Audit of consultant physicians' reply letters for referrals to clinics in a tertiary teaching hospital

Background: Doctors referring patients to consultant physicians seek reply letters which both educate and assist in ongoing patient management. Highly desirable attributes in specialist letters include clearly stated and justified: (i) diagnostic formulations, (ii) management regimens, (iii) use of clinical investigations, (iv) prog-nostic statements, (v) contingency plans and (vi) follow-up arrangements. Aim: To explicitly evaluate the quality of reply letters for new patients referred to clinics at a tertiary teaching hospital. Methods: Letters were sampled from outpatient clinics of 10 different medical specialties at Princess Alexandra Hospital in Brisbane, Australia. Reply letters for new patient referrals between 1 August 2000 and 31 October 2000 were retrieved, from which data were abstracted to calculate the proportion of letters satisfying prespecified quality attributes. Results: Of 297 new patient referrals, reply letters were retrieved for 204 (69%). Of these, 147 (72%) referrals were accompanied by a referral letter, mostly (113/147; 77%) from general practitioners. For 120 referrals involving diagnostic issues, 69 (56%) letters stated a diagnostic formulation. Of 114 letters recommending further clinical investigations, 61 (53%) described a rationale for such testing. In 125 cases where therapy was a key issue, 83 (66%) letters recommended changes to current treatment for which reasons were specified in 46 (55%) cases, and contingency plans provided in 13 (16%). Prognosis was mentioned in only 18 (9%) cases. Follow-up arrangements were detailed in 123 (60%) letters. Assessments of patient understanding and likely adherence to therapy were stated in less than 15% of -letters. Conclusions: Opportunities exist for improving quality of consultant physicians' reply letters in terms of greater use of problem lists, contingency plans, prognostic statements and patient-centred assessments, as well as more frequent enunciation of consultants' reasoning behind requests for further tests and changes to current management. Use of structured letter templates may facilitate more consistent inclusion of key information to referring doctors.

From the sublime to the subliminal: Fear, awe and wonder in international politics

Key events in international politics, such as terrorist attacks, can be characterised as sublime: our minds clash with phenomena that supersede our cognitive abilities, triggering a range of powerful emotions, such as pain, fear and awe. Encounters with the sublime allow us an important glimpse into the contingent and often manipulative nature of representation. For centuries, philosophers have sought to learn from these experiences, but in political practice the ensuing insights are all too quickly suppressed and forgotten. The prevailing tendency is to react to the elements of fear and awe by reimposing control and order. We emphasise an alternative reaction to the sublime, one that explores new moral and political opportunities in the face of disorientation. But we also stress that we do not need to be dislocated by dramatic events to begin to wonder about the world. Moving from the sublime to the subliminal, we explore how it is possible to acquire the same type of insight into questions of representation and contingency by engaging more everyday practices of politics.

EAD: O POLO DE APOIO PRESENCIAL COMO ESPAÇO ORGANIZADOR DA AÇÃO EDUCATIVO-CULTURAL

Esta pesquisa estuda a organização e estruturação de três polos de apoio presencial ligados a modalidade a distância, bem como os processos de gestão e autonomia no contexto em que atuam. Trata-se, portanto, de dois momentos de análise, considerando que o primeiro se relaciona a um estudo descritivo-exploratório no que se refere a organização e estruturação dos polos, a partir de diretrizes preestabelecidas e da discussão sobre a realidade cultural e, ao mesmo tempo contingencial existente neste espaço; o segundo, relacionado à utilização da técnica da entrevista para a análise do processo de gestão e autonomia existente nos polos pesquisados. Para a aplicação da pesquisa, foram realizadas visitas aos polos de apoio presencial (dois localizados no Estado de São Paulo e um no Estado do Paraná) e entrevistas com seus coordenadores, sendo importante destacar que dois destes polos estão ligados à realidade privada e um deles à realidade pública. Respectivamente, tais análises e entrevistas indicaram que apesar das diretrizes preestabelecidas, os polos pesquisados possuem um modelo contingencial e, portanto, cultural de adaptação à realidade em que se instalam; sendo que no caso das entrevistas semiestruturadas e, respectivamente do processo de gestão, existe uma proposta clara por parte dos coordenadores no exercício em se fazer EAD, compreendendo assim, uma gestão voltada a adequações e readequações diante de um contexto em constante desenvolvimento. No que se refere ao processo de autonomia, os fatores que merecem atenção estão diretamente relacionados à compreensão dos sujeitos sobre a existência de trâmites não negociáveis, respectivamente relacionados às bases legais que regulamentam a existência dos polos de apoio presencial, contudo, estabelecidos estes parâmetros, a autonomia se determina pela tomada de decisão deste gestor diante da realidade em que se instala.

A VERDADE É A CONVERSA: Aproximações inesperadas entre o neo-pragmatismo de Richard Rorty e a Teologia da Libertação em Juan Luis Segundo

Este estudo é uma tentativa de promover uma partilha de perspectivas entre o neo-pragmatismo do filósofo Richard Rorty, mormente a partir das obras Filosofia e o espelho da natureza e Contingência, Ironia e Solidariedade e a Teologia da Libertação, em seu mais proeminente representante, Juan Luis Segundo, com o foco principal nas obras Libertação da teologia e O dogma que liberta. Desenvolve-se aqui uma aproximação de olhares para a verdade e a revelação, concebendo-as como processos pedagógicos. A verdade, como conceito não apenas religioso, do que se busca para dar sentido ao mundo e a vida humana e a revelação, como uma experiência marcada pela linguagem e expectativas religiosas de significado existencial são experiências similares e constituem-se não como o resultado de um processo de aprendizagem, mas como o processo em si mesmo, aberto e em constante renovação. A verdade, assim, não seria aonde se chega, mas os caminhos pelos quais se vai. Encontrar os pontos de contato e as possíveis mútuas contribuições do pensamento do filósofo Richard Rorty, e sua filosofia edificante, e do teólogo Juan Luis Segundo, e sua ideia de revelação como processo pedagógico, será meu esforço de aproximação entre suas proposições e a construção de uma proposta que não fuja à linguagem e condição humanas. O humano, que marcado pela liberdade, tem na contingência de suas construções um limite para as suas conquistas e um espaço para a sua libertação de qualquer processo desumanizador.

Extrinsic and intrinsic factors in the Balanced Scorecard adoption: an empirical study in Portuguese organizations

In this article we aim to analyze the relationship between a set of organizational extrinsic and intrinsic factors and the adoption of the Balanced Scorecard(BSC) by privately-owned Portuguese organizations (large companies and small and médium enterprises).These factos are related to companies age,the diversity of products and services,the nature of the ownership structure,the internationalization,and the organizational size. As a primary means of data collection was carried out a postal survey through a questionnaire sent to 549 privately-owned Portuguese organizations, with na overall responserate of 28.2%. The results indicate that the degree of diversity of the products/services of the organization,the owner- ship of foreign groups,and theo rganizational size are positively associated with the implementation of the BSC.Thus,we conclude that the BSC increases with the degree of diversity of the products/services of the organization,that the Portuguese organizations that use the BSC are mainly owned by foreign groups; and larger organizations are most likely to use this tool.

La contingence des faits linguistiques:réflexions sur la variation et le changement

This paper is a reflection on the role of contingent facts for the general understanding of language. Such facts are illustrated by the lacks of proportionality in the paradigm of French indefinites and the irregular correlations between the Null Subject Parameter and other hypothesised parameters. Such contingencies clearly go against the expectation raised by at least some versions of structuralism and the current chomskyan Minimalist Program. As demonstrated by alternative views being developed in various natural and social sciences, and as shown by recent research on formulaic language, contingency may be understood as the result of the expedient character of a medium geared towards action. A view of language as action may thus offer a perspective able to account both for the general default rules shaping a grammar and for the contingencies that entrench them in use, as both are integral and complementary aspects of language.

The Japanisation process in Malaysia

This thesis examines the empirical evidence for the transferability of Japanese soft technology (JST) or Japanese work organisation within two government-initiated, Malaysian-Japanese strategic alliances: PROTON and PERNEC. The government, through its Look East Policy (LEP) began in 1982, taking Japan (and South Korea) as models and partners in Malaysian economic and industrial development process, and expected these alliances to learn the good aspects of Japanese work organisations and management styles in order for them to become independent companies, both technologically and economically. The thesis found that the alliances have been successfully taking and utilising Japanese parts, components, tools, robots and machines; i.e. the 'ready-made hard technology'. [Whereas the important element of soft technology has been ignored]. The soft technology has been slowly and marginally transferred because neither local parties nor their Japanese counterparts within the alliances consider the acquisition or transfer of soft technology to be the main concern or a part of business plan. Although many factors influence management transfer, the thesis has focused on the eagerness and the capability of Malaysian managerial teams to acquire and, to a lesser extent, the readiness of the Japanese to transfer the technology. It was found that there is a lack of demand on technology acquisition by Malaysian managers and lack of responsibility to transfer the technology among Japanese experts. However, the political and social pressures on these alliances, the industrial climate and labour market, leaderships and management system of alliances, and Japanese MNCs regional and global corporate strategies have contributed to the high level of transfer of JST at PROTON compared to PERNEC. The research also found that Malaysian industrial and investment policies have favoured foreign investment but there is a lack of strategies for nurturing indigenous technological development.On the other hand the Japanese MNCs and public agencies have been operating in Malaysia and guided by their regional and global corporate strategies and less concerned with Malaysian technological development. In conclusion, empirically, the JST transfer is minimal. The transfer has been influenced by internal contingency factors of organisation; external industrial, political and cultural environmental factors; and last but not least the Japanese MNCs' global and regional corporate strategies. The transfer of Japanese management in this research is inclined towards core-periphery transfer model, it is also related to organisational and national technological capability.

Designing and managing collaborative enterprises in the automotive industry

This paper presents the findings of a recently completed research project. It sheds light upon the appropriate governance of inter-firm relationships, in order to achieve competitive success for the whole partnership and its individual members. An exploratory study in the German automotive industry using inductive Grounded Theory was conducted, in order to form a set of propositions that were then validated. The research has resulted in the consolidation of these propositions into a novel concept termed Collaborative Enterprise Governance, which draws on an inter-disciplinary body of knowledge. The core of the concept is a competence based contingency framework that helps enterprise managers in selecting the most appropriate governance strategy (i.e. enterprise structure) for an inter-firm relationships within automotive supply networks (i.e. enterprises), depending on various exogenous and endogenous factors.

A conceptual framework for enterprise management

This paper reports on the theoretical foundations and the practical reasons for the increasing popularity of the enterprise management perspective. Theoretical foundations are given that discuss vertically integrated, virtual and extended enterprises in terms of endogenous and exogenous factors, and the tensions that these create. An exploratory study in the German automotive industry using inductive grounded theory was conducted, involving data collection via 28 semi-structured interviews with 16 companies and data validation via a questionnaire survey receiving 110 responses from 52 companies. The research delivers a conceptual framework to show how enterprise structures emerge, depending on the prevailing type of core competencies that they use. Furthermore, it proposes contingency-planning recommendations to facilitate managing the change from one structure to another as the demands placed upon the enterprise change.

Getting the most out of multidisciplinary teams: a multi-sample study of team innovation in health care

Driven by the assumption that multidisciplinarity contributes positively to team outcomes teams are often deliberately staffed such that they comprise multiple disciplines. However, the diversity literature suggests that multidisciplinarity may not always benefit a team. This study departs from the notion of a linear, positive effect of multidisciplinarity and tests its contingency on the quality of team processes. It was assumed that multidisciplinarity only contributes to team outcomes if the quality of team processes is high. This hypothesis was tested in two independent samples of health care workers (N = 66 and N = 95 teams), using team innovation as the outcome variable. Results support the hypothesis for the quality of innovation, rather than the number of innovations introduced by the teams.

Measuring the degree of spatial correlation between histological features in thin sections of brain tissue

Histological features visible in thin sections of brain tissue, such as neuronal perikarya, blood vessels, or pathological lesions may exhibit a degree of spatial association or correlation. In neurodegenerative disorders such as AD, Pick's disease, and CJD, information on whether different types of pathological lesion are spatially correlated may be useful in elucidating disease pathogenesis. In the present article the statistical methods available for studying spatial association in histological sections are reviewed. These include tests of interspecific association between two or more histological features using χ2 contingency tables, measurement of 'complete' and 'absolute' association, and more complex methods that use grids of contiguous samples. In addition, the use of correlation matrices and stepwise multiple regression methods are described. The advantages and limitations of each method are reviewed and possible future developments discussed.

Is there a spatial association between senile plaques and neurofibrillary tangles in Alzheimer's disease?

Objective: To test the hypothesis that the clusters of senile plaques (SP) and neurofibrillary tangles (NFT) in patients with Alzheimer's disease (AD) are spatially associated as predicted by the 'Amyloid Cascade Hypothesis'. Methods: The spatial association between the SP and NFT was studied in the cerebral cortex and hippocampus in six cases of sporadic Alzheimer's disease (AD) using contingency tables. The coefficient C7 was used as an index of spatial association while chi-square with correction for continuity was used as a test of significance. Results: In the brain regions analysed, values of C7 were in the range -0.31 to +0.32 but a statistically significant spatial association between SP and NFT was present in only 8/39 (21%) regions. The degree of spatial association between the SP and NFT was similar in dfferent brain regions and did not vary with apolipoprotein ε genotype of the patient. However, the magnitude of C7 in a region was positively correlated with the density of the NFT and with the total density of SP and NFT but not with the density of SP alone. Conclusion: There was little evidence that SP and NFT were spatially associated except in brain areas with high densities of lesions. The data support the hypothesis that SP and NFT are distributed relatively independently in the cerebral cortex and hippocampus and therefore, could be distinct phenomena in AD.

Shareholder or stakeholder management:strategies for performance optimisation

This paper is based upon the findings of a CIMA research project into the way which corporate performance is affected by the performance measurement system adopted. It compares and contrasts the techniques in use in a sample of large companies that use a variety of techniques. We have classified these techniques into 3 types: • Value based management techniques • Stakeholder management techniques • Traditional accounting techniques. The analysis traces the interactions between corporate objectives, decision making criteria, performance measurement systems, and executive incentive schemes in order to develop an understanding of the effects of such techniques upon corporate performance. This paper seeks to provide some answers to the following two questions: • What approach leads to superior performance for a firm? • What is different between these approaches when they are used in practice, as distinct from theory? In doing so we have drawn upon both contingency theory and sociobiology theory to develop a framework for understanding the relationship between the choke of performance measurement system and the resulting performance.

Measuring the degree of spatial correlation between pathological lesions in Alzheimer's disease

The pathological lesions characteristic of Alzheimer's disease (AD), viz., senile plaques (SP) and neurofibrillary tangles (NFT) may not be randomly distributed with reference to each other but exhibit a degree of sptial association or correlation, information on the degree of association between SP and NFT or between the lesions and normal histological features, such as neuronal perikarya and blood vessels, may be valuable in elucidating the pathogenesis of AD. This article reviews the statistical methods available for studying the degree of spatial association in histological sections of AD tissue. These include tests of interspecific association between two or more histological features using chi-square contingency tables, measurement of 'complete' and 'absolute' association, and more complex methods that use grids of contiguous samples. In addition, analyses of association using correlation matrices and stepwise multiple regression methods are described. The advantages and limitations of each method are reviewed and possible future developments discussed.

The spatial pattern of beta-amyloid (Abeta) deposits in Alzheimer’s disease patients is related to apolipoprotein genotype

The spatial patterns of the diffuse, primitive, and classic beta-amyloid (Abeta) deposits was studied in the frontal and temporal cortex in cases of Alzheimer’s disease (AD) expressing different apolipoprotein (Apo E) genotypes. No significant differences in the density of the three Abeta deposit subtypes were observed in individuals expressing genotypes e2/3 and e3/3 compared with those expressing e3/4 and e4/4. In all patients, Abeta deposit subtypes occurred in the tissue in clusters. Chi-square contingency analyses of the data suggested that the cluster size of the diffuse and classic Abeta deposits was unrelated to Apo E genotype. However, the primitive (‘neuritic’) type Abeta deposits occurred more frequently in smaller, denser clusters in individuals expressing genotypes e3/4 and e4/4 compared with those expressing e2/3 and e3/3. Hence, the presence of the e4 allele may be associated with a more specific pattern of neuronal degeneration in the frontal and temporal cortex in AD.