No / The Mid Staffordshire scandal is a salutary lesson that highlights unacceptable standards of poor care of patients by medical and nursing practitioners. The Francis report (2013) made 290 recommendations and a legal duty to enforce a duty of openness and transparencies has been prioritised. Fischer and Ferlie (2013) argue that rules-based regulation eroded values-based self-regulation, producing professional defensiveness and contradictions that undermine, rather than support, good patient care. The role of managers and clinical leaders will be crucial in achieving positive changes in practice; however, the return of autonomy to the practitioners remains central to re-establishing both public and professional confidence.

No

No

No / Expecting ambulance clinicians to dependably differentiate the life-threatening organ dysfunction caused by sepsis from an inflammatory response to a non-infectious aetiology, relying upon vital signs and a physical examination of the patient alone, must be considered unrealistic. Although lactate measurement has been integrated into numerous prehospital sepsis screening tools, it is not yet measured routinely within UK ambulance services. Research has generally focused on whether handheld point-of-care lactate measurement devices are as accurate as laboratory analysis of venous or arterial samples. The weight of literature has concluded negatively in relation to this. However, there is potential for handheld devices to be used independently to monitor trends in lactate elimination or accumulation to inform decisions on the efficacy of prehospital interventions, or simply to report categorical data in terms of whether lactate levels are elevated or not. This offers UK paramedics the opportunity to improve sepsis care through the enhanced assessment of risk and acuity, the identification of patients with cryptic shock, more aggressive fluid resuscitation and advanced notification to receiving units.

Now treatment of paediatric malignancies is capable of extending the life of children with cancer, there is an increase move toward investigating the quality of life and needs experienced by children and young people diagnosed with cancer. Although earlier investigations examined differences in adjustment among children with cancer and their healthy counterparts, the results of these studies were inconclusive, and there is a considerable lack of studies of the psychological wellbeing of children in the Middle East. In this thesis, two central themes are examined: first, the psychological status of children and young people with cancer in Jordan as indicated by their quality of life and symptoms of anxiety and depression; second, patterns of communication of cancer diagnosis in families caring for children with cancer, to develop a better understanding of Jordanian children's experience with cancer. Fifty eight children and young people and their mothers attending the paediatric oncology services in Jordan participated in this study. In an attempt to explore their psychological wellbeing in greater detail, the study involved another group of fifty six children and young people with chronic illness and a control group of sixty four healthy peers. Three assessment tools were translated into Arabic, piloted and tested for reliability and validity at a number of schools all over Jordan. Then, the tools were administered to the three groups. Participating children and young people were asked to complete self-reported depression and anxiety scales, as well as an instrument to measure the quality of life. Thirty seven mothers of children and young people with cancer completed a self-report measure of stress, anxiety and depression. Mothers were also asked during the interview about the amount of information they shared with their children and their satisfaction with the way the cancer diagnosis was communicated to their children. The results showed that children and young people with cancer function at a very similar level to children and young people without cancer. There were no significant differences on the measure of depression, between the scores of children and young people with cancer, chronic illness and the healthy group. On the quality of life measure, the healthy group scored significantly higher than the children and young people in the other two groups. At the same time, the healthy group scored significantly higher on the anxiety measure. It is suggested that children and young people with cancer are able to cope with their illness because they utilise defensiveness as an adaptive mechanism, since higher scores for defensiveness were associated with lower scores for child-reported depression and anxiety in this group and a significant difference in the level of defensiveness exists between the three groups. This supports previous findings. In addition to these results, this thesis shows that exploring children's and young people's psychological distress in a culture where this is not recognised provides the researcher with a number of concerns. The influence of Arab culture and religion on Jordanian children and young people, the communication patterns of cancer diagnosis, the wisdom of their elders, and the importance of their family result in reluctance to show emotion or to question decisions made on their behalf. The results of quantitative findings and contextual information from the interviews in this thesis go some way to demonstrate the impact that cancer can have on both the patient and family in the Jordanian culture. The child's quality of life can be compromised by the illness. Moreover, communication of the diagnosis of illness has a detrimental effect on both child's and mother's psychological wellbeing.

Typescript, etc. / Digitized by Kansas State University Libraries

Call number: LD2668 .T4 1934 G51

<p> Shared leadership paradigms are becoming more popular in organizations because of the increased responsibilities placed on leaders within health care organizations. Researchers have conducted little research on how individuals on leadership teams perceive their role in engaging with others in their team. The qualitative phenomenological hermeneutic study involved examining how radiology administrators in Northern California describe their lived experiences on shared leadership teams, with an emphasis on their perceptions of team productivity and trust. The conceptual framework for the study included shared leadership theory, which scholars have noted is still a new field of study. Seven research participants representing from three to 18 years of experience as radiology managers with experience serving on shared leadership teams. From the five initial questions and sub questions, the analysis involved breaking down the responses into 175 separate areas of exploration. In addition to the demographics of the groups and types of teams served on, four themes emerged from this data: lived experience on shared leadership teams, knowledge and skills learned from shared leadership teams, key factors affecting team performance on shared leadership teams, and the effect of diversity on shared leadership teams. The implications of the research to leadership are that radiology managers may gain a better understanding of when to use shared leadership and how to best staff the teams to support organizational work, and how to improve shared leadership team dynamics.</p>

<p> The LASIK market in Orange County, CA is extremely saturated, with the exception of the city of Laguna Niguel. This business plan proposes the creation of The LASIK Experts in Laguna Niguel to fulfill the need for such a LASIK center within the city. Based on the detailed financial projections prepared by the company&rsquo;s management, it is estimated that a bank loan is necessary to begin the company&rsquo;s operations successfully. The funds will be used to provide the initial working capital for the first three fiscal years. </p>

The brain requires a continuous supply of oxygen and even a short period ofreduced oxygen supply risks severe and lifelong consequences for theaffected individual. The delivery is a vulnerable period for a baby who mayexperience for example hypoxia (lack of oxygen) that can damage the brain.Babies who experience problems are placed in an intensive care unit wheretheir vital signs are monitored, but there is no reliable way to monitor thebrain directly. Monitoring the brain would provide valuable informationabout the processes going on in it and could influence the treatment and helpto improve the quality of neonatal care. The scope of this project is todevelop methods that eventually can be put together to form a monitoringsystem for the brain that can function as decision-support for the physician incharge of treating the patient.The specific technical problem that is the topic of this thesis is detection ofburst and suppression in the electroencephalogram (EEG) signal. The thesisstarts with a brief description of the brain, with a focus on where the EEGoriginates, what types of activity can be found in this signal and what theymean. The data that have been available for the project are described,followed by the signal processing methods that have been used for preprocessing,and the feature functions that can be used for extracting certaintypes of characteristics from the data are defined. The next section describesclassification methodology and how it can be used for making decisionsbased on combinations of several features extracted from a signal. Theclassification methods Fisher’s Linear Discriminant, Neural Networks andSupport Vector Machines are described and are finally compared with respectto their ability to discriminate between burst and suppression. An experimentwith different combinations of features in the classification has also beencarried out. The results show similar results for the three methods but it canbe seen that the SVM is the best method with respect to handling multiplefeatures.