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Important Shortcomings (important + shortcoming)
Selected AbstractsENDOSCOPIC DEFINITION OF ESOPHAGOGASTRIC JUNCTION FOR DIAGNOSIS OF BARRETT'S ESOPHAGUS: IMPORTANCE OF SYSTEMATIC EDUCATION AND TRAININGDIGESTIVE ENDOSCOPY, Issue 4 2009Norihisa Ishimura The diagnosis of Barrett's esophagus (BE) requires an accurate recognition of the columnar-lined esophagus at endoscopy. However, a universally accepted standardized endoscopic grading system of BE was lacking prior to the development of the Prague ,circumferential and maximal' criteria. In this system, the landmark for the esophagogastric junction (EGJ) is the proximal end of the gastric folds, not the distal end of the palisade vessels, which are used to endoscopically identify the EGJ in Japan. Although the circumferential and maximal criteria are clinically relevant, an important shortcoming of this system may be failure to identify short-segment BE, a lesion that is found frequently in the Japanese. To compare the diagnostic yield for BE when using the palisade vessels versus gastric folds as a landmark for the EGJ, we evaluated interobserver diagnostic concordance. The endoscopic identification of the EGJ using both landmarks resulted in unacceptably low kappa coefficients of reliability. However, there was a statistically significant improvement after the participants were thoroughly trained in identification of the EGJ during the endoscopic study. Although it remains controversial which landmark is better for the endoscopic diagnosis of BE, it is important to systematically educate and train endoscopists in order to improve diagnostic consistency in patients with BE. [source] Inter-organizational use of EMSs in supply chain management: some experiences from Poland and SwedenCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2008Dagmara Nawrocka Abstract The paper investigates the possibility of using environmental management systems (EMSs) as a tool for the environmental management of supply chains. Based on interviews with environmental managers of selected companies, the paper highlights the importance of taking a long-term perspective in terms of both the cooperation with suppliers and developing the supply chain perspective for EMSs. The role of cultural influence from foreign partner companies in building the proactive environmental focus and stimulating the spread of EMSs is underlined here. In addition, the paper looks at the development, use and control of supply chain environmental requirements and their possible integration into the buyer's and supplier's EMSs. Finally, important shortcomings of EMSs, such as the lack of enforcement forbearance and the credibility of ISO 14001 certification, are discussed. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] The German sustainable development strategy: facing policy, management and political strategy assessmentsENVIRONMENTAL POLICY AND GOVERNANCE, Issue 3 2007Ralf Tils Abstract The Germans' conviction of being an international frontrunner in environmental policy stands in contrast to the unwillingness of the German national governments of the 1990s to undertake a commitment for a nationwide sustainable development strategy. Using five core strategy categories, namely horizontal and vertical integration, participation, implementation mechanism, monitoring and evaluation, this article provides an overview of the German sustainable development strategy preparation and implementation process. While the strategy is an ambitious concept, it also exhibits important shortcomings when viewed with different analytical perspectives such as policy, management and political strategy. Only with all of these perspectives combined can we arrive at specific conclusions about the assessment of the strategy process and make the essential characteristics of political strategy apparent. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] A Hormonal Interpretation of Collins's Micro-sociological Theory of ViolenceJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 4 2009ALLAN MAZUR Collins (2008) provides a grand theory that unifies all forms of human violence occurring in face-to-face situations, ranging from spousal abuse to medieval warfare. Laitin (2008) appreciates Collins's microscopic analysis of diverse data but points to important shortcomings in the theory, especially Collins's metaphoric explanations that are not testable. Here Collins's theory is merged with an existing biosocial model of dominance, replacing the metaphors with tangible, measurable hormonal mechanisms. [source] Pretreatment Psychosocial Variables as Predictors of Outcomes Following Lumbar Surgery and Spinal Cord Stimulation: A Systematic Review and Literature SynthesisPAIN MEDICINE, Issue 4 2009James Celestin MD ABSTRACT Background., In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. Objective., The intent of this article is to perform a systematic review to examine the relationship between presurgical predictor variables and treatment outcomes, to review the existing evidence for the benefit of psychological screening prior to lumbar surgery or SCS, and to make treatment recommendations for the use of psychological screening. Results., Out of 753 study titles, 25 studies were identified, of which none were randomized controlled trials and only four SCS studies met inclusion criteria. The methodological quality of the studies varied and some important shortcomings were identified. A positive relationship was found between one or more psychological factors and poor treatment outcome in 92.0% of the studies reviewed. In particular, presurgical somatization, depression, anxiety, and poor coping were most useful in helping to predict poor response (i.e., less treatment-related benefit) to lumbar surgery and SCS. Older age and longer pain duration were also predictive of poorer outcome in some studies, while pretreatment physical findings, activity interference, and presurgical pain intensity were minimally predictive. Conclusions., At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome. [source] Women's perceptions of decision-making about hysterectomyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2004Z. Skea Objective To explore women's views of decision-making relating to hysterectomy. Design Structured questionnaire and in-depth interview surveys. Setting A teaching hospital and a district general hospital in northeast Scotland. Sample Women scheduled for hysterectomy for benign menstrual problems. Methods Pre-operative questionnaires were sent to a consecutive sample of women booked for hysterectomy. A purposive sample was interviewed post-operatively. Main outcome measures Women's experiences of, and satisfaction with, information provision, communication and decision-making processes; the relationship between views of decision-making processes and decisions made. Results One hundred and four women (66%) returned questionnaires. Most responded positively to structured questions about the process by which the decision to have a hysterectomy was reached. Almost all (97%) reported satisfaction with the decision made. Twenty women were interviewed post-operatively. A number, including some who had responded positively on the questionnaire, described aspects of the decision-making process that were suboptimal. Women's perceptions of the decision-making process, including the way their doctors communicated with them, did impinge on their views of the course of action selected. Some women had residual doubts about the appropriateness of hysterectomy. Conclusions In a significant minority of women, there are important shortcomings in current patterns of information provision and communication relating to decision-making. These are unlikely to be picked up by conventional structured patient feedback surveys. Further efforts are required to ensure that women are adequately informed and involved in decisions about gynaecological treatments. [source] | |||||||||||||