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This study approaches how important is a nursing organized service to achieve effectiveness. The author proposes a Nursing service organization model containing items such as: philosophy, goals, internal regiment and policies, divided in directive structure, budget human and material resources, teaching, research and nursing assistance.
Prognostic stratification is essential for the correct management of acute coronary syndromes (ACS). Across the whole spectrum of ACS, prognosis is strongly differentiated and also easy to establish. Shock identifies a small subgroup of patients including more than 50% of total mortality of acute ST-elevation myocardial infarction (STEMI). In non-ST-elevation (NSTE) ACS and in STEMI, heart failure represents a clinical variable with a strong prognostic value: in the GRACE registry only 15% of patients had heart failure with a mortality of 12.4 vs 1.1% in the other patients without heart failure; this important difference was interestingly evident in non-STEMI as well as in STEMI. Age is another pivotal risk indicator like heart rate and systolic blood pressure. It is noteworthy that the prognostic benefit deriving from resource utilization increases in ACS with the level of personal risk. This is true for the use of primary angioplasty in national registries of STEMI as well as for the early invasive strategy in NSTE-ACS in several trials; conversely, the use of aggressive strategies in low-risk ACS populations is often lacking of relevant results on hard endpoints. In our healthcare system with limited resources and with an inhomogeneous structure across the country, regionalization of care is the most efficient choice. Scientific Italian Societies redefined risk criteria for ACS in order to ensure priority to complex care for high-risk subgroups.
The present article shows the methodology of implantation of a quality guarantee program of medical attention through quality circles at the National Institute of Perinatology and it's results. Among them emphasize the following: organization's structure effects. The optimum on resources in it's own process of attention on the satisfaction of the patients and in the learning implicated in the adaptation of the technology to the hospital environment and the characteristics of a different culture from which that technology emerged. The project, conceived as investigation-action, was advised by Public Health Investigation Center and was created with the purpose to secure that the organized conditions under which the medical attention are given were those permitting to raise the quality as much in the among personal dimension as in the technical, through the participation of the personnel directly responsible of the services given. This led to the use of quality circles as participant technical of quality control and as main quality guarantee program of medical attention. Seven stages can be identified in the implantation of the quality assurance program using the quality circles: 1) to elaborate the proposal document and work protocol; 2) negotiation; 3) drawing of a guide for the elaboration of a quality guarantee manual; 4) selection the point of starting; 5) elaboration of the quality guarantee manual by service; 6) to operate the quality circles; 7) evaluation of the program. This experience has demonstrated it's feasible using the quality circles as fundamental components of a quality guarantee program of medical attention and permits to secure that, in general, it is possible to use this technology in the health services.
To correct pathologic conditions and to prevent future problems, all supernumerary, impacted, and malposed teeth should be evaluated with prospects of providing an anatomically acceptable solution. Through logical clinical and radiologic resources, localication of the malpositioned structure is possible. Correction or control of the affected tooth may follow the tenets of deft, delicate, and accurate surgery in consultation with an orthodontist, a cooperative relationship based on mutual respect.
THE NATIONAL OBJECTIVES OF CIVILIAN EMERGENCY PLANNING ARE: (1) protection and preservation of life and property; (2) maintenance of governmental structure; and (3) conservation of resources. The Canada Emergency Measures Organization (E.M.O.) has been developed to accomplish these objectives. E.M.O. co-ordinates other departments and agencies of federal government and its organization is reflected within provincial and municipal governments.Present E.M.O. accomplishments include: an attack warning system; an emergency broadcasting system; emergency government facilities; 400 emergency measure organizations across Canada; plans to implement general readiness; a medical stockpile; and "shadow agencies" for control of housing, food and manpower.PRESENT UNDERTAKINGS INCLUDE: a national survey of fallout shelters; the equipping of the radiation defence (RADEF); the pre-positioning of the items of the medical stockpile; and the training at the Canadian Emergency Measures College at Arnprior.
Ultrastructure of perisomatic gliocytes and glio-neuronal interrelations were studied in celiac nodes in normal young (6 months) and old (28--30 months) rats and at 45-days' hypokinesia. Several variants on how deep gliocytes are situated in the perikaryon, their relation to neuronal processes, as well as the character of border-line membrane relations are described. It was stated that processes of gliocytes have varied relations with each other, with neuronal perikaryon, with neural fibres. In old animals some dystrophic changes were revealed in glio-neuronal complexes. At hypokinesia a wide range of dystrophic changes in all structural elements in the nodes and destruction of some glio-neuronal complexes were observed. These changes were more evident in the old animals and at early stages, but by the end of the experiment they notably subsided. Simultaneously, some qualitative rearrangements of glio-neuronal interrelations took place: the relief of contacting membranes grew complex at the expense of interdirected small processes and deep invaginations of gliocytic processes into the neuronal perikaryon; the number of layers in the glial capsule increased as a result of hyperplasia of perisomatic gliocytic processes migrating towards gliocytic neurons and lemmocytic processes. Variety of forms in the glio-neuronal interrelations evidence in favour of their high structural plasticity. At hypokinesia, great resources of gliocytes to plastic transformations, of compensatory-adaptive importance are realized. In the celiac nodes of the old animals the adaptive rearrangements of the glio-neuronal interrelations developed more slowly and with less efficiency than in the young animals.
Major changes in physician-resource policies and in the structuring of medical licensure requirements in the past decade have resulted in a less flexible system with respect to both choosing and changing a career path in medicine. The survey results reported by Drs. Susan Shaw, Gordon Goplen and Donald S. Houston in this issue (see pages 1035 to 1038) indicate that a high percentage of physicians now practising in Saskatchewan changed their career plans after graduation. The author argues that this finding points to the need to reexamine the transition from undergraduate to postgraduate medical education. The present system needs to be made more flexible so that medical students can gain sufficient clinical experience before deciding on an area of practice and to give practising physicians who want to change specialties the option of retraining.
Two elements are essential for implementing community-based educational programs: a vision of how community experiences fit into the training of the health professionals of the future and a local environment that will support innovation, change, and growth. Change cannot occur unless very basic assumptions regarding medical education are challenged. What is "quality education"? Can programs oriented toward tertiary and specialty care adequately provide the training that should be the core of a 3-year general training program? Do schools and programs select and train physicians to function within the microcosm of the academic center, or do they prepare physicians to manage the country's health care needs? National consensus has had little influence over local environments. Each medical school, training program, and teaching facility must reexamine its values and its culture. Each must have a vision of the physicians of the future and a commitment to train them appropriately. The role of vision and culture in creating successful programs has been clearly described. Several key elements have been found to be consistent with success, the first being vision. Four basic principles will bring the vision to fruition: (1) preserving core values while still stimulating progress; (2) emphasizing the process by which programs are created, implemented, and changed rather than the product; (3) avoiding the "tyranny of the or," learning to be inclusive with a broad vision rather than limited to an "either-or" approach; and (4) aligning the process, management, and values in working toward envisioned progress for the future. Effective leadership is essential for a group or organization to accomplish its mission, as is an organizational structure that aligns responsibility, authority, resources, and accountability.
Structural equation modeling analyses of data from 2 longitudinal community studies of recently laid-off workers examined the interrelationships and pathways from personal coping resources to job-search intensity and the extent and quality of reemployment at 2 follow-ups (at 6 months and at 12 or 24 months). In both studies, the proposed models for predicting reemployment and reemployment quality provided a good fit to the data with the same pattern of results, which demonstrated that job-search motivation increased reemployment at all follow-ups but did not affect reemployment quality. At both the 6- and 12-month follow-ups, level of depressive symptoms decreased the extent and quality of reemployment. The results also highlighted the dual role of financial strain, which on the one hand facilitates reemployment by increasing job-search motivation and job-search intensity and on the other hand inhibits it by increasing depressive symptoms.
UNLABELLED: In this paper, we review the central concepts and implementations of tools for working with network structures in Bioconductor. Interfaces to open source resources for visualization (AT&T Graphviz) and network algorithms (Boost) have been developed to support analysis of graphical structures in genomics and computational biology. AVAILABILITY: Packages graph, Rgraphviz, RBGL of Bioconductor (www.bioconductor.org).
BACKGROUND: Deliberate self-harm (DSH) is a significant public health problem, representing a major burden in terms of morbidity to the individual and health-service utilization. While clinical guidelines suggest good practice for the short-term hospital management of DSH, there remains considerable variability in the way that services are provided. METHOD: A systematic review of the literature was undertaken to examine the current evidence on hospital resource use and costs involved in the short-term hospital management of adults following DSH and to elucidate the factors that influence these differences, in terms of clinical characteristics and service provision. RESULTS: Twenty-one papers reporting on 17 studies met the inclusion criteria for review. Clinical characteristics associated with an increase in resource use included overdose with tricyclic antidepressants (TCAs) compared with selective serotonin re-uptake inhibitors (SSRIs) (weighted ratio 2.6:1) and co-ingestion of alcohol with SSRIs. Variations in service provision, including medical admissions policy and provision of a specialist liaison service, affected resource utilization independently of the clinical needs of patients. CONCLUSIONS: Overdoses of TCAs incur substantially greater hospital costs than overdoses of SSRIs. Variations in the medical seriousness of DSH, and in the structure of service provision, affect the resources used in its short-term hospital management, with little evidence about the impact these differences have on clinical outcome. Research is needed to evaluate the impact of different styles of service provision on outcome, and to incorporate these factors into the trial design of future cost-effectiveness studies of interventions following DSH.
Healthcare policy in the UK is moving towards an expansion in day care services. As it becomes increasingly difficult to deliver clinical teaching to undergraduates in traditional inpatient venues, opportunities must be sought in ambulatory care. The proposed increased activity of day surgery units provides one such resource for the development of a structured clinical teaching programme. This paper highlights 12 tips for the preparation, delivery and evaluation of a clinical teaching programme in the day surgery unit. It describes the implications for staff and resources and indicates the educational opportunities that can be provided.
Since 1996, the University of Michigan's Fogarty International Center training and research program in Environmental and Occupational Health (EOH) in Southern Africa has contributed to capacity development in the 14 countries of the Southern African Development Community. Methods include training citizens from the region in master's, doctoral, and short-term focused programs; assisting the development of graduate programs in EOH at institutions, developing resources for distance-based degree programs; direct support ofjunior and mid-level researchers, and organizing regional short courses and regional conferences. Substantial EOH resources now present in South Africa are leveraged to assist capacity development in the rest of the region. The program's successes appear to be due to strong regional leadership and oversight structures, a strategy of developing EOH resource centers in several countries, and close collaboration with other regional and international EOH programs.
Bioinformatics approaches to carbohydrate research have recently begun using large amounts of protein and carbohydrate data. In this field called glycome informatics, the foremost necessity is a comprehensive resource for genome-scale bioinformatics analysis of glycan data. Although the accumulation of experimental data may be useful as a reference of biological and biochemical information on carbohydrates, this is insufficient for bioinformatics analysis. Thus, we have developed a glycome informatics resource (http://www.genome.jp/kegg/glycan/) in KEGG (Kyoto Encyclopedia of Genes and Genomes), an integrated knowledge base of protein networks, genomic information, and chemical information. This review describes three noteworthy features: (1) GLYCAN, a database of carbohydrate structures; (2) glycan-related pathways; and (3) Composite Structure Map (CSM), a map illustrating all possible variations of carbohydrate structures within organisms. GLYCAN includes two useful tools: an intuitive drawing tool called KegDraw, and an efficient glycan search and alignment tool called KEGG Carbohydrate Matcher (KCaM). KEGG's glycan biosynthesis and metabolism pathways, integrating carbohydrate structures, proteins, and reactions, are also a pivotal resource. CSM is constructed as a bridge between carbohydrate functions and structures. CSM is able to display, for example, expression data of glycosyltransferases in a compact manner. In all the KEGG resources, various objects including KEGG pathways, chemical compounds, as well as carbohydrate structures are commonly represented as graphs, which are widely studied and utilized in the computer science field.
Resilience is a construct of increasing interest, but validated scales measuring resilience factors among adults are scarce. Here, a scale named the Resilience Scale for Adults (RSA) was crossvalidated and compared with measures of personality (Big Five/5PFs), cognitive abilities (Raven's Advanced Matrices, Vocabulary, Number series), and social intelligence (TSIS). All measures were given to 482 applicants for the military college. Confirmatory factor analyses confirmed the fit of the five-factor model, measuring 'personal strength', 'social competence', 'structured style', 'family cohesion' and 'social resources'. Using Big Five to discriminate between well adjusted and more vulnerable personality profiles, all resilience factors were positively correlated with the well adjusted personality profile. RSA-personal strength was most associated with 5PFs-emotional stability, RSA-social competence with 5PFs-extroversion and 5PFs-agreeableness, as well as TSIS-social skills, RSA-structured style with 5PFs-conscientiousness. Unexpectedly but interestingly, measures of RSA-family cohesion and RSA-social resources were also related to personality. Furthermore, the RSA was unrelated to cognitive abilities. This study supported the convergent and discriminative validity of the scale, and thus the inference that individuals scoring high on this scale are psychologically healthier, better adjusted, and thus more resilient.
We analyzed the expression of edge following behavior in German cockroaches, Blattella germanica (L.). Structure of the environment and spatial distribution of resources modified both expression of locomotory behavior of cockroaches and its distribution between the edge and the central area of an experimental arena. When they are in a familiar environment, German cockroaches are definitely not edge followers and they exploit similarly the different parts of the accessible surface of their home range. Cockroaches placed in a new environment tended to follow edges more than undisturbed insects. This modification could be assimilated to a response to stressful conditions.
The aim of the present study is to contribute to an ongoing validation process of the Quality of Life (QoL) construct in the clinical field by investigating its internal structure. Eight (inter)nationally validated questionnaires have been analyzed by an integrative approach in a multicenter study. Data has been collected in a mentally healthy (n = 479), a depressed (n = 171) and a schizophrenic (n = 139) sample. Apart from conventional psychometric criteria a similarity structure analysis (SSA) within a facet analytic methodology has been applied. A dimensional structure of the resulting integrative questionnaire "Modular System for Quality of Life" (MSQoL) could be generated that consists of one "G-factor" (life in general) and six specific dimensions (physical health, vitality, psychosocial relationships, material resources, affect, leisure time). This basic structure represents a core module measured by 47 items which is sufficiently valid for all three samples. The empirical structures of healthy, depressed and schizophrenic samples fulfill the first law of attitude and share a common variance of 95%. In addition, there are four specific modules (demography, family, partnership, profession). No specific modules could be identified for the psychopathological subgroups. The conclusion can be drawn that QoL is construed very similar by all three investigated populations which is the base for searching for quantitative differences and profiles. The MSQoL integrates the non-redundant components of eight QoL-instruments, is psychometrically able to assess the basic structure and can be completed within a cumulative research design by items specific for a particular setting.
Outstanding features of Mediterranean forest area are highlighted with a special reference to biodiversity and connections with forest management. The naturally originated and anthropogenic progress of the mosaic-like evolution, as well as the man-induced factors and natural constraints are described. The past and present close linkages between management and biodiversity are then analysed by means of a few, outstanding cases typical of the geographical region. The management shift on increasing economically marginal forest area (abandonment) appears to be the major force currently driving connections with inherent and associated biodiversity. The goals following the new-established environmental roles of forests have shifted towards adaptive management, namely the implementation of locally tailored rules in accordance with prominent forest functions. Key priorities to face up to the new scenarios are then discussed. Economic and policy implications are addressed with reference to multipurpose forestry and the related annual flow of outputs. It is shown the role of water-related services, as well the provision of various non-wood forest products and public goods in addition to wood and other traditional forest outputs. Reference is also made to the dualism between the Northern and the South-Eastern Mediterranean countries due to different level of economic development (and pressure of forest resources) together with very different institutional structures, i.e. public ownership in Southern and South-Eastern Mediterranean countries. Nevertheless, the situation is going to become more harmonious in the medium run by growing economic development, the affirmation of local rights on forest resources, globalisation and, above all, rural out migration and exchanges of peoples confirming the traditional role of the Mediterranean Region at cross road of South-North and Eastern-Western cultures.