The Cartwright Report was released at a time of massive ethical change in New Zealand medicine, the shock waves spreading throughout the region as they caught the surge of interest in patient autonomy and patient rights. The mood was as revolutionary for health professionals as the late 1960s and 1970s ...

BACKGROUND: The management of vitamin K antagonists (VKAs) associated coagulopathy is a cornerstone of pre-endoscopic assessment of anticoagulated patients presenting with acute gastrointestinal bleeding. AIMS: To evaluate physician attitudes in the management of VKAs-associated coagulopathy in patients presenting with gastrointestinal bleeding and to assess their compliance to current practice guidelines. ...

The critical incident technique provides a means to better understand the reasons behind clinicians' practices and changes in practice. No standardized tool exists to elicit information using this technique. To create and validate a standardized tool that explores change and reasons for change in professional practice. Item generation was based ...

Current fisheries management is, unfortunately, reactive rather than proactive to changes in fishery characteristics. Furthermore, anglers do not act independently on waterbodies, and thus, fisheries are complex socio-ecological systems. Proactive management of these complex systems necessitates an approach-adaptive fisheries management-that allows learning to occur simultaneously with management. A promising area for implementation ...

As knowledge exploded and technology advanced in the last 2 centuries or so, present and several recent generations became the first in history to experience massive change in their lifetimes. In our era of rapid change for which no end is in sight, people have had to adjust to the ...

Research, evidence-based practices are emphasized. Measures should address a process proximate to desired outcome. Changes should strengthen the hand of quality managers.

Everyone in healthcare can feel the ground shifting. The changes are driving demand for information management, and HIM professionals can find new opportunities by keeping engaged and acquiring new skills.

Collaborative efforts among hospitals can facilitate the exchange of ideas, provide a forum for discussing the development of new policies or practices or changes to existing policies and practices, and increase the implementation of best practices. In November 2008, the Massachusetts Breastfeeding Coalition formed a collaborative of maternity facilities wishing ...

With all due respect, the simple truth is that doctors don't always play well in the sandbox. Add in challenges such as reduced reimbursement, shifting to electronic records, and a merger or acquisition, and you have a recipe for trouble. Think marriage is difficult? Work with unhappy doctors and you'll ...

We discuss some issues relevant to paper of Clegg and co-authors published in Statistics in Medicine; 28, 3670-3682. Emphasis is on computation of the variance of the sum of products of two estimates, slopes and breakpoints.

Managers and conservationists often need to prioritize which impacts from climate change to deal with from a long list of threats. However, data which allows comparison of the relative impact from climatic threats for decision-making is often unavailable. This is the case for the management of sea turtles in the ...

Endoscopy is performed frequently in children with chronic abdominal pain (CAP), but its impact on clinical management is unclear. We aimed to examine the frequency of changes in immediate medical management resulting from endoscopy with biopsy evaluating CAP in children. We conducted a prospective cross-sectional study to assess the frequency ...

The rapidly shifting healthcare landscape requires all-wheel-drive management. Organizations must expect and be prepared for constant change.

It is widely accepted that climate change poses severe threats to freshwater ecosystems. Here we examine the scientific basis for adaptively managing vulnerable habitats and species. Our views are shaped by a literature survey of adaptation in practice, and by expert opinion. We assert that adaptation planning is constrained by ...

The unique physiological changes that occur at birth and the adaptations that come in the first weeks of life profoundly affect the clinical management of the surgical newborn patient. The newborn has adaptive challenges that have to be met at birth: (a) establish a functional residual capacity and breathe; (b) ...

In this paper we set forth what we believe to be a relatively controversial argument, claiming that 'bioethics' needs to undergo a fundamental change in the way it is practised. This change, we argue, requires philosophical bioethicists to adopt reflexive practices when applying their analyses in public forums, acknowledging openly ...

We studied self-observations related to weight management recorded with a Wellness Diary application on a mobile phone. The data were recorded by 27 participants in a 12-week study, which included a short weight management lecture followed by independent usage of the Wellness Diary. We studied the validity of self-observed weight, ...

Technological and medical advancements have dramatically accelerated the speed of change in the realm of health care. New technology, the changing needs of patients, and economic pressures all contribute to the need for health organizations to modify practices continually. Quality improvement (QI) of current processes is central to these efforts. ...

Negotiating with payers for better reimbursement, contract language, support for practice enhancement, or changes in policies and procedures is a critical function that may greatly enhance a practice's success over time. This article discusses keys to successful negotiating and several specific areas beyond reimbursement that deserve the reader's attention.

Climate change has the potential to compromise the sustainability of natural resources in Mediterranean climatic systems, such that short-term reactive responses will increasingly be insufficient to ensure effective management. There is a simultaneous need for both the clear articulation of the vulnerabilities of specific management systems to climate risk, and ...

This field study aimed at examining the role of anesthesia teams' adaptive coordination in managing changing situational demands, such as in nonroutine events (NREs). Medical teams' ability to adapt their teamwork (e.g., their coordination activities) to changing situational demands is crucial to team performance and, thus, to patient safety. Whereas ...

The success of Johne's disease (JD) control programs based on risk assessment (RA) depends on producers' compliance with suggested management practices. One objective of this study was to describe the perception of participating Canadian dairy farmers of the impact of JD, the RA process, and suggested management strategies. The second ...

When local resource users detect, understand, and respond to environmental change they can more effectively manage environmental resources. This article assesses these abilities among artisanal fishers in Roviana Lagoon, Solomon Islands. In a comparison of two villages, it documents local resource users' abilities to monitor long-term ecological change occurring to ...

There are three principal elements related to viral safety in the context of immunological veterinary medicinal products: the presence of extraneous agents in either raw material used for production or in the finished product, residual pathogenicity of live viruses used as active ingredients, and incomplete inactivation of inactivated viruses used ...

In the United States, many state and federally funded conservation programs are required to quantify the water quality benefits resulting from their efforts. The objective of this research was to evaluate the impact of conservation practices subsidized by the Oklahoma Conservation Commission on phosphorus and sediment loads to Lake Wister. ...

California Assembly Bill AB487 mandates that all practicing physicians are required to obtain 12 h of Continuing Medical Education in Pain Management and End of Life Care before the year 2006 in order to renew their state license to practice medicine. In order to determine the effectiveness of this bill ...

Managing organizational change has become a significant responsibility of managers. Managing the change process within public health organizations is important because appropriately and systematically managing change is linked to improved organizational performance. However, change is difficult and the change process poses formidable challenges for managers. Managers themselves face increased pressure ...

Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff ...

Comprehensive oxygen management, focused on avoiding hyperoxia and repeated episodes of hypoxia-hyperoxia in very low birth weight infants, has been successfully used for the reduction of retinopathy of prematurity. Building on this experience, the Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity quality improvement initiative was developed to ...

Recent climate talks in Copenhagen reaffirmed the crucial role of reducing emissions from deforestation and degradation (REDD). Creating and strengthening indigenous lands and other protected areas represents an effective, practical, and immediate REDD strategy that addresses both biodiversity and climate crises at once.

The extent to which current landscapes deviate from the historical range of natural variability (RNV) is a common means of defining and ranking regional conservation targets. However, climate-induced shifts in forest composition may render obsolete restoration strategies and conservation targets based on historic climate conditions and disturbance regimes. We used ...

In this month's editorial, the PLoS Medicine Editors call for better data to support policy changes that could reduce the huge global burden of death and injury from road traffic crashes.

BACKGROUND: Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients both acutely and in secondary prevention. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally ...

New technologies emerging from the Human Genome Project and the rapidly expanding direct-to-consumer DNA testing have provided a challenging environment for the entry of pharmacogenomics into clinical practice. The traditional pathology laboratory, which is centered around a referring clinician and the patient, is also being reshaped by these developments. These ...

OBJECTIVE: Strategies for the restoration of function and job performance in workers with musculoskeletal disorders have changed considerably since industrial rehabilitation became a distinct specialization in the 1980s. A rich body of research concerning approaches to medical and rehabilitative management of these disorders exists, resulting in a large number of ...

There is a growing focus in change management literature on the role of emotion in managing change. Barriers to adoption and effective implementation of ambulatory EHR-ranging from technical to financial to logistical-are well-described in the health-care IT literature. In the ARRA era, ambulatory practices are under increasing pressure to overcome ...

Volatile business conditions have led to drastic corporate downsizing, meaning organizations are expected to do more with less. Managers must be more knowledgeable and possess a more eclectic myriad of business skills, many of which have not even been seen until recently. Many internal and external changes have occurred to ...

This chapter gives an educational overview of: * The need for systematic and comprehensive change management in health that involves everybody * Various change management types, models, best practices, and techniques, and how to plan and execute change management * Some of the common mistakes with change management in healthcare.

One response to humanity's unsustainable use of natural resources and consequent degradation, even destruction of the environment, is to establish conservation areas to protect Nature and preserve biodiversity at least in selected regions. In Qatar, the government has shown strong support for this approach, confronted by the environmental consequences of ...

Protected Landscapes (PLs) are increasingly used in Norway to conserve cultural (human modified) landscapes. In many cases the maintenance of agricultural activities in PLs is required to preserve landscape character. Whilst research exists on land conservation policies in general, the particular effects of PL on management and adjustment of the ...

This study explores potential adaptation approaches in planning and management that the United States Forest Service might adopt to help achieve its goals and objectives in the face of climate change. Availability of information, vulnerability of ecological and socio-economic systems, and uncertainties associated with climate change, as well as the ...

The desire to optimize techniques and interventions that comprise clinical practice will inevitably involve the implementation of change in the process of care. To confirm the intended benefits of instituting clinical change, the process should be undertaken in a scientific manner. Although implementing changes in perfusion practice is limited by ...

BACKGROUND: Behaviour change toward achieving a healthy lifestyle is important for all Australians, and general practitioners have a key role to play in assisting patients to make these changes. OBJECTIVE: This is the second of two articles on influencing behaviour change in general practice. This article deals with the 'how ...

Public lands and waters in the United States traditionally have been managed using frameworks and objectives that were established under an implicit assumption of stable climatic conditions. However, projected climatic changes render this assumption invalid. Here, we summarize general principles for management adaptations that have emerged from a major literature ...

Marine protected areas (MPAs) provide place-based management of marine ecosystems through various degrees and types of protective actions. Habitats such as coral reefs are especially susceptible to degradation resulting from climate change, as evidenced by mass bleaching events over the past two decades. Marine ecosystems are being altered by direct ...

Past and present climate has shaped the valued ecosystems currently protected in parks and reserves, but future climate change will redefine these conditions. Continued conservation as climate changes will require thinking differently about resource management than we have in the past; we present some logical steps and tools for doing ...

PURPOSE: We retrospectively examined the clinical efficacy of (11)C-methionine positron emission tomography ((11)C-MET PET) in patients with brain neoplasm, especially whether the (11)C-MET PET changed the clinical management and whether the change was beneficial or detrimental. METHODS: This study reviewed 89 (11)C-MET PET scans for 80 patients (20 scans for ...

This summary article provides an update on novel clinical trials in the field of cardiovascular (CV) medicine which were presented at the Transcatheter Cardiovascular Therapeutics meeting, held in San Francisco in September 2009. The data were presented by leading experts in the field with relevant positions in the trials and ...

Bringing a new medical technology from the lab to the clinic is a daunting prospect, but making sure that same innovation is available to the average patient has proven to be even more challenging. Translational medicine is a movement intended to help bench researchers and bedside clinicians learn from each ...

The universe of medical practice is changing at an ever increasing rate, an exponentially increasing rate. In examining Earth's history from the beginning of time, it is not necessarily change per se that has threatened countless species but the rate of change that has challenged species survival. Darwin's thesis indicates ...