Automated attention flags in chronic disease care planning

Objectives: To assess the value of computerised decision support in the management of chronic respiratory disease by comparing agreement between three respiratory specialists, general practitioners (care coordinators), and decision support software.
Methods: Care guidelines for two chronic obstructive pulmonary disease projects of the SA HealthPlus Coordinated Care Trial were formulated. Decision support software, Care Plan On-Line (CPOL), was created to represent the intent of these guidelines via automated attention flags to appear in patients' electronic medical records. For a random sample of 20 patients with care plans, decisions about the use of nine additional services (eg,.smoking cessation, pneumococcal vaccination) were compared between the respiratory specialists, the patients' GPs and the CPOL attention flags.
Results: Agreement among the specialists was at the lower end of moderate (intraclass correlation coefficient [ICC], 0.48; 95% CI, 0.39-0.56), with a 20% rate of contradictory decisions. Agreement with recommendations of specialists was moderate to poor for GPs (le, 0.49; 95% CI, 0.33-0.66) and moderate to good for CPOL (K, 0.72; 95% CI, 0.55-0.90). CPOL agreement with GPs was moderate to poor (le, 0.41; 95% CI, 0.24-0.58). GPs were less likely than specialists or CPOL to decide in favour of an additional service (P< 0.001). CPOL was 87% accurate as an indicator of specialist decisions. It gave a 16% false-positive rate according to specialist decisions, and flagged 61% of decisions where GPs said No and specialists said Yes.
Conclusions: Automated decision support may provide GPs with improved access to the intent of guidelines; however, further investigation is required.

Women primary principals : leadership between the flags

The purpose of this paper is to outline my research project and share some of the perspectives that have emerged during the process of analysis and reflexivity. This is a case study of twelve female primary school principals in the independent sector in Victoria. Independent schools are generally referred to as the private sector or non-government schools to distinguish them from the government sector. Also the reference to primary principals’ is generally used to refer to a ‘Junior School Head’ position within a K – 12 School. Many schools often combine the role of the Junior Head’s position and / or the Deputy Principal or Assistant Principal’s position.

This paper introduces the work narratives of successful professional women in senior leadership positions in independent schools. The analysis of the narrative process itself and how these women shape and are shaped by their cultural discourses about leadership provides the focus for this study. In particular how the context and discursive strategies they use to tell their stories are instrumental in their construction of professional identity and its relationship to subjectivity. Thus professional work narratives offer insights into subjectivity and identity as the women tell their leadership stories. Initially Clandinin and Connelly’s (1994) ‘narrative inquiry’ approach provided a useful conceptual basis from which to gather the written responses to a questionnaire collected during 2004, interviews (taperecorded and transcribed) and my reflexive journal maintained during and after the interview process.

Mathematics in microworlds: showing the flag!

This article presents an overview of how to use Logo programming to draw national flags. This activity moves away from overt geometry to implicit geometry.

Corporate social responsibility, new activism and public relations

Purpose – This paper aims to analyse why some contemporary corporate organisations are reluctant to articulate the effect of their market positioning behaviour on the unwilling communities that oppose their activities. It describes the communicative interactions between several large corporate organisations and the grassroots activist groups opposing their activities, in Victoria, Australia.

Design/methodology/approach – Extensive secondary data were collected, including extensive newspaper and radio transcripts from the campaign periods, web site downloads, letters and other campaign documents. The research design applied to the data, a qualitative, interpretative analysis, drawing on key theoretical frameworks.

Findings – The research findings suggest that powerful protest strategies, combined with the right political and social conditions, and a shift in the locus of politics and expertise, bring to light public concerns about the ethics of corporate practices, such as public relations, used egocentrically by organisations, to harmonise their activities in late modern Western society. It finds that no serious overhaul of business ethics can occur until the unity of public relations is critically scrutinised and reformed. It helps define an alternative holistic communicative approach which could be applied more widely to business practice that helps avoid the limitations and relativism of public relations.

Originality/value – The research flags new ways of thinking expressed in the notion of public communication that could lead to creative and unusual coherences vital to deal with the apparent ecological challenges for society in late modernity.

The status of flag desecration in Australian law

Law relating to the desecration of the Australian flag in a public place - the influence of the flag on Australia's culture and politics - whether flag desecration is a constitutionally protected political communication - the constitutionality of the Flags (Protection of Australian Flags) Amendment Bill 2008 - whether the treatment of flag desecration under Australian law is likely to change if and when a statutory bill of rights is enacted.

Flagging authenticity

How important are national flags in the emerging global society? This is a relevant question for a world still coming to terms with post-colonialism while also having to deal with the economic and cultural side of globalisation. This contribution to The Identity Journal looks at the value of authenticity and its importance in redefining Australia's national identity. The role of Indigenous culture and its relationship to a broad national identity is explored in the context of proposed changes to the Australian constitution. If passed this constitutional amendment will formally recognise Australia as the home of the worlds oldest living cultures. 

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation

AIMS AND OBJECTIVES: The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND: Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN: A pre-post design was used. METHODS: The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS: From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION: The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE: HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Melbourne Festival review: Vertical Influences' freewheeling dancers skate at breathtaking speeds

A theatre, gallery or concert hall – yes. But an ice rink? This is not a traditional venue for a Melbourne Festival performance. Under the team flags and beyond the trophy cases for competitive hockey and ice-skating, Vertical Influences features two works performed by five performers on skates.