Epidémiologie de la psychiatrie de consultation-liaison du Centre Psychosocial Neuchâtelois dans le service de Médecine interne de l'Hôpital de la Chaux-de-Fonds en 1994 et 1998 : Interactions et régulations

Résumé La psychiatrie de consultation-liaison (CL) connaît depuis une décennie un essor majeur en Europe sous l'impulsion des recherches multicentriques du groupe European Consultation Liaison Psychiatry - ECLVV (Huyse). En Suisse, la discipline reste à développer par manque de consultants spécialisés selon le rapport 2000 de l'Association des professeurs titulaires de chaires. Néanmoins une harmonisation progressive des standards européens de documentation et d'évaluation apparaît progressivement, notamment dans les travaux du Service de Psychiatrie de Liaison du Centre Hospitalier Universitaire Vaudois. Afin d'améliorer sa pratique de consultation-liaison qui restait jusqu'alors frustrante par un sentiment de débordement et d'absence de feed-back des interventions, le Centre Psychosocial Neuchâtelois de La Chaux-de-Fonds (CPS) a constitué une base de données informatisée de CL à des fins de recherche-action selon les recommandations du groupe ECLVV. Nous avons comparé les valeurs de prévalence de notre activité de CL dans le service de médecine interne de l'Hôpital de La Chaux-de-Fonds en 1994, année du début de l'informatisation des données du CPS, et en 1998, année des plus récents résultats exploitables. La taille de l'échantillon était de 78 cas pour 1994 et de 108 cas pour 1998. Les résultats de notre étude épidémiologique rétrospective et descriptive montraient une augmentation en volume des demandes de CL, une diversification et une complexification des cas. Cette charge croissante sur la psychiatrie de consultation-liaison s'observait également dans les données de la littérature. La réponse psychiatrique du CPS montrait une modestie de moyens et du pragmatisme dans le style des interventions. Ces dernières étaient essentiellement de nature de psychiatrie générale et d'urgence, focalisée sur les tentatives de suicides. Les tentamens, ici comme ailleurs, restent le noyau dur de toute pratique de psychiatrie à l'hôpital général. L'état de lieu de notre pratique de consultation-liaison issu de ce travail a permis de créer une base de données simplifée étendue à l'ensemble des demandes de consultation au CPS afin de réguler le flux de toutes ses interventions face aux demandes toujours croissantes. Dans ce sens, notre étude a montré la nécessité de formaliser les demandes de consultation psychiatrique à l'hôpital général afin d'optimaliser les réponses des consultants.

Putting Public Service Motivation into Context. A Balance Between Universalism and Particularism

Research on Public Service Motivation (PSM) has increased enormously in the last 20 years. Besides the analysis of the antecedents of PSM and its impact on organizations and individuals, many open questions about the nature of PSM itself still remain. This article argues that the theoretical construct of PSM should be contextualized by integrating the political and administrative contexts of public servants when investigating their specific attitudes towards working in a public environment. It also challenges the efficacy of the classic four-dimensional structure of PSM when it is applied to a specific context. The findings of a confirmatory factor analysis from a dataset of 3754 employees of 279 Swiss municipalities support the appropriateness of contextualizing parts of the PSM construct. They also support the addition of an extra dimension called, according to previous research, Swiss democratic governance. With regard to our results, there is a need for further PSM research to set a definite measure of PSM, particularly in regard to the international diffusion of empirical research on PSM.Points for practitionersThis study shows that public service motivation is a relevant construct for practitioners and may be used to better assess whether public agents are motivated by values or not. Nevertheless, it stresses also that the measurement of PSM must be adapted to the institutional context as well. Public managers interested in understanding better the degree to which their employees are motivated by public values must be aware that the measurement of this PSM construct has to be contextualized. In other words, PSM is also a function of the institutional environment in which organizations operate.

Strategic Enterprise Architecture Management - Challenges, Best Practices, and Future Developments

The discipline of Enterprise Architecture Management (EAM) deals with the alignment of business and information systems architectures. While EAM has long been regarded as a discipline for IT managers this book takes a different stance: It explains how top executives can use EAM for leveraging their strategic planning and controlling processes and how EAM can contribute to sustainable competitive advantage. Based on the analysis of best practices from eight leading European companies from various industries the book presents crucial elements of successful EAM. It outlines what executives need to do in terms of governance, processes, methodologies and culture in order to bring their management to the next level. Beyond this, the book points how EAM might develop in the next decade allowing today's managers to prepare for the future of architecture management.

New Avenues for Theoretical Contributions in Enterprise Architecture Principles - A Literature Review

Enterprise Architecture (EA), which has been approached by both academia and industry, is considered comprising not only architectural representations, but also principles guiding architecture's design and evolution. Even though the concept of EA principles has been defined as the integral part of EA, the number of publications on this subject is very limited and only a few organizations use EA principles to manage their EA endeavors. In order to critically assess the current state of research and identify research gaps in EA principles, we focus on four general aspects of theoretical contributions in IS. By applying these aspects to EA principles, we outline future research directions in EA principles nature, adoption, practices, and impact.

Rewarding civil service performance through team bonuses : findings, analysis and recommendations

Performance-related pay within public organizations is continuing to spread. Although it can help to strengthen an entrepreneurial spirit in civil servants, its implementation is marred by technical, financial, managerial and cultural problems. This article identifies an added problem, namely the contradiction that exists between a managerial discourse that emphasizes the team and collective performance, on the one hand, and the use of appraisal and reward tools that are above all individual, on the other. Based on an empirical survey carried out within Swiss public organizations, the analysis shows that the team is currently rarely taken into account and singles out the principal routes towards an integrated system for the management and rewarding of civil servants.

Production Flow Analysis - cases from manufacturing and service industry

Production flow analysis (PFA) is a well-established methodology used for transforming traditional functional layout into product-oriented layout. The method uses part routings to find natural clusters of workstations forming production cells able to complete parts and components swiftly with simplified material flow. Once implemented, the scheduling system is based on period batch control aiming to establish fixed planning, production and delivery cycles for the whole production unit. PFA is traditionally applied to job-shops with functional layouts, and after reorganization within groups lead times reduce, quality improves and motivation among personnel improves. Several papers have documented this, yet no research has studied its application to service operations management. This paper aims to show that PFA can well be applied not only to job-shop and assembly operations, but also to back-office and service processes with real cases. The cases clearly show that PFA reduces non-value adding operations, introduces flow by evening out bottlenecks and diminishes process variability, all of which contribute to efficient operations management.

Biomarkers of oxidative stress and its association with the urinary reducing capacity in bus maintenance workers.

BACKGROUND: Exposure to particles (PM) induces adverse health effects (cancer, cardiovascular and pulmonary diseases). A key-role in these adverse effects seems to be played by oxidative stress, which is an excess of reactive oxygen species relative to the amount of reducing species (including antioxidants), the first line of defense against reactive oxygen species. The aim of this study was to document the oxidative stress caused by exposure to respirable particles in vivo, and to test whether exposed workers presented changes in their urinary levels for reducing species.METHODS: Bus depot workers (n = 32) exposed to particles and pollutants (respirable PM4, organic and elemental carbon, particulate metal content, polycyclic aromatic hydrocarbons, NOx, O3) were surveyed over two consecutive days. We collected urine samples before and after each shift, and quantified an oxidative stress biomarker (8-hydroxy-2'-deoxyguanosine), the reducing capacity and a biomarker of PAH exposure (1-hydroxypyrene). We used a linear mixed model to test for associations between the oxidative stress status of the workers and their particle exposure as well as with their urinary level of reducing species.RESULTS: Workers were exposed to low levels of respirable PM4 (range 25-71 μg/m3). However, urinary levels of 8-hydroxy-2'-deoxyguanosine increased significantly within each shift and between both days for non-smokers. The between-day increase was significantly correlated (p < 0.001) with the concentrations of organic carbon, NOx, and the particulate copper content. The within-shift increase in 8OHdG was highly correlated to an increase of the urinary reducing capacity (Spearman ρ = 0.59, p < 0.0001).CONCLUSIONS: These findings confirm that exposure to components associated to respirable particulate matter causes a systemic oxidative stress, as measured with the urinary 8OHdG. The strong association observed between urinary 8OHdG with the reducing capacity is suggestive of protective or other mechanisms, including circadian effects. Additional investigations should be performed to understand these observations.