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Exploring the human resource implications of clinical governance.

In 1998, clinical governance was introduced in the National Health Service, UK (NHS) as a major policy initiative to improve the quality of clinical care. The implementation of clinical governance is crucially dependent on the skills, competencies and willingness of the NHS staff. In turn, clinical governance influences the way people work in health care organisations. Therefore, it is no surprise that the introduction of clinical governance has thrown-up new challenges for human resource management. However, what are these human resource management challenges under the clinical governance framework? The current literature on the subject provides no answer. This article attempts to fill this gap in the literature. A qualitative approach influenced by phenomenological case study approach has been adopted. A heterogeneous group of 33 persons identified through a purposive sampling procedure were interviewed using a semi-structured format. The results indicate that the staff members appreciate the crucial role of human resources management in the implementation of clinical governance. However, there is little evidence to suggest that senior management is paying attention to develop the human resources function around the clinical governance agenda. The seven major human resource implications of clinical governance that emerged from the data analysis are discussed. The author argues that a more proactive HR approach is needed to make clinical governance everyone's business in the NHS organisations.

Evidence-Based Medicine↗

Equity in resource allocation for health: a comparative study of the Ashanti and Northern Regions of Ghana.

Debate over the equitable allocation of financial resources in the health sector has focused overwhelmingly on allocation from national to regional levels. More equitable allocation of such resources within regions has been virtually ignored, creating a vacuum in knowledge regarding how resources are allocated intra-regionally and their potential influence on promoting health equity. In this paper, we report an empirical study examining progress towards equity in intra-regional resource allocation in the Ashanti and Northern regions of Ghana. Relative deprivation across the 31 districts of the two regions was measured as a proxy of health needs. The result was used to develop an equity-adjusted share index (EAS) applied as a yardstick against which progress towards equity was assessed. The study found a significant correlation between districts' share of donor pooled funds (DPF) and the EAS in the Northern region for three of the 4 years investigated. In Ashanti region, a worsening trend in relation to equity in DPF allocation was discovered. The proportion of variance in the share of DPF that could be explained by the EAS reduced incrementally from 56% in 1999 to less than 1% in 2002. The study highlights the need for more emphasis on intra-regional equity in resource allocation in Ghana.

Ghana↗

The Emergency Severity Index (version 3) 5-level triage system scores predict ED resource consumption.

OBJECTIVES: The Emergency Severity Index (ESI) version 3 is a valid and reliable 5-level triage instrument that is gaining in popularity. A unique component of the ESI algorithm is prediction of resource consumption. Our objective was to validate the ESI version 3 triage algorithm in a clinical setting for the following outcome measures: actual resource consumption and patient length of stay in the emergency department and hospital. METHODS: We conducted a retrospective, descriptive study of 403 ED patients who presented to a large academic medical center. The following dependent variables were abstracted from the ED record: number of ED resources used and emergency department and hospital length of stay. The relationship between ESI level and each of the dependent variables was determined. RESULTS: Mean resource use decreased monotonically as a function of ESI level 1 (5), 2 (3.89), 3 (3.3), 4 (1.2) and 5 (0.2). The ED average length of stay (minutes) per ESI level was as follows: 1 (195), 2 (255), 3 (304), 4 (193), and 5 (98). ESI triage level did not predict hospital length of stay. CONCLUSIONS: The ESI algorithm accurately predicted ED resource intensity and gives administrators the opportunity to benchmark ED length of stay according to triage acuity level.

Adolescent↗

A focus group study of factors that promote and constrain the use of satellite-derived fire products by resource managers in southern Africa.

Semi-structured focus group interviews were employed to examine factors that affect the likelihood that resource managers in southern Africa will use information on vegetation fires provided by two satellite-derived products: an active fire product and a burned area product. The two products are updated regularly and aim to deliver the state-of-the-art in the global monitoring of fires from satellite remote-sensing. Both products are derived from data transmitted by the Moderate Resolution Imaging Spectroradiometer (MODIS) sensors carried onboard NASA's Aqua and Terra satellites. The active fire product can be accessed for free via the internet and on media by users working anywhere in the world; the burned area product will be accessible in a similar manner in 2006. The MODIS fire products provide systematic, near-global coverage and are freely available; as such, they give resource managers new opportunities to obtain or supplement information they need to manage vegetation fires effectively. However, the availability of these products does not mean that resource managers will use them, and many other factors are involved. To understand factors that affect whether southern African resource managers will use the two products, two focus groups were held with members of the Southern African Fire Network (SAFNet) in Malawi, Africa, August 2004. Analysis of the group discussions reveals a number of factors that influence whether they will use the products. The qualitative, in depth nature of the group discussions revealed 12 main factors that influence product use; not least the low international internet bandwidths for African countries outside of South Africa. Analysis of the group discussions also suggests how the uptake of MODIS fire products by resource managers in southern Africa might be enhanced by affecting specific changes to how MODIS products are packaged and delivered.

Africa, Southern↗

Resource availability and meiofauna in sediment of tropical seagrass beds: local versus global trends.

Characterisation of productivity-diversity relationships forms an essential step towards a better understanding of biodiversity. In terrestrial systems this is a topical subject and most studies reported a hump-shaped relationship. For marine systems, however, the number of studies dedicated to this is low despite the high interest in this productivity-diversity relationship. The present study reports on meiofauna density/diversity patterns in relation to resource availability as an indicator for the productivity of the ecosystem. Standardised meiofauna samples were collected in tropical seagrass beds from three localities (Kenya, Mexico, the Philippines) in order to contrast local patterns with a more global scale. Although these sites were physically comparable, a range of resource availabilities was found. These differences between localities were mainly due to different tidal regimes and related input of organic matter. At all sites a significant positive effect of resource increase on meiofauna densities was found. This positive effect was less clear for meiofauna diversity. Highest density and diversity levels were reported for the Kenyan site and this is probably linked to a high tidal range. Pooling all localities together resulted in a significant positive linear relationship between resource availability and meiofauna density/diversity. Caution should be taken when choosing resource indicators. Chlorophyll a concentrations, for example, resulted in a positive density-productivity relationship while organic carbon content, an indicator for more refractory material, showed a negative relationship. In all cases, no hump-shaped relationship could be found suggesting that each ecosystem and each group of organisms may show a particular productivity-diversity/density relationship.

Alismatales↗

Modeling and analysis of stoichiometric two-patch consumer-resource systems.

Ecological stoichiometry studies the balance of energy and multiple chemical elements in ecological interactions to establish how the laws of thermodynamics affect food-web dynamics and nutrient cycling in ecosystems. In this paper, we incorporate stoichiometric principles in a model with habitat heterogeneity and dispersal in order to better understand population growth dynamics. This model describes a situation where a resource is separated into two patches by a barrier. Growth of the resource in each patch is limited by soil fertility and self-crowding. The consumer disperses between the two patches and is not affected by the barrier. The consumer's growth is potentially limited by the phosphorus content of the acquired resource. Mathematical analysis of this model and simulations are performed. Several biological implications, including an observed "stoichiometric extinction effect," are demonstrated with simulation where the stoichiometric mechanism appears to promote extinction in a patchy environment. This is in sharp contrast to the notion that stoichiometry mechanism promotes diversity in spatially homogeneous settings. Another important result is the rediscovery of a simple and plausible biological mechanism that generates local and global extinction. In this setting, which can be considered a spatially mediated form of apparent competition, the dispersal of the consumer from the rich patch can des the growth of the resource in the poor patch and in some situations can lead to the extinction of the resource in the poor patch.

Animals↗

Kant goes fishing: Kant and the right to property in environmental resources.

We can observe a connection between some serious environmental problems caused by the overexploitation of environmental resources and the particular conceptions of property rights that are claimed to hold with regard to these resources. In this paper, I investigate whether Kant's conception of property rights might constitute a basis for justifying property regimes that would overcome some of these environmental problems. Kant's argument for the right to property, put forward in his Doctrine of right, is complex. In Section , I attempt an interpretation. Section works out the defining characteristics of the conception of property rights that Kant's argument establishes and investigates their implications for determining property regimes in environmental resources. Kant proposes a minimalist notion of the right to property as a triadic relation between persons with regard to an object, justified only on the condition that it is universalizable in the given circumstances. I argue that this notion offers a promising account for determining property relations with regard to environmental resources. By way of illustration, in Section , I focus on an example of Kantian property rights in one type of environmental resource: the marine fisheries.

Animals↗

Food safety: a guide to Internet resources.

This report provides a brief overview of several reliable Internet resources concerning food toxicology. Some helpful Internet resources have been identified on the basis of quality criteria, of their relevance and the languages availability. The report includes four topic areas, the first provides a brief description of international resources, the second focuses on European resources, the third provides a description of some national resources and the last is a short overview of some databanks available on web.

Databases as Topic↗

Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee.

PURPOSE: This study is intended to resolve the disparity and reach consensus on issues regarding the treatment of children with isolated spleen or liver injuries. To maximize patient safety and assure efficient, cost-effective utilization of resources, it was essential to determine current practice. METHODS: Data from the case records of 856 children with isolated spleen or liver injury treated at 32 pediatric surgical centers from July 1995 to June 1997 were collected. The severity of injury was classified by computed tomography (CT) grade and the data analyzed for intensive care unit (ICU) stay, length of hospital stay, transfusion requirement, need for operation, pre- and postdischarge imaging, and restriction of physical activity. Patients with grade V injuries (2.8%) were excluded leaving 832 patients for detailed review. These data and available literature were analyzed for consensus by the 1998 APSA Trauma Committee. RESULTS: Resource utilization increased with injury severity (see Table 2). Based on the data analysis, literature search, and consensus conference, the authors propose guidelines (see Table 3) for the safe and optimal utilization of resources in routine cases. It is important to emphasize that no recommendation falls outside the 25th percentile of current practice at participating centers. CONCLUSIONS: Diversity of treatment, with attendant variation in resource utilization in children with isolated spleen and liver injury of comparable severity is confirmed. This analysis has stimulated a prospective outcomes study with the objective of validating the evidence-based guidelines proposed. This evidence-based study design can bring order and conformity to patient management resulting in optimal utilization of resources while maximizing patient safety.

Adolescent↗

Hostility and ill health: role of psychosocial resources in two contexts of working life.

OBJECTIVE: The purpose of this study was to examine the extent to which increased risk to health problems in hostile employees is associated with psychosocial resources and life context. METHODS: Social relationships, job control, and sickness absence were assessed among 757 hostile and nonhostile municipal employees in two life contexts: during a stressful organizational downsizing; and during a period after the downsizing. The follow-up time was 550 person-years for men and 1677 person-years for women during the period of downsizing, and 519 person-years for men and 1568 person-years for women during the period after downsizing. RESULTS: The risk of sick leave was 1.2-1.4-fold higher in the hostile individuals than in the others. Small network size in hostile employees related to a 1.4-2.5-fold higher risk of sick leave compared to large network size. In nonhostile employees, network size did not associate with sick leave. Poor job control effected a 50% higher risk of sick leave in hostile than in nonhostile individuals during downsizing. During the less stressful period, both hostility and poorjob control increased absence rates independently of one another. Strong spouse support protected only nonhostile employees from sickness. No differences between hostile and nonhostile employees were found in the levels of psychosocial resources or changes in them. CONCLUSION: The risk of health problems in hostile persons could be linked with heightened vulnerability in poor psychosocial resource conditions and with the inability to benefit from existing psychosocial resources. Such personal deficits seem to be resource-specific and vary somewhat according to an individual's life context.

Adaptation, Psychological↗

Attentional resource and processing speed limitations during sentence processing in Parkinson's disease.

Several studies have suggested that patients with Parkinson's disease (PD) have sentence comprehension difficulty in part because of their limited executive resources. However, these assessments confound the executive resources contributing to sentence comprehension with the resources needed for task performance. In the present study, we used a word detection technique that minimizes task demands in order to evaluate attentional and processing speed resources during the comprehension of simple sentences without subordinate clauses and sentences containing subject-relative and object-relative center-embedded subordinate clauses. We found that PD patients have poor sensitivity to phonetic errors embedded in unbound grammatical morphemes, regardless of the clausal structure of the sentence, suggesting difficulty attending to grammatical morphemes. We also found that PD patients are significantly slowed in their sensitivity to phonetic errors in content words embedded in object-relative center-embedded sentences. Slowed sensitivity to content words in object-relative sentences was correlated with timed executive measures of planning. On a traditional measure of comprehension, these PD patients were impaired for sentences containing object-relative center-embedded clauses compared to sentences with subject-relative center-embedded clauses, and comprehension of object-relative sentences was correlated with executive measures. Our findings are consistent with the claim that limited executive resources for strategic attention and processing speed contribute to the sentence comprehension difficulties of PD patients.

Aged↗

Use of clinical toxicology resources by emergency physicians and its impact on poison control centers.

STUDY OBJECTIVE: The need for clinical toxicology resources by emergency physicians is unclear and may have implications for future training and resource availability. This study was designed to assess current emergency physician use of available resources. DESIGN: Prospective evaluation by mail using a 49-item questionnaire. TYPE OF PARTICIPANTS: All 170 emergency physicians in Utah. INTERVENTIONS: None. RESULTS: The response rate was 75.3% (128 of 170). Resources "outside their own fund of knowledge" were consulted "occasionally" to "frequently" by 98.3%. They used the following resources "occasionally" to "frequently": poison control center (PCC) (93.7%), toxicology textbook (77.6%), "expert colleague" (34.0%), and "in-house POISINDEX" (23.9%). They often contacted the PCC for toxicity information (93.7%) and management recommendations (87.3%) and for acute, symptomatic overdose cases (88.3%). They "almost never" contacted the PCC for adverse drug reactions (76.6%), pill identification (70.2%), consultation with physician toxicologist (68.1%), asymptomatic exposures (62.9%), chronic toxicity (50.4%), or solely to report the case to the American Association of Poison Control Centers data base (90.2%). Those who had access to in-house POISINDEX often did not consult the PCC (82.6%). Of those who did not have in-house POISINDEX, 42.8% contacted the PCC to access it. Providing access to physician toxicologist consultations was thought to be an important role for the PCC by 86.7%, but only 32% of physicians were using this option. CONCLUSION: The vast majority of emergency physicians in Utah consult the PCC only for acute, symptomatic overdoses. They view access to physician toxicologist consultation as an important role for the PCC but seldom use it. The availability of in-house POISINDEX decreases the likelihood of PCC consultations from emergency departments. The frequency of emergency physician consultation with the PCC may decrease as POISINDEX becomes available at more hospitals.

Adult↗

Stressors, resources, and distress among homeless persons: a longitudinal analysis.

Relations among stressors, resources, and psychological distress were examined using two waves of data obtained from a probability sample of homeless persons (N = 430) residing in a large, demographically diverse county in North California. The focus of research was to examine whether and how social resources and housing resources directly affect distress and mediate the impact of stress factors on depressive symptoms. Path analysis results revealed that levels of psychological distress were responsive to change in objective housing circumstances, with the attainment of domicile status being associated with fewer distress symptoms. Our findings, however, indicated only modest effects of social resources on psychological distress through direct effects and mediating effects of life stressors on distress. Overall, the study suggests that the relationships among stressors, resources, and distress for homeless persons may be understood within the same analytical framework for the general population.

Adolescent↗

Networks of nomads: negotiating access to health resources among pastoralist women in Chad.

Health resources among pastoralist groups are strongly gendered. While certain types of health resources fall within the female domain (home-based treatment, caring and supportive roles, and knowledge surrounding particular reproductive conditions) access to most outside health practitioners, treatments and knowledge is controlled largely by men. For pastoralist women, this means that actions taken during illness episodes depend largely on the nature and quality of social support systems available, and on their ability to mobilise them effectively. These support systems include husband and other affines, male kin, and networks of female kin and friends. Factors such as position within domestic and wider social units, as well as life cycle, affect women's ability to access and mobilise these different support systems for their health needs. However, seasonal mobility interacts with gender and social support systems in complex ways that profoundly influence women's access to health resources. Most literature on nomadic peoples and health focuses on the physical barriers posed by spatial mobility to accessing health resources. However, it is suggested here that, for pastoralist women in Chad, the spatial fluidity of social networks might be a more important consideration. At certain times of the year women enjoy relatively easy access to a large range of extended kin and other social contacts, while at other times, when people are very dispersed, options become much more limited, often resulting in illness treatment being delayed. Mobility should not, though, be seen purely as a constraint. It can also be an opportunity, increasing the potential geographical and social resource base with regard to health for women.

Agriculture↗

Informal HIV caregiving in a vulnerable population: toward a network resource framework.

For the impoverished and often stigmatized communities most affected by HIV/AIDS, needs for informal caregiving present tremendous demands on already limited resources. Traditional theoretical frameworks emphasize care needs as driving informal caregiving. The proposed theoretical framework emphasizes microsocial processes that may affect informal caregiving among economically disadvantaged populations. The study examined: (1) network structural factors (homophily) that may affect availability of ties and local sociocultural expression of ties (social roles, behavioral norms) and (2) the role of financial resources in enabling informal caregiving. Low income, African American injection drug using persons living with HIV/AIDS (PLHAs) and their primary HIV supporters were interviewed. Supporters were predominantly female (71%), consanguineal kin (59%) and partners or friends (41%). Compared to the general US population, supporters were disproportionately HIV-infected, drug using, African Americans of poor health and low socioeconomic status. Supporters who perceived their PLHA tie needed informal care, compared to those who perceived no care need, were more than twice as likely to report a history of drug use, functional limitation (IADLs), higher income, and PLHA's financial reliance. Supporters' reported care provision was associated with their financial resources, but not PLHAs' health status. PLHAs' reported care receipt was associated only with their health status.HIV supporters' reported care provision was affected by financial factors, consistent with the proposed theoretical framework, while PLHAs' perceptions of care receipt conformed to traditional "needs"-based frameworks of caregiving. Results suggest that programs are needed to bolster network financial resources of disadvantaged populations affected by HIV to promote and sustain their informal HIV caregiving. Findings may aid in the understanding of informal caregiving as a social process. Network resource-oriented research may allow for ascertainment of community caregiving capacity, and guide the development of interventions to promote HIV caregiving in disadvantaged populations.

Acquired Immunodeficiency Syndrome↗

Event-related-potential (ERP) reflections of mental resources: a review and synthesis.

In this review studies are evaluated that have utilized middle-latency and late components of the event-related potential (ERP) as indices of the activation of processing resources. Processing resources are defined as energetical systems that modulate cognitive processes or data processing systems. An essential element of the resource conceptualization is the idea that processing structures receive not only information input but also input from these energetical systems. It is argued further that the principal role of these systems is to provide the 'gain' for the data processing systems. In reviewing these studies special attention is paid to factors affecting the amplitude of ERP components in single- and dual-task studies, and to the inferences that can be drawn about which particular types of processing resources are reflected in these changes in component amplitudes. Finally, a working model is presented relating middle-latency and late ERP components to specific perceptual, perceptual-central and central processing resources.

Attention↗

Resource partition history and evolutionary specialization of subunits in complex systems.

Specialization for part of the resources available is a common adaptation leading to diversification in biological systems. In complex ecological communities, the history of diversification of parts of a system correlates with the structure of the system in present times. Abundances and sequences of resource partition of species expected by a sequential broken stick model are compared with observed abundances of species and their sequences of evolutionary divergence. Where resources are abundant, first resource partitions correspond to most ancient speciations, and last to recent speciations. The inverse is true when resources are scarce, agreeing with the occupation of extreme habitats by recent species. Diverging species seem to specialize by dividing the niche of common ancestors. Similar trends exist inside genera as well as between families, suggesting similar patterns in diversification and specialization at other levels of biological organization, such as evolution of functional complexes of macromolecules and organs embryogenesis.

Animals↗

Psychological distress of caregivers: moderator effects of caregiver resources?

Personal psychological, social and health resources of informal caregivers are often assumed to attenuate or increase caregiving stress. This hypothesis was tested by investigating the effect of caregivers' resources on the relationship between their appraisal of the caregiving situation and psychological distress. Caregiver resources measured were: problem-focused and emotion-focused coping, neuroticism, received emotional and instrumental support and physical functioning. Results show that none of these caregiver resources has moderator effects, neither for all caregivers together (n = 166), nor for subgroups of caregivers. These subgroups were: spouses, non-spouses, males, females, caregivers of minimally and mildly demented people and of moderately and severely demented people, respectively. The absence of moderator effects on caregiving stress suggests that caregivers of demented elderly people may need attention and support when they perceive pressure, regardless of their personal resources.

Adaptation, Psychological↗