This study first develops an empirically based Western charismatic leadership profile. Using confirmatory factor analysis, the profile is compared with a profile of Iranian managers. The results demonstrate that despite major cultural differences in the two countries, there are core similarities in the profiles across the two cultures. The Canadian charismatic profile of vision, tenacity, intellectual challenge, self-sacrifice, and eloquence is substantially confirmed within the Iranian sample. But we also show that Iranian managers' ratings are significantly lower than those of the Canadian managers, indicating potentially different behavioural manifestations. The paper speculates that while the differences are probably due to cultural differences, the similarities may be due to universal intrinsic human desire for morality, autonomy, and achievement. Copyright Blackwell Publishing Ltd 2004.
BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution. An RT-driven protocol was developed and implemented, enabling consistent screening for SBT readiness. When criteria were met, an SBT was initiated after order placement. The difference in the timing of the first SBT between physician-directed screening and the RT-driven protocol was evaluated. RESULTS: A total of 219 subjects were included in this project (128 pre-intervention; 91 intervention). Baseline demographic data, including mortality risk and endotracheal tube size, were similar in both groups .27], P ؍ .14). RT adherence with patient screening was 56.4%. CONCLUSIONS: An RT-driven protocol was successfully introduced in an academic pediatric ICU. However, it did not impact time of SBT initiation, potentially due to the difficulty in maintaining adherence over time. RT-driven protocols require further study.
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