Orthopedist involvement in the management of clinical activities : a case study

Background The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. Methods We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. Results Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. Conclusions Beyond simply identifying the underlying dynamics of orthopedists’ involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients

Le FORUM, Vol. 35 No. 3

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The founder effect and deleterious genes

During the rapid growth of a population from a few founders, a single deleterious gene in a founder can attain an appreciable frequency in later generations. A computer simulation, which has the population double itself in early generations, indicates a lethal could attain a frequency of 0.1. Since deleterious recessive genes are eliminated from large populations at a very slow rate, variations in their frequencies in present major human populations may be due to the founder effect during earlier rapid expansion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37482/1/1330300107_ftp.pd

Do work exposures help explain musculoskeletal disorder work absence health inequalities?

International audienc

Vers un nouveau monde atlantique

À l’article 4 du traité signé à Paris le 10 février 1763 entre la Grande-Bretagne et la France, on peut lire que « Sa Majesté Très Chrétienne cède et garantit à sadite Majesté britannique, en toute propriété, le Canada avec toutes ses dépendances ». Vingt ans plus tard, de nouvelles négociations franco-britanniques, commencées en avril 1782, se terminent le 3 septembre 1783 par la signature du second traité de Paris, dans lequel la Grande-Bretagne reconnaît l’indépendance des États-Unis d’Amérique. Ainsi, en l’espace de deux décennies, ces deux traités délimitent un tournant majeur dans l’histoire de l’Amérique du Nord. Ils marquent l’aboutissement de plusieurs siècles de rivalités coloniales entre Français et Anglais en Amérique du Nord et annoncent le point de départ d’un « monde atlantique nouveau » dont les États-Unis deviendront le centre. Ce livre entreprend de dresser un inventaire de tous les aspects de cette période de conflits et de négociations : la guerre au xviiie siècle et la marine française, la diplomatie et l’art de la paix, les ambitions impériales françaises hors d’Amérique du Nord, le devenir des populations confrontées à de nouvelles lois et règles de vie : Canadiens, Amérindiens, Anglo-américains