Committee Staff Research Articles

Using Metadata to Design a Database-Driven Website

ABSTRACT After a review of the Kent State Libraries and Media Services Web site, a committee of librarians and staff gathered user feedback and developed a library-specific content management system (CMS) to make the move from a static HTML environment to database-driven design. This article focuses on the significant role of metadata in the CMS from the perspective of one of the site's architects and one of its content developers. This article includes figures and a biography for further reading. The work of the redesign was earlier described in a poster presentation for the 12th Annual ACRL conference.

Hospital-Physician Relations: Two Tracks And The Decline Of The Voluntary Medical Staff Model

Data from the most recent Community Tracking Study (CTS) interviews in twelve nationally representative metropolitan areas indicate that hospitals are increasingly employing physicians, particularly specialists. Nonemployed physicians are separating from hospitals passively by refusing to serve on medical staff committees or take emergency department call, and actively by creating specialized facilities, such as ambulatory surgery centers (ASCs), to compete for hospitals' most profitable services. Employment is more common and physician-owned ASCs are less common in consolidated hospital markets. The interviews also suggest other factors motivating physician employment by, or separation from, hospitals, and likely consequences of these trends.

Congress Benefits From Psychiatrist in Its Midst

Back to table of contents Previous article Next article Association NewsFull AccessCongress Benefits From Psychiatrist in Its MidstKen HausmanKen HausmanSearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0012aPsychiatrist Daniel Bober, D.O., has had an experience of which only a handful of his colleagues can boast. Invited to join the staff of U.S. Sen. Patty Murray (D-Wash.), Bober has been able to contribute directly to the development and advancement of mental health legislation as a Capitol Hill insider.Bober completed a 10-month stint as APA's 2008 Jeanne Spurlock Congressional Fellow earlier this year. The fellowship, now in its sixth year, provides an opportunity for residents and early career psychiatrists in the areas of child and/or minority mental health to learn about the legislative and public-policy processes from the inside, with the goal of preparing them to be mental health advocates in the future. Bober completed a residency in child and adolescent psychiatry at the Yale Child Study Center and a forensic psychiatry fellowship at the University of Massachusetts.Murray serves on several committees that have jurisdiction over health issues, including the ones that are responsible for the mental health parity bill and veterans' health concerns. Bober praised Murray as “a true champion of veterans and people with mental illness and, by virtue of her committee assignments, is able to put her interests in mental health to direct use.” He added that her positions on mental health issues made it easy for him to contribute his clinical training, experience, and knowledge.A particularly rewarding part of his Senate experience, he said, was meeting veterans of the Iraq and Afghanistan wars, as well as their families, at Walter Reed Army Medical Center, where many of the most seriously injured combat veterans are sent. Bober noted that he was able to help Murray and her staff interpret numerous studies of veterans' mental health and discuss sequelae of serving in a war zone. In addition, he said, after meeting with veterans' service organizations and veterans' families, he was better able to“ more clearly define the legislative priorities that we should focus on when trying to help veterans and their families.”Bober also had the opportunity to brief Murray prior to the confirmation hearing for James Peake, M.D., to be secretary of Veterans Affairs. After his confirmation, Peake was the keynote speaker at APA's Advocacy Day program.The reauthorization bill for the Substance Abuse and Mental Health Services Administration (SAMHSA) was another area on which Bober worked. “I participated in weekly working groups with the HELP [Health, Education, Labor, and Pensions] Committee staff to update and modify existing SAMHSA legislation to more clearly reflect the new challenges that we face in mental health and substance abuse treatment,” he said.The fellowship “was an experience I will never forget,” he stated, “and it has emboldened me to continue to serve those who may not have a voice and need someone to fight for them.”Information about the Jeanne Spurlock fellowship and APA's other minority fellowships is posted at<www.psych.org/Resources/OMNA/MFP.aspx>.▪ ISSUES NewArchived

Improving Access to Health Information in Rural South Carolina

Funded by the National Library of Medicine, a committee of local leaders and medical library staff improved access to health information in a poor, rural county of South Carolina with a large minority population. A needs assessment, Internet training, and community events involving high school students were key program components.

Achieving a balance – feast and famine

In 1986 a report by the UK health departments, the Joint Consultants Committee and chairmen of regional health authorities, Achieving A Balance ,1 proposed an integrated package of measures to achieve a gradual reform of hospital staffing in the interests of patients and doctors by reducing registrar numbers. The steering group, which emerged to implement these proposals, reflected a wide range of professional interests – royal colleges, the central committee on hospital medical services, the British Medical Association and its hospital junior staff committee, academic medicine and representatives of health authorities and the health departments.

Public-Academic Partnerships: Improving Care for Older Persons With Schizophrenia Through an Academic-Community Partnership

Public-Academic Partnerships: Improving Care for Older Persons With Schizophrenia Through an Academic-Community Partnership

Comissioning care.

The National Institute for Health and Clinical Excellence (NICE) has published six new guides to help NHS staff commission evidence based care for patients.

Lean Production and Labor Controls in the Chinese Automobile Industry in An Age of Globalization

AbstractThis article explores the changing workplace and labor-management relations in the Chinese automobile industry under the influence of globalization and China's market reform. It depicts the everyday working lives of Chinese autoworkers and the shop-floor dynamics of labor relations based on the author's intensive fieldwork at the seven major automobile assembly enterprises in China during 2004–2007.The main findings of this paper are that, in spite of the generalized lean production and homogenization of workplace experiences of Chinese autoworkers, two different models of labor controls have emerged in the Chinese auto industry: “lean-and-dual” and “lean-and-mean.” On the one hand, under the lean-and-dual regime, management adopts labor force dualism by using both formal contract workers and agency workers on production lines side by side, which leads to a “hybrid” factory regime that combines both “hegemonic” and “despotic” elements. Hegemonic relations have been established between management and formal workers based on high wages, generous benefits, better working conditions, and relatively secure employment for formal workers, while “despotic” labor control characterizes the conditions for temporary agency workers with lower wages and insecure employment.On the other hand, the lean-and-mean type of auto firms adopt a high-wage, high-turnover strategy of lean production without the promise of job security to their entire workforce. The interventionist roles of the Chinese central and local states in regulating labor relations and the roles of managerial staff, factory unions, and factory party committees in building hegemonic consent among workers in the auto industry are also explored. The paper concludes by discussing the potentials and limits of Chinese autoworkers and the likely roles they are to play in the evolution of labor relations under China's current market transition and globalization.

The contribution of volunteers to a successful community‐orientated tuberculosis treatment centre in an urban setting in Nepal

The purpose of the paper is to show that community involvement is a successful way of overcoming certain barriers to the successful management of the current tuberculosis epidemic, namely delayed presentation and non-completion of treatment. Volunteers are an important resource for engaging with the community. This research, conducted in an urban TB treatment centre in Nepal, seeks to investigate the motivations of TB volunteers, and how these motivations can be increased to involve volunteers, and the community, in fulfilling their maximum potential in delivering successful TB treatment programmes. Semi-structured interviews were carried out with 26 TB volunteers, followed by volunteer discussion groups. Topics covered included: detailed accounts of the volunteers' many and varied roles; motivations - how they initially became involved and why they continue to be involved; incentives for volunteering; problems they have encountered; family and friends' attitudes to their volunteering, and the future of TB volunteering. The findings show that the TB volunteers are involved in many important roles. Volunteers initially became involved, having been asked or informed about the programme by area committee members, staff or friends. Most were also involved in other voluntary work. This paper gives recommendations for volunteer programmes in developing countries including: sustained communication and contact between volunteers and the organisation; volunteer programmes based in a centre with an established community focus; flexibility of time commitment; regular recruitment drives for volunteers from different generations and status levels; and the use of training as a possible incentive for volunteering.

The U.S. Congress and the Institutional Design of Agencies

Theories of agency design maintain that lawmakers impose requirements on how bureaucratic agencies make policy decisions, preventing those agencies from undermining lawmakers' political and policy goals. Empirical support for these theories is limited, however, by the difficulty of measuring critical variables hypothesized to influence the use of this tool of political control. For this study, I employed a methodology particularly well suited, but not previously employed, to study variance in the use of agency‐design provisions: interviews with congressional committee staff. Staffers' responses support several theories, cast doubt on one explanation, and point to nuances in other explanations of agency design.

A year of rapid changes

I write to you again, near the middle of my term as your president. As I predicted last October in these pages, this is a year of rapid change for SEG and of rapid realization of our global agenda. This has required extensive travel by your Executive Committee and business staff despite our resolve, as I described to you in October, that much of the international business of the Society should occur over the telephone and the Internet. This is perhaps inevitable, considering our rapidly growing membership (>28 000) and our global demographics (>60% non-U.S. members).

Complications of Laparoscopic Living Donor Nephrectomy and Their Management: The UCLA Experience

Because of the shortage of cadaveric kidneys, laparoscopic living donor nephrectomy (LLDN) has become a more common option for transplant recipients. The complication rate has been reported at 6.4% to 16.5%. We present the initial University of California, Los Angeles experience with the complications and their management during LLDN. From January 2000 to December 2005, a single surgeon performed 300 consecutive LLDNs at our institution. A committee of urologists, nephrologists, and support staff approved each donor before surgery. After LLDN was completed, the patients received 30 mg of ketorolac intravenously every 6 hours until discharge. We reviewed the intraoperative and postoperative complications and their management at our institution. Three patients required open conversion, for an overall conversion rate of 1%. Two of the three conversions were a result of a major vascular complication (0.6%). The first major vascular complication resulted from an endovascular stapler malfunction during transection of an accessory left renal artery. The second vascular complication was a Veress needle injury to the left common iliac artery. Three postoperative major complications (1%) occurred, including 1 case of rhabdomyolysis and 2 cases of chylous ascites. Also, 7 minor postoperative complications (2.3%) occurred. Our overall complication rate was 4%. No patients died, and the mean hospital stay was 1.1 days. Our results have shown that LLDN is a safe procedure associated with low morbidity and a quick recovery. Appropriate patient selection is essential to ensure the safety of this procedure.

The Consequences of Expanded Oral Surgery Scope of Practice in Richmond, Virginia

On March 25, 2001, the Commonwealth of Virginia changed the definition of dentistry and expanded the scope of practice of single-degree oral surgeons to include cosmetic procedures previously restricted to physicians. The Board of Dentistry established standards for practice under the new scope. Suggestions made by the Board of Medicine regarding these standards were disregarded. The authors reviewed the events and consequences surrounding the redefinition of dentistry. Events between January 1, 2000, and January 1, 2005, were reviewed. Data were gathered from public records and Internet sites, reports of physicians practicing cosmetic surgery in the Richmond metropolitan area, hospital staff committees, and medical societies. Physicians in Virginia were ill prepared to participate in the legislative process. Physicians treating patients unhappy with the results of cosmetic procedures by local oral surgeons described errors in preoperative diagnosis, failure to perform the appropriate surgical procedure, or inability to perform the appropriate procedure properly. A survey of cosmetic surgeons showed that 50 percent had cared for similar patients. There was no evidence to demonstrate a significant economic effect from increased competition by oral surgeons. The authors were unable to show that oral surgeons practicing in the Richmond metropolitan area are able to match the community standard for providing care. The authors continue to regard scope of practice as an educational issue. On the basis of their review, it is not clear that standards promulgated by the Virginia Board of Dentistry have thus far produced surgeons capable of matching the Richmond community standard for cosmetic surgery.

Why AMDA Is Still on Sidelines Over AEDs

Why AMDA Is Still on Sidelines Over AEDs

Renovascular Impedance Correlates with Portal Pressure in Patients with Liver Cirrhosis

To prospectively evaluate, in patients with liver cirrhosis, the correlation between the renovascular impedance measured by using color flow and pulsed wave Doppler ultrasonography (US) and the portal pressure measured by using the hepatic venous pressure gradient (HVPG). The study was approved by the senior staff committee (comparable to institutional review board) of the university hospital, and written informed consent was obtained from all patients. Thirty-one patients with cirrhosis (22 men, nine women; mean age, 57.6 years +/- 8.8 [standard deviation]) and esophageal varices were consecutively enrolled in the study. Having fasted, the patients underwent color flow and pulsed wave Doppler US of the right interlobar renal artery (RRA) and the left interlobar renal artery (LRA). The resistance index (RI) and pulsatility index (PI) were determined. On the same day, with fluoroscopic guidance, a 5-F balloon-tipped catheter was advanced, via the right basilic vein, into the right hepatic vein; HVPG was calculated as the difference between the wedged and free hepatic pressures. All measurements were performed in triplicate, and permanent tracings were recorded. Correlations were made by using the Pearson test. The positive predictive value of renovascular impedance for detection of severe portal hypertension was determined. Mean RI and PI values were 0.67 +/- 0.07 and 1.21 +/- 0.25, respectively, for the RRA, and 0.68 +/- 0.07 and 1.24 +/- 0.26, respectively, for the LRA. All patients had portal hypertension (mean HVPG, 19.3 mm Hg +/- 4.7; range, 11.5-33.5 mm Hg). Neither portal pressure nor renal impedance correlated with Child-Pugh score for cirrhosis. Renal artery impedance indexes correlated with the HVPG (for RRA RI: R = 0.424, P = .03; for RRA PI: R = 0.402, P = .04; for LRA RI: R = 0.352, P = .05; for LRA PI: R = 0.393, P = .02). A higher-than-normal renal impedance had a high positive predictive value (RRA RI and PI, 100%; LRA RI, 92%; LRA PI, 84%) for the detection of severe portal hypertension. Renovascular impedance had a direct correlation with HVPG.

The Importance of a Physician Champion in Implementing Practice Change

ISSUE: In Surgical Trauma ICU (SICU), the rate of central line related bloodstream infections (CRBSI), as defined by CDC, was at or above the National Nosocomial Infection Surveillance System(NNIS) mean for several sucessive quarters. There is strong evidence that use of full sterile barriers and chlorhexidine skip prep during insertion of central lines reduces the risk of infection. In an effort to facilitate best practices, a “Barrier Kit” was designed with all necessary supplies and was to be provided to each physician by nursing personnel assisting. These are available in all clinical units. A Central Venous Catheter Insertion form was created to monitor several aspects of central line insertion including use of maximum sterile barriers and chlorhexidine skin prep. These were designed to allow physicians to use them as the procedure note as well. If the physician chose to document the procedure elsewhere, the nurse could complete monitoring information. To facilitate ussage, Materials Management attached a form to each central line kit before delivery to patient care units. Medical Staff and nursing were educated. Compliance with completion of the form was poor and documentation of appropriate barriers and skin prep was less than 100% on completed forms. PROJECT: In April, 2005, the new medical director of SICU accepted the challenge of reducing this infection rate. First, she created a policy on the insertion procedure and presented it for approvel by appropriate medical staff committees. Included in the procedure, nursing personnel assisting the physician were to remind the physician inserting the line if policy was not being followed and complete the form if the physician chose not to. In SICU, if a physician didn't comply, she was to be notified and would discuss policy with that physician. Medical Directors of all units were encouraged to adopt a similar procedure. In SICU a cart was stocked with frequently used central line kits and all needed supplies. She supported a trial of a timed release chlorhexidine gluconate dressing in SICU, and when complete, use of the product on all central lines in the facility. RESULTS: In the four preceeding quarters, the average CRBSI rate in surgical ICU had been 6.8%. In the two quarters following her intervention, there were no CRBSI in the unit. LESSONS LEARNED: Physician involvement and willingness to provide feedback to other physicians is vital in process improvements that require a change in physician practice.

The Impact of Context on Readings of Teaching Portfolios

This study explored the experiences of readers of portfolios created in either formative or summative micro‐contexts. Interviews were conducted with three readers in the formative context (mentors on a graduate certificate in higher education programme), and three readers in the summative context (senior staff committee members reading portfolios created for promotion or confirmation). As expected, thematic analysis of the interview transcripts showed discernible differences in the ways developmental and summative portfolios were read. However, the parallels in the issues raised suggested the strong influence of the macro‐context—an institution with a policy providing for the summative use of teaching portfolios—on the way portfolios in both micro‐contexts are read. Cette étude explore les expériences de lecteurs de portfolios produits dans des micro‐contextes soit formatifs, soit certificatifs. Des entretiens ont été effectués auprès de trois lecteurs dans un contexte formatif (tous mentors dans le cadre d’un programme de certificat postgradué en enseignement supérieur) et de trois lecteurs dans un contexte certificatif (tous membres seniors de comités de personnel évaluant les portfolios créés en vue d’une promotion ou d’une confirmation). Tel qu’envisagé, une analyse thématique de la transcription des entretiens tend à démontrer des différences perceptibles dans la façon selon laquelle les portfolios visant le développement et les portfolios visant la certification ont été lus. Toutefois, les problèmes relevés parallèlement laissent croire à une influence considérable du macro‐contexte—une institution dont les politiques favorisent l’usage certificatif des portfolios—sur la façon selon laquelle les portfolios sont lus dans leur micro‐contexte.

005—The Effectiveness of Staff Nurse Interview Committee on Retention/Recruitment of Registered Nurses

Background: Our hospital uses unit-based hiring practices for all clinical staff, including registered nurses, clinical assistants, clinical technicians, and unit secretaries. We also operate off of a Shared Governance Leadership Model. Prior to the inception of our Staff Nurse Interview Committee, the interviewing and hiring of all new staff were the responsibility of our clinical director. Our director would receive applications from the Human Resources Department and would schedule the interviews as her schedule permitted. On the day of the interview, she would request a member of the Shared Governance Committee to assist her with the interview. This created several problems. First, on some days, there were two to three interviews scheduled in a 12-hour shift. These interviews took floor nurses (who were members of the Shared Governance Committee) away from their patients, which required fellow staff nurses to cover their patients. This led to a decrease in continuity of care for the patients, as well as putting stress on the entire staff having to cover extra patients for up to 3 hours out of the shift. Second, members of the Shared Governance Committee had no experience or training in interviewing and therefore did not know what questions to ask or what to assess. This led to staff feeling uncomfortable with the hiring process.

Fascinating Sessions in Exciting City Promise Not-to-Be-Missed Meeting

Fascinating Sessions in Exciting City Promise Not-to-Be-Missed Meeting

Public Affairs Office

Public Affairs Office