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Jerry G. Blaivas 《International urogynecology journal》2009,20(12):1401-1402
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Government reform of the NHS in the UK has sought to increase the involvement of doctors (clinicians) in hospital management. Using frameworks from the psychological contract and organisational misbehaviour literatures, this paper examines the processes involved when clinicians assume management roles. This literature seeks to explain breaches to expectations regarding prior agreements with management and subsequent actions of 'getting even' as a result of breaches to the employment relationship. A qualitative methodology using interviews was undertaken, which identified two distinct groups of clinician-manager. Investors actively pursued a management opportunity as an alternative to clinical medicine, whilst reluctants tended to assume a management role to protect particular specialities from outside influence or from those they thought would be inappropriate clinician-managers. Investors and reluctants often had very little prior experience of management and managers and had problems reconciling their dual clinician-management role. Poor relationships with hospital managers who often had no understanding of their dual responsibilities led to tensions and conflict, which questions continued developments in this important area of UK health policy. Suggestions for improving this process are outlined. 相似文献
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背景:Nissen胃底折叠术(Nissen fundoplication,NF)已不是治疗胃食管返流性疾病(gastroesophageal reflux disease,GERD)的唯一、有效的方法。对于能降低胃酸的手术方式来讲,如高选择性迷走神经切断术(highly selective vagotomy,HSV),也不仅仅是一种辅助治疗方法。对高选择性迷走神经切断术联合Nissen胃底折叠术(Nissen fundoplication with highly selective vagotomy,NFHSV)治疗GERD的作用目前尚无完整的评价。方法:2003年6月~2005年6月8例女性病人接受NFHSV,8例均有6个月GERD病史,经药物治疗症状无缓解,有餐前痛、消化性溃疡或严重的胃炎。平均随访时间12个月,术前、术后进行烧心严重程度评分测定(heart burn severity score,HSS)。结果:平均手术时间110min,无手术并发症。1例术后须用质子泵抑制剂,术后经戒烟5个月后停药。8例术后症状和烧心严重程度评分测定有明显改善。结论:NFHSV是有效的联合手术方式,尚需要进一步的研究证实这一联合术式的完全有效性和安全性。 相似文献
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Qualls E J Stevens Jason M Seibly Ying H Chen Rob D Dickerman Jerry Noel Keith A Kattner 《Journal of clinical neuroscience》2007,14(6):585-589
The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. He was found to have decreased muscle strength and was hyporeflexic in the involved extremity. Serum testing demonstrated MRSA bacteremia. Neuroimaging studies revealed evidence of paraspinal abscess and a presumed herniated nucleus pulposus at the L5/S1 interspace with significant nerve root compromise. Despite antimicrobials, his symptoms persisted, necessitating surgical exploration. At surgery, paraspinal and epidural abscesses were encountered and debrided; however, no herniated disc was visualized. This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate. 相似文献
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Dmitri Artemov Zaver M. Bhujwalla Ross J. Maxwell John R. Griffiths Ian R. Judson Martin O. Leach Jerry D. Glickson 《Magnetic resonance in medicine》1995,34(3):338-342
The anticancer agent temozolomide labeled with 13C (8-Carbamoyl-3-13C-methylimidazo-[5,1-d]-1,2,3,5-tetrazin-4-(3H)-one), was noninvasively detected in subcutaneous RIF-1 tumors by a selective cross polarization 13C NMR method, at a field strength of 9.4T. Pharmacokinetics of the drug, at a dose of 150 mg/kg, were determined for intravenous and intraperitoneal modes of administration (three animals per mode). The half-life of the drug in the tumors was approximately 60 min. The uptake and clearance of the drug, however, varied significantly between individual hosts, for both modes of administration. These results demonstrate the feasibility of obtaining pharmacokinetics of anticancer agents for individual tumors without the need for a label that might modify drug activity (e.g., fluorine). The variability of the in vivo measurements, even within the same tumor model, demonstrates the necessity of directly monitoring the tumor to evaluate drug pharmacokinetics. 相似文献