Management of sharps in ambulance care : a state-wide survey of paramedic knowledge and reported practice

Paramedics are at high risk of exposure to infectious diseases because they frequently undertake procedures such as the use and disposal of sharps as components of everyday practice. While the literature demonstrates that the management of sharps is problematic across all health disciplines, there is a paucity of research examining sharps management practices in the Australian pre-hospital paramedic context. This study examines knowledge and practices of sharps control among paramedics in Queensland, Australia. A mail survey focusing on infection control knowledge and practices was sent to all clinical personnel of the Queensland Ambulance Service (QAS) (N = 2274). A total of 1258 surveys were returned, a response rate of 55.3%. Participants responded to 12 true/false statements on the management of sharps and three questions about recapping practices. Most respondents were knowledgeable about the correct management of sharps, with a mean of 11.28 (out of 12, SD = 1.32). When gauging reported practices, more than half (59.1%, n = 736) of participants reported recapping a needle, and 38.5% (n = 479) reported never having done so. These results reflect good knowledge of general management of sharps among respondents, but suggest deficits regarding reported practices. The results suggest that a comprehensive ambulance in-service education programme focusing particularly on sharps management is required. The study highlights the need for further research on sharps management practices in the field, identification of barriers to safe sharps practices in pre-hospital settings, and 'best practice' for translating good sharps management knowledge into practice.

The differential effects of organizational antecedents on dimensions of corporate entrepreneurship

This study seeks to further delineate how organizational antecedents differentially influence the three components of corporate entrepreneurship: innovation, venturing or strategic renewal. We argue that structural differentiation may help organizations to maintain multiple and often conflicting demands of entrepreneurial and mainstream activities. Taking a social capital perspective, our study further examines two contingencies in the form of informal integration mechanisms (i.e. connectedness and TMT social integration). Our findings show structural differentiation has a positive effect on all three components of corporate entrepreneurship, yet the effect is moderated by integration mechanisms. Interunit connectedness has a positive moderation effect regarding innovation and venturing, and TMT social integration has a negative moderation effect regarding strategic renewal. This reveals that innovation is influenced by informal integration mechanisms on the organizational level, strategic renewal on top management team level, while venturing is influenced by integration mechanisms on both levels.

Transaction Cost Analysis of PPP Risk Share

PPP (Public Private Partnerships) is a new operation mode of infrastructure projects, which usually undergo long periods and have various kinds of risks in technology, market, politics, policy, finance, society, natural conditions and cooperation. So the government and the private agency should establish the risk-sharing mechanism to ensure the successful implementation of the project. As an important branch of the new institutional economics, transaction cost economics and its analysis method have been proved to be beneficial to the proper allocation of risks between the two parts in PPP projects and the improvement of operation efficiency of PPP risk-sharing mechanism. This paper analyzed the transaction cost of the projects risk-sharing method and the both risk carriers. It pointed out that the risk-sharing method of PPP projects not only reflected the spirit of cooperation between public sector and private agency, but also minimized the total transaction cost of the risk sharing mechanism itself. Meanwhile, the risk takers had to strike a balance between the beforehand cost and the afterwards cost so as to control the cost of risk management. The paper finally suggested three ways which might be useful to reduce the transaction cost: to choose appropriate type of contract of PPP risk-sharing mechanism, to prevent information asymmetry and to establish mutual trust between the two participants.

The future of cognitive and behavioral therapies in the prevention and early management of psychosis : opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Crossing boundaries: Implications of advances in basic sciences for the management of addiction.

This set of papers in this issue of "Addictive Behaviors" was presented at the 2004 'Addictions' conference, which, for the first time, was held in the Southern Hemisphere, on the Sunshine Coast of Queensland, Australia. The theme of the conference, Crossing Boundaries: Implications of Advances in Basic Sciences for the Management of Addiction, speaks for itself. The papers derive from a wide range of empirical paradigms and cover issues with relevance to the development of addiction, to the maintenance of problematic use, and to assessment, treatment, and relapse. Research from Europe and the United States is represented, as well as work from Australia. An international perspective is strongly emphasized from the initial paper by Obot, Poznyak, and Moneiro, (see record 2004-19599-015) which describes the WHO Report on the Neuroscience of Psychoactive Substance Use and Dependence, and summarises some of the report's implications for policy and practice. Hall, Carter, and Morley (see record 2004-19599-014) close the issue with a paper on the wide-ranging ethical implications of advances in neuroscience research, including issues arising from the identification of high risk for addiction, the potential for coercive pharmacotherapy, use of medications to enhance function, and risks to privacy.

The management of transport construction projects : a survey of public sector organisations in Queensland Australia

Construction procurement organisations in the Australian framework provide broad guidelines on project management in setting benchmark performance measurements and processes for evaluating their projects. Despite this, little has been known in the project management practise in transport construction projects in Australia, in particular Queensland. Questionnaire data from 53 project management practitioners employed in State and City public sector organisations in Queensland,suggested that many practitioners in the public sector have little or a lack of understanding of government regulatory policies, which are used as economic evaluation tools for project options. Public sector project managers perceive socio-economic evaluation tools as inappropriate for public sector projects. The survey results also found conducting risk management analysis, developing a risk register and mitigation of risks were most effective way of managing risk. This study provides an opportunity for the public sector to review and provide training on project management practices and government regulatory policies governing public projects. This will improve project management practitioners’ understanding and interpretation of government regulatory policies.

A process for the management of physical infrastructure

Physical infrastructure assets are important components of our society and our economy. They are usually designed to last for many years, are expected to be heavily used during their lifetime, carry considerable load, and are exposed to the natural environment. They are also normally major structures, and therefore present a heavy investment, requiring constant management over their life cycle to ensure that they perform as required by their owners and users. Given a complex and varied infrastructure life cycle, constraints on available resources, and continuing requirements for effectiveness and efficiency, good management of infrastructure is important. While there is often no one best management approach, the choice of options is improved by better identification and analysis of the issues, by the ability to prioritise objectives, and by a scientific approach to the analysis process. The abilities to better understand the effect of inputs in the infrastructure life cycle on results, to minimise uncertainty, and to better evaluate the effect of decisions in a complex environment, are important in allocating scarce resources and making sound decisions. Through the development of an infrastructure management modelling and analysis methodology, this thesis provides a process that assists the infrastructure manager in the analysis, prioritisation and decision making process. This is achieved through the use of practical, relatively simple tools, integrated in a modular flexible framework that aims to provide an understanding of the interactions and issues in the infrastructure management process. The methodology uses a combination of flowcharting and analysis techniques. It first charts the infrastructure management process and its underlying infrastructure life cycle through the time interaction diagram, a graphical flowcharting methodology that is an extension of methodologies for modelling data flows in information systems. This process divides the infrastructure management process over time into self contained modules that are based on a particular set of activities, the information flows between which are defined by the interfaces and relationships between them. The modular approach also permits more detailed analysis, or aggregation, as the case may be. It also forms the basis of ext~nding the infrastructure modelling and analysis process to infrastructure networks, through using individual infrastructure assets and their related projects as the basis of the network analysis process. It is recognised that the infrastructure manager is required to meet, and balance, a number of different objectives, and therefore a number of high level outcome goals for the infrastructure management process have been developed, based on common purpose or measurement scales. These goals form the basis of classifYing the larger set of multiple objectives for analysis purposes. A two stage approach that rationalises then weights objectives, using a paired comparison process, ensures that the objectives required to be met are both kept to the minimum number required and are fairly weighted. Qualitative variables are incorporated into the weighting and scoring process, utility functions being proposed where there is risk, or a trade-off situation applies. Variability is considered important in the infrastructure life cycle, the approach used being based on analytical principles but incorporating randomness in variables where required. The modular design of the process permits alternative processes to be used within particular modules, if this is considered a more appropriate way of analysis, provided boundary conditions and requirements for linkages to other modules, are met. Development and use of the methodology has highlighted a number of infrastructure life cycle issues, including data and information aspects, and consequences of change over the life cycle, as well as variability and the other matters discussed above. It has also highlighted the requirement to use judgment where required, and for organisations that own and manage infrastructure to retain intellectual knowledge regarding that infrastructure. It is considered that the methodology discussed in this thesis, which to the author's knowledge has not been developed elsewhere, may be used for the analysis of alternatives, planning, prioritisation of a number of projects, and identification of the principal issues in the infrastructure life cycle.

Life-cycle management of construction projects based on virtual prototyping technology

Life-cycle management (LCM) has been employed in the management of construction projects for many years in order to reduce whole life cost, time, risk and improve the service to owners. However, owing to lack of an effective information sharing platform, the current LCM of construction projects is not effectively used in the construction industry. Based upon the analysis of the information flow of LCM, a virutal prototyping (VP)-based communication and collaboration information platform is proposed. Following this, the platform is customized using DASSAULT sofware. The whole process of implementing the VP-based LCM are also discussed and, from a simple case study, it is demonstrated that the VP-based communication and collaboration information platform is an effective tool to support the LCM of construction projects.

Integrating information security policy management with corporate risk management for strategic alignment

Information security policy defines the governance and implementation strategy for information security in alignment with the corporate risk policy objectives and strategies. Research has established that alignment between corporate concerns may be enhanced when strategies are developed concurrently using the same development process as an integrative relationship is established. Utilizing the corporate risk management framework for security policy management establishes such an integrative relationship between information security and corporate risk management objectives and strategies. There is however limitation in the current literature on presenting a definitive approach that fully integrates security policy management with the corporate risk management framework. This paper presents an approach that adopts a conventional corporate risk management framework for security policy development and management to achieve alignment with the corporate risk policy. A case example is examined to illustrate the alignment achieved in each process step with a security policy structure being consequently derived in the process. It is shown that information security policy management outcomes become both integral drivers and major elements of the corporate-level risk management considerations. Further study should involve assessing the impact of the use of the proposed framework in enhancing alignment as perceived in this paper.

Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.

Boundary weaving : the social structure and processes of organizational boundaries

Boundaries are an important field of study because they mediate almost every aspect of organizational life. They are becoming increasingly more important as organizations change more frequently and yet, despite the endemic use of the boundary metaphor in common organizational parlance, they are poorly understood. Organizational boundaries are under-theorized and researchers in related fields often simply assume their existence, without defining them. The literature on organizational boundaries is fragmented with no unifying theoretical basis. As a result, when it is recognized that an organizational boundary is "dysfunctional". there is little recourse to models on which to base remediating action. This research sets out to develop just such a theoretical model and is guided by the general question: "What is the nature of organizational boundaries?" It is argued that organizational boundaries can be conceptualised through elements of both social structure and of social process. Elements of structure include objects, coupling, properties and identity. Social processes include objectification, identification, interaction and emergence. All of these elements are integrated by a core category, or basic social process, called boundary weaving. An organizational boundary is a complex system of objects and emergent properties that are woven together by people as they interact together, objectifying the world around them, identifying with these objects and creating couplings of varying strength and polarity as well as their own fragmented identity. Organizational boundaries are characterised by the multiplicity of interconnections, a particular domain of objects, varying levels of embodiment and patterns of interaction. The theory developed in this research emerged from an exploratory, qualitative research design employing grounded theory methodology. The field data was collected from the training headquarters of the New Zealand Army using semi-structured interviews and follow up observations. The unit of analysis is an organizational boundary. Only one research context was used because of the richness and multiplicity of organizational boundaries that were present. The model arose, grounded in the data collected, through a process of theoretical memoing and constant comparative analysis. Academic literature was used as a source of data to aid theory development and the saturation of some central categories. The final theory is classified as middle range, being substantive rather than formal, and is generalizable across medium to large organizations in low-context societies. The main limitation of the research arose from the breadth of the research with multiple lines of inquiry spanning several academic disciplines, with some relevant areas such as the role of identity and complexity being addressed at a necessarily high level. The organizational boundary theory developed by this research replaces the typology approaches, typical of previous theory on organizational boundaries and reconceptualises the nature of groups in organizations as well as the role of "boundary spanners". It also has implications for any theory that relies on the concept of boundaries, such as general systems theory. The main contribution of this research is the development of a holistic model of organizational boundaries including an explanation of the multiplicity of boundaries . no organization has a single definable boundary. A significant aspect of this contribution is the integration of aspects of complexity theory and identity theory to explain the emergence of higher-order properties of organizational boundaries and of organizational identity. The core category of "boundary weaving". is a powerful new metaphor that significantly reconceptualises the way organizational boundaries may be understood in organizations. It invokes secondary metaphors such as the weaving of an organization's "boundary fabric". and provides managers with other metaphorical perspectives, such as the management of boundary friction, boundary tension, boundary permeability and boundary stability. Opportunities for future research reside in formalising and testing the theory as well as developing analytical tools that would enable managers in organizations to apply the theory in practice.

A model of organizational innovation implementation effectiveness in small to medium firms

The present study aims to validate the current best-practice model of implementation effectiveness in small and mid-size businesses. Data from 135 organizations largely confirm the original model across various types of innovation. In addition, we extended this work by highlighting the importance of human resources in implementation effectiveness and the consequences of innovation effectiveness on future adoption attitudes. We found that the availability of skilled employees was positively related to implementation effectiveness. Furthermore, organizations that perceived a high level of benefits from implemented innovations were likely to have a positive attitude towards future innovation adoption. The implications of our improvements to the original model of implementation effectiveness are discussed.

Editoral : Correspondence regarding Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. The Lancet 2011; 378: 731–39. Published 20 August 2011.

We read the excellent review of telemonitoring in chronic heart failure (CHF)1 with interest and commend the authors on the proposed classification of telemedical remote management systems according to the type of data transfer, decision ability and level of integration. However, several points require clarification in relation to our Cochrane review of telemonitoring and structured telephone support2. We included a study by Kielblock3. We corresponded directly with this study team specifically to find out whether or not this was a randomised study and were informed that it was a randomised trial, albeit by date of birth. We note in our review2 that this randomisation method carries a high risk of bias. Post-hoc metaanalyses without these data demonstrate no substantial change to the effect estimates for all cause mortality (original risk ratio (RR) 0·66 [95% CI 0·54, 0·81], p<0·0001; revised RR 0·72 [95% CI 0·57, 0·92], p=0·008), all-cause hospitalisation (original RR 0·91 [95% CI 0·84, 0·99] p=0·02; revised RR 0.92 [95% CI 0·84, 1·02], p=0·10 ) or CHF-related hospitalisation (original RR 0·79 [95% CI 0·67, 0·94] p=0·008; revised RR 0·75 [95% CI 0·60, 0·94] p=0·01). Secondly, we would classify the Tele-HF study4, 5 as structured telephone support, rather than telemonitoring. Again, inclusion of these data alters the point-estimate but not the overall result of the meta-analyses4. Finally, our review2 does not include invasive telemonitoring as the search strategy was not designed to capture these studies. Therefore direct comparison of our review findings with recent studies of these interventions is not recommended.