Electronic patient records: Achieving best practice in information transfer between hospital and community providers - an integration success story

Effective healthcare integration is underpinned by clinical information transfer that is timely, legible and relevant. The aim of this study was to describe and evaluate a method for best practice information exchange. This was achieved based on the generic Mater integration methodology. Using this model the Mater Health Services have increased effective community fax discharge from 34% in 1999 to 86% in 2002. These results were predicated on applied information technology excellence involving the development of the Mater Electronic Health Referral Summary and effective change management methodology, which included addressing issues around patient consent, engaging clinicians, provision of timely and appropriate education and training, executive leadership and commitment and adequate resourcing. The challenge in achieving best practice information transfer is not solely in the technology but also in implementing the change process and engaging clinicians. General practitioners valued the intervention highly. Hospital and community providers now have an inexpensive, effective product for critical information exchange in a timely and relevant manner, enhancing the quality and safety of patient care.

OHS in the nursing workplace: accountability and the management of stress

There has been growing interest in occupational stress in the nursing context, both in New Zealand and internationally. This article takes a critical approach to the literature on nursing stress by examining the implications of a body of research largely informed by a theoretical approach which highlights the individual. In spite of evidence that the main sources of stress for nurses are related to workplace conditions, the focus is on the individual nurse and his/her personal response to stress. This approach encourages the development of interventions where the objectives are the individual management of stress, and thereby consolidates nurses' perceptions of powerlessness. Alternatives to these palliative measures, such as highlighting the legal obligations for employers to provide a safe workplace or collective industrial action for change, are glaringly absent in the literature. The importance of such an approach is supported by recent findings from the United States on the advantages of hospitals which promote nurses' autonomy and control.

Management of a previously eroded tropical Alfisol with herbaceous legumes: Soil loss and physical properties under mound tillage

A study was carried out on a previously eroded Oxic Paleustalf in Ibadan, southwestern Nigeria to determine the extent of soil degradation under mound tillage with some herbaceous legumes and residue management methods. A series of factorial experiments was carried out on 12 existing runoff plots. The study commenced in 1996 after a 5-year natural fallow. Mound tillage was introduced in 1997 till 1999. The legumes - Vigna unguiculata (cowpea), Mucuna pruriens and Pueraria phaseoloides - were intercropped with maize in 1996 and 1998 while yam was planted alone in 1997 and 1999. This paper covers 1997-1999. At the end of each year, residues were either burned or mulched on respective plots. Soil loss, runoff, variations in mound height, bulk density, soil water retention and sorptivity were measured. Cumulative runoff was similar among interactions of legume and residue management in 1997 (57-151 mm) and 1999 (206-397 mm). However, in 1998, cumulative runoff of 95 mm observed for Mucuna-burned residue was significantly greater than the 46 mm observed for cowpea-burned residue and the 39-51 mm observed for mulched residues of cowpea, Mucuna and Pueraria. Cumulative soil loss of 7.6 Mg ha(-1) observed for Mucuna-burned residue in 1997 was significantly greater than those for Pueraria-mulched (0.9 Mg ha(-1)) and Mucuna-mulched (1.4 Mg ha(-1)) residues whereas in 1999 it was similar to soil loss from cowpea treatments and Pueraria-burned residue (2.3-5.3 Mg ha(-1)). There were no significant differences in soil loss in 1998 (1-3.2 Mg ha(-1)) whereas Mucuna-burned residue had a greater soil loss (28.6 Mg ha(-1)) than mulched cowpea (6.9 Mg ha(-1)) and Pueraria (5.4 Ms ha(-1)). Mound heights (23 cm average) decreased non-linearly with cumulative rainfall. A cumulative rainfall of 500 mm removed 0.3-2.3 cm of soil from mounds in 1997, 3.5-6.9 cm in 1998 and 2.3-4.6 cm in 1999, indicating that (detached but less transported) soil from mounds was far higher than observed soil loss in each year. Soil water retention was improved at potentials ranging from -1 to -1500 kPa by Mucuna-mulched residue compared to the various burned-residue treatments. Also, mound sorptivity at -1 cm water head (14.3 cm h(-1/2)) was higher than furrow sorptivity (8.5 cm h(-1/2)), indicating differences in hydraulic characteristics between mound and furrow. Pueraria-mulched residues for mounds had the highest sorptivity of 17.24 cm h(-1/2), whereas the least value of 6.96 cm h(-1/2) was observed in furrow of Mucuna-burned residue. Pueraria phas eoloides was considered the best option for soil conservation on the previously eroded soil, cultivated with mound tillage. (c) 2005 Elsevier B.V. All rights reserved.