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PubMedDate not supplied

The art of delegation.

Effective delegation is a large of a manager's position. Physician executives are expected to be skilled delegators and able to lead team efforts to meet larger organizational goals. Delegation should be a five-step process: (1) Describe the results you want; (2) Listen for suggestions about how the task should be done; (3) Give autonomy and freedom to accomplish the task; (4) Follow up; and (5) Give feedback and credit. This column explores the art of delegating and how to assess your skills in this key management area.

Decision Making, Organizational↗
PubMed1999

Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis.

To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group. The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue. For each instrument the members were asked to judge if the instrument was feasible and relevant. If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list. These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set. This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping. The response rate to the questionnaire was 72%. For each domain one or more instruments were selected, except for Entheses and Fatigue. The chosen instruments were similar for the 3 above settings. Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility. For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research. It is recommended to use these instruments in all research projects in AS.

Antirheumatic Agents↗
PubMed1979

Continuing education in allied health: the state of the art.

This paper reports the results of a study on continuing education in 61 allied units. It was conducted to determine the current state of the art of continuing education activity in allied health units. It was found that while continuing education activities are increasing in allied health, there is not a strong administrative commitment being made to internalize continuing education as a function of education.

Allied Health Personnel↗
PubMed1983

Data-based research in therapeutic recreation: state of the art.

During difficult financial times, it is critical not only to evaluate therapeutic recreation programs and document client progress but also to disseminate objective program data to therapeutic recreation and other practitioners. The purpose of this state-of-the-art research inquiry was to provide the therapeutic recreation discipline and other related helping professions with an accurate and current assessment of empirically based research concerning the provision of recreation for special populations. Eight professional journals in recreation, special education, and psychology from 1977 (the year of PL 94-142) through the current literature were reviewed. Articles using a data-based research methodology in the area of recreation/leisure for special populations were identified. Articles were analyzed according to target population, subject age, purpose of study, and research design. Of the 83 data-based research reports found, 40 studies addressed the mentally retarded population, 26 involved children (birth to 13 years), and the case study (23) and survey (23) research designs were most prevalent. A plea for future data-based research by therapeutic recreation professionals to improve services is made.

Evaluation Studies as Topic↗
PubMedDate not supplied

Reagent lease/rental agreements: an alternative to instrument purchase. Acquire a state-of-the-art analyzer more quickly and easily.

A primary responsibility of the laboratory manager is to obtain analytical instrumentation for his or her facility. Traditionally, analyzers are purchased as capital investments. An increasingly popular alternative is the reagent lease/rental agreement. A manufacturer provides a laboratory with an analyzer with the provision that the laboratory will purchase the reagents from the manufacturer. Reagents are purchased at a set cost per test, which varies with test volume, and this price incorporates a charge for the use of the instrument. The laboratory manager can acquire a state-of-the-art analyzer more quickly and easily than through a purchase and can maintain the flexibility to switch to a more suitable system as technology and service requirements change. Significant advantages and disadvantages accrue to both the laboratory and the manufacturer. The reagent lease/rental agreement is an option definitely worth considering by laboratory managers.

Autoanalysis↗
PubMed1999

Constitutional osteochondrodysplasias identifiable at birth. A short review on the state of the art in radiodiagnosis in the late 20th century.

INTRODUCTION: The value of a systematic radiologic analysis in constitutional osteochondrodysplasias remains underestimated by both neonatologists and radiologists. We report the clinical experience of the Department of Neonatology and Neonatal Intensive Care Unit of St. John Hospital in Rome with constitutional osteochondrodysplasias identifiable at birth. MATERIAL AND METHODS: We reviewed 2120 cases of newborns hospitalized in our unit from January 1996 to August 1998 and here submitted to at least one direct radiograph of chest and abdomen (the so-called "babygram"). All the newborns were clinically assisted by the same three neonatologists and radiologically followed by the only pediatric radiologist, the external consultant for diagnostic imaging of the Intensive Care Unit of the Neonatology Department. RESULTS, DISCUSSION AND CONCLUSIONS: We diagnosed 14 cases of constitutional osteochondrodysplasias (.66%): 4 of them (28.27%) belong to the group considered by the European Society of Pediatric Radiology (ESPR) as lethal before or immediately after birth, while the other 10 (71.43%) belong to different groups of the ESPR classification. Thus, we arbitrarily grouped them into a single pathologic condition, based on their two main features: being generally not lethal and always or very often identifiable at birth. These 10 cases were: 1 campomelic dysplasia, 3 achondroplasias, 2 asphyxiant thoracic dysplasias type Jeune, 1 cherubinic dysplasia, 2 osteogenesis imperfectae, 1 osteopetrosis. We justify the relatively high incidence of constitutional osteochondrodysplasias in our study (.66% versus an average incidence of .076% reported in the world population) on the basis of: a) an increasing number of high-risk newborns in our intensive care unit; b) an improvement in our clinical and radiologic diagnostic skills. We conclude that the state of the art of the diagnosis of constitutional osteochondrodysplasias is still based on the first plain X-ray examination performed at birth because of cardiorespiratory and/or abdominal diseases in the newborn.

Humans↗
PubMed1999

[To use the stethoscope correctly is not easy. The intricate art of auscultation should receive more attention in medical education].

Although the stethoscope is used daily by almost every physician, the full potential of the art of stethoscopy is seldom tapped. It has been replaced by newer and more costly techniques. In the article it is argued that more time in medical education should be allocated to stethoscopy, so that it can be used in selecting patients who will benefit most from examination with modern diagnostic tools. The medical technological background of stethoscopy is also reviewed, as are the reasons why it is difficult to give sound advice on the choice of stethoscope.

Acoustics↗
PubMedDate not supplied

[Autonomy of the nursing profession: state of the art].

This article points out the foundation elements of the nursing education, the way covered till now, the status of the art and what has to be achieved in order to attain Nursing Degree objectives. The different aspects concerning the curricula organization and the model of care are examined. The request of getting nursing teaching and nursing chairs for nurses are an aim not yet met, but they are the basis objectives of the professional engagement. Another important subject concerns the leadership that will allow nurses to be administrators and managers in every respect, also from a juridical point of view, and to express their professionality in a really autonomous way.

Curriculum↗
PubMed1999

The art and science of searching MEDLINE to answer clinical questions. Finding the right number of articles.

The current medical environment makes information retrieval a matter of practical importance for clinicians. Many avenues present themselves to the clinician, but here we focus on MEDLINE by summarizing the current state of the art and providing an innovative approach for skill enhancement. Because new search engines appear rapidly, we focus on generic principles that can be easily adapted to various systems, even those not yet available. We propose an idealized classification system for the results of a MEDLINE search. Type A searches produce a few articles of high quality that are directly focused on the immediate question. Type B searches yield a large number of articles, some more relevant than others. Type C searches produce few or no articles, and those that are located are not germane. Providing that relevant, high-quality articles do exist, type B and C searches may often be improved with attention to search technique. Problems stem from poor recall and poor precision. The most daunting task lies in achieving the balance between too few and too many articles. By providing a theoretical framework and several practical examples, we prepare the searcher to overcome the following barriers: a) failure to begin with a well-built question; b) failure to use the Medical Subject Headings; c) failure to leverage the relationship between recall and precision; and d) failure to apply proper limits to the search. Thought and practice will increase the utility and enjoyment of searching MEDLINE.

Clinical Medicine↗
PubMedDate not supplied

Job sculpting: the art of retaining your best people.

Hiring good people is tough, but keeping them can be even tougher. The professionals streaming out of today's MBA programs are so well educated and achievement oriented that they could do well in virtually any job. But will they stay? According to noted career experts Timothy Butler and James Waldroop, only if their jobs fit their deeply embedded life interests--that is, their long-held, emotionally driven passions. Butler and Waldroop identify the eight different life interests of people drawn to business careers and introduce the concept of job sculpting, the art of matching people to jobs that resonate with the activities that make them truly happy. Managers don't need special training to job sculpt, but they do need to listen more carefully when employees describe what they like and dislike about their jobs. Once managers and employees have discussed deeply embedded life interests--ideally, during employee performance reviews--they can work together to customize future work assignments. In some cases, that may mean simply adding another assignment to existing responsibilities. In other cases, it may require moving that employee to a new position altogether. Skills can be stretched in many directions, but if they are not going in the right direction--one that is congruent with deeply embedded life interests--employees are at risk of becoming dissatisfied and uncommitted. And in an economy where a company's most important asset is the knowledge, energy, and loyalty of its people, that's a large risk to take.

Career Mobility↗
PubMed2000

The Art and Science of Total Synthesis at the Dawn of the Twenty-First Century.

A new millenium has begun-grounds enough to question the present state of the total synthesis of natural products. In this review we answer this question by tracing the evolution of this fine art and science from its birth to the present time. This retrospective on total synthesis should serve to demonstrate how far we have come, yet show that the science of total synthesis is still in its infancy.

Journal Article↗
PubMed1999

Zona pellucida autoantibodies in women undergoing ART.

The presence of ZP autoantibodies in serum and Ffl samples of 109 women attending the ART Center in Kiev was investigated using IIF and ELISA. Positive serum and Ffl samples examined by both methods were found in 20 (18.34%) and in 19 (17.43%) patients respectively; 31 (28.44%) serum samples and 33 (30.27 %) Ffl samples analyzed by IIF were positive; of the samples analyzed by ELISA 21 (19.26%) and 20 (18.34%), respectively, were positive. No relationship was found between ZP autoantibody incidence and the type and cause of infertility. A significant prevalence of ZP autoantibodies detected by ELISA in Ffl was found in patients with fertilization failure (39.13%) and with low fertilization rate (42.85%) when compared to patients with middle fertilization rate (5.71%) and high fertilization rate (8.1%). The clinical significance of ZP autoantibodies in Ffls for in vitro fertilization outcome was suggested.

Adult↗
PubMed2000

[Cryopreservation. State of the art].

Cryopreservation was mainly introduced in order to face the increasing number of stimulation cycles per patient and multiple pregnancy during procedures of in vitro fertilization and embryo transfer, accumulating excess embryos and transferring it in a later cycle. Nevertheless embryo storage has several implications because of moral and legal problems. Starting from 1984, date of the first transfer of a cryopreserved embryo, techniques have evolved and cryopreservation is now a reality in many sterility Centers. The aim of this review is then to point out the state of the art of cryopreservation with regard to embryos and oocyte storage and to have a look to possible futures developments in this technique.

Cryopreservation↗
PubMed2000

Techniques of carotid artery stenting: the state of the art.

The technique of carotid stenting has undergone significant refinement since its introduction and continues to improve as experience with the procedure matures and more suitable equipment becomes available. Improved stent designs and the utilization of cerebral protection devices are expected to significantly impact on the technique, its ultimate outcomes, and widespread application. In using the currently available technology for carotid stenting, patient selection and meticulous attention to procedural details are very important in minimizing embolic events. In this article, we provide a comprehensive practical discussion of the state-of-the-art carotid stenting techniques that have allowed us to maintain low event rates.

Carotid Arteries↗
PubMedDate not supplied

Hepatitis C infection: its sequelae and outcomes--State-of-the-Art Workshop, September 24 to 25, 1998. Canadian Association for the Study of the Liver.

This report summarizes a state-of-the-art workshop held in September 1998 on the "Natural History and Outcome of Hepatitis C Infection". Sixteen Canadian and two internationally renowned hepatologists were invited. A practical classification of HCV infection served as a framework for the meeting. The concepts of modelling of chronic disease, the epidemiology of HCV infection before the introduction of anti-HCV testing, and the outcome of various forms of chronic hepatitis C in adults and children were presented. Lectures on the outcome of HCV cirrhosis, hepatocellular carcinoma, the role of liver transplantation, the influence of host factors on outcome, iron overload in chronic hepatitis C and possible modification of the natural history by antiviral therapy were followed by discussion and consensus statements pertaining to each presentation. "The European Experience in Assessing Chronic Hepatitis C" was presented by Prof G Dusheiko from the United Kingdom, and Prof Leonard Seeff from the National Institutes of Health (United States) presented "The Epidemiology and Outcome of Hepatitis C Infection in the United States and the World".

Adult↗
PubMed2000

Toxic, bioaccumulative and persistent chemicals in central and eastern Europe--state-of-the-art report.

Organic substances that are persistent, bioaccumulative and have toxic characteristics likely to cause adverse effects on human health or have environmental effects are called PBTs (Persistent, Bioaccumulative, Toxic substances). The report "Persistent, Bioaccumulative and Toxic Chemicals in Central and Eastern European Countries--State-of-the-art Report" was prepared by a group of scientists from the Czech Republic, Slovakia, Poland and Estonia and was published on the Internet (http:¿recetox.chemi.muni.cz/).

Environmental Pollutants↗
PubMedDate not supplied

Pediatric sedation: the art and science.

Successful completion of diagnostic and therapeutic orthopaedic procedures in children requires a high level of cooperation and pain control. This article provides a framework for safe and effective sedation of children undergoing such procedures. Following the definition of levels of sedation, the dynamics of the three phases of sedation (pre, intra, and post) are described. Specific sedative-analgesic agents, monitoring, and transport are discussed. Finally, the art of working with children who require sedation is outlined.

Child↗
PubMed2000

[Influence of single-photon emission scan duration measured with the ECAT ART PET scanner].

AIM: The aim was to study the influence of single-photon-transmission scan duration in 3D-PET on the quantitative values of attenuation coefficients and noise in transmission images and of activity concentrations and noise in attenuation corrected emission images of thorax phantom- and patient data. METHOD AND MATERIAL: Using dual collimated Cs-137 singles transmission sources (E gamma = 662 KeV, A = 2* 614 MBq) on an ECAT ART tomograph series of transmission scans of a thorax phantom were acquired pre- and post-injection of 18F. 17 patients underwent two transmission scans. The scan time of the short transmission was chosen according to the results of the phantom studies (noise of Poisson statistics less than 4%). Transmission and attenuation corrected emission images were evaluated with respect to estimated linear attenuation coefficients, noise and specific activities in organs. RESULTS: The phantom studies reveal little variation of the estimated linear attenuation coefficients as a function of scan duration. The estimates of the attenuation coefficients are found to be 1% lower than the expected values for pre- and up to 6.5% lower for post-injection transmissions. The noise level in the transmission images increases as expected for Poisson data. The noise level in the attenuation corrected emission images shows only little increase with decreasing transmission scan time whereas it is strongly influenced by a variation of emission scan time. In patient studies, less than 3% difference was found in the estimated linear attenuation coefficients as well as in the activity concentrations between short (pre or post-injection) and long transmission scans. The noise levels in transmission and emission images are 1% (pre-injection) and 4% (post-injection) higher for short transmission scans. CONCLUSION: Due to the high photon flux, single photon transmission offers good clinical performance with significantly reduced transmission scan durations (< 2 min/bed in pre-, < 4 min/bed in post-injection transmission).

Aged↗