Surgical results: A justification of the surgeon selection process for the ACAS trial

AbstractPurpose: The selection of surgeons to participate in a prospective randomized trial comparing the efficacy of a surgical method with medical management is critically important because it will have a direct impact on the outcome of the study and the future use of the operation. We report the success of the method used for selecting surgeons who participated in the Asymptomatic Carotid Atherosclerosis Study (ACAS) by examining the surgical morbidity and mortality rates and the outcome of the study.Methods: A Surgical Management Committee established criteria for auditing surgeons who wished to participate in the study. The parameters included a minimum performance of at least 12 carotid endarterectomies (CEA) per year and an audit of each surgeon's last 50 consecutive CEAs with required documentation of a combined neurologic morbidity and mortality rate of <3.0% for asymptomatic patients and <5.0% for all indications including symptomatic patients.Results: As of February 1991, 164 surgeons from 48 medical centers applied for ACAS participation. One hundred seventeen were approved, and their aggregate experience of 5641 operations yielded a combined neurologic morbidity and mortality rate of 2.3% for asymptomatic and symptomatic patients combined. The morbidity and mortality rate for CEA on asymptomatic patients was 1.7%. These surgeons, plus those recruited after February 1991, became investigators in the ACAS trial and were responsible for the surgical care of 825 patients who were randomized to the surgical arm. Seven hundred twenty-four patients actually underwent CEA. One patient (0.14%) died and ten patients (1.38%) had strokes within the 30-day perioperative interval, for a combined stroke or death incidence of 1.52%. The 5-year stroke event rate in the surgical group (including perioperative morbidity and mortality rates) was 5.1%, compared with 11% of patients treated medically, yielding a relative risk reduction of 53% in favor of surgery ( p =0.004).Conclusions: A method for selecting surgeons for participation in the ACAS trial was successful in providing low perioperative morbidity and mortality rates. This materially influenced the outcome of the study in favor of CEA. (J VASC SURG 1996;23:323-8.

Between consultation and collective bargaining? The changing role of non-union employee representatives: a case study from the finance sector

This article reviews the roles and activities of non-union employee representatives (NERs) acting as forum officers in a large Internet finance company. Currently there is little academic coverage concerning NERs in this sector, including their contributions to employment relations, their motivations and orientations towards representative role and activities, or relations with management and fellow employees. An important precondition to answering one of the main questions asked of NERs is whether such representation constitutes the foundation of some nascent trade unionism, or whether by acting as forum representatives, they are positioning themselves to support management agendas and outlook? The range of data from this article's longitudinal case study, indicating time usage including individual and collective representation, suggests that NERs allegiances and roles remain ambiguous, existing as they do in the intersection between consultation and collective bargaining. An important factor may be their capacity for independent action and independence from senior management

Containing, embracing and hyper-activating Britishness: British-based foreign-owned firms

There are in the UK ownership forms different to the characteristics of Britishness – British-based foreign-owned firms where dominant owners may have differentiated control interests. These may contain, that is, override, national institutional characteristics embedded in a particular national capitalism. Accordingly, separating the agency of these firms from presumed business system structures may reveal how diverse patterns of firm ownership – those associated with British-based foreign-owned firms – can inform dynamic ownership developments in British capitalism which contain and hyper-activate Britishness. The article theorizes British-based foreign-owned firms and provides empirical detail on how ownership characteristics influence financial commitment and strategic control in 10 of these firms

Workplace violence experienced by nursing students: A UK survey

© 2016 Elsevier Ltd. Aims: To appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies universities can implement to successfully manage the impact. Background: Workplace violence is defined as a violent act(s) directed toward workers and can include physical, psychological or verbal behaviour. It is prevalent in nursing and causes victims work-based stress that can affect not only the individual but also the quality of care. Similar negative experiences amongst students can have a direct impact on the development of future professional skills. Design: This study employed a cross-sectional survey design. Questions were uploaded in the format of a commercial internet survey provider (SurveyMonkey.com) and distributed across a sample of nursing schools in the UK. The survey was voluntary and employed a validated tool to assess workplace violence and was based on a similar study in Australia. The number of respondents was 657. This paper reports on the quantitative results. Findings: Nearly half of the students (42.18%) indicated they had experienced bullying/harassment in the past year while on clinical placement. One-third (30.4%) had witnessed bullying/harassment of other students and 19.6% of incidents involved a qualified nurse. The unwanted behaviours made some students consider leaving nursing (19.8%). Some respondents said the standard of patient care (12.3%) and their work with others (25.9%) were negatively affected. Conclusions: Workplace violence can influence nursing students' attitude toward the profession and their level of satisfaction with the work. Whilst it was reassuring to note that the majority of the participants knew where/how to report, only one fifth had actively reported an episode of bullying/harassment. Current students are the nurses and leaders of the future and have a key role in shaping the culture of generations to come. Universities and clinical providers need to work together to reduce the incidence and impact of workplace violence in order to improve the culture of practice

Women take care and men take charge’: The case of leadership and gender in the Public and Commercial Services Union

This article presents the findings of a case study that aimed to understand the specific leadership styles that are valued by women and men lay representatives in the Public and Commercial Services (PCS) union and to determine the gendered implications for increasing women’s leadership and representation in trade unions. Survey responses from PCS lay representatives (reps) show the majority of women and men agreed that the leadership style they value, and makes a good union leader, is post-heroic (communal) leadership. This approach is associated with leadership characteristics such as being helpful, sensitive, and kind and are generally practised by women. This contrasts with male union leaders who are associated with a traditional, heroic (agentic) leadership style characterised by confidence, self-reliance, and decisiveness. Although some differences exist that highlight gender issues, both women and men lay reps have positive attitudes towards increasing women’s representation and participation in union leadership

Applying Budd's model to partnership

Over the last decade, the notions of workplace partnership and labour-management cooperation have resulted in distinctive and vociferous debates regarding forms of employee voice in the UK. It is proposed that there is a need to reconsider how we actually evaluate both the process and outcomes of partnership. This article reports on detailed case studies conducted in three diverse banking organizations in order to understand more about the process and outcomes of partnership. The study then applies the 'efficiency, equity, voice' framework developed by Budd, which has not been widely employed in industrial relations research. Accordingly, the article examines if and how partnership contributes to the balancing of efficiency, equity and voice. Judged in this light, the case studies demonstrate various degrees of success in terms of the extent to which partnership has facilitated voice and promoted more considered decision-making, for both management and employees. The article also demonstrates the usefulness of the Budd framework as a device in analysing employment relations processes and outcomes

Legitimisation strategies and managerial capture: a critical discourse analysis of employment relations in Nigeria

YesIrrespective of the fundamental role of legitimacy in industrial relations as well as social and organisational life, little is known of the subtle meaning-making strategies through which organisational concepts, such as employment relations and engagement, are legitimised in modern world of work, particularly in developing countries such as Nigeria, which results in managerial capture. As a result, this paper explores the discursive legitimisation strategies used when making sense of employment relations in Nigeria’s conflictual, non-participatory employment relations terrain. Relying on Leeuwen’s (1995) legitimisation strategies, critical discourse analysis (CDA) and call by Bailey, Luck & Townsend (2009) and Legge (1995) to widen employment relations discourse, we explore interview, focus group and shadow report data, and distinguish and analyse five legitimisation strategies. The strategies include authorisation, moralisation, mythopoesis, rationalisation, and management. Therefore, we contend that while these specific legitimisation strategies appear in separate data source, their recurrent manifestation and application underscores legitimising discourse of managerial capture in Nigeria’s employment relations