The clinical effectiveness of interventions to assist perioperative temperature management for women undergoing Cesarean Section : a systematic review

Background Women undergoing Cesarean Section (CS) are vulnerable to the adverse effects associated with perioperative core temperature drop, in part due to the tendency for CS to be performed under neuraxial anesthesia, blood and fluid loss, and vasodilation. Inadvertent perioperative hypothermia (IPH) is a common condition that affects patients undergoing surgery of all specialties and is detrimental to all age groups, including neonates. Previous systematic reviews on IPH prevention largely focus on either adult or all ages populations, and have mainly overlooked pregnant or CS patients as a distinct group. Not all recommendations made by systematic reviews targeting all adult patients may be transferable to CS patients. Alternative, effective methods for preventing or managing hypothermia in this group would be valuable. Objectives To synthesize the best available evidence in relation to preventing and/or treating hypothermia in mothers after CS surgery. Types of participants Adult patients over the age of 18 years, of any ethnic background, with or without co-morbidities, undergoing any mode of anesthesia for any type of CS (emergency or planned) at healthcare facilities who have received interventions to limit or manage perioperative core heat loss were included. Types of intervention(s) Active or passive warming methods versus usual care or placebo, that aim to limit or manage core heat loss as applied to women undergoing CS were included. Types of studies Randomized controlled trials (RCTs) that met the inclusion criteria, with reduction of perioperative hypothermia a primary or secondary outcome were considered. Types of outcomes Primary outcome: maternal core temperature measured during the preoperative, intraoperative and postoperative phases of care Secondary outcomes: newborn core temperature at birth, umbilical pH obtained immediately after birth, Apgar scores, length of Post Anesthetic Care Unit (PACU) stay, maternal thermal comfort. Search strategy A comprehensive search was undertaken of the following databases from their inception until May 2012: ProQuest, Web of Science, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Mednar, OpenGrey, Clinical Trials. There were no language restrictions. Methodological quality Retrieved papers were assessed for methodological quality by two independent reviewers prior to inclusion using JBI software. Disagreements were resolved via consultation with the third reviewer. An assessment of quality of the included papers was also made in relation to five key quality factors. Data collection Two independent reviewers extracted data from the included papers using a previously piloted customized data extraction tool. Results 12 studies with a combined total of 719 participants were included. Three broad intervention groups were identified; intravenous (IV) fluid warming, warming devices, leg wrapping. IV fluid warming, whether administered intraoperatively or preoperatively, was found to be effective at maintaining maternal (but not neonatal) temperature and preventing shivering, but does not improve thermal comfort. The effectiveness of IV fluid warming on Apgar scores and umbilical pH remains unclear. Warming devices, including forced air warming and under body carbon polymer mattresses, were effective at preventing hypothermia and reduced shivering, however were most effective if applied preoperatively. The effectiveness of warming devices to improve thermal comfort remains unclear. Preoperative forced air warming appears to aid maintenance of neonatal temperature, while intraoperative forced air warming does not. Forced air warming was not effective at improving Apgar scores and the effects for umbilical pH remain unclear. Conclusions Intravenous fluid warming, by any method, improves maternal temperature and reduces shivering for women undergoing CS. Preoperative body warming devices also improve maternal temperature, in addition to reducing shivering.

Design led innovation : shifting from smart follower to digital strategy leader in the Australian airport sector

This paper presents and discusses organisational barriers and opportunities arising from the dissemination of design led innovation within a leading Australian airport corporation. This research is part of a greater action research program which aims to integrate design as a strategic capability through design led innovation within Australian businesses. Findings reveal that there is an opportunity to employ the theoretical framework and tools of design led innovation in practice to build collaborative idea generation by involving customers and stakeholders within the proposal of new to world propositions. The iterative gathering of deep customer insights also provided an opportunity to leverage a greater understanding of stakeholders and customers in strengthening continuing business partnerships through co-design. Challenges to the design led approach include resistance to the exploratory nature of gathering deep customer insights, the testing of long held assumptions and market data, and the disruption of an organisational mindset geared toward risk aversion instilled within the aviation industry. The implication from these findings is that design led innovation can provide the critical platform to allow for a business to grow and sustain internal design capabilities necessary to challenge prevailing assumptions about how its business model operates to deliver value to customers and stakeholders alike. The platform of design led innovation also provides an avenue to support a cultural transformation towards anticipating future needs necessary for establishing a position of leadership within the broader economic environment.

Self management of haemodialysis for end stage renal disease : a systematic review

Background Exploring self management in End Stage Renal Disease is extremely important for patients as they encounter several challenges including ongoing symptoms, complex treatments and restrictions, uncertainty about life and a dependency on technology, all of which impact upon their autonomy particularly after commencement of haemodialysis. Objective To summarise the effects of nursing interventions which effect selfmanagement of haemodialysis for patients with End Stage Renal Disease. Search strategy Search terms were chosen after reviewing text words and MeSH terms in relevant articles and databases. An extensive search of the literature from 1966 to June 2009 was conducted across a range of health databases including Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science. Further studies were identified from reference lists of all retrieved studies. Selection criteria We considered randomised controlled trials that compared interventions to improve self management of haemodialysis in patients with ESRD. In the absence of RCTs, comparative studies without randomisation as well as before and after studies were considered for inclusion. Methodological quality Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (SUMARI). Data collection and analysis Data was extracted using the JBI data extraction tool for evidence of effectiveness independently by pairs of review authors. The evidence was reported in narrative summaries due to heterogeneity of the interventions of the studies. Results and conclusions Five randomised controlled trials were included in the review. Overall, the evidence found that psychosocial and educational interventions influenced self management of haemodialysis in this patient population.

A business engineering approach to client relationship management in a knowledge based firm

This thesis examines Customer Relationship Management and how the capabilities of an organisation to innovate can be enhanced via its implementation in a Knowledge Based Firm. The research identifies current customer knowledge components within an organisation and identifies for future use, CRM components for implementation within a Knowledge Based Firm. Opinions from a panel of experts' are identified for best practice customer relationship strategy, the most important CRM processes and identification of customer knowledge components that will form the basis of implementing a successful CRM to gain a competitive advantage through enhancing the innovative capability for a Knowledge Based Firm.

Towards an integrated maturity model of asset management capabilities

Asset service organisations often recognize asset management as a core competence to deliver benefits to their business. But how do organizations know whether their asset management processes are adequate? Asset management maturity models, which combine best practices and competencies, provide a useful approach to test the capacity of organisations to manage their assets. Asset management frameworks are required to meet the dynamic challenges of managing assets in contemporary society. Although existing models are subject to wide variations in their implementation and sophistication, they also display a distinct weakness in that they tend to focus primarily on the operational and technical level and neglect the levels of strategy, policy and governance as well as the social and human resources – the people elements. Moreover, asset management maturity models have to respond to the external environmental factors, including such as climate change and sustainability, stakeholders and community demand management. Drawing on five dimensions of effective asset management – spatial, temporal, organisational, statistical, and evaluation – as identified by Amadi Echendu et al. [1], this paper carries out a comprehensive comparative analysis of six existing maturity models to identify the gaps in key process areas. Results suggest incorporating these into an integrated approach to assess the maturity of asset-intensive organizations. It is contended that the adoption of an integrated asset management maturity model will enhance effective and efficient delivery of services.

Dynamic weaving in aspect oriented business process management

Reducing complexity in Information Systems is an important topic in both research and industry. One strategy to deal with complexity is separation of concerns, which results in less complex, easily maintainable and more reusable systems. Separation of concerns can be addressed through the Aspect Oriented paradigm. Although this paradigm has been well researched in programming, it is still at the preliminary stage in the area of Business Process Management. While some efforts have been made to extend business process modelling with aspect oriented capability, it has not yet been investigated how aspect oriented business process models should be executed at runtime. In this paper, we propose a generic solution to support execution of aspect oriented business process models based on the principle behind dynamic weaving of aspects. This solution is formally specified using Coloured Petri Nets. The resulting formal specification serves as the blueprint to the implementation of a service module in the framework of a state-of-the-art Business Process Management System. Using this developed artefact, a case study is performed in which two simplified processes from real business in the domain of banking are modelled and executed in an aspect oriented manner. Through this case study, we also demonstrate that adoption of aspect oriented modularization increases the reusability while reducing the complexity of business process models in practice.

Knowledge Management Strategies in Technopreneurial Firms

Intellectual capital is increasingly viewed as the single most important asset of organisations. While most large organisations have resources, staff and plans in place to support and develop intellectual capital, many smaller organisations do not. In particular technology-oriented young firms (technopreneurial firms), which play an important role in innovation and commercialisation of new ideas, do not have well developed strategies for managing their intellectual capital. These firms are often founded by engineers, scientists or academics who posses great scientific/technological knowledge, but limited know-how in other aspects of managing a business including knowledge management (KM). Successful managing and integrating their specialised knowledge is of particular importance when it comes to developing a new product or process. This article therefore focuses on developing strategies for knowledge management within technopreneurial organisations as they incorporate technology and strive to build and retain a productive and creative workforce.

Process model comprehension : the effects of cognitive abilities, learning style, and strategy

Process models are used to convey semantics about business operations that are to be supported by an information system. A wide variety of professionals is targeted to use such models, including people who have little modeling or domain expertise. We identify important user characteristics that influence the comprehension of process models. Through a free simulation experiment, we provide evidence that selected cognitive abilities, learning style, and learning strategy influence the development of process model comprehension. These insights draw attention to the importance of research that views process model comprehension as an emergent learning process rather than as an attribute of the models as objects. Based on our findings, we identify a set of organizational intervention strategies that can lead to more successful process modeling workshops.

Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review

Background Post-stroke recovery is demanding. Increasing studies have examined the effectiveness of self-management programs for stroke survivors. However no systematic review has been conducted to summarize the effectiveness of theory-based stroke self-management programs. Objectives The aim is to present the best available research evidence about effectiveness of theory-based self-management programs on community-dwelling stroke survivors’ recovery. Inclusion criteria Types of participants All community-residing adults aged 18 years or above, and had a clinical diagnosis of stroke. Types of interventions Studies which examined effectiveness of a self-management program underpinned by a theoretical or conceptual framework for community-dwelling stroke survivors. Types of studies Randomized controlled trials. Types of outcomes Primary outcomes included health-related quality of life and self-management behaviors. Secondary outcomes included physical (activities of daily living), psychological (self-efficacy, depressive symptoms), and social outcomes (community reintegration, perceived social support). Search Strategy A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese. Methodological quality The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies. Data Collection A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results. Data Synthesis There were incomplete details about the number of participants and the results in two studies, which makes it impossible to perform meta-analysis. A narrative summary of the effectiveness of stroke self-management programs is presented. Results Three studies were included. The key issues of concern in methodological quality included insufficient information about random assignment, allocation concealment, reliability and validity of the measuring instruments, absence of intention-to-treat analysis, and small sample sizes. The three programs were designed based on the Stanford Chronic Disease Self-management program and were underpinned by the principles of self-efficacy. One study showed improvement in the intervention group in family and social roles three months after program completion, and work productivity at six months as measured by the Stroke Specific Quality of Life Scale (SSQOL). The intervention group also had an increased mean self-efficacy score in communicating with physicians six months after program completion. The mean changes from baseline in these variables were significantly different from the control group. No significant difference was found in time spent in aerobic exercise between the intervention and control groups at three and six months after program completion. Another study, using SSQOL, showed a significant interaction effect by treatment and time on family roles, fine motor tasks, self-care, and work productivity. However there was no significant interaction by treatment and time on self-efficacy. The third study showed improvement in quality of life, community participation, and depressive symptoms among the participants receiving the stroke self-management program, Stanford Chronic Disease Self-management program, or usual care six months after program completion. However, there was no significant difference between the groups. Conclusions There is inconclusive evidence about the effectiveness of theory-based stroke self-management programs on community-dwelling stroke survivors’ recovery. However the preliminary evidence suggests potential benefits in improving stroke survivors’ quality of life and self-efficacy.

Acticoat™ : A cost-effective and evidence-based dressing strategy [Letter to the Editor]

We thank Dr. Burd et al. for taking an interest in our paper [1]. The retrospective cohort study was performed and published for two reasons. Firstly, we wished to compare and contrast the use of Acticoat™ and Silvazine™, and secondly we wished to demonstrate how one's practice can be dramatically altered by a change in dressing used. We found that Acticoat™ was safe and easy to use, caused less trauma to patients, required less frequent dressing changes and enabled treatment to be conducted on an outpatient, rather than an inpatient basis. During the period of Acticoat™ treatment we also saw a dramatic reduction in grafting requirements and also in the need for long-term scar management. Burd et al. correctly state that silver-based dressings are now more widely available, however many burn centres in the world continue to use silver sulphadiazine with daily baths. We therefore feel that a comparison is very relevant and useful. Prospective, randomised clinical trials of a range of silver-based dressings would indeed be useful, and hopefully Dr. Burd and colleagues will take up their own suggestion and perform these studies...

Conceptualizing the interplay of knowledge accumulation and integration capabilities in service innovation-based competitive strategy : a project-oriented firm context

While past knowledge-based approaches to service innovation have emphasized the role of integration of knowledge in the provisioning of solutions, these approaches fail to address complexities involved with knowledge integration in project-oriented context, specifically, how the firm’s capability to acquire new knowledge from clients and past project episodes influence the development of new service solutions. Adopting a dynamic capability framework and building on knowledge-based approaches to innovation, this paper presents a conceptual model that captures the interplay of learning capabilities and the knowledge integration capability in the service innovation-based competitive strategy. Implications to theory and directions for future research are discussed.

Towards networked governance : improving interagency communication and collaboration for disaster risk management and climate change adaptation in Australia

Major disasters, such as bushfires or floods, place significant stress on scarce public resources. Climate change is likely to exacerbate this stress. An integrated approach to disaster risk management (DRM) and climate change adaptation (CCA) could reduce the stress by encouraging the more efficient use of pooled resources and expertise. A comparative analysis of three extreme climate-related events that occurred in Australia between 2009 and 2011 indicated that a strategy to improve interagency communication and collaboration would be a key factor in this type of policy/planning integration. These findings are in accord with the concepts of Joined-up Government and Network Governance. Five key reforms are proposed: developing a shared policy vision; adopting multi-level planning; integrating legislation; networking organisations; and establishing cooperative funding. These reforms are examined with reference to the related research literature in order to identify potential problems associated with their implementation. The findings are relevant for public policy generally but are particularly useful for CCA and DRM.

Management based on exhaled nitric oxidelevels adjusted for atopy reduces asthma exacerbations in children : A dual centre randomised controlled trial

While several randomised control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual centre RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed ten times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomised (FeNO=31, controls=32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), p=0.021; number to treat for benefit=4 (95%CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1). The final daily inhaled corticosteroids (ICS) dose was significantly (p=0.037) higher in the FeNO group (median 400µg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings.

Effects of a pediatric weight management program with and without active video games

Importance Active video games may offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown. Objective To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community. Design, Setting, and Participants Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%). Interventions All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program. Main Outcomes and Measures Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score. Results Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], −10.9% [1.6%] vs −5.5% [1.5%]; P = .02) and BMI z score (−0.25 [0.03] vs −0.11 [0.03]; P < .001). Conclusions and Relevance Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight.