Caring for patients with limb amputation

This article provides an overview of the care of patients undergoing limb amputation. Absence of a limb can be congenital or the result of trauma or complications of chronic diseases. While the economic burden of limb amputation is significant, nurses have an important role in limiting other losses attributable to limb loss, such as long-term disability leading to loss of employment and delayed return to work or school. Comprehensive nursing assessments and appropriate interventions, pre and post-operatively, as well as early discharge planning and community reintegration can help avoid some of these losses. Nurses should be aware of the resources available in communities and work in multidisciplinary teams to ensure optimal outcomes for patients following limb amputation and their families.

New Generation Rollingstock Depot: Case Study Report

This report summarises the findings of a case study on Queensland’s New Generation Rollingstock (NGR) Project carried out as part of SBEnrc Project 2.34 Driving Whole-of-life Efficiencies through BIM and Procurement. This case study is one of three exemplar projects studied in order to leverage academic research in defining indicators for measuring tangible and intangible benefits of Building Information Modelling (BIM) across a project’s life-cycle in infrastructure and buildings. The NGR is an AUD 4.4 billion project carried out under an Availability Payment Public-Private Partnership (PPP) between the Queensland Government and the Bomabardier-led QTECTIC consortium comprising Bombardier Transportation, John Laing, ITOCHU Corporation and Aberdeen Infrastructure Investments. BIM has been deployed on the project from conceptual stages to drive both design and the currently ongoing construction at the Wulkuraka Project Site. This case study sourced information from a series of semi-structured interviews covering a cross-section of key stakeholders on the project. The present research identified 25 benefits gained from implementing BIM processes and tools. Some of the most prominent benefits were those leading to improved outcomes and higher customer satisfaction such as improved communications, data and information management, and coordination. There were also a number of expected benefits for future phases such as: • Improved decision making through the use of BIM for managing assets • Improved models through BIM maturity • Better utilisation of BIM for procurement on similar future projects • New capacity to specify the content of BIM models within contracts There were also three benefits that were expected to have been achieved but were not realised on the NGR project. These were higher construction information quality levels, better alignment in design teams as well as project teams, and capability improvements in measuring the impact of BIM on construction safety. This report includes individual profiles describing each benefit as well as the tools and processes that enabled them. Four key BIM metrics were found to be currently in use and six more were identified as potential metrics for the future. This case study also provides insights into challenges associated with implementing BIM on a project of the size and complexity of the NGR. Procurement aspects and lessons learned for managers are also highlighted, including a list of recommendations for developing a framework to assess the benefits of BIM across the project life-cycle.

A journey access tool to facilitate better health outcomes for people with disabilities

- Background One of the three objectives of the WHO Global Disability Action Plan 2014–2021 is removal of barriers and improved access to health services and programmes. Access to transport contributes to positive health outcomes; however, people with disabilities leaving their dwellings are confronted with barriers to their mobility. Mobility restrictions, sensory or other disabilities increase their vulnerability as road users, exposing them to higher risks of injury. PHSW and CARRS-Q have been collaborating with Handicap International Cambodia (HIC) on a Journey Access Tool (JAT). - Aims Use of the JAT is to (1) Identify transport and journey safety and barriers for people with disability and (2) Evaluation and modification of the tool after trailing to for use by NGOs and government agencies in prioritising actions around barriers. - Methodology The tool has undergone initial proof-of-concept testing in India and Viet Nam, and was trialled in Cambodia in February and May, 2015. Five teams were formed comprising a person with disability (physical, sensory or intellectual), researchers from QUT, staff from HIC, and local university students. The JAT was completed by each team and then discussed and evaluated. Two further Cambodian trials are scheduled for 2015. - Results The JAT is responsive to rural and urban contexts, and has utility for people with different disabilities. Two tools have been developed: a short version for people with a disability to complete independently, or with assistance; and a version for NGOs, DPOs and government. The tool has efficacy for advocacy.   - Conclusion The JAT has potential to assist the Mekong region with: (1) evaluating access for people with disability and other vulnerable members of the community including older people; (2) developing plans for changes to the routes in consultation with local authorities; (3) evaluating the effectiveness of implemented changes in terms of access and health; (4) inputting into policy; (5) The tool can be used for advocacy for change.

Design studio terrains: Mapping the learning landscapes of Australian architectural education

It has been nearly 25 years since the problems associated with passive learning in large undergraduate classes were first established by McDermott (1991). STEM education, for example North Carolina State University’s SCALE-UP project, has subsequently been influenced by some unique aspects of design studio education. While there are now many institutions applying SCALE-UP or similar approaches to enable lively interaction, enhanced learning, increased student engagement, and to teach many different content areas to classes of all sizes, nearly all of these have remained in the STEM fields (Beichner, 2008). Architectural education, although originally at the forefront of this field, has arguably been left behind. Architectural practice is undergoing significant change, globally. Access to new technology and the development of specialised architectural documentation software has scaffolded new building procurement methods and allowed consultant teams to work more collaboratively, efficiently and even across different time zones. Up until recently, the spatial arrangements, pedagogical approaches, and project work outcomes in the architectural design studio, have not been dissimilar to its inception. It is not possible to keep operating architectural design studios the same way that they have for the past two hundred years, with this new injection of high-end technology and personal mobile Wi-Fi enabled devices. Employing a grounded theory methodology, this study reviews the current provision of architectural design learning terrains across a range of tertiary institutions, in Australia. Some suggestions are provided for how these spaces could be modified to address the changing nature of the profession, and implications for how these changes may impact the design of future SCALE-UP type spaces outside of the discipline of architecture, are also explored.

Roles, responsibilities and scope of practice: describing the ‘state of play’ for infection control professionals in Australia and New Zealand

Background In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice. Methods A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken. Results A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams. Conclusion This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.

Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): A prospective cohort study

Background/Aim: To investigate the role of eccentric knee flexor strength, between-limb imbalance and biceps femoris long head (BFlh) fascicle length on the risk of a future hamstring strain injury (HSI). Methods: Elite soccer players (n=152) from eight different teams participated. Eccentric knee flexor strength during the Nordic hamstring exercise and BFlh fascicle length were assessed at the beginning of pre-season. The occurrences of a HSI following this were recorded by the team medical staff. Relative risk (RR) was determined for univariate data, and logistic regression was employed for multivariate data. Results: Twenty-seven new HSIs were reported. Eccentric knee flexor strength below 337N (RR = 4.4; 95% CI = 1.1 to 17.5) and BFlh fascicles shorter than 10.56cm (RR = 4.1; 95% CI=1.9 to 8.7) significantly increased the risk of a subsequent HSI. Multivariate logistic regression revealed significant effects when combinations of age, previous history of HSI, eccentric knee flexor strength and BFlh fascicle length were explored. From these analyses the likelihood of a future HSI in older athletes or those with a previous HSI history was reduced if high levels of eccentric knee flexor strength and longer BFlh fascicles were present. Conclusions: The presence of short BFlh fascicles and low levels of eccentric strength in elite soccer players increase the risk of a future HSI. The greater risk of a future HSI in older players or those with a previous HSI is reduced when they possess longer BFlh fascicles and high levels of eccentric strength.

Rockhampton's Resilient Future Design Charrette

The QUT Centre for Subtropical Design conducted a design-led interdisciplinary collaborative workshop (charrette) to develop some initial ideas for how innovation in research and practice can be applied to the complex problem of resilient future-focussed urban renewal in Rockhampton’s flood-prone suburbs and core grid. Three creative teams explored a range of scenarios for Rockhampton’s resilience in built form over the longer term. A large number of sketches, drawings and text were produced over two days. This report identifies themes, principles and strategies which emerged from the charrette. Each group proposed multiple guiding principles that fell into three strategic approaches: defend (through construction of a levee); adapt (by designing with flood in mind); retreat (a long term view to relocate populations in flood-prone areas). All three groups identified the importance of design that accommodates art, heritage, recreation, sustainability and tourism, and proposed these as principles to guide future strategies that mediate between Rockhampton’s broader ecological landscape and urban living to accommodate more affordable housing options, demonstrate sustainability and be climate responsive to predicted increased extreme weather events including flooding. The charrette outcomes pave the way to investigate wider issues and solutions to Rockhampton’s resilient future, beyond a levee as an isolated structure.

Methodology for developing competency standards for dietitians in Australia

Competency standards document the knowledge, skills, and attitudes required for competent performance. This study develops competency standards for dietitians in order to substantiate an approach to competency standard development. Focus groups explored the current and emerging purpose, role, and function of the profession, which were used to draft competency standards. Consensus was then sought using two rounds of a Delphi survey. Seven focus groups were conducted with 28 participants (15 employers/practitioners, 5 academics, 8 new graduates). Eighty-two of 110 invited experts participated in round one and 67 experts completed round two. Four major functions of dietitians were identified: being a professional, influencing the health of individuals, groups, communities, and populations through evidence-based nutrition practice, and working collaboratively in teams. Overall there was a high level of consensus on the standards: 93% achieved agreement by participants in round one and all revised standards achieved consensus on round 2. The methodology provides a framework for other professions wishing to embark on competency standard review or development.

Advancing initiatives in care of cognitively impaired patients in acute care settings

In November 2014, the Australian Commission on Safety and Quality in Health Care (ACSQHC) released “A better way to care: Safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospital”. http://www.safetyandquality.gov.au/our-work/cognitive-impairment. The handbook is available as three separate resources for the three audiences: clinicians, service managers and consumers. These resources are designed to inform and guide improved care for older patients with cognitive impairment (CI) (dementia, delirium) in acute care settings. In particular, the service managers resource recommends that organisations comprehensively prepare themselves so that they are alert to delirium and the risk it poses for patients, that they can recognise and respond to patients with CI, and that they are able to provide safe and high quality care tailored to individual patient’s needs. Service managers and clinicians should carefully consider the information provided in the resources and judiciously explore how best to modify and adapt everyday care practices where appropriate. It is important that clinical teams respond to the available information as the ACSQHC identifies that dementia and/or delirium is associated with adverse outcomes, including functional decline, increased risk of falls, and increased morbidity and mortality...

From mundane to smart: Exploring interactions with ‘smart' design objects

In addition to functional and technological features, the role of augmented objects should also be seen in terms of how effectively they fit into the everyday practices of users and how they enhance users' experiences. In this article, the authors introduce a low-tech, internet-of-things technology called CAM (Cooperative Artefact Memory) that is used as a collaborative tool in design studio environments. CAM works as an object memory technology and allows industrial and product designers to collaboratively store relevant information onto their physical design objects, such as sketches, collages, storyboards, and physical mock-ups in the form of messages, annotations and external web links. In the context of this study, CAM serves as an important probing device to understand designers' interaction and experiences with augmented design objects, in their natural environment. The authors carried out a small-scale field trial of CAM in an academic design studio, over three student design projects. In this article, they discuss the findings of their field trial and show how CAM was used by the participants, how it was integrated into the design process and how it was appropriated for different purposes. The authors also found that CAM supported coordination and awareness within the design teams, yet its serendipitous and asynchronous nature facilitated creative and playful interactions between team members. In general, the results show how CAM transformed mundane design objects into “smart” objects that made the creative and playful side of cooperative design visible.

Design based research methodology for teaching with technology in English

Design based research (DBR) is an appropriate method for small scale educational research projects involving collaboration between teachers, students and researchers. It is particularly useful in collaborative projects where an intervention is implemented and evaluated in a grounded context. The intervention can be technological, or a new program required by policy changes. It can be applied to educational contexts, such as when English teachers undertake higher degree research projects in their own or others’ sites; or for academics working collaboratively as researchers with teams of teachers. In the case described here the paper shows that DBR is designed to make a difference in the real world contexts in which occurs.

Empowerment climate, supervisory support for creativity and work role performance in new product development settings: A team level investigation

This thesis is an examination of how organisational context variables affect the performance of new product development (NPD) teams. Specifically, the extent to how team empowerment climate and supervisory support for creativity impact NPD team performance. Moreover, this thesis is a step forward in the ongoing development of work role performance theory by examining Griffin et al.'s (2007) work role performance model in the context of NPD teams. This thesis addresses the lack of research exploring work role performance dimensions in NPD teams and the extent to which a team empowerment climate and supervisory support for creativity impact NPDs performance.

Coaching knowledge, learning and mentoring in the Australian Football League

Understanding the work of Senior and Assistant Coaches in the AFL is important to better develop the next generation of performance coaches. Hence the focus of this research was to examine the knowledge, competences and learning of senior and assistant coaches in the Australian Football League. Specifically, the research sought to understand the ways in which Senior and Assistant Coaches in the AFL have come to know their “craft” with the particular aim of enhancing future coaching practice. Performance coaching is generally regarded as a cognitive activity and therefore “getting inside the heads” of AFL coaches will assist in our understanding of the complex coaching work in which they are engaged. In-depth interviews provided coaches an opportunity to reflect on their practices and how they learned their craft. Fundamental to this research was an understanding that the AFL and each club within the league be regarded as learning organizations and workplaces where learning takes place. Moreover the process of mentoring is regarded as a central learning process and a significant factor contributing to improved professional coaching practice. This applied research aims to inform coach development in Australian football, the annual review process (quality of performance) of employed coaches, and the recruitment of coaches in the AFL. Improving the quality of coaching in the AFL will, in turn, improve the performance of the players and teams, and subsequently enhance the continued development and sustainability of the game.

How do Australian podiatrists manage patients with diabetes The Australian diabetic foot management survey

Background Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. Methods A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. Results Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). Conclusions This study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

Conceptualising social media support for tacit knowledge sharing: physicians’ perspectives and experiences

Purpose – This paper aims to explore the potential contributions of social media in supporting tacit knowledge sharing, according to the physicians’ perspectives and experiences. Design/methodology/approach – Adopting a qualitative survey design, 24 physicians were interviewed. Purposive and snowball sampling were used to select the participants. Thematic analysis approach was used for data analysis. Findings – The study revealed five major themes and over 20 sub-themes as potential contributions of social media to tacit knowledge flow among physicians. The themes included socialising, practising, networking, storytelling and encountering. In addition, with the help of the literature and the supporting data, the study proposed a conceptual model that explains the potential contribution of social media to tacit knowledge sharing. Research limitations/implications – The study had both theoretical (the difficulty of distinguishing tacit and explicit knowledge in practice) and practical limitations (small sample size). The study findings have implications for the healthcare industry whose clinical teams are not always physically co-located but must exchange their critical experiential and tacit knowledge. Originality/value – The study has opened up a new discussion of this area by demonstrating and conceptualising how social media tools may facilitate tacit knowledge sharing.