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.

Business Process Quality Management

Process modeling is a central element in any approach to Business Process Management (BPM). However, what hinders both practitioners and academics is the lack of support for assessing the quality of process models – let alone realizing high quality process models. Existing frameworks are highly conceptual or too general. At the same time, various techniques, tools, and research results are available that cover fragments of the issue at hand. This chapter presents the SIQ framework that on the one hand integrates concepts and guidelines from existing ones and on the other links these concepts to current research in the BPM domain. Three different types of quality are distinguished and for each of these levels concrete metrics, available tools, and guidelines will be provided. While the basis of the SIQ framework is thought to be rather robust, its external pointers can be updated with newer insights as they emerge.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.

Lean project management in large scale industrial project via standardization

Lean project management is the comprehensive adaption of other lean concept like lean construction, lean manufacturing and lean thinking into project management context. Execution of many similar industrial projects creates the idea of lean project management in companies and rapidly growing in industries. This paper offers the standardization method in order to achieve Lean project management in large scale industrial project. Standardization refers to all activity which makes two projects most identical and unify to each other like standardization of design, reducing output variability, value analysis and strategic management. Although standard project may have minor effi ciency decrease, compare to custom built project; but great advantage of standard project like cost saving, time reduction and quality improvement justify standardization methodology. This paper based on empirical experience in industrial project and theoretical analysis of benefi ts of project standardization.

Engaging operations management students by designing the unit with industry focus

Operations management is an area concerned with the production of goods and services ensuring that business operations are efficient in utilizing resource and effective to meet customer requirements. It deals with the design and management of products, processes, services and supply chains and considers the acquisition, development, and effective and efficient utilization of resources. Unlike other engineering subjects, content of these units could be very wide and vast. It is therefore necessary to cover the content that is most related to the contemporary industries. It is also necessary to understand what engineering management skills are critical for engineers working in the contemporary organisations. Most of the operations management books contain traditional Operations Management techniques. For example ‘inventory management’ is an important topic in operations management. All OM books deal with effective method of inventory management. However, new trend in OM is Just in time (JIT) delivery or minimization of inventory. It is therefore important to decide whether to emphasise on keeping inventory (as suggested by most books) or minimization of inventory. Similarly, for OM decisions like forecasting, optimization and linear programming most organisations now a day’s use software. Now it is important for us to determine whether some of these software need to be introduced in tutorial/ lab classes. If so, what software? It is established in the Teaching and Learning literature that there must be a strong alignment between unit objectives, assessment and learning activities to engage students in learning. Literature also established that engaging students is vital for learning. However, engineering units (more specifically Operations management) is quite different from other majors. Only alignment between objectives, assessment and learning activities cannot guarantee student engagement. Unit content must be practical oriented and skills to be developed should be those demanded by the industry. Present active learning research, using a multi-method research approach, redesigned the operations management content based on latest developments in Engineering Management area and the necessity of Australian industries. The redesigned unit has significantly helped better student engagement and better learning. It was found that students are engaged in the learning if they find the contents are helpful in developing skills that are necessary in their practical life.

Open source software for workflow management : the case of YAWL

"This column is distinguished from previous Impact columns in that it concerns the development tightrope between research and commercial take-up and the role of the LGPL in an open source workflow toolkit produced in a University environment. Many ubiquitous systems have followed this route, (Apache, BSD Unix, ...), and the lessons this Service Oriented Architecture produces cast yet more light on how software diffuses out to impact us all." Michiel van Genuchten and Les Hatton Workflow management systems support the design, execution and analysis of business processes. A workflow management system needs to guarantee that work is conducted at the right time, by the right person or software application, through the execution of a workflow process model. Traditionally, there has been a lack of broad support for a workflow modeling standard. Standardization efforts proposed by the Workflow Management Coalition in the late nineties suffered from limited support for routing constructs. In fact, as later demonstrated by the Workflow Patterns Initiative (www.workflowpatterns.com), a much wider range of constructs is required when modeling realistic workflows in practice. YAWL (Yet Another Workflow Language) is a workflow language that was developed to show that comprehensive support for the workflow patterns is achievable. Soon after its inception in 2002, a prototype system was built to demonstrate that it was possible to have a system support such a complex language. From that initial prototype, YAWL has grown into a fully-fledged, open source workflow management system and support environment

Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

Provisional supervision in Hong Kong : third time lucky?

Provisional supervision (PS) is Hong Kong’s proposed new corporate rescue procedure. In essence, it is a procedure for the preparation by a professional, usually an accountant or a solicitor, of a proposal for a voluntary arrangement, supported by a moratorium. There should be little court involvement in the process and it is anticipated that the costs and delays of the process would be less than alternate, currently available procedures. This article will retrace some of the key events and issues arising from the numerous policy and legislative debates about PS in Hong Kong. At present the Hong Kong government is in the midst of drafting a new Bill on corporate rescue procedure to be introduced to the HKSAR Legislative Council. This will be the third attempt. Setting aside the controversies and the content of this new effort by the Hong Kong administration, the Global Financial Crisis in 2008 has signalled to the international policy and business community, free markets alone cannot be an effective regulatory mechanism. Having legal safeguards and clear rules to regulate procedures and conduct of market participants are imperative to avoid future financial meltdowns.

Cancer-related symptom clusters for symptom management in outpatients after commencing adjuvant chemotherapy, at 6 months, and 12 months

Goals of work: The aim of this secondary data analysis was to investigate symptom clusters over time for symptom management of a patient group after commencing adjuvant chemotherapy. Materials and methods: A prospective longitudinal study of 219 cancer outpatients conducted within 1 month of commencing chemotherapy (T1), 6 months (T2), and 12 months (T3) later. Patients' distress levels were assessed for 42 physical symptoms on a clinician-modified Rotterdam Symptom Checklist. Symptom clusters were identified in exploratory factor analyses at each time. Symptom inclusion in clusters was determined from structure coefficients. Symptoms could be associated with multiple clusters. Stability over time was determined from symptom cluster composition and the proportion of symptoms in the initial symptom clusters replicated at later times. Main results Fatigue and daytime sleepiness were the most prevalent distressing symptoms over time. The median number of concurrent distressing symptoms approximated 7, over time. Five consistent clusters were identified at T1, 2, and T3. An additional two clusters were identified at 12 months, possibly due to less variation in distress levels. Weakness and fatigue were each associated with two, four, and five symptom clusters at T1, T2, and T3, respectively, potentially suggesting different causal mechanisms. Conclusion: Stability is a necessary attribute of symptom clusters, but definitional clarification is required. We propose that a core set of concurrent symptoms identifies each symptom cluster, signifying a common cause. Additional related symptoms may be included over time. Further longitudinal investigation is required to identify symptom clusters and the underlying causes.

Queensland Government’s people’s question time : the challenges and opportunities of population growth in Queensland

As AITPM National President, I was invited by Queensland’s Premier, Hon. Anna Bligh MP, as an audience guest to People’s Question Time on Wednesday 24 March 2010, which focused on ‘The Challenges and Opportunities of Population Growth in Queensland’. On the panel were: Premier and Minister for the Arts, Anna Bligh; Minister for Climate Change and Sustainability, Kate Jones; Minister for Infrastructure and Planning, Stirling Hinchliffe; Michael Rayner – Growth Management Summit Advisory Panel, Principal Director, Cox Rayner Architects; and Greg Hallam – Executive Director, Local Government Association of Queensland. The moderator for this session was Law Academic Erin O’Brien, of Queensland University of Technology.

The use of supply chain management to reduce delays : Malaysian public sector construction projects

Construction delays are a critical problem for Malaysian public sector projects. These delays have been blamed mainly on inefficient traditional construction practices that continue to dominate the current industry. This paper reports the progress to date of a Ph.D. research project aimed at developing a framework to utilize Supply Chain Management (SCM) tools to improve the time performance of Malaysian Government projects. The potential of SCM has been identified for public sector governance and its use in Malaysia is now being considered within the strategy of the Malaysian Construction Industry Master Plan (2006-2015). Encouraged by success in the UK, there is a cautious optimism concerning the successful application of SCM in Malaysia. This paper considers delay as a problem in Malaysian public sector projects, establishes the need to embrace SCM and then elucidates the need and strategies for the development of a delay reduction framework. A literature review, survey mechanism and structured interview schedule will be undertaken to achieve the research objectives. The final research outcome will be a framework that addresses root delay contributors (“pathogens”) and applies SCM tools for their mitigation.

Leg Clubs® : a clinically and cost-effective approach to lower limb management

Leg ulcers affect 55000-90000 people, predominantly aged over 65, in the UK at any one time. Traditional care, delivered in people’s homes by district nurses or in GP clinics, is costly and often not effective, with slow healing rates and a high incidence of recurrence. A social model of leg ulcer clinics developed by the author has been shown to improve healing and reduce recurrence within a highly cost-effective framework that delivers genuine patient empowerment, public health education and social outreach. This paper outlines the rationale for the Leg Club, its clinical and social impact, and the infrastructure behind it. It also considers the challenges to establishing and running a Leg Club.

Improved salinity management for the Nebine / Mungallala / Wallam catchment

The low stream salinity naturally in the Nebine-Mungallala Catchment, extent of vegetation retention, relatively low rainfall and high evaporation indicates that there is a relatively low risk of rising shallow groundwater tables in the catchment. Scalding caused by wind and water erosion exposing highly saline sub-soils is a more important regional issue, such as in the Homeboin area. Local salinisation associated with evaporation of bore water from free flowing bore drains and bores is also an important land degradation issue particularly in the lower Nebine, Wallam and Mungallala Creeks. The replacement of free flowing artesian bores and bore drains with capped bores and piped water systems under the Great Artesian Basin bore rehabilitation program is addressing local salinisation and scalding in the vicinity of bore drains and preventing the discharge of saline bore water to streams. Three principles for the prevention and control of salinity in the Nebine Mungallala catchment have been identified in this review: • Avoid salinity through avoiding scalds – i.e. not exposing the near-surface salt in landscape through land degradation; • Riparian zone management: Scalding often occurs within 200m or so of watering lines. Natural drainage lines are most likely to be overstocked, and thus have potential for scalding. Scalding begins when vegetation is removed, and without that binding cover, wind and water erosion exposes the subsoil; and • Monitoring of exposed or grazed soil areas. Based on the findings of the study, we make the following recommendations: 1. Undertake a geotechnical study of existing maps and other data to help identify and target areas most at risk of rising water tables causing salinity. Selected monitoring should then be established using piezometers as an early warning system. 2. SW NRM should financially support scald reclamation activity through its various funding programs. However, for this to have any validity in the overall management of salinity risk, it is critical that such funding require the landholder to undertake a salinity hazard/risk assessment of his/her holding. 3. A staged approach to funding may be appropriate. In the first instance, it would be reasonable to commence funding some pilot scald reclamation work with a view to further developing and piloting the farm hazard/risk assessment tools, and exploring how subsequent grazing management strategies could be incorporated within other extension and management activities. Once the details of the necessary farm level activities have been more clearly defined, and following the outcomes of the geotechnical review recommended above, a more comprehensive funding package could be rolled out to priority areas. 4. We recommend that best-practice grazing management training currently on offer should be enhanced with information about salinity risk in scald-prone areas, and ways of minimising the likelihood of scald formation. 5. We recommend that course material be developed for local students in Years 6 and 7, and that arrangements be made with local schools to present this information. Given the constraints of existing syllabi, we envisage that negotiations may have to be undertaken with the Department of Education in order for this material to be permitted to be used. We have contact with key people who could help in this if required. 6. We recommend that SW NRM continue to support existing extension activities such as Grazing Land Management and the Monitoring Made Easy tools. These aids should be able to be easily expanding to incorporate techniques for monitoring, addressing and preventing salinity and scalding. At the time of writing staff of SW NRM were actively involved in this process. It is important that these activities are adequately resourced to facilitate the uptake by landholders of the perception that salinity is an issue that needs to be addressed as part of everyday management. 7. We recommend that SW NRM consider investing in the development and deployment of a scenario-modelling learning support tool as part of the awareness raising and education activities. Secondary salinity is a dynamic process that results from ongoing human activity which mobilises and/or exposes salt occurring naturally in the landscape. Time scales can be short to very long, and the benefits of management actions can similarly have immediate or very long time frames. One way to help explain the dynamics of these processes is through scenario modelling.

Working time alterations within the Australian construction industry

Purpose: The purpose of this paper is to provide a labour process theory interpretation of four case studies within the Australian construction industry. In each case study a working time intervention (a shift to a five-day working week from the industry standard six days) was implemented as an attempt to improve the work-life balance of employees. ----- ----- Design/methodology/approach: This paper was based on four case studies with mixed methods. Each case study has a variety of data collection methods which include questionnaires, short and long interviews, and focus groups. ----- ----- Findings: It was found that the complex mix of wage- and salary-earning staff within the construction industry, along with labour market pressures, means that changing to a five-day working week is quite a radical notion within the industry. However, there are some organisations willing to explore opportunities for change with mixed experiences. ----- ----- Practical implications: The practical implications of this research include understanding the complexity within the Australian construction industry, based around hours of work and pay systems. Decision-makers within the construction industry must recognize a range of competing pressures that mean that “preferred” managerial styles might not be appropriate. ----- ----- Originality/value:– This paper shows that construction firms must take an active approach to reducing the culture of long working hours. This can only be achieved by addressing issues of project timelines and budgets and assuring that take-home pay is not reliant on long hours of overtime.

Local adjustment and global adaptation of control periods for QoC management of control systems

Linking real-time schedulability directly to the Quality of Control (QoC), the ultimate goal of a control system, a hierarchical feedback QoC management framework with the Fixed Priority (FP) and the Earliest-Deadline-First (EDF) policies as plug-ins is proposed in this paper for real-time control systems with multiple control tasks. It uses a task decomposition model for continuous QoC evaluation even in overload conditions, and then employs heuristic rules to adjust the period of each of the control tasks for QoC improvement. If the total requested workload exceeds the desired value, global adaptation of control periods is triggered for workload maintenance. A sufficient stability condition is derived for a class of control systems with delay and period switching of the heuristic rules. Examples are given to demonstrate the proposed approach.