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.

How education should link with career paths

How good is your pharmacy practice? And what does “good” look like? Take a look back at the education and training you have received in your career to date. Has it stood you in good stead? Certainly there is a need to establish a model of professional education and development that produces good pharmacists — you should be able to demonstrate your competence regardless of your sector of work. It may help if we move away from the view that excellence in pharmacy practice is primarily defined by where you practise and the kind of job that you do. The Modernising Pharmacy Careers programme’s aspirations to integrate the undergraduate degree with the preregistration training year are bold and to be applauded — provided the outcome delivers changes that are more than superficial. The new model needs to deliver greater integration of education with practice, while retaining an adequate science base. Theory should be put into the context of practice-based, cross-sector learning needs and opportunities. For example, is the classroom really the best environment in which to learn dispensing? Pharmacokinetic theory could be put into context through creatively designed work placements. And it might make more sense to learn patient counselling in a community pharmacy, and so on. Is it resources we lack to make this happen? Or do we lack the collective will to be imaginative, to be radical and to conceive new approaches to professional education? Implicit in this new approach to education is the expectation that pharmacists should teach and mentor and, conversely, that those who teach should also engage in relevant practice. University education must produce graduates whose knowledge and competence are useful to employers. Moreover, graduates must be adequately prepared to enter any area of the profession endowed with professional self-confidence (something, arguably, that needs further development within the pharmacy psyche). Of course, becoming qualified is just the beginning. Post-qualification, pharmacists need structured career paths that foster this professional confidence, support learning and ensure recognition. To this end, the Royal Pharmaceutical Society-led professional curriculum group is working to define knowledge, skills and experience for all areas of advanced practice. More than ever, the profession needs to adopt a culture of learning, teaching and practice research that is unified. The question is: how do we move away from merely collecting qualifications (trophies) to developing meaningful careers? Pharmacists in all areas and at all levels of the profession need to consider their own willingness to make this shift. The RPS and MPC are leading the way, but are we following?

Advanced mean field methods:theory and practice

A major problem in modern probabilistic modeling is the huge computational complexity involved in typical calculations with multivariate probability distributions when the number of random variables is large. Because exact computations are infeasible in such cases and Monte Carlo sampling techniques may reach their limits, there is a need for methods that allow for efficient approximate computations. One of the simplest approximations is based on the mean field method, which has a long history in statistical physics. The method is widely used, particularly in the growing field of graphical models. Researchers from disciplines such as statistical physics, computer science, and mathematical statistics are studying ways to improve this and related methods and are exploring novel application areas. Leading approaches include the variational approach, which goes beyond factorizable distributions to achieve systematic improvements; the TAP (Thouless-Anderson-Palmer) approach, which incorporates correlations by including effective reaction terms in the mean field theory; and the more general methods of graphical models. Bringing together ideas and techniques from these diverse disciplines, this book covers the theoretical foundations of advanced mean field methods, explores the relation between the different approaches, examines the quality of the approximation obtained, and demonstrates their application to various areas of probabilistic modeling.

Industrial networks of the future:review of research and practice

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? Firstly, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example in assembly operations. Secondly, the increased tendency towards specialization has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies to supply niche markets. Thirdly, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than previously was the case. Fourthly, there is a continuous move towards more loosely connected entities that comprise manufacturing networks. More traditional concepts, such as the “keiretsu” and “chaibol” networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these four fundamental challenges to prepare for the industrial networks of 2020 and beyond.

Strategy-as-practice:a review and future directions for the field

This review maps and critically evaluates the rapidly growing body of research in the strategy-as-practice field. Following an introduction on the emergence and foundations of strategy-as-practice, the review is structured in three main parts, based on the terminology, issues and research agendas outlined in the field. First, the paper examines the concepts of practitioners and praxis. A typology of nine possible domains for strategy-as-practice research is developed, based on the way that different studies conceptualize the strategy practitioner and the level of strategy praxis that they aim to explain. Second, the paper reviews the concept of practices, which has been adopted widely but inconsistently within the strategy-as-practice literature. While there is no dominant view on practices, the review maps the various concepts of practices that inform the strategy-as-practice field and outlines avenues for future research. The final section attends to the call for strategy-as-practice research to develop and substantiate outcomes that may better explain or inform strategy praxis. Five categories of outcomes are found within existing empirical studies, and an agenda for building upon this evidence is advanced. The paper concludes with a summation of the current state of the field and some recommendations on how to take strategy-aspractice research forward.

The acquisition of French past tenses by tutored anglophone advanced learners : is aspect enough?

Following Andersen's (1986, 1991) study of untutored anglophone learners of Spanish, aspectual features have been at the centre of hypotheses on the development of past verbal morphology in language acquisition. The Primacy of Aspect Hypothesis claims that the association of any verb category (Aktionsart) with any aspect (perfective or imperfective) constitutes the endpoint of acquisition. However, its predictions rely on the observation of a limited number of untutored learners at the early stages of their acquisition, and have yet to be confirmed in other settings. The aim of the present thesis is to evaluate the explanatory power of the PAH in respect of the acquisition of French past tenses, an aspect of the language which constitutes a serious stumbling block for foreign learners, even those at the highest levels of proficiency (Coppieters 1987). The present research applies the PAH to the production of 61 anglophone 'advanced learners' (as defined in Bartning 1997) in a tutored environment. In so doing, it tests concurrent explanations, including the influence of the input, the influence of chunking, and the hypothesis of cyclic development. Finally, it discusses the cotextual and contextual factors that still provoke what Anderson (1991) terms "non-native glitches" at the final stage, as predicted by the PAH. The first part of the thesis provides the theoretical background to the corpus analysis. It opens with a diachronic presentation of the French past tense system focusing on present areas of competition and developments that emphasize the complexity of the system to be acquired. The concepts of time, grammatical aspect and lexical aspect (Aktionsart) are introduced and discussed in the second chapter, and a distinctive formal representation of the French past tenses is offered in the third chapter. The second part of the thesis is devoted to a corpus analysis. The data gathering procedures and the choice of tasks (oral and written film narratives based on Modern Times, cloze tests and acceptability judgement tests) are described and justified in the research methodology chapter. The research design was shaped by previous studies and consequently allows comparison with these. The second chapter is devoted to the narratives analysis and the third to the grammatical tasks. This section closes with a summary of discoveries and a comparison with previous results. The conclusion addresses the initial research questions in the light of both theory and practice. It shows that the PAH fails to account for the complex phenomenon of past tense development in the acquisitional settings under study, as it adopts a local (the verb phrase) and linear (steady progression towards native usage) approach. It is thus suggested that past tense acquisition rather follows a pendular development as learners reformulate their learning hypotheses and become increasingly able to shift from local to global cues and so to integrate the influence of cotext and context in their tense choice.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Servitization within manufacturing:exploring the provision of advanced services and their impact on vertical integration

Purpose – The debate about services-led competitive strategies continues to grow, with much interest emerging around the differing practices between production and servitized operations. The purpose of this paper is to contribute to this discussion by investigating the vertical integration practice (in particular the micro-vertical integration, otherwise known as the supply chain position) of manufacturers who are successful in their adoption of servitization. Design/methodology/approach – To achieve this the authors have investigated a cross-section of four companies which are successfully delivering advanced services coupled to their products. Findings – Manufacturers who have embraced the servitization trend tend to retain capabilities in design and production, and do so because this benefits their speed, effectiveness and costs of supporting assets on advanced services contracts. Research limitations/implications – These are preliminary findings from a longer term research programme. Practical implications – Through this research note the authors seek to simultaneously contribute to the debate in the research community and offer guidance to practitioners exploring the consequences of servitization. Originality/value – Successful servitization demands that manufacturers adopt new and alternative practices and technologies to those traditionally associated with production operations. A prevailing challenge is to understand these differences and their underpinning rationale. Therefore, in this research note, the authors report on the practices of four case companies, explore the rationale underpinning these, and propose an hypothesis for the impact on vertical integration of successful servitization.

A review of research and practice for the industrial networks of the future

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? First, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example, in assembly operations. Second, the increased tendency towards specialisation has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies for niche markets. Third, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than was previously the case. Fourth, there is becoming a continuous move towards more loosely connected entities that comprise manufacturing networks. Finally, in these networks, concepts for supply chain management should address collaboration and information technology that supports decentralised decision-making, in particular to address sustainable and green supply chains. More traditional concepts, such as the keiretsu and chaibol networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these five fundamental challenges to prepare for the industrial networks of 2020 and beyond. © 2010 Springer-Verlag London.

Industrial networks of the future:a critical commentary on research and practice

Academia has followed the interest by companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? Firstly, it seems that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example in assembly operations. Secondly, the increased tendency to specialize forces other parts of industrial networks to introduce advanced manufacturing technologies for niche markets. Thirdly, the capital market for investments in capacity and the trade in manufacturing as a commodity dominates resource allocation to a larger extent. Fourthly, there will be a continuous move toward more loosely connected entities forming manufacturing networks. More traditional concepts, like keiretsu and chaibol networks, do not sufficiently support this transition. Research should address these fundamental challenges to prepare for the industrial networks of 2020 and beyond.

Leadership in high-value services for manufacturers:advanced services and their impact on vertical integration

The debate about services-led competitive strategies continues to grow with much interest emerging around the differing practices between production and servitised operations. This paper contributes to this discussion byinvestigating the vertical integration practice (in particular the micro-vertical integration otherwise known as the supply chain position)of manufacturers who are successful in their adoption of servitization.Although these are preliminary findings from a longer-term research programme, through this technical note we seek to simultaneously contribute to the debate in the research community and offer guidance to practitioners exploring the consequences of servitization. Keyword: Servitization, Product-Service Systems, Through-life Services.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Exploring business models to provide a foundation for enhanced eye care services in high street optometric practice

High street optometric practices are for-profit businesses. They mostly provide sight testing and eye examination services and sell optical products, such as spectacles and contact lenses. The sight testing services are often sold at a vastly reduced price and profits are generated primarily through high margin spectacle sales, in a loss leading strategy. Published literature highlights weaknesses in this strategy as it forms a barrier to widening the scope of services provided within optometric practices. This includes specialist non-refraction based services, such as shared care. In addition this business strategy discourages investment in advanced diagnostic equipment and higher professional qualifications. The aim of this thesis was to develop a greater understanding of the traditional loss-leading strategy. The thesis also aimed to assess the plausibility of alternative business models to support the development of specialist non-refraction services within high street optometric practice. This research was based on a single independent optometric practice that specialises in advanced retinal imaging and offers a broad range of shared care services. Specialist non-refraction based services were found to be poor generators of spectacle sales likely due to patient needs and presenting concerns. Alternative business strategies to support these services included charging more realistic professional fees via cost-based pricing and monthly payment plans. These strategies enabled specialist services to be more self-sustainable with less reliance on cross-subsidy from spectacle sales. Furthermore, improving operational efficiency can increase stand-alone profits for specialist services.Practice managers may be reluctant to increase professional fees due to market pressures and confidence. However, this thesis found that patients were accepting of increased professional fees. Practice managers can implement alternative business models to enhance eye care provision in high street optometric practices. These alternative business models also improve revenues and profits generated via clinical services and improve patient loyalty.