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PubMed2004

The aging of a clinical information system.

The senescence of a clinical information system is more likely to have administrative than technical bases. Supporting this claim is a case study of one aging oncology information system. The case study is qualitative, as behooves the subject matter. Content analysis of several documents suggests that the change in job description of the data coordinator led to a workflow breakdown. Next, twenty-two individuals were interviewed. Notes from the interviews were coded, and the resulting patterns led to partial support for the workflow breakdown conjecture, refutation of the hypothesis that users disliked the character-based, human-computer interface, support of the conjecture that political rather than technical factors drive the usage patterns of the system, and evidence that 'political' activity will determine the future of the information system. A stakeholder matrix is proposed that addresses administrative concerns. Also, the issue of the uniqueness of any oncology clinical information system is linked to the plans for this legacy system.

Databases, Factual↗
PubMed2006

Patient perception of the role of anesthesiologists: a perspective from the Caribbean.

STUDY OBJECTIVE: To assess patients' perception of the role of an anesthesiologist in a Caribbean country. DESIGN: Self-administered structured questionnaire evaluation. SETTING: Preoperative waiting rooms of three tertiary-care teaching hospitals: Port of Spain General Hospital, Eric Williams Medical Sciences Complex, and San Fernando General Hospital, Trinidad. PATIENTS: 424 adult surgical patients awaiting elective surgery. INTERVENTIONS: None. MEASUREMENTS: A questionnaire was devised to test the knowledge of the respondents regarding the job description, attitudes, and various roles of anesthesiologists in the hospital. MAIN RESULTS: 371 completed responses were obtained for analysis. One tenth of the respondents did not know who an anesthesiologist was and 59% of them knew that an anesthesiologist was a doctor; there was a statistically significant association of the educational level of the respondent and this response. Of the respondents, 70% felt that the anesthesiologists were easy to talk to and pleasant by the bedside; 46% responded that the anesthesiologists did not discuss the complications and side effects of drugs before the procedure; 5% considered the anesthesiologists as more important than the surgeon, and 59% considered both equally important. Only 19% responded that they knew that the anesthesiologists had a role in the intensive care unit. CONCLUSIONS: Patients still have inadequate knowledge regarding anesthesiologists and their different roles in hospitals.

Adult↗
PubMed2004

An exploration of midwives' views of the current system of maternity care in England.

OBJECTIVE: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care. DESIGN: an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection. SETTING: 15 focus group interviews were conducted at 14 sites in England. PARTICIPANTS: a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002. FINDINGS: the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.

Clinical Competence↗
PubMed2006

Workload of primary-care midwives.

OBJECTIVE: to assess the actual workload of primary-care midwives in the Netherlands. BACKGROUND: In 2000, a strike and large demonstration before parliament convinced everyone of the shortage of midwives and their excessive workload. The government reacted by increasing the capacity of the midwifery schools and lowering the 'standard caseload' for a full-time working midwife. To assess whether this would lead to sufficient improvement of the situation, more insight was needed of the actual workload of midwives in primary care. METHOD: a 4-year prospective survey of the work of primary-care midwives, during 3 weeks each year, including all midwives working in a representative sample of midwifery practices. On average, 224 midwives participated each year. During 3 weeks in the summer and autumn, midwives kept a diary of their work, with an accurate timetable, covering 24 hours a day. They also filled out questionnaires about practice organisation, work schedules and experiences of workload. FINDINGS: primary-care midwives worked an average of 29 hours a week, and about 74% of their time (22 hours a week) was spent on client-related activities. On average, a midwife was on call during 53 hours a week, and 17 of the 29 hours of work took place during on-call-hours. This meant that an average midwife was involved in her work 65 hours a week. The time spent on direct client care increased by nearly 20%. In particular, the average time spent with a woman during labour and birth increased by almost one-third. CONCLUSION: primary-care midwives spend an average of 29 hours per week working, and this has remained constant between 2001 and 2004. In client-related care, there has been a shift towards fewer clients per midwife but more time per client.

Adult↗
PubMed2005

Technical support assistants--a new concept in the OR.

INCREASINGLY COMPLEX TECHNOLOGY, a shortage of surgical first assistants, and the growth of surgical services provided the impetus for expanding the technical support assistant role in one facility. AN EDUCATIONAL PROGRAM was developed based on the job description and the participants' learning needs. PROGRAM EVALUATIONS were positive and reinforced the success of the educational program.

Biomedical Technology↗
PubMed1998

Using a case scenario approach to evaluate age-specific competencies.

Age-specific competencies for staff members having direct patient contact is a requirement of the Joint Commission on Accreditation of Healthcare Organizations. This article addresses an annual competency evaluation of perioperative staff members relating to age-specific criteria. Several types of case scenarios were developed and given to staff members (eg, RNs, surgical technologists, OR assistants, postanesthesia care unit attendants) according to their specific job descriptions and responsibilities within the surgical services department. A case scenario format was used because of the variety of health care personnel and the ability to manipulate the scenarios according to the needs of patients, staff members, and the institution. The evaluation tools were meant to adequately assess staff members' abilities to care for patients throughout the life span.

Adolescent↗
PubMed1998

Interviewing techniques for hiring quality employees in the OR.

Today's OR requires high caliber employees to provide quality patient care and excellent service to their medical staff members. As such, there is clearly a need for some mode of identifying the appropriate individuals to fill specific vacant positions. A recent survey was conducted of OR directors and managers in Miami, Fla. The purpose of the survey was to identify exactly what types of education and/or training directors and managers had acquired with respect to interviewing techniques and to determine whether there was any consistency in their interview processes. Based on the surveys' findings it was found that there is a lack of relevant training amongst those directors and managers who conduct interviews. This training could include the implementation of standardized interview questions (for candidates of specific job descriptions) for use on a consistent basis, as well as a process of evaluation for the interview.

Florida↗
PubMed1991

Absentee patterns among OR staff. Identifying aspects of the problem.

Absenteeism continues to be a great concern to hospital administrators. Nursing personnel should have a clear idea of acceptable attendance parameters based on written policies that are routinely administered. Efforts are now directed toward exploring strategies that reward personnel for good attendance records. Early development of professional attitudes related to absenteeism should continue to be supported and fostered. Implications from this preliminary study indicate that it may be more cost-effective to hire RNs than STs to work in ORs.

Absenteeism↗
PubMed1992

Standards of perioperative nursing. Clinical practice/professional performance.

The standards of perioperative nursing provide a mechanism to delineate the responsibilities of registered nurses engaged in practice in the perioperative setting. The standards of perioperative nursing and recommended practices serve as the basis for quality monitoring and evaluation systems; data bases; regulatory systems; the development and evaluation of nursing service delivery systems and organizational structures; certification activities; job descriptions and performance appraisals; agency policies, procedures, and protocols; and educational offerings.

Clinical Competence↗
PubMed1997

The esophagus for the nonesophagologist.

The esophagus is a muscular tube (striated muscle at the top end, smooth muscle in the middle and lower portion) connecting the pharynx and the stomach. It is closed at both the top and bottom ends by specialized muscular sphincters. Deglutition begins as a programmed act, mediated by nerve fibers from the brain stem, and spreads aborally with a wave of inhibition preceding a moving-ring contraction that obliterates the lumen of the esophagus. Fluids fall by gravity in the upright position or are pushed down by the moving ring contraction when the subject is horizontal. There are several factors that prevent constant regurgitation of gastric contents back into the esophagus. Reflux of both gas and liquid does occur as a normal event. The esophagus usually performs its job description of transferring material from the pharynx to the stomach and venting the stomach when necessary with a minimum of fuss.

Deglutition↗
PubMed1995

The relationship between career satisfaction and fellowship training in academic surgeons.

BACKGROUND: Academic surgeons make various important decisions about their careers; however, little is known about the relationships between fellowship training, career development issues, and academic responsibilities. METHODS: Surgeon members of the Association for Surgical Education were surveyed about career development issues. Three hundred ninety-two (75.2%) surgeons responded. RESULTS: An exploratory factor analysis of the career development issues revealed four career development factors. Statistically significant differences were found between types of fellowship training and the career development factors. Nonfellowship-trained and clinical-fellowship-trained surgeons spend their time similarly to physicians in other specialties. Research-fellowship-trained surgeons spent significantly more time doing research, had fewer concerns about professional confidence, and expressed greater satisfaction with their careers. CONCLUSION: There is a relationship between career development issues, fellowship training, and type of fellowship training. Attention to these issues may be important in recruiting and retaining academic surgeons.

Career Mobility↗
PubMed2002

Navigating the territory of job design.

Assuming that work contexts are changing and becoming ever more diverse, questions have been raised about the current state and relevance of job design theory. In this paper we review the field of job design from three paradigmatic perspectives, namely, functionalism, interpretivism and critical theory. We point out that the core of job design theory, across all paradigms, has traditionally been concerned with the outcomes of job design, the role of key factors such as control, demand, and skill, and how jobs can be changed. By outlining two scenarios about how work is changing, we argue that, although job design still has a lot to offer (its traditional core concerns are still relevant), it must develop to have a wider appeal and to have more relevance. Finally, we propose how job design can develop as a field. These proposals are based on our belief that job design theory can progress most fully if it draws on a wide range of theories from across different paradigms and from grounded studies of the changing nature of work in diverse occupational contexts.

Ergonomics↗
PubMed2003

Membrane fission: model for intermediate structures.

Membrane budding-fission is a fundamental process generating intracellular carriers of proteins. Earlier works were focused only on formation of coated buds connected to the initial membrane by narrow membrane necks. We present the theoretical analysis of the whole pathway of budding-fission, including the crucial stage where the membrane neck undergoes fission and the carrier separates from the donor membrane. We consider two successive intermediates of the reaction: 1), a constricted membrane neck coming out of aperture of the assembling protein coat, and 2), hemifission intermediate resulting from self-fusion of the inner monolayer of the neck, while its outer monolayer remains continuous. Transformation of the constricted neck into the hemifission intermediate is driven by the membrane stress produced in the neck by the protein coat. Although apparently similar to hemifusion, the fission is predicted to have an opposite dependence on the monolayer spontaneous curvature. Analysis of the further stages of the process demonstrates that in all practically important cases the hemifission intermediate decays spontaneously into two separate membranes, thereby completing the fission process. We formulate the "job description" for fission proteins by calculating the energy they have to deliver and the radii of the protein coat aperture which have to be reached to drive the fission process.

Cell Surface Extensions↗
PubMed1986

Health effects of low-level exposure to polychlorinated biphenyls.

A polychlorinated biphenyl (PCB) spill resulting from a transformer explosion in Syracuse, New York, with no subsequent fire, provided an opportunity for the examination of the effects of low-level PCB exposure without the confounding presence of furans and dioxins. The incident provided 52 individuals exposed to PCB among building personnel, police, firemen, and public utility employees. Sixty-eight nonexposed were matched to the exposed group by sex, age, employer, and job description. Data were collected on the exposed relative to their activities at the spill site, their location, possible routes of exposure, duration of exposure, and subsequent health effects. Exposed and nonexposed were interviewed for past medical history and relevant symptoms. Blood chemistries were studied inclusive of SGOT, SGPT, total protein, CBC, cholesterol, and triglyceride levels, as well as a fasting blood PCB level measurement. Six weeks after the spill, exposed and nonexposed were reinterviewed and had their blood work repeated except for the CBC and PCB levels. Exposed and nonexposed laboratory results were unremarkable. Some transient skin irritation believed to be associated with PCBs was noted. There were significant PCBs in blood level trends for occupation, age, duration of exposure, and level of alcohol consumption. Triglyceride level was highly correlated with PCB level. This relationship held when age and alcohol consumption were controlled for.

Adolescent↗
PubMed2001

Factors influencing job valuation: a comparative study of critical care and non-critical care nurses.

This study sought to identify the relationship between three predictor variables, perceived collaboration with medical staff, autonomy and independent actions and an outcome, the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical care nurses perceived themselves to have a more collaborative relationship with the medical staff, described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more, however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work.

Adult↗
PubMed2001

Autonomy: an important component for nurses' job satisfaction.

This quantitative pilot study (n=178), conducted in a large Brisbane teaching hospital in Australia, found autonomy to be the most important job component for registered nurses' job satisfaction. The actual level of satisfaction with autonomy was 4.6, on a scale of 1 for very dissatisfied to 7 for very satisfied. The mean for job satisfaction was 4.3, with the job components professional status and interaction adding most substantially to the result. There was discontentment with the other two job components, which were task requirements and organisational policies. Demographic comparisons showed that nurses who were preceptors had significantly less job satisfaction than the other nurses at the hospital.

Adult↗
PubMed1997

A profile of directors of clerkships in obstetrics and gynecology in the United States and Canada.

OBJECTIVE: To describe current professional activities, demographic profiles, and attitudes of directors of clerkships in university and community teaching sites. METHODS: Written surveys were mailed to departments of obstetrics and gynecology in the United States and Canada. Results were analyzed for differences in demographics, professional activities, and responses to statements describing career development of medical teachers and levels of institutional support. RESULTS: Responses from 132 of 148 (89%) medical schools and 67 of 96 (70%) known community-based clerkship directors showed no significant differences between the two groups in demographics or professional responsibilities. Three-quarters were men. The mean age was 47 years, mean duration as a faculty member 11 years, and mean tenure as clerkship director 8 years. One-half had been a clerkship director less than 5 years. The average clerkship director reported working approximately 56 hours per week, of which 44% was devoted primarily to patient care, 24% to teaching, and 18% to administration. These faculty members describe the activities of their position as fulfilling and worthy of recognition in the academic promotions process. CONCLUSION: Directors of clinical clerkships in obstetrics and gynecology in both university- and community-based programs spend about one-half of their time in teaching and administration. They find their work fulfilling and worthwhile. Profiles are consistent over time and comparable to those described by clerkship directors in other specialties.

Adult↗
PubMed1998

Update on imaging of orthopedic infections.

Although the diagnosis of infection is only a small part of the orthopedist's job description, it is a important part. This article discusses the fundamentals of orthopedic infections and highlights the refinements on this topic from a radiologic perspective. In addition to reviewing the imaging appearance of musculoskeletal infections in bone and the surrounding soft tissues, we focus on the advantages and disadvantages of five imaging methods: radiography, sonography, CT, scintigraphy, and MR imaging. Finally, we review three specific situations that have garnered substantial attention in recent medical literature: chronic recurrent multifocal osteomyelitis, musculoskeletal infections in AIDS patients, and pedal infections in diabetic patients.

Diabetic Foot↗