Initial emergency nursing management of patients with severe traumatic brain injury : development of an evidence-based care bundle for the Thai emergency department context.

Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI.

Measurement of stable changes of self-management skills after rehabilitation: a latent state–trait analysis of the Health Education Impact Questionnaire (heiQ™)

Methods: Subjects were N = 580 patients with rheumatism, asthma, orthopedic conditions or inflammatory bowel disease, who filled out the heiQ™ at the beginning, the end of and 3 months after a disease-specific inpatient rehabilitation program in Germany. Structural equation modeling techniques were used to estimate latent trait-change models and test for measurement invariance in each heiQ™ scale. Coefficients of consistency, occasion specificity and reliability were computed.

Is alcohol and community sport a good mix? Alcohol management, consumption and social capital in community sports clubs

Objective: Community sports clubs provide an important contribution to the health and wellbeing of individuals and the community; however, they have also been associated with risky alcohol consumption. This study assessed whether a club's alcohol management strategies were related to risky alcohol consumption by members and levels of social capital, as measured in terms of participation in and perceived safety of the club. Method: A total of 723 sports club members from 33 community football clubs in New South Wales, Australia, completed a computer assisted telephone interview (CATI) and a management representative from each club also completed a CATI. The club representative reported on the club's implementation of 11 alcohol management practices, while club members reported their alcohol consumption and perceived levels of safety at the club and participation in the club. Results: A structural equation model identified having the bar open for more than four hours; having alcohol promotions; and serving intoxicated patrons were associated with increased risky alcohol consumption while at the club; which in turn was associated with lower levels of perceived club safety and member participation. Conclusion and implications: The positive contribution of community sports clubs to the community may be diminished by specific inadequate alcohol management practices. Changing alcohol management practices can reduce alcohol consumption, and possibly increase perceived aspects of social capital, such as safety and participation.

Building Nature’s Safety Net 2014 : A decade of protected area achievements in Australia

The single most important asset for the conservation of Australia’s unique and globally significant biodiversity is the National Reserve System, a mosaic of over 10,000 discrete protected areas on land on all tenures: government, Indigenous and private,including on-farm covenants, as well as state, territory and Commonwealth marine parks and reserves.THE NATIONAL RESERVE SYSTEMIn this report, we cover major National Reserve System initiatives that have occurred in the period 2002 to the present and highlight issues affecting progress toward agreed national objectives. We define a minimum standard for the National Reserve System to comprehensively, adequately and representatively protect Australia’s ecosystem and species diversity on sea and land. Using government protected area, species and other relevant spatial data, we quantify gaps: those areas needing to move from the current National Reserve System to one which meets this standard. We also provide new estimates of financial investments in protected areas and of the benefits that protected areas secure for society. Protected areas primarily serve to secure Australia’s native plants and animals against extinction, and to promote their recovery.BENEFITSProtected areas also secure ecosystem services that provide economic benefits forhuman communities including water, soil and beneficial species conservation, climatemoderation, social, cultural and health benefits. On land, we estimate these benefitsare worth over $38 billion a year, by applying data collated by the Ecosystem ServicesPartnership. A much larger figure is estimated to have been secured by marineprotected areas in the form of moderation of climate and impact of extreme eventsby reef and mangrove ecosystems. While these estimates have not been verified bystudies specific to Australia, they are indicative of a very large economic contributionof protected areas. Visitors to national parks and nature reserves spend over $23.6 billion a year in Australia, generating tax revenue for state and territory governments of $2.36 billion a year. All these economic benefits taken together greatly exceed the aggregate annual protected area expansion and management spending by all Australian governments, estimated to be ~$1.28 billion a year. It is clear that Australian society is benefiting far greater than its governments’ investment into strategic growth and maintenance of the National Reserve System.Government investment and policy settings play a leading role in strategic growth of the National Reserve System in Australia, and provide a critical stimulus fornon-government investment. Unprecedented expansion of the National Reserve System followed an historic boost in Australian Government funding under Caring for Our Country 2008–2013. This expansion was highly economical for the Australian Government, costing an average of only $44.40 per hectare to buy and protect land forever. State governments have contributed about six times this amount toward the expansion of the National Reserve System, after including in-perpetuity protected area management costs. The growth of Indigenous Protected Areas by the Australian Government has cost ~$26 per hectare on average, including management costs capitalised in-perpetuity, while also delivering Indigenous social and economic outcomes. The aggregate annual investment by all Australian governments has been ~$72.6 million per year on protected area growth and ~$1.21 billion per year on recurrent management costs. For the first time in almost two decades, however, the Australian Government’s National Reserve System Program, comprising a specialist administrative unit and funding allocation, was terminated in late 2012. This program was fundamental in driving significant strategic growth in Australia’s protected area estate. It is highly unlikely that Australia can achieve its long-standing commitments to an ecologically representative National Reserve System, and prevent major biodiversity loss, without this dedicated funding pool. The Australian Government has budgeted ~$400 million per year over the next five years (2013-2018) under the National Landcare and related programs. This funding program should give high priority to delivery of national protected area commitments by providing a distinct National Reserve System funding allocation. Under the Convention on Biological Diversity (CBD), Australia has committed to bringing at least 17 percent of terrestrial and at least 10 per cent of marine areas into ecologically representative, well-connected systems of protected areas by 2020 (Aichi Target 11).BIODIVERSITY CONSERVATIONAustralia also has an agreed intergovernmental Strategy for developing a comprehensive, adequate and representative National Reserve System on land andsea that, if implemented, would deliver on this CBD target. Due to dramatic recent growth, the National Reserve System covers 16.5 per cent of Australia’s land area, with highly protected areas, such as national parks, covering 8.3 per cent. The marine National Reserve System extends over one-third of Australian waters with highly protected areas such as marine national parks, no-take or green zones covering 13.5 per cent. Growth has been uneven however, and the National Reserve System is still far from meeting Aichi Target 11, which requires that it also be ecologically representative and well-connected. On land, 1,655 of 5,815 ecosystems and habitats for 138 of 1,613 threatened species remain unprotected. Nonetheless, 436 terrestrial ecosystems and 176 threatened terrestrial species attained minimum standards of protection due to growth of the National Reserve System on land between 2002 and 2012. The gap for ecosystem protection on land – the area needed to bring all ecosystems to the minimum standard of protection – closed by a very substantial 20 million hectares (from 77 down to 57 million hectares) between 2002 and 2012, not including threatened species protection gaps. Threatened species attaining a minimum standard for habitat protection increased from 27 per cent to 38 per cent over the decade 2002–2012. A low proportion of critically endangered species meeting the standard (29 per cent) and the high proportion with no protection at all (20 per cent) are cause for concern, but one which should be relatively easy to amend, as the distributions of these species tend to be small and localised. Protected area connectivity has increased modestly for terrestrial protected areas in terms of the median distance between neighbouring protected areas, but this progress has been undermined by increasing land use intensity in landscapes between protected areas.A comprehensive, adequate and representative marine reserve system, which meetsa standard of 15 per cent of each of 2,420 marine ecosystems and 30 per cent of thehabitats of each of 177 marine species of national environmental significance, wouldrequire expansion of marine national parks, no-take or green zones up to nearly 30per cent of state and Australian waters, not substantially different in overall extentfrom that of the current marine reserve system, but different in configuration.Protection of climate change refugia, connectivity and special places for biodiversityis still low and requires high priority attention. FINANCING TO FILL GAPS AND MEET COMMITMENTSIf the ‘comprehensiveness’ and ‘representativeness’ targets in the agreed terrestrial National Reserve System Strategy were met by 2020, Australia would be likely to have met the ‘ecologically representative’ requirement of Aichi Target 11. This would requireexpanding the terrestrial reserve system by at least 25 million hectares. Considering that the terrestrial ecosystem protection gap has closed by 20 million hectares over the past decade, this required expansion would be feasible with a major boost in investment and focus on long-standing priorities. A realistic mix of purchases, Indigenous Protected Areas and private land covenants would require an Australian Government National Reserve System investment of ~$170 million per year over the five years to 2020, representing ~42 per cent of the $400 million per year which the Australian Government has budgeted for landcare and conservation over the next five years. State, territory and local governments, private and Indigenous partners wouldlikewise need to boost financial commitments to both expand and maintain newprotected areas to meet the agreed National Reserve System strategic objectives.The total cost of Australia achieving a comprehensive, adequate and representativemarine reserve system that would satisfy Aichi Target 11 is an estimated $247 million.

Towards a resilience management framework for complex enterprise systems upgrade implementation

The lack of knowledge of how resilience management supports enterprise system (ES) projects accounts for the failure of firms to leverage their investments in costly ES implementations. Using a structured-pragmatic- situational (SPS) case study research approach, this paper reports on an investigation into the resilience management of a large utility company as it implemented an ES upgrade. Drawing on the literature and on the case study findings, we developed a process-based resilience management framework that involves three strategies (developing situation awareness, demystifying threats, and executing restoration plans) and four organisational capabilities that transform resilience management concepts into practices. We identified the crucial phases of ES upgrade implementation and developed indicators for how different strategies and capabilities of resilience management can assist managers at different stages of an ES upgrade. This research advances the state of existing knowledge by providing specific and verifiable propositions for attaining a state of resilience, the knowledge being grounded in the empirical reality of a case study. Moreover, the framework offers ES practitioners a roadmap to better identify appropriate responses and levels of preparedness.

Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury

AIMS AND OBJECTIVES: To test the feasibility of an evidence-based care bundle in a Thai emergency department. The specific objective of this study was to examine the impact of the implementation of the care bundle on the initial emergency nursing management of patients with severe traumatic brain injury. BACKGROUND: A care bundle approach is one strategy used to improve the consistency, quality and safety of emergency care for different patients groups, however, has not been tested in patients with severe traumatic brain injury. DESIGN: A pretest/post-test design was used. The study intervention was an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury. METHODS: Nonparticipant observations were conducted between October 2012-June 2013 at an emergency department of a 640 bed regional hospital in Southern Thailand. The initial emergency nursing care was observed in 45 patients with severe traumatic brain injury: 20 patients in the pretest period and 25 patients in the post-test period. RESULTS: There were significant improvements in clinical care of patients with severe traumatic brain injury after implementation of the care bundle: (1) use of end-tidal carbon dioxide monitoring, (2) frequency of respiratory rate assessment, (3) frequency of pulse rate and blood pressure assessment, and (4) patient positioning. CONCLUSION: This study demonstrated that implementation of an evidence-based care bundle improved specific elements of emergency nurses' clinical management of patients with severe traumatic brain injury. RELEVANCE TO CLINICAL PRACTICE: The study suggests that a care bundle approach can be used as a strategy to improve emergency nursing care of patients with severe traumatic brain injury.

The effect of a staged, emergency department specific rapid response system on reporting of clinical deterioration

BACKGROUND: Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited. AIMS: To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care. METHODS: A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random sampling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages. RESULTS: The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7%; 68.8%; 55.3%; 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h; p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044). CONCLUSIONS: A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes.

Effects of multiple disturbance processes on arboreal vertebrates in Eastern Australia: implications for management

Habitat loss and invasive predators increasingly threaten global biodiversity. Here we use a landscape-scale experimental approach to explore the individual and synergistic effects of logging and an invasive predator, the red fox Vulpes vulpes on two common native arboreal vertebrates (a predator and prey species) in south-eastern Australia. We used site occupancy methods to evaluate different models evaluating the effects of site specific forest logging disturbance, lethal fox baiting and forest structural elements for explaining variation in site occupancy of a large monitor lizard Varanus varius, and a marsupial prey, the common ringtail possum Pseudocheirus peregrinus across a complex forest landscape. Site occupancy of ringtail possum was influenced by habitat resources and the structural complexity of forest, which indirectly mediated predation risk. Presence of fox baiting had no direct effect on the ringtail site occupancy. In contrast, access to prey resources and fox baiting appeared to best explain site occupancy variation in monitor lizards across the landscape. While these species are affected primarily by separate disturbances, synergistic interactions between the processes may intensify their effects. Our results demonstrate that species susceptibility to disturbance processes are highly idiosyncratic. This approach makes efficient use of integrated modelling to aid conservation management at both local and landscape levels.

SecDSVL: a domain-specific visual language to support enterprise security modelling

Enterprise security management requires capturing different security and IT systems' details, analyzing and enforcing these security details, and improving employed security to meet new risks. Adopting structured models greatly helps in simplifying and organizing security specification and enforcement processes. However, existing security models are generally limited to specific security details and do not deliver a comprehensive security model. They also often do not have user-friendly notations, being complicated extensions of existing modeling languages (such as UML). In this paper, we introduce a comprehensive Security Domain Specific Visual Language (SecDSVL), which enables capturing of key security details to support enterprise systems security management process. We discuss our SecDSVL, tool support and the model-based enterprise security management approach it supports, give a usage example, and present evaluation experiments of SecDSVL.

A model driven approach to care planning systems for consumer engagement in chronic disease management

This work demonstrates a model-driven approach to the development of care plan systems, amenable to: (a) a flexible and extensible definition of care plan scope; and (b) deployment of care plan viewing and tracking functionality to a wide range of physical computing devices. The approach utilises a care plan domain model from which guideline implementers formulate care plan templates aligning to specific clinical guidelines. A clinical end user would subsequently constrain that template (e.g., selecting a subset of available activities and specific targets) to create a care plan instance for an individual patient. An XML care plan visualisation definition created using the Marama tool is transformed to OpenLaszlo script from which Shockwave Flash objects can be compiled, creating Flash applications that run on a variety of hardware for both clinical and patient users. The approach is illustrated with respect to an overweight and obesity guideline.

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 −3.0 kg (95% CI = −3.5 to −2.4 kg) and at 24 months (n = 357) was −2.3 kg (95% CI = −3.2 to −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.