bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal Associations of Importance of Religion and Frequency of Service Attendance with Depression Risk among Adolescents in Nova Scotia
Authors: Rasic Daniel , Asbridge Mark , Kisely Steve , Langille Donald
Published: January 2017

Objective:

To examine the directionality of associations between self-reported religious importance or worship attendance and depression among adolescents, and to determine whether social supports or general self-efficacy are mechanisms of observed associations.

Method:

A cohort ( n = 976) of Canadian high school students were surveyed in Grade 10 (2000 to 2001) and 2 years later (2002 to 2003). Logistic regression was conducted separately among adolescents with and without elevated depressive symptoms to examine associations between baseline religious attendance and religious importance with later depression, adjusting for confounding factors. Effects of reverse causation were also assessed, determining associations between baseline depression and follow-up religious attendance and importance.

Results:

Girls who were not depressed at baseline and who attended religious services had lower odds of later depression (adjusted odds ratio [AOR] 0.46; 95% CI 0.22 to 0.95, P < 0.05), which was accounted for by general self-efficacy. Boys who were depressed at baseline who attended religious services had lower odds of still being depressed at follow-up (AOR 0.23; 95% CI 0.06 to 0.80, P < 0.01). Depression at baseline predicted lower attendance at follow-up among boys (AOR 0.26; 95% CI 0.09 to 0.75, P < 0.01).

Conclusions:

Religious attendance independently predicts lower depression at follow-up among girls, and may do so by increasing self-efficacy. Among boys with depression, religious attendance predicts a lower likelihood of still being depressed at follow-up. The relation between religious attendance and depression in boys is bidirectional.
Craving in Patients with Schizophrenia and Cannabis Use Disorders
Authors: Schnell Thomas , Becker Theresa , Thiel Maria Chantal , Gouzoulis-Mayfrank Euphrosyne
Published: January 2017

Objective:

Cannabis use is widespread among patients with schizophrenia despite its negative impact on the course of the disease. Craving is a considerable predictor for relapse in people with substance use disorders. Our investigation aimed to gain insight into the intensity and dimensions of cravings in patients with schizophrenia and cannabis use disorders (CUDs), compared with otherwise healthy people with CUDs (control subjects).

Method:

We examined 51 patients with schizophrenia and CUDs and 51 control subjects by means of the Cannabis-Craving Screening questionnaire.

Results:

We found greater overall intensity of craving and greater relief craving in patients with schizophrenia and CUDs. Reward craving was greater in the CUDs group. Relief craving was associated with symptoms of schizophrenia in patients with schizophrenia and CUDs.

Conclusion:

Our findings are in line with the view that aspects of self-medication or affect regulation may account (at least in part) for cannabis use in people with schizophrenia. A better understanding of the dimensions of craving may help to improve targeted therapeutic interventions that aim to reduce drug consumption in this difficult-to-treat patient group.
Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors
Authors: Maxwell Colleen J , Stock Kathryn , Seitz Dallas , Herrmann Nathan
Published: January 2017

This paper provides a comprehensive review of studies examining adherence and (or) persistence with dementia pharmacotherapy during the past decade, including a summary of the key patient-, drug-, system-, and provider-level factors associated with these measures. Estimates of adherence and 1-year persistence to these drugs have ranged from 34% to 94% and 35% to 60%, respectively. Though many studies reported nonsignificant associations, there are data suggesting that patient age, sex, ethnoracial background, socioeconomic status, and region-specific reimbursement criteria, as well as the extent and quality of interactions among patients, caregivers, and providers, may influence persistence with pharmacotherapy. As many studies relied on administrative data, limited information was available regarding the relevance of patient's cognitive and functional status or the importance of caregiver involvement or assistive devices to adherence or persistence.
Families of Children with Attention Deficit Hyperactivity Disorder: A Review
Authors: Hechtman Lily
Published: January 2017

Objectives:

1) To review the evidence of attention deficit hyperactivity disorder (ADHD) and other conditions in family members (siblings and parents) of children with ADHD and determine the importance of genetic and environmental factors in this condition. 2) To describe the prospective 10-year follow-up of 65 families with ADHD children and 43 families of matched normal controls. 3) To review various studies that have looked at parent–child interactions with ADHD children on and off stimulant medication, and such interactions over time. The paper thus provides an overview of family pathology and functioning of families of ADHD children over time.

Method:

The paper outlines twin, sibling, family and adoption studies with regard to possible genetic and environmental factors in ADHD. It also presents data of a prospective 10-year follow-up of 65 families with ADHD children and 43 families of normal controls. This family study evaluated sociocultural factors, child rearing practices, health of family members and relationships, as well as the parental view of the child's functioning over time.

Results:

A review of the literature suggests that ADHD has a strong genetic component, but that environmental factors also play an important role. Families of children with ADHD have more problems than families of normal controls, but these problems improve as the child with ADHD grows up and leaves home. Families of ADHD subjects can appreciate positive as well as negative changes in their children over time. Generally, family interactions with children with ADHD are problematic but improve when the child is on medication and when the child becomes an adult.

Conclusions:

This condition has strong genetic underpinnings; therefore, diagnosing and treating family members (parents and siblings) as well as the child with ADHD is important in improving parent–child interactions and better long-term outcome for the child and his or her family.
Sex-Role Attitudes and Clinical Appraisal in Psychiatry Residents
Authors: Belitsky Catherine A , Toner Brenda B , Ali Alisha , Yu Betty , Osborne Susan L , deRooy Elizabeth
Published: January 2017

Objective:

To measure sex-role beliefs of psychiatry residents and to examine bias in clinical appraisal.

Method:

Residents (45 female, 51 male) evaluated 1 of 4 possible clinical case histories— a female or male patient with histrionic personality disorder (HPD) or antisocial personality disorder (APD)— and completed the Sex-Role Egalitarianism Scale (SRES).

Results:

As predicted, female residents were more egalitarian than male residents (P < 0.03) according to the SRES. As expected, significantly more male than female patients received the diagnosis of APD (P < 0.00002). Although it was predicted that female patients would more often be given the HPD diagnosis than males, no significant gender differences were found. Sex of resident was not found to influence clinical behaviour significantly.

Conclusions:

These results highlight differential sex-role attitudes, as measured by the SRES, between female and male residents and suggest that residents' sex-role biases affect the diagnosis of APD. These results have implications for psychiatric assessment and treatment. Further understanding of these issues is critical to the development of educational tools to address sex biases in psychiatry.
Memory Impairment in Schizophrenia: Perspectives from Psychopathology and Pharmacotherapy
Authors: Stip Emmanuel
Published: January 2017

Objective:

To describe the concept of memory impairment in schizophrenia and the clinical implications of this concept in terms of patient assessment and neuroleptic drug use.

Method:

Narrative literature review.

Results:

Individuals suffering from schizophrenia normally exhibit some degree of memory impairment. Recent work in psychopathology indicates that the impairment is comprehensive, involving the sensory, short-term, and long-term memory stores. Memory impairment appears to be a primary symptom of the disease, and its underlying causes are likely organic. A number of medications, however (for example, traditional neuroleptics and drugs that have pronounced anticholinergic activity), may cause or exacerbate impairment. In particular, anticholinergic agents used to treat extrapyramidal symptoms, a common complication of neuroleptic drugs, appear to have a deleterious effect on memory.

Conclusions:

Memory impairment is an important consideration in the clinical assessment and management of patients with schizophrenia. The use of atypical antipsychotics like risperidone appears to have no impact on memory function; because risperidone is associated with a low incidence of extrapyramidal side effects, it can obviate the need for anticholinergic medications—thus offering greater hope of nondebilitative intervention. The advent of medications that are safer (on cognition) could also lead to generally better outcomes by facilitating compliance with drug regimens and rehabilitation programs.
Patients versus Rehabilitation Practitioners: A Comparison of Assessments of Needs for Care
Authors: Comtois Ginette , Morin Christiane , Lesage Alain , Lalonde Pierre , Likavc̆anova Elena , L‘Écuyer Geneviève
Published: January 2017

Objective:

A group of 47 young adults suffering from schizophrenia was interviewed to garner their views on their needs for care.

Method:

Three members of a specialized multidisciplinary rehabilitation team, who had been caring for these patients, on average, for the past 4 years, completed a questionnaire to assess the needs for care of these individuals. Patient and staff assessments were then compared.

Results:

Patients and staff do not share similar views on the presence of clinical and social problems. Further analyses of the perceived importance of living-skills deficits, the perceived difficulties in dealing with these, and the recent developments in rehabilitation practices challenge whether patient-staff consensus is indeed essential for rehabilitation.

Conclusion:

We propose that staff should listen to patients' points of view more carefully, especially in the areas of work, studies, and independent living.
Treatment Outcome of Personality Disorders
Authors: Sanislow Charles A , McGlashan Thomas H
Published: January 2017

Objective:

To review the treatment outcome of personality disorders.

Method:

A literature search of studies pertaining to personality disorder and outcome was conducted, and studies that focused primarily on Axis II were retained. Of these, naturalistic outcome studies were distinguished from those that addressed treatment outcome specifically. The treatment outcome studies were examined in terms of type of treatment intervention, dependent variables, and outcome.

Results:

Contrary to contemporary assumptions about Axis II, a substantial number of treatment outcome studies were identified. Trends in the assumptions underlying psychosocial and pharmacologic approaches were identified on the basis of dependent variables.

Conclusion:

There is evidence that effective treatments exist to alleviate symptoms and reduce symptomatic behaviours that accompany personality disorders. What these results hold for the idea of remission from personality disorder is considered.
Determinants of the Y Descent and its Usefulness as a Predictor of Ventricular Filling
Authors: Magder S. , Erice F. , Lagonidis D.
Published: January 2017

Our objective was to determine if the magnitude of the Y descent in the central venous pressure tracing could be used to determine which patients have restrictive hemodynamics. To better understand the determinants of the Y descent, we also examined the effects of changes in blood volume, changes in pleural pressure, and respiratory maneuvers on its magnitude. Studies were performed in both humans and dogs. In six anesthetized dogs, we examined the effect on the Y descent in central venous pressure (CVP) of an infusion of normal saline, a decrease in pleural pressure produced by having animals perform a Mueller maneuver, and the combination of a Mueller maneuver and volume loading. Observations were made with the chest closed, chest open, and chest and pericardium open. The state of the chest did not effect the Y descent. The Y descent was only significantly increased when a Mueller maneuver was combined with volume loading. There was a significant inverse relationship between the magnitude of the decrease in esophageal pressure and the Y descent. There was also a linear relationship between the CVP and Y descent. For the human studies, we examined patients undergoing routine cardiac surgery. They were examined during spontaneous breathing before intubation, with positive pressure breathing and closed chest, with positive pressure breathing and open chest, with an open pericardium, with a closed chest and positive pressure breathing postsurgery, and with spontaneous breathing after extubation following surgery. The Y descent was greater in spontaneous breaths postsurgery compared to before surgery, and this was associated with an increase in CVP. However, the magnitude of CVP did not correlate with the magnitude of the Y descent. A restrictive pattern in cardiac filling was identified by a lack of respiratory variation in right atrial pressure during spontaneous breaths. All patients with large Y descents had a restrictive pattern, but many patients with restrictive filling patterns did not have a large Y descent. The magnitude of the Y descent is affected by the volume status, the magnitude and direction of the changes in pleural pressure, and the compliance of the pericardial compartment. A large Y descent indicates a restrictive cardiac state, but a small Y descent does not rule out a restrictive condition because of the many interacting variables.
Recent Advances in the Understanding and Treatment of Migraine
Authors: Fullerton Terence
Published: January 2017

Migraine is a disorder that afflicts more than 23 million individuals in the United States alone. The disorder is characterized by paroxysmally recurring attacks, which are moderately to severely disabling. The migraine attack is typified by a severe, usually unilateral headache, which is pulsatile in quality, and by one or more concomitant symptoms, such as nausea, vomiting, photophobia, and/or phonophobia. Because of its debilitating nature, migraine causes significant morbidity among sufferers, including lost time from work or school, and inability to perform other normal daily activities during attacks. The precise pathogenesis of migraine remains to be elucidated. However, the attack may be initiated and perpetuated by both neural and vascular mechanisms. The trigeminovascular system appears to be particularly involved. Treatment of migraine consists of avoidance of trigger factors, acute or abortive pharmacotherapy, and prophylactic pharmacotherapy. A plethora of endogenous and exogenous migraine triggers have been identified, some of which can be avoided or controlled in order to reduce attack frequency. The ergots represent the accepted standard for the treatment of the acute attack, though significant toxicity and the potential for rebound headache with overuse limit the usefulness of these agents. Simple and combination analgesics are also limited by their inherent propensity to cause a rebound phenomenon when overused. Sumatriptan is a selective serotonin receptor agonist that is now available for abortive treatment of migraine. It has been shown to be highly effective in treating the acute attack. Beta-blocking drugs are the agents of choice for migraine prophylaxis, though anti-depressant compounds, calcium channel antagonists, non-steroidal anti-inflammatory drugs, cyproheptadine, and methysergide are also used. Non-pharmacological therapy may be tried, but is rarely effective by itself.
Postoperative Epidural Pain Management
Authors: Dewell William Marshall
Published: January 2017

Postoperative pain can be effectively managed with epidurally administered opioids or local anesthetics. This article briefly reviews spinal cord anatomy. Pharmacokinetic and pharmacodynamic properties of epidurally administered opioids and local anesthetics are outlined. The pharmacist's participation in a pharmaceutical care plan for the acute postoperative pain patient is also discussed.
Cognitive Services in Nutrition Support Pharmacy
Authors: Murray James J.
Published: January 2017

Many new opportunities are available to the clinical pharmacist in search of an appropriate environment in which to tailor specific clinical services. This is an opportune time for pharmacists to become more creative in their practice settings and to become more involved with, and responsible for, the therapy process of patients. Cognitive services provide a value-added service to the patient, physician, and third-party payor. The value of pharmaceutical cognitive services becomes more evident in the outpatient setting. The value of cognitive services varies depending on the practice setting, demographics of the patient, and resources of the pharmacy organization. This article describes a pharmacist's experience in developing nutritional support cognitive services to patients and targeted physicians in an outpatient home infusion pharmacy. If properly developed, a well-marketed cognitive service can add tremendous revenue to a pharmacy by creating respect and loyalty from physicians and third-party payors, creating a formidable patient base. Cognitive services are not reimbursed separately at present, but future studies should show the value of these services if more pharmacists will provide cost-effective cognitive services and be able to show more positive patient therapy outcomes.
Tacrine for Alzheimer's Disease: Therapeutic Considerations
Authors: Finley Ron
Published: January 2017

Alzheimer's disease (AD) is a progressive, irreversible neurological disease that burdens both patient and family with emotional, financial, and social costs. Approximately four million people have been diagnosed as having AD. In 1991, 266,000 cases of AD were diagnosed. This number is expected to increase as our population ages. In the past numerous drugs have been studied and used clinically in an attempt to reverse or slow the memory impairment, confusion, and behavioral problems caused by AD. None have been found to be consistently effective. In November 1993 the first drug in the USA, tacrine (Cognex), was approved for the treatment of AD. This approval has not come without some controversy. A considerable debate still exists as to the efficacy of tacrine in AD. Approximately 45% of patients will have a substantial increase in their liver function tests (ALT). Patients require close monitoring, especially during the first 18 weeks of treatment. In addition to this, tacrine does appear to have a number of less serious, but bothersome side effects and possible drug-drug and drug-disease interactions. This article provides the pharmacist with practical information regarding the safe, most effective use of this interesting drug. Tacrine is the first drug approved for the treatment of AD, but almost certainly not the last.
Humor: A Holistic Nursing Intervention
Authors: Pasquali Elaine Anne
Published: January 2017

Humor is a complex phenomenon A holistic approach to humor that integrates biophysical, psychological, sociocultural, and spiritual dimensions takes into consideration the complexity of humor. A lively sense of humor is dependent on well–functioning dimensions of self. Defective development of any or all of the dimensions of self undermine one's sense of humor. Humor contributes to the promotion and maintenance of wellness and it also offers promise as a noninvasive yet effective strategy for the treatment ofillness. In order to use humor therapeutically, client coping patterns, anxiety level, and sense of humor need to be thoroughly assessed. The use of humor can be a truly holistic nursing intervention.
The NANDA Taxonomy: An Aid to Holistic Practice
Authors: Frisch Noreen Cavan
Published: January 2017

Sensitive nurses strive to meet each client in a truly holistic sense, wanting to care for the body, mind and spirit of each patient. The present article describes how theconcept of nursing diagnoses and the use of the current NANDA taxonomy serve as powerful and effective tools in elevating nursing practice to its holistic ideals. A brief history of the nursing diagnosis movement is given, followed by case examples whichdemonstrate application and effectiveness.
Evaluation of the Performance of Diagnosis-Related Groups and Similar Casemix Systems: Methodological Issues
Authors: Palmer George , Reid Beth
Published: January 2017

With the increasing recognition and application of casemix for managing and financing healthcare resources, the evaluation of alternative versions of systems such as diagnosis-related groups (DRGs) has been afforded high priority by governments and researchers in many countries. Outside the United States, an important issue has been the perceived need to produce local versions, and to establish whether or not these perform more effectively than the US-based classifications. A discussion of casemix evaluation criteria highlights the large number of measures that may be used, the rationale and assumptions underlying each measure, and the problems in interpreting the results. A review of recent evaluation studies from a number of countries indicates that considerable emphasis has been placed on the predictive validity criterion, as measured by the R2 statistic. However, the interpretation of the findings has been affected greatly by the methods used, especially the treatment and definition of outlier cases. Furthermore, the extent to which other evaluation criteria have been addressed has varied widely. In the absence of minimum evaluation standards, it is not possible to draw clear-cut conclusions about the superiority of one version of a casemix system over another, the need for a local adaptation, or the further development of an existing version. Without the evidence provided by properly designed studies, policy-makers and managers may place undue reliance on subjective judgements and the views of the most influential, but not necessarily best informed, healthcare interest groups.
When Does Regionalization of Expensive Medical Care save Money?
Authors: Menke Terri J. , Wray Nelda P.
Published: January 2017

Regionalization of expensive, high-technology medical care is often proposed as a way to reduce medical costs. Most empirical estimates of the cost implications of regionalization suffer from methodological shortcomings. Here, we discuss all the factors that must be taken into account to produce an accurate assessment of how regionalization changes costs. These factors include the following: (1) The extent of resource sharing among different services; (2) The extent of unused capacity; (3) Whether regionalized facilities have high, low or average costs; (4) Costs of a regionalized system, including transporting patients to the regionalized facilities, coordinating care between the referring and regionalized providers, and out-of network care; (5) The effect of regionalization on the volume of care; and (6) whether a short- or long-term view is taken.
Hospital Board Power
Authors: Starkweather David
Published: January 2017

This paper is about governance of community not-for-profit hospitals. It begins by noting the marked inconsistencies between widely shared views of official hospital board functions and the actual performance of these boards. Several models of organisation power are then reviewed, with comment on their adequacy for hospitals. Then the notion of hospital board power as a convenient fiction is presented. The paper concludes with a discussion of the sufficiency of this arrangement for hospital performance.
The Marketing Activities of Hospitals: Environmental, Organizational, and Managerial Influences
Authors: Myrtle Robert C. , Martinez Charles F.
Published: January 2017

This article reports the results of a study designed to examine the relationship of environmental, organizational and structural factors, perceptions of key decision makers about competitive conditions, and changes in operational performance with the level of the marketing activities engaged in by 145 California hospitals. Measures assessing the impact of environmental conditions and the perception of the key decision makers were found to be related to the marketing activities of the organization. However, the relationship between measures which examined the structural and performance impacts on the marketing activities did not demonstrate the same predictive ability. The results suggest that marketing activities were affected by the key decision maker's assessment of the competitive nature of the environment, influence of key stakeholders, and tangible changes in the organization's task environment. Performance and other measures were not found to be as influential in determining these activities.
Linkworkers in Antenatal Care: Facilitators of Equal Opportunities in Health Provision or Salves for the Management Conscience?
Authors: Hicks Carolyn , Hayes Linda
Published: January 2017

A number of reports have highlighted non-English speaking Asian women as being at risk from limited health care provision (eg Whitehead, 1987). Of particular relevance to the present survey is their low uptake of antenatal care which may contribute to the above-average perinatal mortality rates for this group. In an attempt to ameliorate this problem, a Linkworker service was introduced in a number of multi-racial health districts. The survey reported here was an attempt to establish the efficacy of this service. From an initial sample of 30 health districts, 20 replies were obtained which provided some valuable insights on the current status of the Linkworker provision. In summary, the responses indicated that there is a worrying mis-match between client need and service planning, largely because relevant information about supply and demand is not collated. The net result is that many of the at-risk group are still denied the full and appropriate services of the Linkworker. It is concluded that if Linkworker provision is seen as a valuable commodity in enhancing equal opportunities in health care, then the service needs to be systematised. If it is perceived to be of little demonstrable value, then it should be scrapped. In either case, some clear policy decisions are required.
Policies and Practices Related to Information System Adoption in Hospitals Owned by Ministries of Health in the Arab Gulf
Authors: Nabali Haifa M.
Published: January 2017

This is a discussion paper based on the findings from a study of the factors affecting the adoption of computer-based hospital information systems (CBHIS) in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as visits to ministries of health in these countries. The focus of this paper is on the adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of the main role that ministries of health play as providers of health care in the Region.

Prior to describing CBHIS adoption practices, an overview of the Region in terms of its economic development and its health care delivery systems is presented. Next, the research setting along with the major findings are briefly described followed by a discussion of the advantages and disadvantages of centralized CBHIS adoptions. Finally, management guidelines related to the adoption of CBHIS by multi-hospital institutions are proposed.
The Making of Effective Managers: The Sudanese and the US Perspectives
Authors: Jain Sagar C. , Abubaker Gafer
Published: January 2017

This article, the first from the International Project on Culture and Management, a worldwide study to determine the role of national culture in managerial behavior and effectiveness, accomplishes two tasks. It describes the essential features of the design of the whole project and compares the questionnaire responses of US and Sudanese college students on four aspects of normative managerial behavior-personality, knowledges skills, and values. Data are analyzed by factor analysis and stepwise regression. The findings validate the hypothesis that Americans and the Sudanese expect significantly different behaviors from their managers in all four areas.
Satisfaction with Primary Health Care and Confidence in General Practitioners: An Exploratory Comparison of US and UK Students
Authors: Schlegelmilch Bodo B. , Carman James M.
Published: January 2017

This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers.
Employees' Views of Their Work Experience in Private Hospitals
Authors: Sieveking Nicholas , Bellet William , Marston Ronald C.
Published: January 2017

Employees in 10 private for-profit hospitals responded to questionnaires regarding their work experiences, hospital facilities, and employer. Replicated results identified themes of employee opinions, including: Supervision, The Employer, Role Significance, Hospital Image, Competitiveness, Benefits, Cohesiveness, and Work Load. Only scores on the Role Significance scale differed between clinical and non-clinical respondents, with the former scoring higher. Survey methodology can be used to define an organization's culture from the employee's viewpoint. Their perception of this culture helps determine their behavior at work and their conveying the image of their facility in the community.

The recent emphasis on quality improvement and ‘bottom-up’ management presents a particularly well-suited opportunity for the effective use of surveys. Quality improvement efforts involve employee groups which empower workers as active diagnosticians, internal consultants, and decision makers. Survey defined ‘action levers’ portray avenues along which such constructive efforts might be directed. Also, surveys identify themes through which management can evaluate organizational performance overall and department by department, building in means by which those responsible for units of the hospital can be accountable for achieving measurable results.
Health Services Research – What it is, How to Do it, and Why it Matters
Authors: Lilford Richard J.
Published: January 2017

The term ‘Health Services Research’ (HSR) has achieved only recent currency in the UK. The purpose of this short article is to explain what it is, to say how it differs from clinical research even when using similar methods, and to argue that it is likely to become of rapidly increasing importance to health policy-makers and managers.
The Relationship between Well-Being and Job Satisfaction for Staff Working on Long Stay Wards for the Elderly Confused
Authors: Mountain Gail , Dabbs Alan , Bowie Peter
Published: January 2017

The psychological well-being and job satisfaction of nursing staff working on long stay wards for the elderly confused were examined in one health district. Feelings of well-being were not related to job satisfaction. However, feelings of unhappiness were found to be related to job dissatisfaction, this relationship was found in the ward managers (predominantly males) and not other qualified or unqualified staff. The implications of this finding are discussed.
The Role of the Middle Manager in Health Care Research: Some Problems and Perspectives
Authors: Hicks Carolyn
Published: January 2017

There is mounting pressure on health care professionals to undertake research. However, despite national and local directives, relatively little research is published within the paramedical professions. One reason for this may relate to the fact that changes in basic training have located the bulk of the research skills amongst the most newly qualified but potentially least influential staff. This pilot study examined the impact of developing research competencies in a group of middle managers, on the assumption that they might then influence and facilitate research productivity among junior staff. The study was largely unsuccessful as a result of numerous practical and attitudinal problems. Some suggestions are put forward for overcoming some of these difficulties and thus for increasing research output amongst the paramedical professions
Taylorism in a Post-Modern Age?
Authors: Freemantle Nick
Published: January 2017

F. W. Taylor made an early and important contribution to the organisation of work in an industrial society. His ideas, or versions of his ideas, are once again receiving attention. Some commentators even describe a new or neo Taylorism (Pollitt, 1990). This paper argues that the only theoretical justification for the re-introduction of Taylorist strategies in the workplace is found in the notion of the post-modern world; where rationality is replaced by a ritual of signs and work becomes part of that ritual; where form replaces rationale, and strategies for work are governed by processes of survival in the remnants of modernity.

‘… I use … the words bringing the science and the workman together. It is unfortunate, however, that the word bringing has a rather disagreeable sound, a rather forceful sound; and in a way, when it is first heard it puts one out of touch with what we have come to look at as the modern tendency …’ F. W. Taylor (Pugh, 1990, p 206).
HMO Survival: Determination of Optimal Size
Authors: Clement Dolores G.
Published: January 2017

The concept of prepaid health care as embodied by health maintenance organizations (HMOs) provides variety in the provision and coverage of health care benefits. This is important in the development of a diverse and appropriate health care system for the US. HMOs were developed to provide a cost-effective, alternative form of health care delivery and financing to ensure access and continuity. HMOs can achieve this only by sustaining organizational viability. A survivor analysis modelling technique is employed to analyze the optimal size of HMOs by region model type and profit status over the period from 1977 through 1986. A determination of an optimal size category establishes a survival criterion for HMOs. A minimum enrolment of at least 25,000 members should be achieved as quickly as possible. This minimum standard can be used as a guide for initial success, however a higher enrollment in the 40,000 to 60,000 member range appears necessary for longer-term survival.
Attitudes and Knowledge about Case Mix Reform among Hospital Staff in Australia
Authors: Degeling P. , Black D. , Palmer G. , Walters J.
Published: January 2017

This paper reports some of the findings of a national survey of staff in acute care hospitals about their knowledge of case mix and their attitudes towards it. Our findings suggest that, despite the range and scope of activities that have been pursued under the Australian Casemix Development Program (ACDP), knowledge of case mix among acute care hospital staff remains patchy. The evidence also shows that significant aspects of the DRG classification system and the uses to which it can be put are not accepted by many hospital staff, particularly medical staff. The paper concludes with a discussion of what some of these findings imply for future activity on case mix reform.
Development of a Psychometrically Valid Training Needs Analysis Instrument for Use with Primary Health Care Teams
Authors: Hicks C. , Hennessy D. , Barwell F.
Published: January 2017

The growing demand for professional updating and training within the health service has created a proliferation of post-registration courses, many of which fail to reach the appropriate personnel or the real training objectives of the participants and their managers. One reason behind this problem relates to the fact that many such courses are constructed and delivered in a haphazard way, without systematic reference to the direct and indirect consumers of the educational programmes. A more rational approach to post-experience provision of this sort might involve the methodical collection of information regarding the training needs of target health professional populations. Such a data base would afford a global overview of competencies and deficiencies, both within and between individuals. From this the content, level and focus of training could be customized to meet the reported needs, thereby streamlining the commissioning process to enhance efficiency and effectiveness. Previous attempts to rationalize provision through the prior use of training needs analysis instruments have been compromised by the shortcomings of the analysis tool.

This study, then, was an attempt to redress this problem, using a training needs analysis instrument developed along traditional psychometric principles. The tool was intended to be used with primary health care teams because of the increasing role this sector of the health service will play in the future delivery of care, although this would not preclude its use with other health care professionals (following appropriate modification), since the principles behind its construction and format are transferable. The instrument has demonstrable construct, content and face validity and significant reliability. Moreover, preliminary investigations suggest that it also has criterion validity in the areas tested. These findings suggest that the instrument is unique of its kind. Early use of the tool has demonstrated its value in a variety of ways, such as in team building exercises and skill mix reviews as well as in precise and effective commissioning of training and education in a range of areas.
Specialty Location Decisions in the Reformed NHS: A Case Study
Authors: Hindle T. , Roberts E. , Worthington D.
Published: January 2017

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of ‘small’ specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.
The Effects of Organizational Structure on Hospital Performance
Authors: Perryman-Starkey M. , Rivers P. Asubonteng , Munchus G.
Published: January 2017

The relationship between organizational structure and organizational performance would seem at first to be straightforward and obvious. The more complex organizational structures will result in positive organizational performance (i.e. greater effectiveness or profitability). The premise is that the ability of an organization to achieve its mission successfully should be a result of the organizational structure. It is generally accepted that certain structural configurations are able to achieve certain goals better than others (i.e. a diversified structure as opposed to a simple structure). The research to date indicates that this is not necessarily true. The specific issue examined in this paper will be the effect of structural diversification on performance in industry and healthcare.
Staffing Intensity, Skill Mix and Mortality Outcomes: The Case of Chronic Obstructive Lung Disease
Authors: Robertson R. H. , Hassan M.
Published: January 2017

The hospital re-engineering movement has resulted in major changes in hospital staffing. These staffing changes have the potential to reduce staffing intensity and skill mix, both generally and within specific caregiver groups. Prior research has shown that both skill mix and staffing intensity are positively associated with outcomes indicative of the quality of hospital care. This study extends beyond prior research by expanding the scope of staffing intensity and skill mix measures beyond that of physicians and nursing personnel and by focusing on a specific diagnostic group, patients with chronic obstructive pulmonary disease (COPD). Multiple regression analysis was performed using the 30-day post-admission observed mortality rate for Medicare patients being treated for COPD relative to the predicted rate as the dependent variable. Analyses were repeated for 1989, 1990 and 1991. Among the explanatory variables were staffing intensity measures for health care workers that were thought to contribute significantly to the care needed by patients with COPD. The results indicate that the only group of health care workers which showed staffing intensities positively associated with better outcomes in this group of patients was respiratory care practitioners, respiratory therapists and respiratory therapy technicians. The results relative to skill mix were inconclusive. It was concluded that during the 19891991 period, hospitals with higher staffing intensities for both respiratory therapists and respiratory therapy technicians had better outcomes for their Medicare inpatients being treated for COPD.
Condom Use and ‘Withdrawal’: Exploring Gay Men's Practice of Anal Intercourse
Authors: Richters Juliet , Knox Stephanie , Crawford June , Kippax Susan
Published: January 2017

Some gay men who have unprotected anal intercourse avoid ejaculation—they practise ‘withdrawal’. Using data collected in 1997 from a sample of Sydney gay men ( n=625), we explored the relation between men's practice of ejaculation and their use of condoms. We also investigated whether men who had unprotected withdrawal but not unprotected ejaculation were more likely to think unprotected withdrawal was safe, liked condoms less, liked anal intercourse more, or were more sexually adventurous. Considering separately insertive and receptive anal intercourse with regular and with casual partners, we found that the majority of men who practised unprotected withdrawal also practised unprotected ejaculation. Of those whose only unprotected sex was withdrawal (‘true withdrawers’), most never used condoms (they did not also have protected sex with ejaculation). True withdrawers were compared with men who had unprotected ejaculation, who always used condoms, who had no anal sex and who had no partners. Those who were true withdrawers with casual partners were more likely to believe withdrawal was safe; no group effects were found with regular partners. No significant differences in condom attitudes were found. True withdrawers with regular partners liked anal intercourse less than other men, but true withdrawers with casual partners were indistinguishable from those who had unprotected ejaculation. True withdrawers did not differ in sexual adventurousness from other men who had anal intercourse. Most withdrawers avoided anal sex with ejaculation rather than use condoms. Converting them into reliable condom users may be a considerable challenge for health promotion.
Trend of Antimicrobial Resistance in Neisseria Gonorrhoeae at New Delhi, India
Authors: Ray Krishna , Bala Manju , Kumar Jogindar , Misra R S
Published: January 2017

We aim to monitor the trends of antimicrobial resistance in Neisseria gonorrhoeae and to compare the results of antimicrobial sensitivity by disc diffusion and minimum inhibitory concentration (MIC). Two hundred and eleven confirmed strains of N. gonorrhoeae were subjected to antimicrobial sensitivity testing by disc diffusion using penicillin, tetracycline, ciprofloxacin and ceftriaxone from 1995 to June 1999. Penicillinase-producing Neisseria gonorrhoeae (PPNG) were detected by lodometric method. Minimum inhibitory concentration was determined by E test. A low level of penicillin resistance and PPNG detected in 1996 was maintained over the years. Significant increasing trend of tetracycline and ciprofloxacin resistance with high MIC i.e. 2–96 μg/ml and 1–32 μg/ml respectively were found. Ceftriaxone was found to be the drug of choice, being 100% sensitive. Comparison of resistance pattern by the 2 tests showed satisfactory agreement. Emergence of penicillin, quinolone and tetracyline resistance in N. gonorrhoeae isolates from a major STD centre at New Delhi indicates the need for increased awareness, prudent use of antimicrobials, and evaluation of new antimicrobials for the treatment of gonorrhoea.
What is the Role of Scrotal Ultrasound Scans in Genitourinary Medicine?
Authors: Banerjee I , Scott G R
Published: January 2017

The objective of the study was to review the indications for scrotal ultrasound scans and to assess the impact on patient management.

We therefore performed a retrospective analysis. Case notes of all males referred for a scrotal ultrasound between April 1998 and March 2001 were studied. Data were extracted for the following: age, presenting complaints, physical findings on examination, results of a full sexual screen, treatment, ultrasound result and the designation of the person requesting the scan. All data were tabulated and summated using ‘Windows Excel’ software.

One hundred and fifteen men were referred for an ultrasound in this period of time. None had an ultrasound more than once. Of these, 25 subjects could not be included as they either failed to attend for their scan ( n = 8) or their notes could not be traced ( n = 17). Twelve subjects were excluded as they did not fit the selection criteria ( n = 12).

Median age was 30 years (Range 19–61 years). The commonest reason for referral was testicular pain ( n = 43) followed by testicular lump ( n = 19). The commonest abnormality on examination was an inflamed epididymis ( n = 18). Forty-two of the ultrasound scans were normal. A testicular mass was detected in only five of the 78 patients (6.4%), of which one was a malignancy (1.2%). A direct referral to a urologist for further management was made in only nine patients.

Scrotal ultrasound for pain has limited impact on patient management apart from reassuring a worried patient. However, it remains an important investigation in the management of a suspected testicular lump.
Audit of the Management of Early Syphilis at North Manchester General Hospital
Authors: Kingston M A , Higgins S P
Published: January 2017

The city of Manchester has seen a sustained increase in reported cases of early (infectious) syphilis since the late 1990s. We audited the management of patients presenting with early syphilis to North Manchester General Hospital, with reference to the UK national guidelines. Between January 1999 and December 2001 72 cases of early syphilis were identified. Most (90%) occurred in men who have sex with men, 50% of whom were HIV-positive. Serology and polymerase chain reaction testing of lesions were useful diagnostic tests. Treatment regimens followed the national guidelines in 63% of cases, with adherence to the guidelines improving as the outbreak continued. The majority of patients were treated with intramuscular penicillin (78%), with only three discontinuing this treatment due to side effects. Only 4% of sexual contacts identified were traced and screened, an indication of high levels of both anonymous sex and partner change in this group.