Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

A Review of Sport-Related Head Injuries / 대한신경손상학회지

We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.

Public hearing or 'hearing public'? an evaluation of the participation of local stakeholders in environmental impact assessment of Ghana's Jubilee oil fields.

This article investigates the involvement of local stakeholders in the environmental impact assessment (EIA) processes of Ghana's first off-shore oil fields (the Jubilee fields). Adopting key informants interviews and documentary reviews, the article argues that the public hearings and the other stakeholder engagement processes were cosmetic and rhetoric with the view to meeting legal requirements rather than a purposeful interest in eliciting inputs from local stakeholders. It further argues that the operators appear to lack the social legitimacy and social license that will make them acceptable in the project communities. A rigorous community engagement along with a commitment to actively involving local stakeholders in the corporate social responsibility (CSR) programmes of the partners may enhance the image of the partners and improve their social legitimacy. Local government agencies should be capacitated to actively engage project organisers; and government must mitigate the impact of the oil projects through well-structured social support programmes.

Experts' opinions on terminology for complementary and integrative medicine - a qualitative study with leading experts.

BACKGROUND: Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term "integrative medicine" with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a "conventional framework of thinking". The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general. METHODS: We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda. RESULTS: Overall the current terminology was seen as a problem, although most experts agreed that the term "integrative medicine" (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine. CONCLUSION: The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.

The DO difference: an analysis of causal relationships affecting the degree-change debate.

CONTEXT: The academic credential awarded to osteopathic physicians is the doctor of osteopathy or doctor of osteopathic medicine (DO) degree. Public recognition of the degree has been disappointingly low, however, leading some members of the profession to argue for a change in the degree's name and formal designation. OBJECTIVES: To investigate antecedents to the desire among osteopathic medical students to change vs retain the DO degree designation and maintain "the DO difference." METHODS: A self-administered cross-sectional 38-item electronic survey was distributed to 480 students at an osteopathic medical school in the Midwestern United States. The instrument included knowledge-based items about osteopathic principles and practice (OPP) as well as items designed to assess attitudes, subjective norms, perceived behavioral control, and intention to support a proposed degree change. RESULTS: An overall response rate of 45% was achieved (n=214). Structural equation modeling revealed that low levels of OPP knowledge were associated with positive attitudes and subjective norms favoring a degree change with the reverse true for opposing students. Knowledge did not influence perceived behavioral control. Attitudes were the best predictor of intention to vote with 85% variance predicted in our models; perceived behavioral control was the best predictor of intention to debate with approximately 38% variance observed. CONCLUSIONS: As a result of diminished use of palpation and osteopathic manipulative treatment--two historic markers of professional identity among osteopathic physicians--the DO degree designation as an indicator of difference has received increasing scrutiny. Improved student awareness of OPP is essential to maintaining the DO difference in clinical practice and with regard to the DO degree designation.

The future of nursing: career choices in potential student nurses.

Young people leaving schools and sixth-form colleges have the opportunity to choose a career path from an increasing number of courses in colleges of further and higher education. Nursing studies are now competing with a range of health-related disciplines such as health studies, psychology and complementary therapy. Compared with nursing studies, many of these courses appear more exciting and appealing to students who are in the process of choosing a career or programme of study. While the increased choice is a positive move for students, it may contribute to the shortage of students currently entering some areas of nursing. Indeed, some specialties in nursing, including mental health and learning disabilities, are so depleted in students that they are reaching a point of crisis. There is also concern that recruitment into nursing remains predominately female and white British. Given the diversity of the UK population and the reliance on school leavers as a potential source of supply, it is important to understand why male students and those from multiracial and multicultural environments choose, or do not choose, nursing studies. This research study involved a sample of 106 16-year-old students from three secondary schools in the north-west and south-east of England. The questionnaire results, collected in schools, revealed that students held traditional views or knew very little about the nursing profession.

Marketing the health care experience: eight steps to infuse brand essence into your organization.

One of the most elusive challenges in health care marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largest integrated health care delivery system in San Diego, has proven that focusing first on improving the health care experience for patients, physicians, and employees can provide the impetus for a vital marketing strategy that can lead to increased market share and net revenue. Over the last five years, this nonprofit health system has transformed the health care experience into tangible actions that are making a difference in the lives of all those the system serves. That difference has become Sharp's "brand essence"--a promise to the community that has been made through marketing, public relations, and advertising and then delivered through the dedicated work of Sharp's 14,000 team members. They call this performance improvement strategy The Sharp Experience. This article outlines the eight-step journey that led the organization to this brand essence marketing campaign, a campaign whose centerpiece is an award-winning 30-minute television documentary that use real-time patient stories to demonstrate Sharp's focus on service and patient-centered care against a backdrop of clinical quality and state-of-the-art technology, and documentary-style radio and television commercials.

Media Monday tip sheet builds Spartanburg's media relations.

Media Monday is published weekly and sent to area newsrooms by the Spartanburg Regional Healthcare System, Spartanburg, S.C. The news and feature tip sheet was started in 1998 in order to disperse a lot of information with a limited number of staff.

Toxicity of Kidney and Urinary Tract induced by Chinese Herb Medicine

Toxicity in kidney and urinary tract after using Chinese herb medicine in general people could be a problem in Korea. However, reported cases of Chinese herb toxicity in the literature are unexpectedly rare compared to the actual clinical experiences. It is assumed that this low incidence is due to the difficulty of the user to know the rescription or exact name of herb medicine. Ignorance about the nature of Chinese herb medicine might result in fatal effect for the health of general people. To prevent the possible organ toxicity of Chinese herb medicine, we need to consider three requirements. First, enough cases showing toxicity of herb medicine should be collected. Second, comparative analysis of the collected cases should be carried out. Third, public relations (P.R.) to the general people and the governmental regulation should be performed. That is, Information collection Data analysis P.R. and Regulation. I have been personally experienced some cases of typical Chinese herb induced nephropathy in the patients with past history using chines herb medicine. All of them showed clinical progression to chronic renal failure. The common problem in these patients were the ignorance about the prescribed herb medicine. These are actual reality in Korea and it means that the resolution of the problem and further prevention for the other people is impossible in this country. Rapidly progressive renal fibrosis after a slimming regimen including Chinese herbs containing aristolochic acid has been identified as Chinese-herb nephropathy. Chinese herb nephropathy have been reported in the literature world-widely (Toxicology 2002; 181-2: 577-80; Clin Nephrol 2000; 53(4): 301-6; Intern Med 2001; 40(4): 296-300; Am J Nephrol 2001; 21(6): 441-8; Nephrology 2004; 9(3): 126-9) since an outbreak of rapidly progressive renal failure observed in Belgium in 1992~1993, related to a slimming regimen involving Chinese herbs (Bull Mem Acad R Med Belg 1994; 149: 128-35). Seventy one cases were registered and renal failure has been progressed in most cases despite the withdrawal of the Chinese herbs. Renal biopsies showed an extensive interstitial fibrosis with loss of tubules. Chinese herb nephropathy contains a variety of clinical features of progressive renal failure to Fanconi's syndrome. Fanconi's syndrome has mostly been reported in Asian countries, and is characterized by proximal tubular dysfunction and slower progression to end-stage renal disease. It has been reported that Aristolochic acid componant in chinese herb induce the toxicity in kiney and urinary tract in humans and animals (J Pharm Belg 1997; 52(1): 7-27; J Am Soc Nephrol 2002; 13: 431-6). It has also been reported that the prevalence of urothelial carcinoma among patients with end-stage Chinese-herb nephropathy (caused by aristolochia species) is high (N Engl J Med 2000; 342(23): 1686-92). Chinese herb, Aristolochia Fang-chi, has been proved nephrotoxic and does not provide enough safety for common health care. The overview shows that attention is caught to the danger of Chinese herbs of unknown origin and these observations indicate the need of intensive search of nephrotoxins in cases of interstitial nephritis of unknown origin.