Treatment decisions. Every manager's nightmare.
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Biomedical subjects
Publications and source records attributed to A Wall.
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Changing structures, roles and relationships have thrown many of the old certainties of health service management into question. But whereas clinicians have professional codes to guide them, managers have had to make difficult choices and decisions in the absence of a written and clearly understood ethical framework. More recently, codes of practice for NHS boards and for individuals have started to address this issue. This Health Management Guide aims to provide a practical introduction to the ethics of health service management.
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Management development in the NHS has reached a hiatus, yet there are no apparent moves from the centre to address this. The Journal brought together senior figures from the four dedicated management development providers in an informal round table discussion, chaired by Rob MacLachlan, to open the debate.
Differences in androgen-dependent forms of behavior and plasma testosterone levels in the spontaneously hypertensive rat (SHR) and its normotensive counterpart the Wistar-Kyoto rat (WKY) are described here. Copulatory behavior (solitary test to avoid influence of experience) and certain androgen-dependent elements of sociosexual orientation were significantly attenuated in the SHR compared to the WKY male rat. After castration, the differences in sociosexual orientation were no longer apparent. In contrast, differences in other behavioral elements, such as locomotion, were unchanged after castration. Plasma testosterone levels were significantly higher in the SHR than in the WKY male rats. Taken together, the behavioral and hormonal data suggest a decreased central nervous responsiveness to androgens in the SHR rats. This could lead to reduced androgen-dependent behavior, and possibly also to a decreased testosterone feedback control.
OBJECTIVE: To estimate the prevalence of antibody to human T-cell lymphotropic virus type I/II (anti-HTLV-I/II) in people from an HTLV-I/II-endemic area (the Caribbean) living in a nonendemic region (Canada). DESIGN: Cross-sectional household survey. SETTING: Households in Toronto in 1989. PARTICIPANTS: A modified quota sampling method was used to recruit subjects of Caribbean origin as well as other Canadians. Of 2900 people invited to participate in the study 1323, 743 of Caribbean origin, were interviewed about their background and possible exposure to HTLV-I/II. MAIN OUTCOME MEASURES: Blood samples were analysed for anti-HTLV-I/II by means of an enzyme-linked immunoassay, the result being confirmed by the Western blot technique and radioimmunoprecipitation assay. The samples were also analysed for antibody to human immunodeficiency virus (anti-HIV) and hepatitis B surface antigen (HBsAg) and for surrogate markers of non-A, non-B hepatitis. RESULTS: A total of 853 blood samples (64.5%) were analysed, 483 (56.6%) from subjects of Caribbean origin. The proportion of subjects who agreed to give a blood sample was similar for the Caribbean and non-Caribbean strata. Eleven subjects, all of Caribbean origin (2.3% of the Caribbean stratum), were confirmed to be positive for anti-HTLV-I/II. There were no significant differences between the antibody-positive and antibody-negative subjects with respect to sex, age, racial origin or residence in the Caribbean for at least 22 years. All anti-HTLV-I/II-positive subjects were negative for anti-HIV and HBsAg, and four (36.4%) were positive for antibody to HBsAg and to hepatitis B core antigen. CONCLUSIONS: Except for origin, an association between antibody positivity and other factors could not be demonstrated. The findings suggest that blood donor screening might include place of origin in addition to the usual lifestyle or behavioural factors. However, the need to ensure safety of transfusion must be balanced against the need for participation of all groups in the blood transfusion program.
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Clinical assessment of the function of the knee joint after surgically and conservatively treated fracture of the patella was carried out. On the basis of C. Ranawat criteria it was found that regardless the method of treatment applied restriction of the joint function was expressed mainly by limited range of motion and by weakening of the knee extensors. The results of surgical and conservative management are similar. The best results of treatment for fracture of the patella were achieved in patients operated with the use of wire loop-cerclage.
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Donor behavior in completing a pre-donation confidential self-exclusion form, which identified blood donors at high-risk of AIDS exposure, was evaluated. The form was completed by all donors during a 12 month period beginning in September, 1985. 188,824 units of blood were collected from 123,608 donors. On the first donation occasion 901 donors (0.73%) laboratory (LAB) designated, 224 (0.18%) did not complete the form correctly, and the remaining 122,483 transfusion (TRAN) designated. A greater proportion of LAB donors were men, under the age of 30 and had not donated in the previous two years than TRAN designated donors. Confirmed reactive anti-HIV, Western blot positive (WB+) results were greater in LAB than TRAN donors (1.664% vs 0.014%) on the first donation occasion. There were 43,982 donors who returned to donate on at least one other occasion. Of these, 43,778 designated TRAN initially, and only 217 (0.49%) changed their designation to LAB on any subsequent donation event. In contrast, of the 204 donors who designated LAB initially, 134 (65.6%) changed to TRAN on at least one other occasion. A variety of designation combinations from LAB to TRAN and back to LAB occurred. Thus, donors who initially LAB designated were more likely to change their designation on at least one other occasion than those who initially designated for TRAN. Of two donors who became anti-HIV WB positive on the second donation, one of these LAB designated on both occasions, was negative for anti-HIV by enzyme-linked immunoassay (EIA-) on the first donation but converted to EIA+, WB+ on the second.(ABSTRACT TRUNCATED AT 250 WORDS)
Views from three general managers focus respectively on the impact of the Griffiths changes after five years; how 'success' in general management may be evaluated; and the changing nature of central-local relationships. At district level, the job of DGM has changed much more than was expected and the demands have greatly increased. These developments have resulted in increased satisfaction for the general manager and a desire to achieve results. 'Success' in general management is an elusive concept. There are many perceptions of success. For general managers, success may be reduced to a struggle for survival. Ultimately, success needs to be extended beyond short-term goals and to be concerned with shaping the longer term future. Central-local relationships have, in many ways, changed little. The major criticism of the centre by the service remains much the same as before the Griffiths reforms-the lack of central leadership and direction. Regions are perceived as part of the centre by districts and units. There is much to be done to make central-local relationships more creative and supportive.