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Considerable Confusion (considerable + confusion)
Selected AbstractsRoom for improvement: nurses' and physicians' views of a post-operative pain management programACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010C. S. HARTOG Background: The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. Methods: A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. Results: Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85±1.82; nurses consistently rated levels higher than physicians. Staff over- or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy. Conclusion: Despite staff's high personal priority and well-established APS and pain management program, post-operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches. [source] Corporate reputation: Meaning and measurementINTERNATIONAL JOURNAL OF MANAGEMENT REVIEWS, Issue 2 2005Rosa Chun Corporate reputation has attracted interest from a wide range of academic disciplines. It is also a growing focus for business and media attention. This paper examines the construct of corporate reputation, first by untangling the terminological problems that have been caused by the interdisciplinary nature of much of the earlier work in the area. The construct of reputation and the allied constructs of image and identity are each reviewed. A structure is proposed in which the three constructs can be seen as labelling different but allied concepts. I then move on to consider how reputation has been measured. The paper uncovers considerable confusion in the use of what might appear to be basic terms and links this to a subsequent lack of grounded measurement tools in the sector, until relatively recently. With a clearer understanding of the construct of corporate reputation and the allied constructs of image and identity, researchers are now well placed to test the relationships widely claimed by practitioners between corporate reputation and other variables such as commercial performance and employee and customer satisfaction. The review ends by illustrating some of the issues that can be assessed from the basis of a clearer conceptualization of reputation and its measurement. [source] Room for improvement: nurses' and physicians' views of a post-operative pain management programACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010C. S. HARTOG Background: The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. Methods: A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. Results: Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85±1.82; nurses consistently rated levels higher than physicians. Staff over- or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy. Conclusion: Despite staff's high personal priority and well-established APS and pain management program, post-operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches. [source] SIX CHALLENGES IN DESIGNING EQUITY-BASED PAYJOURNAL OF APPLIED CORPORATE FINANCE, Issue 3 2003Brian J. Hall The past two decades have seen a dramatic increase in the equitybased pay of U.S. corporate executives, an increase that has been driven almost entirely by the explosion of stock option grants. When properly designed, equity-based pay can raise corporate productivity and shareholder value by helping companies attract, motivate, and retain talented managers. But there are good reasons to question whether the current forms of U.S. equity pay are optimal. In many cases, substantial stock and option payoffs to top executives,particularly those who cashed out much of their holdings near the top of the market,appear to have come at the expense of their shareholders, generating considerable skepticism about not just executive pay practices, but the overall quality of U.S. corporate governance. At the same time, many companies that have experienced sharp stock price declines are now struggling with the problem of retaining employees holding lots of deep-underwater options. This article discusses the design of equity-based pay plans that aim to motivate sustainable, or long-run, value creation. As a first step, the author recommends the use of longer vesting periods and other requirements on executive stock and option holdings, both to limit managers' ability to "time" the market and to reduce their incentives to take shortsighted actions that increase near-term earnings at the expense of longer-term cash flow. Besides requiring "more permanent" holdings, the author also proposes a change in how stock options are issued. In place of popular "fixed value" plans that adjust the number of options awarded each year to reflect changes in the share price (and that effectively reward management for poor performance by granting more options when the price falls, and fewer when it rises), the author recommends the use of "fixed number" plans that avoid this unintended distortion of incentives. As the author also notes, there is considerable confusion about the real economic cost of options relative to stock. Part of the confusion stems, of course, from current GAAP accounting, which allows companies to report the issuance of at-the-money options as costless and so creates a bias against stock and other forms of compensation. But, coming on top of the "opportunity cost" of executive stock options to the company's shareholders, there is another, potentially significant cost of options (and, to a lesser extent, stock) that arises from the propensity of executives and employees to place a lower value on company stock and options than well-diversified outside investors. The author's conclusion is that grants of (slow-vesting) stock are likely to have at least three significant advantages over employee stock options: ,they are more highly valued by executives and employees (per dollar of cost to shareholders); ,they continue to provide reasonably strong ownership incentives and retention power, regardless of whether the stock price rises or falls, because they don't go underwater; and ,the value of such grants is much more transparent to stockholders, employees, and the press. [source] Relationships between psychological climate perceptions and work outcomes: a meta-analytic reviewJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 4 2003Christopher P. Parker In this study, meta-analytic procedures were used to examine the relationships between individual-level (psychological) climate perceptions and work outcomes such as employee attitudes, psychological well-being, motivation, and performance. Our review of the literature generated 121 independent samples in which climate perceptions were measured and analyzed at the individual level. These studies document considerable confusion regarding the constructs of psychological climate, organizational climate, and organizational culture and reveal a need for researchers to use terminology that is consistent with their level of measurement, theory, and analysis. Our meta-analytic findings indicate that psychological climate, operationalized as individuals' perceptions of their work environment, does have significant relationships with individuals' work attitudes, motivation, and performance. Structural equation modeling analyses of the meta-analytic correlation matrix indicated that the relationships of psychological climate with employee motivation and performance are fully mediated by employees' work attitudes. We also found that the James and James (1989) PCg model could be extended to predict the impact of work environment perceptions on employee attitudes, motivation, and performance. Despite the number of published individual-level climate studies that we found, there is a need for more research using standardized measures so as to enable analyses of the organizational and contextual factors that might moderate the effects of psychological climate perceptions. Finally, we argue for a molar theory of psychological climate that is rooted in the psychological processes by which individuals make meaning or their work experiences. Copyright © 2003 John Wiley & Sons, Ltd. [source] The terminal nerve and its relation with extrabulbar "olfactory" projections: Lessons from lampreys and lungfishesMICROSCOPY RESEARCH AND TECHNIQUE, Issue 1-2 2004Christopher S. Von BartheldArticle first published online: 29 NOV 200 Abstract The definition of the terminal nerve has led to considerable confusion and controversy. This review analyzes the current state of knowledge as well as diverging opinions about the existence, components, and definition of terminal nerves or their components, with emphasis on lampreys and lungfishes. I will argue that the historical terminology regarding this cranial nerve embraces a definition of a terminal nerve that is compatible with its existence in all vertebrate species. This review further summarizes classical and more recent anatomical, developmental, neurochemical, and molecular evidence suggesting that a multitude of terminalis cell types, not only those expressing gonadotropin-releasing hormone, migrate various distances into the forebrain. This results in numerous morphological and neurochemically distinct phenotypes of neurons, with a continuum spanning from olfactory receptor-like neurons in the olfactory epithelium to typical large ganglion cells that accompany the classical olfactory projections. These cell bodies may lose their peripheral connections with the olfactory epithelium, and their central projections or cell bodies may enter the forebrain at several locations. Since "olfactory" marker proteins can be expressed in bona fide nervus terminalis cells, so-called extrabulbar "olfactory" projections may be a collection of disguised nervus terminalis components. If we do not allow this pleiomorphic collection of nerves to be considered within a terminal nerve framework, then the only alternative is to invent a highly species- and stage-specific, and, ultimately, thoroughly confusing nomenclature for neurons and nerve fibers that associate with the olfactory nerve and forebrain. Microsc. Res. Tech. 65:13,24, 2004. © 2004 Wiley-Liss, Inc. [source] Levodopa responsiveness in disorders with parkinsonism: A review of the literature,MOVEMENT DISORDERS, Issue 15 2007Radu Constantinescu MD Abstract A literature review was conducted to investigate whether or not levodopa (LD) responsiveness (LR) is a useful criterion in the diagnosis of parkinsonian disorders. Although LR does appear to differ among the parkinsonian disorders, there is considerable confusion in the literature. While most patients with Parkinson's disease (PD) have a sustained benefit from LD, a small minority of patients with documented PD do not respond. The literature suggests that the LR rate is higher for multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) than based on published diagnostic criteria. Magnitude and duration of response to LD and tolerability (time course, type and distribution of dyskinesias, mental effects and motor worsening) may be useful features in distinguishing PD, MSA, PSP, and CBD. Efforts should be directed toward better defining LR when used for diagnostic purposes and in scientific publications. © 2007 Movement Disorder Society [source] Origins and migratory routes of murine Cajal-Retzius cellsTHE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 3 2007Fernando García-Moreno Abstract The first layer that appears in the cortical neuroepithelium, the preplate, forms in the upper part of the cortex immediately below the pial surface. In mice, this layer exists between embryonic days (E) 10 and 13, and it hosts different cell populations. Here, we have studied the first cell population generated in the preplate, the Cajal-Retzius cells. There is considerable confusion regarding these cells with respect to both their site of generation and the migratory routes that they follow. This perhaps is due largely to the different opinions that exist regarding their characterization. We have studied the site of origin of these cells, their migratory routes, and the molecular markers that may distinguish them by injecting tracers into early embryos, culturing them in toto for 24 hours, and then performing immunohistochemistry. We found that the Cajal-Retzius cells are most likely generated in the cortical hem by comparing with other cortical or extracortical origins. These cells are generated mainly at E10 and E11, and they subsequently migrate tangentially to cover the whole cortical mantle in 24 hours. From their site of origin in the medial wall of the telencephalon, they spread in a caudorostral direction, following an oblique migratory path toward the lateral part of the neuroepithelium. Prior to the splitting of the preplate, a percentage of the Cajal-Retzius cells that can be distinguished by the expression of reelin do not contain calretinin. Furthermore, there were no early-migrating neurons that expressed calbindin. J. Comp. Neurol. 500:419,432, 2007. © 2006 Wiley-Liss, Inc. [source] Empirical tests for ecological exchangeabilityANIMAL CONSERVATION, Issue 3 2005Russell B. Rader The concept of ecological exchangeability, together with genetic exchangeability, is central to both the Cohesion Species Concept as well as to some definitions of Evolutionarily Significant Units. While there are well-established criteria for measuring genetic exchangeability, the concept of ecological exchangeability has generated considerable confusion. We describe a procedure that uses the complementary strengths, while recognising the limitations, of both molecular genetic data and ecological experiments to determine the ecological exchangeability of local populations within a species. This is the first synthesis of a combined approach (experiments and genetics) and the first explicit discussion of testing ecological exchangeability. Although it would be ideal to find functional genes that interact to influence quantitative traits resulting in ecological differences (e.g. growth, size, fecundity), we suggest that our current knowledge of functional markers is too limited for most species to use them to differentiate adaptively different local populations. Thus, we argue that ecological experiments using whole organisms combined with neutral markers that indicate evolutionary divergence, provide the strongest case for detecting adaptive differences among local populations. Both genetic divergence and ecological experiments provide the best information for infering ecological exchangeability. This procedure can be used to decide which local populations should be preserved to maintain intraspecific variation and to determine which populations would enhance captive-breeding programs, augment endangered local populations and could best be used to re-introduce native species into historically occupied areas. [source] | ||||||||||||||||