A critical perspective on organisational development and patient safety in Austria.

Contrary to the international trend of building Critical Incident Reporting Systems (CIRS) into national health systems there is no national CIRS in Austrian hospitals. In response to this lack of a national policy the Austrian Association for Gynaecology and Obstetrics (OEGGG) has started an initiative enabling Women Hospitals in Austria to join a voluntary international online CIRS. This study critically addresses the problem of preventable error leading to patient harm and investigates the contribution that CIRS, arguably one key element in the new patient safety movement, may have so that fewer patients die. This is necessary as progress in patient safety has been much slower than anticipated, despite the patient safety revival around the year 2000, increasing attention and numerous initiatives. Moreover there is little systematic documentation and contemporary knowledge about the implementation, management, and effect of CIRS in health care.This study critically investigates this gap from a critical ethnographic perspective and provides an in-depth account of CIRS in an Austrian context. The study uses interviews, a questionnaire, and fieldwork observation over a period of two years at one Women Hospital in Vienna. Interviews and questionnaire are used to assess the organisation and these data provide ground for subsequent critical ethnographic observation. The fieldwork observation in the hospital is used to illustrate ways in which this type of research can contribute to the growth of knowledge on managerial (non-clinical) aspects of patient safety. Observational studies can serve to identify latent managerial system vulnerabilities and leverage points that can aid the identification, development and implementation of overall system improvements. In addition a continuous in-depth literature review is being employed.Findings suggest that the current hospital organisation is ill resourced in implementing new patient safety strategies and effectively identifying and addressing critical incidents. In particular the study identifies latent managerial factors that complicate the performance of health care professionals and potentially contribute to adverse outcomes. It suggests that the 'systems approach' to error in health care currently focuses too much on core medical tasks and a principal separation between clinical and non clinical aspects of service provision needs to be made. Key contributions emanating from this research are a clinical / non-clinical patient safety continuum model, a patient safety framework, three phases of CIRS operationalisation, the research method employed, as well as the notion that different research ethics in different health systems require more careful interpretation of research contributions. In addition the continuous literature review reveals that one of the key arguments of the new patient safety movement, the high number of preventable errors leading to death in health care, is incorrect. This is critical as it does not allow channelling limited resources to where they are most needed. The study emphasises the need for more research in this subject area and more organisational support in health care organisations

Free fatty acids link metabolism and regulation of the insulin-sensitizing fibroblast growth factor-21

OBJECTIVE—Fibroblast growth factor (FGF)-21 improves insulin sensitivity and lipid metabolism in obese or diabetic animal models, while human studies revealed increased FGF-21 levels in obesity and type 2 diabetes. Given that FGF-21 has been suggested to be a peroxisome proliferator–activator receptor (PPAR) –dependent regulator of fasting metabolism, we hypothesized that free fatty acids (FFAs), natural agonists of PPAR, might modify FGF-21 levels. RESEARCH DESIGN AND METHODS—The effect of fatty acids on FGF-21 was investigated in vitro in HepG2 cells. Within a randomized controlled trial, the effects of elevated FFAs were studied in 21 healthy subjects (13 women and 8 men). Within a clinical trial including 17 individuals, the effect of insulin was analyzed using an hyperinsulinemic-euglycemic clamp and the effect of PPAR activation was studied subsequently in a rosiglitazone treatment trial over 8 weeks. RESULTS—Oleate and linoleate increased FGF-21 expression and secretion in a PPAR-dependent fashion, as demonstrated by small-interfering RNA–induced PPAR knockdown, while palmitate had no effect. In vivo, lipid infusion induced an increase of circulating FGF-21 in humans, and a strong correlation between the change in FGF-21 levels and the change in FFAs was observed. An artificial hyperinsulinemia, which was induced to delineate the potential interaction between elevated FFAs and hyperinsulinemia, revealed that hyperinsulinemia also increased FGF-21 levels in vivo, while rosiglitazone treatment had no effect. CONCLUSIONS—The results presented here offer a mechanism explaining the induction of the metabolic regulator FGF-21 in the fasting situation but also in type 2 diabetes and obesity

HRM and workplace spirituality: some thoughts, notes and observations

The topic of spirituality and faith in the workplace is generating increasing interest among numerous stakeholders: business leaders, workers of all ranks, labour union representatives and academic researchers. Despite the challenges and opportunities presented by an array of spiritual and religious issues in the workplace, people management scholars have been relatively slow engaging in this upcoming topic. The aim of the paper is to identify, document, and analyze those scholarly sources where HRM and workplace spirituality, religion included, have been engaged in academic discourse and in documented practice. The article presents results of a keyword search in the 2013 Handbook of Faith and Spirituality in the Workplace (Neal, 2013). It identifies four distinct areas of HRM engagement with workplace spirituality: legal and equal employment opportunity issues; leadership and managerial spirituality; spiritual development programs; and sourcing & recruitment. Based on our review and analysis of the literature we argue that an explicit link between HRM and workplace spirituality has been demonstrated. More research is necessary to further our understanding on the role of HRM in workplace spirituality

Материалы к познанию Ostracoda Чёрного моря

Increased geographical mobility, improved medical treatment, and prolonged life expectancy have changed the way of life for older persons and their next of kin. This chapter discusses intergenerational care, mainly from the next of kin’s point of view, when an older family member and the next of kin live far from each other. The study is based on my—the author’s—autoethnographic account of the experience after my father suffered a stroke a few years ago. Inspired by Ellis et al. (2011, p. 392), who stated that autoethnography may ‘analyse personal experience in order to understand cultural experience’, I use my father’s and my own experiences to analyse how geographical distance and serious illness impact intergenerational care and kinship. While I argue that intergenerational care across geographical distance creates certain vulnerabilities, this specific situation also enables and enacts kinship relations. The study focused on practical support, emotional relations, and communication technologies, and their limitations when illness hits and life changes. It also adds to our understanding of aging, illness, and care across vast geographical distances. I claim that the autoethnographic approach accommodates the subjectivity, emotions and first-hand experiences between the older person and the next of kin. This geography of intergenerational care provides new knowledge about an experience, influencing the later years, for an increasing number of individuals and service-providing municipalities, especially in regions marked by outmigration and high youth mobility