What We Have Here is a Failure to Communicate! Improving Communication between Tertiary to Primary Care for Chronic Heart Failure Patients

Background:  The aims of this study were to determine the documentation of pharmacotherapy optimization goals in the discharge letters of patients with the principal diagnosis of chronic heart failure. Methods:  A retrospective practice audit of 212 patients discharged to the care of their local general practitioner from general medical units of a large tertiary hospital. Details of recommendations regarding ongoing pharmacological and non-pharmacological management were reviewed. The doses of medications on discharge were noted and whether they met current guidelines recommending titration of angiotensin-converting enzyme inhibitors and beta-blockers. Ongoing arrangements for specialist follow up were also reviewed. Results:  The mean age of patients whose letters were reviewed was 78.4 years (standard deviation ± 8.6); 50% were men. Patients had an overall median of six comorbidities and eight regular medications on discharge. Mean length of stay for each admission was 6 days. Discharge letters were posted a median of 4 days after discharge, with 25% not posted at 10 days. No discharge letter was sent in 9.4% (20) of the cases. Only six (2.8%) letters had any recommendations regarding future titration of angiotensin-converting enzyme inhibitors and 6.6% (14) for beta-blockers. Recommendations for future non-pharmacological management, for example, diuretic action plans, regular weight monitoring and exercise plans were not found in the letters in this audit. Conclusion:  Hospital discharge is an opportunity to communicate management plans for treatment optimization effectively, and while this opportunity is spurned, implementation gaps in the management of cardiac failure will probably remain.

Crisis preparedness of construction companies

In high-risk industries, companies with well-conceived crisis management plans are at a commercial advantage. While there is some understanding of the risk management practices of construction companies, there is little insight into their crisis preparedness. This paper presents the findings of exploratory research that investigated this issue. Using a diagnostic model of crisis preparedness that has been developed and tested across a broad range of industries, it concludes that if the sample surveyed is typical, then corporate philosophies in construction companies do not support crisis management activities. Furthermore, crisis planning is rudimentary and undertaken in an insular, informal, fragmented fashion, supported by few resources and little strategic guidance. Consequently, many construction companies will have an inadequate understanding of their crisis exposure, of how to cope with crises when they happen, and of how to learn and recover from their aftermath.

Murray-Darling basin governance : the focus of the law

The legal arrangements for the management of the Murray-Darling Basin in Australia have changed significantly over the years. The Constitution of the Commonwealth has led to the legal arrangements for the management of the Murray-Darling Basin. The Water Act 2000 of Queensland aimed at advancing sustainable management and efficient use of water and other resources by establishing a system for the planning, allocation and use of water. The Water Management Act 2000 of New South Wales ensures the sustainable and integrated management of the water resources of the state benefiting the present and future generations. The Natural Resources Management Act 2004 of South Australia applies to water resources and to other natural resources. The Act aimed at assisting the achievement of ecologically sustainable development in the state.

Dying in hospital: medical failure or natural outcomes?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

Bargara Pasturage Reserve : Future Visions

Bargara Pasturage Reserve: Future Visions This exhibition showcases the work of Postgraduate Landscape Architecture and final year Undergraduate Civil and Environmental Engineering students in response to issues of sustainability in a coastal wetland known as the Bargara Pasturage Reserve; an exemplar of the many issues facing sensitive coastal places in Queensland today. The 312ha Pasturage Reserve at Bargara is the only biofilter between the pressures of Bargara’s urban and tourism expansion, surrounding sugarcane farming, and the Great Sandy Marine Park, including the largest concentration of nesting marine turtles on the eastern Australian mainland. This ephemeral wetland, while struggling to fulfil its coastal biofiltration function, is also in high demand for passive recreation, and the project partners’ priorities were to meet both of these challenges. The students were required to plan and design for the best balance possible amongst, but not limited to: wetland and coastal ecological health, enhancement of cultural heritage and values, sustainable urban development, and local economic health. To understand these challenges, QUT staff and students met with partners, visited and analysed the Pasturage Reserve, spent time in and around Bargara talking to locals and inviting dialogue with Indigenous representatives and the South Sea Islander community. We then went home to Brisbane to undertake theoretical and technical research, and then worked to produce 11 Strategic Plans, 2 Environmental Management Plans and 33 Detailed Designs. One group of students analysed the Bargara coastal landscape as an historical and ongoing series of conversations between ecological systems, cultural heritage, community and stakeholders. Another group identified the landscape as neither ‘urban,’ ‘rural,’ nor ‘natural,’ instead identifying it metaphorically as a series of layered thematic ‘fields’ such as water, conservation, reconciliation, and educational fields. These landscape analyses became the organising mechanisms for strategic planning. An outstanding Strategic Plan was produced by Zhang, Lemberg and Jensen, entitled Metanoia, which means to ‘make a change as the result of reflection on values’. Three implementation phases of “flow”, “flux”, and “flex” span twenty-five years, and present a vision a coastal and marine research and conservation hub, with a focus on coastal wetland function, turtle habitat and coral reef conservation. An Environmental Management Plan by Brand and Stickland focuses on protecting and improving wetland biodiversity and habitat quality, and increasing hydrological and water quality function; vital in a coastal area of such high conservation value. After the planning phase, students individually developed detailed design proposals responsive to their plans. From Metanoia, Zhang concentrated on wetland access and interpretation, proposing four focal places to form the nucleus of a wider pattern of connectivity, and to encourage community engagement with coastal environmental management and education. Jensen tackled the thorny issue of coastal urban development, proposing a sensitive staged eco-village model which maintains both ecological and recreational connectivity between the wetland and the marine environment. This project offered QUT’s partners many innovative options to inform their future planning. BSC, BMRG and Oceanwatch Australia are currently engaged in the investigation of on-ground opportunities drawing on these options.

Spatiotemporal modelling in estimation of nitrous oxide emissions from soil

Nitrous oxide is a major greenhouse gas emission. The aim of this research was to develop and apply statistical models to characterize the complex spatial and temporal variation in nitrous oxide emissions from soils under different land use conditions. This is critical when developing site-specific management plans to reduce nitrous oxide emissions. These studies can improve predictions and increase our understanding of environmental factors that influence nitrous oxide emissions. They also help to identify areas for future research, which can further improve the prediction of nitrous oxide in practice.

Alcohol restrictions and drink driving in remote Indigenous communities in Queensland, Australia

Alcohol restrictions have been implemented in many Indigenous communities internationally, with the aim to reduce alcohol-related harm. Whilst a range of reviews have evaluated such restrictions using different measures, drink driving has been described in several reviews as increasing. Presently, this remains anecdotal; with limited empirical evidence to corroborate these reports. In Australia, the Queensland government introduced alcohol management plans in remote Indigenous communities, during 2002-2003, with total alcohol prohibition commencing in 2008 in some communities. Given road crashes are one of the leading causes of injuries for Indigenous peoples, this study aims to identify if the restrictions have been successful in reducing drink driving or have increased such behaviour. We examine this by reviewing changes in conviction rates and in offender and offence characteristics following the 2008 restrictions. Using de-identified Queensland court drink driving conviction data (2006-2011), from four Indigenous communities, Robust Poisson regression models compared counts of drink driving convictions pre (2006-2008) versus post SRS (2009-2011). Changes in offender characteristics and conviction details (blood alcohol concentration (BAC) and sentencing severity), were examined using chi-squares. Results indicate a decline in convictions after the 2008 SRS in three communities. However, a significant increase in convictions was identified in one study community. Community-level disparity included significant decline in BAC in one community (χ 2=5.58, p=0.02) compared with the three other communities that did not indicate change and a significant increase the number of women convicted in two communities (χ 2=17.36, p<0.01; χ 2=5.79, p=0.04). Alcohol restrictions may have important implications in road safety with these reductions in convictions and BAC in some communities. However, an increase in the number of women convicted and limited changes in BAC for other communities demonstrate the complex relationship between alcohol use, remoteness and driving. Greater focus on demand reduction strategies may be necessary to address alcohol misuse.

Road infrastructure vulnerability to groundwater table variation due to sea level rise

This study was conducted to assess the vulnerability of coastal road infrastructures due to climate change induced sea level rise and extreme weather conditions through the estimation of road subgrade strength reduction as a result of changes in soil moisture content. The study area located in the Gold Coast, Australia highlighted that the risk is significant. In wet seasons or areas with wet condition, the groundwater table is already high, so even a small change in the groundwater table can raise the risk of inundation; particularly, in areas with existing shallow groundwater. The predicted risk of a high groundwater table on road infrastructure is a long-term hazard. Therefore, there is time to undertake some management plans to decrease the possible risks, for instance, some deep root plants could be planted along the roads with a high level of risk, to decrease the groundwater table elevation.

Reframe : QUT's Evaluation Framework 2014 Communications Plan

2014 is the year for embedding the Reframe: QUT’s Evaluation Framework as core business within the University, with the following providing an outline of the Learning and Teaching Unit’s (LTU) planned activities to support this implementation. LTU is continuing its commitment to intensive support and engagement with the academic and teaching focused community within QUT. The Academic Quality and Standards team have extended the existing communication and dissemination activities into a comprehensive communication plan for 2014, with major initiatives defined within this document. It should be noted that these activities are aligned to the discussions from the 2013 Integrated Management of Feedback (IMF) Steering Group and as endorsed by the University Learning and Teaching Committee at their meeting in February, 2014.

Development of a new regulatory model for occupational health and safety in the New South Wales coal industry: an issues paper for the New South Wales Department of Mineral Resources

This paper addresses the regulatory issues arising in developing a new regulatory model for the New South Wales Coal Industry. As such, it identifies the relevant literature on this subject, the options available for reform, and the experience of Australian and key international bodies responsible for the development of regulatory standards in this area. In particular it: Identifies the main shortcomings in the existing regulatory approach; Identifies the potential roles/main strengths and weaknesses of different types of standards (eg specification, performance, process and systems-based rules) and potential “best practice’ combinations of standards; Examines the appropriateness of the current regulatory regime whereby the general OHS legislation (including the general duty provisions) applies to mining in addition to the large body of regulation which is specific to mining; Identifies the importance of, and possible means of addressing, issues of worker participation within the coal mining industry; Draws on the literature on what motivates companies and individuals for the purpose of recommending key provisions for inclusion in new legislation to provide appropriate personal and organisational incentives; Draws on the literature on major hazards facilities to suggest the appropriate roles for OHS management systems and safety reports or comparable approaches (eg mine safety management plans); Draws on the United Kingdom (UK) and United States of America (USA) experience of coal mine safety and its regulation for comparative purposes, and for insights as to what sort of regulation most effectively reduces work related injury and disease in coal mining; Examines the relevant roles of International Labour Organisation (ILO) Conventions; Examines the extent to which different regulatory regimes would be appropriate to open cut and underground coal mining; and Examines options for reform. This paper is focussed specifically on the issues identified above.

Tamworth Regional Council Social Plan 2006

The Tamworth Regional Social Plan is a document for collaborative planning involving the three spheres of government, the community and commercial sectors, with the aim of enhancing the quality and fairness of life in Tamworth. The Plan is a way of identifying needs and priorities for community facilities and services for Tamworth. The Social Plan reflects Council’s ongoing commitment to the people of the Tamworth Region and, in particular, the social needs and aspirations of our community. The Local Government (General) Amendment (Community and Social Plans) Regulation 1998 grew out of the 1996 NSW Social Justice Directions Statement “Fair Go, Fair Share, Fair Say” which committed the Department of Local Government to ensuring government services are responsive to community needs and diversity. The regulation is designed to:- • Improve Councils’ ability to take account of community needs when formulating their management plans; • Assist Councils to provide or advocate for appropriate and accessible services/facilities; and • Increase the community’s ability to monitor Council efforts in addressing community needs over time. The Local Government (General) Regulation 1999 requires that all councils develop a community/social plan and that all plans be prepared in accordance with guidelines issued by the Department. While Council has a broad function of providing leadership for Tamworth, it is not the only group responsible for providing community services. Developing the Social Plan has required cooperation with various State and Federal agencies as well as with Tamworth’s community groups and agencies.

Applying integrated resource and environmental management to transmission right-of-way maintenance

The concept of a substantive integrator is introduced as a method for integrated resource and environmental management as a means to assimilate different resource values at the operational or field level. A substantive integrator is a strategic management tool for integrating multiple uses into coprorate management regimes that traditionally manage for single values. Wildlife habitat management is presented as a substantive integrator for managing vegetation on electric utility power line corridors. A case study from northern British Columbia provides an example of wildlife habitat management as a means to integrate other resource values such as aesthetics, access and subsistence along British Columbia Hydro and Power Authority's transmission rights-of-way.

A framework for analyzing system intelligence of the building control system : a study of the integrated building management system

The lack of satisfactory consensus for characterizing the system intelligence and structured analytical decision models has inhibited the developers and practitioners to understand and configure optimum intelligent building systems in a fully informed manner. So far, little research has been conducted in this aspect. This research is designed to identify the key intelligent indicators, and develop analytical models for computing the system intelligence score of smart building system in the intelligent building. The integrated building management system (IBMS) was used as an illustrative example to present a framework. The models presented in this study applied the system intelligence theory, and the conceptual analytical framework. A total of 16 key intelligent indicators were first identified from a general survey. Then, two multi-criteria decision making (MCDM) approaches, the analytic hierarchy process (AHP) and analytic network process (ANP), were employed to develop the system intelligence analytical models. Top intelligence indicators of IBMS include: self-diagnostic of operation deviations; adaptive limiting control algorithm; and, year-round time schedule performance. The developed conceptual framework was then transformed to the practical model. The effectiveness of the practical model was evaluated by means of expert validation. The main contribution of this research is to promote understanding of the intelligent indicators, and to set the foundation for a systemic framework that provide developers and building stakeholders a consolidated inclusive tool for the system intelligence evaluation of the proposed components design configurations.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.