Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and Subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Mapping IT innovation in Facilities Management

Over the past decade there has been significant growth in the facilities management (FM) sector resulting in a diverse and highly competitive marketplace. This marketplace engages contractors, in-house teams, suppliers, consultants and professional institutions. Many of these organisations have had to innovate to differentiate themselves from competitors. The subject of this paper is facilities management innovation. More specifically, it examines the introduction of information technology (IT) to support such innovations. Our understanding of how such innovations are brought about is scant. The intention of this paper is to examine the motivations and factors which have brought about ‘information system’ innovations in the sector based on an examination of a small but diverse collection of case studies. The study specifically considers the route by which the selected innovations came about and the way in which the innovation has diffused throughout the rest of the organisation. The IT innovations identified in case studies include whole life cost modelling, a content management solution, open book partnering, management information portal (fmNet), RFID technology, and capacity and capability planning. Taken together they characterise a sector that is using IT to codify and standardise information such that useful knowledge becomes widely dispersed.

Theory and practice in value management: a reply to Ellis et al (2005)

The constructivist model of 'soft' value management (VM) is contrasted with the VM discourse appropriated by cost consultants who operate from within UK quantity surveying (QS) practices. The enactment of VM by cost consultants is shaped by the institutional context within which they operate and is not necessarily representative of VM practice per se. Opportunities to perform VM during the formative stages of design are further constrained by the positivistic rhetoric that such practitioners use to conceptualize and promote their services. The complex interplay between VM theory and practice is highlighted and analysed from a non-deterministic perspective. Codified models of 'best practice' are seen to be socially constructed and legitimized through human interaction in the context of interorganizational networks. Published methodologies are seen to inform practice in only a loose and indirect manner, with extensive scope for localized improvization. New insights into the relationship between VM theory and practice are derived from the dramaturgical metaphor. The social reality of VM is seen to be constituted through scripts and performances, both of which are continuously contested across organizational arenas. It is concluded that VM defies universal definition and is conceptualized and enacted differently across different localized contexts.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Model-based life cycle cost and assessment tool for sustainable building design decision

There is a growing concern in reducing greenhouse gas emissions all over the world. The U.K. has set 34% target reduction of emission before 2020 and 80% before 2050 compared to 1990 recently in Post Copenhagen Report on Climate Change. In practise, Life Cycle Cost (LCC) and Life Cycle Assessment (LCA) tools have been introduced to construction industry in order to achieve this such as. However, there is clear a disconnection between costs and environmental impacts over the life cycle of a built asset when using these two tools. Besides, the changes in Information and Communication Technologies (ICTs) lead to a change in the way information is represented, in particular, information is being fed more easily and distributed more quickly to different stakeholders by the use of tool such as the Building Information Modelling (BIM), with little consideration on incorporating LCC and LCA and their maximised usage within the BIM environment. The aim of this paper is to propose the development of a model-based LCC and LCA tool in order to provide sustainable building design decisions for clients, architects and quantity surveyors, by then an optimal investment decision can be made by studying the trade-off between costs and environmental impacts. An application framework is also proposed finally as the future work that shows how the proposed model can be incorporated into the BIM environment in practise.

A value chain approach to animal diseases risk management: technical foundations and practical framework for field application

Classical risk assessment approaches for animal diseases are influenced by the probability of release, exposure and consequences of a hazard affecting a livestock population. Once a pathogen enters into domestic livestock, potential risks of exposure and infection both to animals and people extend through a chain of economic activities related to producing, buying and selling of animals and products. Therefore, in order to understand economic drivers of animal diseases in different ecosystems and to come up with effective and efficient measures to manage disease risks from a country or region, the entire value chain and related markets for animal and product needs to be analysed to come out with practical and cost effective risk management options agreed by actors and players on those value chains. Value chain analysis enriches disease risk assessment providing a framework for interdisciplinary collaboration, which seems to be in increasing demand for problems concerning infectious livestock diseases. The best way to achieve this is to ensure that veterinary epidemiologists and social scientists work together throughout the process at all levels.

Sub-agent elements for control methods in multi-agent energy management system

Increased penetration of generation and decentralised control are considered to be feasible and effective solution for reducing cost and emissions and hence efficiency associated with power generation and distribution. Distributed generation in combination with the multi-agent technology are perfect candidates for this solution. Pro-active and autonomous nature of multi-agent systems can provide an effective platform for decentralised control whilst improving reliability and flexibility of the grid.

The cost of choice: how corporate real estate managers evaluate business space options

Firms are faced with a wider set of choices when they identify a need for new office space. They can build or purchase accommodation, lease space for long or short periods with or without the inclusion of services, or they can use “instant office” solutions provided by serviced office operators. But how do they evaluate these alternatives and are they able to make rational choices? The research found that the shortening of business horizons lead to the desire for more office space on short-term contracts often with the inclusion of at least some facilities management and business support services. The need for greater flexibility, particularly in financial terms, was highlighted as an important criteria when selecting new office accommodation. The current office portfolios held were perceived not to meet these requirements. However, there was often a lack of good quality data available within occupiers which could be used to help them analyse the range of choices in the market. Additionally, there were other organisational constraints to making decisions about inclusive real estate products. These included fragmentation of decisions-making, internal politics and the lack of assessment of business risk alongside real estate risk. Overall therefore, corporate occupiers themselves act as an interial force to the development of new and innovative real estate products.

Europe’s biocidal products directive: benefits and costs in urban pest management

The European Commission’s Biocidal Products Directive (Council Directive 98/8 EC), known as the BPD, is the largest regulatory exercise ever to affect the urban pest control industry. Although focussed in the European Union its impact is global because any company selling pest control products in the EU must follow its principles. All active substances, belonging to 23 different biocidal product types, come within the Directive’s scope of regulatory control. This will eventually involve re-registration of all existing products, as well as affecting any new product that comes to the market. Some active substances, such as the rodenticides and insecticides, are already highly regulated in Europe but others, such as embalming fluids, masonry preservatives, disinfectants and repellents/attractants will come under intensive regulatory scrutiny for the first time. One of the purposes of the Directive is to offer enhanced protection for human health and the environment. The potential benefit for suppliers of pest control products is mutual recognition of regulatory product dossiers across 25 Member States of the European Union. This process, requiring harmonisation of all regulatory decision-making processes, should reduce duplicated effort and, potentially, allow manufacturers speedier access to European markets. However, the cost to industry is enormous, both in terms of the regulatory resources required to assemble BPD dossiers and the development budgets required to conduct studies to meet its new standards. The cost to regulatory authorities is also tremendous, in terms of the need to upgrade staff capabilities to meet new challenges and the volume of the work expected by the Commission when they are appointed the Rapporteur Member State (RMS) for an active substance. Users of pest control products will pay a price too. The increased regulatory costs of maintaining products in the European market are likely to be passed on, at least in part, to users. Furthermore, where the costs of meeting new regulatory requirements cannot be recouped from product sales, many well-known products may leave the market. For example, it seems that in future few rodenticides that are not anticoagulants will be available within the EU. An understanding of the BPD is essential to those who intend to place urban pest control products on the European market and may be useful to those considering the harmonisation of regulatory processes elsewhere. This paper reviews the operation of the first stages of the BPD for rodenticides, examines the potential benefits and costs of the legislation to the urban pest control industry and looks forward to the next stages of implementation involving all insecticides used in urban pest management.