Building equity in chronic disease management in Thailand : a whole-system provincial trial of systematic, pro-active chronic illness care

Thailand has a history of implementing innovative and proactive policies to address the health needs of its population. Since 1962 Thailand has implemented initiatives that led to it having a health system characterized by a primary care focus, decentralization and mechanisms to maximize equity and universal access to basic care at the local level. Thai health structures initially evolved to meet challenges including infectious and developmental diseases and later HIV. Early in the 21st century chronic illness rapidly became the greatest cause of morbidity and mortality and the question has arisen how Thailand can adapt its strong health system to deal with the new epidemics. This article describes an effort to reorient provincial health services to meet the needs of the increasing number of people with diabetes and heart disease. It describes measures taken to build on the equity-promoting elements of the Thai health system. The project included; a situational analysis, development and implementation of a chronic disease self-management intervention implemented by nurses and alignment of provincial health services. The self-management intervention is currently being evaluated within a clustered randomized control trial. The evaluation has been developed to fit with the focus on equity in relation to both selection criteria and the outcomes that are being assessed.

Implementation of the nurse practitioner role within a Victorian healthcare network : an organisational perspective

Objective
This paper presents a discussion of the development of a framework to implement and sustain the nurse practitioner (NP) role within one health service designed to strengthen the capacity of the health system and which could be readily transferable to other health services.
Setting
Eastern Health (EH) is a multi‑campus tertiary health care organisation servicing a population of approximately 800,000 people in the east and outer eastern suburbs of Melbourne, Australia. EH is committed to advancing the nursing profession and exploring innovative, research based models of practice that are responsive to the needs of the community it serves.
Primary argument
The Framework documents the processes of providing a new career pathway for advanced practice nurses that incorporates education and training, and utilises current evidenced‑based practice guidelines to define and promote the scope of practice.
Conclusion
Strong organisational support to facilitate interdisciplinary and multidisciplinary learning opportunities assists integration of the NP role into the healthcare team. Role clarity will assist interprofessional teams to understand and value the role NPs provide.

Individuals' absorptive capacity in enterprise system assimilation

The capability of an individual to absorb knowledge about enterprise resource planning (ERP) is a critical element in the development of an organisation’s absorptive capacity (ACAP) during assimilation phase of ERP. Prior research have tended to overlook the roles that individuals play in identify external and internal knowledge, assimilate and exploit ERP knowledge. By defining ACAP at the individual level, we seek to enrich our understanding of how individual learn ERP knowledge and how such efforts facilitate the ERP assimilation within organisations. We develop a theoretical model to investigate the assimilation of enterprise systems in the post-implementation stage. Specifically, this model explains how communication climate and top management participation moderates the impact of Individuals’ ACAP on the assimilation of ERP systems.

Reported medication errors after introducing an electronic medication management system

Aims and objectives
To explore the effects of introducing an electronic medication management system on reported medication errors.
Background
Computerised medication management systems have been found to improve medication safety; however, introducing medication management system into healthcare environments can create unanticipated or new problems and opportunities for medication error.
Design
Descriptive analysis of medication error reports.
Methods
This was a retrospective analysis of 359 incident reports drawn from the period of 1 May 2005–30 April 2006 across two hospital sites of a single not-for-profit private health service located in metropolitan Melbourne. Site A used a conventional pen and paper system for medication management, and Site B had introduced a computerised medication management system.
Results
Most medication errors occurred at the nurse administration (71·5%) and prescribing (16·4%) stages of delivery. The most common medication error type reported at Site A was omission (33%), and at Site B was wrong documentation (24·2%). A higher proportion of errors at the prescribing phase, and less nurse administration errors, were detected at Site B where the medication management system was in use. The incidence of other, less frequent errors was similar across the two hospital sites.
Conclusions
This examination of medication error reports suggests there are differences in the types of medication errors that are reported in association with the introduction of electronic medication management system compared to pen and paper system systems. The findings provide a new insight into the effects of introducing an electronic medication management system on the types of medication errors reported.
Relevance to clinical practice
The findings provide a new insight into the types of medication errors that are reported during implementation of an electronic medication management system. Extra support for physicians prescribing practices should be considered.

Scaling-up from an implementation trial to state-wide coverage : results from the preliminary Melbourne Diabetes Prevention Study

Background
The successful Greater Green Triangle Diabetes Prevention Program (GGT DPP), a small implementation trial, has been scaled-up to the Victorian state-wide ‘Life!’ programme with over 10,000 individuals enrolled. The Melbourne Diabetes Prevention Study (MDPS) is an evaluation of the translation from the GGT DPP to the Life! programme. We report results from the preliminary phase (pMDPS) of this evaluation.
Methods
The pMDPS is a randomised controlled trial with 92 individuals aged 50 to 75 at high risk of developing type 2 diabetes randomised to Life! or usual care. Intervention consisted of six structured 90-minute group sessions: five fortnightly sessions and the final session at 8 months. Participants underwent anthropometric and laboratory tests at baseline and 12 months, and provided self-reported psychosocial, dietary, and physical activity measures. Intervention group participants additionally underwent these tests at 3 months. Paired t tests were used to analyse within-group changes over time. Chi-square tests were used to analyse differences between groups in goals met at 12 months. Differences between groups for changes over time were tested with generalised estimating equations and analysis of covariance.
Results
Intervention participants significantly improved at 12 months in mean body mass index (−0.98 kg/m2, standard error (SE) = 0.26), weight (−2.65 kg, SE = 0.72), waist circumference (−7.45 cm, SE = 1.15), and systolic blood pressure (−3.18 mmHg, SE = 1.26), increased high-density lipoprotein-cholesterol (0.07 mmol/l, SE = 0.03), reduced energy from total (−2.00%, SE = 0.78) and saturated fat (−1.54%, SE = 0.41), and increased fibre intake (1.98 g/1,000 kcal energy, SE = 0.47). In controls, oral glucose at 2 hours deteriorated (0.59 mmol/l, SE = 0.27). Only waist circumference reduced significantly (−4.02 cm, SE = 0.95).

Intervention participants significantly outperformed controls over 12 months for body mass index and fibre intake. After baseline adjustment, they also showed greater weight loss and reduced saturated fat versus total energy intake.

At least 5% weight loss was achieved by 32% of intervention participants versus 0% controls.
Conclusions
pMDPS results indicate that scaling-up from implementation trial to state-wide programme is possible. The system design for Life! was fit for purpose of scaling-up from efficacy to effectiveness.

Security risks/vulnerability in a RFID system and possible defenses

Remote technologies are changing our way of life. The radio frequency identification (RFJD) system is a new technology which uses the open air to transmit information. This information transmission needs to be protected to provide user safety and privacy. Business will look for a 5ystem that hasfraud resilience to prevent the misuse of information to take dishonest advantage. The business and the user need to be assured that the transmitted information has no content which is capable of undertaking malicious activities. Public awareness of RFID security will help users and organizations to understand the need for security protection. Publishing a security guideline from the regulating body and monitoring implementation of that guideline in RFID 5ystems will ensure that businesses and users are protected. This chapter explains the importance of security in a RFID system and will outline the protective measures. It also points out the research direction of RFID 5ystems.

Deakin University Library : an active partner in the implementation of the new generation e-learning platform Desire2Learn

Deakin University has a long association with e-learning platforms, utilising the functionality of various Learning Management Systems (LMS) over a period of years. Transforming learning and teaching is a key priority of the University and moving to a new generation e-learning platform that supports engaging learning experiences through quality course design is a strategic imperative.

In 2010 Deakin University selected Desire2Learn as its replacement LMS, an innovative platform that offers next generation functionality. The University is investing significant resources in 2011 to implement the new system. The Library is harnessing the opportunity to embed search and discovery and information access throughout the LMS, including presence at the highest level of navigation. A Library widget providing students with clear pathways and immediate access to key library collections, services and features is being developed by the Library in conjunction with the Faculties‟ academic champions and educational developers. Liaison Librarians are negotiating with academic staff to create context-specific pathways, to utilise Desire2Learn Web2.0 capabilities and to imbed more personalised resources and LibGuides aligned with units of study. This is happening at a time when libraries are introducing new approaches to information discovery.

This paper describes Deakin University Library‟s journey in partnering with academic staff and others across the University to implement Desire2Learn as a vital new e-learning platform. It reports on many outcomes including: value created by embedding quality information in learner-centred course delivery; increased awareness of library subscription resources when accessible within students‟ workspace; strong and continuing relationships built with academic staff; enhanced Library staff engagement with flexible learning principles and new technologies. The question of where embedding information access in online courses and units fits with the Library‟s exploration of web scale solutions is also touched upon. And finally, an insight into how recent research undertaken by Deakin University Library has influenced our approach to information discovery solutions suggests an opportunity for many more questions to be explored.

Reduced emergency calls and improved weekend discharge after introduction of a new electronic handover system

Objectives: To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends.

Design, setting and participants: Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of the Blue BARRWUE handover system at Geelong Hospital.

Intervention: Implementation of the Blue BARRWUE handover system and its components (updated working diagnosis, background, alerts, resuscitation status, requests, who to do what and when, updates and executable discharge plan).
Main outcome measures: Presence of any written handover notes or updated working diagnoses in the BOSSnet clinical information system, content of handover notes, frequency of weekend discharges and medical emergency team (MET) calls before and after implementation.

Results: In the 12 months before implementation of the Blue BARRWUE handover system, 976 patients (47.98%) had a handover note in BOSSnet, versus 1646 patients (95.09%) in the 12 months after implementation (P< 0.001; rate ratio [RR], 20.75; 95% CI, 16.33–26.44). Before implementation, 289 patients (14.21%) were discharged over weekends, versus 353 patients (20.39%) after implementation, (P < 0.001; RR, 1.44; 95% CI, 1.25–1.65). MET calls were made for 152 general medical patients before implementation (7.47%), versus 95 general medical patients (5.49%) after implementation (P= 0.01; RR, 0.73; 95% CI, 0.57–0.94).

Conclusions: The Blue BARRWUE system has sustainably improved written handover in our organisation and was associated with improvement in both patient safety and hospital efficiency.

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

The design and implementation of a novel method for quantifying training loads in elite rowing: the T2minute method

Introduction: A systematic approach to managing the training of elite athletes is supported by accurate training load measurement. However, quantifying the training of elite Australian rowers is complex due to unique challenges: 1) the multi-centre, multi-state structure of the national program; 2) the variety of training undertaken, incorporating rowing-specific and non-specific modalities, with continuous and interval efforts that span the full intensity spectrum; and 3) the limitations of existing quantification methods for capturing total training loads undertaken from varied training. These challenges highlighted a need to create a consistent, location-independent framework for prescribing training in elite rowing, with a capacity to account for varied training. Methods: An in-house proprietary measure (the T2minute method) was developed at the National Rowing Centre of Excellence (NRCE), as a collaborative project between sport scientists and national squad coaches. The design phase was informed by assessments of the existing training measures, and built upon standardised intensity zones established at the Australian Institute of Sport. A common measurement unit was chosen: one T2minute equates to one minute of on-water single scull rowing at T2 intensity (∼60–72% VO2max). Each intensity zone was assigned a weighting factor according to the curvilinear relationship between power output, intensity, and blood lactate response. Each training mode was assigned a weighting factor based on whether coaches perceived it to be “harder” or “easier” than onwater rowing. With coaches’ feedback, the method was refined over a period of five months. The T2minute method was implemented as the core framework for prescribing training for elite Australian rowers throughout the 2009–2012 Olympic cycle. Results: The implementation of the T2minute method successfully established consistency with training prescription and monitoring practices within the NRCE high performance program. The national roll out this method has influenced rowing training methodology at elite and sub-elite levels in Australia. Since implementation, the method has undergone scientific validation. Further research is underway, utilising the method to explore complex relationships between rowers’ training and performance outcomes. Conclusion: The T2minute method is a novel approach that allows rowing coaches and sport scientists to utilise one consistent system to quantify load from varied training. Its implementation represents a considerable achievement in establishing a common framework for managing the training process within a complex organisational structure. This collaborative approach used to develop the T2minute method provides unique insight into the important considerations and practical challenges of applying training science to enhance elite sport performance.

Managing the implementation of business intelligence systems : a critical success factors framework

The implementation of a BI system is a complex undertaking requiring considerable resources. Yet there is a limited authoritative set of CSFs for management reference. This article represents a first step of filling in the research gap. The authors utilized the Delphi method to conduct three rounds of studies with 15 BI system experts in the domain of engineering asset management organizations. The study develops a CSFs framework that consists of seven factors and associated contextual elements crucial for BI systems implementation. The CSFs are committed management support and sponsorship, business user-oriented change management, clear business vision and well-established case, business-driven methodology and project management, business-centric championship and balanced project team composition, strategic and extensible technical framework, and sustainable data quality and governance framework. This CSFs framework allows BI stakeholders to holistically understand the critical factors that influence implementation success of BI systems.

Development and implementation of a novel measure for quantifying training loads in rowing : the T2minute method

Development and implementation of a novel measure for quantifying training loads in rowing: The T2minute method. J Strength Cond Res 28(4): 1172–1180, 2014—The systematic management of training requires accurate training load measurement. However, quantifying the training of elite Australian rowers is challenging because of (a) the multicenter, multistate structure of the national program; (b) the variety of training undertaken; and (c) the limitations of existing methods for quantifying the loads accumulated from varied training formats. Therefore, the purpose of this project was to develop a new measure for quantifying training loads in rowing (the T2minute method). Sport scientists and senior coaches at the National Rowing Center of Excellence collaborated to develop the measure, which incorporates training duration, intensity, and mode to quantify a single index of training load. To account for training at different intensities, the method uses standardized intensity zones (T zones) established at the Australian Institute of Sport. Each zone was assigned a weighting factor according to the curvilinear relationship between power output and blood lactate response. Each training mode was assigned a weighting factor based on whether coaches perceived it to be “harder” or “easier” than on-water rowing. A common measurement unit, the T2minute, was defined to normalize sessions in different modes to a single index of load; one T2minute is equivalent to 1 minute of on-water single scull rowing at T2 intensity (approximately 60–72% V[Combining Dot Above]O2max). The T2minute method was successfully implemented to support national training strategies in Australian high performance rowing. By incorporating duration, intensity, and mode, the T2minute method extends the concepts that underpin current load measures, providing 1 consistent system to quantify loads from varied training formats.

Elements underpinning successful implementation of a national best-practice child investigative interviewing framework

The complexity and effort required to achieve the widespread implementation of best-practice child interview guidelines justifies the establishment of structures to enhance cross-jurisdictional sharing of expertise, resources and training delivery support. Australia has made great strides toward such a system via work currently being undertaken by police jurisdictions to facilitate greater consistency in education and training for practitioners in the area of investigative interviewing, strengthening collaboration between police and tertiary education institutions, and growing commitment to evidence-based policy and practice among police executives. To maximise progress, however, organisations need to consider the development of a coordinated continual quality improvement approach. This will be impeded by three structural elements: access to field interviews for practitioner feedback and organisational evaluation, interviewer tenure and case tracking. This article discusses each element, their roles within a national best-practice interview framework, and attempts by some jurisdictions to address them. It also provides recommendations to guide further reform.

Cleanup worker exposures to hazardous chemicals at a former nuclear weapons plant : piloting of an exposure surveillance system

Cleanup of former U.S. Department of Energy (DOE) nuclear weapons production facilities involves potential exposures to various hazardous chemicals. We have collaboratively developed and piloted an exposure database and surveillance system for cleanup worker hazardous chemical exposure data with a cleanup contractor at the Rocky Flats Environmental Technology Site (RFETS). A unique system feature is the incorporation of a 34-category work task-coding scheme. This report presents an overview of the data captured by this system during development and piloting from March 1995 through August 1998. All air samples collected were entered into the system. Of the 859 breathing zone samples collected, 103 unique employees and 39 unique compounds were represented. Breathing zone exposure levels were usually low (86% of breathing zone samples were below analytical limits of detection). The use of respirators and other exposure controls was high (87 and 88%, respectively). Occasional high-level excursions did occur. Detailed quantitative summaries are provided for the six most monitored compounds: asbestos, beryllium, carbon tetrachloride, chromium, lead, and methylene chloride. Task and job title data were successfully collected for most samples, and showed specific cleanup activities by pipe fitters to be the most commonly represented in the database. Importantly, these results demonstrate the feasibility of the implementation of integrated exposure database and surveillance systems by practicing industrial hygienists employed in industry as well as the preventive potential and research uses of such systems. This exposure database and surveillance system--the central features of which are applicable in any industrial work setting--has enabled one of the first systematic quantitative characterizations of DOE cleanup worker exposures to hazardous chemicals.