Systems Medicine and Integrated Care to Combat Chronic Noncommunicable Diseases.

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

The Quality of Paediatric Nursing Care - Children’s Perspective

Hoitotyön laatu - lasten näkökulma Tämän kolmivaiheisen tutkimuksen tarkoituksena oli kuvailla lasten odotuksia ja arviointeja lasten hoitotyön laadusta sekä kehittää mittari kouluikäisille sairaalassa oleville lapsille laadun arviointiin. Perimmäisenä tavoitteena oli lasten hoitotyön laadun kehittäminen sairaalassa. Ensimmäisessä vaiheessa 20 alle kouluikäistä (4-6v) sekä 20 kouluikäistä (7-11v) lasta kuvailivat odotuksiaan lasten hoitotyön laadusta. Aineisto kerättiin haastattelulla ja lasten piirustusten avulla, sekä analysoitiin sisällön analyysilla. Lasten odotukset lasten hoitotyön laadusta kohdistuivat hoitajaan, hoitotyön toimintoihin ja ympäristöön, fyysinen ympäristö korostui piirustuksissa. Ensimmäisen vaiheen tulosten, aikaisemman kirjallisuuden sekä Leino-Kilven “HYVÄ HOITO” mittarin pohjalta kehitettiin “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari ja testattiin sen psykometrisiä ominaisuuksia tutkimuksen toisessa vaiheessa. Mittaria kehitettiin ja testattiin kolmen vaiheen kautta. Aluksi asiantuntijapaneeli (n=7) arvioi mittarin sisältöä. Seuraavaksi mittari esitestattiin kahdesti kouluikäisillä sairaalassa olevilla lapsilla (n=41 ja n=16), samassa vaiheessa myös viiden lastenosaston hoitajat (n=19) yhdessä arvioivat mittarin sisältöä sekä 8 lasta. Lopuksi mittaria testattiin kouluikäisillä lapsilla (n=388) sairaalassa sekä hoitajat (n=198) arvioivat mittarin sisällön validiteettia. Mittarin kehittämisen aikana päälaatuluokkien: hoitajan ominaisuudet, hoitotyön toiminnot ja hoitotyön ympäristö Cronbachin alfa kertoimet paranivat. Pääkomponentti analyysi tuki mittarin hoitotyön toimintojen ja ympäristön alaluokkien teoreettista rakennetta. Kolmannessa vaiheessa “Lasten Hoidon Laatu Sairaalassa” (LHLS III, versio neljä) mittarilla kerättiin aineisto Suomen yliopistosairaaloiden lastenosastoilta kouluikäisiltä 7-11 -vuotiailta lapsilta (n=388). Mittarin lopussa lapsia pyydettiin lisäksi kuvailemaan kivointa ja ikävintä kokemustaan sairaalahoidon aikana lauseen täydennystehtävänä. Aineisto analysoitiin tilastollisesti sekä sisällön analyysilla. Lapset arvioivat fyysisen hoitoympäristön, hoitajien inhimillisyyden ja luotettavuuden sekä huolenpidon ja vuorovaikutustoiminnot kiitettäviksi. Lapset arvioivat hoitajien viihdyttämistoiminnot kaikkein alhaisimmiksi. Lapsen ikä ja sairaalantulotapa olivat yhteydessä lasten saamaan tiedon määrään. Lasten kivoimmat kokemukset liittyivät ihmisiin ja heidän ominaisuuksiinsa, toimintoihin, ympäristöön sekä lopputuloksiin. Ikävimmät kokemukset liittyivät potilaana oloon, tuntemuksiin sairauden oireista sekä erossaoloon, hoitotyön fyysisiin toimintoihin sekä ympäristöön. Tutkimuksen tulokset osoittavat lasten olevan kykeneviä arvioimaan omaa hoitoaan ja heidän näkökulmansa tulisi nähdä osana koko laadun kehittämisprosessia parannettaessa laatua käytännössä todella lapsilähtöisemmällä lähestymistavalla. “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari on mahdollinen väline saada tietoa lasten arvioinneista lasten hoitotyön laadusta, mutta mittarin testaamista tulisi jatkaa tulevaisuudessa

Private Home Care in Municipal Service Systems – A Case Study among Finnish and Swedish Municipalities

The aim of this study is to assess the current and future preconditions for conducting private business in municipal service systems for home care in Lahti and Hyvinkää in Finland, and in Uppsala and Huddinge in Sweden. This study also aims to assess the implications of quality related issues on the preconditions for conducting private business in the service systems in question. The theories and the research methodologies of the study are based on the Business Model Generation and the Business Model Canvas -concepts. Also a couple of frameworks on implications of quality are applied and integrated into the study. The study is completed as a case study – with structured and identical approaches for all four municipalities. The analyses and assessments of the study are primarily qualitative, but supported by simple quantitative methodologies. The data of the study consists primarily of publicly available information, and secondarily of answers provided by the case-municipalities to multiple choice questions. The results of the study show that the service systems for home care among the case-municipalities are, from perspective of private companies, diverse with local characteristics. Both the premises for conducting private business and the quality-issues are in many respects different in the Finnish and the Swedish case-municipalities. This is partly due to differences in the national service systems; the service voucher system versus the system of choice. Still, it appears that the current preconditions for conducting private business in the service systems for home care, including the implications of quality, would be more favorable in Uppsala and Huddinge than in Lahti and Hyvinkää. On the other hand, the service systems are subject to changes, and the most positive and significant development is here forecasted for a Finnish case-municipality (Lahti). Communication of quality is clearly more advanced in the Swedish case-municipalities. The results of this study can be utilized in several ways, for instance by private companies interested in entering into service systems for home care, either in some of the case-municipalities, or in some other Finnish or Swedish municipalities. Also municipalities can apply the analyses of the study when designing, developing or evaluating their own service systems for home care.

Supporting employer branding by inbound marketing in Russia

The objective of this study is to understand how employer branding can be strategically supported by inbound marketing in Russia. Furthermore, the aim is to examine the special features of inbound marketing in Russia, as well as to learn what the most useful inbound marketing channels are in the Russian context. The theoretical background of this study is built from employer branding and inbound marketing literature. Inbound marketing is currently lacking a profound research on the topic and thus, this study contributes to the inbound marketing literature as well. The empirical data of this research is collected via three qualitative expert field interviews. The interviews were conducted between January and February 2014. Furthermore, a thematic content analysis was used in the process of analyzing the research results. Both the employer branding and inbound marketing are growing their importance in Russia. The results of this study suggest that a combination of employer branding and inbound marketing can bring companies competitive advantage over others in the Russian market. It is, however, crucial to first understand the peculiarities of the inbound marketing in Russia before taking it to the employer branding context. This study provides a framework for inbound marketing tools in Russia. The proposed framework takes into careful consideration the cultural factors affecting the selection of the inbound marketing tools in Russia. Furthermore, the results of this study suggest how inbound marketing could be successfully combined with employer branding in Russia in order to strengthen the employer brands in the Russian market. However, these results are mainly applicable in the Russian context. Therefore, additional research is needed in order to understand the relationship between the employer branding and inbound marketing in other cultural settings or in particular fields of business.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Supporting and maximizing communication between individuals with intellectual disabilities and health care providers

The goal of the present study was to examine the barriers to access in health services faced by individuals with intellectual disabilities (ID), as well as the nature of communication between people with ID and those who are directly involved in supporting their health and well being. The study included in-depth interviews with five adults who have been identified as having ID and are supported by a community agency, five community agency support staff and four physicians who are specialists in supporting people who have ID. A qualitative content analysis approach facilitated the comparative exploration of key themes that each participant group saw as positive or negative influences on health care access and on effective health care communication. Themes drawn from the findings emphasize the unique roles each of these groups plays within the dialogical framework of the health care encounter. Of particular importance to informants was the issue of people with ID being seen as full participants in their own health care who, like all people, are unique individuals and not simply members of an identified or marginalized group. Participants across groups emphasized the need for the health care recipient to be known as an individual who is an expert in her/his own health and well being and, therefore, entitled to full participation with the support of but not control by others.

Exploring the Perceptions of Cultural Competence Among Personal Support Workers in an Ontario Long-Term Care Home: A Case Study

Personal Support Workers (PSWs) spend a large amount of time with long-term care (LTC) home residents providing assistance with their activities of daily living. The s limited research on their perceptions of cultural competence presents the need to bridge this knowledge gap. The researcher conducted a qualitative case study at a LTC home in Ontario. Data were collected by conducting a policy document analysis, a key informant interview with the Director of Care (DOC), and two focus groups with PSWs. The five major overarching themes were: The Culture of the LTC Home, Provision of a Supportive Environment, Collaborative Team Approach to Care, Building a Relationship with the Residents, and Maintenance of Staff Morale. The findings illuminated the broad nature of culture, connections to person centered care, and the factors that facilitate or hinder PSWs’ culturally competent care. The ambiguous perception of cultural competence among PSWs suggests further research and education on cultural competence in LTC home settings.

Employer Perspectives on Secondary School Cooperative Education in a Southern Ontario City in Canada

Despite 2 Ontario Ministry of Education policy documents which mandate that regular program effectiveness surveys be completed in secondary school co-op programs, research was either not occurring or data were not being made available. A lack of co-op research also existed at the postsecondary level. The primary reason for this study was to determine the perspectives of current secondary school co-op employers in the Hamilton-Wentworth District School Board (HWDSB) and to identify any program strengths as well as any areas in which improvement can be made. A secondary aim of the study was to discover the reasons that some employers decline to participate in the co-op program, and why other employers decide to discontinue their co-op partnerships. An online survey was utilized with 2 Likert scales and open-ended questions to solicit responses from the 100 participants. The findings from this study strongly supported previous secondary and postsecondary co-op research. Overall, the HWDSB co-op program was found to be very strong, and employer satisfaction very high. There were, however, areas in which improvement could be made. Although most employers felt supported by institutions and felt that expectations were clearly communicated and were reasonable, there was evidence that many employers perceived a lack of institutional support which included factors such as communication, student placement and fit, and institutional responsiveness. In addition, some employers felt that students were underprepared for the workplace and lacked basic employability skills such as dependability and responsibility.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Family members' perceptions of nurse caring behaviours in the intensive care unit

La présence de membres de la famille dans les milieux de soins critiques a augmentée graduellement au cours des dernières années. La présente recherche visait à décrire la perception que les membres de la famille avait eu à l’égard des comportements de caring des infirmières lors de leur visite aux soins intensifs. Plus spécifiquement, ce projet avait pour but d’explorer les différences entre les perceptions de membres de la famille dont le proche était hospitalisé pour une blessure traumatique versus une maladie grave non-traumatique. Les différences ont aussi été examinées selon certaines caractéristiques personnelles d’un membre de la famille soit leur genre, leur expérience antérieure de visites aux soins intensifs, leur âge et leur perception de la gravité du problème de santé de leur proche. Le cadre de référence de cette étude était basé sur les facteurs caratifs proposés par Watson (1985). L’importance et la satisfaction des membres de la famille à l’égard des comportements de caring de la part des infirmières ont été mesurées par les versions française et anglaise adaptées du Caring Behaviors Assessment (CBA) (Cronin & Harrison, 1988). Les données ont été analysées en utilisant les techniques d’analyse MANOVA et des tests de corrélation de Pearson. En général, les résultats indiquent que les membres de la famille rapportent des degrés d’importance et de satisfaction similaires selon que leur proche était hospitalisé pour une blessure traumatique ou une maladie grave non-traumatique. Peu de différences émergent selon les caractéristiques personnelles des membres de la famille. Un coefficient de corrélation significatif (0.36, p = 0.012) existe entre la perception des membres de la famille de la gravité du problème de santé, et l’importance de la dimension ‘réponses aux besoins’. Par ailleurs, les comportements de caring regroupés dans la dimension ‘réponses aux besoins’ ont été perçus comme étant les plus importants et les membres de familles étaient très satisfaits des comportements de caring des infirmières. Cette étude fournit des pistes pour l’enseignement, la clinique et la recherche et met en lumière la perception des membres de la famille des soins infirmiers humains chez des proches hospitalisés dans une unité de soins intensifs.

Développement, mise à l'essai et évaluation d'une intervention de pratique réflexive avec des infirmières oeuvrant auprès de personnes âgées hospitalisées

Cette recherche visait à développer, mettre à l’essai et évaluer les effets d’une intervention de pratique réflexive (IPR) avec des infirmières œuvrant auprès d’aînés hospitalisés. Fondée sur la théorie du Human Caring de Watson (1979) et sur le modèle de réflexion structurée de Johns (2006), l’étude a été réalisée au moyen d’un devis mixte. Le développement et la mise à l’essai de l’IPR ont été réalisés au moyen d’une approche qualitative de type recherche-action. L’évaluation de l’intervention a été effectuée à l’aide d’une approche qualitative et d’une approche quantitative de type quasi-expérimental avec groupe de comparaison (GC). Au terme de l’IPR, les infirmières étaient invitées à décrire les retombées perçues de cette intervention, soit les habiletés et les savoirs infirmiers développés suite à une pratique réflexive (PR), ainsi que leur perception de la PR comme moyen d’amélioration de leur pratique professionnelle. De plus, comparativement à un GC, trois hypothèses étaient formulées : les infirmières du groupe expérimental (GE) ayant bénéficié d’une IPR amélioreraient significativement leurs attitudes et leurs connaissances à l’égard des aînés; identifieraient davantage d’interventions infirmières adaptées à la clientèle âgée hospitalisée, et obtiendraient un niveau de réflexion supérieur. L’étude a été effectuée auprès de 43 infirmières (GE = 22; GC = 21) travaillant dans un centre hospitalier universitaire. L’IPR s’est déroulée sur une période de 22 semaines. Elle comprenait huit ateliers thématiques d’une durée de 75 minutes chacun, dispensés aux trois semaines, combinés à des lectures et à des exercices individuels. L’IPR portait sur trois thèmes centraux du séjour hospitalier des aînés : la médication, la mobilisation et la planification du congé. Des données qualitatives et quantitatives ont été colligées par le biais de questionnaires ouverts (vignettes, écrit réflexif) et standardisés (Kogan’s Attitudes Toward Old People Scale, Palmore’s Facts on Aging Quiz) pré et post intervention pour les deux groupes. Les infirmières du GE ont également complété un questionnaire sur l’expérience de la PR et certaines d’entre elles ont participé à des groupes de discussion focalisée. Une analyse de contenu thématique, selon l’approche de Miles et Huberman (2003), a été réalisée sur les données qualitatives, alors que des tests de classement de Wilcoxon ont été effectués sur les données quantitatives. Les résultats soulignent que les infirmières ont développé différentes habiletés nécessaires à une PR telles que l’introspection, l’ouverture aux autres et l’analyse critique. Les participantes reconnaissent que l’IPR leur a notamment permis de développer des savoirs empirique, éthique, esthétique, personnel et émancipatoire. De plus, elles perçoivent que l’IPR est un moyen d’amélioration de la pratique professionnelle puisqu’elle peut, entre autres, contrer la routinisation des soins. Par ailleurs, comparativement au GC, les infirmières du GE ont amélioré significativement leurs attitudes et leurs connaissances à l’égard des aînés. Cependant, aucune différence significative entre le GE et le GC n’a été révélée suite à l’IPR quant au nombre d’interventions adaptées aux situations vécues par les aînés hospitalisés et au niveau de réflexion atteint. Les hypothèses de recherche ont ainsi été partiellement soutenues. Cette étude démontre le potentiel d’une IPR comme approche de développement professionnel novateur qui valorise l’expérience des infirmières, tout en leur permettant de modifier positivement leurs attitudes à l’égard des aînés et d’ajuster leurs connaissances aux besoins de cette clientèle hautement fragile et vulnérable.

Las prácticas de recursos humanos y su incidencia en el bienestar laboral de los empleados

El objetivo del presente trabajo es formular, mediante una profunda revisión documental, bibliográfica y empírica, una fundamentación teórica sobre si existe o no incidencia de las prácticas de recursos humanos sobre el bienestar laboral de los empleados, y el que grado en que esta se presenta sobre aspecto como el engagement y la satisfacción laboral. Se realizó la revisión de múltiples estudios empíricos que aportaran evidencia sobre la relación que se presenta entre las principales prácticas de recursos humanos – provisión de personal, formación y desarrollo, promoción de personal, evaluación de desempeño, compensación y pago, y balance trabajo-familia – y el bienestar laboral, representado en el engagement y satisfacción en el trabajo de los empleados. Los resultados de este trabajo indican la existencia de una relación e incidencia de las prácticas de recursos humanos, el bienestar laboral, el engagement y la satisfacción laboral. De igual forma se encontró que estas relaciones son principalmente de carácter positivo, lo cual indica que las organizaciones que desarrollan este tipo de prácticas en su interior, fomentan tanto el desarrollo y la presencia de bienestar laboral en sus empleados, como su perdurabilidad.

Cuidar dos cuidadores : o (des)envolvimento da espiritualidade na prevenção de quadros de stress e burnout

A Humanidade anda cansada, esgotado. Um cansaço que é a soma do fardo de cada um e também parte do fardo de outros. E a Humanidade busca explicações para este cansaço. E quer aliviá-lo. E quer minimizá-lo. Mas busca muito mais que isso. Trata-se, enfim, de buscar não o remédio mas o sentido da própria existência, as respostas adedentro, ou seja, bem no interior do ser humano. O presente trabalho pretende ser uma reflexão – compreender para agir - sobre a busca da dimensão da espiritualidade como possível resposta na prevenção de quadros de stress e burnout. Quem trabalho na área da assistência e na relação de ajuda contínua com pessoas em situação de extrema fragilidade sabe que se não houver um cuidado na reposição de energias, com muita facilidade a pessoa chega a um estado de cansaço e a qualquer momento o turboadrenalina pode queimar. No âmbito da gestão de unidades sociais e bem-estar, cuidar dos cuidadores é a maior e mais nobre missão de qualquer Instituição. Pois, que serviços seriam vivenciados sem as pessoas que formam o corpo e, por isso, a vida de uma Instituição? O caminho da nossa reflexão é orientado para a Comunidade Vida e Paz, como espaço relacional que quer e procura ser um espaço de renovação de vidas – das pessoas sem abrigo – onde, amparadas por um conjunto de Cuidadores, cujo olhar se orienta num trabalho de unificação da pessoa, são imbuídos por uma espiritualidade que se quer colaborante na missão de dignificar cada pessoa e devolvê-la à sua condição original. A pessoa, cada pessoa, é a soma de si, da relação com outros e da relação com o transcendente. Na missão de cuidar, pode a espiritualidade ser ausente? Desta, retiramos um sentido coerente da existência, a verdade do dom e da dádiva e, por isso, uma vida feliz.

O Cuidador de Enfermagem e o Cuidar em Uma Unidade de Terapia Intensiva; The Nursing Caregiver and the Caring in Intensive Care Units

There are several aggressive factors in Intensive Care Units (ICU), which reach not only patients, but the nursing caregivers, since they participate in complex procedures and death of patients. Nursing caregivers may have difficulties on their daily work routine that can influence the way of care. The goal of this study was to identify the aspects of nursing caregivers working in adult ICU. It is a describe-exploratory study with qualitative approach, developed among 21 ICU adult nursing caregivers of a school hospital in Paraná. The data were collected in May and July, 2009 by recorded and transcribed semi-structured interviews. Four categories for analysis were identified: the aspects of ICU assistance, the meaning of healthcare for the nursing caregivers, the understanding of healthcare positive aspects and disclosing the difficulties of caring. The results revealed that caring is related to some factors such as mixed feelings, the mental and physical damage caused by stress; the understanding of total caring, scientific-technique procedures, family engagement in the assistance and humanization. The positive aspects are related to the welfare due to satisfaction in the work done and recognition of work. The difficulties involved death situations, psychological and biological damages, establishing links with patients and the uncaring toward the nursing caregivers.

High activity supported gold catalysts by incipient wetness impregnation

It is generally thought that catalysts produced by incipient wetness impregnation (IW) are very poor for low temperature CO oxidation, and that it is necessary to use methods such as deposition-precipitation (DP) to make high activity materials. The former is true, indeed such IW catalysts are poor, and we present reactor data, XPS and TEM analysis which show that this is due to the very negative effect of the chloride anion involved in the preparation, which results in poisoning and excessive sintering of the Au particles. With the DP method, the chloride is largely removed during the preparation and so poisoning and sintering are avoided. However, we show here that, contrary to previous considerations, high activity catalysts can indeed be prepared by the incipient wetness method, if care is taken to remove the chloride ion during the process. This is achieved by using the double impregnation method (DIM). In this a double impregnation of chloroauric acid and a base are made to precipitate out gold hydroxide within the pores of the catalyst, followed by limited washing. This results in a much more active catalyst, which is active for CO oxidation at ambient temperature. The results for DIM and DP are compared, and it is proposed that the DIM method may represent an environmentally and economically more favorable route to high activity gold catalyst production. (C) 2007 Elsevier B.V. All rights reserved.