Overview of the Management of Cough: CHEST Guideline and Expert Panel Report

This overview will demonstrate that cough is a common and potentially expensive health-care problem. Improvement in the quality of care of those with cough has been the focus of study for a variety of disciplines in medicine. The purpose of the Cough Guideline and Expert Panel is to synthesize current knowledge in a form that will aid clinical decision-making for the diagnosis and management of cough across disciplines and also identify gaps in knowledge and treatment options.

Methodologies for the Development of the Management of Cough: CHEST Guideline and Expert Panel Report

BACKGROUND: This series of guidance documents on cough, which will be published over time, is a hybrid of two processes: (1) evidence-based guidelines and (2) trustworthy consensus statements based on a robust and transparent process.

METHODS: The CHEST Guidelines Oversight Committee selected a nonconflicted Panel Chair and jointly assembled an international panel of experts in each clinical area with few, if any, conflicts of interest. PICO (population, intervention, comparator, outcome)-based key questions and parameters of eligibility were developed for each clinical topic to inform the comprehensive literature search. Existing guidelines, systematic reviews, and primary studies were assessed for relevance and quality. Data elements were extracted into evidence tables and synthesized to provide summary statistics. These, in turn, are presented to support the evidence-based graded recommendations. A highly structured consensus-based Delphi approach was used to provide expert advice on all guidance statements. Transparency of process was documented.

RESULTS: Evidence-based guideline recommendations and consensus-based suggestions were carefully crafted to provide direction to health-care providers and investigators who treat and/or study patients with cough. Manuscripts and tables summarize the evidence in each clinical area supporting the recommendations and suggestions.

CONCLUSIONS: The resulting guidance statements are based on a rigorous methodology and transparency of process. Unless otherwise stated, the recommendations and suggestions meet the guidelines for trustworthiness developed by the Institute of Medicine and can be applied with confidence by physicians, nurses, other health-care providers, investigators, and patients.

“It’s very complicated”: a qualitative study of medicines management in intermediate care facilities in Northern Ireland

Background: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. 

Methods: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. 

Results: Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. 

Conclusions: Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

Application of disturbance management principles in fresh food supply chains

The desire for more robust supply chains has led to a growth in theoretical and practical interest in the application of both preventive and impact reductive disturbance management principles. This application should ultimately lead to less vulnerable and more competitive supply chains. Based on the extant literature we identify fresh food supply chain's contextual factors (products, processes, supply chain networks and supply chain business environment) and their corresponding characteristics, as well as the main disturbance management principles used. To analyse their influence on the selection and application of disturbance management principles in fresh food supply chains we conducted three case studies. In each case we collected data on the relevant contextual factors, disturbance management principles applied and company background. As an underlying methodology, we first conduct within-case analysis and then expand the analyses to a cross-case context. Based on the findings from these case studies, propositions are built concerning the nature of contextual factors and their characteristics, and their influence on the selection and application of disturbance management principles in fresh food supply chains. Our main findings are related to the identification of contextual characteristics of fresh food supply chains that are either critical vulnerability sources, critical enablers or conditionals and as such require, facilitate or condition selection and application of disturbance management principles.

Understanding Graduate Recruitment, Development and Retention for the Enhancement of Talent Management: Sharpening “the edge” of Graduate Talent

Graduates are deemed to be a key source of talent within many organisations and thus recruiting, developing and retaining them is viewed as a logical talent management (TM) strategy. However, there has been little attention paid to university graduates as part of an organisation’s TM strategy. Such a specific focus addresses the need for further research into the segmentation of talent pools and the specific challenges different talent pools are likely to create. This research, which utilised a qualitative data collection strategy, examined the experiences and practices of six large UK organisations in relation to graduate TM. Drawing from Gallardo-Gallardo, Dries and González-Cruz’s (2013. What is the meaning of ‘talent’ in the world of work? Human Resource Management Review, 23, 290–300.) framework for the conceptualisation of talent, the findings from this research indicate and explain why graduate employers are frequently compelled to use the object approach (talent as characteristics of people) due to the unique characteristics that recent graduates possess, even though other studies have found that a subject approach (talent as people and what they do) is preferred by most employers. Ultimately, employers conceptualise graduate talent by what they describe as ‘the edge’ which needs to be ‘sharpened’ to fully realise the potential that graduates offer.