Medicine through untinted glasses

1976 ◽  
Vol 45 (4) ◽  
pp. 369-375
Author(s):  
Roger O. Egeberg
Keyword(s):  
State Government ◽  
Medical Profession ◽  
Content Type ◽  
The Public ◽  
Medical Programs ◽  
Fine Print

✓ The 1976 Cushing orator takes a critical look at federal medical programs today, and at the health desires and needs of the public. He outlines the possible future roles of federal and state government and of the medical profession itself.

Institutional pressures influencing environmental management accounting adoption by Malaysian local governments

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Che Ku Hisam Che Ku Kassim ◽  
Noor Liza Adnan ◽  
Roziani Ali
Keyword(s):  
Environmental Management ◽  
State Government ◽  
Local Governments ◽  
Management Accounting ◽  
The State ◽  
Institutional Pressures ◽  
Content Type ◽  
The Public ◽  
Reporting Practices ◽  
Environmental Management Accounting

Purpose Because of the heightened environmental awareness of the public, local governments (LGs) are being pressured to improve on the extent and quality of environmental disclosures (EDs) provided in an array of reporting media. The lack of an accounting tool to identify, measure and report EDs has propelled the infusion of environmental management accounting (EMA) to support the reporting practices. This paper aims to examine the institutional pressures influencing EMA adoption by Malaysian LGs. Design/methodology/approach Using the consensus approach, a self-administered questionnaire survey is conducted on accountants in LGs in Peninsular Malaysia. The items in the questionnaire are based on the findings of prior studies on EMA adoption. Findings The results suggest that coercive isomorphism from the state government is perceived to be the influential institutional factor placing intense pressures on LGs to adopt EMA. Research limitations/implications The results solidify the potential role of the state government in any public policy changes which could further stimulate and promote the adoption of EMA. Originality/value Insufficient empirical evidence on the adoption of EMA in LGs within a developing country’s perspective contributes to a limited understanding on the development of environmental-related practices in different economic stages and environment as well as within the public sector’s perspective.

scholarly journals The impact of blame culture on paramedic practice

2018 ◽  
Vol 7 (3) ◽  
pp. 214-227
Author(s):  
Andrew Kirk ◽  
Kevin Armstrong ◽  
Niina Nurkka ◽  
Annette Jinks
Keyword(s):  
Medical Profession ◽  
Clinical Care ◽  
Content Type ◽  
The Public ◽  
Inappropriate Use ◽  
Blame Culture ◽  
Working Practices ◽  
Use Of Social Media ◽  
The Impact ◽  
Insight Into

Purpose The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care. Design/methodology/approach Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought. Findings Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices. Originality/value Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.

Politics and health: an emerging technology

1984 ◽  
Vol 61 (4) ◽  
pp. 625-632
Author(s):  
Robert M. Rosenzweig
Keyword(s):  
World War Ii ◽  
Research University ◽  
Central Government ◽  
Medical Profession ◽  
Political Scientist ◽  
Role Of Government ◽  
Content Type ◽  
The Government ◽  
Fine Print

✓ A political scientist examines the worlds of advanced medicine and the modern research university. Both elements are affected by the growth in the role of government. Central government had sharply limited powers early in this century, but by the middle third their powers were enlarged, particularly in the spheres of the economy and social welfare. The last third of the century will reveal what the governed want of the government. The scientific and technological aspects of World War II plunged the universities into the limelight as the main producers of vital knowledge and as objects of national policy. This power of knowledge expanded from national security to public health and welfare. Governmental patronage fostered basic medical research and revolution in biology. With advanced research there marched advanced training. America's leading research universities became stronger and flourished for a few decades, to be confronted suddenly by a shift in government priorities. Governmental fiscal support has dwindled while governmental regulation has increased. The medical profession passed from an early position of opposing the role of government to a position in which it paid inadequate attention to the adverse consequences of the systems that were adopted. Physicians who practice in a variety of settings have a variety of interests which account for the division within the profession. In a political setting it is advantageous and more important to have a clear view of central common interests. The speaker's advice to his colleagues in education is applicable to medicine, to act now in a manner to serve as a model for a vision of a “plausible future.” The measure of success in the future depends upon the ability to preserve those values, practices, and habits of mind that account for our value to society. The primacy of scholarly judgments over political judgments is not always easy to achieve in dealings with governments.

Cushing Oration, 1988: Law and medicine: conflict or collaboration?

1988 ◽  
Vol 69 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Brian Dickson
Keyword(s):  
Informed Consent ◽  
Medical Profession ◽  
Standard Of Care ◽  
Ethical Values ◽  
Common Goal ◽  
Content Type ◽  
Legal Rules ◽  
Fair Compensation ◽  
The Common ◽  
Fine Print

✓ Doctors and lawyers share the common goal of pursuit of the welfare of the patient and client. Even where litigation brings physicians into conflict with the law, collaboration must be our guide. The standard of care is defined by reference to the expertise of the medical profession. The need for informed consent is based upon the moral and ethical values our professions share. In assessing fair compensation, legal rules are shaped by the need to make the lives of the injured and disabled bearable, again an ethical value we hold in common. The nature of our day-to-day tasks and the methods we employ may be different, but we must never lose sight of the fact that the interests of society can only be met if we work closely together.

Are the public tertiary education building projects devoid of risks in the Nigerian construction context?

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Olufisayo Adedokun ◽  
Isaac Aje ◽  
Oluwaseyi Awodele ◽  
Temitope Egbelakin
Keyword(s):  
Risk Factors ◽  
Data Collection ◽  
State Government ◽  
Tertiary Education ◽  
High Reliability ◽  
Building Projects ◽  
Content Type ◽  
The Public ◽  
Competitive Tendering ◽  
Significant Difference

Purpose The non-performance of construction projects in meeting the set objectives has continued to draw researchers worldwide. Despite this, little attention is accorded to public tertiary education building projects in Nigeria. Therefore, on this background, this study aims to assess the perceptions of stakeholders on the level of occurrence of risk factors in the public tertiary education building projects (TEBP) to enhance the performance of these projects. Design/methodology/approach The study adopted a quantitative method of data collection via a questionnaire survey. In total, 452 questionnaires were administered to the respondents comprising client representatives, consultants (quantity surveyors, architects, services and structural engineers and builders) and the contractor. The respondents were involved in the conception and execution of TEBP across five public tertiary education institutions in Ondo State, Nigeria. Of 452 questionnaires, 279 were retrieved and found suitable for analysis, indicating a 61.73% response rate. The reliability analysis for the research instrument was 0.965 via the Cronbach α test, indicating the high reliability of the instrument used for the data collection. Moreover, the clusters of risk factors also had reliability values that ranged between 0.719 and 0.875. Findings The study found inflation, delayed payments in contracts, high competition bids, delay in work progress and occurrence of variations are the most frequently occurring risk factors in public TEBP. By contrast, difficulty to access the site, environmental factors and pollution were found to be low-weighted risks with the least likelihood of occurrence. The results of this study indicated the existence of significant differences in some of the risk factors in terms of the level of risk occurrence in TEBP. The risk factors were eventually clustered into eight major groups for TEBP. The post hoc comparisons using the least significant difference test also indicated differences between the contractors and consultants in the ranking of risks occurrence in TEBP, but no significant differences between clients/contractors and clients/consultants. Research limitations/implications The findings in this study are limited to the public TEBP procured via competitive tendering; therefore, the results might not be applicable when other procurement methods are being considered. Besides, the study classified the project participants based on organizations and not on the different ownership status of the projects, such as federal or state government-owned TEBP. However, the literature shows that likelihood of risk occurrence could vary due to the degree of project ownership. Practical implications The information provided with respect to the most frequently occurring risk factors would enhance the performance of public TEBP. Originality/value This study contributes to the existing body of knowledge on the subject within a previously unexplored context where insights were provided on the most frequently occurring risk factors on the public TEBP.

Transforming hospital management à la francaise

2014 ◽  
Vol 27 (5) ◽  
pp. 406-416 ◽  
Author(s):  
Didier Vinot
Keyword(s):  
French Literature ◽  
Public Management ◽  
Medical Profession ◽  
Hospital Management ◽  
Actor Network Theory ◽  
Public Hospitals ◽  
Content Type ◽  
The Public ◽  
Key Factor ◽  
French Tradition

Purpose – The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the managerial roles of doctors. Design/methodology/approach – The paper is exploratory and is based on both the analysis of French literature dealing with the results of the 2009 reform, and ten semi-directed interviews with clinical managers and top leaders in the public hospital sector. Findings – The author reports on the major hospital management reforms of 2009 and analyse the implications for the medical profession and management. The author shows that the involvement of the classical clinical leaders has become less regulated as the units no longer have a clear legal basis. The governance of the newly introduced “medical poles” appears to be shaped by various factors: there is high correlation between centrality, prestige and “clan involvement”, which suggests that professionals holding new responsibilities obtain power and legitimacy by consolidating pre-existing networks. While it is often argued that high-quality clinical leadership is a key factor of organisational success, the findings suggest that the performance of clinical managers relies on this network and legitimacy acquired from it. Originality/value – Drawing on the “sociology of translation” and actor-network theory (Callon and Latour, 1991), this paper provides a new conceptual framework for the analysis of the transformation of the role of clinical leaders, arguing that this transformation depends highly on their abilities to build and use networks. The findings challenge the French tradition of public management that presupposes a clear division of power between doctors and administrative staff.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 90-92 ◽  
Author(s):  
Mark E. Linskey
Keyword(s):  
Gamma Knife ◽  
Stereotactic Radiotherapy ◽  
Three Dimensional ◽  
Late Recurrence ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Content Type ◽  
Single Fraction ◽  
Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

Sign in / Sign up

Export Citation Format

Share Document