bluuebunny/crossref_metadata_2025 huggingface dataset:
Binding site prediction and improved scoring during flexible protein–protein docking with ATTRACT
Authors: Fiorucci Sébastien , Zacharias Martin
Published: June 2010

The ATTRACT protein–protein docking program combined with a coarse‐grained protein model has been used to predict protein–protein complex structures in CAPRI rounds 13–19. For six targets acceptable or better quality solutions have been submitted (high quality predictions for targets 32, 40, 41, and 42). The improved performance compared to previous rounds can be attributed in part to the inclusion of conformational flexibility during systematic searches and an optimized scoring function. In addition, a recently developed method for the prediction of putative protein binding sites based on the electrostatic penalty to place neutral low dielectric probes on the protein surface was applied to the most recent targets. The approach resulted in useful predictions of putative binding sites that can help to limit the systematic docking searches. Possible improvements of the docking approach in particular at the scoring and refinement steps are discussed. Proteins 2010. © 2010 Wiley‐Liss, Inc.
Variance scaling in shallow‐cumulus‐topped mixed layers
Authors: Neggers R. A. J. , Stevens B. , Neelin J. D.
Published: July 2010

Scaling of thermodynamic variance in shallow‐cumulus‐topped mixed layers is studied using large‐eddy simulation (LES). First, the performance of the top‐down scaling (the turbulent flux at mixed‐layer top divided by w*) is evaluated for transient shallow‐cumulus convection over land. The results indicate that this scaling fails to capture all the variance in the top half of the mixed layer when shallow cumulus clouds are present. A variance‐budget analysis is then performed, to derive a new scaling for the variance at mixed‐layer top, which differs from the standard top‐down scaling by a factor of one Richardson number. The essential new features of the proposed scaling are that the local vertical gradient is retained and that a balance is assumed between gradient production of variance and removal by transport and dissipation, using an adjustment time‐scale given by w*/h. Evaluation against LES for a range of different cases, including a dry convective boundary layer as well as steady‐state marine and transient continental shallow cumulus, reveals a data‐collapse of the newly‐scaled variance, for all hours and all cases in the top half of the mixed layer. The corresponding vertical structure is shown to resemble a power‐law function. The results suggest that the structure of variance in the dry convective boundary layer is similar to that in the sub‐cloud mixed layer. In transient situations, the scaling reproduces the time‐development of variance at sub‐cloud mixed‐layer top. The new cloud‐base variance scale is then further interpreted in the context of statistical cloud schemes, which depend on the variance as the second moment of the associated probability density function. The results suggest that the area fraction of the moist convective thermals uniquely depends on the ratio of cloud‐base transition‐layer depth to sub‐cloud mixed‐layer depth. This puts ‘valve’‐ or ventilation‐type closures for the cloud‐base mass flux in the context of the variance budget for the sub‐cloud layer. Copyright © 2007 Royal Meteorological Society
In situ measurements of liquid water content profiles in midlatitude stratiform clouds
Authors: Korolev A. V. , Isaac G. A. , Strapp J. W. , Cober S. G. , Barker H. W.
Published: July 2010

Statistical characteristics of 584 liquid water content (LWC) profiles collected mainly in midlatitude supercooled stratiform frontal clouds during five field campaigns are presented. It has been found that the majority (55%) of liquid layers have thickness less than 500 m and the depth of these layers decreases with decreasing temperature. LWC profiles for thin cloud layers are usually close to quasi‐adiabatic, whereas for thick clouds they are approximately constant with an average LWC value close to 0.14 g m−3. Good agreement was observed between cumulative distributions for liquid water paths derived from in situ LWC profiles and those inferred in previous experiments from ground‐based 37 GHz radiometers. Copyright © 2007 Crown in the right of Canada. Published by John Wiley & Sons, Ltd
The value of observations. I: Data denial experiments for the Atlantic and the Pacific
Authors: Kelly Graeme , Thépaut Jean‐Noël , Buizza Roberto , Cardinali Carla
Published: July 2010

Adding targeted observations to the array of observations routinely available to numerical weather prediction is generally found to give small impact, although studies have often focused on a very limited number of cases in field experiments. It is expected that observation targeting in sensitive areas may have more impact on forecasts ‘busts’. A forecast ‘bust’ in a given verification region is defined as a doubling of the mean monthly error for the day‐two forecast. This does not occur very often in the operational ECMWF system. The primary purpose of this study is to produce three reference data‐assimilation experiments: the first assimilation experiment uses all available observations (as they are used in the operational ECMWF analysis system). The second assimilation experiment systematically excludes all observations in the North Pacific oceanic region. The third assimilation experiment systematically excludes all observations in the North Atlantic oceanic region. These three experiments are then used to evaluate the potential of targeting strategies which are described in two separate papers (parts II and III of this study).

Results, based on a summer and a winter season, indicate that on average:

Oceanic data are important to reduce day‐2 forecast errors over the downstream land areas, the downstream impact of observations over the Pacific Ocean being larger than the downstream impact of observations over the Atlantic Ocean.

The removal of observations taken over the Pacific Ocean has generally a small impact on medium‐range forecasts verified over Europe, but results strongly depend on the data‐assimilation system used to assimilate the observations.

Forecasts started from 3D‐Var analyses are worse than forecasts started from 4D‐Var analyses and, given the current observing system, the relative impact of ocean observations is higher if a 3D‐Var system is used instead of a 4D‐Var system. In other words, 4D‐Var is better capable of propagating information from data‐rich to data‐void areas, and is therefore less vulnerable to data gaps in a system which otherwise includes a large number of satellite observations. Copyright © 2007 Royal Meteorological Society
Reversed flow in the south‐Alpine Toce Valley during MAP‐IOP 8: Further analysis of latent cooling effects
Authors: Zängl G.
Published: July 2010

Numerical simulations are presented to examine the physical mechanisms leading to downvalley flow in the south‐Alpine Toce Valley during MAP IOP 8 (20–21 October 1999), continuing a recent study by Asencio and Stein. The downvalley flow occurred during a phase of moderate precipitation, opposing the southerly (upslope) flow at higher levels that generated the precipitation. Based on sensitivity experiments with suppressed latent cooling by melting and evaporation, Asencio and Stein concluded that cooling by melting was important for maintaining a northerly low‐level flow in the exit region of the Toce Valley and the adjacent parts of the Po Valley. Here, the investigation is extended to the Toce Valley itself, using a finer model resolution that allows the valley topography to be properly resolved. The effects of cooling by melting and evaporation are tested separately. In addition, the evaporation of precipitating hydrometeors and cloud water is considered separately. The tests indicate that the effects of cooling by melting and evaporation of precipitating hydrometeors are quite small. A markedly larger impact is found for the evaporation of cloud water, which is advected into the valley area by the subsiding motion compensating for the low‐level downvalley flow. This appears to be related to the fact that cloud water is assumed to evaporate instantaneously in a subsaturated atmosphere via saturation adjustment, whereas larger hydrometeors have a fairly small evaporation rate in a nearly saturated atmosphere. Nevertheless, the sensitivity of the simulated flow field to completely suppressing latent cooling is not as large as found in the preceding study. Though latent cooling substantially intensifies the downvalley flow and prevents temporary changes to upvalley flow, it does not appear to be essential for the development of downvalley flow. An additional driving mechanism based on the evolution of the mesoscale pressure field is proposed. Copyright © 2007 Royal Meteorological Society
The contamination of ‘data impact’ in global models by rapidly growing mesoscale instabilities
Authors: Hodyss Daniel , Majumdar Sharanya J.
Published: July 2010

This paper illustrates a caveat in the ‘data impact’ method, in which the influence of assimilating a specific set of observations on a numerical weather forecast is evaluated. The ‘signal’ of data impact is defined as the difference between two forecasts, which are identical except that one forecast withholds the data in question from the assimilation. While it is anticipated that a coherent signal from observations in the midlatitude storm track is propagated dynamically by a forecast model from the vicinity of the observation locations, the reality is that the signal may become contaminated by initially small instabilities in dynamically unrelated locations. The initial signal may be non‐zero in these remote locations due to small differences between the two analyses arising from truncation errors in the data assimilation scheme and/or the model's truncated spectral basis. The notion that the dynamical signal is contaminated is corroborated by assessing the data impact in the Northern Hemisphere of one rawinsonde released over Antarctica. After just a few hours, an amplifying signal manifests itself in convective areas in the Tropics, and even in locations along the midlatitude storm track where moist instabilities exist. Rapid growth and upscale evolution from the mesoscale to synoptic scales is evident. We find that the evaluation of the efficacy of a given set of observations on weather forecasts of more than two days may be compromised by initially small instabilities, particularly for spectral models and data assimilation schemes. The effective time is expected to be shorter in the Tropics. Copyright © 2007 Royal Meteorological Society
Lead Your Boss
Authors: Watson Carolyn
Published: July 2010

Lead Your Boss John Baldoni 2009, AMACOM 226 pages, $21.95 hardcover
Clinical Issues—July 2010
Authors: Denholm Bonnie , Burlingame Byron
Published: July 2010

This Month

Intravasation and fluid deficit during hysteroscopy procedures

Key words: fluid management, fluid deficit, fluid overload, intravasation, hyponatremia, hysteroscopy.

Fluid selection during minimally invasive surgery

Key words: minimally invasive surgery, fluid selection, electrolyte solutions, distention media, irrigation solutions, fluid risks.

Comparing hysteroscopic insufflators and laparoscopic insufflators

Key words: insufflators, hysteroscopy, laparoscopy, minimally invasive surgery, distention media.

Using IV bags to position patients

Key words: patient positioning, positioning equipment, IV bags, burns.

Storage of disinfected laryngoscope blades

Key words: laryngoscope blades, high‐level disinfection, packaging.
Preparing for Leadership
Authors: Joiner Stacy M.
Published: July 2010

Preparing for Leadership Donna J. Dennis 2009, AMACOM 160 pages, $17.95 softcover
Phosphorylation of spinal N‐methyl‐d‐aspartate receptor NR1 subunits by extracellular signal‐regulated kinase in dorsal horn neurons and microglia contributes to diabetes‐induced painful neuropathy
Authors: Daulhacl Laurence , Maffrel Violette , Malletl Christophe , Etiennel Monique , Privatl Anne‐Marie , Kowalski‐Chauvell Aline , Seval Catherine , Fialipl Joseph , Eschalierl Alain
Published: July 2010

The N‐methyl‐d‐aspartate receptor (NMDAR) contributes to central sensitization in the spinal cord, a phenomenon which comprises various pathophysiological mechanisms responsible for neuropathic pain‐like signs in animal models. NMDAR function is modulated by post‐translational modifications including phosphorylation, and this is proposed to underlie its involvement in the production of pain hypersensitivity. As in diabetic patients, streptozotocin‐induced diabetic rats exhibit or not somatic mechanical hyperalgesia; these rats were named DH and DNH respectively. At three weeks of diabetes, we present evidence that somatic mechanical hyperalgesia was correlated with an enhanced phosphorylation of the NMDAR NR1 subunit (pNR1) in the rat spinal cord. This increase was not found in normal and DNH rats, suggesting that this regulation was specific to hyperalgesia. Double immunofluorescence studies revealed that the numbers of pNR1‐immunoreactive neurons and microglial cells were significantly increased in all laminae (I—II and III—VI) of the dorsal horn from DH animals. Western‐blots analysis showed no change in NR1 protein levels, whatever the behavioural and glycemic status of the animals. Chronic intrathecal treatment (5μg/rat/day for 7 days) by U0126 and MK801, which blocked MEK (an upstream kinase of extracellular signal‐regulated protein kinase: ERK) and the NMDAR respectively, simultaneously suppressed somatic mechanical hyperalgesia developed by diabetic rats and decreased pNR1. These results indicate for the first time that increased expression of pNR1 is regulated by ERK and the NMDAR via a feedforward mechanism in spinal neurons and microglia and represents one mechanism involved in central sensitization and somatic mechanical hyperalgesia after diabetes.
Prévoir les services aux patients: Vision du 21e siècle d'un centre médical universitaire
Authors: Katravas Annette A. , Major Pierre E. , Macpherson Alison K. , Lynn Jeannie , Fortin Jacques , Lecher Liane , Vaughn Kathryn , Riley Donna , Steinmetz Nicolas
Published: July 2010

Cet article propose un aperçu de l'élaboration et de l'utilisation du modèle créé par le Centre universitaire de santé McGill pour prévoir les services aux patients en l'an 2004, ainsi que des conseils sur l'utilisation du modèle. Les facteurs critiques de succès ainsi que des exemples de cas sont également cités. Les perspectives foumies seront utiles pour les hôpitaux et autres institutions qui reconnaissent la nécessité d'établir une planification et des prévisions à long terme.
Team-Based Planning: New Tools for New Times
Authors: Handyside Jim , Parkinson Jane
Published: July 2010

The collaborative process of team-based planning draws upon the strengths of a team and develops the skills that healthcare providers need to build consensus during this time of significant change. This article describes three examples of team-based planning and shows how applying an integrated set of tools can help formulate plans and create new options to meet the challenges facing today's healthcare organizations.
The Creation of a Profession Leader Role in an Academic Health Sciences Center
Authors: Adamson B. , Shackleton T. L. , Wong C. , Prendergast M. , Payne E.
Published: July 2010

The introduction and administration of any new role in a dynamic changing environment requires strong leadership and specific, purposeful administrative strategies. This article describes the development of a professional leader role at one campus of a recently merged academic health sciences centre. Understanding the operational challenges may help other healthcare organizations that wish to introduce and refine professional leadership roles.
Toward 2025: Diagnoses and Prognoses for Canada's Healthcare System
Authors: Caro Denis H.J.
Published: July 2010

Despite the Canadian healthcare system's enormous achievements of the past 50 years, the system is now at a crossroads. The healthcare world in Canada in 2025 will be a confluence of five transformational forces, including social ecological paradigm shifts, virtual e-care, e-management networks, transnational systems and humane caring environments. What follows is a glimpse into the underlying forces that will reshape healthcare by 2025.
Remanier le paradigme de la gestion des soins de santé: vers une gestion organique
Authors: Rathwell Thomas , Persaud D. David
Published: July 2010

Dans le premier volet de cette série de deux articles, nous avons démontré que l'adoption de techniques d'organisation de la production et l'application d'approches axées sur le marché pour la prestation de soins de santé n'avaient pas répondu aux attentes initiales. De plus, la situation impose de grandes contraintes aux gestionnaires qui se voient forcés d'appliquer ces mécanismes. Dans ce deuxième volet, nous proposons une nouvelle philosophie de gestion des soins de santé qui se rapproche davantage des véritables racines de la prestation des soins de santé au Canada.
Emergence of New Professional Leadership Roles within a Health Professional Group following Organizational Redesign
Authors: Chan Angela , Heck Carol S.
Published: July 2010

Results of a survey conducted in all Ontario hospitals have shown that several new non-management professional leadership positions and a model of shared governance within a health professional group have emerged. The model was most evident in healthcare organizations with a program management structure. This article discusses the roles and activities of these advanced professional leaders and shared responsibilities for one professional group (physiotherapy) in light of the results of the survey.
Le rôle changeant des dirigeants du réseau canadien de la santé: résultat d'un sondage national
Authors: Armstrong Russell , Brunelle Francis W. H. , Angus Douglas E. , Levac Gaston
Published: July 2010

Afin d'établir la façon dont les dirigeants du réseau canadien de la santé réagissent à une décennie marquée par la régionalisation, les fusions d'hôpitaux et d'autres transformations du système de santé, un sondage national a été mené de janvier à mai 2000. Le sondage abordait un vaste éventail de sujets y compris les tendances qui entraînent une telle mutation, la préparation de carrière nécessaire pour affronter ces tendances, les qualités de chef qui sont gages d'efficacité et les évolutions des fonctions typiques d'un directeur de services de santé telles qu'il ou qu'elle les perçoit. Les résultats du sondage contribuent de manière significative au dialogue national sur la promotion du leadership et la planification de la relève dans les organismes de la santé.
Enhancing Service Delivery Capacity through Knowledge Exchange: The Seniors Health Research Transfer Network
Authors: Conklin James , Stolee Paul , Luesby Deirdre , Sharratt Michael T. , Chambers Larry W.
Published: July 2010

The Seniors Health Research Transfer Network (SHRTN) was launched in 2005 in Ontario to improve the quality of health care provided to seniors by facilitating knowledge exchange opportunities for formal and informal caregivers, researchers and policymakers.

This article describes the conceptual basis and development of SHRTN, as well as achievements, challenges and lessons learned during its first year of operation, which ended in March 2006. We begin by discussing knowledge exchange networks and their conceptual basis. We then offer a brief history of SHRTN, tracing its origins to both a broad interprofessional interest in creating and sharing knowledge within and across organizations, and also to the efforts of a small group of early champions. After this, we describe the main events, achievements and surprises of SHRTN's first year.

Experience with SHRTN has highlighted the importance of careful attention to governance issues in the organization of knowledge exchange networks, and the challenge of balancing management control with broad participation and flexibility. Collaboration can yield synergy and innovation, but requires commitment from participants. The SHRTN experience has demonstrated that planning and coordinating a provincial network that engages diverse stakeholders is a logistical challenge that requires dedicated infrastructure and funding support.
Public-Private Partnerships: A Canadian Hospital's Perspective
Authors: Philpott Thomas G.
Published: July 2010

The McGill University Health Centre (MUHC) is undergoing a $1.579 billion redevelopment project, placing it amongst the largest hospital redevelopment projects in the world. As the Quebec government and the MUHC were considering the Public-Private Partnership (PPP) procurement alternative, the MUHC embarked upon an investigation of various jurisdictions' experiences with PPPs. The studies concluded that there are various frameworks available and that the specific characteristics of a project should be considered when determining which model to use.
How Can Frontline Managers Demonstrate Leadership in Enabling Interprofessional Practice?
Authors: Suter Esther , Arndt Julia , Lait Jana , Jackson Karen , Kipp Jean , Taylor Elizabeth , Arthur Nancy
Published: July 2010

Interprofessional practice has been proposed to address many of the current health system challenges. Little attention has been paid to the role of frontline managers in supporting effective interprofessional practice. Qualitative interviews suggest that frontline managers can demonstrate leadership in enabling interprofessional practice by creating an organizational culture for interprofessional practice, eliminating barriers to collaboration, and acting as role models and facilitators. New management approaches may be needed to meet these demands.
Measuring Patient Satisfaction — Be Prepared
Authors: MacDonald Pauline
Published: July 2010

This article describes the approach used by the Queen Elizabeth II Health Sciences Centre to measure inpatient satisfaction at the recently merged institution. It presents some of the issues that arose in the planning stages, including use of prior consent. It is important to plan the methodology, the execution, the communication strategy and the follow-up before the process begins to ensure the results are credible, communicated and translated into quality improvement actions.
Introducing “Evidence” into Board Decision-Making
Authors: Menon Devidas , Gebran Joseph
Published: July 2010

The purpose of this article is to report on the results of a workshop that introduced evidence-based decision-making techniques to Board members of regional health authorities in Alberta.

Results and conclusions: The workshop demonstrated that it is possible to design a process for the incorporation of evidence in administrative decision-making. The participants demonstrated that they were able to apply scientific evidence in administrative decision making and that the decisions taken were reasonably consistent. Also, in the absence of evidence, values took precedence in the decision-making process and the decisions taken were less consistent.
Survivor's Syndrome: A Comparison of the Perceptions of Administrators, Managers, Nurses and Physicians during the Restructuring of Ontario Hospitals
Authors: Lees Martin , Steeves William
Published: July 2010

Leaders must approach organizational restructuring by addressing employees' concerns, or risk many potentially negative consequences among “survivors”. This article provides important insights for administrators, managers and planners about the perceptions of people remaining on the job during the restructuring of Ontario hospitals. The findings, relevant to most organizations undergoing or considering restructuring, support the need for proactive change management, including tailored intervention strategies, to assist “survivors”.
Adapting Prehospital Care to a Large Rural Geographic Area: A Review of the Emergency Health Services Nova Scotia Implementation
Authors: Howlett Michael K.
Published: July 2010

Nova Scotia is building a system of prehospital care based on four principles: “Fail Safe” government ownership; “Full Service” advanced life support capable; “High Performance” resource efficiency; and “Fiscally Responsible” performance goals, incentives and penalties. Emergency Health Services Nova Scotia exercises funding and regulatory control through service provided by a private contractor. Benefits include improved fleet and equipment management, information systems, 911 dispatch and performance tracking, medical control and paramedic care, and public accountability. Problems include rural dispatch, budget costs, labour issues and stakeholder communication.
Measuring Aspects of Devolved Health Authority Performance: Nova Scotia Patients Who Travel Further Than Necessary to Obtain Hospital Care
Authors: Hanlon Neil T.
Published: July 2010

This article presents a set of performance indicators measuring how well devolved health authorities do at providing secondary-level hospital services to residents in their jurisdictions. The study is based on an analysis of Nova Scotia discharge abstract data from 1992–93 to 1999–00. While most residents of Nova Scotia obtain this level of care in their own districts, wide variations persisted over time in hospitals' commitment to residents within their own districts.
Use of a Program Logic Model to Guide the Development of a Strategic Plan for Wellington County Hospitals Network
Authors: Fraser Brenda , Hollett R. Grant
Published: July 2010

This article describes how the Wellington County Hospitals Network successfully used a program logic model as a decision-making framework to guide the development of the Network's first strategic plan. The advantages and disadvantages of this approach to the development of a strategic plan and identification of short-term priorities for action by the Network are discussed.
Implementing CQI While Reducing the Work Force: How Does it Influence Hospital Performance?
Authors: Rondeau Kent V. , Wagar Terry H.
Published: July 2010

During the 1990s, many Canadian hospitals introduced quality improvement initiatives while radically reducing their work force. Yet, the incompatible nature of QM and organizational downsizing suggests that the success of one or both change management programs will be sacrificed when done concurrently. Results from a large sample of Canadian hospitals suggest that the implementation of a strong quality improvement initiative can mitigate the negative consequences of severe work force contractions on certain valued organizational performance objectives.
Can Leadership Make a Difference?
Authors: Wong Jocelyne , Modrow Robert
Published: July 2010

Strong leadership is needed to reform the healthcare system in an accountable and transparent manner. This article examines the context of leadership development programs and the conditions that lead to their success as measured by effective outcomes. The article includes a discussion of evaluating leadership performance in the context of 360-degree feedback. In light of the current healthcare climate, caution should be exercised in implementing leadership training programs and the 360-degree process.
Building an Effective Risk Management Program in a Healthcare Setting
Authors: Patrick Louise
Published: July 2010

This paper outlines a step-by-step approach to implementing an integrated risk management program in a healthcare setting. The paper argues for a corporate approach to risk management, based on centralized analysis of incidents and a focus on proactive management of risk factors. The paper discusses implementation from both structural and process perspectives and within the context of Canadian accreditation standards and the National Patient Safety Steering Committee recommendations.
How Many Surgeons Does a Province Need, and How Do We Determine Appropriate Numbers?
Authors: Roos Noralou P. , Fransoo Randy
Published: July 2010

The study compared each province's supply of surgeons in three specialities (ophthalmologists, orthopedic surgeons, and cardiac and thoracic surgeons) with the rates of key procedures (cataract removal, hip and knee replacement, and coronary artery bypass) that residents received. We found little or no relationship between the supply of surgeons and a population's surgery rate. We conclude that the supply of surgical specialists is the wrong focus for health care resource planning.
Adventures in Research Land: Another Glance “Through the Looking Glass” to See What Constitutes Research
Authors: Casebeer Ann , Verhoef Marja
Published: July 2010

There are many frames and rules of thumb for determining what constitutes ‘research’. Some views are directed by the perspective or philosophical underpinnings of particular disciplines or approaches to research.1,2,3 Others are guided by rules concerning or definitions of what ‘evidence’ is, or whether ‘new’ knowledge is created.4,5,6 A recent paper by Jarvis7 suggests that we should differentiate among research, evaluation and measures to assure quality, and that this may help us steer a course through the roles and reasons for these various and varying activities. While the desire to clarify some distinct territory for what constitutes research versus something else is understandable, we argue that these distinctions in the end are at best unhelpful, can be misleading and actually do more harm than good — which in itself is an outcome that good research should avoid. This brief report is not a critique of the specific nomenclature suggested by Jarvis or other existing frames for identifying ‘research’. Our intent is rather to begin a more general commentary on the very subject raised near the end of Jarvis's paper: “The three primary approaches to reviewing what we do are research, evaluation and quality assurance. There are similarities, differences and overlaps among these three approaches. They are part of a continuum with no clear distinctions between them.”7, p.36
Federal Governance in Emergency Management in Canada: Quo Vadis?
Authors: Caro Denis H.J. , Angelis Demetrios
Published: July 2010

Emergency management has become a focus of scientific study on how to better understand the hazards that shape our natural and constructed environments in order to establish standards for a safer world. It comprises the body of knowledge, policy and practice associated with humanitarian responses to both natural and technological disasters and emergencies. Its objective is to decrease the vulnerability of Canadian communities through improved access to emergency services, information, education and empowerment. In this article, we explore several important emergency management issues concerned with information support that require an examination of the basic tenets of emergency governance in Canada.
Application of an Impact of Restructuring Scale to the Healthcare Sphere
Authors: Greenglass Esther R. , Burke Ronald J.
Published: July 2010

Job loss and job insecurity are frequently associated with today's widespread restructuring and downsizing of the workplace. The authors have developed an Impact of Restructuring Scale that quantifies the effects of restructuring in the healthcare sphere. The scale documents the effects of the resulting cutbacks, hospital mergers and hospital closings on two areas: quality of healthcare services and effects on staff. The study described in this article applies the scale to the healthcare sphere as reported in a sample of 1,363 nurses employed in hospitals that were being restructured. The nurses returned a self-report questionnaire in which they reported their reactions on a variety of measures designed to assess extent of restructuring initiatives, stressors, hospital support, job satisfaction and distress. Results showed that predictors of the impact of restructuring on nurses include restructuring initiatives undertaken by the hospital, deterioration of hospital facilities and services, work stressors (e.g., workload, bumping, use of generic workers) and social support. Hospital restructuring was also associated with lower job security, diminished job satisfaction and an increase in depression, anxiety and somatization.
Mieux gérer la durée du séjour des patients en utilisant la technique de la pertinence
Authors: Kaplow M. , Charest S. , Mayo N. , Benaroya S.
Published: July 2010

Une équipe multidisciplinaire en service sur deux étages du service de médecine générale à l'Hôpital Royal Victoria a choisi la Gestion pertinente des soins de santé (GPSS) pour évaluer la pertinence de la durée du séjour de leurs patients. L'infirmière analyste qui a examiné 100 fiches de patients, admis consécutivement et dont la durée de séjour totalisait 1095 jours-patient, a conclu que 33 pour cent de ces journées n'auraient pas dû être de séjour à l'hôpital. On a obtenu des renseignements sur tes motifs invoqués pour chacune de ces journées non pertinentes et mis en place des stratégies visant à résoudre ces problèmes. Le changement de mentalité chez les spécialistes de la santé a constitué le principal résultat de cette étude: Depuis, ils abordent de manière plus positive leur choix des soins à dispenser aux malades et les façons de les administrer efficacement.
Learning to Support Your Work Force in Changing Times
Authors: Langill G. , Ware M.L.
Published: July 2010

This article looks at how one health care organization, the Royal Ottawa Health Care Group, has taken a proactive approach to the human resource challenges associated with ongoing changes and transitions in the work place. The overriding objective has been to retain a stable, highly skilled and motivated work force, which is essential to providing quality care.
Advanced Practice Nursing: Parameters for Successful Integration
Authors: Howlett Michael K. , Tamlyn Deborah
Published: July 2010

This article analyzes advanced practice nursing roles through a literature review and a pilot stakeholder survey in relation to five strategic areas: (1) definitions and scope of practice; (2) education, credentialing and regulation; (3) new roles in healthcare; (4) costs and benefits in health reform; and (5) implementation and relationships. The Canadian health services environment is best served by a multifaceted APN role, defined by a nursing paradigm that invokes collaborative relationships with physicians, and education and credentialing that is based on national standardization.
L'exercice infirmier avancé: Paramètres pour une intégration réussie
Authors: Howlett Michael K. , Tamlyn Deborah
Published: July 2010

Cet article analyse les rôles confiés à la pratique infirmière de niveau avancé par le biais d'une étude de la documentation ainsi qu'une étude pilote auprès des intervenants relativement à cinq domaines stratégiques: (1) définition et étendue de la pratique; (2) formation, délivrance de titres professionnels et réglementation; (3) nouveaux rôles dans les soins de santé; (4) rapport coût-efficacité de la réforme de la santé; et (5) mise en oeuvre et relations. Le système canadien de services de santé serait mieux servi par l'attribution d'un rôle polyvalent aux WA (infirmières en pratique avancée ou Advanced Practice Nurses), défini en fonction d'un paradigme des soins infirmiers qui fait appel à la collaboration avec les médecins, et par la formation et la délivrance de titres professionnels fondés sur des normes nationales.
Réforme de la santé et évolution technologique: transition du profil d'hospitalisation pour quatre interventions au Manitoba
Authors: Soodeen Ruth-Ann , Roos Leslie L. , Peterson Sandra
Published: July 2010

Cette étude a été menée à partir de données recueillies au Manitoba de 1991 à 1996 afin d'évaluer les effets des réformes de la santé et des progrès technologiques sur les profils d'hospitalisation, la mortalité et les taux de réadmission. La cholécystectomie et la chirurgie herniaire ont servi d'indicateurs en vue de l'évaluation des effets combinés de la nouvelle technologie et des réformes de la santé, tandis que l'appendicectomie et l'hystérectomie ont permis de mesurer les effets des seules réformes de la santé. L'introduction de nouvelles technologies (c.-à-d. la laparoscopie) et les mesures de réforme de la santé (c.-à-d. les séjours moins longs à l'hôpital) n'ont pas eu d'effets défavorables sur le nombre d'interventions, sur la mortalité postchirurgicale ni sur le nombre de réadmissions postchirurgicales.
Hospital and Unit Cost Allocation Methods
Authors: St-Hilaire Carole , Crépeau Paul K.
Published: July 2010

The quest for an efficient healthcare system has resulted in the publication of many assessments relating to health facilities. Some use a methodological approach that, at first glance, appears questionable in terms of allocation of overhead or support costs among the facilities' centres of activity. The objective of this article is to verify, using hospital utilization data, whether the choice of an allocation method significantly affects the unit cost of such resources. The results obtained from our sample suggest that no statistically significant relationship exists between the methods used and the unit costs produced.
Case Management Approaches for In-Home Care
Authors: McWilliam Carol L. , Stewart Moira , Desai Kathy , Wade Terrance , Galajda Joanne
Published: July 2010

Restructuring healthcare delivery systems within limited budgets presents multiple management challenges. As hospitals have downsized, the demand for in-home services has increased. The involvement of multiple provider agencies and professionals has heightened duplication and fragmentation of services and has complicated the need to develop client-focused, evidence-based approaches. In response to these challenges, community-based case management has burgeoned.
Organizational Justice Principles and Large-Scale Change: The Case of Program Management
Authors: Persaud D. David , Narine Lutchmie
Published: July 2010

Many of the barriers to implementation of large-scale change in healthcare organizations seem to be related to a lack of attention to the human change that needs to occur. One element of this human dimension that change agents overlook is the role that perception of fairness to employees plays in implementing large-scale organizational change. This article uses program management (an organizational design that has been implemented in many healthcare facilities across Canada) as an example of large-scale structural change and demonstrates the importance of applying procedural and interactional justice principles to enhance the implementation of organizational change.
Program Budgeting and Marginal Analysis: A Priority-Setting Framework for Canadian Regional Health Authorities
Authors: Mitton Craig , Donaldson Cam , Dean Stafford , West Bruce
Published: July 2010

Health regions in Canada are responsible for meeting the needs of local populations with limited resources. However, relatively little attention has been given to this within-region resource allocation problem. An economic approach to needs assessment, namely program budgeting and marginal analysis, may be of benefit. Its potential for use in Canada is examined, in particular with examples from two Alberta health regions, the Calgary Regional Health Authority and the Chinook Health Region.
Differentiating among Research, Evaluation and Measures to Assure Quality
Authors: Jarvis Hilary
Published: July 2010

This article explores the similarities, differences and overlaps among research, evaluation and quality measurement. Criteria for determining the differences are offered as a quick guide to differentiating among them. These criteria are the purpose of the project, generalizability, intended use of the findings, intended subjects and intent to prove causation. Determining the key differences among research, evaluation and quality measurement facilitates the choice of restrictions, supports and reporting process that should be applied to each.
Going beyond Triage in Tajikistan Health Reform in the Former Soviet Union
Authors: Alidina Shehnaz , Annett Hugh
Published: July 2010

Tajikistan is among the few countries where life expectancy diminished during the 1990's. To rebuild a health system fractured by economic collapse, political disintegration and civil war, the Essential Hospital Services Project was initiated to restore essential hospital services, encourage structural reform and build the health system's capacity to sustain itself. The article provides an overview of these reform efforts, outlines some of the challenges of health reform in Tajikistan and illustrates the benefits global partnerships can achieve when sharing creative new approaches to health reform.
Total Hip and Knee Replacement Surgeries in Alberta Utilization and Associated Outcomes
Authors: Alibhai Arif , Saunders Duncan , Johnston DWC , Bay Kyung
Published: July 2010

Objective:

Between 1994/95 and 1996/7, the healthcare system in Alberta underwent a radical transformation that saw the regionalization of service delivery and a reduction in overall healthcare funding. The aim of this study is to examine trends in utilization and associated post-operative complications and readmissions for two procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA) during this period of restructuring.

Methods:

This is a six-year retrospective analysis using hospital separation and healthcare insurance plan registry databases. During the study period, we looked at trends in inpatient procedure volumes, average lengths of stay, postoperative complications during the index hospital stay and readmissions within one year.

Results:

Over a six-year period, the age-sex standardized provincial rate of THAs increased by 18% while the rate of TKAs increased by 73%. Average lengths of stay decreased for both procedures by over 50%. The rate of procedures with at least one postoperative complication within the index episode of care decreased over the study period by 19% for THA and 21% for TKA. Readmissions due to complications of surgery increased overall by 32% for THA and 2% for TKA. Regional and sex differences were observed throughout the period.

Conclusions:

While the overall rate of hospitalizations has decreased in Alberta, the rates of THA and TKA procedures have increased. The lengths of stay following these procedures have, at the same time, reduced dramatically. Adverse outcomes as measured by complication rates associated with these procedures have decreased, though readmissions due to complications after surgery have increased.
Strides in Care Management: The Development of a Framework to Facilitate Quality Outcomes
Authors: Adams-Best Linda
Published: July 2010

Care Management has been in existence for years. The thrust of the role is to monitor, evaluate and enhance resource utilization while maintaining quality of care. The pivotal assumption being through enhanced patient flow, and coordinated services with appropriate resource utilization, better patient outcomes are achieved.

During times of fiscal restraint, quality may become a secondary concern. This paper presents a framework to assist Care Managers, and administrators, in achieving desired outcomes that embrace fiscal accountability and quality patient care. Donabedian's model1 and Systems theory2,3 are the foundations for this framework.
Buts et structures de la recherche en milieu hospitalier au Canada: Résultats d'un sondage national
Authors: Harper Dan W. , O'Hara Patricia A. , Sigouin Jeannine
Published: July 2010

On connaît très peu de choses sur l'envergure, le but et l'organisation actuels de la recherche en milieu hospitalier au Canada. À un moment où les hôpitaux doivent relever le défi de la réorganisation, il semblerait que de tels renseignements soient essentiels. Pour étudier cette question, les auteurs ont interrogé des hôpitaux canadiens de plus de 100 lits. Les résultats, rapportés ici, révèlent que presque tous les hôpitaux interrogés ont fait de la recherche sous une forme ou une autre au cours des douze mois précédents, quoique le type et le nombre de projets de recherche aient tendance à varier selon la taille de l'hôpital et l'affiliation universitaire. L'étude a aussi permis de voir que la plupart des hôpitaux ont des ressources dédiées spécifiquement à la recherche, revoient les cas de déontologie, et participent à des recherches pluridisciplinaires. Selon la grande majorité des participants, l'importance de la recherche en milieu hospitalier devrait augmenter dans l'avenir.
Exploring Approaches to the Administration of a Long-Term Care Facility: The Application of a Community Planning and Development Process
Authors: Caldwell Wayne J. , Murray J.A.
Published: July 2010

This article outlines the approaches taken to the management of two long-term care facilities by the County of Huron in southwestern Ontario in 1994. Lay-offs, a move to new facilities, loss of local political confidence, changes in key administrative personnel and low staff morale prompted the county to ask an interim administrative team to develop and implement an appropriate response. The article explains how community development and planning principles and techniques were applied to the management of the homes to achieve an overall improvement in communication, staff morale and attitude. These approaches may prove helpful to other administrations facing major change.
Portfolio Management for Off-Line Revenue Initiatives
Authors: Edgett Scott J.
Published: July 2010

During the past decade, the health services sector has experienced a period of rapid change that has resulted in the creation of a large number of new services. This article advocates the use of a service development matrix as a planning aid for senior managers seeking to attract additional revenue through the development of new services. By strategically selecting and developing new services, rather than simply imitating other health care providers, marketers will be better able to focus limited corporate resources on new service initiatives that generate positive returns.
The Role of Consumers in Health Care Decision Making
Authors: Ahearn Kathleen , Donohue Marguerite , Manga Pran
Published: July 2010

This paper focuses on the results of a survey of chief executive officers and consumer board members of Ontario hospitals and community health centres regarding the role of consumers in health care decision making. The opinions of both the chief executive officer and consumer board member respondents were elicited regarding the value of consumer input in decision making for the organizations studied. Results indicate that consumer board members feel that their input into organizational decision making is valued, chief executive officers value the input of consumers, and consumer involvement in decision making is increasing. More women are now involved on boards of the organizations studied, but visible minority representation remains low on hospital boards. Consumer board members feel that their decision making is influenced by providers on the board.
Structuring the Design and Implementation of Leadership and Teamwork for Program Management
Authors: Brittain Brian , Langill George
Published: July 2010

Health care providers throughout Canada are aspiring to improve how they manage their resources, while maintaining or improving the quality of patient care through more patient-focused, team-based approaches. Many of the current program management models being implemented in the field are designed to realize these aspirations. Yet they are actually opposing them because of a lack of clarity about accountability and authority. Working relationships (teamwork) within clinical teams, and between clinical teams, physicians, support functions and the senior management committee, have been vague. This lack of clarity in role relationships has created many problems. This article demonstrates how we attempted to solve some of these problems at the Royal Ottawa Health Care Group.