Helping victims of violence in Uganda

We report on a project to assist victims of war and violence in Uganda. The original aim of this project, set up by the Medical Foundation for the Care of Victims of Torture, was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in that country. We found, however, that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support and against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel, we have developed a programme of training and discussion for health workers, and a service to reach the many women who have suffered rape, and whose suffering has continued, largely ignored.     

IMPROVE: bridge over troubled waters

BACKGROUND: The original collaborative project was described in a 1995 Journal article titled "Competing HMOs Collaborate to Improve Preventive Services." IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) was a large randomized controlled trial using continuous quality improvement to implement clinical systems to improve the delivery of adult preventive services in primary care settings. The project was funded by the Agency for Health Care Policy and Research and initiated as a collaboration between two health maintenance organizations (HMOs) in the Twin Cities: Health Partners and Blue Plus. METHODOLOGY: Forty-four clinics were recruited for the study. Initially the 22 intervention clinics received the multifaceted intervention of leadership support, training on CQI and prevention systems, and consultation and networking opportunities. Next, the comparison clinics received similar assistance, and other clinics were invited into the collaboration. Ultimately, 57 clinics were involved in the project. Multiple collaborations--among clinics, leaders, and HMOs--developed during the project. STATUS: Despite turmoil in the environment during the project, many benefits have been described, including enhanced leadership, growth of systems thinking, better change management skills, and collaboration of competing organizations. SUMMARY: The IMPROVE collaboration survived and flourished in a very competitive market. It was viewed positively by clinicians, medical clinics, and HMOs, and its benefits have extended into the community.     

The role of motor neuron impulse activity in regulation of myosin composition of slow-twitch skeletal muscle

Information technology is growing rapidly in both its capability and capacity to support the delivery of health care. This paper describes the work of the Dental Interspec project, commissioned by the Department of Health. The aim of the project is to provide a framework for the development of information management and technology in dentistry. It is hoped that the work of this project can be built on to eventually produce integrated information systems which would have the potential to improve primary dental care delivery for both patients and dentists.     

Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context

This paper argues that we should understand the process of IT design as the development of sociotechnical configurations. Drawing upon our experiences with an electronic patient record (EPR) on an Intensive Care Unit (ICU), we depict medical work practices as natural systems. Several considerations for design are developed. First, the EPR should not be overly structured with rationalistic and prefixed notions of the organization and content of medical work. Implementing structure is crucial, however, this should be derived from detailed, empirical knowledge of the practice involved. Second, it is crucial to ensure that the usage of the system will yield immediate benefits for primary users: the systems should support work, not generate it. Third, designing IT should include being aware of the socio political nature of seemingly 'neutral' tools as EPRs.     

Project Alliancing at National Museum of Australia—Collaborative Process

Project alliancing is a new alternative to traditional project delivery systems, especially in the commercial building sector. The Collaborative Process is a theoretical model of people and systems characteristics that are required to reduce the adversarial nature of most construction projects. Although developed separately, both are responses to the same pressures. Project alliancing was just used successfully to complete the National Museum of Australia. This project was analyzed as a case study to determine the extent to which it could be classified as a “collaborative project.” Five key elements of The Collaborative Process were reviewed and numerous examples from the management of this project were cited that support the theoretical recommendations of this model. In the case of this project, significant added value was delivered to the client and many innovations resulted from the collective work of the parties to the contract. It was concluded that project alliances for commercial buildings offer many advantages over traditional project delivery systems, which are related to increasing the levels of collaboration among a project management team.     

Team work between family physician, clinical assistant and nurse practitioner: dilemmas and hot potatoes. The nurse practitioner in a triangular situation

Patient anxiety is frequently associated with admission and treatment in Critical Care Units. In Critical Care, one aim is the promotion of comfort so that anxiety experienced by patients can be reduced. In this article, a quasi-experimental design which attempted to determine the effectiveness of Therapeutic Touch as a nursing intervention is described. It was hypothesized that Therapeutic Touch would promote comfort and reduce anxiety. Before implementation of the project, a semi-structured interview was conducted amongst nurses (n = 18) from an Intensive Care Unit in a District General Hospital in East London. Interviews were conducted in order to determine the nurses' perceptions of the effectiveness of Therapeutic Touch as a complementary therapy. Initial findings of nurse interviews, a nurse's personal experiences of administering Therapeutic Touch and a case study indicate there may be a place for Therapeutic Touch as an intervention for promoting comfort and reducing anxiety in Critical Care.     

Testicular histopathology in congenital lipoid adrenal hyperplasia: a light and electron microscopic study

During the 1980s, interest was shown in North America as to how Intensive Care Nurses use their work time, in response to a shortage of trained nurses. These studies were developed to investigate the amount of nursing time that could be saved by computerised recording systems. Similar pressures are now present in the United Kingdom, but there are no published work load studies of Intensive Care Nurses. This study used a five category tool to examine the work load of nurses in a cardiothoracic ICU. The methodology was designed so that comparison could be made with the earlier American studies. The 36 nurses studied spent 41% of their time in direct nursing care, 22% in patient assessment, 19% in clerical duties, 11% in time outside the unit and 7% in non-nursing duties. These findings were compared with the North American studies. Similarities were found which give some support to the reliability and validity of the tool.     

Knowledge and Reasoning for MEP Coordination

The coordination of mechanical, electrical, and plumbing (MEP) systems is a major challenge for complex buildings and industrial plants. The process involves locating equipment and routing connecting elements for each building system. This multidiscipline effort is time-consuming and expensive and requires knowledge regarding each system over the project life cycle. Current practice requires representatives from each MEP trade to work together to identify and resolve interferences. Effective MEP coordination requires recalling and integrating knowledge regarding design, construction, operations, and maintenance of each MEP system. Currently, designers and constructors use tailored CAD systems to design and fabricate MEP systems, but no knowledge-based computer technology exists to assist in the multidiscipline MEP coordination effort. The paper describes results from a research project to capture knowledge related to design criteria, construction, operations, and maintenance of MEP systems and apply this knowledge in a computer tool that can assist designers and builders in resolving coordination problems for multiple MEP systems.     

Coordinating Building Systems: Process and Knowledge

The coordination of mechanical, electrical, and plumbing (MEP) systems to detail their configuration is a major challenge for complex buildings and industrial projects. Specialized consultants and contractors design and construct these systems. Computer tools can assist with this activity, but fragmented responsibility for these systems and the knowledge required for their design, installation, and operation make this difficult. This paper reports initial results from a research project to develop a computer tool to assist in coordinating MEP systems. It describes current practice, a revised work process using a computer tool, required knowledge, and development of a prototype system. These results confirm the feasibility of capturing the distributed knowledge required and of developing a computer tool to assist with MEP coordination, along with the potential to implement the tool and significantly improve this important project process.     

Lessons in cooperation: an update on improving the quality of hospital care

BACKGROUND: Between 1989 and 1997 the Robert Wood Johnson Foundation (Princeton, NJ) launched a demonstration project, the Improving the Quality of Hospital Care Program, to test a consortium approach to quality improvement. As part of the project, four hospital consortia in various parts of the United States shared quality resources (for example, training) and collaborated on improvement efforts. Although cooperation was not a natural approach for enhancing quality in hospitals, the consortia mounted improvements in multiple clinical areas, such as diabetes care, the intensive care unit (ICU), prevention of wound infections, and care in rural areas. WHERE ARE THEY NOW? Of the four consortia that received implementation funding, all are continuing some explicit focus on improving quality, but only two have retained the organizational form of a consortium. Based at the University of Iowa (Iowa City), the Institute for Quality Healthcare continues to operate as a free-standing consortium with more than 40 hospital members. The Vermont Program for Quality in Health Care (Montpelier) provides information and education to improve quality of care statewide. LESSONS FROM THE PROGRAM: The program taught valuable lessons about what hospitals can do together and what they can achieve when they cooperate around quality of care issues. Sharing resources for education, providing a forum for quality improvement professionals to work together on specific issues, and identifying means of improving specific aspects of care in the group are all feasible in the consortium model. Even a chaotic environment can support cooperation.     

Integrated health delivery systems: Psychology's potential role.

Describes the ways in which psychologists are defining their role within integrated health delivery systems (IHDSs). The integration of psychological services with primary medical care is discussed. Examples of medical crisis counselling services as part of a medical practice and PhD student preparation for professional work in IHDSs are provided. Recent collaboration between the military and the APA Committee for the Advancement of Professional Practice's Task Force on Primary Care is mentioned. For psychology, the key will be legislatively broadening psychologists' defined role within the generic health delivery system to match their existing everyday clinical role in health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

关于工程项目内部审计工作的思考

企业工程项目内部审计工作作用在于协助管理层监督、调查、评价内部控制制度。通过适时提供改进建议，以求内部控制制度得以持续实施。     

Improving Employees’ Work-Life Balance in the Construction Industry: Project Alliance Case Study

Work-life conflict has a damaging effect on job satisfaction, organizational commitment, productivity turnover, and absenteeism. On an individual level, work-life conflict is associated with employee burnout, mental health issues, substance abuse, and diminished family functioning. Thus, work-life balance is an important issue to the construction industry, in terms of both organizational effectiveness and occupational health. Long and inflexible work hours are the most consistent predictor of work-life conflict among construction employees, particularly those working on-site or in a project office. There is considerable resistance to the adoption of new ways of scheduling work within the industry. This paper describes the post hoc evaluation of a compressed work week (reducing the length of the working week, but increasing the length of the working day) in a case study project alliance in Queensland, Australia. Quantitative and qualitative data are presented to demonstrate the beneficial impact of the initiative on employees’ work-life balance. The evaluation provides prima facie evidence that alternative work schedules can improve construction employees’ work-life balance, creating benefits for construction employees and organizations. The paper concludes that project alliances provide an ideal environment in which work-life balance initiatives can help to create high-performance work systems in the construction sector.     

Mixed Reality-Based Visualization Interfaces for Architecture, Engineering, and Construction Industry

Varied computing devices and automated sensors will enable new human-computer interface paradigms for interacting with digitally managed project information. The writers therefore propose the development of Mixed Reality (MR)-based computer interfaces, and especially Augmented Reality systems, for the architecture, engineering, and construction industry and describe the technologies and principles for applying such computer interfaces to support all phases of the constructed facility project life cycle. An Augmented Reality computer-aided drawing prototype is described as an experimental platform to study the human factors issues in interacting with Augmented Reality three-dimensional digital design models. Two critical research needs are cited for realizing effective Augmented Reality systems: (1) human factors research for development of visualization tools to enhance design comprehension and support collaborative work, and (2) the development of a technology infrastructure for “augmented” control and inspection interfaces to directly access digital project plan and site information that may be spatially referenced and displayed in the field. Research should be geared to advance knowledge regarding spatial cognition, human–computer interfaces, and computer-mediated human-to-human interactions, and it should address application of MR to all phases of the project life cycle.     

Work satisfaction of health personnel in primary care

OBJECTIVE: To determine the level of work satisfaction of health professionals working in Primary Care and to establish the social, demographic and professional factors which determine it. DESIGN: An observational, crossover study using a self-administered questionnaire. SETTING: Primary Care. PARTICIPANTS: All the doctors and nurses working in the Primary Care teams in the Albacete Health Area (468 in all). MEASUREMENTS AND MAIN RESULTS: The scale of work satisfaction of health professionals in Primary Care teams was used. Social, demographic and professional data were collected. 9 dimensions or components of work satisfaction were identified through a factorial analysis. The lowest scores were for motivation, opportunities for professional development and coordination with specialists. CONCLUSIONS: The findings show, in general, indifference as to work satisfaction or lack of it in areas such as motivation and opportunities for professional development. The differences observed in those polled relate to their job and work-place, and also, in the case of doctors, to specialist training.     

Community-based medical systems advancement in a hospital-primary health care centre in Crete, Greece: concepts, methods, and the new role of the general practitioner

Modern health systems research and development emphasize the transition from hospital to primary health care. Importantly, this transition is projected to be coordinated and interactive, as facilitated, e.g., by improved information systems and collaboration between the involved parties, including Universities and health authorities. An ideal combination of this might accordingly be offered by a synthesis of a basic hospital and primary health care center in an area of suitable site, size, and structure. We believe that our institution, Nosokomion Neapolis, in; the moderate-size Cretan township of Neapolis (New-city) offers an interesting model example of this, because of its affiliation with the University of Heraklion and its international and EU-supported project status. In the present report we want to emphasize the elements that are particularly well suited and manageable and in many ways both opportunistic and conscientious "back to the future" instances of a successful Hospital/Primary Health Care integration. Specifically, we think that the advantages in local area epidemiology, prevention, and quality assurance are apparent, and nurture a--rather renewed that new-role of the general practitioner as both a holistic population doctor and a health systems researcher for the year 2,000 and beyond.     

Psychotherapy for depression: No stronger medicine.

Comments on the work by R. F. Mu?oz et al (see record 1994-31016-001), commending them for their review and evaluation of the Agency for Health Care Policy and Research (1993) Depression in Primary Care guidelines. However, the recommendation to combine psychotherapy and pharmacotherapy is criticized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using Digital Socialization to Support Geographically Dispersed AEC Project Teams

In the field of knowledge management research, socialization means to convert individual into group tacit knowledge. This process matters from the outset of an architecture, engineering, and construction (AEC) project to enhance collaborative work. Face-to-face meetings and phone calls undoubtedly facilitate socialization. However, meetings can be hard to timetable and expensive when AEC teams are geographically dispersed, whereas phone calls are cheap but offer limited capabilities for problem solving. Further, both media are not good at supporting asynchronous socialization. This study investigates the extent Internet-based media can promote cross-firm socialization and enhance collaborative work. The cross fertilization of findings from an exploratory case study with theory in computer-supported collaborative work (CSCW) informs the development of a conceptual framework on digital socialization. This framework underpins IDRAK—a proof-of-concept of a rich Internet application prototype to promote socialization in AEC projects. Our main contribution is the design of a novel methodology to evaluate the usability of digital systems to support socialization at the early design stage of an AEC project. The results from our lab experiments suggest that IDRAK can satisfactorily and efficiently enhance collaborative work. However, more research is needed, first, to evaluate the effectiveness of IDRAK to improve design quality and asynchronous socialization; and second, to investigate how other CSCW features can improve the performance of IDRAK-like systems.     

Flow Production of Pipe Spool Fabrication: Simulation to Support Implementation of Lean Technique

Pipe spool fabrication is an important stage in industrial construction project delivery. It is a complex production system characterized by product uniqueness and high product mix, which pose challenges to the analysis and improvement of this system. This research applies lean production principles and flow production to shop fabrication, and uses a simulation-based approach as a tool to facilitate its implementation. The work described in the paper is based on a real case study undertaken with an Edmonton-based industrial construction contractor. The traditional batch-and-queue fabrication system and the new cell-based work flow fabrication systems were compared and analyzed. Simulation models were built to experiment with the old and new production systems and quantitatively test the effects of lean principles on the performance of the systems. The developed simulation-based approach proves a practical and more powerful tool than the value stream map for modeling and for quantitatively evaluating the performance of a complex and dynamic spool fabrication shop.     

The computer-based patient record challenges towards timeless and spaceless medical practice

Although computerization is increasingly advocated as a means for hospitals to enhance quality of care and control costs, few studies have evaluated its impact on the day-to-day organization of medical work. This study investigated a large Computerized Patient Record (CPR) project ($50 million U.S.) aimed at allowing physicians to work in a completely electronic record environment. The present multiple-case study analyzed the implementation of this project conducted in four hospitals. Our results show the intricate complexity of introducing the CPR in medical work. Profound obstructions to the achievement of a tighter synchronization between the care and information processes were the main problems. The presence of multiple information systems in one (Communication, Decision Support, and Archival record keeping) was overlooked. It introduced several misconceptions in the meaning and codification of clinical information that were then torn apart between information richness to sustain clinical decisions and concision to sustain care coordination.