Anxiety disorders : assessment and management in general practice

Background: Anxiety is a normal physiological response to a threat. Anxiety disorders occur when this normal physiological response is associated with high levels of autonomic arousal, erroneous cognitions and dysfunctional coping strategies. Anxiety disorders are highly prevalent and present commonly to general practice. Anxiety disorders are often comorbid with other psychiatric and medical disorders and may be associated with significant morbidity.

Objective: This article describes the diagnosis, assessment and management of anxiety disorders in the general practice setting.

Discussion: Assessment in patients presenting with anxiety symptoms involves excluding a medical cause, identifying features of specific anxiety disorders as well as other coexisting psychiatric disorders, and assessing the degree of distress. Management options include psychoeducation, psychological treatments (particularly cognitive behaviour therapy) and pharmacological treatments. Patients with a diagnosis of an anxiety disorder can access Medicare funded psychological care under a number of Australian government initiatives. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are the first line pharmacological agents used to treat anxiety disorders. Regular review is vital to monitor for clinical improvement and more complex presentations may require specialist psychological or psychiatric referral.

Exploring distributed leadership for the quality management of online learning environments

Online learning environments (OLEs) are complex information technology (IT) systems that intersect with many areas of university organisation. Distributed models of leadership have been proposed as appropriate for the good governance of OLEs. Based on theoretical and empirical research, a group of Australian universities proposed a framework for the quality management of OLEs, and sought to validate the model via a survey of Australasian university representatives with OLE leadership responsibility. For the framework elements: Planning and Resourcing were rated most important; Organisational structure was rated least important; Technologies were rated low in importance and high in satisfaction; Resourcing and Evaluation were rated low in satisfaction; and Resourcing had the highest rating of importance coupled with low satisfaction. Considering distributed leadership in their institution, respondents reported that the organisational alignments represented by 'official' reporting and peer relationships were significantly more important and more effective than the organisational alignments linking the formal and informal leaders. From a range of desirable characteristics of distributed leadership, 'continuity and sustainability' received the highest rating of importance and a low rating of 'in evidence' - there are concerns about the sustainability of distributed leadership for the governance of OLEs in universities.

Evaluation of building performance for strategic facilities management in healthcare : a case study of a public hospital in Australia

Purpose - This paper evaluates the main elements of building performance namely building function, building impact and building quality in order to promote strategic facilities management in healthcare organisation to improve core (health) business activities. Design/methodology/approach - Based on current available toolkits, a questionnaire is issued to healthcare users (staff) in a public hospital about their level of agreement in relation to these elements. Statistical analysis is conducted to regroup the elements. These regrouped elements and their inter relationships are used to develop a framework for measuring building performance in healthcare buildings. Findings - The analysis helped to clarify the understanding and agreement of users in Australian healthcare organisation with regards to building performance. Based on the survey results, 11 new elements were regrouped into three groups. These new regrouped elements will be used to develop a reliable framework for measuring performance of Australian healthcare buildings. Originality/value - Currently there is no building performance toolkit available for Australian healthcare organisation. The framework developed in this paper will help healthcare organisations with a reliable performance tool for their buildings and this will promote strategic facilities management.

Business relationship development and management in China

The Australian Government's White Paper on Australia in the Asian Century, released in October 2012, is based on the premise that the transformation of the Asian region into the world's economic powerhouse is not only unstoppable, it is gathering pace. Asia's extraordinary ascent has already changed the Australian economy, society and strategic environment. Within a few years, Asia will be the world's largest producer of goods and services, as well as the largest consumer market and the home of the majority of the world's middle class. The White Paper notes that thriving in the Asian century requires the Australian nation to have a clear plan to seize the economic opportunities and manage the strategic challenges that will arise, by taking a farsighted approach focused on fairness. To do so, Australians must be Asia-literate and Asia-capable, with a thorough understanding of Asian cultures and languages. These capabilities are needed to build stronger connections and partnerships across the region. Australia's commercial success in the region requires that highly innovative, competitive Australian firms and institutions develop collaborative relationships with others m the region. Australian firms need new business models and new mind-sets to operate and connect with Asian markets. Against this backdrop, this chapter discusses several important issues relating to Australian firms developing and managing their business relationships in China, in the context of urban planning, architecture, civil engineering and construction. The chapter examines the Chinese business environment, in terms of guanxi, business opportunities, risks and strategies, in a case study of the successful partnerships established to manage the 'Water Cube' for the Beijing Olympic Games in 2008.

Occasional paper : Towards the development of an online learning environment (OLE) quality management framework

The project is committed to understanding, recognising and developing various forms of institutionally relevant distributed leadership in developing and trialling various components of a quality management framework for online learning environments in Australian higher education. This paper provides an overview of issues related to the management and improvement of quality, including in the context of higher education. In response to the complex and multi-dimensional nature of both quality and online learning environments (OLEs), the concept of a framework for organising policies, procedures and actions relating to the good governance of OLEs can be found in the literature. Such frameworks vary in scope, format and title, and a (non-exhaustive) sample is presented in summary here. Key learnings that can be drawn from the exemplars frameworks and the related literature include:
- the processes for the design of such frameworks;
- the components of such frameworks;
- the measurement mechanisms and metrics employed in such frameworks; and
- the validation of such frameworks.

Knowledge management in future factories

Technology in the manufacturing sector has seen rapid change, transforming from stand alone, manual processes to smart, integrated systems. We have witnessed the migration of relay-based systems to advance SCADA systems, manual pro-duction to fully automated, and hand written reports to interactive computer-based dashboards. We are now seeing the emergence of smart products manufactured in smart plants and the evolution of smart services in manufacturing. Future manu-facturing systems will be distinguished by intelligent machines, automation and human factors’ integration. This talk will focus on how knowledge can be embed-ded in processes and products through the use of simulation and modelling tools to streamline future smart production systems and improve product quality. The implications to future smart manufacturing enterprises are explored through a se-ries of case studies from aerospace, mining and small and medium manufacturing enterprises.

A prospective analysis of pain experience, beliefs and attitudes, and pain management in a cohort of Danish surgical patients.

Background: 

Leadership and management in the early years

This book has been written for all leaders and aspiring leaders with responsibility for improving the quality of early years settings. It brings together current research and effective practice to provide you with the knowledge, understanding and skills you need to motivate and get the best from your team, identify and develop your personal leadership style and clarify your vision for quality.

Associations between economic hardship and markers of self-management in adults with type 2 diabetes: results from Diabetes MILES - Australia

A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours.

Demo abstract: wind measurements for water quality studies in urban reservoirs

Water quality monitoring and prediction are critical for ensuring the sustainability of water resources which are essential for social security, especially for countries with limited land like Singapore. For example, the Singapore government identified water as a new growth sector and committed in 2006 to invest S$ 330 million over the following five years for water research and development [1]. To investigate the water quality evolution numerically, some key water quality parameters at several discrete locations in the reservoir (e.g., dissolved oxygen, chlorophyll, and temperature) and some environmental parameters (e.g., the wind distribution above water surface, air temperature and precipitation) are used as inputs to a three-dimensional hydrodynamics-ecological model, Estuary Lake and Coastal Ocean Model - Computational Aquatic Ecosystem Dynamics Model (ELCOM-CAEDYM) [2]. Based on the calculation in the model, we can obtain the distribution of water quality in the whole reservoir. We can also study the effect of different environmental parameters on the water quality evolution, and finally predict the water quality of the reservoir with a time step of 30 seconds. In this demo, we introduce our data collection system which enables water quality studies with real-time sensor data.

Patient self-management in chronic heart failure – establishing concordance between guidelines and practice

 Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self- management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.

Current approaches to obesity management in UK Primary Care: the Counterweight Programme

Background/Aims Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care.

Method A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) ≥30 kg m−2, n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18–75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded.

Results Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected.

Conclusion Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention.

Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement

Background Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings.

Aim To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving ≤5% loss at 12 and 24 months.

Design of study Prospective evaluation of a new continuous improvement model for weight management in primary care.

Setting Primary care, UK.

Method Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI) ≥30 kg/m2 or ≥28 kg/m2 with obesity-related comorbidities.

Results Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI ≥40 kg/m2 and 74% had ≥1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for ≥12 months, and 825 for ≥24 months. Mean weight change in those who attended and had data at 12 months (n = 642) was &minus;3.0 kg (95% CI = &minus;3.5 to &minus;2.4 kg) and at 24 months (n = 357) was &minus;2.3 kg (95% CI = &minus;3.2 to &minus;1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of ≥5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months.

Conclusion This intervention achieves and maintains clinically valuable weight loss within routine primary care.