Tailoring treatment to the individual in type 2 diabetes practical guidance from the Global Partnership for Effective Diabetes Management

Good glycaemic control continues to be the most effective therapeutic manoeuvre to reduce the risk of development and/or progression of microvascular disease, and therefore remains the cornerstone of diabetes management despite recent scepticism about tight glucose control strategies. The impact on macrovascular complications is still a matter of debate, and so glycaemic control strategies should be placed in the context of multifactorial intervention to address all cardiovascular risk factors. Approaches to achieve glycaemic targets should always ensure patient safety, and results from recent landmark outcome studies support the need for appropriate individualisation of glycaemic targets and of the means to achieve these targets, with the ultimate aim to optimise outcomes and minimise adverse events, such as hypoglycaemia and marked weight gain. The primary goal of the Global Partnership for Effective Diabetes Management is the provision of practical guidance to improve patient outcomes and, in this article, we aim to support healthcare professionals in appropriately tailoring type 2 diabetes treatment to the individual. Patient groups requiring special consideration are identified, including newly diagnosed individuals with type 2 diabetes but no complications, individuals with a history of inadequate glycaemic control, those with a history of cardiovascular disease, children and individuals at risk of hypoglycaemia. Practical guidance specific to each group is provided.

Using DEA and simulation in guiding operating units to improved performance

The potential for the use of DEA and simulation in a mutually supporting role in guiding operating units to improved performance is presented. An analysis following a three-stage process is suggested. Stage one involves obtaining the data for the DEA analysis. This can be sourced from historical data, simulated data or a combination of the two. Stage two involves the DEA analysis that identifies benchmark operating units. In the third stage simulation can now be used in order to offer practical guidance to operating units towards improved performance. This can be achieved by the use of sensitivity analysis of the benchmark unit using a simulation model to offer direct support as to the feasibility and efficiency of any variations in operating practices to be tested. Alternatively, the simulation can be used as a mechanism to transmit the practices of the benchmark unit to weaker performing units by building a simulation model of the weaker unit to the process design of the benchmark unit. The model can then compare performance of the current and benchmark process designs. Quantifying improvement in this way provides a useful driver to any process change initiative that is required to bring the performance of weaker units up to the best in class. © 2005 Operational Research Society Ltd. All rights reserved.

An investigation into enterprise structure and ERP implementations:a contribution to praxis

This professional doctoral research reports on the relationship between Enterprise Systems, specifically Enterprise Resource Planning Systems, and enterprise structures. It offers insights and guidance to practitioners on factors for consideration in the implementation of ERP systems in organisations operating in modern enterprise structures. It reports on reflective ethnographic action research conducted in a number of companies from a diverse range of industries covering supply chains for both goods and services. The primary contribution is in highlighting areas in which clients, practitioners and ERP software vendors can bring a greater awareness of internet era enterprise structures and business requirements into the ERP arena. The concepts and insights have been explored in a focus group setting, comprised of practitioners from the enterprise systems implementation and consulting fraternity and revealed limitations and constraints in the implementation of enterprise systems. However, it also showed that current systems do not have the full capabilities required to support, in use, modern era enterprise structures, as required by practitioners and decision makers.

Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

Representing human expertise by the OWL web ontology language to support knowledge engineering in decision support systems

Clinical decision support systems (CDSSs) often base their knowledge and advice on human expertise. Knowledge representation needs to be in a format that can be easily understood by human users as well as supporting ongoing knowledge engineering, including evolution and consistency of knowledge. This paper reports on the development of an ontology specification for managing knowledge engineering in a CDSS for assessing and managing risks associated with mental-health problems. The Galatean Risk and Safety Tool, GRiST, represents mental-health expertise in the form of a psychological model of classification. The hierarchical structure was directly represented in the machine using an XML document. Functionality of the model and knowledge management were controlled using attributes in the XML nodes, with an accompanying paper manual for specifying how end-user tools should behave when interfacing with the XML. This paper explains the advantages of using the web-ontology language, OWL, as the specification, details some of the issues and problems encountered in translating the psychological model to OWL, and shows how OWL benefits knowledge engineering. The conclusions are that OWL can have an important role in managing complex knowledge domains for systems based on human expertise without impeding the end-users' understanding of the knowledge base. The generic classification model underpinning GRiST makes it applicable to many decision domains and the accompanying OWL specification facilitates its implementation.

Advancing the psychology of entrepreneurship:a review of the psychological literature and an introduction

This article provides a narrative review of psychology of entrepreneurship research published in leading psychology journals, based on which we develop an organising framework for future psychological contributions to this field. Furthermore, we introduce the manuscripts collected in this special issue. Our review identified five research areas, broadly corresponding with basic psychological domains, namely personal differences; careers; health and well-being; cognition and behaviour; and leadership; as well as three cross-cutting themes: gender issues; genetic and biological foundations; and context. With the aim to stimulate integration across different approaches and disciplines, we propose a framework to understand how psychologists can offer innovative contributions to the multi-disciplinary entrepreneurship literature. This includes a focus on the entrepreneur embedded in and in interaction with his or her immediate and wider context; attention to different types of entrepreneurs; and a focus on dynamic within-person processes evolving over time.

"Well did you feel jealous?" Control and ideology in police interviews with rape complainants

The methods used by the UK Police to investigate complaints of rape have unsurprisingly come under much scrutiny in recent times, with a 2007 joint report on behalf of HM Crown Prosecution Service Inspectorate and HM Inspectorate of Constabulary concluding that there were many areas where improvements should be made. The research reported here forms part of a larger project which draws on various discourse analytical tools to identify the processes at work during police interviews with women reporting rape. Drawing on a corpus of video recorded police interviews with women reporting rape, this study applies a two pronged analysis to reveal the presence of these ideologies. Firstly, an analysis of the discourse markers ‘well’ and ‘so’ demonstrates the control exerted on the interaction by interviewing officers, as they attach importance to certain facts while omitting much of the information provided by the victim. Secondly, the interpretative repertoires relied upon by officers to ‘make sense’ of victim’s accounts are subject to scrutiny. As well as providing micro-level analyses which demonstrate processes of interactional control at the local level, the findings of these analyses can be shown to relate to a wider context – specifically prevailing ideologies about sexual violence in society as a whole.

Cross country comparison of careers in logistics management in Australia and Britain

Purpose – The aim of this research was to ascertain the current roles and responsibilities of logistics managers in two countries, how they compare their situation with other managers and to identify the types of knowledge and experience that would assist them to develop their careers. Design/methodology/approach – This paper compares the results of a postal survey of 303 Australian and 161 British logistics managers. Findings – The study indicates that logistics managers in both countries share many similar experiences, responsibilities and perceptions of their career situations. They take considerable pride and satisfaction from these careers but recognise the need for continuing professional development in their present and future roles. Research limitations/implications – The research is limited to the respondents to the surveys. Further research in other countries including less well-developed economies would add to the generalisation of results. Practical implications – It is argued that for successful international supply chain management, there is a need to review both current and future provision in higher education and continuing professional development, in order to strengthen strategic competences and increase understanding of the significance of interdisciplinary awareness in global markets. Originality/value – This paper represents the first attempt to understand the roles, responsibilities, career pathways and future needs of logistics managers in the two countries. Its results should provide guidance to top managers for the future success of the logistics function in their organisations.

The social cognitive neuroscience of organisations

Social cognitive neuroscience is an emerging branch of cognitive neuroscience that bridges together social psychology and neuroscience. At its core is an understanding of the relationship between the brain and social interaction. The social cognitive neuroscientist places empirical endeavor within a three–stage framework, and questions falling under the SCN rubric undergo interrogation at each of these three levels. Firstly, we seek to understand a neuroscience of social interactions at the social level. Here we need to understand the motivational and other social factors that drive our behavior and experience in the real world. It goes without saying that any study of the cognitive neuroscience of socially interactive behavior must first be informed by social psychological theory to maintain ecological validity. Second, the social cognitive neuroscientist must be an adroit cognitive psychologist and be able to examine interactive behavior from the cognitive level. It is here that information–processing models and theories are applied to the understanding of our social behavior. Finally, studies at the neural level seek to inform us about the cortical structures, as well as the way they interact with other, in the mediation of the previous cognitive level. This volume brings together contributions from leading thinkers in both the social cognitive neurosciences and business to provide a comprehensive introduction and overview of a social cognitive neuroscience of the business brain. NOTE: Annals volumes are available for sale as individual books or as a journal. For information on institutional journal subscriptions, please visit www.blackwellpublishing.com/nyas. ACADEMY MEMBERS: Please contact the New York Academy of Sciences directly to place your order (www.nyas.org). Members of the New York Academy of Science receive full–text access to the Annals online and discounts on print volumes. Please visit http://www.nyas.org/MemberCenter/Join.aspx for more information about becoming a member

Decision support system for inspection and maintenance:a case of oil pipelines

The existing method of pipeline health monitoring, which requires an entire pipeline to be inspected periodically, is unproductive. A risk-based decision support system (DSS) that reduces the amount of time spent on inspection has been presented. The risk-based DSS uses the analytic hierarchy process (AHP), a multiple attribute decision-making technique, to identify the factors that influence failure on specific segments and analyzes their effects by determining probability of occurrence of these risk factors. The severity of failure is determined through consequence analysis. From this, the effect of a failure caused by each risk factor can be established in terms of cost and the cumulative effect of failure is determined through probability analysis. The model optimizes the cost of pipeline operations by reducing subjectivity in selecting a specific inspection method, identifying and prioritizing the right pipeline segment for inspection and maintenance, deriving budget allocation, providing guidance to deploy the right mix labor for inspection and maintenance, planning emergency preparation, and deriving logical insurance plan. The proposed methodology also helps derive inspection and maintenance policy for the entire pipeline system, suggest design, operational philosophy, and construction methodology for new pipelines.

The primacy of theory

Purpose – The purpose of this editorial is to provide indicative guidance to prospective EJM contributors of the importance of theoretical development to the success of submissions. Design/methodology/approach – The authors use a combination of conceptual thinking and theoretical literature to present key concepts of theory and its relevance to a manuscript's contribution to knowledge. Findings – The authors propose some guidelines for researchers who wish to publish the results of their work in EJM, and these also have relevance to other top academic journals. Research limitations/implications – The topic of theoretical conceptualisation and development is a complex one. Because of space constraints, the coverage of many issues is necessarily brief in this article. Practical implications – Scholars should find the thoughts contained in this article to be of significant benefit to their publication efforts in EJM and other top journals. Originality/value – While other top marketing journals have in the past provided similar guideline-style pieces, this is one of the few to be written from an inclusive perspective, with the explicit focus on the theoretical development stage.

Role of organizational identification, on Implicit Leadership Theories ILTs, transformational leadership and work attitudes

This investigation explores the effects of organizational identification on employees’ Implicit Leadership Theories (ILTs) and the perception of leader behaviors. The study involved a cross-sectional survey of 439 employees from seven companies based in South Wales. Respondents completed two questionnaires that measured their organizational identification, ILTs, recognition of ILTs in their manager, manager’s leadership behaviors (transactional and transformational), and psychological reactions (job satisfaction, well-being, and turnover intentions). The level of organizational identification did not affect the prototype of an ideal work-based leader. However, high organizational identification was associated with more positive ratings on the actual manager, the extent to which their manager displayed transactional and transformational behaviors, and with more positive psychological reactions to work. Employees high in organizational identification based their judgments of their leader’s transactional and transformational behaviors on the extent to which they recognized their leader as possessing leadership traits. However, those low on organizational identification allowed their prototype of their ideal leader to bias their judgment of their actual leader’s behavior. Finally, there was partial support for the augmenting hypothesis (that tranformational leadership would predict additional variance in psychological outcomes above that predicted by transactional leadership) for those high in organizational identification but not for those low in organizational identification.

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.

What are the practical implications for treating diabetes in light of recent evidence? Updated recommendations from the Global Partnership for Effective Diabetes Management

The Global Partnership for Effective Diabetes Management was established in 2004 to provide practical guidance to improving glycaemic control for people with type 2 diabetes. Those recommendations have been updated to take account of recent trials assessing the effects of intensive glucose control. We continue to emphasis the importance of early and sustained glycaemic control, aiming for HbA( 1c) 6.5-7% wherever safe and appropriate. Individualisation of targets and the management process is strongly encouraged to accommodate patient circumstances and to avoid hypoglycaemia. Prompt introduction of combinations of agents is suggested when monotherapy is inadequate.Treatments will preferably address the underlying pathophysiology of type 2 diabetes and integrate within a wider programme of care which also aims to reduce modifiable cardiovascular risk factors and better equip patients in the self-management of their condition.

Medicines management across the primary-hospital healthcare interface: a study of paediatric patients

A comparison of medicines management documents in use by NHS organisations in the West Midlands confirms that there are important differences between the primary care and hospital sectors in respect to medicines management interface issues. Of these, two aspects important to paediatric patients have been studied. These are the transfer of information as a patient is admitted to hospital, and access to long-term medicines for home-patients. National guidance provided by NICE requires medication reconciliation to be undertaken on admission to hospital for adults. A study of paediatric admissions, reported in this thesis, demonstrates that the clinical importance of this process is at least as important for children as for adults, and challenges current UK guidance. The transfer of essential medication information on hospital admission is central to the medication reconciliation process. Two surveys of PCTs in 2007 and again in 2009 demonstrate that very few PCTs provide guidance to GPs to support this process. Provision of guidance is increasing slowly but remains the exception. The provision of long-term medicines for children at home is hindered by this patient population often needing unlicensed drugs. Further studies demonstrate that primary care processes regularly fail to maintain access to essential drugs and patients and their carers frequently turn to hospitals for help. Surveys of hospital medical staff (single site) and hospital nurses (six UK sites) demonstrates the activity these healthcare workers perform to help children get the medicines they need. A similar survey of why carers turn to a hospital pharmacy department for urgent supplies (usually termed rescue-medicines) adds to the understanding of these problems and supports identifying service changes. A large survey of community pharmacies demonstrates the difficulties they have when dispensing hospital prescriptions and identifies practical solutions. This programme concludes by recommending service changes to support medication management for children.