Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Human resource management practices in the multinational company: A test of system, societal, and dominance effects

Does the use of HRM practices by multinational companies (MNCs) reflect their national origins or are practices similar regardless of context? To the extent that practices are similar, is there any evidence of global best standards? The authors use the system, societal, and dominance framework to address these questions through analysis of 1,100 MNC subsidiaries in Canada, Ireland, Spain, and the United Kingdom. They argue that this framework offers a richer account than alternatives such as varieties of capitalism. The study moves beyond previous research by differentiating between system effects at the global level and dominance effects arising from the diffusion of practices from a dominant economy. It shows that both effects are present, as are some differences at the societal level. Results suggest that MNCs configure their HRM practices in response to all three forces rather than to some uniform global best practices or to their national institutional contexts.

National institutions and employers’ age management practices in Britain and Germany:‘Path dependence’and option exploration

We pursue a comparative analysis of employers’ age management practices in Britain and Germany, asking how valid ‘convergence’ and ‘Varieties of Capitalism’ theories are. After rejecting the convergence verdict, we proceed to ask how far ‘path dependence’ helps explain inter-country differences. Through 19 interviews with British and German experts, we find that firms have reacted in different ways to promptings from the EU and the two states. Change has been modest and a rhetoric-reality gap exists in firms as they seek to hedge. We point to continuities in German institutional methods of developing new initiatives, and the emerging role of British NGOs in helping firms and the state develop new options. We argue that ‘path dependence’ offers insight into the national comparison, but also advance the idea of national modes of firm optionexploration as an important way of conceptualizing the processes involved.

Knowledge Management Techniques to Augment Textual CBR (PhD Thesis)

The past decade had witnessed an unprecedented growth in the amount of available digital content, and its volume is expected to continue to grow the next few years. Unstructured text data generated from web and enterprise sources form a large fraction of such content. Many of these contain large volumes of reusable data such as solutions to frequently occurring problems, and general know-how that may be reused in appropriate contexts. In this work, we address issues around leveraging unstructured text data from sources as diverse as the web and the enterprise within the Case-based Reasoning framework. Case-based Reasoning (CBR) provides a framework and methodology for systematic reuse of historical knowledge that is available in the form of problemsolution
pairs, in solving new problems. Here, we consider possibilities of enhancing Textual CBR systems under three main themes: procurement, maintenance and retrieval. We adapt and build upon the stateof-the-art techniques from data mining and natural language processing in addressing various challenges therein. Under procurement, we investigate the problem of extracting cases (i.e., problem-solution pairs) from data sources such as incident/experience
reports. We develop case-base maintenance methods specifically tuned to text targeted towards retaining solutions such that the utility of the filtered case base in solving new problems is maximized. Further, we address the problem of query suggestions for textual case-bases and show that exploiting the problem-solution partition can enhance retrieval effectiveness by prioritizing more useful query suggestions. Additionally, we illustrate interpretable clustering as a tool to drill-down to domain specific text collections (since CBR systems are usually very domain specific) and develop techniques for improved similarity assessment in social media sources such as microblogs. Through extensive empirical evaluations, we illustrate the improvements that we are able to
achieve over the state-of-the-art methods for the respective tasks.

Assessing elements of a family approach to reduce adolescent drinking frequency: parent-adolescent relationship, knowledge management, and keeping secrets

AIMS: To estimate 1) the associations between parent-adolescent relationship, parental knowledge and subsequent adolescent drinking frequency and 2) the influence of alcohol use on parental knowledge.

DESIGN: Path analysis of school based cohort study with annual surveys SETTING: Post primary schools from urban and intermediate/rural areas in Northern Ireland PARTICIPANTS: 4,937 post primary school students aged around 11 years in 2000 followed until around age 16 in 2005.

MEASUREMENTS: Pupil reported measures of: frequency of alcohol use; parental-child relationship quality; sub-dimensions of parental monitoring: parental control, parental solicitation, child disclosure and child secrecy.

FINDINGS: Higher levels of parental control (Ordinal logistic OR 0.86 95% CI 0.78, 0.95) and lower levels of child secrecy (OR 0.83 95% CI 0.75 0.92) were associated with less frequent alcohol use subsequently. Parental solicitation and parent-child relationship quality were not associated with drinking frequency. Weekly alcohol drinking was associated with higher subsequent secrecy (Beta -0.42 95% CI -0.53, -0.32) and lower parental control (Beta -0.15 95% CI -0.26, -0.04). Secrecy was more strongly predictive of alcohol use at younger compared with older ages (P=0.02), and alcohol use was less strongly associated with parental control among families with poorer relationships (P=0.04).

CONCLUSIONS: Adolescent alcohol use appears to increase as parental control decreases and child secrecy increases. Greater parental control is associated with less frequent adolescent drinking subsequently, while parent-child attachment and parental solicitation have little influence on alcohol use. 

Knowledge Management in the Health Sector

Este artigo consiste numa introdução à importancia de gestão do conhecimento nas organizações de saúde. frmas de gerir o conhecimento; formas e meios de partilha do conhecimento. Aborda igualamente as comunidade e pratica eas respectivas ferramentas utilizadas

Governing through community? A comparative study of changing management practices in mixed tenure housing development

An important feature of UK housing policy has been the promotion of consortia between local authorities, private developers and housing associations in order to develop mixed tenure estates to meet a wide range of housing needs. Central to this approach has been a focus on the management of neighbourhoods, based on the assumption that high densities and the inter-mixing of tenure exacerbates the potential for incivility and anti-social behaviour and exerts a disproportionate impact on residents' quality of life. Landlord strategies are therefore based on a need to address such issues at an early stage in the development. In some cases community-based, third sector organisations are established in order to manage community assets and to provide a community development service to residents. In others, a common response is to appoint caretakers and wardens to tackle social and environmental problems before they escalate and undermine residents’ quality of life. A number of innovative developments have promoted such neighbourhood governance approaches to housing practice by applying community development methods to address potential management problems. In the process, there is an increasing trend towards strategies that shape behaviour, govern ethical conduct, promote aesthetic standards and determine resident and landlord expectations. These processes can be related to the wider concept of governmentality whereby residents are encouraged to become actively engaged in managing their own environments, based on the assumption that this produces more cohesive, integrated communities and projects positive images. Evidence is emerging from a number of countries that increasingly integrated and mutually supportive roles and relationships between public, private and third sector agencies are transforming neighbourhood governance in similar ways. This paper will review the evidence for this trend towards community governance in mixed housing developments by drawing on a series of UK case studies prepared for two national agencies in 2007. It will review in particular the contractual arrangements with different tenures, identify codes and guidelines promoting 'good neighbour' behaviour and discuss the role of community development trusts and other neighbourhood organisations in providing facilities and services, designed to generate a well integrated community. The second part of the paper will review evidence from the USA and Australia to see how far there is a convergence in this respect in advanced economies. The paper will conclude by discussing the extent to which housing management practice is changing, particularly in areas of mixed development, whether there is a convergence in practice between different countries and how far these trends are supported by theories of governmentality.

Hierarchical structures: conducive or barrier to knowledge management?

This study examines managers‟ perceptions of Knowledge Management (KM) prior to implementation of KM-systems in a global insurance company and investigates whether Hierarchical structures are conducive to KM. Mixed methods are used, combining large scale surveying and case study using content analysis to organize the data into themes that provide the basis for arguments. Evidence suggests that managers strongly align their perception of KM with communication. Despite a multi-layered, hierarchical structure and strong middle management presence, organizational structure was not viewed as an issue. These factors are usually barriers to communication and organizational flexibility, yet managers believe that they may not inhibit KM becoming fully embedded. This evidence is contradicted by the results of a global KM study where silos, stovepipe and hierarchical structures were commonly cited as barriers. This contributes to the understanding of managerial mis-conceptions of knowledge as opposed to communication, and how organizations effectively share knowledge.

Success or failure in knowledge management systems: a universal issue

This paper takes a sociotechnical viewpoint of knowledge management system (KMS) implementation in organizations considering issues such as stakeholder disenfranchisement, lack of communication, and the low involvement of key personnel in system design asking whether KMS designers could learn from applying sociotechnical principles to their systems. The paper discusses design elements drawn from the sociotechnical principles essential for the success of IS and makes recommendations to increase the success of KMS in organizations. It also provides guidelines derived from Clegg’s Principles (2000) for KMS designers to enhance their designs. Our data comes from the application of a plurality of analysis methods on a large comprehensive global survey conducted from 2007 to 2011 of 1034 participants from 76 countries. The survey covers a variety of organizations of all types and sizes from a comprehensive selection of economic sectors and industries. Our results showed that users were not satisfied with the information and knowledge systems that they were being offered. In addition to multiple technology and usability issues, there were human and organisational barriers that prevented the systems from being used to their full potential. We recommend that users of KMS are integrated into the design team so that these usability and other barriers can be addressed during the feasibility stage as well as the actual design and implementation phases.

The impact of talent management practices on employee retention: The moderator effect of leader-member exchange and role modeling

Organizations are undergoing serious difficulties to retain talent. Authors argue that Talent Management (TM) practices create beneficial outcomes for individuals and organizations. However, there is no research on the leaders’ role in the functioning of these practices. This study examines how LMX and role modeling influence the impact that TM practices have on employees’ trust in their organizations and retention. The analysis of two questionnaires (Nt1=175; Nt2=107) indicated that TM only reduced turnover intentions, via an increase in trust in the organization, when role modeling was high and not when it was low. Therefore, we can say that leaders are crucial in the TM context, and in sustaining a competitive advantage for organizations.

Performance management practices in Portugal.

Performance management and assessment has returned to the forefront of the public debate in Portugal, at the same time that some international studies point Portugal as a country with bad management practices, highlighting performance management practices. Despite all this attention, there is little information about how those practices are applied in the country. This research’s goal is to assess why performance management systems and practices are so poorly applied in Portugal. To achieve this goal we studied employees’ perception about the topic and diagnose the associated problems. The methodology comprised inductive and qualitative research, in the form of interviews with employees from different professions, industries, hierarchies, and ages. Our findings suggest that performance management failure is related with a procedural problem with three different dimensions: Insufficient Planning, Process & Integrity Issues, and Non-Meritocratic Logic. By exposing the different components of the Portuguese performance management problem, we shed light into the topic and allow organizations to understand and face their performance management systems’ flaws.