824 resultados para Practice Management, Medical.


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This article deals with a number of supply chain management (SCM) issues: SCM’s “Big Idea” – integration, Divergence of Theory and Practice - the limitations of “hard-wiring”, The “Human Chain”, The Way Forward – asking the right question?

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Companies are increasingly focusing on the development of core competencies as an integral part of their overall strategy development and implementation. The corollary of this is that functions regarded as being non-core are being outsourced. This paper investigates the case for and against outsourcing and in addition what is happening in Ireland regards outsourcing. Furthermore to analysis of current literature in the field, an Irish-wide postal and e-mail survey, as well as three case studies revealed many interesting facts. The key findings of the work are manufacturing outsourcing is now the most popular function to be outsourced for both small to medium sized enterprises (SMEs) and large enterprises. Large enterprises (LEs) do not prepare or examine hidden costs more than SMEs, nor do they differ much in relation to the use of consultants. Furthermore, the importance of time spent on preparing or producing contract, and the impact the contract can have on the supplier-buyer relation do not differ significantly. It was found that most companies outsourced within Ireland, which led to further investigation in that area. In relation to logistics outsourcing specifically, this has become very important in the supply chain over the last 20 years as an activity that was traditionally handled by firms as a support function. At that time logistics activities such as warehousing, distribution, transportation and inventory management were given low priority compared with other business functions within the organisation. However, since the customer has become more demanding, the logistics function has now become a source of competitive advantage and there has been a growing emphasis on providing good customer service.

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Purpose: The purpose of this paper is to examine the effect of the quality of senior management leadership on social support and job design, whose main effects on strains, and moderating effects on work stressors-to-strains relationships were assessed. Design/methodology/approach: A survey involving distribution of questionnaires was carried out on a random sample of health care employees in acute hospital practice in the UK. The sample comprised 65,142 respondents. The work stressors tested were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and turnover intentions. Structural equation modelling and moderated regression analyses were used in the analysis. Findings: Quality of senior management leadership explained 75 per cent and 94 per cent of the variance of social support and job design respectively, whereas work stressors explained 51 per cent of the variance of strains. Social support and job design predicted job satisfaction and turnover intentions, as well as moderated significantly the relationships between quantitative workload/hostility and job satisfaction/turnover intentions. Research limitations/implications: The findings are useful to management and to health employees working in acute/specialist hospitals. Further research could be done in other counties to take into account cultural differences and variations in health systems. The limitations included self-reported data and percept-percept bias due to same source data collection. Practical implications: The quality of senior management leaders in hospitals has an impact on the social environment, the support given to health employees, their job design, as well as work stressors and strains perceived. Originality/value: The study argues in favour of effective senior management leadership of hospitals, as well as ensuring adequate support structures and job design. The findings may be useful to health policy makers and human resources managers. © Emerald Group Publishing Limited.

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Aim: Systemic hypertension is a silent killer that may have very few warning signs. This study examines detection and management of patients with cardiovascular disease (CVD) by optometrists in the UK. Method: A survey was sent out to 1402 optometrists who practice in the UK to investigate the nature and knowledge of detection of systemic hypertension. Results: The survey response rate was 37%. Optometrists were neutral to slightly positive towards the use of blood pressure (BP) monitors, but not on a routine basis. The most frequently asked question during history and symptoms concerned the patient's prescribed medication for systemic hypertension, and the least was that of specifying the last BP measurement. The additional test most widely used in the examination of the systemic hypertensive patient was direct ophthalmoscopy with red-free filter. Over one-tenth of optometric practices had a BP monitor, with automated devices being the most popular. Patients most likely to have their BP measured were suspect systemic hypertensives. Retinal haemorrhages are the most important finding in influencing an optometrist's referral criteria for suspected systemic hypertension. Conclusion: Although optometrists monitor the retina for signs of damage from systemic hypertension, further education in this important condition is warranted. © 2005 The College of Optometrists.

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Purpose: The aim of this paper is to identify and gain insights into the significance of barriers contributing to the purported "gap" between academic management accounting research and practice. Design/methodology/approach: Drawing on diffusion of innovations theory, this study collects and analyses data from a questionnaire survey and follow-up interviews with 19 representatives of the four principal professional accounting bodies in Australia. Findings: Professional accounting bodies perceive the gap between academic research and practice in management accounting to be of limited concern to practitioners. The two most significant barriers to research utilisation by practitioners are identified as: difficulties in understanding academic research papers; and limited access to research findings. In acting as a conduit between the worlds of academia and practice, professional bodies have an important role to play by demonstrating the mutual value to both academics and practitioners resulting from a closer engagement between MA research and practice. Research limitations/implications: As one of the few empirically-based, theoretically informed investigations exploring the research-practice gap in management accounting, this study provides insights rather than "answers". Its findings therefore serve as a foundational basis for further empirical and theoretical enquiry. Originality/value: This study contributes to the conversation about the "research-practice gap" in management accounting by adopting a distinct theoretical vantage point to organize, analyse and interpret empirical evidence obtained from Australian professional accounting bodies about management accounting practice. © Emerald Group Publishing Limited.

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The Republic of Ireland and Northern Ireland were provided with aid to offset locational disadvantages in the run up to the Single European Market. Since then the Republic has emerged as the fastest growing member of the E.U. Success has not been underpinned by the transport system, suggesting that business has had to overcome locational disadvantages by strong performance elsewhere in the supply chain. The evidence indicates that there are Irish firms operating supply chain management techniques at a truly international standard. The problem is that there are so few in that category Meeting Ireland’s competitiveness challenge means closing the gap between the small group of large and foreign-owned firms, which display excellence in SCM, and the larger group of indigenous small and medium size businesses, which do not.

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The primary aim of this research is to understand what constitutes management accounting and control (MACs) practice and how these control processes are implicated in the day to day work practices and operations of the organisation. It also examines the changes that happen in MACs practices over time as multiple actors within organisational settings interact with each other. I adopt a distinctive practice theory approach (i.e. sociomateriality) and the concept of imbrication in this research to show that MACs practices emerge from the entanglement between human/social agency and material/technological agency within an organisation. Changes in the pattern of MACs practices happens in imbrication processes which are produced as the two agencies entangle. The theoretical approach employed in this research offers an interesting and valuable lens which seeks to reveal the depth of these interactions and uncover the way in which the social and material imbricate. The theoretical framework helps to reveal how these constructions impact on and produce modifications of MACs practices. The exploration of the control practices at different hierarchical levels (i.e. from the operational to middle management and senior level management) using the concept of imbrication process also maps the dynamic flow of controls from operational to top management and vice versa in the organisation. The empirical data which is the focus of this research has been gathered from a case study of an organisation involved in a large vertically integrated palm oil industry company in Malaysia specifically the refinery sector. The palm oil industry is a significant industry in Malaysia as it contributed an average of 4.5% of Malaysian Gross Domestic Product, over the period 1990 -2010. The Malaysian palm oil industry also has a significant presence in global food oil supply where it contributed 26% of the total oils and fats global trade in 2010. The case organisation is a significant contributor to the Malaysian palm oil industry. The research access has provided an interesting opportunity to explore the interactions between different groups of people and material/technology in a relatively heavy process food industry setting. My research examines how these interactions shape and are shaped by control practices in a dynamic cycle of imbrications over both short and medium time periods.

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Purpose: The purpose of the research described in this paper is to disentangle the rhetoric from the reality in relation to supply chain management (SCM) adoption in practice. There is significant evidence of a divergence between theory and practice in the field of SCM. Design/methodology/approach: Based on a review of extant theory, the authors posit a new definitional construct for SCM – the Four Fundamentals – and investigated four research questions (RQs) that emerged from the theoretical review. The empirical work comprised three main phases: focussed interviews, focus groups and a questionnaire survey. Each phase used the authors’ definitional construct as its basis. While the context of the paper’s empirical work is Ireland, the insights and results are generalisable to other geographical contexts. Findings: The data collected during the various stages of the empirical research supported the essence of the definitional construct and allowed it to be further developed and refined. In addition, the findings suggest that, while levels of SCM understanding are generally quite high, there is room for improvement in relation to how this understanding is translated into practice. Research limitations/implications: Expansion of the research design to incorporate case studies, grounded theory and action research has the potential to generate new SCM theory that builds on the Four Fundamentals construct, thus facilitating a deeper and richer understanding of SCM phenomena. The use of longitudinal studies would enable a barometer of progress to be developed over time. Practical implications: The authors’ definitional construct supports improvement in the cohesion of SCM practices, thereby promoting the effective implementation of supply chain strategies. A number of critical success factors and/or barriers to implementation of SCM theory in practice are identified, as are a number of practical measures that could be implemented at policy/supply chain/firm level to improve the level of effective SCM adoption. Originality/value: The authors’ robust definitional construct supports a more cohesive approach to the development of a unified theory of SCM. In addition to a profile of SCM understanding and adoption by firms in Ireland, the related critical success factors and/or inhibitors to success, as well as possible interventions, are identified.

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PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

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The approach of all ophthalmologists, diabetologists and general practitioners seeing patients with diabetic retinopathy should be that good control of blood glucose, blood pressure and plasma lipids are all essential components of modern medical management. The more recent data on the use of fenofibrate in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye studies is reviewed. In FIELD, fenofibrate (200 mg/day) reduced the requirements for laser therapy and prevented disease progression in patients with pre-existing diabetic retinopathy. In ACCORD Eye, fenofibrate (160 mg daily) with simvastatin resulted in a 40% reduction in the odds of retinopathy progressing over 4 years, compared with simvastatin alone. This occurred with an increase in HDL-cholesterol and a decrease in the serum triglyceride level in the fenofibrate group, as compared with the placebo group, and was independent of glycaemic control. We believe fenofibrate is effective in preventing progression of established diabetic retinopathy in type 2 diabetes and should be considered for patients with pre-proliferative diabetic retinopathy and/or diabetic maculopathy, particularly in those with macular oedema requiring laser. © 2011 Macmillan Publishers Limited All rights reserved.

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A műhelytanulmány két kutatási kérdést vizsgál. Egyrészt kiemelt szakirodalom alapján megvizsgálja, hogy az elméleti ajánlások milyen vezetési stílust és vezetői stílusjegyeket fogalmaznak meg követendőnek egy lean vállalat számára. Másrészt megvizsgálja, hogy a lean menedzsment gyakorlatának alkalmazásában fejlettebb vállalatok vezetői valóban az irodalom által javasolt, kívánatosnak tekintett vezetői stílusjegyeket tekintik-e pozitívnak. Vizsgálatunkat a Versenyképesség Kutató Központ 2009-es kérdőívének adatbázisán végeztük el, melyben mintegy 300 vállalat négy vezetőjének válaszai állnak rendelkezésre. A rendelkezésre álló mintából mi az 50 fő feletti foglalkoztatottal rendelkező, feldolgozóipari vállalatokra fókuszáltunk, esetükben elemeztük a vezérigazgató és a termelésvezető által követendőnek, jónak tartott vezetői stílusjegyek alkalmazását. ----- Abstract: The working paper focuses on two connected research quesions: Ono ne hand based on selected literature it systematically looks at the ideal leadership style and connected leader attributes that help in transforming a company into a real lean organization. On the other hand the paper analyzes whether leaders of companies with more developed lean practice do or do not follow these leadership related suggestions formulated in the literature. The study uses the fourth round of the Hungarian Competitiveness Research Survey from 2009. The survey has 300 valid observations. Four different respondents in each company filled in questionnaires, all of them were top managers (CEO, marketing /sales, finance, production). Plants were quite different alongside the most important organizational dimensions (volume, number of employee, industry, ownership). Previous researches pointed out that lean management is more likely applied by larger manufacturer. Hence, this study is limited to the analysis of questionnaires filled in by producers that have more than 50 employees. We analyze the leadership styles of two managers, namely the CEO and production manager.

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A nemzetközi szakirodalom a vezetőt a lean termelés bevezetésében és fenntartásában is kulcsszereplőként határozza meg. Ennek ellenére nagyon kevés empirikus elemzés vizsgálja a vezetőkkel kapcsolatos kérdéseket. A szerzők a kontingencialista leadership elmélet keretei között a lean termelési rendszer és a vezetési jellemzők kapcsolatát vizsgálják elméleti szempontból és empirikusan egyaránt. Bár a kérdés nem került korábbi munkák fókuszába, az elméleti és empirikus megfontolások alapján egyaránt megállapítható, hogy több vezetési jellemző is szorosan kapcsolható egy jól működő lean termelővállalat vezetőjéhez. Követendő vezetési jellemzőként jelenik meg többek között az együttműködő, a delegáló, a teljesítményorientált vagy fejlődésorientált. Azonosíthatók olyan jellemzők is, amelyek elméletileg nem egyeztethetők össze a lean termelési rendszer logikájával, pl. autokrata, diktatórikus vagy mikrovezető ______ The working paper focuses on two connected research questions: on one hand based on widely accepted literature it systematically maps the ideal leadership style and related leader attributes that help in transforming a company into a real and well-functioning lean organization. On the other hand the paper analyzes whether leaders of companies with more developed lean practice do or do not follow these leadership attributes recommended by literature. The study uses the fourth round of the Hungarian Competitiveness Research Survey from 2009. This study is limited to the analysis of questionnaires filled in by producers that have more than 50 employees (about 65 manufacturing firms). The authors analyze the leadership styles of two managers, namely the CEO and production manager. Results of the empirical analysis revealed astonishing and contradictory attitudes toward ideal leadership attributes of leaders operating in more developed lean companies.

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A szerzők cikkükben a számítástechnikai hulladékokkal foglalkoznak, számítástechnikai eszközök alatt a számítógép konfigurációk összetevőit értik, tehát számítógépeket (asztali, hordozható, terminál stb.), és perifériáit (monitor, nyomtató, cd-író stb.), valamint ezek alkatrészeit és kiegészítőit (chipek, mechanikus részek, festékkazetták stb.). A rendszeres használat környezeti hatásait csak abból a szempontból vizsgálták, hogy ennek során bizonyos alkatrészek, kellékek (kiemelten a nyomtatók festékkazettái) a gépnél nagyobb gyakorisággal cserélődnek, s válhatnak hulladékká. A fő fókusz a számítástechnikai eszközök élettartamának vége, s ebből a szempontból kulcsfogalom a használt személyi számítógép kategória. _____ In their article, the authors discuss the issue of computer waste; under the category of information technology devices they understand the components of computer configurations, that is computers (desktop, portable, terminal etc.) and their peripheries (monitor, printer, CD writer, etc), and also the components and supplements of these (chips, mechanical parts, toner cartridges, etc.). The environmental impact of regular use was examined only from one aspect: during regular use certain components and accessories (especially the toner cartridges of printers) are more often changed and become waste. The main focus is the end of the life time of computer devices, and from this point of view used personal computers are a key concept.

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Treatment of sensory neuropathies, whether inherited or caused by trauma, the progress of diabetes, or other disease states, are among the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord would be the logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the transplant of cells or a cell line to treat human disease. The history of the research and development of useful cell-transplant-based approaches offers an understanding of the advantages and problems associated with these technologies, but as an adjuvant or replacement for current pharmacological treatments, cell therapy is a likely near future clinical tool for improved health care.

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Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.