Barriers to effective cancer pain management: A survey of hospitalized cancer patients in Australia

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be distressing, horrible or excruciating, with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and farther research using concepts drawn from broader social and behavioral models. J Pain Symptom Manage 2002:23:393-405. (C) U.S. Cancer Pain Relief Committee, 2002.

Guidelines for the treatment of postmenopausal osteoporosis for general practitioners

BACKGROUND: Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis. OBJECTIVE: This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.

How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Infusing the use of seasonal climate forecasting into crop management practice in North East Australia using discussion support software

Seasonal climate forecasting offers potential for improving management of crop production risks in the cropping systems of NE Australia. But how is this capability best connected to management practice? Over the past decade, we have pursued participative systems approaches involving simulation-aided discussion with advisers and decision-makers. This has led to the development of discussion support software as a key vehicle for facilitating infusion of forecasting capability into practice. In this paper, we set out the basis of our approach, its implementation and preliminary evaluation. We outline the development of the discussion support software Whopper Cropper, which was designed for, and in close consultation with, public and private advisers. Whopper Cropper consists of a database of simulation output and a graphical user interface to generate analyses of risks associated with crop management options. The charts produced provide conversation pieces for advisers to use with their farmer clients in relation to the significant decisions they face. An example application, detail of the software development process and an initial survey of user needs are presented. We suggest that discussion support software is about moving beyond traditional notions of supply-driven decision support systems. Discussion support software is largely demand-driven and can compliment participatory action research programs by providing cost-effective general delivery of simulation-aided discussions about relevant management actions. The critical role of farm management advisers and dialogue among key players is highlighted. We argue that the discussion support concept, as exemplified by the software tool Whopper Cropper and the group processes surrounding it, provides an effective means to infuse innovations, like seasonal climate forecasting, into farming practice. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

Diagnosis and management of unusual dental abscesses in children

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses,. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities Which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.

Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

Developments regarding the integration of the occupational safety and health with quality and environment management systems

Nanotechnology is the manipulation of matter on na almost atomic scale to produce new structures, materials, and devices. As potential occupational exposure to nanomaterials (NMs) becomes more prevalente, it is importante that the principles of medical surveillance and risk management be considered for workers in the nanotechnology industry.However, much information about health risk is beyond our current knowledge. Thus, NMs presente new challenges to understanding, predicting, andmanageing potential health risks. First, we briefly describe some general features of NMs and list the most importante types of NMs. This review discusses the toxicological potential of NMs by comparing possible injury mechanism and know, or potentially adverse, health effects. We review the limited research to date for occupational exposure to these particles and how a worker might be exposed to NMs. The principles of medical surveillance are reviewed to further the discussion of occupational health surveillance are reviewed to further the discussion of occupational health surveillance for workers exposed to NMs. We outlinehow occupational health professionals could contribute to a better knowledge of health effects by the utilization of a health surveillance program and by minimizing exposure. Finally, we discuss the early steps towards regulation and the difficulties facing regulators in controlling potentially harmful exposures in the absence of suficiente scientific evidence.

Integration of management systems: towards a sustained success and development of organizations

Effective environmental management within companies, integrated with other management areas like quality and occupational health and safety, is nowadays assumed to be a strategic way to implement and improve lean and cleaner production. Also, sustainable development (SD) and business sustainability can be achieved through a better coordinated management of processes versus associated resources. This paper presents an in depth discussion regarding the promotion of integrated management systems, their benefits and major contribution towards the sustainable development of cleaner production related features. It addresses issues regarding the contributions resulting from the integration of standardized Management System (MS) from both internal and external perspectives. Complementing the overall review of aspects to the development of integrated management systems a survey was conducted in order to better understand the relevance of the identified success factors. The main findings in this paper are as follows: a contextualization model of sustainable development and integrated management systems considering the Triple Bottom Line: economic, social and environmental; and, a method and associated model to support the development of integrated management systems as well as general guidelines to support integration. It can be concluded that a proactive approach and commitment to cleaner production, supported by an integrated management system, brings relevant savings for organizations as well as providing value to the relevant interested parties.

Improving management skills through business simulation

A survey was conducted among students of the Accounting and Administration undergraduate degree at ISCAP – IPP (School of Accounting and Administration of Polytechnic Institute of Porto) in order to understand their perception value of their course Business Simulation (BS). This course is provided in a business environment where students can learn by doing through the management of a company as they were in the real life, but risk-free. The learning tasks are provided in an action-oriented format to maximize the learning process. Students learn by doing a set of tasks every session and have also to produce reports and presentations during the course. BS is part of the undergraduate degree of Accounting and Administration at ISCAP – IPP since the beginning of 2003. The questionnaire we used captured the students’ perception about general and specific skills and competencies considered important for managers and accountants in the real life, about the methodology used in the course, which is totally different from the traditional form, and also about the adequacy of the course included as part of the undergraduate degree. The results showed that students’ perception is highly positive and almost all of them think they improve the skills needed for a job during the course. These results are consistent with [1] Adler and Milne’s research in which the authors found that students agree with the use of action-oriented learning tasks in order to provide them the needed attitudes, skills, and knowledge. The improvement of group skills is the most important issue for students, which can be understandable as BS is the only course from the degree in Accounting and Administration they really have to work in groups.

Distributed generation producers' reserve management

Sustainable development concerns are being addressed with increasing attention, in general, and in the scope of power industry, in particular. The use of distributed generation (DG), mainly based on renewable sources, has been seen as an interesting approach to this problem. However, the increasing of DG in power systems raises some complex technical and economic issues. This paper presents ViProd, a simulation tool that allows modeling and simulating DG operation and participation in electricity markets. This paper mainly focuses on the operation of Virtual Power Producers (VPP) which are producers’ aggregations, being these producers mainly of DG type. The paper presents several reserve management strategies implemented in the scope of ViProd and the results of a case study, based on real data.

Distributed energy resources management with cyber-physical SCADA in the context of future smart grids

In the energy management of a small power system, the scheduling of the generation units is a crucial problem for which adequate methodologies can maximize the performance of the energy supply. This paper proposes an innovative methodology for distributed energy resources management. The optimal operation of distributed generation, demand response and storage resources is formulated as a mixed-integer linear programming model (MILP) and solved by a deterministic optimization technique CPLEX-based implemented in General Algebraic Modeling Systems (GAMS). The paper deals with a vision for the grids of the future, focusing on conceptual and operational aspects of electrical grids characterized by an intensive penetration of DG, in the scope of competitive environments and using artificial intelligence methodologies to attain the envisaged goals. These concepts are implemented in a computational framework which includes both grid and market simulation.

Lean thinking: Glass Wall Management

Sendo os desperdícios “Waste” associados à atividade industrial em Portugal e nos mercados globais e os seus custos inerentes, uma das maiores preocupações a todos os níveis de gestão empresarial, a filosofia “Lean” nasce como ajuda e encaminhamento na solução desta problemática. O conceito “Lean”, no que se refere à indústria, desde sempre e até aos dias de hoje, tem uma enorme ênfase, com a adoção deste conceito.Verificam-se bons resultados ao nível da redução de custos, melhoria da qualidade geral dos artigos produzidos, no controlo da produção em geral e é uma poderosa ferramenta no estreitamento da relação entre os diferentes intervenientes da cadeia de valor de determinado produto, sobretudo com fornecedores e com clientes. Com “Lean Management” e “Glass Wall Management”, em ambientes onde as empresas mais avançadas estão a procurar melhorar a sua competitividade através de uma gestão transparente (“Glass Wall Management”), a partir da qual, “toda informação relevante é compartilhada de maneira a que todos entendam a situação”(Suzaki, K, 1993), ganha cada vez mais importância a existência de uma estrutura organizacional que permita esta transparência e a consequente maturidade das empresas. Neste trabalho foram descritos alguns processos de gestão transparente desenvolvidos nos últimos dois anos numa PME portuguesa, aprofundando o processo de gestão transparente vigente e as ferramentas que ajudam a empresa e que na sua globalidade poderão ser extrapoladas a outras PME Portuguesas de modo que a informação importante e relevante seja partilhada por todos os intervenientes na estrutura empresarial, sendo entendida e desenvolvida por todos através de Edições e Revisões aos documentos mais importantes da empresa. Neste estudo foram contactadas vinte e uma PME’S portuguesas de tipologia de produção MTO (Make to Order) do sector dos estofos/mobiliário, e solicitado o preenchimento de um Questionário, tendo como fim em vista, a verificação do uso desta metodologia “Glass Wall Management” à escala empresarial portuguesa e a interpretação do Conceito Geral “Lean” como filosofia de redução de materiais, tempos e custos.

A model for heterogeneous networks management and Performance evaluation

In general, modern networks are analysed by taking several Key Performance Indicators (KPIs) into account, their proper balance being required in order to guarantee a desired Quality of Service (QoS), particularly, cellular wireless heterogeneous networks. A model to integrate a set of KPIs into a single one is presented, by using a Cost Function that includes these KPIs, providing for each network node a single evaluation parameter as output, and reflecting network conditions and common radio resource management strategies performance. The proposed model enables the implementation of different network management policies, by manipulating KPIs according to users' or operators' perspectives, allowing for a better QoS. Results show that different policies can in fact be established, with a different impact on the network, e.g., with median values ranging by a factor higher than two.

A general overview on hybrid and electric vehicles

The economical and environment impacts of fossil energies increased the interest for hybrid, battery and fuel-cell electric vehicles. Several demanding engineering challenges must be faced, motivated by different physical domains integration. This paper aims to present an overview on hybrid (HEV) and electric vehicles (EV) basic structures and features. In addition, it will try to point out some of the most relevant challenges to overcome for HEV and EV may be a solid option for the mobility issue. New developments in energy storage devices and energy management systems (EMS) are crucial to achieve this goal.