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Progress on quality management in the German health system – a long and winding road
Juergen Breckenkamp, Christiane Wiskow, Ulrich Laaser
Health Research Policy and Systems , 2007, DOI: 10.1186/1478-4505-5-7
Abstract: This review summarizes recent developments in medical quality management as related to the federal reform legislation in Germany. It provides an overview on the infrastructure, actors and on the current discussion concerning quality management in medical care.Germany had to catch up on implementing quality management in the health system compared to other countries. Considerable progress has been made, however, it is recognized that the full integration of quality management will require long-term commitment in developing methods, instruments and communication procedures. The most ambitious project at present is the development of a comprehensive comparative quality management system for hospitals at national level, including public reporting. For the time being medical quality management in Germany is dealt with as a technical and professional issue while the aspects of patient orientation and transparency need further advancement.Medical care in Germany is recognized as having a high standard in general. The health care is mainly financed by a fee-based system with a multiplicity of health insurances. The German system known as Bismarck model is the oldest health insurance system in the world, established in 1883. It is still characterized by obligatory insurance, a large number of group specific insurances, guaranty of continued salary payments in case of prolonged incapacity, and division of fees between labourers and employers. Although modified in many details the basic structures of the system have survived since. Nevertheless the Bismarckian systems reached the limits during the nineties mainly because of technological advances in health care, demographic ageing, and increasing unemployment. The crisis of health care financing lead to reform processes which also included the issue of quality assurance.Quality assurance is an integrated part of health professions with a long tradition of developing methods to assess the quality of work [1]. Generally, quality
The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana, and Tanzania
Helen Prytherch,Melkidezek T. Leshabari,Christiane Wiskow,Gifty A. Aninanya
Global Health Action , 2012, DOI: 10.3402/gha.v5i0.19120
Abstract: Background: The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective: To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design: Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion: This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions: It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated.
Alzheimer's Disease and the Amyloid Cascade Hypothesis: A Critical Review
Christiane Reitz
International Journal of Alzheimer's Disease , 2012, DOI: 10.1155/2012/369808
Abstract: Since 1992, the amyloid cascade hypothesis has played the prominent role in explaining the etiology and pathogenesis of Alzheimer's disease (AD). It proposes that the deposition of β-amyloid (Aβ) is the initial pathological event in AD leading to the formation of senile plaques (SPs) and then to neurofibrillary tangles (NFTs), neuronal cell death, and ultimately dementia. While there is substantial evidence supporting the hypothesis, there are also limitations: (1) SP and NFT may develop independently, and (2) SPs and NFTs may be the products rather than the causes of neurodegeneration in AD. In addition, randomized clinical trials that tested drugs or antibodies targeting components of the amyloid pathway have been inconclusive. This paper provides a critical overview of the evidence for and against the amyloid cascade hypothesis in AD and provides suggestions for future directions. 1. Introduction Alzheimer’s disease (AD), which is characterized by progressive deterioration in cognition, function, and behavior, places a considerable burden on western societies. It is the sixth leading cause of all deaths and the fifth leading cause of death in persons aged ≥65 years. To date, an estimated 5.4 million Americans have AD, but due to the baby boom generation, the incidence in 2050 is expected to reach a million persons per year, resulting in a total estimated prevalence of 11 to 16 million affected persons. Since the first description of presenile dementia by Alois Alzheimer in 1907 [1], senile plaques (SPs) and neurofibrillary tangles (NFTs) are considered the key pathological hallmarks of AD [2]. The identification of β-amyloid (Aβ) in SPs [3] and genetic studies that identified mutations in the amyloid precursor protein (APP) [4], presenilin 1 (PSEN1), and presenilin 2 (PSEN2) genes [5, 6] leading to the accumulation of Aβ and early-onset familial dementia [4, 5, 7], resulted in the formulation of the “Amyloid Cascade Hypothesis” (ACH; Figure 1) [8, 9]. According to the ACH, the deposition of Aβ is the initial pathological trigger in the disease, which subsequently leads to the formation of NFTs, neuronal cell death and dementia. While there is considerable evidence supporting this hypothesis, there are observations that seem to be inconsistent. This paper summarizes the current evidence for and against the amyloid cascade in AD. Figure 1: Amyloid cascade hypothesis. 2. Amyloid Cascade Hypothesis As described above, two key observations resulted in the original formulation of the ACH (Figure 1). First, the detection of Aβ as a main constituent of the
Glandular areas associated with the male genitalia in Triatoma rubrofasciata (Triatominae, Reduviidae, Hemiptera) and other Reduviidae
Weirauch, Christiane;
Memórias do Instituto Oswaldo Cruz , 2003, DOI: 10.1590/S0074-02762003000600011
Abstract: in this paper, glandular areas associated with the phallus in triatoma rubrofasciata are described and illustrated for the first time. the glandular areas lie in the membrane surrounding the articulatory apparatus. in order to unambiguously define the locality of the respective glandular areas, some features of the pygophore-phallus connection are redescribed. a possible functional context of the gland secretions is discussed. a preliminary study of several other reduviidae implies that the described glandular areas occur in a wider range of taxa in this group.
O Conselho Argentino para as Rela??es Internacionais (CARI) nos anos 1990 e a virada neoliberal argentina
Sauerbronn, Christiane;
Revista de Sociologia e Política , 2009, DOI: 10.1590/S0104-44782009000200006
Abstract: this article attempts to identify the role played by the argentine council for international relations (consejo argentino para las relaciones internacionales (cari)) in the dissemination of neo-liberal ideas and the guidance of certain paradigm shifts that served as a tool for formulating argentine foreign policy during the menem government (1989-1999). we see the cari as a think tank that connects a network of decision-makers, academics and entrepreneurs, and contributes to the plotting of new routes for foreign policy. through a policy of "revolving doors" for members and through the production of seminars, study groups and publications, the council influences the country's foreign policy as a domestic force that is part of the structuring and formulating of the latter, with an international political agenda that is reflected in its activities. our idea is to identify, through analysis of cari actions around the most significant topics of foreign policy during the period and through its relationship with key actors such as the united states and great britain, council participation - as supported by the menem administration - in the way argentine foreign policy unfolded during the period. the change in argentina's political positions and its new stance regarding voting patterns in international forums, bi-lateral partnerships, support for neo-liberal policies, the defense of argentine interests in the arctic, associated with government support and the active role that the cari played between 1989 and 1999, show that the council was attentive to the conjuncture at that particular moment and contributed to the dissemination and implementation of changes in the country's foreign policy.
Flood prevention and protection at the Bibliothèque nationale de France
Christiane Baryla
Liber Quarterly : The Journal of European Research Libraries , 2006,
Abstract: To begin with, let me introduce myself: my name is Christiane Baryla and I am the Director of the IFLA Core activity on Preservation and Conservation or PAC. This programme is hosted by the Bibliothèque nationale de France (BnF) in Paris and this is the reason why I am authorised to speak about flood prevention and protection in the National Library. This paper is the last one in a morning dedicated to terrorism attacks and climate changes. When you listen to criminal experts and to flood specialists in Paris, they both say the same thing: we don’t know where or when, but we do know that a terrorist attack is possible and has to be planned for. We do know that a major flood in Paris may occur, but current weather forecasting knowledge is unable to give us any probability for the year or the month of that eventuality.
Praktikum Medizinische Recherche: Erfahrungen mit einer curricular integrierten Schulungsveranstaltung / Medical Information Retrieval Training: a practical training integrated into the curriculum
Wagner, Christiane
GMS Medizin-Bibliothek-Information , 2006,
Abstract: n June 2004 a course problem oriented learning (POL) has been introduced at the medical faculty of the University Leipzig. The course on the topic Infectology and Immunology“ takes place once a year and lasts for four weeks. It consists of a series of lectures and tutorials, in which small groups of students work on clinical case examples. Also part of the course are some practical training sessions. One of them is a 90 minutes practical training on searching for medical literature, which is organized by the medical library. In 2006 the practical training took place for the third time. The article tells about the development within the three years and the experiences that have been made.
The arrested step , Nightwood de Djuna Barnes : Une image est une halte que fait l’esprit entre deux incertitudes “The arrested step”, Djuna Barnes’s Nightwood: “An image is a stop the mind makes between uncertainties”
Christiane Guillois
Revue LISA / LISA e-journal , 2009, DOI: 10.4000/lisa.114
Abstract: The tortured universe of Nightwood engages in a fundamental questioning of the common notion of man’s duality. Against a backdrop in which night is indistinguishable from day and characters are denied their wholeness, the body, essentially the body seen in movement, appears as the paradox inherent in the human condition. The reader encounters five characters drifting towards madness in an unsettled world, and a startlingly poetic prose that constantly disrupts the flow of events as it relentlessly explores their existential depths. With an unwavering sense of urgency, the literature of excess that defines Djuna Barnes’s work pushes back the limits of the unacceptable, as if to bring into the light that which is most intimate in man. She will have none of fossilized emotions and acts predicated on habit. She seeks the authentic, and it is this quest that leads her to bodies in motion, for while fashioned out of personal history, they throb with pulsations that are universal. In her search for the universal in this animal aspiring to transcendence and now passing through its human stage, she probes the bodies of her characters with a doggedness that leads to near-disintegration. What is human in man is not permanently established; it is to be rediscovered and reconquered, constantly.
Christiane Nord
TEFLIN Journal , 2006,
Abstract: Taking a prospective approach to translation, translators choose their translation strategies according to the purpose or function the translated text is intended to fulfill for the target audience. Since communicative purposes need certain conditions in order to work, it is the translator's task to analyze the conditions of the target culture and to decide whether, and how, the source-text purposes can work for the target audience according to the specifications of the translation brief. If the target-culture conditions differ from those of the source culture, there are usually two basic options: either to transform the text in such a way that it can work under target-culture conditions (= instrumental translation), or to replace the source-text functions by their respective meta-functions (= documentary translation).
Point Canonical Transformation versus Deformed Shape Invariance for Position-Dependent Mass Schr dinger Equations
Christiane Quesne
Symmetry, Integrability and Geometry : Methods and Applications , 2009,
Abstract: On using the known equivalence between the presence of a position-dependent mass (PDM) in the Schr dinger equation and a deformation of the canonical commutation relations, a method based on deformed shape invariance has recently been devised for generating pairs of potential and PDM for which the Schr dinger equation is exactly solvable. This approach has provided the bound-state energy spectrum, as well as the ground-state and the first few excited-state wavefunctions. The general wavefunctions have however remained unknown in explicit form because for their determination one would need the solutions of a rather tricky differential-difference equation. Here we show that solving this equation may be avoided by combining the deformed shape invariance technique with the point canonical transformation method in a novel way. It consists in employing our previous knowledge of the PDM problem energy spectrum to construct a constant-mass Schr dinger equation with similar characteristics and in deducing the PDM wavefunctions from the known constant-mass ones. Finally, the equivalence of the wavefunctions coming from both approaches is checked.
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