Managing peripheral intravenous devices in the adults' general surgical setting: a best practice implementation report

AIM The aim of this evidence-based practice (EBP) project was to promote adherence to the current best practice in monitoring and optimal replacement of peripheral intravenous device (PIVD). METHODS This EBP project took place in a 30-bed acute general surgical ward. Twenty in-patients with PIVD in situ for 4 days or more were recruited. There were five stages in the project: identification of EBP topic, criteria, sample and setting; baseline; dissemination of baseline audit results and identification of best practice barriers; identification of barriers to EBP and implementation of strategies promoting EBP; and postimplementation audit. RESULTS There were eight criteria in this project. The first audit showed moderate compliance in PIVD monitoring and optimal replacement. The project identified three barriers: lack of awareness of the current evidence-based guidelines, hospital policy not being aligned with current guidelines and no standard form of documentation. In order to overcome these barriers the following strategies were used: audit and feedback, interactive educational meetings, reminders and hospital policy change. The second audit showed minor improvements in each criterion. Compliance with documentation remained a challenge, possibly because of the lack of standardised documentation. DISCUSSION Although the project did not render us the results we aimed for, it was successful because it highlighted the current EBP in PIVD management. The major challenges of the project were time and the lack of opinion leaders in our project team. We felt that more time was needed to adapt to the practice change and standardised documentation could not be developed in such a short time period. Further, the role of the opinion leader proved to be vital in this project. We felt that had we recruited more than one opinion leader, the results would have been different.

Reframe QUT's evaluation framework : a case study of planning, policy and positioning leading to educational best practice

Every university in Australia has a set of policies that guide the institution in its educational practices, however, the policies are often developed in isolation to each other. Now imagine a space where policies are evidence-based, refined annually, cohesively interrelated, and meet stakeholders’ needs. Is this happenstance or the result of good planning? Culturally, Queensland University of Technology (QUT) is a risk-averse institution that takes pride in its financial solvency and is always keen to know “how are we going?” With a twenty-year history of annual reporting that assures the quality of course performance through multiple lines of evidence, QUT’s Learning and Teaching Unit went one step further and strategically aligned a suite of policies that take into consideration the needs of their stakeholders, collaborate with other areas across the institution and use multiple lines of evidence to inform curriculum decision-making. In QUT’s experience, strategic planning can lead to policy that is designed to meet stakeholders’ needs, not manage them; where decision-making is supported by evidence, not rhetoric; where all feedback is incorporated, not ignored; and where policies are cohesively interrelated, not isolated. While many may call this ‘policy nirvana’, QUT has positioned itself to demonstrate good educational practice through Reframe, its evaluation framework. In this case, best practice was achieved through the application of a theory of change and a design-led logic model that allows for transition to other institutions with different cultural specificity. The evaluation approach follows Seldin’s (2003) notion to offer depth and breadth to the evaluation framework along with Berk’s (2005) concept of multiple lines of evidence. In summary, this paper offers university executives, academics, planning and quality staff an opportunity to understand the critical steps that lead to strategic planning and design of evidence-based educational policy that positions a university for best practice in learning and teaching.

Applying for funding is the worst part of my job

That’s what one researcher told us when we asked them about applying for NHMRC Project Grant funding. Others said that applying for funding had made them ill, lost them friends, ruined Christmas and caused arguments with friends and family. What makes applying for funding so bad? We’ve tried to summarise the problems with the system in the diagram above. This is based on our group’s four years of research into the funding process. Some of the arrows are based on evidence from our surveys (Survey 1, Survey 2), others are based on anecdote or experience and so maybe wrong. Please let me know if I’ve missed an arrow or an issue.

Designing with people with disabilities : adapting best practices of DIY and organizational approaches

Individualization of design is often necessary particularly when designing with people with disabilities. Maker communities, with their flexible Do-It-Yourself (DIY) practices, offer potential to support individualized and cost-effective product design. However, efforts to adapt DIY practices in designing with people with disabilities tend to face difficulties with regard to continuous commitment, infrastructure provision and proper guidance. We carried out interviews with diverse stakeholders in the disability services sector and carried out observations of local makerspaces to understand their current practices and potential for future collaborations. We found that makerspace participants face difficulties in terms of infrastructure provision and proper guidance whereas Disability Service Organizations face difficulties in continuous expertise. We suggest that artful infrastructuring to blend the best of both approaches offers potential to create a sustainable community that can design individualized technologies to support people with disabilities.

Is biggest best? A comparative analysis of the financial viability of the Brisbane City Council

Structural reform through forced mergers has been a dominant feature of Australian local government for decades. Advocates of compulsory consolidation contend that larger municipalities perform better across a wide range of attributes, including financial sustainability. While empirical scholars of local government have invested considerable effort into investigating these claims, no-one has yet examined the performance of Brisbane City Council against other local authorities, despite the fact that it is by far the largest council in Australia. This paper seeks to remedy this neglect by comparing Brisbane with Sydney City Council, an average of six south east Queensland councils and an average of ten metropolitan New South Wales councils against four measures of financial performance over the period 2008 to 2011.

Combining initial segments of lists

We propose a new way to build a combined list from K base lists, each containing N items. A combined list consists of top segments of various sizes from each base list so that the total size of all top segments equals N. A sequence of item requests is processed and the goal is to minimize the total number of misses. That is, we seek to build a combined list that contains all the frequently requested items. We first consider the special case of disjoint base lists. There, we design an efficient algorithm that computes the best combined list for a given sequence of requests. In addition, we develop a randomized online algorithm whose expected number of misses is close to that of the best combined list chosen in hindsight. We prove lower bounds that show that the expected number of misses of our randomized algorithm is close to the optimum. In the presence of duplicate items, we show that computing the best combined list is NP-hard. We show that our algorithms still apply to a linearized notion of loss in this case. We expect that this new way of aggregating lists will find many ranking applications.

Open problem: Shifting experts on easy data

A number of online algorithms have been developed that have small additional loss (regret) compared to the best “shifting expert”. In this model, there is a set of experts and the comparator is the best partition of the trial sequence into a small number of segments, where the expert of smallest loss is chosen in each segment. The regret is typically defined for worst-case data / loss sequences. There has been a recent surge of interest in online algorithms that combine good worst-case guarantees with much improved performance on easy data. A practically relevant class of easy data is the case when the loss of each expert is iid and the best and second best experts have a gap between their mean loss. In the full information setting, the FlipFlop algorithm by De Rooij et al. (2014) combines the best of the iid optimal Follow-The-Leader (FL) and the worst-case-safe Hedge algorithms, whereas in the bandit information case SAO by Bubeck and Slivkins (2012) competes with the iid optimal UCB and the worst-case-safe EXP3. We ask the same question for the shifting expert problem. First, we ask what are the simple and efficient algorithms for the shifting experts problem when the loss sequence in each segment is iid with respect to a fixed but unknown distribution. Second, we ask how to efficiently unite the performance of such algorithms on easy data with worst-case robustness. A particular intriguing open problem is the case when the comparator shifts within a small subset of experts from a large set under the assumption that the losses in each segment are iid.

What’s best for our lymphoedema patients? Have we lost the patient as an individual in the quest for good science?

In a recent issue of the Journal of Lymphoedema, Nickolaidis and Karlsson (2013) indicated that most of the standard treatments for lymphoedema patients were explored and developed early last century, and suggested that holistic assessment of the individual is critical for good outcomes, but that perhaps “less emphasis should be placed on manual lymphatic drainage (MLD) and more on compression, exercise and weight reduction.”

A Few Best Men

Like most of Stephan Elliott’s movies, A Few Best Men is difficult to discuss without focusing on the director himself. A wedding-gone-wrong comedy, A Few Best Men is Elliott’s first Australian feature film in seventeen years. After directing the low-budget crime-thriller Frauds (1993), Elliott achieved worldwide success as writer-director of the Oscar-winning road movie Adventures of Priscilla, Queen of the Desert (1994). A quirky and visually striking film about two drag-queens and a transsexual’s journey across the harsh Australian outback in a bus named Priscilla, the movie earned over US$70 million at the international box-office and became an instant Australian classic. Elliott’s career, however, self-destructed soon after...

Special issue on best papers from the "BPM 2012" workshops

Business Process Management (BPM) (Dumas et al. 2013) investigates how organizations function and can be improved on the basis of their business processes. The starting point for BPM is that organizational performance is a function of process performance. Thus, BPM proposes a set of methods, techniques and tools to discover, analyze, implement, monitor and control business processes, with the ultimate goal of improving these processes. Most importantly, BPM is not just an organizational management discipline. BPM also studies how technology, and particularly information technology, can effectively support the process improvement effort. In the past two decades the field of BPM has been the focus of extensive research, which spans an increasingly growing scope and advances technology in various directions. The main international forum for state-of-the-art research in this field is the International Conference on Business Process Management, or “BPM” for short—an annual meeting of the aca ...

Automatic image scaling for place recognition in changing environments

Robustness to variations in environmental conditions and camera viewpoint is essential for long-term place recognition, navigation and SLAM. Existing systems typically solve either of these problems, but invariance to both remains a challenge. This paper presents a training-free approach to lateral viewpoint- and condition-invariant, vision-based place recognition. Our successive frame patch-tracking technique infers average scene depth along traverses and automatically rescales views of the same place at different depths to increase their similarity. We combine our system with the condition-invariant SMART algorithm and demonstrate place recognition between day and night, across entire 4-lane-plus-median-strip roads, where current algorithms fail.

What can we do to improve the coordination of care for cancer patients?

The delivery of cancer services has become increasingly complex as we move to more personalized diagnostic and treatment approaches and cancer is recognized as a chronic disease. Cancer patients today typically come into contact with multiple health services over long periods. Healthcare reforms in many countries also mean that the various services involved in cancer care are funded by a confusing mix of personal, private insurer, and government sources. It is not surprising then that many patients today tell us their cancer experience is disjointed. Importantly, this lack of coordination of cancer care results in poor outcomes that can range from minor inconvenience at best to potentially life-threatening safety incidents at worst.

Report: The Canadian Best Practices Educational Toolkits: Translating evidence-based stroke recommendations into practical implementation resources

The Canadian Best Practice Recommendations for Stroke Care are intended to reduce variations in stroke care and facilitate closure of the gap between evidence and practice (Lindsay et al., 2010). The publication of best practice recommendations is only the beginning of this process. The guidelines themselves are not sufficient to change practice and increase consistency in care. Therefore, a key objective of the Canadian Stroke Network (CSN) Best Practices Working Group (BPWG) is to encourage and facilitate ongoing professional development and training for health care professionals providing stroke care. This is addressed through a multi-factorial approach to the creation and dissemination of inter-professional implementation tools and resources. The resources developed by CSN span pre-professional education, ongoing professional development, patient education and may be used to inform systems change. With a focus on knowledge translation, several inter-professional point-of-care tools have been developed by the CSN in collaboration with numerous professional organizations and expert volunteers. These resources are used to facilitate awareness, understanding and applications of evidence-based care across stroke care settings. Similar resources are also developed specifically for stroke patients, their families and informal caregivers, and the general public. With each update of the Canadian Best Practice Recommendations for Stroke Care, the BPWG and topic-specific writing groups propose priority areas for ongoing resource development. In 2010, two of these major educational initiatives were undertaken and recently completed—one to support continuing education for health care professionals regarding secondary stroke prevention and the other to educate families, informal caregivers and the public about pediatric stroke. This paper presents an overview of these two resources, and we encourage health care professionals to integrate these into their personal learning plans and tool kits for patients.