Can telepharmacy provide pharmacy services in the bush?

Rural and remote community pharmacies service large areas of rural Queensland, and because of the distances involved often do not meet the patients for whom they provide medication. Telepharmacy would improve the quality of pharmaceutical services provided in rural and remote areas, by allowing community pharmacists to have realtime contact with dispensing doctors, aboriginal health workers and patients via a video-phone. We used commercial (analogue) videophones to connect community pharmacists to dispensing doctors, patients in depot pharmacies (i.e. those with no pharmacist) and aboriginal health workers. However, various problems occurred and only 10 video-phone interactions were recorded during the six-month project. In all of the recorded interactions, the video-phone was actually used as a conventional telephone because a video-connection could not be established at the time of the call. (This may have been due to telephone network problems in the rural areas.) Despite these problems, all project participants showed great enthusiasm for the potential benefits of such a service.

Editorial

On behalf of the Operational Research Society, Palgrave Macmillan and the editorial team, I am pleased to welcome readers to this, the first issue of Knowledge Management Research & Practice (KMRP). The aim of KMRP is to provide an outlet for rigorous, high-quality, peer-reviewed articles on all aspects of managing knowledge, organisational learning, intellectual capital and knowledge economics. The Editorial Board intends that there be a particular emphasis on cross-disciplinary approaches, and on the mixing of 'hard' (e.g. technological) and 'soft' (e.g. cultural or motivational) issues. This issue features four regular papers and an editorial paper; in addition, there are two book reviews. KMRP is intended as a truly international journal. The papers in this issue feature authors based in five different countries on three continents; eight different countries and four continents if the editorial paper is included. The first of the regular papers is 'The Knowledge-Creating Theory Revisited: Knowledge Creation as Synthesizing Process', by Ikujiro Nonaka and Ryoko Toyama. There can be few readers who are unaware of the work on knowledge creation by Nonaka and his co-workers such as Takeuchi, and this paper seeks to revisit and extend some of the earlier ideas. The second paper is 'Knowledge Sharing in a Multi-Cultural Setting: A Case Study' by Dianne Ford and Yolande Chan. They present a case study that explores the extent to which knowledge sharing is dependent on national culture. The third paper is 'R&D Collaboration: The Role of bain Knowledge-creating Networks' by Malin Brännback. She also draws upon Nonaka and Takeuchi's work on knowledge creation, using the case of knowledge-creating networks in biopharmaceutical R&D involving both universities and industry as an example. The fourth regular paper is 'The Critical Role of Leadership in Nurturing a Knowledge Supporting Culture' by Vincent Ribière and Alea Saa Sitar. They examine the role of leaders in knowledge management generally, and especially in knowledge organisations, from the viewpoint of 'leading through a knowledge lens'. In addition, this issue includes an 'editorial paper', 'Knowledge Management Research & Practice: Visions and Directions' by the editorial team of John Edwards, Meliha Handzic, Sven Carlsson, and Mark Nissen. This paper presents a small survey of academics and practitioners, outlines key directions for knowledge management research and practice, and gives the editorial team's views on how KMRP can help promote scholarly inquiry in the field. We trust that you will both enjoy reading this first issue and be stimulated by it, and cordially invite you to contribute your own paper(s) to future issues of KMRP.

Knowledge management research and practice:visions and directions

This editorial paper outlines key directions for knowledge management research and practice. The editorial team presents the results from a small survey of academics and practitioners about the present and future of knowledge management, and the editors include their own informed views on how this journal can help promote scholarly inquiry in the field.

Alogliptin after acute coronary syndrome in patients with type 2 diabetes

Background - To assess potentially elevated cardiovascular risk related to new antihyperglycemic drugs in patients with type 2 diabetes, regulatory agencies require a comprehensive evaluation of the cardiovascular safety profile of new antidiabetic therapies. We assessed cardiovascular outcomes with alogliptin, a new inhibitor of dipeptidyl peptidase 4 (DPP-4), as compared with placebo in patients with type 2 diabetes who had had a recent acute coronary syndrome. Methods - We randomly assigned patients with type 2 diabetes and either an acute myocardial infarction or unstable angina requiring hospitalization within the previous 15 to 90 days to receive alogliptin or placebo in addition to existing antihyperglycemic and cardiovascular drug therapy. The study design was a double-blind, noninferiority trial with a prespecified noninferiority margin of 1.3 for the hazard ratio for the primary end point of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results - A total of 5380 patients underwent randomization and were followed for up to 40 months (median, 18 months). A primary end-point event occurred in 305 patients assigned to alogliptin (11.3%) and in 316 patients assigned to placebo (11.8%) (hazard ratio, 0.96; upper boundary of the one-sided repeated confidence interval, 1.16; P<0.001 for noninferiority). Glycated hemoglobin levels were significantly lower with alogliptin than with placebo (mean difference, -0.36 percentage points; P<0.001). Incidences of hypoglycemia, cancer, pancreatitis, and initiation of dialysis were similar with alogliptin and placebo. Conclusions - Among patients with type 2 diabetes who had had a recent acute coronary syndrome, the rates of major adverse cardiovascular events were not increased with the DPP-4 inhibitor alogliptin as compared with placebo. (Funded by Takeda Development Center Americas; EXAMINE ClinicalTrials.gov number, NCT00968708.)

Miotomía extendida en el tratamiento de la acalasia

La acalasia es una enfermedad esofágica poco frecuente que se acompaña de una importante alteración de la calidad de vida de los pacientes. Su etiología no está totalmente aclarada y sus características clínicas principales son la disfagia y la regurgitación. El tratamiento de la acalasia está dirigido al alivio funcional y sintomático mediante la abertura del esfínter esofágico inferior, siendo al momento la miotomía laparoscópica la técnica de elección mientras que las dilataciones neumáticas y la inyección de toxina botulínica deben considerarse como técnicas de recurso en casos seleccionados. Objetivo: Evaluar los resultados de la miotomía extendida más funduplicatura parcial anterior de Dorr como tratamiento de la acalasia por vía laparoscópica, comparándola con nuestra experiencia previa mediante la técnica estándar. Materiales y método: diseño: Estudio prospectivo, descriptivo y longitudinal. Sede: Hospital Latino, Cuenca - Ecuador. Pacientes y método: Desde junio de 1992 hasta diciembre del 2011 se intervinieron 39 pacientes con diagnóstico de acalasia que recibieron tratamiento quirúrgico por medio de cirugía mínimamente invasiva. Se estudió la edad, sintomatología previa, clasificación según Stewart, tiempo de evolución de los síntomas, técnica operatoria realizada, control postoperatorio. Resultados: Se intervinieron 39 paciente, con edad promedio de 66 años, mínima 23 y máxima 81. La sintomatología presentada fue disfagia en el 100%, regurgitación en el 74,4%, pérdida de peso en el 71,8% y odinofagia en el 28.2%. El tiempo de evolución de los síntomas fueron: menor a 2 años 48.7% (n=19), de 2 a 4 años 33.3% (n=13), de 4 a 6 años de 12.8% (n=5), y de 6 a 8 años un 5.1% (n=2). Según Stewart se clasificaron en I 8% (n=3), II 49% (n=19), III 38% (n=15) y IV 5% (n=2).La técnica empleada fue Miotomía + Dorr 57% (n=22), Miotomía extendida + Dorr 20% (n=8), Miotomía sola 18% (n=7), Miotomía + Toupet 5% (n=2). Se ha realizado seguimiento del 75% de pacientes, con resultados excelentes en el 91%, y bueno en el 9%. En los ocho últimos casos se realizó la miotomía extendida más funduplicatura tipo Dorr, brindando resultados excelentes a corto plazo. Conclusión: la miotomía gástrica extendida mejora el resultado de la terapia quirúrgica para la acalasia sin incrementar la tasa de reflujo gastroesofágico anormal cuando se añade una funduplicatura parcial anterior tipo Dorr.

Seismic waveform inversion for core-mantle boundary topography

International audience

Savani: A variable resolution whole-mantle model of anisotropic shear velocity variations based on multiple data sets

International audience