Management of lipids in rural Australia : are the guidelines being followed?

Background: Hypercholesterolaemia is ranked seventh among the major factors contributing to the overall burden of disease in Australia. Guidelines for evidence-based lipid management were released in 2001 and updated in 2005, however little population level data has been published on the current gap between recommended management and actual practice in Australia.

Method: Three population stratified surveys were undertaken in the Greater Green Triangle. Three thousand three hundred and twenty adults aged 25–74 years were randomly selected, stratified by gender and 10-year age groups. Anthropometric, clinical and self-administered questionnaire data relating to cardiovascular disease risk were collected in accordance with the WHO MONICA protocol. Blood samples were collected for lipid profile analysis. Participants were divided into four groups—Group 1: treated, high CVD risk; Group 2: treated, primary prevention; Group 3: untreated, high CVD risk; Group 4: untreated, low CVD risk. For each of these groups we compared cholesterol, HDL cholesterol, triglyceride and LDL cholesterol with targets recommended by the National Heart Foundation's 2005 guidelines.

Results: All lipids were at target in 39.4% of the study population with marked differences between groups: Group 1, 11.2%; Group 2, 38.5%; Group 3, 1.8%; Group 4, 47.6%.

Only 50.8% of the untreated high CVD risk group reported having blood cholesterol measured within the last 12 months.

Conclusion: Current rates of detection and treatment practices in rural Australia are suboptimal. Although one-third of the study population age 25–74 years are at sufficiently high risk to warrant consideration of lipid lowering medication only just over half of these were on treatment at the time of the study. These results suggest that an intensive implementation plan is required for the management of hyperlipidaemia in rural Australia.

Using competencies in human resource management : case studies in Australian companies

This study investigated the use of competencies for human resource management in seven Australian companies. Despite advocacy for the use of competencies by Government Committees and Task Forces (For example Carmichael (1992), Mayer, (1992) and Karpin, 1995), and the existence of competency standards for eighty per cent of the Australian workforce, the competency approach has not been widely adopted. A review of the literature indicated that the term competency had several meanings with different implications for its use depending on the meaning. The study looked at how individuals have defined the term and applied the approach to human resource management practices. Interviews were conducted with Human Resource and Training managers, and operative staff in companies using competencies. How they defined the term, described the rationale for using competencies, and applied competencies to selection, training, performance appraisal and remuneration were determined. Case studies were written for each company to describe their particular application of competencies. Competencies were found to be defined in several ways by those interviewed. Some advantages of using competencies in human resource management applications were found. The amount of work involved in introducing the competency approach was described as a reason why competencies have not been more widely adopted.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Stakeholder involvement and interplay in coastal zone management and marine protected area planning

Most of Australia’s coastline and marine waters are crown ‘land’ and can be accessed by the public. As a result, many different users and stakeholder groups have an interest in coastal and marine planning and management decisions. As a way of analysing stakeholder involvement and interplay in coastal zone management and marine protected area (MPA) development in Australia, three case studies are presented to dissect the issues and explore common themes. The three themes are 1) Stakeholder involvement in implementing the oceans policy, 2) Stakeholder involvement in marine protected area network identification and 3) Stakeholder involvement in coastal land issues.

Corporate governance of executive remuneration with special reference to Bangladesh

This discussion paper focuses on corporate governance issues associated with executive compensation arrangements. An historical perspective is used to demonstrate the absence of a sound empirically-based understanding of good corporate governance practices in relation to share-based payment arrangements. The paper provides an overview of issues including the potential earnings dilution and volatility effects of the introduction of regulations affecting executive remuneration. Potential research questions have been framed addressing each of the major issues identified in this paper. It is concluded that corporate regulators should ensure they are familiar with and that they consider best practice models for corporate governance when developing new or revising existing business regulation. It is proposed that further research to remedy this deficiency would enable a more accurate assessment of the impact of management on accounting regulation and the better design and implementation of regulation.

Young adults’ management of Type 1 diabetes during life transitions

Aim. To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events.
Background. Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals’ problem-solving, coping abilities and blood glucose levels.
Design. A qualitative interpretive inquiry.
Method. Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR NVIVO 7 software.
Results. Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using ‘strategic thinking and planning’ with strategies of ‘self-negotiation to minimise risks’; ‘managing diabetes using previous experiences’; ‘connecting with others with diabetes’; ‘actively seeing information to ‘patch’ knowledge gaps’; and ‘putting diabetes into perspective’.
Conclusions. Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions.
Relevance to clinical practice. It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.

An integrated management systems approach to corporate sustainability

Purpose – This paper seeks to describe an integrated management systems (IMS) approach for the integration of corporate sustainability into business processes.
Design/methodology/approach – An extensive review of published literature was conducted. Building on existing research, the paper presents an original framework for structuring the integration of corporate sustainability with existing business infrastructure. The framework is supported by a detailed set of diagnostic questions to help guide the process. Both the framework and the diagnostic questions are based on the “Plan-Do-Check-Act” cycle of continuous improvement.
Findings – The paper highlights the need for a systematic means to integrate sustainability into business processes. Building on that point, the paper illustrates how an IMS approach can be used to structure the entire process of managing, measuring, and assessing progress towards corporate sustainability.
Practical implications – The paper should be of interest to both practitioners and researchers. The framework and diagnostic questions will help guide decision makers through the process of building sustainability into their core business infrastructure. Since the framework and diagnostic questions provide the flexibility to accommodate specific organizational contexts, it is anticipated that they will have wide applicability.
Originality/value – The paper makes several contributions. The framework provides a systematic approach to corporate sustainability that has not been elaborated on in previous publications. The unique set of diagnostic questions provides a means to evaluate the extent to which corporate sustainability has been integrated into an organization.

Impact of climate change issues on businesses : an action plan using a corporate governance approach

Business globally are readying themselves for wide-ranging impacts as they transition towards a low carbon footprint economy. This paper discusses the major impacts for the firm due to the move to a low-carbon footprint system. In doing so it highlights the crucial link between opportunities, costs, risks and structural changes faced by firms, and presents a framework for managing the complex, multi-pronged impacts. The paper provides a conceptual model that will assist decision-makers to deal with risk management or bottom-line protection issues as well as exploiting the business opportunity the new regulatory environment will produce. The model argues for a holistic corporate governance mechanism, with responsibility and accountability of climate change risk management placed with the board of directors and senior management.

Young adults' management of type 1 diabetes during life transitions

Aim. To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events.

Background. Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals’ problem-solving, coping abilities and blood glucose levels.

Design. A qualitative interpretive inquiry.

Method. Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR_ NVIVO 7 software.

Results. Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using ‘strategic thinking and planning’ with strategies of ‘self-negotiation to minimise risks’; ‘managing diabetes using previous experiences’; ‘connecting with others with diabetes’; ‘actively seeing information to ‘patch’ knowledge gaps’; and ‘putting diabetes into perspective’.

Conclusions. Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions.

Relevance to clinical practice. It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.