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Clear Direction (clear + direction)

Distribution by Scientific Domains

Medical Sciences	83%

Selected Abstracts

Three-dimensional reconstruction of the mucosa from sequential sections of biopsy specimens of patients with ulcerative colitis: Relationship between crypt structure and vascular architecture

DIGESTIVE ENDOSCOPY, Issue 2 2004
Hiroo Furukawa
Background:, In a previous paper, the stereographic reconstruction of the crypt structure of ulcerative colitis using the RATOCK System was described. The relationship between the blood vessels and the crypt structure is the focus of the current paper, using two kinds of tissue staining color in which the color differs. Stereographic images make the relationship between the crypt structure and blood vessel distribution understandable at a glance. Methods:, The methods used here are identical to those described in a previous paper. In the present paper, five cases of ulcerative colitis (UC) are examined. Biopsy specimens were obtained from the diseased, normal, and transitional zones (the area between the normal and diseased zones) from each patient. Three-dimensional reconstruction was created using TRI for Windows (RATOC System Tokyo, Japan) software. In the present paper, two kinds of dyeing method between H&E and monoclonal antibody staining of the tissue was used. It was proven that the distribution of gland and blood vessel is very clear in the 3-D reconstruction shown. Results:, (i) The blood vessels in the normal zones run parallel to the crypt in a regular manner and are almost identical to one another in diameter. (ii) In the transitional and diseased zones, the blood vessels show no clear direction and produce many branches without any apparent order. The blood vessels are, moreover, irregular in diameter. (iii) In short, clear parallelism is lost in both the transitional and diseased zones. Conclusion:, Stereographic reconstruction of endoscopically obtained biopsy specimens of UC-affected tissues makes it possible to understand at a glance the distribution of blood vessels and their relationship to crypts. The relationship of these was clarified by the combined use of two kinds of dyeing method with three-dimensional reconstruction. [source]

From rhetoric to reality: including patient voices in supportive cancer care planning

HEALTH EXPECTATIONS, Issue 3 2005
Sara K. Tedford Gold PhD
Abstract Objective, To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co-ordination. Context, In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach, Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In-depth, semi-structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results, The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion, These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. [source]

Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

HEALTH SERVICES RESEARCH, Issue 1p1 2007
Sylvia J. Hysong
Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source]

SATISFACTION, CITIZENSHIP BEHAVIORS, AND PERFORMANCE IN WORK UNITS: A META-ANALYSIS OF COLLECTIVE CONSTRUCT RELATIONS

PERSONNEL PSYCHOLOGY, Issue 1 2010
DANIEL S. WHITMAN
This paper offers theoretical development clarifying the structure and function of collective job satisfaction and uses meta-analytic methods (k,= 73) to examine the satisfaction,performance relationship when both constructs are construed at the work unit level. Overall, our results suggest that the relationship between unit-level job satisfaction and unit-level performance is significant (,= .34). Specifically, significant relationships were found between unit-level job satisfaction and unit-level criteria, including productivity, customer satisfaction, withdrawal, and organizational citizenship behaviors (OCB). Furthermore, the satisfaction-performance relationship was moderated by the strength of unit consensus, performance criteria, industry type, and whether the sample was U.S. based. Although these moderators were identified, collective satisfaction positively predicted performance across all levels of moderators. In addition, results indicate that unit-level OCB has a moderately strong relationship with unit-level performance. Only limited support was found for the notion that OCB is a route through which satisfaction has an impact on performance. We elaborate on these findings and attempt to provide a more clear direction for future research in this area. [source]

Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator)

PEDIATRIC DIABETES, Issue 2 2008
Diabetes Research In Children Network (DirecNet) Study Group
Background:, There are no published guidelines for use of real-time continuous glucose monitoring data by a patient; we therefore developed the DirecNet Applied Treatment Algorithm (DATA). The DATA provides algorithms for making diabetes management decisions using glucose values: (i) in real time which include the direction and rate of change of glucose levels, and (ii) retrospectively based on downloaded sensor data. Objective:, To evaluate the use and effectiveness of the DATA in children with diabetes using a real-time continuous glucose sensor (the FreeStyle Navigator). Subjects:, Thirty children and adolescents (mean ± standard deviation age = 11.2 ± 4.1 yr) receiving insulin pump therapy. Methods:, Subjects were instructed on use of the DATA and were asked to download their Navigator weekly to review glucose patterns. An Algorithm Satisfaction Questionnaire was completed at 3, 7, and 13 wk. Results:, At 13 wk, all of the subjects and all but one parent thought that the DATA gave good, clear directions for insulin dosing, and thought the guidelines improved their postprandial glucose levels. In responding to alarms, 86% of patients used the DATA at least 50% of the time at 3 wk, and 59% reported doing so at 13 wk. Similar results were seen in using the DATA to adjust premeal bolus doses of insulin. Conclusions:, These results show the feasibility of implementing the DATA when real-time continuous glucose monitoring is initiated and support its use in future clinical trials of real-time continuous glucose monitoring. [source]

Managing alcohol-related problems among Indigenous Australians: what the literature tells us

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010
Dennis Gray
Abstract Objective: To contextualise and provide an overview of two review papers , prepared as part of a larger research program , dealing with different aspects of the treatment of Indigenous Australians with alcohol-related problems. Method: The papers were reviewed thematically and compared to identify key issues raised in them. Findings: Together, the papers highlight the paucity of the evidence base for the provision of treatment for Indigenous Australians with alcohol-related problems. Among the key issues identified are: the need to engage with clients in culturally safe ways; practitioner, organisational and client barriers to engagement; the contexts in which Indigenous drinking and treatment take place; the need to develop rigorous methods of evaluation more appropriate to Indigenous cultural and service provision settings; and the importance of effective partnerships in the provision of services. Conclusion: For those working in the field, the reviews direct attention to the need to review and interrogate our current practice. They also provide clear directions for future research. [source]