893 resultados para Lund Integrated Medicines Management (LIMM)
Resumo:
Field experiments were conducted in field bean in the north-eastern part of the Republic of Croatia to compare weed control and crop response under different management practices within the critical period of field bean production. The practices consisted in broadcast application of labelled rate of preemergence herbicide (PRE) and postemergence herbicide application: (POST) broadcast, band application over the rows, and band application combined with mechanical cultivation using of different herbicide doses recommended by the manufacturer (2x, 1x, 1/2x, 1/4x, 1/8x). In 1999, weed control with PRE application of pendimethalin was superior to POST bentazone application due to late emergence of weeds and lack of residual herbicide control. In 2000 bentazone combined with cycloxydim controlled weeds in field bean better than PRE herbicide application. Based on the results of this research, single PRE or POST application of herbicide did not control a broad spectrum of weeds and did not provide the commercially acceptable full season control. Reduced rates of herbicide are not advisable tinder high weed pressure.
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Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.
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Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.
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Sustainable lake management for nutrient-enriched lakes must be underpinned by an understanding of both the functioning of the lake, and the origins of changes in nutrient loading from the catchment. To date, limnologists have tended to focus on studying the impact of nutrient enrichment on the lake biota, and the dynamics of nutrient cycling between the water column, biota and sediments within the lake. Relatively less attention has been paid to understanding the specific origins of nutrient loading from the catchment and nutrient transport pathways linking the lake to its catchment. As such, when devising catchment management strategies to reduce nutrient loading on enriched lakes, assumptions have been made regarding the relative significance of non-point versus point sources in the catchment. These are not always supported by research conducted on catchment nutrient dynamics in other fields of freshwater science. Studies on nutrient enrichment in lakes need to take account of the history of catchment use and management specific to each lake in order to devise targeted and sustainable management strategies to reduce nutrient loading to enriched lakes. Here a modelling approach which allows quantification of the relative contribution of nutrients from each specific point and non-point catchment source over the course of catchment history is presented. The approach has been applied to three contrasting catchments in the U.K. for the period 1931 to present. These are the catchment of Slapton Ley in south Devon, the River Esk in Cumbria and the Deben Estuary in Suffolk. Each catchment showed marked variations in the nature and intensity of land use and management. The model output quantifies the relative importance of point source versus non-point livestock and land use sources in each of the catchments, and demonstrates the necessity for an understanding of site-specific catchment history in devising suitable management strategies for the reduction of nutrient loading on enriched lakes.
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Increasing energy use has caused many environmental problems including global warming. Energy use is growing rapidly in developing countries and surprisingly a remarkable portion of it is associated with consumed energy to keep the temperature comfortable inside the buildings. Therefore, identifying renewable technologies for cooling and heating is essential. This study introduced applications of steel sheets integrated into the buildings to save energy based on existing technologies. In addition, the proposed application was found to have a considerable chance of market success. Also, satisfying energy needs for space heating and cooling in a single room by using one of the selected applications in different Köppen climate classes was investigated to estimate which climates have a proper potential for benefiting from the application. This study included three independent parts and the results related to each part have been used in the next part. The first part recognizes six different technologies through literature review including Cool Roof, Solar Chimney, Steel Cladding of Building, Night Radiative Cooling, Elastomer Metal Absorber, and Solar Distillation. The second part evaluated the application of different technologies by gathering the experts’ ideas via performing a Delphi method. The results showed that the Solar Chimney has a proper chance for the market. The third part simulated both a solar chimney and a solar chimney with evaporation which were connected to a single well insulated room with a considerable thermal mass. The combination was simulated as a system to estimate the possibility of satisfying cooling needs and heating needs in different climate classes. A Trombe-wall was selected as a sample design for the Solar Chimney and was simulated in different climates. The results implied that the solar chimney had the capability of reducing the cooling needs more than 25% in all of the studied locations and 100% in some locations with dry or temperate climate such as Mashhad, Madrid, and Istanbul. It was also observed that the heating needs were satisfied more than 50% in all of the studied locations, even for the continental climate such as Stockholm and 100% in most locations with a dry climate. Therefore, the Solar Chimney reduces energy use, saves environment resources, and it is a cost effective application. Furthermore, it saves the equipment costs in many locations. All the results mentioned above make the solar chimney a very practical and attractive tool for a wide range of climates.
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Purpose - This paper aims to propose a model of production management that integrates knowledge management, as a third dimension, to the production and work dimensions and to identify factors that promote a favorable context for knowledge sharing and results achievement in the production operations shop floor environment.Design/methodology/approach - The model proposed is built from opportunities identified in the literature review.Findings - The factors in the model integrate its three main components: knowledge management, production organization and work organization, providing a representation of the dynamics of the workplace and shop floor environment.Practical implications - The proposed model and its factors allow managers to better understand and to improve the organization activities, because it integrates knowledge management with the production organization and work organization components of traditional models.Originality/value - Literature acknowledges the role of knowledge as competitive advantage, but it is still dealt in an implicit way within the traditional models of production management. This paper proposes a model and factors that provide a favorable context for tacit knowledge sharing and results achievement in the production operations shop floor environment. The model explicitly integrates knowledge management with traditional models' components.
Resumo:
This paper aims to examine the relevance of a production management model, in the shop-floor operations environment, that integrates the dimensions of production organisation (lean and mass production), work organisation (enriched and semi-autonomous groups) and knowledge management. A theoretical model has been applied to automotive companies to verify model adherence. Each of those dimensions has been described by factors. Shop-floor personnel interviews were conducted to confirm the factors relevance to that company. Results have shown that the model represented the reality of those companies concerning the researched dimensions. The factors allow managers to promote a favourable context for knowledge sharing. © 2010 Inderscience Enterprises Ltd.