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As employee careers have evolved from linear trajectories confined within 1 organization to more dynamic and boundaryless paths, organizations and individuals alike have increasingly considered reestablishing prior employment relationships. These "boomerang employees" follow career paths that feature 2 or more temporally separated tenures in particular organizations ("boomerang organizations"). ⋯ Results based on a sample of boomerang employees and employers in the same industry (professional basketball) indicate that intra- and extraorganizational knowledge construction and disruptions, as well as transition events, are significantly predictive of boomerangs' return performance. Comparisons with 2 matched samples of nonboomerang employees likewise suggest distinctive patterns in the performance of boomerang employees. (PsycINFO Database Record
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Tarragona strategy--appropriate antibiotic therapy in the ICU].
Appropriate antibiotic initial therapy remarkably decreases the mortality of patients with infections in the ICU. The establishment of an appropriate initial therapy follows empirical aspects. This practice was first done for the treatment of nosocomial pneumonia. Since that time the practice became known as Tarragona strategy. ⋯ This procedure is safe, reduces mortality, limits the development of resistance, and is economic.
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Asthma affects almost 20 million people in the United States and more than 300 million people worldwide. Of these, 10-15% have severe asthma, which is refractory to commonly available drugs. New drugs are needed because those that are currently available cannot control symptoms and exacerbations in all patients and can cause adverse reactions. ⋯ Other new drug classes--including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors--remain in earlier phases of development. Despite some preliminary efficacy data, there is insufficient evidence to make strong recommendations about the use of these newer agents. Future research on the clinical efficacy of these biologic agents, the effect of newer agents on severe asthma in pediatric patients, and the biology of non-eosinophilic and corticosteroid resistant asthma is needed to reduce the morbidity of asthma worldwide.
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Randomized Controlled Trial Comparative Study
A new model of delirium care in the acute geriatric setting: geriatric monitoring unit.
Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU) where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. ⋯ This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care, but also improved staff knowledge and satisfaction. The model may then be transposed across various locations and disciplines in the acute hospital where delirious patients could be sited.
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Mechanical ventilation in a situation of mass casualty respiratory failure will require a substantial increase in the capacity for mechanical ventilation, to prevent unnecessary mortality. Concern over the difficulties of treating large numbers of patients with respiratory failure is exceeded only by our lack of experience on which to base decisions. This review evaluates the likely scenarios that could lead to mass casualty respiratory failure and the types of respiratory failure anticipated. ⋯ Matching the degree of respiratory impairment anticipated from the most likely mass casualty scenarios allows conclusions to be drawn regarding the performance characteristics of ventilators required for these situations. Little is known about the success of mechanical-ventilator stockpiling for mass casualty respiratory failure. Careful planning with an emphasis on matching ventilator performance to patient need and caregiver skill is critical to appropriate stockpile choices.