Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Hospitality Management Accounting: Current Problems and Future Opportunities

This paper discusses areas for future research opportunities by addressing accounting issues faced by management accountants practicing in hospitality organizations. Specifically, the article focuses on the use of the uniform system of accounts by operating properties, the usefulness of allocating support costs to operated departments, extending our understanding of operating costs and performance measurement systems and the certification of practicing accountants.

Learning Management Systems (LMS) and e-learning management: an integrative review and research agenda

Information Technology (IT) can be an important component for innovation since enabling e-learning it can provide conditions to which the organization can work with new business and improved processes. In this regard, the Learning Management Systems (LMS) allows communication and interaction between teachers and students in virtual spaces. However the literature indicates that there are gaps in the researches, especially concerning the use of IT for the management of e-learning. The purpose of this paper is to analyze the available literature about the application of LMS for the e-learning management, seeking to present possibilities for researches in the field. An integrative literature review was performed considering the Web of Science, Scopus, Ebsco and Scielo databases, where 78 references were found, of which 25 were full papers. This analysis derives interesting characteristics from scientific studies, highlighting gaps and guidelines for future research.

Role of climate on barn owls road-kill likelihood and the effect on population viability in future climate change

Roads represent a new source of mortality due to animal-vehicle risk of collision threatening log-term populations’ viability. Risk of road-kill depends on species sensitivity to roads and their specific life-history traits. The risk of road mortality for each species depends on the characteristics of roads and bioecological characteristics of the species. In this study we intend to know the importance of climatic parameters (temperature and precipitation) together with traffic and life history traits and understand the role of drought in barn owl population viability, also affected by road mortality in three scenarios: high mobility, high population density and the combination of previous scenarios (mixed) (Manuscript). For the first objective we correlated the several parameters (climate, traffic and life history traits). We used the most correlated variables to build a predictive mixed model (GLMM) the influence of the same. Using a population model we evaluated barn owl population viability in all three scenarios. Model revealed precipitation, traffic and dispersal have negative relationship with road-kills, although the relationship was not significant. Scenarios showed different results, high mobility scenario showed greater population depletion, more fluctuations over time and greater risk of extinction. High population density scenario showed a more stable population with lower risk of extinction and mixed scenario showed similar results as first scenario. Climate seems to play an indirect role on barn owl road-kills, it may influence prey availability which influences barn owl reproductive success and activity. Also, high mobility scenario showed a greater negative impact on viability of populations which may affect their ability and resilience to other stochastic events. Future research should take in account climate and how it may influence species life cycles and activity periods for a more complete approach of road-kills. Also it is important to make the best mitigation decisions which might include improving prey quality habitat.

Parents’ experiences during the transition from childhood to adolescence with Type 1 Diabetes: Parent-child relationships and support received during this time and clinical research portfolio

Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.

Pressure management in water distribution systems: current status, proposals, and future trends

Pressure management (PM) is commonly used in water distribution systems (WDSs). In the last decade, a strategic objective in the field has been the development of new scientific and technical methods for its implementation. However, due to a lack of systematic analysis of the results obtained in practical cases, progress has not always been reflected in practical actions. To address this problem, this paper provides a comprehensive analysis of the most innovative issues related to PM. The methodology proposed is based on a case-study comparison of qualitative concepts that involves published work from 140 sources. The results include a qualitative analysis covering four aspects: (1) the objectives yielded by PM; (2) types of regulation, including advanced control systems through electronic controllers; (3) new methods for designing districts; and (4) development of optimization models associated with PM. The evolution of the aforementioned four aspects is examined and discussed. Conclusions regarding the current status of each factor are drawn and proposals for future research outlined

The personally controlled electronic health record (PCEHR) for adults with severe communication impairments: findings of pilot research.

To date, there is little information in the literature to guide the provision of supports for using the Personally Controlled Electronic Health Record (PCEHR) in populations with severe communication impairments associated with a range of disabilities. In this paper we will (a) outline the rationale for use of PCEHR in these populations by providing an overview of relevant research to date, and (b) present results of three integrated pilot studies aiming to investigate the barriers to and facilitators for PCEHR use by people with severe communication impairments and their service providers. Finally, we will present directions for future research on use of PCEHR by people with severe communication impairments.

Estimating the effect of common method variance: the method-method pair technique with an illustration from tam research

This paper presents a meta-analysis-based technique to estimate the effect of common method variance on the validity of individual theories. The technique explains between-study variance in observed correlations as a function of the susceptibility to common method variance of the methods employed in individual studies. The technique extends to mono-method studies the concept of method variability underpinning the classic multitrait-multimethod technique. The application of the technique is demonstrated by analyzing the effect of common method variance on the observed correlations between perceived usefulness and usage in the technology acceptance model literature. Implications of the technique and the findings for future research are discussed.

A research agenda for design-based learning in engineering education

It is often argued that ‘design’ is an (perhaps the) essential characteristic of engineering practice; that, “Design requires unique knowledge, skills, and attitudes common to all engineering disciplines, and it is these attributes that distinguish engineering as a profession.” Hence, it is not surprising to see engineering design identified as a key element of engineering education. There are a range of pedagogical models described, badged with a range of names, that are suggested as approaches to teaching engineering design, for example: project-based learning, problem-based learning, design-based learning, conceive-design-implement-operate (CDIO), problem-oriented project-based learning, social design based learning and project-oriented, design-based learning. While significant literature on engineering design education generally exists, many authors note open questions regarding optimal pedagogical approaches, and opportunities for further evaluation and research. In this paper we draw on literature about design education and DBL in engineering education, and synthesise themes that present a potential research agenda for those educators involved in DBL in engineering education.A search of the research literature was conducted using terms related to DBL in engineering education, including ‘Engineering Design’, ‘Design Education’, ‘Engineering + Project Based Learning’, ‘Engineering + Problem Based Learning’ and ‘Engineering + Design Based Learning’. The literature thus collected was expanded by inspecting the lists of references in the initially identified literature set for further potentially relevant literature. This process was repeated until no further related literature was identified, and resulted in 124 items. All collected literature was carefully reviewed for explicitly identified suggestions for future research. The authors also considered the literature set as a whole to identify additional research possibilities implied by aspects of DBL practice commonly addressed weakly, or not at all, in the available published research. From the results of this review, a set of themes was synthesised by grouping related research recommendations and possibilities. In the following section the identified research themes are presented and, for each, a summary of the supporting literature is given and a central research question is formulated by the authors.

Interventions for comorbid problem gambling and psychiatric disorders : advancing a developing field of research

Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study.

Identifying knowledge gaps in seagrass research and management: An Australian perspective.

Seagrass species form important marine and estuarine habitats providing valuable ecosystem services and functions. Coastal zones that are increasingly impacted by anthropogenic development have experienced substantial declines in seagrass abundance around the world. Australia, which has some of the world's largest seagrass meadows and is home to over half of the known species, is not immune to these losses. In 1999 a review of seagrass ecosystems knowledge was conducted in Australia and strategic research priorities were developed to provide research direction for future studies and management. Subsequent rapid evolution of seagrass research and scientific methods has led to more than 70% of peer reviewed seagrass literature being produced since that time. A workshop was held as part of the Australian Marine Sciences Association conference in July 2015 in Geelong, Victoria, to update and redefine strategic priorities in seagrass research. Participants identified 40 research questions from 10 research fields (taxonomy and systematics, physiology, population biology, sediment biogeochemistry and microbiology, ecosystem function, faunal habitats, threats, rehabilitation and restoration, mapping and monitoring, management tools) as priorities for future research on Australian seagrasses. Progress in research will rely on advances in areas such as remote sensing, genomic tools, microsensors, computer modeling, and statistical analyses. A more interdisciplinary approach will be needed to facilitate greater understanding of the complex interactions among seagrasses and their environment.

Scoping review of adherence promotion theories in pelvic floor muscle training : 2011 ics state-of-the-science seminar research paper I of IV

Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

The Terminal Value (TV) Performing in Firm Valuation: The Gap of Literature and Research Agenda

The uncertainty about the future of firms must be modeled and incorporated in the valuation of enterprises outside the explicit period of analysis, i.e., in the continuing or terminal value (TV). There is a multiplicity of factors that influence the TV of firms which are not being considered within current evaluation models. This aspect leads to the incurring of unrecoverable errors, thus leading to values of goodwill or bad will far away from the substantial value of intrinsic assets. As a consequence, the evaluation results will be presented markedly different from market values. There is no consensus in the scientific community about the method of computation of the TV as a forecast in an infinite horizon. The size of the terminal, or non-explicit period, assumed as infinite, is never called into question by scientific literature, or the probability of business bankruptcy. This paper aims to promote a study of the existing literature on the TV, to highlight the fragility of the evaluation models of companies that have been used by the academic community and by financial analysts, and to point out lines for future research to minimize these errors.

Scoping review of adherence promotion theories in pelvic floor muscle training : 2011 ics state-of-the-science seminar research paper I of IV

Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.