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PubMed1990

Online access to MEDLINE in clinical settings. A study of use and usefulness.

STUDY OBJECTIVE: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. DESIGN: Longitudinal descriptive study. SETTING: Inpatient and outpatient services of a university medical center. PARTICIPANTS: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so. INTERVENTIONS: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time. MEASUREMENTS AND MAIN RESULTS: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information. CONCLUSIONS: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

Academic Medical Centers↗
PubMed2006

Evaluation of a redesigned self-checkout station for wheelchair users.

Self-checkout is the emergent/emerging retail technology wherein users (shoppers) check out their own items using an interactive kiosk. A dramatic growth is anticipated in the prevalence of self-checkout systems in retail environments. A study was conducted to develop and evaluate a redesign of a self-checkout system with a focus on issues related to physical accessibility for wheelchair users. Two checkout station prototypes were built: a full-scale model of an existing system and a full-scale model of a system with design modifications (e.g., inclusion of appropriate wheelchair clearance under the workstation, reduced vertical position of the credit card reader, etc.). Five wheelchair users and 10 non-wheelchair users performed simulated self-checkout activities using both workstations. The principal independent variable was workstation type (standard design vs. modified design). The dependent measures were productivity (time to complete a transaction), shoulder flexion angle, torso flexion angle, and the user's subjective assessment of the experience. The results of this study indicate that workstation type did not influence productivity levels in either participant group (wheelchair users or non-wheelchair users). Posture, on the other hand, was significantly improved: the peak shoulder angle was reduced by 64% in wheelchair users and by 69% in the non-wheelchair user group. Peak flexion angle of the torso was also reduced by 67% for wheelchair users. Subjective feedback from the wheelchair user group supported the postural data by showing an overall preference for the redesigned workstation, whereas the non-wheelchair group showed no preference between the two. These results indicate that design for populations with specific limitations does not need to come at a cost of reduced accessibility for persons without these limitations; universal design is achievable.

Architectural Accessibility↗
PubMed2005

Clusters of mutations from transient hypermutability.

Collections of mutants usually contain more mutants bearing multiple mutations than expected from the mutant frequency and a random distribution of mutations. This excess is seen in a variety of organisms and also after DNA synthesis in vitro. The excess is unlikely to originate in mutator mutants but rather from transient hypermutability resulting from a perturbation of one of the many transactions that maintain genetic fidelity. The multiple mutations are sometimes clustered and sometimes randomly distributed. We model some spectra as populations comprising a majority with a low mutation frequency and a minority with a high mutation frequency. In the case of mutants produced in vitro by a bacteriophage RB69 mutator DNA polymerase, mutants with two mutations are in approximately 10-fold excess and mutants with three mutations are in even greater excess. However, phenotypically undetectable mutations seen only as hitchhikers with detectable mutations are approximately 5-fold more frequent than mutants bearing detectable mutations, indicating that they arose in a subpopulation with a higher mutation frequency. Excess multiple mutations may contribute critically to carcinogenesis and to adaptive mutation, including the adaptations of pathogens as they move from host to host. In the case of the rapidly mutating riboviruses, the viral population appears to be composed of a majority with a mutation frequency substantially lower than the average and a minority with a huge mutational load.

Animals↗
PubMed1998

Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning.

OBJECTIVE: Investigate support for the transactional stress and coping model for mothers of children with congenital heart defects, in accounting for the variance in maternal adjustment. METHODS: Participants were 52 mothers of children recruited from a university medical center. Measures included illness variables, cognitive processes (i.e., appraisals of stress, expectations, methods of coping, family functioning, and maternal psychological adjustment). RESULTS: Maternal adjustment was associated with high levels of daily stress and palliative coping techniques and was not significantly associated with severity of the cardiac defect. Together, the variables of the model accounted for approximately 38% of the variance in maternal adjustment. CONCLUSIONS: The findings are in accord with previous research among other chronically ill populations in suggesting an association between stress, coping, and maternal adjustment. Within the limitations of the study, the data were interpreted to support the utility of theoretical models in identifying areas in need of intervention across chronic illness groups.

Adaptation, Psychological↗
PubMed1987

Patient satisfaction with the clinical encounter: social psychological determinants.

Patient-practitioner transactions in the ambulatory setting have become an increasingly important focus for research in recent years. In particular, there is growing interest in providing empirical support for our anecdotal, 'common-sense' notions that clinical encounter experiences are a major determinant of outcomes such as the patient's satisfaction with the encounter. The present study was designed to look at this issue and addressed the following two research questions: Is there a relationship between fulfillment of patient requests for services and patient satisfaction with the clinical encounter? and What degree of satisfaction is explained by the qualities of the encounter as compared to the characteristics of the patient, physician, and system of health care? Four newly-developed instruments were administered to a convenience sample of 144 adult patients and their physicians prior to and following actual visits to a University Family Practice Center. Meeting patients' requests increased their satisfaction with the encounter. At least 19% of the variance in patient satisfaction could be attributed to request fulfillment. The implications of these findings for future research into the doctor-patient relationship are discussed.

Adult↗
PubMed2002

Prediction of an HMG-box fold in the C-terminal domain of histone H1: insights into its role in DNA condensation.

In eukaryotes, histone H1 promotes the organization of polynucleosome filaments into chromatin fibers, thus contributing to the formation of an important structural framework responsible for various DNA transaction processes. The H1 protein consists of a short N-terminal "nose," a central globular domain, and a highly basic C-terminal domain. Structure prediction of the C-terminal domain using fold recognition methods reveals the presence of an HMG-box-like fold. We recently showed by extensive site-directed and deletion mutagenesis studies that a 34 amino acid segment encompassing the three S/TPKK motifs, within the C-terminal domain, is responsible for DNA condensing properties of H1. The position of these motifs in the predicted structure corresponds exactly to the DNA-binding segments of HMG-box-containing proteins such as Lef-1 and SRY. Previous analyses have suggested that histone H1 is likely to bend DNA bound to the C-terminal domain, directing the path of linker DNA in chromatin. Prediction of the structure of this domain provides a framework for understanding the higher order of chromatin organization.

Amino Acid Sequence↗
PubMed1992

[Study on the relationship between toddler temperament and development (first report)--the correlation among toddler temperament, maternal perception and rearing environment].

The purpose of this study is to clarify how a child's temperament and maternal perception influences the rearing environment. As the conceptual framework, we used A.J. Sameroff's transactional model and Miyake's conceptual model of mother and child. The following process was hypothesized: toddler temperament influences maternal perception, which in turn influences rearing environment under which children are developing. Questionnaires concerning toddler temperament, maternal perception and rearing environment were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and results from 306 mothers and children who answered the questionnaires were analyzed. The results were as follows: (1) Child temperament showed a tendency to accord with maternal perception of how easy it is to handle him/her. (2) Maternal perception was related to rearing environment. (3) Temperamental characteristics were related to rearing environment. (4) While the influence of child temperament and maternal perception on the rearing environment was not shown to be strong, the hypothesized process of this study was supported to a certain degree. From these results, it appears that it is important to pay attention to a child's temperament as a contributing factor in the health practice of mother and child.

Child Rearing↗
PubMed2006

Influence of the site of small bowel resection on intestinal epithelial cell apoptosis.

Massive small bowel resection (SBR) results in a significant increase in intestinal epithelial cell (EC) proliferation as well as apoptosis. Because the site of SBR (proximal (P) vs. distal (D)) affects the degree of intestinal adaptation, we hypothesized that different rates of EC apoptosis would also be found between P-SBR and D-SBR models. Wild-type C57BL/6J mice underwent: (1) 60% P-SBR, (2) 60% D-SBR, or (3) SHAM-operation (transaction-reanastomosis) at the mid-gut point. Mice were sacrificed after 7 days. EC apoptosis was measured by TUNEL staining. EC-related apoptotic gene expression including intrinsic and extrinsic pathways was measured with reverse transcriptase-polymerase chain reaction. Bcl-2 and bax protein expression were analyzed by Western immunoblotting. Both models of SBR led to significant increases in villus height and crypt depth; however, the morphologic adaptation was significantly higher after P-SBR compared to D-SBR (P<0.01). Both models of SBR led to significant increases in enterocyte apoptotic rates compared to respective sham levels; however, apoptotic rates were 2.5-fold higher in ileal compared to jejunal segments (P<0.01). P-SBR led to significant increases in bax (pro-apoptotic) and Fas expression, whereas D-SBR resulted in a significant increase in TNF-alpha expression (P<0.01). EC apoptosis seems to be an important component of intestinal adaptation. The significant difference in EC apoptotic rates between proximal and distal intestinal segments appeared to be due to utilization of different mechanisms of action.

Adaptation, Physiological↗
PubMedDate not supplied

[From acute victimization at chronic victimization: socio-cognitive approach of differential tolerance threshold].

BACKGROUND: Work, for many years reduced to a purely instrumental dimension, proves to be a true microcosm of society, with its informal modes, its emotional networks and its series of evils and dilemmas. This human apprehension of the professional sphere tends to reveal a pole with multiple facets, some of which have long been concealed, but whose individual, social and economic extent can't let people ignore them. This social perception, which contributes to regard work as sacred and makes it impervious to any aggression, should be abandoned. Bearing this in mind, our study endeavours to show that "work" and "victim" are far more overlapping than antagonistic realities; it aims at determining the impact of two aggressive methods via the professional pole, namely: moral harassment at work and armed attacks within bank premises. Such an approach tends to unify health psychology, occupational psychology and victimology, thus opening a breach in the stereotyped view which crystallizes the professional sphere into a kind of representative noose devoid of the most human bases. We then suggest, as a first hypothesis, that the nature of the victimization process, resulting from specific aggressive scenarios, would determine different psychological, physiological and relational consequences, apprehended under the generic expression of tolerance threshold. In other words, "mobbing", through its proactive, intentional and obsessional dimension would tend to lower the victims' threshold more than hold-ups, which are characterized by a reactive aspect, and obey unfavourable socio-economic contingencies. Our research also aims at apprehending this dynamic relationship binding victimization types to tolerance thresholds through two analysing factors. These psychological mediators are derived from Lazarus and Folkman's "transactional model of stress", which postulates that stress would rise from the perception people get of the transaction between the requirements of the situation and their own resources. These modulators would correspond to the social evaluation of the stressor and the adjustment strategies adopted by the victims. We then postulate the fact that these interfering variables would determine a connection between the type of victimization and the series of signs and symptoms generated. In other words, the aversive modes would refer to a process of significance via these interpolated socio-cognitive factors, thus forming a trace of the traumatic event according to the tolerance threshold expressed. More precisely, our assumption consists in postulating that the insidious and latent aspect of harassment which is supposed to support a dispositional attribution of the harasser's intrigues as well as the preferential adoption of coping strategies centred on emotional control, would lower the victims' tolerance threshold further, than a visible and instantaneous hold-up which is supposed to condition an essentially situational perception and the adoption of strategies mainly directed towards the problem. METHOD: Since this study is the subject of a comparative research strategy, its required the constitution of three independent samples: ten harassment victims; seven armed attack victims; ten witnesses, all salaried employees; they had not been subjected to either type of attack but were questioned about a working life event seen as stressful. The three groups, set up according to sex and age considerations, agreed to be subjected to a semi-directive interview. Considering the exploratory nature of this present research, the process proved to be most suitable since, through the filter of the people's subjectivity, it clearly determined the meaning granted by the victim to the aversive situation. In order to comply with a standardization preoccupation, each interview was identically structured using a preset question grid and similar operating conditions. The data collected were then subjected to four levels of analysis. An analysis of contents, centred on a logic-semantic frequency dimension of speech, obtained a simplified representation of the whole of the data. This first level of analysis, supplemented by descriptive statistics, validated, in the second stage, the significance of the differences in the semantic categories. In the third stage, an "analysis of adjacency" associated with a factorial analysis of the correspondences, delineated the differentiating values of the three groups of subjects. A final stage of analysis, centred on a multiaxial dimension [DSM IV ], permitted the constitution of clinical pictures. RESULTS: In accordance with the general assumption, the results show that the victims reveal a dominating presence of mobbing signs related to depression and anxiety symptomatology with an acute emotional threshold. Hold-up victims also show undoubted but significantly less harmful consequences. These victims have turned out to be more centred on the anxious pole and the social and family fields. Moreover, while the victims of harassment unanimously evoke the emergence of a break-up in dynamics conveying a freeze of the social matrix, some of the victims of armed attacks express "secondary benefits" through the setting-up of gregarious dynamics on professional as well as on family level. DISCUSSION: Considering these results, there seems to be a double induction of such a difference. The social evaluation tends to be a first explanatory inference as for the expressed tolerance level. As a matter of fact, the frequential analysis reveals a different perception of the attacker. The supernumerary evocation of dispositional factors, supposing a personal motivation marked with intrigues concealed behind an apparent legitimacy, draws a very personological profile of the harasser. This majority of intrinsic determinants reveals an increase in the causal weight of the harasser; at the same time, it disregards the possible influence of extrinsic factors. In that respect, the harasser is seen as the only instigator of the attacks, which consequently worsens his/her responsibility and culpability. No difference appears between the harasser himself and the hypothetical causes of the aversive situation: the harasser is seen as the source of the attacks and the attacks as the concretization of the harasser's state of mind. On the basis of this report, the victims of harassment tend to amalgamate the personality and the situation. The victims of armed attacks, as for them, are characterized by a more situational evaluation of the stressor, revealing an apparent will to segment the aversive situation: on the one hand the act, and the other the attacker, as though, eventually, the latter was but one element depending on a specific situation. The majority enunciation of extrinsic factors supposes an obvious intention to diffuse the hold-up man's responsibility over contextual attributes. The second inference lies in the strategies used to adjust to the situation. Whatever the type of victimization, the passive coping system reveals as dominating. However, this tendency seems to be more moderate with hold-up victims, who tend to counterbalance the strategies centred on emotional control with strategies directed towards an active resolution of the problem. CONCLUSION: Considering these first results, which call for further study, our impression is that it seems to be relevant to consider the setting-up of psychological therapy programs adapted to the very nature of each victimization case.

Adaptation, Psychological↗
PubMed2006

Effect of walking speed changes on tibialis anterior EMG during healthy gait for FES envelope design in drop foot correction.

Functional electrical stimulation may be used to correct hemiplegic drop foot. An optimised stimulation envelope to reproduce the EMG pattern observed in the tibialis anterior (TA) during healthy gait has been proposed by O'Keeffe et al. [O'Keeffe, D.T., Donnelly, A.E., Lyons, G.M., 2003. The development of a potential optimised stimulation intensity envelope for drop foot applications. IEEE Transactions on Neural Systems and Rehabilitation Engineering]. However this envelope did not attempt to account for changes in TA activity with walking speed. The objective of this paper was to provide data to enable the specification of an algorithm to control the adaptation of an envelope with walking speed. Ten young healthy subjects walked on a treadmill at 11 different walking speeds while TA EMG was recorded. The results showed that TA EMG recorded around initial contact and at toe off changed with walking speed. At the slowest velocities, equivalent to hemiplegic walking, the toe-off burst (TOB) of EMG activity had larger peak amplitude than that of the heel-strike burst (HSB). The peak amplitude ratio of TOB:HSB was 1:0.69 at the slowest speed compared to, 1:1.18 and 1:1.5 for the self-selected and fastest speed, respectively. These results suggest that an FES envelope, which produces larger EMG amplitude for the TOB than the HSB, would be more appropriate at walking speeds typical of hemiplegic patients.

Adaptation, Physiological↗
PubMed2000

Cementless fixation for primary segmental bone tumor endoprostheses.

To combat the high incidence of aseptic loosening for young patients and for patients with failed implants after resection for bone tumors, intramedullary cementless fixation of massive tumor implants was investigated. These implants consist of a hydroxyapatite coated titanium stem. To date, 47 of these prostheses have been inserted for the treatment of primary bone tumors. Radiographs indicate that the stems are osseointegrated. Radiolucent lines have not been seen between the implant and the bone. Bone remodeling changes have been observed. In several cases in which the implant was not seated properly on the transaction site, bone grew to the shoulder of the implant. Bone remodeling was particularly evident in stems that were coated over their entire surface. In these cases, the implant induced local bone resorption so that the bone around the midstream region became thinner, with resorption of cortical bone on the periosteal surface and maintenance of bone on the endosteal surface adjacent to the stem. This effect was attributed to stress shielding, and a three-dimensional finite element model using loading data obtained from a telemetry study indicated that, where the stem was bonded to the bone over the entire surface, stresses in the outer cortex became reduced. In the finite element model, reducing the region of hydroxyapatite coating to approximately 1/3 of the stem length reduced the extent of the low-stress area in the outer cortex. Subsequently, prostheses have been coated with hydroxyapatite over only approximately 1/3 of their stem. This method of fixing the massive endoprosthesis to the bone is thought to be successful in the short-term and offers an alternative to cemented fixation.

Bone Neoplasms↗
PubMedDate not supplied

Age and gender as determinants of stress exposure, generation, and reactions in youngsters: a transactional perspective.

The present study used a contextual and transactional approach to examine age and gender differences in the experience and consequences of life stress in clinic-referred preadolescents and adolescents. Eighty-eight youngsters and their parents completed the Child Episodic Life Stress Interview, a detailed semistructured interview assessing the occurrence of stressful events in multiple life domains. Interviews were coded using a contextual threat rating method to determine event stressfulness and dependence. Youngsters also completed the Children's Depression Inventory and the Revised Child Manifest Anxiety Scale to assess self-reported symptoms of depression and anxiety. Consistent with predictions, age- and gender-related patterns of life stress varied across the type and context of stressors. Most notably, adolescent girls experienced the highest levels of interpersonal stress, especially stress and conflict that they generated within parent-child and peer relationships. Preadolescent girls experienced the highest levels of independent stress and conflict in the family context. Adolescent boys experienced the highest levels of noninterpersonal stress associated with self-generated events. Girls demonstrated particular vulnerability to depressive responses to dependent stress. The results build on and extend previous theory and research on age and gender differences in close relationships and stress, and illustrate the value of more refined conceptual models and more sophisticated methodologies in child life stress research.

Adaptation, Psychological↗
PubMed2006

Outstanding scientist of the year 2006: Rogel Patawaran, BS.

Rogel Patawaran is cofounder of iQSecure Solutions, Inc., a secure web mail company, which began in 2002 and is currently based in Santa Monica, California. Its unique service enables hospitals, clinics, and doctors' offices the opportunity to have secure web-based video and telephone conferencing by simply switching online services offered by this innovative company. In addition, he is cofounder of AuthoTecq, based in Long Beach, California, and inventor of the AuthoTecq system in 1999. The AuthoTecq system is an online credit card processing company. Rogel Patawaran sought to remedy one of the problems facing users of internet transactions. Because internet merchants act as their own gateway for financial transactions, they have been storing credit card numbers in their own databases, thereby failing to address the necessary security provisions involved in the storage of such sensitive information. AuthoTecq removes this responsibility from the merchant by processing financial transactions on behalf of the merchants. Its system dramatically reduces credit card theft, and thereby decreases the amount of credit card fraud. In his landmark book Saving Lives & Saving Money, Newt Gingrich, former Speaker of House of Representatives, describes a new approach to the challenge of creating a better system of personal health and health care for the 21st century, a system that saves lives and saves money. He indicates that you could be visiting a clinic with electronic medical records, electronic laboratory reports, and electronic drug prescriptions. This entirely electronic clinic saves money and lives because it is far more accurate than a paper system. Such clinics exist at the Kaiser Permanente Hospitals, the Mayo Clinic in Jacksonville, Florida, the Cleveland Clinic, many Harvard hospitals, and all Veteran Administration hospitals in the US. He indicates that healthcare is the only industry in America that can give you a disease and then charge you to cure it. He further reports that out of 100 hospital patients, five or six will be the victim of a preventable error. He states that medication errors alone kill 7000 people each year, adding $2 billion to the overall cost of healthcare. He stresses that these 7000 needless deaths are not only unacceptable but un-American as well. During the 1990s, the pharmaceutical industry sought help from the Food and Drug Administration (FDA) to develop a standard by which a paperless system could be adopted for healthcare. In March of 1997, the FDA issued its final ruling, which established the criteria for which the FDA will recognize the transmission of authenticity within electronic data as well as establishing standards of authenticity for electronic data equivalent to the validity of signatures on paper documents and records. The FDA also recognizes the growth that can be experienced by converting healthcare technology to a paperless system, such as the expediting of patient files in a more organized manner, increasing the speed of file transfer of such documents, reducing prescription errors, enabling computer-generated data analysis and statistics, and reducing storage space. Rogel Patawaran and his colleagues also realized that electronic healthcare technology using the highest standard of data encryption to transfer data could also dramatically improve the safety of patients in our nation and the world. To answer the needs within healthcare technology, Rogel Patawaran created a system for healthcare providers using the most superior encryption methods, and in the process creating iQSolutions, Inc. Its web mail system uses the Public Key Infrastructure (PKI) format, which is the strongest known encryption format. PKI is used in combination with the Advance Encryption Standard (AES) digital encryption algorithm, which is the current algorithm used by banks and government agencies, thereby protecting the privacy and accuracy of the information. Rogel Patawaran's remarkable contributions to the encryption process will aid in the number of lives saved as well as helping to avoid medical malpractice by ensuring the accuracy of medical records, as well as reducing the number of medication errors or inappropriate prescriptions being filled. These remarkable accomplishments in patient safety are accomplished at a rapid speed that ensures that data-sensitive patient files can be securely transmitted between and within hospitals. Finally, with the growing need for an electronic system within the medical field, doctors will be able to securely access all such data from anywhere and at any time, thus reducing the age-old problem of time constraints that a paper system presented doctors and hospitals alike. In recognition of Rogel Patawaran's contributions to the medical field through the use of encryption teamed with the transferring of sensitive data such as hospital records, Rogel Patawaran has been selected as the Outstanding Scientist of 2006.

Artificial Intelligence↗
PubMed2007

Intraclass retrieval of nonrigid 3D objects: application to face recognition.

As the size of the available collections of 3D objects grows, database transactions become essential for their management with the key operation being retrieval (query). Large collections are also precategorized into classes so that a single class contains objects of the same type (e.g., human faces, cars, four-legged animals). It is shown that general object retrieval methods are inadequate for intraclass retrieval tasks. We advocate that such intraclass problems require a specialized method that can exploit the basic class characteristics in order to achieve higher accuracy. A novel 3D object retrieval method is presented which uses a parameterized annotated model of the shape of the class objects, incorporating its main characteristics. The annotated subdivision-based model is fitted onto objects of the class using a deformable model framework, converted to a geometry image and transformed into the wavelet domain. Object retrieval takes place in the wavelet domain. The method does not require user interaction, achieves high accuracy, is efficient for use with large databases, and is suitable for nonrigid object classes. We apply our method to the face recognition domain, one of the most challenging intraclass retrieval tasks. We used the Face Recognition Grand Challenge v2 database, yielding an average verification rate of 95.2 percent at 10-3 false accept rate. The latest results of our work can be found at http://www.cbl.uh.edu/UR8D/.

Algorithms↗
PubMed2004

Time-driven activity-based costing.

In the classroom, activity-based costing (ABC) looks like a great way to manage a company's limited resources. But executives who have tried to implement ABC in their organizations on any significant scale have often abandoned the attempt in the face of rising costs and employee irritation. They should try again, because a new approach sidesteps the difficulties associated with large-scale ABC implementation. In the revised model, managers estimate the resource demands imposed by each transaction, product, or customer, rather than relying on time-consuming and costly employee surveys. This method is simpler since it requires, for each group of resources, estimates of only two parameters: how much it costs per time unit to supply resources to the business's activities (the total overhead expenditure of a department divided by the total number of minutes of employee time available) and how much time it takes to carry out one unit of each kind of activity (as estimated or observed by the manager). This approach also overcomes a serious technical problem associated with employee surveys: the fact that, when asked to estimate time spent on activities, employees invariably report percentages that add up to 100. Under the new system, managers take into account time that is idle or unused. Armed with the data, managers then construct time equations, a new feature that enables the model to reflect the complexity of real-world operations by showing how specific order, customer, and activity characteristics cause processing times to vary. This Tool Kit uses concrete examples to demonstrate how managers can obtain meaningful cost and profitability information, quickly and inexpensively. Rather than endlessly updating and maintaining ABC data,they can now spend their time addressing the deficiencies the model reveals: inefficient processes, unprofitable products and customers, and excess capacity.

Commerce↗
PubMed2006

Development of a practical costing method for hospitals.

To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.

Accounting↗
PubMed2001

Leadership, organizational stress, and emotional exhaustion among hospital nursing staff.

STUDY'S RATIONALE AND OBJECTIVES: We examined the effect of work stressors and head nurses' transactional and transformational leadership on the levels of emotional exhaustion experienced among their staff. METHODOLOGICAL DESIGN AND RESEARCH METHODS: A questionnaire was sent to all nurses of a university hospital. Usable returns were received from 625 nurses, giving a response rate of 39.2%. Data were treated using correlational analyses and multiple regression. The latter modelled stressors and leadership as predictors of nurses' reported emotional exhaustion. MEASURES: Work stressors were assessed using the Nursing Stress Scale (NSS) which comprises 34 items divided into three subscales (referring to stress from the physical, psychological, and social environment), and the role ambiguity (three items) and conflict (three items) scales. Leadership was measured with the Multifactor Leadership Questionnaire. RESULTS: In regression analyses, work stressors as a whole were found to explain 22% of the variance in emotional exhaustion whereas leadership dimensions explained 9% of the variance in that outcome measure. Stress emanating from the physical and social environment, role ambiguity, and active management-by-exception leadership were significantly associated with increased levels of emotional exhaustion. Transformational and contingent reward leadership did not influence emotional exhaustion. LIMITATIONS: A limitation of this study is that it considered only the emotional exhaustion dimension of burnout. Also, as data were cross-sectional in nature, conclusions regarding the direction of causality among variables cannot be drawn. CONCLUSIONS: This study provided, for the first time, a test of the influence of leadership on burnout among nurses, taking into account the role of work stressors. Future research is needed to examine if the effects reported herein can be replicated using the two other dimensions of burnout (depersonalization and reduced personal accomplishment).

Adult↗
PubMed1998

Pain coping strategies predict perceived control over pain.

Perceptions of control over pain and specific pain coping strategies are associated with a number of positive outcomes in patients with chronic pain conditions. Transactional models of stress have emphasized coping as a process that is both determined by, and influences appraisals of control. While perceptions of control and coping efforts are associated with better adjustment, little is known about the specific coping strategies that contribute to perceptions that pain is controllable. One hundred and ninety-five (65% female) individuals with chronic pain conditions admitted to an inpatient unit completed the Multidimensional Pain Inventory, the Survey of Pain Attitudes and the Coping Strategies Questionnaire. Stepwise multiple regression analyses were used to predict perceived pain control from measures of pain severity and coping. After controlling for pain severity and education, coping self-statements and reinterpreting pain sensations predicted greater perceptions of control over pain, whereas ignoring pain sensations predicted lower perceptions of control over pain. The coping strategies did not interact with pain severity in predicting perceptions of control. Coping flexibility, or the number of pain coping strategies reported at a high frequency, also predicted perceptions of control over pain and did not interact with pain severity. The present findings suggest that, regardless of pain severity, the use of specific cognitive pain coping strategies may increase perceptions of control over pain. Since the existing coping literature largely identifies maladaptive pain coping strategies, it is especially critical to establish which pain coping strategies are adaptive. Specific cognitive strategies, particularly coping self statements, are important components for cognitive-behavioral interventions for chronic pain management. Future research will need to determine whether other adaptive cognitive strategies such as reinterpreting pain sensations can be increased with cognitive interventions, since this strategy is infrequently used.

Adaptation, Psychological↗