People with ID as active participants in nursing research : a literature review.

Aim: The movement from a medical model of disability to a more social model implies an imperative to include the views of people with ID in research regarding their care. Contemporary quality processes in improving care require consumer involvement at many levels and in doing so have shown better outcomes. A New Zealand research study is being undertaken utilizing focus groups with people with ID to understand their experiences during a psychiatric inpatient admission. The primary focus of this presentation will concern the literature review, undertaken as part of the study, of research in which people with ID have participated. Method: The literature review was conducted using a variety of electronic databases and search terms to identify studies with people with ID as active participants. Results: Only a few studies have been undertaken with people with ID as participants. While these studies demonstrate numerous benefits in including the voice of the person with ID this still remains absent from much of the research discourse. Conclusion: It is accepted and indeed advocated that people with ID have the same rights as others in regard to choosing whether or not they wish to participate in research. High response rates in the few identified studies indicated that people with ID are eager to be consulted. It is recommended that the unique needs of people with ID be taken into account in the research evidence base for future services.

A methodological evaluation of business process compliance management frameworks

Existing compliance management frameworks (CMFs) offer a multitude of compliance management capabilities that makes difficult for enterprises to decide on the suitability of a framework. Making a decision on the suitability requires a deep understanding of the functionalities of a framework. Gaining such an understanding is a difficult task which, in turn, requires specialised tools and methodologies for evaluation. Current compliance research lacks such tools and methodologies for evaluating CMFs. This paper reports a methodological evaluation of existing CMFs based on a pre-defined evaluation criteria. Our evaluation highlights what existing CMFs offer, and what they cannot. Also, it underpins various open questions and discusses the challenges in this direction.

Improving the Walkability of Subtropical Urban Areas: a case study analysis for the development of a design process

This research develops a new framework to be used as a tool for analysing and designing walkable communities. The literature review recognises the work of other researchers combining their findings with the theory of activity nodes and considers how a framework may be used on a more global basis. The methodology develops a set of criteria through the analysis of noted successful case studies and this is then tested against an area with very low walking rates in Brisbane, Australia. Results of the study suggest that as well as the accepted criteria of connectivity, accessibility, safety, security, and path quality further criteria in the form or planning hierarchy, activity nodes and climate mitigation could be added to allow the framework to cover a broader context. Of particular note is the development of the nodal approach, which allows simple and effective analysis of existing conditions, and may also prove effective as a tool for planning and design of walkable communities.

Process monitoring using sensors in YAWL

This article describes the architecture of a monitoring component for the YAWL system. The architecture proposed is based on sensors and it is realized as a YAWL service to have perfect integration with the YAWL systems. The architecture proposed is generic and applicable in different contexts of business process monitoring. Finally, it was tested and evaluated in the context of risk monitoring for business processes.

Nutrition screening and risk factors prior to chemotherapy in cancer patients 65 years and older

Background The largest proportion of cancer patients are aged 65 years and over. Increasing age is also associated with nutritional risk and multi-morbidities—factors which complicate the cancer treatment decision-making process in older patients. Objectives To determine whether malnutrition risk and Body Mass Index (BMI) are associated with key oncogeriatric variables as potential predictors of chemotherapy outcomes in geriatric oncology patients with solid tumours. Methods In this longitudinal study, geriatric oncology patients (aged ≥65 years) received a Comprehensive Geriatric Assessment (CGA) for baseline data collection prior to the commencement of chemotherapy treatment. Malnutrition risk was assessed using the Malnutrition Screening Tool (MST) and BMI was calculated using anthropometric data. Nutritional risk was compared with other variables collected as part of standard CGA. Associations were determined by chi-square tests and correlations. Results Over half of the 175 geriatric oncology patients were at risk of malnutrition (53.1%) according to MST. BMI ranged from 15.5–50.9kg/m2, with 35.4% of the cohort overweight when compared to geriatric cutoffs. Malnutrition risk was more prevalent in those who were underweight (70%) although many overweight participants presented as at risk (34%). Malnutrition risk was associated with a diagnosis of colorectal or lung cancer (p=0.001), dependence in activities of daily living (p=0.015) and impaired cognition (p=0.049). Malnutrition risk was positively associated with vulnerability to intensive cancer therapy (rho=0.16, p=0.038). Larger BMI was associated with a greater number of multi-morbidities (rho =.27, p=0.001. Conclusions Malnutrition risk is prevalent among geriatric patients undergoing chemotherapy, is more common in colorectal and lung cancer diagnoses, is associated with impaired functionality and cognition and negatively influences ability to complete planned intensive chemotherapy.

Malnutrition and chemotherapy : implications for nursing practice

Background: Malnutrition before and during chemotherapy is associated with poor treatment outcomes. The risk of cancer-related malnutrition is exacerbated by common nutrition impact symptoms during chemotherapy, such as nausea, diarrhoea and mucositis. Aim of presentation: To describe the prevalence of malnutrition/ malnutrition risk in two samples of patients treated in a quaternary-level chemotherapy unit. Research design: Cross sectional survey. Sample 1: Patients ≥ 65 years prior to chemotherapy treatment (n=175). Instrument: Nurse-administered Malnutrition Screening Tool to screen for malnutrition risk and body mass index (BMI). Sample 2: Patients ≥ 18 years receiving chemotherapy (n=121). Instrument: Dietitian-administered Patient Generated Subjective Global Assessment to assess malnutrition, malnutrition risk and BMI. Findings Sample 1: 93/175 (53%) of older patients were at risk of malnutrition prior to chemotherapy. 27 (15%) were underweight (BMI <21.9); 84 (48%) were overweight (BMI >27). Findings Sample 2: 31/121 patients (26%) were malnourished; 12 (10%) had intake-limiting nausea or vomiting; 22 (20%) reported significant weight loss; and 20 (18%) required improved nutritional symptom management during treatment. 13 participants with malnutrition/nutrition impact symptoms (35%) had no dietitian contact; the majority of these participants were overweight. Implications for nursing: Patients with, or at risk of, malnutrition before and during chemotherapy can be overlooked, particularly if they are overweight. Older patients seem particularly at risk. Nurses can easily and quickly identify risk with the regular use of the Malnutrition Screening Tool, and refer patients to expert dietetic support, to ensure optimal treatment outcomes.

A nurse-led model of oncogeriatric assessment

Background There is growing consensus that a multidisciplinary, comprehensive and standardised process for assessing the fitness of older patients for chemotherapy should be undertaken to determine appropriate cancer treatment. Aim This study tested a model of cancer care for the older patient incorporating Comprehensive Geriatric Assessment (CGA), which aimed to ensure that 'fit' individuals amenable to active treatment were accurately identified; 'vulnerable' patients more suitable for modified or supportive regimens were determined; and 'frail 'individuals who would benefit most from palliative regimens were also identified and offered the appropriate level of care. Methods A consecutive-series n=178 sample of patients >65 years was recruited from a major Australian cancer centre. The following instruments were administered by an oncogeriatric nurse prior to treatment: Vulnerable Elders Survey-13; Cumulative Illness Rating Scale (Geriatric); Malnutrition Screening Tool; Mini-mental State Examination; Geriatric Depression Scale; Barthel Index; and Lawton Instrumental Activities of Daily Living Scale. Scores from these instruments were aggregated to predict patient fitness, vulnerability or frailty for chemotherapy. Physicians provided a concurrent (blinded) prediction of patient fitness, vulnerability or frailty based on their clinical assessment. Data were also collected on actual patient outcomes (eg treatment completed as predicted, treatment reduced) during monthly audits of patient trajectories. Data analysis Data analysis is underway. A sample of 178 is adequate to detect, with 90% power, kappa coefficients of agreement between CGA and physician assessments of K>0.90 ("almost perfect agreement"). Primary endpoints comprise a) whether the nurse-led CGA determination of fit, vulnerable or frail agrees with the oncologist's assessments of fit, vulnerable or frail and b) whether the CGA and physician assessments accurately predict actual patient outcomes. Conclusion An oncogeriatric nurse-led model of care is currently being developed from the results. We conclude with a discussion of the pivotal role of nurses in CGA-based models of care.

Comprehensive assessment of the fitness of older people for chemotherapy

Purpose: To present the results of a mixed-method study comparing the level of agreement of a two-phased, nurse-administered Comprehensive Geriatric Assessment (CGA) with current methods that assess the fitness for chemotherapy of older cancer patients. A nurse-led model of multidisciplinary cancer care based on the results is also described. Methods: The two phases comprised initial screening by a nurse with the Vulnerable Elders Survey-13 [VES-13], followed by nurse administration of a detailed CGA. Both phases were linked to a computerised algorithm categorising the patient as ‘fit’, ‘vulnerable’ or ‘frail’. The study determined the level of agreement between VES-13- and CGA-determined categories; and between the CGA and the physicians’ assessments. It also compared the CGA’s predictive abilities in terms of subsequent treatment toxicity; while interviews determined the acceptability of the nurse-led procedure from key stakeholders' perspectives. Results: Data collection was completed in December 2011. The results will be presented at the conference. A consecutive-series n=170 will be enrolled, 33% of whom are ‘fit’; 33% ‘vulnerable’; and 33% ‘too frail’ for treatment. This sample can detect, with 90% power, kappa coefficients of agreement of ≥ 0.70 or higher (“substantial agreement”). Fitness sub-group comparisons of agreement between the medical oncologist and the nurse assessments can detect kappa estimates of Κ ≥ 0.80 with the same power. Conclusion: The results have informed a nurse-led model of cancer care. It meets a clear need to develop, implement and test a nurse-led, robust, evidence-based, clinically-justifiable and economically-feasible CGA process that has relevance in national and international contexts.

Identification of symptom clusters in patients with chronic venous leg ulcers

Context Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL. Objectives To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers. Methods For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters. Results Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue. Conclusion Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.

Modelling the flow of cane constituents through the milling process of a raw sugar factory

This thesis reports on an investigation to develop an advanced and comprehensive milling process model of the raw sugar factory. Although the new model can be applied to both, the four-roller and six-roller milling units, it is primarily developed for the six-roller mills which are widely used in the Australian sugar industry. The approach taken was to gain an understanding of the previous milling process simulation model "MILSIM" developed at the University of Queensland nearly four decades ago. Although the MILSIM model was widely adopted in the Australian sugar industry for simulating the milling process it did have some incorrect assumptions. The study aimed to eliminate all the incorrect assumptions of the previous model and develop an advanced model that represents the milling process correctly and tracks the flow of other cane components in the milling process which have not been considered in the previous models. The development of the milling process model was done is three stages. Firstly, an enhanced milling unit extraction model (MILEX) was developed to access the mill performance parameters and predict the extraction performance of the milling process. New definitions for the milling performance parameters were developed and a complete milling train along with the juice screen was modelled. The MILEX model was validated with factory data and the variation in the mill performance parameters was observed and studied. Some case studies were undertaken to study the effect of fibre in juice streams, juice in cush return and imbibition% fibre on extraction performance of the milling process. It was concluded from the study that the empirical relations developed for the mill performance parameters in the MILSIM model were not applicable to the new model. New empirical relations have to be developed before the model is applied with confidence. Secondly, a soluble and insoluble solids model was developed using modelling theory and experimental data to track the flow of sucrose (pol), reducing sugars (glucose and fructose), soluble ash, true fibre and mud solids entering the milling train through the cane supply and their distribution in juice and bagasse streams.. The soluble impurities and mud solids in cane affect the performance of the milling train and further processing of juice and bagasse. New mill performance parameters were developed in the model to track the flow of cane components. The developed model is the first of its kind and provides some additional insight regarding the flow of soluble and insoluble cane components and the factors affecting their distribution in juice and bagasse. The model proved to be a good extension to the MILEX model to study the overall performance of the milling train. Thirdly, the developed models were incorporated in a proprietary software package "SysCAD’ for advanced operational efficiency and for availability in the ‘whole of factory’ model. The MILEX model was developed in SysCAD software to represent a single milling unit. Eventually the entire milling train and the juice screen were developed in SysCAD using series of different controllers and features of the software. The models developed in SysCAD can be run from macro enabled excel file and reports can be generated in excel sheets. The flexibility of the software, ease of use and other advantages are described broadly in the relevant chapter. The MILEX model is developed in static mode and dynamic mode. The application of the dynamic mode of the model is still under progress.

Construct Redundancy in Process Modeling Grammars: Improving the Explanatory Power of Ontological Analysis

Conceptual modelling supports developers and users of information systems in areas of documentation, analysis or system redesign. The ongoing interest in the modelling of business processes has led to a variety of different grammars, raising the question of the quality of these grammars for modelling. An established way of evaluating the quality of a modelling grammar is by means of an ontological analysis, which can determine the extent to which grammars contain construct deficit, overload, excess or redundancy. While several studies have shown the relevance of most of these criteria, predictions about construct redundancy have yielded inconsistent results in the past, with some studies suggesting that redundancy may even be beneficial for modelling in practice. In this paper we seek to contribute to clarifying the concept of construct redundancy by introducing a revision to the ontological analysis method. Based on the concept of inheritance we propose an approach that distinguishes between specialized and distinct construct redundancy. We demonstrate the potential explanatory power of the revised method by reviewing and clarifying previous results found in the literature.

Does preoperative oral carbohydrate reduce hospital stay?

Background Carbohydrate-rich fluids are used to improve postoperative recovery but the effectiveness of the product for reducing length of hospital stay is uncertain. Objective To assess the effectiveness of preoperative loading with carbohydrates on postoperative outcomes. Participants Forty six patients booked for elective colorectal surgery. Methods Participants were allocated to a Carbohydrate-rich fluid group or Usual Care group during their pre-admission clinic visit. The primary outcome was ‘Time to readiness for discharge’. Results Patients in the control group spent on average 4.3 days (95% confidence interval 3.2 to 5.7) and the Carbohydrate-rich fluid group spent 4.1 days (95% confidence interval 3.2 to 5.4) until the primary outcome was met (p=0.824). Conclusion The safety of preoperative high carbohydrate fluids is supported but we were unable to confirm or refute the benefit of CHO for shorter hospital stay following elective colorectal surgery.

Profiling event logs to configure risk indicators for process delays

Risk identification is one of the most challenging stages in the risk management process. Conventional risk management approaches provide little guidance and companies often rely on the knowledge of experts for risk identification. In this paper we demonstrate how risk indicators can be used to predict process delays via a method for configuring so-called Process Risk Indicators(PRIs). The method learns suitable configurations from past process behaviour recorded in event logs. To validate the approach we have implemented it as a plug-in of the ProM process mining framework and have conducted experiments using various data sets from a major insurance company.

Nursing practice environment, quality of care and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses’ perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.

Cost-informed operational process support

The ability to steer business operations in alignment with the true origins of costs, and to be informed about this on a real-time basis, allows businesses to increase profitability. In most organisations however, high-level cost-based managerial decisions are still being made separately from process-related operational decisions. In this paper, we describe how process-related decisions at the operational level can be guided by cost considerations and how these cost-informed decision rules can be supported by a workflow management system. The paper presents the conceptual framework together with data requirements and technical challenges that need to be addressed to realise cost-informed workflow execution. The feasibility of our approach is demonstrated using a prototype implementation in the YAWL workflow environment.