Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

A rationalist perspective on the autonomy of international sport governing bodies : towards a pragmatic autonomy in the steering of sports

International sport governing bodies (ISGBs) are built on the foundations of freedom of association and traditionally enjoy a large degree of autonomy in their decision-making. Their autonomy is increasingly confined, however, and their hierarchical self-governance is giving way to a more networked governance, in which different stakeholders exert power in different ways and in different contexts in a complex web of interrelationships. Taking a rationalist perspective on the autonomy of ISGBs, this article demonstrates that ISGBs are deploying strategies to safeguard their waning governing monopoly over international sport. Opting for an inductive approach, the authors present four possible conceptualizations of autonomy as applied to ISGBs, namely political autonomy, legal autonomy, financial autonomy and pyramidal autonomy. For each dimension, they describe the different strategies ISGBs wield in order to safeguard different dimensions of their autonomy. This article uses governance theories to hypothesize that the autonomy of ISGBs can be understood as 'pragmatic autonomy' since ISGBs only cede certain aspects of their autonomy under particular circumstances and when being subject to specific threats. Acting in a rationalist manner, they are able to keep control over governance developments in sport by using indirect and more subtle forms of governance.

La Iluminación de las ciudades y su imagen nocturna: caso de Lyon y Barcelona

Este trabajo pretende estudiar el uso que se hace de la iluminación para la puesta en valor del patrimonio. Aquí veremos las medidas, normativas, y usos que emplea la ciudad en el espacio nocturno y la relación que tiene con el turismo. Ver si se transmite a través de la imagen inducida nocturna de la ciudad. En un segundo tiempo, miraremos si esas medidas influyen en la imagen del destino. Es decir, si las intenciones de los agentes inductivos, con las medidas, proyectos y normativas se ven reflejados y presentes en las imágenes inducidas del destino

Desproporcionamento de tolueno sobre zeólitas tipo mordenita - atividade e seletividade na obtenção de xilenos

A sodium mordenite zeolite (Na-MOR) was synthesized and modified by dealumination with chloridric acid solution (H-MOR). X-Ray Diffraction (XRD), Inductive Coupled Plasm (ICP) and Scanning Electron Micrograph (SEM) techniques were used for sample characterization. The zeolite catalytic behavior was evaluated through toluene disproportionation at 435°C. It was verified that mordenites were very selective for the disproportionation reaction and the samples with higher aluminum content showed larger initial activity, however, these samples showed too a higher deactivation velocity due to a blockage of the unidimensional porous system of the zeolite by coke deposits. The selectivity to xylene isomers was practically not influenced by the Si/Al ratio and changed with the time on stream, due to coke formation. Transition state shape selectivity inside the mordenite pores is also discussed.

Tehokerrointa korjaava skalaariohjaus puoliohjatussa ja kuusikytkintasasuuntaajassa

Verkon harmonisvirtoja rajoittavien standardien tiukentuessa joudutaan etenkin suuritehoisissa tehoelektronisissa laitteissa siirtymään aktiivisiin transistoriohjattuihin tasasuuntaajiin, jotka korjaavat tehokerrointa ja siten pienentävät verkkoon kytkeytyviä häiriövirtoja. Tässä diplomityössä esitellään yleisimpien kolmivaiheisten tasasuuntaajatopologioiden eroja ja vertaillaan puoliohjatun kolmikytkintopologian ja kuusikytkintopologian suorituskykyä tehokertoimen ja harmonissärön osalta, 16 kilowatin teholuokan taajuusmuuttajassa. Tasasuuntaajille tehtiin skalaariohjaukseen perustuva simulointimalli. Työn tavoitteena esitellään simulointitulokset harmonistason sekä tehokertoimen osalta. Työ liittyy Lappeenrannan teknillisen yliopiston sovelletun elektroniikan laboratorion ja Vacon Oyj:n yhteiseen hankkeeseen.

Módulo eletrônico de controle para válvulas solenóides

This technical note describes a new and simple electronic circuit for driving solenoid valves. The circuit is based on a single integrated circuit DRV103, which is able to drive resistive or inductive loads up to 1.5 A. Switching of 12-V loads can be controlled by TTLlevel signals in two distinct steps. Initially, 12 V is applied during 110 ms, followed by 4.2 V RMS until the end of the activation TTL pulse. This mode of operation is particularly suitable to drive solenoids, because it requires a higher voltage to start and a lower maintenance voltage. By using this circuit, power consumption and heating are reduced and the solenoid lifetime is enhanced. Moreover, this circuit is specially appropriated to build computercontrolled solenoid valves systems.

Merimies on erimies? Organisaatiositoutuminen suomalaisessa risteilyvarustamossa. Case: Kristina Cruises Oy

Tutkimuksen tavoitteena on selvittää, miten organisaatioon sitoutuminen moniulotteisena käsitteenä ymmärretään yrityksen johtoryhmässä ja avainesimiesten kesken, kun työpaikkana on risteilyvarustamo ja -laiva. Tutkimuksen empiirisen aineiston muodostaa viisi haastattelua laivan palveluosastoilta sekä yrityksen johtoryhmän haastattelut. Teoriaosuudessa on keskitytty kuvailemaan sitoutumiseen vaikuttavia tekijöitä ottaen huomioon kohdeorganisaation toimintaympäristö. Tässä tutkimuksessa organisaatiositoutuminen ymmärretään yksilön henkilökohtaisten tarpeiden, tunnepitoisen kiinnittymisen ja työyhteisön vaikutuksen yhteenliittymänä. Tutkimus on laadullinen ja aineiston keräystapana on käytetty pääasiallisesti teemahaastattelua. Aineistoa on täydennetty muutamalla avoimella sähköpostikyselyllä. Analysointi tapahtui teemoittelun avulla, josta johtopäätöksiin edettiin induktiivisesti. Tutkimustulosten perusteella voidaan todeta, että organisaatiositoutuminen kohdeyrityksessä on ymmärretty lähes samalla tavalla sekä johtoryhmän että esimiesten kesken. Huomioon otettavia aiheita sitouttamista silmällä pitäen ovat yrityksen arvojen ja tavoitteiden merkitys läpi koko sitoutumisprosessin.

Competitive flexibility in systems supplier companies in mechanical engineering industry

Systems suppliers are focal actors in mechanical engineering supply chains, in between general contractors and component suppliers. This research concentrates on the systems suppliers’ competitive flexibility, as a competitive advantage that the systems supplier gains from independence from the competitive forces of the market. The aim is to study the roles that power, dependence relations, social capital, and interorganizational learning have on the competitive flexibility. Research on this particular theme is scarce thus far. The research method applied here is the inductive multiple case study. Interviews from four case companies were used as main source of the qualitative data. The literature review presents previous literature on subcontracting, supply chain flexibility, supply chain relationships, social capital and interorganizational learning. The result of this study are seven propositions and consequently a model on the effects that the dominance of sales of few customers, power of competitors, significance of the manufactured system in the end product, professionalism in procurement and the significance of brand products in the business have on the competitive flexibility. These relationships are moderated by either social capital or interorganizational learning. The main results obtained from this study revolve around social capital and interorganizational learning, which have beneficial effects on systems suppliers’ competitive flexibility, by moderating the effects of other constructs of the model. Further research on this topic should include quantitative research to provide the extent to which the results can be reliably generalized. Also each construct of the model gives possible focus for more thorough research.

International Partner Management in the Software Industry

The purpose of this research is to describe how the scope of internationalization affects partner management in software companies. The effects are analyzed separately for small and large companies. Partner management is described from three perspectives: who should manage partnerships, how they should be managed and how does the context affect the choice of management style. Inductive case study is selected as research design. Eventually four case companies are chosen. The findings reveal that the size of the company affects the volume whereas the scope of internationalization affects the choice of partner management activities. Companies with high scope of internationalization required a more formal yet flexible management system whereas companies with low scope of internationalization relied more on the informal relations and personal management.

TransPromo communication as a part of company’s marketing communications when the e-bill is a medium

The goal of this thesis was to research what TransPromo is, why companies want to implement TransPromo communication, and what the elements of effective Transpromo communication are. Furthermore, the goal was to develop a TransPromo communication strategy and a normative model for TeliaSonera Finland, which depicts the elements of effective TransPromo communication when the electronic bill is a medium. Abductive reasoning was utilized in this thesis, which means that empirical and theoretical worlds are alternating in researcher’s reasoning process. This thesis didn’t rely on any specific theory nor did it utilize any previous theoretical model. However, certain theoretical connections existed so this thesis cannot be considered purely inductive. The empirical part of this thesis was conducted by examining secondary industry data and by conducting specialist interviews at TeliaSonera Finland and Strålfors. Grounded Theory approach was utilized in the analysis of the interview data and content analysis was used in the analysis of secondary industry data. This thesis increases knowledge in the area of TransPromo communication, and provides one definition of TransPromo communication. As a result of this thesis, a TransPromo communication strategy and a normative model for TeliaSonera Finland was built. The model depicts the elements of the effective TransPromo communication when the e-bill is a medium. The TranPromo communication objective is to utilize transaction documents, such as bills, in order to deliver targeted and personalized marketing messages to current customers. The aim is to strengthen the customer relationship, and to enforce up-sell and cross-sell opportunities and cost savings.

Desenvolvimento de conjunto membrana-eletrodos para célula a combustível de metanol direto passiva

Direct methanol fuel cells (DMFCs) without external pumps or other ancillary devices for fuel and oxidant supply are known as passive DMFCs and are potential candidates to replace lithium-ion batteries in powering portable electronic devices. This paper presents the results obtained from a membrane electrode assembly (MEA) specifically designed for passive DMFCs. Appropriated electrocatalysts were prepared and the effect of their loadings was investigated. Two types of gas diffusion layers (GDL) were also tested. The influence of the methanol concentration was analyzed in each case. The best MEA performance presented a maximum power density of 11.94 mW cm-2.

Antenna Design for Contactless IC Card Applications

Contactless integrated circuit cards are one form of application of radio frequency identification. They are used in applications such as access control, identification, and payment in public transport. The contactless IC cards are passive which means that both the data and the energy are transferred to the card without contact using inductive coupling. Antenna design and optimization of the design for contactless IC cards defined by ISO/IEC14443 is studied. The basic operation principles of contactless system are presented and the structure of contactless IC card is illustrated. The structure was divided between the contactless chip and the antenna. The operation of the antenna was covered in depth and the parameters affecting to the performance of the antenna were presented. Also the different antenna technologies and connection technologies were provided. The antenna design process with the parameters and the design tools isillustrated and optimization of the design is studied. To make the design process more ideal a target of development was discovered, which was the implementation of test application. The optimization of the antenna design was presented based on the optimization criteria defined in this study. The solution for the implementation of these criteria and the effect of each criterion was found. For enhancing the performance of the antenna a focus for future study was proposed.

Comparison of some properties of Cu(II) 2,3- , 3,5- and 2,6-dimethoxybenzoates

The physico-chemical properties and thermal stability in air of Cu(II) 2,3- , 3,5- and 2,6-dimethoxybenzoates were compared and the influence of the position of -OCH3 substituent on their thermal stability was investigated. The complexes are crystalline, hydrated salts with blue colour. The carboxylate ion is a bidentate chelating or bridging group. The thermal stability of analysed Cu(II) dimethoxybenzoates was studied in the temperature range of 293-1173 K. The positions of methoxy- groups in benzene ring influence the thermal properties of studied complexes. Their different thermal properties are markedly connected with the various influence of inductive, mesomeric and steric effects of -OCH3 substituent on the electron density in benzene ring. The magnetic susceptibilities of the complexes were measured over the range of 76-300 K and the magnetic moments were calculated. The results show that they form dimers.

Magnetic, thermal and spectral properties of Ni(II) 2,3- , 3,5- and 2,6-dimethoxybenzoates

Complexes of Ni(II) 2,3-, 3,5- and 2,6-dimethoxybenzoates have been synthesized, their physico-chemical properties have been compared and the influence of the position of -OCH3 substituent on their properties investigated. The analysed compounds are crystalline, hydrated salts with green colour. The carboxylate ions show a bidentate chelating or bridging coordination modes. The thermal stabilities of Ni(II) dimethoxybenzoates were investigated in air in the range of 293-1173 K. The complexes decompose in three steps, yelding the NiO as the final product of decomposition. Their solubilities in water at 293 K are in the order of 10-2-10-4 mol×dm-3. The magnetic susceptibilities for the analysed dimethoxybenzoates of Ni(II) were measured over the range of 76-303 K and the magnetic moments were calculated. The results reveal that the complexes are the high-spin ones and the ligands form the weak electrostatic field in the octahedral coordination sphere of the central Ni(II) ion. The various position -OCH3 groups in benzene ring cause the different steric, mesomeric and inductive effects on the electron density in benzene ring.

Nursing Ethics Education in Finland from the Perspective of Codes of Ethics

The purpose of this study was to analyze nursing ethics education from the perspective of nurses’ codes of ethics in the basic nursing education programmes in polytechnics in Finland with the following research questions: What is known about nurses’ codes in practice and education, what contents of the codes are taught, what teaching and evaluation methods are used, which demographic variables are associated with the teaching, what is nurse educators’ adequacy of knowledge to teach the codes and nursing students’ knowledge of and ability to apply the codes, and what are participants’ opinions of the need and applicability of the codes, and their importance in nursing ethics education. The aim of the study was to identify strengths and possible problem areas in teaching of the codes and nursing ethics in general. The knowledge gained from this study can be used for developing nursing ethics curricula and teaching of ethics in theory and practice. The data collection was targeted to all polytechnics in Finland providing basic nursing education (i.e. Bachelor of Health Care). The target groups were all nurse educators teaching ethics and all graduating nursing students in the academic year of 2006. A total of 183 educators and 214 students from 24 polytechnics participated. The data was collected using a structured questionnaire with four open-ended questions, designed for this study. The data was analysed by SPSS (14.0) and the open-ended questions by inductive content analysis. Descriptive statistics were used to summarize the data. Inferential statistics were used to estimate the differences between the participant groups. The reliability of the questionnaire was estimated with Cronbach’s coefficient alpha. The literature review revealed that empirical research on the codes was scarce, and minimal in the area of education. Teaching of nurses’ codes themselves and the embedded ethical concepts was extensive, teaching of the functions of the codes and related laws and agreements was moderate, but teaching of the codes of other health care professions was modest. Issues related to the nurse-patient relationship were emphasised. Wider social dimensions of the codes were less emphasized. Educators’ and students’ descriptions of teaching emphasized mainly the same teaching contents, but there were statistically significant differences between the groups in that educators assessed their teaching to be more extensive than what students had perceived it had been. T he use of teaching and evaluation methods was rather narrow and conventional. However, educators’ and students’ descriptions of the used methods differed statistically significantly. Students’ knowledge of the codes and their ability to apply them in practice was assessed as mediocre by educators and by students themselves. Most educators assessed their own knowledge of the codes as adequate to teach the codes, as did most of the students. Educators who regarded their knowledge as adequate taught the codes more extensively than those who assessed their knowledge as less adequate. Also students who assessed their educators’ knowledge as adequate perceived the teaching of the codes to be more extensive. Otherwise educators’ and students’ demographic variables had little association with their descriptions of the teaching. According to the participants, nurses need their own codes, and they are also regarded as applicable in practice. The codes are an important element in nursing ethics education, but their teaching needs development. Further research should focus on the organization of ethics teaching in the curricula, the teaching process, and on the evaluation of the effectiveness of ethics education and on educators’ competence. Also the meaning and functions of the codes at all levels of nursing deserve attention. More versatile use of research methods would be beneficial in gaining new knowledge.