Clinical trials are often designed as either pragmatic or explanatory. The pragmatic clinical trials are generally used for measuring the effectiveness of a treatment in common clinical practice, while the explanatory trial for measuring the efficacy of a treatment under ideal conditions. Since the methods concerning pragmatic clinical trials are less introduced in China, its archetypal features, advantages and limitations were introduced in this paper. And a current study of pragmatic clinical trials on using acpuncture for treatment of low back pain carried out in German was taken as an example to illustrate the practical methods concretely. The key steps of the design were presented in detail, and reasonable suggestions about the problems often encountered in the trial, as well as how to balance the internal and external validity, outcome measurement, etc., were offered.
Clinical Trials as Topic ; methods ; standards ; Data Interpretation, Statistical ; Decision Making, Organizational ; Humans

Decision Making, Organizational ; Disasters ; Earthquakes ; Humans ; Public Health Practice ; Stress Disorders, Post-Traumatic

Healthcare accreditation program was started in November 2010. The program was operated by newly born institute, Korea Institute for Healthcare Accreditation. Major characteristic of healthcare accreditation program in Korea is spontaneous program that hospitals voluntarily request for accreditation survey. Goals of healthcare accreditation program in Korea are to change the culture of healthcare supply side from supplier oriented to consumer oriented culture and to change regulation for quality improvement from government initiated regulation to self regulated quality improvement activities by hospitals. Objectives of accreditation are to assure the patient safety and to improve quality of healthcare services in hospitals. Korean Association of Hospital Management conducted a survey on the impact of accreditation program on hospital management, the survey was supported by Korea Institute for Healthcare Accreditation. Results of the survey showed that accredited hospital had changed to positive direction in patient safety, decision making process, organizational culture and hospital management. Assignments of accreditation program in Korea to be solved are to develop incentive for active participation of small size hospitals, to improve quality of surveyors and to increase the apprehension of accreditation of general population. Korea Institute for Healthcare Accreditation endeavor to improve quality of surveyors under in depth training program and to advertise accreditation program through radio and TV to the general population. However the incentive program must be developed by government policy.
Accreditation ; Decision Making ; Delivery of Health Care ; Korea ; Motivation ; Organizational Culture ; Patient Safety ; Quality Improvement ; Quality of Health Care

PURPOSE:This research explored the voices of nurses in contemporary times and unraveled nurses' situations for the purpose of generating a substantive theory to guide and refine nursing practice.
METHOD:The  grounded  theory  methodology  of  qualitative  research  was  utilized patterned mainly in the works of Glaser and Strauss. Criterion sampling was used in the selection of 31 participants and the basis for selection was employment in the hospital, academe, and community and being part of different levels of management (nurses from top, middle, first, and staff levels). Theoretical sampling also informed the final list of study informants and was conducted by snowballing that consisted of 10  participants.  The  data  gathering  procedures  included  the  combination  of interviews, observations, and document and literature analysis.
FINDINGS:The study revealed three major themes: (1)nursing as a profession,(2)Nightingale in the 21st century:life of a nurse in today's context,and (3)the challenges and opportunities to quality of nursing care.
CONCLUSION:Nursing   is   dynamic,   complex,   diverse,   expanding   and   highly contextualized. Nursing is a field that grows with time and nurses are adaptive to the widening demands of their profession. The goal of nursing remains a Nightingale's pledge  and  an  endeavor  amidst  nurses'  constant  battle  between  motivations  and challenges.  The  Integrated  Systems  Approach  to  Nursing  Care  model  was developed to be used as a framework for sound decision-making in nursing practice.Nursing,  nightingale  and  beyond  is  a  picture  of  struggles,  success,  and  potential solutions to the predicaments surrounding the nursing profession.
CLINICAL RELEVANCE:The  study  has  potential  to  help  health  managers  and  policy implementers in providing assistance to nurses in enhancing their knowledge and skills, increasing their emotional and psychological resilience and in revitalizing their commitment to the nursing profession.It may also aid in  the  reconsideration  of institutional policies and set-ups toward collaborative and enabling work environment. In addition, it may serve as a guide in creating proactive health governance, in facilitating nurses' work motivation  and  retention  through  the  due  implementation  of nursing law and other statures for the welfare of health workers, in providing additional plantilla position for nurses in the country, and in increasing funding for health programs to create more learning and practice environment for nurses. Lastly, the utilization of the theory  can  be  used  in  developing  a  more  responsive  nursing practice.

Human ; Male ; Female ; Middle Aged ; Adult ; Motivation ; Organizational Policy ; Resilience, Psychological ; Goals ; Nurses ; Workplace ; Qualitative Research ; Models, Nursing ; Decision Making

OBJECTIVETo explore feasibility of applying evidence grading system in clinical decision-making analysis.

METHODSUsing grading system as well as a quantitative approach to generate the threshold NNT((T)), and conducting clinical decision-making analysis through one study on Asymptomatic carotid atherosclerosis.

RESULTSNNT((T)) was 12, comparing with no-intervention in the ACA study that NNT = 6. NNT < NNT((T)) indicated the benefits of intervention outweigh the risks and costs.

CONCLUSIONTo obtain the rate of adverse event and the specifying approximate cost were vital in the process of applying grading system in clinical decision-making.

Advance Care Planning ; Algorithms ; Carotid Artery Diseases ; economics ; therapy ; Decision Making, Organizational ; Evidence-Based Medicine ; methods ; Health Care Costs ; Humans ; Models, Theoretical

OBJECTIVES: This study was conducted to investigate the current status of outsourcing in Korean hospital information systems and the factors influencing its introduction. METHODS: The authors surveyed 136 hospitals located in Seoul and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and inhibitors to outsourcing in hospital information systems were derived from literature and expert reviews. Multiple logistic regression analysis was applied to identify the major influencing factors on outsourcing in hospital information systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which were mainly tertiary hospitals, responded to using outsourcing for their hospital information systems. "Hardware and software maintenance and support," "application development," and "management of service and staff" were the major areas of outsourcing. Outsourcing had been employed for 4~7 years by 45.5% of the hospitals and the proportion of the budget used for outsourcing was less than 20%. A need for an extension in outsourcing was agreed on by 76.5% of the hospitals. The multiple logistic regression analysis showed that both consumer satisfaction and security risk have an influence on hospital information system outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is expected to increase just as in other industries. One primary facilitator to outsourcing in other industries is consumer satisfaction. We found that this was also a facilitator to outsourcing in hospital information systems. Security risk, which is usually considered an inhibitor to information technology outsourcing, was proven to be an inhibitor here as well. The results of this study may help hospital information systems establish a strategy and management plan for outsourcing.
Security Measures ; Outsourced Services/economics/*utilization ; Maintenance ; Logistic Models ; Korea ; Hospital Information Systems/*organization & administration ; Health Services Research ; Decision Making, Organizational ; Consumer Satisfaction ; Computer Security

PURPOSE: This study was to determine the mediator or moderator role of empowerment in the relationship between the head nurse's transformational leadership and organizational commitment as perceived by staff nurses. METHODS: Data was collected from 451 nurses in a tertiary hospital located in B city by means of structured questionnaires. Data was analyzed with descriptive statistics, Pearson's correlation coefficient and hierarchial multiple regression using the SPSS program. RESULTS: Empowerment showed mediating effects between the head nurse's transformational leadership and organizational commitment as perceived by staff nurses. However, empowerment did not show moderating effects. CONCLUSION: Nurses' perception of empowerment, the head nurse's transformational leadership and organizational commitment have a strong relationship. This finding suggests the importance of empowering nurses to increase organizational commitment.
Adult ; Decision Making, Organizational ; Female ; Humans ; *Leadership ; Nurse Administrators/organization & administration/*psychology ; Nursing Administration Research ; Nursing Staff, Hospital/organization & administration/*psychology ; Personnel Loyalty ; Questionnaires