Change begets change: emerging role of the human resources development practitioner

This article has discussed three essential role shifts for the HRD practitioner: reactor to initiator, "pair-of-hands" to collaborator, and problem solving consultant to action learning facilitator. These shifts in role are required for the process of helping manage organizational change in our hospitals. Ongoing learning will be the essential ingredient to successfully manage change in health care organizations. This continual learning is not for clients alone, but is also required by HRD practitioners who want to be taken seriously as contributing to the achievement of their organization's future vision. While the effective HRD practitioner will need to continually experiment with new approaches, a starting point today is with the role changes described in this article.     

Physician's anxiety and physician's elegance. Problems in dealing with cost reduction, education of general practitioners and optimal size of practice networks in a cross-national comparison

The key reason for physicians networking in managed care is to get a better coping with uncertainty on action (treatment) decisions. The second reason for networking in managed care are financial benefits grounds. But this reason is very ambivalent. Three different action problems (role conflicts) in managed care network are to solved, which was also in single practices. In the lecture the decision strategies and decision resources has been compared. Observations are done using expert interviews, patient interviews and analysis of documents in USA, Germany and Switzerland. The first problem is the choosing of a cost reduction strategy which is not reducing the effectiveness. Such "ugly" solution strategies like exclusion of "expensive" patients and a rationing of necessary medical services in a kind of McDonalds network of physicians will fail the target. The optimost way is a saving of all unnecessary medical even injourious performances. The chosen cost reduction strategy is not real visible from outside but in fact limited cognizable and controllable. Evidence based health care can be a resource of treatment decisions and could train such decisions but it will not substitute these decisions. The second problem is the making of real family practitioners as gatekeepers. Knowledge about the care system is still not making a real family practitioner, even if this is the minimum condition of their work. Also contractual relationships between insurance and doctor as a gatekeeper or financial incentives for patients are still making not a real family practitioner as a gatekpeeper. Only throughout the trust of patients supported by second opinions is making the real family practitioner as a gatekeeper. "Doctor hopping" could be the reaction by scarcity of trustworthy family practitioners as gatekeepers. The third problem is the choosing of the optimal scale of a network due to the very different optimal size of networks regarding the requirement of risk spreeds, of the motivated engagement, of competition, incentives of inclusion of insurantes, they always need other net sizes. But it is possible, for each requirement there could function different networks. A practice (doctor's office) can be a member in different networks in several levels. The social transition from a small office to a network of offices is in all business lines a cultural shock involving not only benefits also psychical and social distress. In this there is no difference between health or agriculture or each other business of trade and industry. The destiny of the joint doctor's offices in Germany suggest due to a very serious power to scatter this networks. The comparative analysis of conflicts, strains, resources and strategies of associations and networks could yield from a developed methodical repository in sociology and social psychology what exists since 40 years (see also Meyer--in this journal). But therefore must be included also the action problems, which are only mentioned in passing of the according profession horizon.     

The potential economic value of a hookworm vaccine

Hookworm infection is a significant problem worldwide. As development of hookworm vaccine proceeds, it is essential for vaccine developers and manufacturers, policy makers, and other public health officials to understand the potential costs and benefits of such a vaccine. We developed a decision analytic model to evaluate the cost-effectiveness of introducing a hookworm vaccine into two populations in Brazil: school-age children and non-pregnant women of reproductive age. Results suggest that a vaccine would provide not only cost savings, but potential health benefits to both populations. In fact, the most cost-effective intervention strategy may be to combine vaccine with current drug treatment strategies.     

The influence of patient-practitioner agreement on outcome of care.

A previous study suggested that patient-practitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medical record. Patients expected less and reported less improvements of problems that were neither mentioned by the practitioner nor written in the medical record than was the case for problems listed both by patients and practitioners. The findings of this study confirm those of the previous study in suggesting that practitioner-patient agreement about problems is associated with greater expectations for improvement and with better outcome as perceived by patients. In addition, they indicate that practitioners also report better outcome under the same circumstances.     

The right approach to solving problems

A review of brain functioning, particularly as it relates to the use of the right brain suggests that this center of creativity is not often tapped. However, when a group of people gather to learn how to tap their creative potential, many difficult problems can be solved. As applied to solving recruiting problems, the use of creative problem-solving techniques can tap the vast potential in a medical group to find new solutions to the problems that never seem to go away. Conducting creative problem-solving sessions requires a skilled practitioner who can draw out the potential in group members. The process is not without some costs, as the authors point out, but the benefits can be well worth the effort.     

建立医师定期考核制度研究项目概述

采用文献资料分析和专题组讨论相结合的研究方法,对于目前医师定期考核制度的现状、问题、发展趋势进行了研究和探讨,认为医师定期考核制度的有效实施尚存在一些政策阻力。制度在准入后管理中的定位比较模糊,制度的操作流程有待优化完善,不良执业行为积分制度是医师定期考核的一个重要抓手,构建医师征信平台势在必行。法制化、标准化、常态化是医师队伍管理的发展趋势。     

医院感染管理存在的问题和对策

目的了解医疗机构医院感染管理存在的主要问题,探讨医院感染管理方法,提高医院感染管理质量。方法通过对医疗机构的匿院感染管理现状进行调查分析,结合医院感染法规要求,提出相应措施。结果通过加强医院感染管理各环节的监督检查,提高了医护人员对医院感染管理的认识,使各项医院感染制度与措施得以落实,有效地控制了医院感染。结论加强医院感染管理,是提高医疗护理质量的重要保证。     

Recent trends in infectious diseases for travellers

In the early 1970s medicine was considered to have conquered infectious diseases. The following three decades have shown this optimism to be misplaced, with both traditional infections increasing in prevalence and novel diseases appearing. Many of these diseases have become major problems in developing countries, and coupled with the exponential growth in international traffic now pose a significant risk to the traveller. The threat to the package tourist differs greatly from that to the businessman, soldier or backpacker. The latter groups may have little control over their food and water supplies and be exposed to vector-borne and zoonotic infections normally restricted to remote locations. However the package holidaymaker may be involved in mass outbreaks of food poisoning with novel pathogens or acquire unusual infections from close proximity to other tourists. All groups may be susceptible to diseases transmitted during travel, and these may be more common than is presently recognised. The common factor is that all such infections may be transported around the world within their incubation period, and that any disease can now present to any doctor. Today more than ever before it is incumbent on any practitioner to ask not only 'where have you been?' but also 'what were you doing there?'     

Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery

A surveillance programme was started after a period of high infection rates in an orthopaedic surgical department. The programme was aimed at reducing infection rates in elective hip and knee replacement procedures, and at creating awareness of infection control practices in an acute hospital. Possible causes of the initial high infection rates were analysed and discussed with healthcare workers involved in orthopaedic surgery. No specific cause could be found but substantial logistic improvements were achieved by studying for five years that may have contributed to the reduction of postoperative infections. Surveillance is an important part of any hospital-acquired infection surveillance programme. Its success depends on the ability of the infection control practitioner (ICP) to form a partnership with the surgical staff. Creating a sense of ownership of the surveillance initiative amongst the surgical staff enhances co-operation and ensures that the best use is made of the information generated. It is not possible to eliminate surgical-site infections (SSI) completely, but by a process of sharing information we have been able to influence behaviour to reduce the incidence of SSI.     

艾滋病对公安工作的挑战与应对(摘要)

艾滋病既是医学问题也是复杂的社会问题，对艾滋病感染者的管理已成为当前公安机关面临的新问题，提高公安机关的管理水平和公安民警的艾滋病预防知识，是公安机关需要研究和重视的问题。1.对公安民警加强艾滋病预防教育工作；2.加强对违法犯罪艾滋病病毒感染者的监管工作；3.甄别“病情证明”，严肃处理规避行为；4.正确处理对高危人群管理的几个法律问题。     

Avian rhinotracheitis

Turkey rhinotracheitis, now commonly termed avian pneumovirus (APV) infection, is associated with serious welfare and economic problems in susceptible populations of turkeys and probably also of chickens. The infection principally affects the upper respiratory tract, although egg-laying performance may also be affected in breeding turkeys. Secondary infections exacerbate the effects of the primary virus infection. The virus persists for only a short time both in the host and in the environment and is not known to be transmitted via the egg. Highly effective vaccines are available to control APV infections, and hence good biosecurity and careful use of these vaccines should enable infection to be controlled and spread restricted. Diagnosis and surveillance are normally performed serologically using enzyme-linked immunosorbent assays (ELISAs). Several different ELISA kits are available commercially, but these give variable results and are not wholly satisfactory since interpretation of results is difficult.     

An Inter- and Intra-University Comparison With Short Case-Based Testing

Comparisons between PBL and non-PBL medical schools on problem-solving ability often show no differences. This could be either due to the fact that no difference in problem-solving skills exists or that the instruments used are inadequate. In this study a key-feature approach case-based examination was used to compare two medical schools in the Netherlands, one of which has a PBL curriculum (Maastricht) and one which has a program half way a transition from a non-PBL towards a PBL curriculum (Groningen). Differences were found both in proficiency scores and in the pattern of response times, both supporting the assumption that a PBL approach would lead to a higher level of problem solving ability. The effect size, however, is not as large as originally assumed by the PBL proponents. Conclusions must be drawn with caution, but it seems likely that a test based on large numbers of short cases is the most sensitive in detecting differences in problem solving ability between students of different curricula. This revised version was published online in June 2006 with corrections to the Cover Date.     

Infection control in small rural facilities: a generic service plan

The South West Region Infection Control Association (SWICA) has identified a range of problems facing the infection control practitioner (ICP) in a small rural hospital. These include lack of knowledge, support, resources and time, as well as other issues associated with the rural location. These serious problems prompted SWICA to develop a generic service plan which can be used as a guide to help ICPs fulfil their role to the best advantage. The plan needs only to be individualised for nosocomial surveillance and target dates but can be altered or expanded as needed. The rural health sector in NSW consists of a large number of small facilities, with ICPs in a similar situation to those in the south west region. This service plan is available to anyone who would like to use it. [AIC Aust Infect Control 2000; 5(3):19-22].     

Management of cancer-associated venous thrombosis

The association between malignancy and venous thromboembolic disease has been recognized for over a century and a half. During this time, a substantial body of literature has developed showing that malignancy is not only a hypercoagulable state characterized by an increased risk of thrombosis but also that components of blood coagulation reactions are capable of supporting tumor growth and dissemination. In recent years a succession of meticulously performed clinical trials has clarified optimal therapy intended to both prevent and treat thromboembolism that occurs in the setting of cancer. However, much remains to be accomplished in terms of practitioner education on the merits of optimal therapy. Of perhaps greater interest is the possibility that drugs capable of controlling cancer-associated hypercoagulability may provide a means for improving cancer survival while avoiding the toxicities characteristic of conventional anti-tumor therapy. Clearly, ample incentive exists for collaboration between basic and clinical scientists interested in improving the management of malignancy and its thromboembolic complications.     

What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm

Assessment of the safety of nutrients presents a challenge different from that posed by the assessment of other chemicals in food such as additives or contaminants. Because nutrients are essential, a dose-response relation exists at both ends of the intake range, separated by a safe range of intake that reflects normal homeostatic processes. The safe intake may not be the same for all population groups and life stages. The size of the safe intake range for each nutrient will vary and in a few cases may be very small. Certain nutrients such as vitamin A and manganese have known and potentially serious adverse effects at high intakes, whereas others such as iron or vitamin C may have more minor adverse effects that are readily reversible and may only be associated with supplement intake. The risk of harm occurring from taking dietary supplements will depend on the safe intake range of the nutrient concerned, the susceptibility of the individual, and the likely intake of the same nutrient from other supplements or the rest of the diet. In many cases, the available database for the safety of nutrients is very limited because the studies, where available, were not designed to assess adverse effects but may have detected problems when they occurred. Further information on the safety of nutrients could be obtained through careful experimental design.     

The ethics of infection control: philosophical frameworks.

Recent developments that are relevant to the ethics of infection control include the patient safety movement, the appearance of new diseases (notably, severe acute respiratory syndrome) that pose threats to healthcare workers, data confirming the suspicion that infection control measures such as isolation may compromise patient care, and, in philosophy, renewed interest in virtue ethics and communitarianism. We review general ethical frameworks and relevant vocabulary for infection control practitioners and hospital epidemiologists. Frameworks for the ethics of infection control resemble those of public health more than those of clinical medicine but embrace elements of both. The optimum framework, we suggest, takes into account a virtue-based communitarianism. The virtue ethics movement stresses the need to consider not only rules and outcomes but also the character of the individual(s) involved. Communitarianism emphasizes the well-being and values of local communities, best determined by shared, democratic decision making among stakeholders. Brief discussions of 15 consecutive cases illustrate the extent to which the daily practice of infection control poses problems heavily freighted with ethical overtones.     

Classical swine fever (hog cholera) in wild boar in Europe

Classical swine fever (CSF) is of increasing concern in Europe where wild boar appear to play an important epidemiological role. In most parts of the continent, demographic trends are on the increase, due to improvement in game management. As a result of higher densities, populations become more susceptible to various infectious diseases, among which CSF is cause for particular concern. Wild boar do not appear to be a classic reservoir in most cases, but nevertheless may perpetuate foci of infection over the long term, constituting a real threat for the pig farming industry. Since the infection does not appear to spread easily in natural populations of free-ranging wild boars, control of the disease may be feasible. However, most of the appropriate measures, such as banning hunting, are not considered acceptable. Consequently, the expertise of wildlife disease specialists is required to help solve the problem when it occurs.     

Assessment of problem-solving ability

It is recognized that no problem solving can take place without a background knowledge. As the highest marks in PMPs are now being consistently achieved by those candidates who arrive at the correct diagnosis without accumulating excessive information and at the same time avoiding irrelevant or incorrect data the PMP may be measuring efficiency in problem solving ability. This would appear to be substantiated by the fact that reasonable correlations are obtained between each candidate's remarks in problems of widely differing system disease patterns.
The mark allocation is such that the problem solving ability relates to the field of general practice and no detailed specialist knowledge of any particular disease pattern is being measured. In measuring problem solving ability it is advisable to allocate a maximum positive mark for each section, this mark being the total of that awarded for information considered necessary to solve the particular problem. Any negative marks scored must be taken from the maximum positive mark allowed and not from the total positive score obtained, which may be considerably more than the former. In this way the efficient performer is appropriately rewarded whilst the more devious data gatherer is appropriately penalized.     

Value of an infection control practitioner in improving infection control practices at ambulatory sites.

Little information exists on the state of infection control (IC) practices in ambulatory sites. In preparation for a JCAHO survey, 62 ambulatory sites were visited to monitor and improve IC practices. A dedicated IC practitioner was instrumental in improving practices at ambulatory sites and in successfully completing a JCAHO survey.