Patients who attend a private practice vs a university outpatient clinic: how do they differ?

Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured. The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care. We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP). Eligible patients were >30 years, Swiss nationals or long term residents, with one or more chronic conditions and attending the same practice for >3 years. They were asked to complete a questionnaire on sociodemographic data, use of medical resources and reasons for choosing and remaining at the same practice. Semi-structured interviews were conducted with a randomly selected subset of 26 patients to further explore their preferences. 329 patient questionnaires were completed, 219 by PP and 110 by OC patients. OC patients tended to be of lower socioeconomic status than PP patients. The main reason for choosing a PP were personal recommendation, while a higher percentage of patients chose the OC because they could obtain a first appointment quickly. A higher percentage of PP patients accorded importance to physician communication skills and trust, whereas a higher percentage of OC patients favoured investigation facilities. Qualitative data suggested that although OC and PP patients reported different reasons for consulting, their expectations on the medical and relationship level were similar. Our study suggests that the two groups of patients belong to different social backgrounds, have different patterns of care-seeking and attach importance to different aspects of care continuity. However, patients' expectations and perceptions of the physician-patient relationship are similar.

Orosomucoid (alpha-1 acid glycoprotein) phenotyping by use of immobilized pH gradients with 8 M urea and immunoblotting. A new variant encountered in a population study.

Orosomucoid (ORM) phenotyping has been performed on 329 unrelated Swiss subjects, using immobilized pH gradients with 8 M urea and 2% v/v 2-mercaptoethanol followed by immunoblotting. After desialylation the band patterns of ORM confirmed that the polymorphism of the structural locus ORM1 is controlled by three codominant autosomal alleles (ORM1*F1, ORM1*S and ORM1*F2). One rare and one new allele were detected. The rare variant, tentatively assigned to the second structural locus ORM2, is observed in a cathodal position and named ORM2 B1. The new variant, tentatively assigned to the first structural locus ORM1, is observed in a region located between ORM1 S and ORM1 F2, and named ORM1 F3. Moreover, the pI values of the ORM variants have been measured accurately with Immobiline Dry Plates (LKB): they were found to be within the pH range 4.93-5.14.

Modernización de regadios de un sector de la Comunidad de regantes de Fraga, Torrente y Velilla de Cinca

El objecto del proyecto es el de especificar las condiciones técnicas y económicas de los equipos de bombeo, línea de impulsión y red de riego para la modernización de los regadíos de un sector de la Comunidad de regantes de las huertas de Fraga, Torrente y Velilla de Cinca.

Modeling and measuring organizational renewal capability

Globalization and new information technologies mean that organizations have to face world-wide competition in rapidly transforming, unpredictable environments, and thus the ability to constantly generate novel and improved products, services and processes has become quintessential for organizational success. Performance in turbulent environments is, above all, influenced by the organization's capability for renewal. Renewal capability consists of the ability of the organization to replicate, adapt, develop and change its assets, capabilities and strategies. An organization with a high renewal capability can sustain its current success factors while at the same time building new strengths for the future. This capability does not only mean that the organization is able to respond to today's challenges and to keep up with the changes in its environment, but also that it can actas a forerunner by creating innovations, both at the tactical and strategic levels of operation and thereby change the rules of the market. However, even though it is widely agreed that the dynamic capability for continuous learning, development and renewal is a major source of competitive advantage, there is no widely shared view on how organizational renewal capability should be defined, and the field is characterized by a plethora of concepts and definitions. Furthermore,there is a lack of methods for systematically assessing organizational renewal capability. The dissertation aims to bridge these gaps in the existing research by constructing an integrative theoretical framework for organizational renewal capability and by presenting a method for modeling and measuring this capability. The viability of the measurement tool is demonstrated in several contexts, andthe framework is also applied to assess renewal in inter-organizational networks. In this dissertation, organizational renewal capability is examined by drawing on three complimentary theoretical perspectives: knowledge management, strategic management and intellectual capital. The knowledge management perspective considers knowledge as inherently social and activity-based, and focuses on the organizational processes associated with its application and development. Within this framework, organizational renewal capability is understood as the capacity for flexible knowledge integration and creation. The strategic management perspective, on the other hand, approaches knowledge in organizations from the standpoint of its implications for the creation of competitive advantage. In this approach, organizational renewal is framed as the dynamic capability of firms. The intellectual capital perspective is focused on exploring how intangible assets can be measured, reported and communicated. From this vantage point, renewal capability is comprehended as the dynamic dimension of intellectual capital, which consists of the capability to maintain, modify and create knowledge assets. Each of the perspectives significantly contributes to the understanding of organizationalrenewal capability, and the integrative approach presented in this dissertationcontributes to the individual perspectives as well as to the understanding of organizational renewal capability as a whole.

Projecte de condicionament del camí rural de l’Aiguabarreig al terme municipal de Massalcoreig (Lleida)

El tema d’aquest projecte és el condicionament del camí rural, situat al llarg del riu Cinca, al terme municipal de Massalcoreig (Lleida). Aquest projecte està format per quatre documents, classificats en dos volums. Al primer volum trobem el document número 1, format per la memòria amb els seus annexes on es defineixen les característiques bàsiques a tenir en compte per a realitzar el condicionament del camí, així com el desenvolupament de les activitats. Al segon volum, trobem la resta de documents. En primer lloc, trobem el segon document, els plànols necessaris per a dur a terme l’obra. A continuació, el tercer document és el plec de condicions en el que s’estipulen les normes que s’han de tenir en compte durant l’execució del projecte. Finalment, el quart document, és el pressupost, on hi ha el cost de l’obra.

La Governació al Principat de Catalunya i als comtats de Roselló i Cerdanya

A Catalunya, entre els segles XIII i XV, s'articula Palta delegado del sobirá, veritable reflex de la consolidado de la posició reial i catalitzadora de les tensions entre els vectors de poder. La figura es mostra com elevada magistratura d'un país cohesionat per la propia sinergia deis diferents grups de pressió, entre els quals evolucionará fins a sortir dels temps medievals amb una posició afermada pero, alhora, ja desplagada de destacades preeminéncies. El recorregut per aquesta institució, dones, transporta la consolidació reial entre l'emergéncia municipal i la puixanga baronial a través de les llums i foscors deis segles que clouen l'edat mitjana.

Emergency department visits for non-life-threatening conditions : evolution over 13 years in a Swiss urban teaching hospital

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

Competencia de trabajo en equipo: definición y categorización

La competencia de trabajo en equipo se impone a la individualización laboral. El cambio de estructura y proceso de las organizaciones de la sociedad actual ha generado un gran impacto en la nueva manera de trabajar. Las tareas han aumentado su dificultad, haciendo que su resolución individual sea imposible. Es por este motivo, que las organizaciones del trabajo reclaman, hoy más que nunca, la competencia transversal de trabajo en equipo. Este constructo (Competencia de Trabajo en Equipo) recientemente nuevo en las organizaciones ofrece definiciones y modelos de categorización subyacentes que necesitan hacerse oír en el panorama sociolaboral. En esta revisión de la literatura se analizan los 4 modelos más representativos de la competencia de trabajo en equipo, a través de los cuales se propone una definición de la competencia y una posible estructura de la categorización de la misma.

Strokes in the anterior circulation: comparison between bridging and intravenous thrombolysis.

BACKGROUND AND PURPOSE: To compare safety and efficacy of bridging approach with intravenous (IV) thrombolysis in patients with acute anterior strokes and proximal occlusions. PATIENTS AND METHODS: Consecutive patients with ischemic anterior strokes admitted within a 4 h 30 min window in two different centers were included. The first center performed IV therapy (alteplase 0.6 mg/kg) during 30 min and, in absence of clinical improvement, mechanical thrombectomy with flow restoration using a Solitaire stent (StS); the second carried out IV thrombolysis (alteplase 0.9 mg/kg) alone. Only T, M1 or M2 occlusions present on CT angiography were considered. Endpoints were clinical outcome and mortality at 3 months. RESULTS: There were 63 patients in the bridging and 163 in the IV group. No significant differences regarding baseline characteristics were observed. At 3 months, 46% (n = 29) of the patients treated in the combined and 23% (n = 38) of those treated in the IV group had a modified Rankin scale (mRS) of 0-1 (P < 0.001). A statistical significant difference was observed for all sites of occlusion. In a logistic regression model, National Institute of Health Stroke Scale (NIHSS) and bridging therapy were independent predictors of good outcome (respectively, P = 0.001 and P = 0.0018). Symptomatic hemorrhage was documented in 6.3% vs 3.7% in the bridging and in the IV group, respectively (P = 0.32). There was no difference in mortality. CONCLUSIONS: Our results suggest that patients treated with a bridging approach were more likely to have minimal or no deficit at all at 3 months as compared to the IV treated group.

Molecular characterization of papaya genotypes using AFLP markers

Due to the low genetic variability reported in the commercial plantations of papaya (Carica papaya L.), the objective of this study was analyze the genetic diversity of 32 genotypes including cultivars, landraces, inbred lines, and improved germplasm using the AFLP technique (Amplified Fragment Length Polymorphism). The genetic distance matrix was obtained using the Nei and Li genetic distance and clustering was performed using the unweighted pair-method with arithmetic mean (UPGMA). Using 11 combinations of EcoRI/MseI primers, 383 polymorphic bands were obtained. On average, 34.8 polymorphic bands were obtained per primer combination. Five clusters were formed. The traditional cultivar 'Sunrise' and the inbred line CMF-L30-08 were the closest genotypes, and the improved germplasm (CMF041) and landrace (CMF233) the most distant. The main papaya cultivars commercially grown in Brazil, as well as four inbred lines and three improved germplasm, were clustered together, however, were not grouped in the same branch. The genetic distance between the Sunrise and Golden cultivars was 0.329, and even arising from mutation and selection within the Sunrise variety, the Golden stores considerable genetic variability. Additional variability was observed in the inbred lines derived from papaya breeding program at Embrapa Cassava and Fruits.

CoDiab-VD: protocol of a prospective population-based cohort study on diabetes care in Switzerland.

BACKGROUND: Diabetes represents an increasing health burden worldwide. In 2010, the Public Health Department of the canton of Vaud (Switzerland) launched a regional diabetes programme entitled "Programme cantonal Diabète" (PcD), with the objectives to both decrease the incidence of diabetes and improve care for patients with diabetes. The cohort entitled CoDiab-VD emerged from that programme. It specifically aimed at following quality of diabetes care over time, at evaluating the coverage of the PcD within this canton and at assessing the impact of the PcD on care of patients with diabetes. METHODS/DESIGN: The cohort CoDiab-VD is a prospective population-based cohort study. Patients with diabetes were recruited in two waves (autumn 2011--summer 2012) through community pharmacies. Eligible participants were non-institutionalised adult patients (≥ 18 years) with diabetes diagnosed for at least one year, residing in the canton of Vaud and coming to a participating pharmacy with a diabetes-related prescription. Women with gestational diabetes, people with obvious cognitive impairment or insufficient command of French were not eligible. Self-reported data collected, included the following primary outcomes: processes-of-care indicators (annual checks) and outcomes of care such as HbA1C, (health-related) quality of life measures (Short Form-12 Health Survey--SF-12, Audit of Diabetes-Dependent Quality of Life 19--ADDQoL) and Patient Assessment of Chronic Illness Care (PACIC). Data on diabetes, health status, healthcare utilisation, health behaviour, self-management activities and support, knowledge of, or participation to, campaigns/activities proposed by the PcD, and socio-demographics were also obtained. For consenting participants, physicians provided few additional pieces of information about processes and laboratory results. Participants will be followed once a year, via a mailed self-report questionnaire. The core of the follow-up questionnaires will be similar to the baseline one, with the addition of thematic modules adapting to the development of the PcD. Physicians will be contacted every 2 years. DISCUSSION: CoDiab-VD will allow obtaining a broad picture of the care of patients with diabetes, as well as their needs regarding their chronic condition. The data will be used to evaluate the PcD and help prioritise targeted actions. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, identifier NCT01902043, July 9, 2013.

Hoitotiede

Hoitotieteen pääkokoelma sijaitsee Terveystieteiden osastokirjastossa, jossa painettu yleiskokoelma koostuu 790 nimekkeestä monografioita (painettujen monografiasarjojen osat ovat mukana luvussa). Hoitotiede-kokoelmasta yli 40 % (329 nimekettä) käsittelee käytännön hoitotyötä joko yleisesti (21 % / 168) tai jollakin erityisalueella (20 % /161). Erityisalueista suurimmat ovat geriatrinen hoitotyö (6 % / 42) ja psykiatrinen hoitotyö (4 % 35). Lähes kolmasosa kokoelmasta on yleisteoksia (27 % / 241) käsittäen mm. koulutusta (5 % /41), tutkimusta (11 % /86) ja hoitotyötä ammattina (6 % /51) tarkastelevaa kirjallisuutta. Hoitotyön etiikkaa, filosofiaa ja psykologiaa on kokoelmassa vajaa viidennes (17 % / 137). Hallintoa, esimiestehtäviä ja hoitotyön opetusta käsittelevää kirjallisuutta oli 5 % (43 nimekettä). Hoitotiede on käsikirjaston hyllyluokittelussa osana lääketiedettä. Hoitotieteen alueen nimekkeitä on käsikirjaston kokoelmasta 12 kappaletta, joista pääosa (8 kpl) oli sanakirjoja. Painettuja lehtiä on 8 nimekettä (Hoitotiede, Nursing Clinics of North America, Sairaanhoitaja, Terveydenhoitaja, Pro Terveys, Vård i Norden, Tutkiva hoitotyö, Spirium). Sähkökirjoja kokoelmassa on noin 50 nimekettä Ebrary-tietokannassa, 2 nimekettä NetLibrary-tietokannassa ja 2 nimekettä Taylor & Francis eBooks online -tietokannassa ja sähköisiä terveystieteen sanastoja 5 kpl (Hoidokki – hoitotyön asiasanasto, FinMeSH-asiasanasto, Medical Subject Headings (MeSH), Sosiaali- ja terveydenhuollon sanastoja (STAKES) ja Swedish MeSH). Verkkolehtiä kokoelmassa on noin 230 nimekettä (ISI Web of Knowledge Journal Citation Reports -tietokannan listaamista 36 nimekkeestä kokoelmissa on 86 % (31 nimekettä). Tietokantoja on 33, mm. lehtitietokanta Ebscohost Academic Search Premier ja viitetietokantoja mm. British Nursing Index, CINAHL (Ovid), EBM Reviews: Cochrane Database of Systematic Reviews, Medic, Medline (Ovid)ja PsycINFO (Ebsco).

Le développement des nāyikābhedas de la littérature sanskrite à la littérature braj : la naissance d'un genre

This article has as its aim to follow the development of a sub-genre called nāyikābheda s through the kāmaśātra s and alaṅkāraśāstra s of Sanskrit literature, Bhānudatta's Rasamañjarī , vernacular literature and the example of the Braj author Dev. Drawing on a few examples from the works of Dev, a skilled poet concerning the descriptions of the nāyikā s, we will see from where the poet takes his inspiration, how he transgresses genre boundaries and the way he creates typologies of women.