PINCER trial: a cluster randomised trial comparing the effectiveness and cost-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 in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Risk management and the corporate real estate portfolio

In a global business economy, firms have a broad range of corporate real estate needs. During the past decade, multiple strategies and tactics have emerged in the corporate real estate community for meeting those needs. We propose here a framework for analysing and prioritising the various types of risk inherent in corporate real estate decisions. From a business strategy perspective, corporate real estate must serve needs beyond the simple one of shelter for the workforce and production process. Certain uses are strategic in that they allow access to externalities, embody the business strategy, or provide entrée to new markets. Other uses may be tactical, in that they arise from business activities of relatively short duration or provide an opportunity to pre-empt competitors. Still other corporate real estate uses can be considered “core” to the existence of the business enterprise. These might be special use properties or may be generic buildings that have become embodiments of the organisation’s culture. We argue that a multi-dimensional matrix approach organised around three broad themes and nine sub-categories allow the decision-maker to organise and evaluate choices with an acceptable degree of rigor and thoroughness. The three broad themes are Use (divided into Core, Cyclical or Casual) – Asset Type (which can be Strategic, Specialty or Generic) and Market Environment (which ranges from Mature Domestic to Emerging Economy). Proper understanding of each of these groupings brings critical variables to the fore and allows for efficient resource allocation and enhanced risk management.

Multiple-project discount rates for cost-benefit analysis in construction projects: A formal risk model for microgeneration renewable energy technologies

The traditional economic approach for appraising the costs and benefits of construction project Net Present Values involves the calculation of net returns for each investment option under different discount rates. An alternative approach consists of multiple-project discount rates based on risk modelling. The example of a portfolio of microgeneration renewable energy technology (MRET) is presented to demonstrate that risks and future available budget for re-investment can be taken into account when setting discount rates for construction project specifications in presence of uncertainty. A formal demonstration is carried out through a reversed intertemporal approach of applied general equilibrium. It is demonstrated that risk and the estimated available budget for future re-investment can be included in the simultaneous assessment of the costs and benefits of multiple projects.

Practicing sustainability in PFI project management

This paper investigates the relationship of the project management in Private Finance Initiative (PFI) and sustainability. A live PFI project is selected as a case study, where contract review and monitoring on project management are carried out to evaluate the sustainability of project management. The PFI procurement shows great advantages in increased contractual responsibilities of the contractor in sustainable construction, and also in practicing sustainability in project management. Six main sustainable attributes of the project management are selected to evaluate the sustainability of project management in the PFI project. The project management process in the case study is closely monitored in order to verify how the PFI project promotes sustainability in practice. The project management in the different stages of the PFI project, including tendering, design, construction and operation, contributes to the six sustainable attributes in different ways. The project management in PFI project paid more attention in sustainable development during its whole process. As the private sector is responsible to the whole life of the building project, the project manager has to consider the long-term benefits during the management process. The government should take advantages of PFI project management in practicing sustainability therefore to promote sustainable development of the national infrastructure services.

Implementing ‘Site BIM’: a case study of ICT innovation on a large hospital project

Numerous Building Information Modelling (BIM) tools are well established and potentially beneficial in certain uses. However, issues of adoption and implementation persist, particularly for on-site use of BIM tools in the construction phase. We describe an empirical case-study of the implementation of an innovative ‘Site BIM’ system on a major hospital construction project. The main contractor on the project developed BIM-enabled tools to allow site workers using mobile tablet personal computers to access design information and to capture work quality and progress data on-site. Accounts show that ‘Site BIM’, while judged to be successful and actively supporting users, was delivered through an exploratory and emergent development process of informal prototyping. Technical IT skills were adopted into the construction project through personal relationships and arrangements rather than formal processes. Implementation was driven by construction project employees rather than controlled centrally by the corporate IT function.

Portfolio-Werbung als Technik des Impression Management: Eine Untersuchung zur gegenseitigen Stärkung von Dachmarke und Produktmarken in komplexen Markenarchitekturen

In recent years, the importance of the corporate brand (e.g. P&G, Nestlé, Unilever) has grown significantly and companies increasingly strive to strengthen their corporate brand. One way to strengthen the corporate brand is portfolio advertisement, in which the corporate brand is presented alongside with several product brands of its portfolio (e.g. VW with its product brands Touareg, Touran, Golf and Polo). The aim of portfolio advertising is to generate a positive image spill-over effect from the product brands onto the corporate brand in order to enhance the consumers’ perceived competence of the corporate brand. In four experimental settings Christian Boris Brunner demonstrates the great potential of portfolio advertising and highlights the risks associated with portfolio advertising in practice. In a first experiment, he compares portfolio advertising with single brand advertisements. Moreover, in case of portfolio advertising he manipulates the fit between the product brands, because the consumer has to establish a logical coherence between the individual brands. However, asconsumers have limited capacity for processing information, special attention should be paid to the number of product brands and to the processing depth of the consumer during confrontation with portfolio advertising. These key factors are taken into consideration in a second extensive experiment involving fictitious corporate and product brands. The effects of portfolio advertising on a product brand are also examined. Furthermore, the strength of product brands, i.e. brand knowledge as well as brand image and consumer’s knowledge of the brands, must be taken into consideration. In a third experiment, both the brand strength of real product brands as well as the fit between product brands are manipulated. Portfolio advertising could also have a positive image spill-over effect when companies introduce a new product brand under the umbrella of the corporate brand while communicating all product brands together. Based on considerations, in a fourth experiment, Christian Boris Brunner shows that portfolio advertising could also have a positive image spill-over effect on a new (unknown) product brand. Concluding his work, Christian Boris Brunner provides implications for future research concerning portfolio advertising as well as the management of a corporate brand in complex brand architectures. Concerning practical implications, these four experiments underline a high relevance to marketing and brand managers, who could increase corporate and product brands’ potential by means of portfolio advertising.

Executive project management structure and the challenges acing its adoption in the Nigerian construction industry

Project management (PM) is a globally recognized discipline and has been widely adopted within the construction industry. Despite advancements in the PM discipline, the ineffective traditional management system, typical of the non-executive PM structure, is still widely used in the Nigerian construction industry. The aim of this paper is thus to explore the challenges facing the adoption of the executive PM structure in Nigeria. The paper first assesses the level of growth of PM in Nigeria using UK best practices as a benchmark and identifies the key PM characteristics in the two countries. Focus group interviews were used to collect the primary data for the study and content analysis was used to present the results in a thematic format. The study revealed the key barriers to the adoption of an executive PM structure in Nigeria as a lack of proper awareness, unfavorable policies, skill shortages, the traditional culture of stakeholders and the absence of a regulatory body. It is recommended that the government, as a major player/client in the Nigerian construction industry, should lead the campaign to change the traditional industry approach to project management. This is necessary if construction stakeholders in Nigeria are to be educated and encouraged towards adopting and putting into practice effective PM.

An ontological approach to competency management

Competency management is a very important part of a well-functioning organisation. Unfortunately competency descriptions are not uniformly specified nor defined across borders: National, sectorial or organisational, leading to an opaque competency description market with a multitude of competency frameworks and competency benchmarks. An ontology is a formalised description of a domain, which enables automated reasoning engines to be built which by utilising the interrelations between entities can make “intelligent” choices in different situations within the domain. Introducing formalised competency ontologies automated tools, such as skill gap analysis, training suggestion generation, job search and recruitment, can be developed, which compare and contrast different competency descriptions on the semantic level. The major problem with defining a common formalised ontology for competencies is that there are so many viewpoints of competencies and competency frameworks. Work within the TRACE project has focused on finding common trends within different competency frameworks in order to allow an intermediate competency description to be made, which other frameworks can reference. This research has shown that competencies can be divided up into “knowledge”, “skills” and what we call “others”. An ontology has been created based on this with a simple structure of different “kinds” of “knowledges” and “skills” using semantic interrelations to define the basic semantic structure of the ontology. A prototype tool for analysing a skill gap analysis has been developed. Personal profiles can be produced using the tool and a skill gap analysis is performed on a desired competency profile by using an ontologically based inference engine, which is able to list closest fit and possible proficiency gaps

Modelling nitrogen fluxes from the land surface to the coastal zone in European systems: the perspective of the INCA project

This paper describes the results and conclusions of the INCA (Integrated Nitrogen Model for European CAtchments) project and sets the findings in the context of the ELOISE (European Land-Ocean Interaction Studies) programme. The INCA project was concerned with the development of a generic model of the major factors and processes controlling nitrogen dynamics in European river systems, thereby providing a tool (a) to aid the scientific understanding of nitrogen transport and retention in catchments and (b) for river-basin management and policy-making. The findings of the study highlight the heterogeneity of the factors and processes controlling nitrogen dynamics in freshwater systems. Nonetheless, the INCA model was able to simulate the in-stream nitrogen concentrations and fluxes observed at annual and seasonal timescales in Arctic, Continental and Maritime-Temperate regimes. This result suggests that the data requirements and structural complexity of the INCA model are appropriate to simulate nitrogen fluxes across a wide range of European freshwater environments. This is a major requirement for the production of coupled fiver-estuary-coastal shelf models for the management of our aquatic environment. With regard to river-basin management, to achieve an efficient reduction in nutrient fluxes from the land to the estuarine and coastal zone, the model simulations suggest that management options must be adaptable to the prevailing environmental and socio-economic factors in individual catchments: 'Blanket approaches' to environmental policy appear too simple. (c) 2004 Elsevier B.V. All rights reserved.

Bioremediation of acid mine drainage: an introduction to the Wheal Jane wetlands project

Acid mine drainage (AMD) is a widespread environmental problem associated with both working and abandoned mining operations. As part of an overall strategy to determine a long-term treatment option for AMD, a pilot passive treatment plant was constructed in 1994 at Wheat Jane Mine in Cornwall, UK. The plant consists of three separate systems; each containing aerobic reed beds, anaerobic cell and rock filters, and represents the largest European experimental facility of its kind. The systems only differ by the type of pre-treatment utilised to increase the pH of the influent minewater (pH<4): lime-dosed (LD), anoxic limestone drain (ALD) and lime free (LF), which receives no form of pre-treatment. The Wheal Jane pilot plant offered a unique facility and a major research project was established to evaluate the pilot plant and study in detail the biological mechanisms and the geochemical and physical processes that control passive treatment systems. The project has led to data, knowledge, models and design criteria for the future design, planning and sustainable management of passive treatment systems. A multidisciplinary team of scientists and managers from the U.K. universities, the Environment Agency and the Mining Industry has been put together to obtain the maximum advantage from the excellent facilities facility at Wheal Jane. (C) 2004 Elseaier B.V All rights reserved.

A conventionally managed project: a systems based case study

The technique of linear responsibility analysis is used for a retrospective case study of a private development consisting of an extension to an existing building to provide a wholesale butchery facility. The project used a conventionally organized management process. The organization structure adopted on the project is analysed using concepts from the systems theory, which are included in Walkers theoretical model of the structure of building project organizations. This model proposes that the process of building provision can be viewed as systems and sub-systems that are differentiated from each other at decision points. Further to this, the sub-systems can be viewed as the interaction of managing system and operating system. Using Walkers model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficiency of the organizational structure used. The project's organization structure diverged from the models propositions resulting in delay to the project's completion and cost overrun but the client was satisfied with the project functionally.