Demand for hospital emergency departments : a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.

Developing tools to facilitate integrated reflection

Much has been said and documented about the key role that reflection can play in the ongoing development of e-portfolios, particularly e-portfolios utilised for teaching and learning. A review of e-portfolio platforms reveals that a designated space for documenting and collating personal reflections is a typical design feature of both open source and commercial off-the-shelf software. Further investigation of tools within e-portfolio systems for facilitating reflection reveals that, apart from enabling personal journalism through blogs or other writing, scaffolding tools that encourage the actual process of reflection are under-developed. Investigation of a number of prominent e-portfolio projects also reveals that reflection, while presented as critically important, is often viewed as an activity that takes place after a learning activity or experience and not intrinsic to it. This paper assumes an alternative, richer conception of reflection: a process integral to a wide range of activities associated with learning, such as inquiry, communication, editing, analysis and evaluation. Such a conception is consistent with the literature associated with ‘communities of practice’, which is replete with insight into ‘learning through doing’, and with a ‘whole minded’ approach to inquiry. Thus, graduates who are ‘reflective practitioners’ who integrate reflection into their learning will have more to offer a prospective employer than graduates who have adopted an episodic approach to reflection. So, what kinds of tools might facilitate integrated reflection? This paper outlines a number of possibilities for consideration and development. Such tools do not have to be embedded within e-portfolio systems, although there are benefits in doing so. In order to inform future design of e-portfolio systems this paper presents a faceted model of knowledge creation that depicts an ‘ecology of knowing’ in which interaction with, and the production of, learning content is deepened through the construction of well-formed questions of that content. In particular, questions that are initiated by ‘why’ are explored because they are distinguished from the other ‘journalist’ questions (who, what, when, where, and where) in that answers to them demand explanative, as opposed to descriptive, content. They require a rationale. Although why questions do not belong to any one genre and are not simple to classify — responses can contain motivational, conditional, causal, and/or existential content — they do make a difference in the acquisition of understanding. The development of scaffolding that builds on why-questioning to enrich learning is the motivation behind the research that has informed this paper.

Engaging parents in STEM: Coteaching and cogenerative dialoguing in a Queensland high school

Diminished student interest in science, technology, engineering and mathematics (STEM) is recognised by educators, researchers and public policy makers as a concerning global trend. Inviting stakeholders like scientists and industry specialists to discuss their work is one means schools use to facilitate student engagement in the sciences. However, these visits generally comprise one-off sessions with minimal relevance to students’ particular and ongoing learning needs. This case study investigated coteaching and cogenerative dialoguing with parents in teaching a Year-8 multidisciplinary unit with science and technology foci. Two parents cotaught alongside the resident teacher and researcher over eight months. This paper concentrates on one parent, a medical scientist by profession. Data sources included video and audio recordings of cogenerative dialogues and classroom interactions, student work samples and journal entries. Data were interrogated using the sociological constructs of fields and capitals and the dialectic of structure|agency. The findings reveal how (a) the parent’s science and technology knowledge was tailored to the students’ needs initially and continually and (b) student-generated data indicated enhanced engagement in science and technology. The research speaks to schools and governments about enhancing STEM education by furthering collaborative relationships with relevant stakeholders.

Designing an immersive environment for public use

Bystander is a multi-user, immersive, interactive environment intended for public display in a museum or art gallery. It is designed to make available heritage collections in novel and culturally responsible ways. We use its development as a case study to examine the role played in that process by a range of tools and techniques from participatory design traditions. We describe how different tools were used within the design process, specifically: the ways in which the potential audience members were both included and represented; the prototypes that have been constructed as a way of envisioning how the final work might be experienced; and how these tools have been brought together in ongoing designing and evaluation. We close the paper with some reflections on the extension of participatory commitments into still-emerging areas of technology design that prioritise the design of spaces for human experience and reflective interaction.

A prospective surveillance model for rehabilitation for women with breast cancer

Background: The current model of care for breast cancer is focused on disease treatment followed by ongoing recurrence surveillance. This approach lacks attention to the patients’ physical and functional well-being. Breast cancer treatment sequelae can lead to physical impairments and functional limitations. Common impairments include pain, fatigue, upper extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence supports prospective surveillance for early identification and treatment as a means to prevent or mitigate many of these concerns. Purpose: This paper proposes a prospective surveillance model for physical rehabilitation and exercise that can be integrated with disease treatment to create a more comprehensive approach to survivorship health care. The goals of the model are to promote surveillance for common physical impairments and functional limitations associated with breast cancer treatment, to provide education to facilitate early identification of impairments, to introduce rehabilitation and exercise intervention when physical impairments are identified and to promote and support physical activity and exercise behaviors through the trajectory of disease treatment and survivorship. Methods: The model is the result of a multi-disciplinary meeting of research and clinical experts in breast cancer survivorship and representatives of relevant professional and advocacy organizations. Outcomes: The proposed model identifies time points during breast cancer care for assessment of and education about physical impairments. Ultimately, implementation of the model may influence incidence and severity of breast cancer treatment related physical impairments. As such, the model seeks to optimize function during and following treatment and positively influence a growing survivorship community.

Making space for place-making pedagogies : stretching normative mandated literacy curriculum

In an era of normative standardised literacy curriculum continuing to make space for culturally responsive literacy pedagogy is on ongoing challenge for early childhood educators. Collaborative participatory research and ethnographic studies of teachers who accomplish innovative and inclusive early childhood education in culturally diverse high poverty communities is urgent for the profession. Such pedagogies involve complex understandings of the cultural and political histories, and the dynamic potential, of the places in which school communities are located. By incorporating the study of local histories and biographies and researching neighbourhood changes teachers adapt mandated curriculum to maintain community knowledges and allow for positive identity work at the same time as they meet the authorised systems objectives. When teachers work with children as co-researchers through the study of people's lives in particular places and times, the community and its complex histories become a rich resource for young people's literacy repertoires.

Managing innovative change within organisations and project team environments

In an attempt to enhance the efficiency, productivity and competitiveness of today’s Architectural, Engineering, and Contractor (AEC) industry, this paper summarises the current status of an ongoing PhD research investigation in developing a sustainable AEC industry specific best-practice ‘Innovation-driven Change Framework’—more specifically a summation of the ‘fourth interrelated dynamic’ (culture). Leveraging off the outcomes of a two year industry and government supported Cooperative Research Centre for Construction Innovation (CRCCI) research project, as well as referring to recent internationally renowned case studies and related literature investigations, this research investigation includes further identifying, processing, analysing and categorizing various culture change methods, models, frameworks and processes utilized within the AEC and other industry sectors, and incorporating these findings in developing an AEC industry-specific ‘Innovation-driven Change Framework’

Understanding successful use of technology in organisations in developing countries : a structurational perspective

Information Technology and its relationship to organisational performance has been a subject of continued interest to researchers and other stakeholders in developing countries. While there is concurrence that IT does contribute to performance, and we are efficiently expanding our knowledge on what factors cause better leveraging of IT resources in organisations, we have done little to understand how these factors interact with technology that results in improved performance. This paper suggests looking that the interaction between organisational resources and technology within the structurational lens, which recognises the recursive interaction between technology and people in the presence of social practices, and the norms that inform their ongoing practices. An ethnographic approach to understanding this interaction between technology and resources, as suggested by the structuration perspective, is suggested, aiming to provide richer insights on the nature of the environment that promotes better use of IT resources in developing countries. Such insights could provide the IT users in developing countries with at least an initial conception of the “IT usage platform” that they could promote in their organisations to leverage the most from their IT resources.

The impact of tenure type on the desire for retirement village living

In 2005 17.3% of Australians were aged 60 years and older (Australian Bureau of Statistics). A consequence of this aging population is the increased use of self-contained independent living units (SCILU) in Retirement Villages by older Australians. The retirement village sector has thus become a significant sector within the residential property market. In seeking to determine the impact of tenure type on the desirability of RV living this paper first profiles a typical SCILU in Australia, before explaining and examining the various tenure types offered by the market. This paper concludes that the multiplicity of offerings of the SCILU product with respect to tenure type, when combined with deferred management fees and participation in capital gains/losses, may be contributing to a lack of clarity in what the SCILU product entails and the security of investment it offers. This perception is supported by litigated disputes and may be damaging the reputation, ongoing viability and desirability of SCILUs.

Deep Blue Orchestra

Under an Australian Research Council Linkage Grant, the partnering research organisations QUT, Creative Media Warehouse, The Brisbane Festival and The Queensland Orchestra undertook extensive reviews of many aspects of traditional and contemporary arts practice. We will publish excerpts from the findings soon. deepblue is committed to ongoing research as a part of the day to day operation and is currently working in partnership with John Kotzas and the team at QPAC on exploring new techniques for presenting and marketing deep blue.

A process evaluation of a comprehensive school based injury prevention program

A process evaluation enables understanding of critical issues that can inform the improved, ongoing implementation of an intervention program. This study describes the process evaluation of a comprehensive, multi-level injury prevention program for adolescents. The program targets change in injury associated with violence, transport and alcohol risks and incorporates two primary elements: an 8-week, teacher delivered attitude and behaviour change curriculum for Grade 8 students; and a professional development program for teachers on school level methods of protection, focusing on strategies to increase students’ connectedness to school.

Developing support for micro-entrepreneurs in a developing economy in Africa

The purpose of this paper is to explore the means of building the capacity of those who are running an organisation designed to support and resource start-ups and growing micro enterprises among some of the world’s poorest urban poor. The project is based in Beira, Mozambique, one of the poorest countries in the world. The result of this study is the development of a model for providing ongoing, inexpensive, effective, capacity building in developing economies. The model also provides a base for the further development of strategies to provide better support to micro entrepreneurs in poor developing economies.

Editorial : advancing innovation in accounting research

We live in uncertain times. The sub-prime crisis that commenced in the U.S. in 2007, the global economic crisis that followed, and the recent sovereign debt crisis in various European countries have led to ongoing instability in global financial markets that continues to receive daily media attention. These uncertain times create enormous opportunities for researchers across many disciplines to research capital markets and business practices. From an accounting perspective, accounting regulators have been active in developing new standards to address risk management issues arising from the crises and have continued to develop and refine financial reporting standards. With the adoption of, or transition to international financial reporting standards (IFRS) in many countries, the globalisation of financial reporting standards is close to becoming a reality. However, doubts still remain about whether the IFRS will lead to any real long-term improvement in financial reporting and transparency (see Sunder, 2011)...

When non-significance maybe significant: lessons learned from a study into the development, implementation and evaluation of a risk assessment tool for fleet settings

Introduction This study reports on the development of a self report assessment tool to increase the efficacy of crash prediction within Australian Fleet settings Over last 20 years an array of measures have been produced (Driver anger scale, Driving Skill Inventory, Manchester Driver Behaviour Questionnaire, Driver Attitude Questionnaire, Driver Stress Inventory, Safety Climate Questionnaire) While these tools are useful, research has demonstrated limited ability to accurately identify individuals most likely to be involved in a crash. Reasons cited include; - Crashes are relatively rare - Other competing factors may influence crash event - Ongoing questions regarding the validity of self report measures (common method variance etc) - Lack of contemporary issues relating to fleet driving performance

Context-aware methods for process modeling

Recent studies have started to explore context-awareness as a driver in the design of adaptable business processes. The emerging challenge of identifying and considering contextual drivers in the environment of a business process are well understood, however, typical methods used in business process modeling do not yet consider this additional contextual information in their process designs. In this chapter, we describe our research towards innovative and advanced process modeling methods that include mechanisms to incorporate relevant contextual drivers and their impacts on business processes in process design models. We report on our ongoing work with an Australian insurance provider and describe the design science we employed to develop these innovative and useful artifacts as part of a context-aware method framework. We discuss the utility of these artifacts in an application in the claims handling process at the case organization.