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Article

George Rust, Morna Gailor, Elvan Daniels, Barbara McMillan‐Persaud, Harry Strothers and Robert Mayberry

The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic…

Abstract

Purpose

The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low‐income patients.

Design/methodology/approach

The paper suggests a primary care process re‐design, using point of care finger‐stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit.

Findings

The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent (p=0.40, n=106). For the 69 patients who had both pre‐ and post‐intervention results, HbA1c levels decreased significantly from 8.55 to 7.84 (p=0.004, n=69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face‐to‐face visit with lab results available, occurred for only 68.6 percent of elevated HbA1c levels before the intervention, vs. 100 percent post‐intervention (p<0.001). Only 28.6 percent of patients with HbA1c levels >8.0 had their regimens intensified in the pre‐intervention phase, compared with 53.8 percent in the post‐intervention phase (p=0.03).

Research limitations/implications

This was a pilot‐study in one urban health center. Larger group‐randomized controlled trials are needed.

Practical implications

The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control.

Originality/value

This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes.

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

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Book part

Paul Paolucci, Micah Holland and Shannon Williams

Machiavelli's dictums in The Prince (1977) instigated the modern discourse on power. Arguing that “there's such a difference between the way we really live and the way we…

Abstract

Machiavelli's dictums in The Prince (1977) instigated the modern discourse on power. Arguing that “there's such a difference between the way we really live and the way we ought to live that the man who neglects the real to study the ideal will learn to accomplish his ruin, not his salvation” (Machiavelli, 1977, p. 44), his approach is a realist one. In this text, Machiavelli (1977, p. 3) endeavors to “discuss the rule of princes” and to “lay down principles for them.” Taking his lead, Foucault (1978, p. 97) argued that “if it is true that Machiavelli was among the few…who conceived the power of the Prince in terms of force relationships, perhaps we need to go one step further, do without the persona of the Prince, and decipher mechanisms on the basis of a strategy that is immanent in force relationships.” He believed that we should “investigate…how mechanisms of power have been able to function…how these mechanisms…have begun to become economically advantageous and politically useful…in a given context for specific reasons,” and, therefore, “we should…base our analysis of power on the study of the techniques and tactics of domination” (Foucault, 1980, pp. 100–102). Conceptualizing such techniques and tactics as the “art of governance”, Foucault (1991), examined power as strategies geared toward managing civic populations through shaping people's dispositions and behaviors.

Details

Social Theory as Politics in Knowledge
Type: Book
ISBN: 978-1-84950-363-1

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Article

Sandra A. Mathers, Graham A. McKenzie and Rosemary A. Chesson

The main purpose of the study was to investigate practices relating to informed consent for radiological procedures.

Abstract

Purpose

The main purpose of the study was to investigate practices relating to informed consent for radiological procedures.

Design/methodology/approach

All Health Boards in Scotland (15) were included in the survey and 62 hospitals were contacted. A questionnaire was developed and sent to superintendent radiographers and radiology managers. Quantitative data were entered in to SPSS‐PC for analysis.

Findings

A response rate of 95.2 per cent (59/62) was achieved. A total of 15 hospitals described having a trust policy document on consent and six hospitals reported departmental policies. The majority of hospitals used consent forms for interventional procedures, but not for conventional procedures, although two hospitals obtained informed consent for intravenous urography, and one for barium enemas. All departments (n=25/25) using consent forms required the patient to sign the consent form and 20 departments retained the form. Nine departments placed these in the patient's medical records.

Research implications/limitations

The survey demonstrated considerable diversity in hospital practices regarding informed consent for radiological procedures. The findings have significant implications for clinical governance, especially regarding risk management. Some staff may be putting themselves at risk in an increasingly litigious society. The transferability of this Scottish study needs to be established through surveys in other parts of the UK.

Practical implications

The study reports diversity in practice when gaining informed consent for radiological procedures and the lack of standardisation for this process.

Originality/value

No previous UK empirical studies on informed consent for radiological procedures has been published.

Details

Clinical Governance: An International Journal, vol. 10 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

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Book part

Abstract

Details

Social Theory as Politics in Knowledge
Type: Book
ISBN: 978-1-84950-363-1

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Book part

Brian McKenna

This chapter will examine ideological debates currently taking place in academics. Anthropologists – and all academic workers – are at a crossroads. They must determine…

Abstract

This chapter will examine ideological debates currently taking place in academics. Anthropologists – and all academic workers – are at a crossroads. They must determine what it means to “green the academy” in an era of permanent war, “green capitalism,” and the neoliberal university (Sullivan, 2010). As Victor Wallis makes clear, “no serious observer now denies the severity of the environmental crisis, but it is still not widely recognized as a capitalist crisis, that is, as a crisis arising from and perpetuated by the rule of capital, and hence incapable of resolution within the capitalist framework.”

Details

Environmental Criminology
Type: Book
ISBN: 978-1-78743-377-9

Keywords

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Article

Geoffrey W. Goodhew, Peter A. Cammock and Robert T. Hamilton

The purpose of this paper is to study the consistency in the management of poor performance by a group of experienced managers working at the same level in a service…

Abstract

Purpose

The purpose of this paper is to study the consistency in the management of poor performance by a group of experienced managers working at the same level in a service organisation which had a formal performance management process.

Design/methodology/approach

A case study is developed using cognitive scripts to reveal how front‐line managers in a large service organisation dealt with the issue of poor performance. The nature of their scripts was also related to measures of the managers' experience.

Findings

The management of poor performance is still fraught with inconsistency even among an experienced group of managers. Those who had been managers longest were the most likely to act consistently in this area.

Research limitations/implications

The research is based on the perceptions of the managers all‐operating at the same level and in one organisation and it is not possible to generalise across other levels or organisations.

Practical implications

The inconsistency of approach does suggest that organisations should at least review their procedures and facilitate the development of managers in this area.

Originality/value

The paper presents the managers' voice on this area of their work, a perspective that is essential for management development in this area.

Details

Journal of Management Development, vol. 27 no. 9
Type: Research Article
ISSN: 0262-1711

Keywords

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Article

Gary L. Lemons

bell hooks says in “Reconstructing Black Masculinity” thatn[c]ollectively we can break the life threatening choke‐holdpatriarchal masculinity imposes on black men and…

Abstract

bell hooks says in “Reconstructing Black Masculinity” that n[c]ollectively we can break the life threatening choke‐hold patriarchal masculinity imposes on black men and create life sustaining visions of a reconstructed black masculinity that can provide black men ways to save their lives and the lives of their brothers and sisters in struggle. Toward the work of political (re)unification of the genders in black communities today, black men must acknowledge and begin to confront the existence of sexism in black liberation struggle as one of the chief obstacles empeding its advancement. Making womanist space for black men to participate in allied relation to feminist movement to oppose the opression of women means black men going against the grain of the racist and sexist mythology of black manhood and masculinity in the U.S. Its underlying premise rooted in white supremacist patriarchal ideology continues to foster the idea that we pose a racial and sexual threat to American society such that our bodies exist to be feared, brutalized, imprisoned, annihilated‐made invisible.

Details

International Journal of Sociology and Social Policy, vol. 17 no. 1/2
Type: Research Article
ISSN: 0144-333X

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Article

Margaret K. Formica, Sonali Rajan and Nicholas Simons

The purpose of this paper is to investigate the relationship between rates of firearm homicide in New York State (NYS) and indicators of access to and quality of…

Abstract

Purpose

The purpose of this paper is to investigate the relationship between rates of firearm homicide in New York State (NYS) and indicators of access to and quality of healthcare from 2011 to 2017.

Design/methodology/approach

Utilizing data from the NYS Division of Criminal Justice Services Uniform Crime Reporting Supplemental Homicide Reports and Robert Wood Johnson Foundation County Health Rankings Program, a county-level ecologic study was conducted, descriptive statistics provided and multivariable analyses conducted to determine the associations between critical indicators of county health and firearm homicide.

Findings

The majority of firearm homicide victims (n=2,619) were young, Black, men and the highest rates of firearm homicide were situated in urban centers. Subgroup analyses excluding large urban centers and controlling for key demographics illustrated that those counties with lower rates of clinicians were significantly associated with higher rates of firearm homicide.

Research limitations/implications

Despite challenges integrating two large data sets, the present findings were able to illustrate the critical relationship between access to healthcare and prevalence of firearm homicide.

Practical implications

The results of this study reinforce the importance of access to primary healthcare services and its relationship to critical health outcomes.

Social implications

In urban settings, firearm homicides disproportionately impact young Black men, who are among the least likely to have access to healthcare. In more rural areas, access to healthcare is related directly to improved health outcomes, including reduced rates of firearm homicides.

Originality/value

This is the first study to explore and subsequently establish the relationship between indicators of community health and firearm homicide in NYS.

Details

Journal of Aggression, Conflict and Peace Research, vol. 11 no. 2
Type: Research Article
ISSN: 1759-6599

Keywords

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Abstract

Details

Entrepreneurship in Policing and Criminal Contexts
Type: Book
ISBN: 978-1-80071-056-6

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Book part

Joshua H. Tamayo-Sarver, Neal V. Dawson, Susan W. Hinze, Rita K. Cydulka, Robert S. Wigton and David W. Baker

The purpose of this paper is to draw on previous work in multiple disciplines to establish a theoretical framework for clinical decision-making that incorporates…

Abstract

The purpose of this paper is to draw on previous work in multiple disciplines to establish a theoretical framework for clinical decision-making that incorporates non-medical factors, such as race/ethnicity, into the way physicians make decisions in the practice of medicine. The proposed Rapid Clinical Decision in Context (RCDC) model attempts to understand the influence of various contextual elements on physicians’ decision-making process. The RCDC model provides a basis for future studies to move beyond documentation of areas where disparities exist to understand the causes of the disparities and designing interventions to address those causes. The paper concludes with a discussion on possible studies to test the proposed model.

Details

Health Care Services, Racial and Ethnic Minorities and Underserved Populations: Patient and Provider Perspectives
Type: Book
ISBN: 978-0-76231-249-8

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