The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role. © 2004 Elsevier Ltd. All rights reserved.

Shareholder or stakeholder management:strategies for performance optimisation

This paper is based upon the findings of a CIMA research project into the way which corporate performance is affected by the performance measurement system adopted. It compares and contrasts the techniques in use in a sample of large companies that use a variety of techniques. We have classified these techniques into 3 types: • Value based management techniques • Stakeholder management techniques • Traditional accounting techniques. The analysis traces the interactions between corporate objectives, decision making criteria, performance measurement systems, and executive incentive schemes in order to develop an understanding of the effects of such techniques upon corporate performance. This paper seeks to provide some answers to the following two questions: • What approach leads to superior performance for a firm? • What is different between these approaches when they are used in practice, as distinct from theory? In doing so we have drawn upon both contingency theory and sociobiology theory to develop a framework for understanding the relationship between the choke of performance measurement system and the resulting performance.

Shareholder value application in UK listed companies

This paper is based upon the initial findings of a CIMA research project into the way in which corporate performance measurement systems are influenced by the use of shareholder value management techniques. It compares and contrasts the techniques in use in a sample of 10 companies that either explicitly use shareholder value techniques also known as Value-Based Management (VBM), or explicitly do not use such techniques. The analysis undertaken is based upon the finding of semi-structured interviews with company representatives which formed the first part of the data collection process of the project. The analysis traces the interactions between corporate objectives, decision making criteria, performance measurement systems and executive incentive schemes in order to develop an understanding of the effects of such shareholder value techniques upon corporate behaviour. The literature reviewed suggests that the other aspects of the planning and control system should be aligned with the corporate objectives whether a company has adopted VBM or not. Therefore this research contributes new evidence on the use of VBM techniques in the UK and also more generally on whether VBM and non-VBM companies internal planning and control systems are aligned.

Automatic indexing and retrieval of encounter-specific evidence for point-of-care support

Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories. © 2010 Elsevier Inc.

A bridge too far? Breaching the research/learning and teaching nexus in a previously research-led university

The relationship between research and learning and teaching represents what has been described as ‘amongst the most intellectually tangled, managerially complex and politically contentious issues in mass higher education’ (Scott, 2005, p 53). Despite this, arguments that in order to achieve high quality scholarly outcomes, university teachers need to adopt an approach to teaching similar to that of research (i.e. founded upon academic rigour and evidence), has long been discussed in the literature (see for example, Elton, 2005 & Healey, 2000). However, the practicalities of promoting an empirical and evidence-based approach to teaching within a research-led institution makes dealing with the research/learning and teaching nexus a somewhat challenging proposition. Drawing upon the findings of a mixed methodological study, this paper critically analyses the pedagogical, organisational and practical issues encountered by academics and support staff working within a newly established Centre for Learning Innovation and Professional Practice. Comprising an eclectic group of staff drawn from across the five Schools in the University, the Centre is dedicated to enhancing student learning through the development of evidence based teaching practice. Based upon the premise that the promotion of research-led teaching will act to bring teaching and research together, and in doing so enhance students learning experiences (Simmons & Elen 2007), the paper critically analyses the challenges encountered by staff responsible for developing and introducing a new learning & teaching focused organisational strategy (by reflecting on the previous 12 months work). In doing so it makes a significant contribution to current academic theory and debate in the areas of pedagogic practice and organisational management. Focusing specifically on the impact of the new policy on various aspects of university life including, pedagogic practice, student support, staff training, and organisational management, the paper critically addresses the cultural and attitudinal challenges of change management (Kotter, 1996) within a ‘grey-brick’ university. It concludes by arguing that the move towards becoming a more learning-focused university has started to develop an awareness of the positive impact the change initiative is having on the student experience and wider institution; whilst also drawing attention to the organisational challenges ahead.

Organizational change and development in India:a case of strategic organizational change and transformation

Purpose – The purpose of this paper is to examine developments in the field of organizational change (OC) with reference to the context of India. It highlights the need to analyze this topic in the present Indian economic environment and discusses the main developments reported in the Indian literature on the same. Design/methodology/approach – Empirical evidence based on a qualitative analysis of a case study undertaken at a public-private partnership transformation at North Delhi Power Limited (NDPL) in India is presented. Findings – The findings focus on trust building and belongingness for the employees, establishing a high-performance orientation, quality improvements, and the resultant transformations at NDPL. The analysis indicates a number of ways by which NDPL sought to improve its efficiency in order to better adapt to the rapidly changing Indian business environment. Practical implications – Based on the findings, the paper identifies key messages for policy makers and change agents regarding how to transform companies in the rapidly changing business contexts of emerging markets such as India. Originality/value – The paper offers an in-depth analysis of OC practices in a large organization in India.

Electronics:a case study of economic value added in target costing

Whilst target costing and strategic management accounting (SMA) continue to be of considerable interest to academic accountants, both suffer from a relative dearth of empirically based research. Simultaneously, the subject of economic value added (EVA) has also been the subject of little research at the level of the individual firm.The aim of this paper is to contribute to both the management accounting and value based management literatures by analysing how one major European based MNC introduced EVA into its target costing system. The case raises important questions about both the feasibility of cascading EVA down to product level and the compatibility of customer facing versus shareholder focused systems of performance management. We provide preliminary evidence that target costing can be used to align both of these perspectives, and when combined with other SMA techniques it can serve as " the bridge connecting strategy formulation with strategy execution and profit generation" ( Ansari et al., 2007, p. 512). © 2012 Elsevier Ltd.

Broadening the evidence base and the mind when thinking about mixed methods research

On behalf of my coauthors, Dr Michael Larkin and Professor Paul Flowers, and I would like to thank Dr Pierre Pluye for his letter in response to our article.1 Dr Pluye supported our argument that a broader evidence base is needed in evidence-based healthcare. He provided the readers of this journal with important additional information which updates them on the progress in the area of mixed studies reviews and further detail about the Mixed Methods Appraisal Tool (MMAT).2 Since writing our …

The role of shared decision-making in audiologic rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

Discovering biomarkers for antidepressant response:protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort

Background: Major Depressive Disorder (MDD) is among the most prevalent and disabling medical conditions worldwide. Identification of clinical and biological markers ("biomarkers") of treatment response could personalize clinical decisions and lead to better outcomes. This paper describes the aims, design, and methods of a discovery study of biomarkers in antidepressant treatment response, conducted by the Canadian Biomarker Integration Network in Depression (CAN-BIND). The CAN-BIND research program investigates and identifies biomarkers that help to predict outcomes in patients with MDD treated with antidepressant medication. The primary objective of this initial study (known as CAN-BIND-1) is to identify individual and integrated neuroimaging, electrophysiological, molecular, and clinical predictors of response to sequential antidepressant monotherapy and adjunctive therapy in MDD. Methods: CAN-BIND-1 is a multisite initiative involving 6 academic health centres working collaboratively with other universities and research centres. In the 16-week protocol, patients with MDD are treated with a first-line antidepressant (escitalopram 10-20 mg/d) that, if clinically warranted after eight weeks, is augmented with an evidence-based, add-on medication (aripiprazole 2-10 mg/d). Comprehensive datasets are obtained using clinical rating scales; behavioural, dimensional, and functioning/quality of life measures; neurocognitive testing; genomic, genetic, and proteomic profiling from blood samples; combined structural and functional magnetic resonance imaging; and electroencephalography. De-identified data from all sites are aggregated within a secure neuroinformatics platform for data integration, management, storage, and analyses. Statistical analyses will include multivariate and machine-learning techniques to identify predictors, moderators, and mediators of treatment response. Discussion: From June 2013 to February 2015, a cohort of 134 participants (85 outpatients with MDD and 49 healthy participants) has been evaluated at baseline. The clinical characteristics of this cohort are similar to other studies of MDD. Recruitment at all sites is ongoing to a target sample of 290 participants. CAN-BIND will identify biomarkers of treatment response in MDD through extensive clinical, molecular, and imaging assessments, in order to improve treatment practice and clinical outcomes. It will also create an innovative, robust platform and database for future research. Trial registration: ClinicalTrials.gov identifier NCT01655706. Registered July 27, 2012.

Knowledge acquisition and research evidence in autism:researcher and practitioner perspectives and engagement

Background: Government policy and national practice guidelines have created an increasing need for autism services to adopt an evidence-based practice approach. However, a gap continues to exist between research evidence and its application. This study investigated the difference between autism researchers and practitioners in their methods of acquiring knowledge. Methods: In a questionnaire study, 261 practitioners and 422 researchers reported on the methods they use and perceive to be beneficial for increasing research access and knowledge. They also reported on their level of engagement with members of the other professional community. Results: Researchers and practitioners reported different methods used to access information. Each group, however, had similar overall priorities regarding access to research information. While researchers endorsed the use of academic journals significantly more often than practitioners, both groups included academic journals in their top three choices. The groups differed in the levels of engagement they reported; researchers indicated they were more engaged with practitioners than vice versa. Conclusions: Comparison of researcher and practitioner preferences led to several recommendations to improve knowledge sharing and translation, including enhancing access to original research publications, facilitating informal networking opportunities and the development of proposals for the inclusion of practitioners throughout the research process.