicaid fee schedule did not have the desired effect of controlling Medicaid expenditures on physician services.
Level of Analysis Considerations in Organizational Citizenship Behaviour Research: An Empirical Investigation of Individual and Work Group Effects among Hospital Employees
Authors: Bolon D. S.
Published: January 2017

An implicit assumption in previous research is that the relationship between job satisfaction and organizational citizenship behaviour is an individual level phenomenon. However, due to the use of raw score correlation-based or related analyses, previous investigations have not shown empirical support for the individual level of analysis. This study empirically tested several relationships between job satisfaction (including facets) and a specific type of citizenship behaviour in order to determine whether such relationships were relevant for individuals or for the entire work group. Results indicate an overall lack of group-based effects. Instead, individual-difference effects represent the significant relationships found in the data. Several null effects were also obtained. These results go beyond the traditional approach to organizational citizenship behaviour research because group-based relationships have been explicitly rejected rather than simply assumed to be unimportant. Evidence for individual-differences was provided by testing for levels of analysis effects in terms of individuals and work groups. Future research should assess the generalizability of these results by including tests for levels of analysis.