Preparing for the future:Challenges and opportunities for management and leadership skills

The development of effective leaders is essential for all healthcare professions and increasingly is becoming a key focus for the UK dental profession. There is comparatively little research about dental leadership in a UK context and the paper below should begin to help to redress the balance and to highlight areas for future consideration.
The aim of the study was to explore dental leaders’ perceptions of the current position of leadership in the dental profession and used a qualitative key informant study to do this. Three broad emergent themes are described and discussed - characteristics and behaviours of dental leaders; challenges for dental leaders; education and training for dental leadership. The findings show that whilst recognising that a lack of focus on leadership skills has caused problems in the past, current dental leaders are prepared to lead the profession forward. They view education at all levels as vital to this process and education for leadership at undergraduate level is perceived as an important way forward.

Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry

Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit. A significant unmet clinical need remains in this group, specifically a requirement for therapies which reduce systemic steroid exposure.

Polycyclic aromatic hydrocarbon (PAH) dispersion and deposition to vegetation and soil following a large scale chemical fire

Polycyclic aromatic hydrocarbons (PAHs) were determined in soil and vegetation following a large scale chemical fire involving 10,000 ton of polypropylene. In comparison with sites outside the plume from the fire, PAH concentrations were elevated in grass shoots (by up to 70-fold) and in soil (by up to 370-fold). The pattern of PAH dispersion under the plume was dependent on the physical-chemical properties of individual PAHs. The lighter, least hydrophobic PAHs were dispersed into the environment at greater distances than heavier, more hydrophobic PAHs. At the most distant sampling point (4.5 km) under the plume, the low molecular weight PAHs were still considerably elevated in vegetation samples compared to control sites. Dispersion appeared to be regulated by the compounds partitioning between the vapour and particulate phase, with dry particulate deposition occurring closer to the fire source than gaseous deposition. For all PAHs, the fire resulted in greater contamination of soils compared to grasses, with the relative ratio of plant/soil contamination decreasing as hydrophobicity increased.

Population enumeration and assessing conservation status in a widespread amphibian: A case study of Rana temporaria in Ireland

Global amphibian declines are a major element of the current biodiversity crisis. Monitoring changes in the distribution and abundance of target species is a basic component in conservation decision making and requires robust and repeatable sampling. For EU member states, surveillance of designated species, including the common frog Rana temporaria, is a formal requirement of the 'EC Habitats & Species Directive'. We deployed established methods for estimating frog population density at local water bodies and extrapolated these to the national and ecoregion scale. Spawn occurred at 49.4% of water bodies and 70.1% of independent 500-m survey squares. Using spawn mat area, we estimated the number of adult breeding females and subsequently the total population assuming a sex ratio of 1:1. A negative binomial model suggested that mean frog density was 23.5 frogsha [95% confidence interval (CI) 14.9-44.0] equating to 196M frogs (95%CI 124M-367M) throughout Ireland. A total of 86% of frogs bred in drainage ditches, which were a notably common feature of the landscape. The recorded distribution of the species did not change significantly between the last Article 17 reporting period (1993-2006) and the current period (2007-2011) throughout the Republic of Ireland. Recording effort was markedly lower in Northern Ireland, which led to an apparent decline in the recorded distribution. We highlight the need to coordinate biological surveys between adjacent political jurisdictions that share a common ecoregion to avoid apparent disparities in the quality of distributional information. Power analysis suggested that a reduced sample of 40-50 survey squares is sufficient to detect a 30% decline (consistent with the International Union for Conservation of Nature Category of 'Vulnerable') at 80% power providing guidance for minimizing future survey effort. Our results provin assessments for R. temporaria and other clump-spawning amphibians. 2013 The Zoological Society of London.

Changes in management and outcome of patients with rectal cancer in northern ireland:1996-2006

Aim This study aimed to document developments in rectal cancer services in a UK population and evaluate changes in outcome over a 10-year period.

Method Patients diagnosed with primary rectal carcinoma in 1996, 2001 and 2006 were identified by the Northern Ireland Cancer Registry. Data were retrospectively collected on presentation, investigation, treatment and staging. Differences over the period were analysed using the chi-squared test; Kaplan–Meier and Cox regression tests were used for survival analysis.

Results After exclusions there were 636 patients, including 187 presenting in 1996, 203 in 2001 and 246 in 2006. The use of preoperative MRI of the rectum, endorectal ultrasound and abdominal CT increased during the study period. For patients treated by surgery, total mesorectal excision (TME) increased from 19% in 1996 to 64% in 2006 (P < 0.001). The use of radiotherapy (27% in 1996, 47% in 2006) and chemotherapy (21% in 1996, 32% in 2006) increased. The overall 5-year survival improved significantly between 1996 and 2006 from 34% in 1996 to 45% in 2006 (P = 0.02). Among patients having surgery, 5-year survival increased from 43% in 1996 to 63% in 2006 (P < 0.001). Multivariate analysis showed that the improvement in survival was associated with TME and chemotherapy, while radiotherapy was not.

Conclusion Survival of patients with rectal cancer in Northern Ireland has improved significantly over the last decade, probably due to the increased use of TME and chemotherapy.

Keywords Surgery, rectum, oncology

What does this paper add to the literature?
This population-based study demonstrates a significant improvement in survival over recent years of rectal cancer patients in Northern Ireland. It concludes that surgical resection with TME and chemotherapy have had a significant impact on survival and that the improvement was not due to a stage-migration effect.

Using geostatistical Bayesian Updating to integrate airborne radiometrics and soil geochemistry to improve mapping for mineral exploration

Mineral exploration programmes around the world use data from remote sensing, geophysics and direct sampling. On a regional scale, the combination of airborne geophysics and ground-based geochemical sampling can aid geological mapping and economic minerals exploration. The fact that airborne geophysical and traditional soil-sampling data are generated at different spatial resolutions means that they are not immediately comparable due to their different sampling density. Several geostatistical techniques, including indicator cokriging and collocated cokriging, can be used to integrate different types of data into a geostatistical model. With increasing numbers of variables the inference of the cross-covariance model required for cokriging can be demanding in terms of effort and computational time. In this paper a Gaussian-based Bayesian updating approach is applied to integrate airborne radiometric data and ground-sampled geochemical soil data to maximise information generated from the soil survey, to enable more accurate geological interpretation for the exploration and development of natural resources. The Bayesian updating technique decomposes the collocated estimate into a production of two models: prior and likelihood models. The prior model is built from primary information and the likelihood model is built from secondary information. The prior model is then updated with the likelihood model to build the final model. The approach allows multiple secondary variables to be simultaneously integrated into the mapping of the primary variable. The Bayesian updating approach is demonstrated using a case study from Northern Ireland where the history of mineral prospecting for precious and base metals dates from the 18th century. Vein-hosted, strata-bound and volcanogenic occurrences of mineralisation are found. The geostatistical technique was used to improve the resolution of soil geochemistry, collected one sample per 2 km2, by integrating more closely measured airborne geophysical data from the GSNI Tellus Survey, measured over a footprint of 65 x 200 m. The directly measured geochemistry data were considered as primary data in the Bayesian approach and the airborne radiometric data were used as secondary data. The approach produced more detailed updated maps and in particular maximized information on mapped estimates of zinc, copper and lead. Greater delineation of an elongated northwest/southeast trending zone in the updated maps strengthened the potential to investigate stratabound base metal deposits.

Waste Management and Sustainability during the Design Phase of a Construction Project: A Qualitative Review

Waste management and sustainability are two core underlying philosophies that the construction sector must acknowledge and implement; however, this can prove difficult and time consuming. To this end, the aim of this paper is to examine waste management strategies and the possible benefits, advantages and disadvantages to their introduction and use, while also to examine any inter-relationship with sustainability, particularly at the design stage. The purpose of this paper is to gather, examine and review published works and investigate factors which influence economic decisions at the design phase of a construction project. In addressing this aim, a three tiered sequential research approach is adopted; in-depth literature review, interviews/focus groups and qualitative analysis. The resulting data is analyzed, discussed, with potential conclusions identified; paying particular attention to implications for practice within architectural firms. This research is of importance, particularly to the architectural sector, as it can add to the industry’s understanding of the design process, while also considering the application and integration of waste management into the design procedure. Results indicate that the researched topic had many advantages but also had inherent disadvantages. It was found that the potential advantages outweighed disadvantages, but uptake within industry was still slow and that better promotion and their benefits to; sustainability, the environment, society and the industry were required.

Quality Management and Managerialism in Healthcare:: A Critical Historical Survey

Quality Management and Managerialism in Healthcare creates a comprehensive and systematic international survey of various perspectives on healthcare quality management together with some of their most pertinent critiques. Chapter one starts with a general discussion of the factors that drove the introduction of management paradigms into public sector and health management contexts in the mid to late 1980s. Chapter two explores the rise of risk awareness in medicine; which, prior to the 1980s, stood largely in isolation to the implementation of managerial performance targets. Chapter three investigates the widespread adoption of performance management and clinical governance frameworks during the 1980s and 1990s. This is followed by Chapters four and five which examine systems based models of patient safety and the evidence-based medicine movement as exemplars of managerial perspectives on healthcare quality. Chapter six discusses potential future avenues for the development of alternative perspectives on quality of care which emphasise workforce involvement. The book concludes by reviewing the factors which have underpinned the managerialist trajectory of healthcare management over the past decades and explores the potential impact of nascent technologies such as 'connected health' and 'telehealth' on future developments.

Management and diagnosis of psychogenic cough, habit cough, and tic cough: A systematic review

BACKGROUND: Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology.

METHODS: We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic, and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted, and we searched bibliographies of included studies to identify additional references.

RESULTS: A total of 18 uncontrolled studies were identified, enrolling 223 patients (46% male subjects, 96% children and adolescents). Psychogenic cough was the most common descriptive term used (90% of the studies). Most of the patients (95%) had no cough during sleep; barking or honking quality of cough was described in only eight studies. Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias.

CONCLUSIONS: Only low-quality evidence exists to support a particular strategy to define and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.

Evidence-based management and intervention for autism spectrum disorders

Autism Spectrum Disorder (ASD) is diagnosed along a continuum of behavioural variants in social communication and repetitive behaviours [96]. Most individuals on the autism spectrum also experience differences in sensory perception. Some individuals on the spectrum are ‘high-functioning’ and able to cope in every day environments, while others are severely affected, non-verbal, and may have co-occurring diagnoses, such as intellectual disability, epilepsy, and/or obsessional, conduct, or mental health disorders. These individuals require substantial support, caring and careful management, and evidence-based, effective interventions.