Stage of change of cigarette smoking in alcohol-dependent patients.

Despite the heavy burden of tobacco-related problems in alcohol-dependent patients, little effort has been directed toward reducing the prevalence of smoking in these patients. It seems reasonable to develop nicotine addiction treatments for alcohol-dependent patients based on the smoker's stage of change. To assess the stage of change for tobacco consumption and possible quitting barriers in alcohol-dependent patients, 88 consecutively admitted inpatients of a Swiss university-affiliated alcohol withdrawal clinic were interviewed with a semistructured schedule. More than half of the alcohol-dependent smokers (50.7%) considered the possibility of smoking cessation or had already decided to stop, although the majority (83.1%) were highly dependent smokers. Positive reinforcers were factors influencing motivation both to stop smoking as well as to continue smoking, whereas negative reinforcers had no influence. As recovering alcoholic patients are often interested in smoking cessation and the introduction of nicotine treatment interventions has been shown not to jeopardize the outcome of alcohol treatment, alcohol treatment programs should include counseling for smoking cessation. Education and training for staff is essential, as their beliefs and habits remain an important barrier.

Migrations sans frontières mais...barrières des représentations [Migration without borders, but...barriers of meaning].

Immigration, a political, economic, demographic, social and ethic, as well as a medical issue, continues. Among migrants, asylum seekers, refugees and undocumented immigrants are characterised by their vulnerability, particularly related to their health status. Western physicians are more and more frequently confronted to "colorful" and often vulnerable patients. They face diseases related to international migrations; and at the same time have to integrate the differences in representations and meanings given to illness by patients of diverse origins. A bio-psychosocial and spiritual approach coupled with an evaluation of pre-migration, migration and post-migration trajectories is therefore useful for the clinician; these complementary approaches have all been integrated in the learning of cultural competencies.

Qualité et économies: vont-elles de pair [Quality and saving: do they run together?]

In the healthcare debate, it is often stated that better quality leads to savings. Quality systems lead to additional costs for setting up, running and external evaluations. In addition, suppression of implicit rationing leads to additional costs. On the other hand, they lead to savings by procedures simplification, improvement of patients' health state and quicker integration of new collaborators. It is then logical to imagine that financial incentives could improve quality. First evidences of pay for performances initiatives show a positive impact but also some limitations. Quality and savings are linked together and require all our attention.

Key cognitive and collaborative aptitudes in ambulance people

The aim of our study was to identify and document some key cognitive aptitudes used by ambulance people in emergency situations. Better knowing such aptitudes is necessary for a school of ambulance people in order to improve the selection and education of students. The idea was to better consider real work activity requirements and characteristics, and to develop and implement genuine educational content and selection tools. We followed the work activity of ambulance professionals involved in real emergency situations. Some interventions were filmed and post-analyzed. We completed and validated our analysis by means of interviews with ambulance personnel. We selected some video sequences and used them as a support for the interviews. We identified and documented many different key aptitudes like orientation and spatial sense, the capacity to perform complex cognitive tasks and delicate manipulations in the context of divided attention, as well as diverse aptitudes relevant in collaborative work.

Communication with terminal cancer patients in palliative care: are there differences between nurses and physicians?

The aim of this study was to find whether there were interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes that concern such patients. Given that interdisciplinary team work is one of the basic values in palliative care, if there are conflicting views between professions on such important issues it is most important to know about these and to understand them. A questionnaire utilized in an earlier survey of palliative care physicians and addressing their attitudes to and beliefs about specific elements of communication and decision making was sent to a sample of palliative care nurses working in the same regions, i.e. the French-speaking parts of Switzerland, Belgium and France. After a second mailing (reminder), 135 of the 163 questionnaires (83%) were returned. There was general agreement between nurses and physicians on questions dealing with perceptions of patients' knowledge of their diagnosis and stage of disease, patients' need for information, "do not resuscitate" orders and ethical principles in decision-making processes. Statistically significant, but small, differences between professional groups were only observed for a minority of the questions. Interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes affecting these patients were not so marked that they could be called "conflicting interprofessional views."

Environmental Conditions Manual, January 2014

Infectious diseases are a continuing threat to all people, regardless of age, gender, lifestyle, ethnic background, or socioeconomic status. They cause illness, suffering and even death, and place an enormous financial burden on society. Although modern advances have controlled some infectious diseases, new ones are constantly emerging. State public health officials rely on local public health agencies, healthcare providers, laboratories and other public health personnel to report the occurrence of notifiable diseases. Without such data, trends cannot be accurately monitored, unusual occurrences of diseases (such as outbreaks) might not be detected or appropriately responded to, and the effectiveness of control and prevention activities cannot be evaluated.

Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients.

The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. Physicians who stated that they practised palliative care at least 30% of their time were considered evaluable as palliative care specialists. Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%) respondents were considered to be palliative care specialists. Palliative care physicians in all three regions believed that cancer patients should be informed of their diagnosis and the terminal nature of their illness. Physicians reported that at least 60% of their patients knew their diagnosis and the terminal stage of their illness in 52% and 24% of cases in South America, and 69% and 38% of cases in Europe, respectively. All physicians agreed that 'do not resuscitate' orders should be present, and should be discussed with the patient in all cases. While 93% of Canadian physicians stated that at least 60% of their patients wanted to know about the terminal stage of their illness, only 18% of South American, and 26% of European physicians said this (P < 0.001). Similar results were found when the physicians were asked the percentage of families who want patients to know the terminal stage of their illness. However, almost all of the physicians agreed that if they had terminal cancer they would like to know. There was a significant association between patient based decision-making and female sex (P = 0.007), older age (P = 0.04), and physicians from Canada and South America (P < 0.001). Finally, in their daily decision making, South American physicians were significantly more likely to support beneficence and justice as compared with autonomy. Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.

L'hypnose intégrée aux soins de patients brûlés: impact sur le niveau de stress de l'equipe soignante [Hypnosis integrated in burn care: impact on the healthcare team's stress].

Hypnosis for burn care was introduced in 2004 in the CHUV burn center showing great benefit for burned patients. Whereas advantages of hypnosis for the patient are well established, the impact on the medical staff remains poorly assessed. This manuscrit reviews current attested benefits of hypnosis for patients, specially for burned patients. The results of a recent study assessing the impact of hypnosis on the staffs level of stress caused by burn treatment, will also be introduced.

Tuotantotiedon hallinnan tietotekniset ratkaisut

Tiedonhallinta on yritykselle yhtä tärkeää kuin esimerkiksi materiaalien- tai henkilöstönhallinta. Tällä hetkellä yritykset eivät kuitenkaan vieläusein hyödynnä kaikkia tietotekniikan tarjoamia mahdollisuuksia. Useat valmistajat tekevät laitteita jotka on suunniteltu toimimaan vaativissa olosuhteissa. Myös tuotannonohjaus-ohjelmistoissa on alettu kiinnittää entistä enemmän huomiota niiden ulottumisessa tuotantotyöntekijöiden käyttöön asti. Tietoteknisten ratkaisuiden suorituskyky ei enää aseta rajoituksia tuotantotiedon hallinnan kehittämiselle. Työssä kartoitettiin valmistavan teollisuuden tuotantotiedon hallinnan tietoteknisiä ratkaisuja ja niiden tarjoamia mahdollisuuksia tiedon keräämiseen, käsittelyyn ja välittämiseen oikeaan paikkaan oikeaan aikaan.Erityistä huomiota kiinnitettiin ratkaisujen ulottuvuudesta tuotantotyöntekijöille asti. Tutkimus on osa Tuotantotiedon Hallinta-tutkimushanketta ja työn toteutuksessa huomioitiin tutkimushankkeessa mukana olevien yritysten tarpeita tuotantotiedon hallinnan apuvälineille. Tietoteknisten ratkaisuiden perustekniikka on jo kypsää ja se ei aseta rajoituksia pilottihankkeen toteutukselle. Työssä kartoitettiin myös pilottihankkeeseen soveltuvia, markkinoilla olevia tuotannonohjausohjelmistoja. Ohjelmistot vaativat kuitenkin vielä jatkokehitystä täyttääkseen kaikki hankkeen tavoitteet.

Educación de Enfermería para el autocuidado y control de la Hipertensión Arterial (HTA) en personas con HTA Crónica

La Hipertensión Arterial (HTA) es uno de los principales factores de riesgo de morbilidad y mortalidad cardíaca y cerebrovascular, que afecta mundialmente, por lo que conlleva a un problema de salud pública universal. Es por ello que, el JNC7 recomienda una serie de actividades de autocuidado (AC), que se dividen en el tratamiento farmacológico y no-farmacológico, en el que deberá intervenir el personal sanitario, entre ellos, enfermería, para lograr el control de la enfermedad y evitar complicaciones.

HR-asiantuntijapalveluiden käyttö PK-yrityksissä. Case: Virvo Oy palveluiden tarjoajana

Tutkielma on kvalitatiivinen haastattelututkimus, jonka tavoitteena on tarkastella HR-asiantuntijapalveluiden;konsultoinnin, ulkoistamisen ja vuokrajohtajuuden käyttöä sekä mahdollisuuksia PK-sektorilla. Tutkimuksessa perehdytään myös työn toimeksiantajan, case-yritys Virvon liiketoimintaan HR-asiantuntijapalveluiden markkinoilla ja siihen, miten Virvo pystyy vastaamaan näihin haasteisiin. HR-asiantuntijapalveluiden markkinoiden selvittämiseksi on haastateltu neljää HR-asiantuntijaa. Tämän pohjalta on tehty 15 PK-yrityksen toimitusjohtajan haastattelua HR-asiantuntijapalveluiden käytön selvittämiseksi. Tehdyt haastattelut ovat olleet puolistrukturoituja, jolloin on käytetty valmiita kysymyspohjia. Tutkimuksessa on selvinnyt, että HR-asiantuntijamarkkinat ovat vasta muotoutumassa ja että ala on varsin uusi. PK-yritysten HR-toimintojen haasteisiin pystytään parhaiten vastaamaan HR-asiantuntijapalveluilla, jotka ovat selkeitä kokonaisuuksia ja järkevästi hinnoiteltuja. Tärkeinä asioina on nähty esimerkiksi käytännön toteutus sekä lisäajan saaminen varsinaisen liiketoiminnan hoitamiseen. Palveluiden käyttö korostuu erityisesti erilaisissa muutostilanteissa kuten esimerkiksi yrityksen kasvuvaiheessa. Voidaan todeta myös, että liiketoiminnan tila vaikuttaa HR-asiantuntijapalveluiden käyttöön.

Attitudes Toward Organizational Change among Public Middle Managers

Positive attitudes toward change (PATC) are an important current issue in public organizations facing profound financial and managerial reforms. This study aims to identify social and organizational antecedents of PATC. The investigated population is composed of middle managers working in Swiss public hospitals (N = 720), which are currently being confronted by major reforms. Partial mediation effects of organizational commitment (OC) in the relationships between independent variables and PATC are also controlled. The findings show that perceived social support (work relationships with colleagues and supervisors) as well as perceived organizational support (employee voice and participation, information and communication, work-life balance) are positively and significantly related to PATC. Stress perception is shown to have a negative impact on PATC. This article provides valuable contributions with respect to antecedents of attitudes toward change in a population of public middle managers.