Preventing infections following caesarean section

Surgical site infections following caesarean section are a serious and costly adverse event for Australian hospitals. In the United Kingdom, 9% of women are diagnosed with a surgical site infection following caesarean section either in hospital or post-discharge (Wloch et al 2012, Ward et al 2008). Additional staff time, pharmaceuticals and health supplies, and increased length of stay or readmission to hospital are often required (Henman et al 2012). Part of my PhD investigated the economics of preventing post-caesarean infection. This paper summarises a review of relevant infection prevention strategies. Administering antibiotic prophylaxis 15 to 60 minutes pre-incision, rather than post cordclamping, is probably the most important infection prevention strategy for caesarean section (Smaill and Gyte2010, Liu et al 2013, Dahlke et al 2013). However the timing of antibiotic administration is reportedly inconsistent in Australian hospitals. Clinicians may be taking advice from the influential, but out-dated RANZCOG and United States Centers for Disease Control and Prevention guidelines (Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2011, Mangram et al 1999). A number of other important international clinical guidelines, including Australia's NHMRC guidelines, recommend universal prophylactic antibiotics pre-incision for caesarean section (National Health and Medical Research Council 2010, National Collaborating Centre for Women's and Children's Health 2008, Anderson et al 2008, National Collaborating Centre for Women's and Children's Health 2011, Bratzler et al 2013, American College of Obstetricians and Gynecologists 2011a, Antibiotic Expert Group 2010). We need to ensure women receive preincision antibiotic prophylaxis, particularly as nurses and midwives play a significant role in managing an infection that may result from sub-optimal practice. It is acknowledged more explicitly now that nurses and midwives can influence prescribing and administration of antibiotics through informal approaches (Edwards et al 2011). Methods such as surgical safety checklists are a more formal way for nurses and midwives to ensure that antibiotics are administered pre-incision (American College of Obstetricians and Gynecologists 2011 b). Nurses and midwives can also be directly responsible for other infection prevention strategies such as instructing women to not remove pubic hair in the month before the expected date of delivery and wound management education (Ng et al 2013). Potentially more costly but effective strategies include using a Chlorhexidine-gluconate (CHG) sponge preoperatively (in addition to the usual operating room skin preparation) and vaginal cleansing with a povidone-iodine solution (Riley et al 2012, Rauk 2010, Haas, Morgan, and Contreras 2013).

Attributes of service delivery modes and their impact on consumer satisfaction

Consumersatisfaction is fundamental to organisational success. It is well recognised that personal service is important in achieving consumer satisfaction. However, the application of self-service technology (SST) is widcning and is attennuating traditional exchanges between consumers and service employees. The effect of this reduction of personal service on consumer satisfaction judgements is not well understood. This study addresses this gap by investigating the relative effects of SST and personal service attributes on overall consumer satisfaction. Thc study highlights important service attributes applicable to SST and personal service. The conceptual framework is tested using data collected from 241 leisure and business travellers drawn from premium hotels in a regional area. Structural equation modelling techniques support the conceptual framework. As expected, the attributes of personal service and SST contribute to consumer satisfaction. However, thc impact of personal service attributes 011 consumer satisfaction is much stronger than the effects of SST attributes. Though SST is an important determinant of consumer satisfaction, interactions with staff are critical. These results have applications for the theory and practice of services marketing, and high light avenues for further investigation.

Orals ain't orals : how instruction and assessment practices affect delivery choices with prepared student oral presentations.

Despite an ostensibly technology-driven society, the ability to communicate orally is still seen as an essential ability for students at school and university, as it is for graduates in the workplace. The need to develop effective oral communication skills is often tied to future work-related tasks. One tangible way that educators have assessed proficiency in this area is through prepared oral presentations. While some use the terms oral communication and oral presentation interchangeably, other writers question the role more formal presentations play in the overall development of oral communication skills. Adding to the discussion, this paper is part of a larger study examining the knowledge and skills students bring into the academy from previous educational experiences. The study examines some of the teaching and assessment methods used in secondary schools to develop oral communication skills through the use of formal oral presentations. Specifically, it will look at assessment models and how these are used as a form of instruction as well as how they contribute to an accurate evaluation of student abilities. The purpose of this paper is to explore key terms and identify tensions between expectations and practice. Placing the emphasis on the ‘oral’ aspect of this form of communication this paper will particularly look at the ‘delivery’ element of the process.

Literature Review Value Alignment Process for Project Delivery

The objective of the project “Value Alignment Process for Project Delivery” is to provide a catalyst and tools for reform in the building and construction industry to transform business-as-usual performance into exceptional performance. The outcomes of this project will be beneficial to not only the construction industry, but to the community as a whole because a more sophisticated industry can deliver more effective use of assets, financing, operating and maintenance of facilities to suit the community’s needs. The research project consists of a study into best practice project delivery and the development of a suite of products, resources and services to guide project teams towards the best approach for a specific project. These resources will be focused on promoting the principles that underlie best practice project delivery, rather than on identifying a particular delivery system. The need for such tools and resources becomes more and more acute as the environment within which the construction industry operates becomes more and more complex, and as business and political imperatives shift to encompass or represent diverse stakeholder interests. To this end, this literature review looks at why it is essential to achieve transformation in the Australian construction industry in the context of its importance to the Australian economy. It seeks to investigate the concepts of ‘alignment’ and value’ as they pertain to construction industry processes and relationships. It comprehensively reviews drivers of project excellence and best practice project delivery principles and looks at how clients approach selection of project delivery systems. It critiques existing project delivery strategies and gives an overview of recent best practice initiatives. The literature review represents a milestone against the Project Agreement and forms a foundation document for this research project

Re-valuing construction through project delivery

In moving from lowest cost adversarial based traditional procurement towards value driven methodologies the challenges range from re-engineering the process, to metrics and team alignment. This paper describes research into methodologies which encourage alignment of project partners towards achieving mutually beneficial goals. The research identifies nine variables which influence the achievement of successful projects delivering value. Results from case studies illustrate that not all parties can achieve value for themselves which directs attention to the balance between deliverables and the interests of team members. Re- valuing construction demands refocusing towards the delivery of operational assets and their place in the value system whilst recognising the need to manage the delivery process and the team to align the value to the parties. The objective of the project was to develop tools and recommendations for reform of project delivery in the building and construction industry to transform business-as-usual performance into exceptional performance. Benefits flow not only to the construction industry, but to the community as a whole because a more sophisticated industry can deliver more effective use of assets, financing, operating and maintenance of facilities to suit the community’s needs. This research was funded by the Australian Cooperative Research Centre for Construction Innovation.

Achieving value alignment in project delivery

A study into best practice project delivery and the development of a suite of products, resources and services to help guide clients and project teams towards the best approach for specific projects.

Reduction of Secondary Degeneration after Spinal Cord Injury by Acute Delivery of Proinflammatory Growth Factors

INTRODUCTION Inflammation is a protective attempt to facilitate the removal of damaged tissue and to initiate the healing response in other tissues. However, after spinal cord injury (SCI), this response is prolonged leading to secondary degeneration and glial scarring. Here, we investigate the potential of sustained delivery of pro-inflammatory factors vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) to increase early inflammatory events and promote inflammatory resolution. Method Animal ethics approval was obtained from the Queensland University of Technology. Adult Wistar-Kyoto rats (12-16 weeks old) were subjected to laminectomies and T10 hemisections. Animals were then randomised to treatment (implantation of osmotic pump (Alzet) loaded with 5ug VEGF & 5 ug PDGF) or control groups (lesion control or lesion plus pump delivering PBS). Rats were sacrificed at one month and the spinal cords were harvested and examined by immunohistology, using anti-neurofilament-200(NF200) and anti- ionized calcium binding adapter molecule 1 (Iba1). One way ANOVA was used for statistic analysis. Results At 1 month, active pump-treated cords showed a high level of axonal filament throughout the defects as compared to the control groups. The mean lesion size, as measured by NF200, was 0.47mm2 for the lesion control, 0.39mm2 for the vehicle control and 0.078mm2 for the active pump group. Significant differences were detected between the active pump group and the two control groups (AP vs LC p= 0.017 AG vs VC p= 0.004). Iba-1 staining also showed significant differences in the post-injury inflammatory response. Discussion We have shown that axons and activated microglia are co-located in the lesion of the treated cord. We hypothesise the delivery of VEGF/PDGF increases the local vessel permeability to inflammatory cells and activates these along with the resident microglia to threshold population, which ultimately resolved the prolonged inflammation. Here, we have shown that maintaining the inflammatory signals for at least 7 days improved the morphology of the injured cord. Conclusion This study has shown that boosting inflammation, by delivery VEGF/PDGF, in the early phase of SCI helps to reduce secondary degeneration and may promote inflammation resolution. This treatment may provide a platform for other neuro-regenrative therapies.