927 resultados para inadequate post-operative pain management


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Whilst a consistent link between the adoption of human resource management (HRM) practices by organisations and their performance has been confirmed by numerous studies, there is a need for greater understanding of why such effects occur. Recently, the attention of researchers has shifted towards understanding the so-called ‘black box’ linking HRM and business performance. This study focuses on this area of research by testing processes through which HRM may affect performance, in particular the process of HR implementation, mediation mechanisms, and fit with internal and external boundary conditions. This research was based on a sample of 136 Post Office branches in the UK and investigated the role of HR implementation, employee attitudes and competitive environment. The study revealed that HR implementation, a climate for service, job satisfaction and effective organisational commitment predicted independent measures of economic and service performance in branches. Employee attitudes moderated the relationship between implemented HRM and service performance, and both job satisfaction and commitment were found to mediate relationships between a climate for service and service performance. Finally, relative levels of competition faced by branches moderated the relationship between employee attitudes and sales. The findings demonstrate how the process of HR implementation, interactions with employee attitudes and moderation by external competition all influence the impact of HR systems on service and economic performance outcomes. These results illustrate the need for greater attention to processes of internal and external fit within HRM research in order to develop theory relating to why HR systems affect performance.

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A hálózatos iparágakban, ahogy a postai szolgáltatásoknál is, a forgalomban lévő készpénz nagyméretű működőtőkét jelenthet. A Magyar Posta a levél- és csomagkézbesítésen kívül jelentős készpénzforgalmat bonyolít le: nyugdíjakat, segélyeket és készpénz-átutalási megbízásokat továbbít. A forgalom napi ingadozása a vállalat likvideszköz-igényét jelentősen meghatározza. A posta esetében a postahivatalok készpénzgazdálkodása jól működő hüvelykujjszabályokon keresztül történik, ezek a szabályok döntési teret hagynak a hálózat heterogén egyedi szereplőinek. Az egyedi készletezési viselkedést a vállalati működőtőke meghatározásakor figyelembe kell venni. A tanulmány az egyedi készletezési szokások modellezésére új módszertant ajánl, majd a viselkedésmintákat csoportosítva a pénzkészletezésnek, a vállalati működőtőke szintjének és a vállalati likviditási pozíciónak a kapcsolatát elemzi. / === / The cash in circulation within network industries such as post-office services can repre-sent a sizeable quantity of operating capital. The Hungarian Post Office, besides han-dling mail, handles a significant amount of cash turnover, forwarding pensions, welfare benefits, and cash orders. Fluctuation in the daily volume of these is a strong factor in determining the company's liquidity requirements. The management of cash in post of-fices is governed by rules of thumb that operate well; the regulations leave decision-making scope for the diverse individual actors in the network. Attention has to be paid to individual cash holding when determining the corporate operating capital. The study suggests a new methodology for modelling the individual cash-holding habits, and goes on to group the behaviour patterns by analysing the connection between cash holding, level of corporate operating capital, and corporate liquidity position.

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In 2013-15 there was a new type of post graduate training elaborated and piloted in Hungary at the Institute of Executive Training and Continuing Education (VTKI) within the National University of Public Service (NKE). Although the pilot financed by the State Administration Reform Operative Program (ÁROP) had not lacked the previously established attempts to include interactivity in the training, it was the first to observe and apply the actual principles of the European Union 2020 expressed in the threefold criteria of economic growth: smartness, sustainability and inclusiveness. All of them are represented by a pillar of the program like e-learning, class training and field training with the inclusion of local society. According to the objectives of the program there were at least 10 thousand attendees from the civil service sphere set as project indicators, so it has been a large scale training program that took place in 2014 in Hungary. The following article shows the innovations included in this new approach model of post graduate training civil servants.

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This paper assesses the status of pre-disaster risk management in the case of Turkey. By focusing on the period following the catastrophic August 17, 1999 earthquake, the study benefits from USAID’s Disaster Risk Management Benchmarking Tool (DRMBT). In line with the benchmarking tool, the paper covers key developments in the four components of pre-disaster risk management, namely: risk identification, risk mitigation, risk transfer and disaster preparedness. In the end, it will present three major conclusions: (i) Although post-1999 Turkey has made some important progress in the pre-disaster phase of DRM, particularly with the enactment of obligatory earthquake insurance and tightened standards for building construction, the country is far away from substantial levels of success in DRM. (ii) In recent years, local governments have had been given more authority in the realm of DRM, however, Turkey’s approach to DRM is still predominantly centralized at the expense of successful DRM practices at the local level. (iii) While the devastating 1999 earthquake has resulted in advances in the pre-disaster components of DRM; progress has been mostly in the realm of earthquakes. Turkey’s other major disasters (landslides, floods, wild fires i.e.) also require similar attention by local and central authorities.

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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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Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

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Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

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Abimbola Ayorinde’s PhD funded by the Medical Research Council. This study was funded by the British Pain Society (Mildred Clulow Award) and preparatory work by National Health Service Grampian.

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BACKGROUND: The unimodal approach of using pentazocine as post-cesarean section pain relief is inadequate, hence the need for a safer, easily available and more effective multimodal approach. AIM: To evaluate the effectiveness of rectal diclofenac combined with intramuscular pentazocine for postoperative pain following cesarean section. METHODS: In this double blind clinical trial, 130 pregnant women scheduled for cesarean section under spinal anesthesia were randomly assigned to two groups. Group A received 100mg diclofenac suppository and group B received placebo suppository immediately following surgery, 12 and 24h later. Both groups also received intramuscular pentazocine 30mg immediately following surgery and 6 hourly postoperatively in the first 24 h. Postoperative pain was assessed by visual analogue scale at end of surgery and 2, 12 and 24 h after surgery. Patient satisfaction scores were also assessed. RESULTS: One hundred and sixteen patients completed the study. Combining diclofenac and pentazocine had statistically significant reduction in pain intensity at 2, 12, and 24 hours postoperatively compared to pentazocine alone (p <0.05). No significant side effects were noted in both groups. The combined group also had significantly better patient satisfaction scores. CONCLUSION: The addition of diclofenac suppository to intramuscular pentazocine provides better pain relief after cesarean section and increased patient satisfaction.

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Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.

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International audience