Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment–elevation myocardial infarction in Australia

Background Improving timely access to reperfusion is a major goal of ST-segment–elevation myocardial infarction care. We sought to compare the population impact of interventions proposed to improve timely access to reperfusion therapy in Australia. Methods and Results Australian hospitals, population, and road network data were integrated using Geographical Information Systems. Hospitals were classified into those that provided primary percutaneous coronary intervention (PPCI) or fibrinolysis. Population impact of interventions proposed to improve timely access to reperfusion (PPCI, fibrinolysis, or both) were modeled and compared. Timely access to reperfusion was defined as the proportion of the population capable of reaching a fibrinolysis facility ≤60 minutes or a PPCI facility ≤120 minutes from emergency medical services activation. The majority (93.2%) of the Australian population has timely access to reperfusion, mainly (53%) through fibrinolysis. Only 40.2% of the population had timely access to PPCI, and access to PPCI services is particularly limited in regional and nonexistent in remote areas. Optimizing the emergency medical services’ response or increasing PPCI services resulted in marginal improvement in timely access (1.8% and 3.7%, respectively). Direct transport to PPCI facilities and interhospital transfer for PPCI improves timely access to PPCI for 19.4% and 23.5% of the population, respectively. Prehospital fibrinolysis markedly improved access to timely reperfusion in regional and remote Australia. Conclusions Significant gaps in timely provision of reperfusion remain in Australia. Systematic implementation of changes in service delivery has potential to improve timely access to PPCI for a majority of the population and improve access to fibrinolysis to those living in regional and remote areas.

Competing through service innovation : the role of bricolage and entrepreneurship in project-oriented firms

The criticality of service innovation in building and sustaining competitive advantage is gaining increasing recognition in the marketplace. Using empirical data from US and Australian project-oriented firms, the study uses a multi-staged multi-method research program to demonstrate how entrepreneurial service firms strategically combine resources at hand (bricolage) to innovate and stay ahead of rivals. The research shows that service entrepreneurship (SE) and bricolage influence two forms of service innovation (interactive and supportive), which in turn is associated with sustained competitive advantage (SCA). The results suggest that SE and bricolage indirectly relate to SCA through service innovation. The findings offer novel insights into how project-oriented service firms engage in innovation. In short, the findings encourage the “making do by combining resources at hand” as higher levels of entrepreneurial bricolage are associated with higher levels of interactive and supportive innovation enabling SCA, suggesting a new model.

Knowledge-Intensive Business Processes: Proceedings of the 1st International Workshop on Knowledge-intensive Business Processes [CEUR Workshop Proceedings, Volume 861]

Nowadays, Workflow Management Systems (WfMSs) and, more generally, Process Management Systems (PMPs) are process-aware Information Systems (PAISs), are widely used to support many human organizational activities, ranging from well-understood, relatively stable and structures processes (supply chain management, postal delivery tracking, etc.) to processes that are more complicated, less structured and may exhibit a high degree of variation (health-care, emergency management, etc.). Every aspect of a business process involves a certain amount of knowledge which may be complex depending on the domain of interest. The adequate representation of this knowledge is determined by the modeling language used. Some processes behave in a way that is well understood, predictable and repeatable: the tasks are clearly delineated and the control flow is straightforward. Recent discussions, however, illustrate the increasing demand for solutions for knowledge-intensive processes, where these characteristics are less applicable. The actors involved in the conduct of a knowledge-intensive process have to deal with a high degree of uncertainty. Tasks may be hard to perform and the order in which they need to be performed may be highly variable. Modeling knowledge-intensive processes can be complex as it may be hard to capture at design-time what knowledge is available at run-time. In realistic environments, for example, actors lack important knowledge at execution time or this knowledge can become obsolete as the process progresses. Even if each actor (at some point) has perfect knowledge of the world, it may not be certain of its beliefs at later points in time, since tasks by other actors may change the world without those changes being perceived. Typically, a knowledge-intensive process cannot be adequately modeled by classical, state of the art process/workflow modeling approaches. In some respect there is a lack of maturity when it comes to capturing the semantic aspects involved, both in terms of reasoning about them. The main focus of the 1st International Workshop on Knowledge-intensive Business processes (KiBP 2012) was investigating how techniques from different fields, such as Artificial Intelligence (AI), Knowledge Representation (KR), Business Process Management (BPM), Service Oriented Computing (SOC), etc., can be combined with the aim of improving the modeling and the enactment phases of a knowledge-intensive process. The 1st International Workshop on Knowledge-intensive Business process (KiBP 2012) was held as part of the program of the 2012 Knowledge Representation & Reasoning International Conference (KR 2012) in Rome, Italy, in June 2012. The workshop was hosted by the Dipartimento di Ingegneria Informatica, Automatica e Gestionale Antonio Ruberti of Sapienza Universita di Roma, with financial support of the University, through grant 2010-C26A107CN9 TESTMED, and the EU Commission through the projects FP7-25888 Greener Buildings and FP7-257899 Smart Vortex. This volume contains the 5 papers accepted and presented at the workshop. Each paper was reviewed by three members of the internationally renowned Program Committee. In addition, a further paper was invted for inclusion in the workshop proceedings and for presentation at the workshop. There were two keynote talks, one by Marlon Dumas (Institute of Computer Science, University of Tartu, Estonia) on "Integrated Data and Process Management: Finally?" and the other by Yves Lesperance (Department of Computer Science and Engineering, York University, Canada) on "A Logic-Based Approach to Business Processes Customization" completed the scientific program. We would like to thank all the Program Committee members for the valuable work in selecting the papers, Andrea Marrella for his valuable work as publication and publicity chair of the workshop, and Carola Aiello and the consulting agency Consulta Umbria for the organization of this successful event.

Dealing with unfinished business : preparing pre-service social education teachers for curriculum change

Pre-service teacher education is unfinished business. New social education teachers face the challenge of fluid policy environments in which curriculum content and pedagogy are continually changing. The evolving Australian curriculum is the most recent example of such fluidity with its emphasis on shifting the educational agenda to a focus on discipline-based approaches. This paper addresses the concerns of final year pre-service and early career social education teachers, in terms of their professional development needs, by drawing on the findings of a pilot study with students and recent graduates from a university in south-east Queensland. It concludes that social education curriculum units which embed links to professional practice and professional development in teaching, learning and assessment may provide the way forward for enhancing the transition to practice for beginning teachers and assist them in navigating constant change.

Digital Storytelling within a Service-Learning Partnership: Technology as Product and Process for University Students and Culturally and Linguistically Diverse High School Youth

This chapter describes a university/high school partnership focused on digital storytelling. It also explains the multi-stage process used to establish this successful partnership and project. The authors discuss the central role that technology played in developing this university/high school partnership, a collaboration that extended the impact of a digital storytelling project to reach high school students, university students, educators, high school administrators, and the local community. Valuing a reflective process that can lead to the creation of a powerful final product, the authors describe the impact of digital storytelling on multiple stakeholders, including the 13 university students and 33 culturally and linguistically diverse high school youth who participated during the fall of 2009. In addition, the chapter includes reflections from university and high school student participants expressed during focus groups conducted throughout the project. While most participants had a positive experience with the project, complications with the technology component often caused frustrations and additional challenges. Goals for sharing this project are to critically evaluate digital storytelling, describe lessons learned, and recommend good practices for others working within a similar context or with parallel goals.

The heart of quality teaching : a values-based pedagogy for pre-service teacher education

In an ever changing world the adults of the future will be faced with many challenges. To cope with these challenges it seems apparent that values education will need to become paramount within a child.s education. A considerable number of research studies have indicated that values education is a critical component within education (Lovat & Toomey, 2007b). Building on this research Lovat (2006) claimed that values education was the missing link in quality teaching The concept of quality teaching had risen to the fore within educational research literature in the late 20th century with the claim that it is the teacher who makes the difference in schooling (Hattie, 2004). Thus, if teachers make such a difference to student learning, achievement and well-being, then it must hold true that pre-service teacher education programmes are vital in ensuring the development of quality teachers for our schools. The gap that this current research programme addressed was to link the fields of values education, quality teaching and pre-service teacher education. This research programme aimed to determine the impact of a values-based pedagogy on the development of quality teaching dimensions within pre-service teacher education. The values-based pedagogy that was investigated in this research programme was Philosophy in the Classroom. The research programme adopted a nested case study design based on the constructivist-interpretative paradigm in examining a unit within a pre-service teacher education programme at a Queensland university. The methodology utilised was qualitative where the main source of data was via interviews. In total, 43 pre-service teachers participated in three studies in order to determine if their involvement in a unit where the focus was on introducing pre-service teachers to an explicit values-based pedagogy impacted on their knowledge, skills and confidence in terms of quality teaching dimensions. The research programme was divided into three separate studies in order to address the two research questions: 1. In what ways do pre-service teachers perceive they are being prepared to become quality teachers? 2. Is there a connection between an explicit values-based pedagogy in pre-service teacher education and the development of pre-service teachers. understanding of quality teaching? Study One provided insight into 21 pre-service teachers. understandings of quality teaching. These 21 participants had not engaged in an explicit values-based pedagogy. Study Two involved the interviewing of 22 pre-service teachers at two separate points in time . prior to exposure to a unit that employed a values-explicit pedagogy and post this subject.s lecture content delivery. Study Three reported on and analysed individual case studies of five pre-service teachers who had participated in Study Two Time 1 and Time 2, as well as a third time following their field experience where they had practice in teaching the values explicit pedagogy. The results of the research demonstrate that an explicit values-based pedagogy introduced into a teacher education programme has a positive impact on the development of pre-service teachers. understanding of quality teaching skills and knowledge. The teaching and practice of a values-based pedagogy positively impacted on pre-service teachers with increases of knowledge, skills and confidence demonstrated on the quality teaching dimensions of intellectual quality, a supportive classroom environment, recognition of difference, connectedness and values. These findings were reinforced through the comparison of pre-service teachers who had participated in the explicit values-based pedagogical approach, with a sample of pre-service teachers who had not engaged in this same values-based pedagogical approach. A solid values-based pedagogy and practice can and does enhance pre-service teachers. understanding of quality teaching. These findings surrounding the use of a values-based pedagogy in pre-service teacher education to enhance quality teaching knowledge and skills has contributed theoretically to the field of educational research, as well having practical implications for teacher education institutions and teacher educators.

Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane

Aim: The aim of this pilot study is to describe the use of an Emergency Department (ED) at a large metropolitan teaching hospital by patients who speak English or other languages at home. Methods: All data were retrieved from the Emergency Department Information System (EDIS) of this tertiary teaching hospital in Brisbane. Patients were divided into two groups based on the language spoken at home: patients who speak English only at home (SEO) and patients who do not speak English only or speak other language at home (NSEO). Modes of arrival, length of ED stay and the proportion of hospital admission were compared among the two groups of patients by using SPSS V18 software. Results: A total of 69,494 patients visited this hospital ED in 2009 with 67,727 (97.5%) being in the SEO group and 1,281 (1.80%) in the NSEO group. The proportion of ambulance utilisation in arrival mode was significantly higher among SEO 23,172 (34.2%) than NSEO 397 (31.0%), p <0.05. The NSEO patients had longer length of stay in the ED (M = 337.21, SD = 285.9) compared to SEO patients (M= 290.9, SD = 266.8), with 46.3 minutes (95%CI 62.1, 30.5, p <0.001) difference. The admission to the hospital among NSEO was 402 (31.9%) higher than SEO 17,652 (26.6%), p <0.001. Conclusion: The lower utilisation rates of ambulance services, longer length of ED stay and higher hospital admission rates in NSEO patients compared to SEO patients are consistent with other international studies and may be due to the language barriers.

The influence of service quality and trade show effectiveness on post-show purchase intention

Purpose The purpose of this paper is to develop and test an integrative services framework to investigate the role of perceived trade show effectiveness on overall trade show service outcome, conceptualised as the intention to purchase a related product after, rather than during, a show. Design/methodology/approach Drawing on the services marketing and trade show literature, the authors test a model of trade show effectiveness with data collected from 592 attendees at a major automotive trade show in a large metropolitan centre. Findings Results show that improving trade show visitors' perceived service quality positively affects visitor perceptions of trade show effectiveness. Furthermore, both trade show effectiveness and service quality directly influence future purchase intention. Research limitations/implications Employing a services theoretical framework to evaluate trade show visitor experiences provides an alternative to the traditional marketing communications approach. By viewing such visits as service encounters, managers must inevitably consider the effects of service quality and service outcomes in determining the likely success of their shows. The study primarily focuses on one large consumer show and therefore does not constitute a complete, nor necessarily representative, sample of the trade show industry. Originality/value The original contribution of the paper stems from the paucity of research conceptualising trade shows as services and the comparative lack of emphasis placed on visitors rather than exhibitors in the literature. The research not only has utility for trade show organisers but also provides necessary theory-based research in the trade show domain.

What health problems overcrowd hospital emergency departments in Queensland and has this changed over time? A case study of two hospitals in Queensland 2001 - 2009

Aim: to describe what health problems patients attending emergency department with and whether this changed over time. Methods: Electronic data was retrieved from EDIS (Emergency Department Information System) and HBCIS (Hospital Based Clinical Information System) in two hospitals in Queensland in the period 2001-2009. The ICD-10 code of patient's diagnosis was then extrapolated and then group into ICD-10 chapters, such that the health problem can be presented. Results: Among the specific health problems, Chapter XIX 'Injury and poisoning' ranked number one consistently (ranging from 22.1% to 31.2% of the total presentations) in both the urban and remote hospitals in Queensland. The top ten specific presenting health problems in both the urban and remote hospital include Chapter XI 'Digestive system', Chapter XIV 'Genitourinary system', Chapter IX 'Circulatory system', and Chapter XIII 'Musculoskeletal system and connective tissue'. Chapter X 'Respiratory system' made the top ten presenting Chapters in both hospitals, but ranked much higher (number four consistently for the eight years, ranging from 6.8% to 8.3%) in the remote hospital. Chapter XV 'Pregnancy childbirth and puerperium' made to the top ten in the urban hospital only while Chapter XII 'Skin and subcutaneous tissue', Chapter I 'Infectious and parasitic diseases' made the top ten in the remote hospital only. Conclusion: The number one health problem presenting to both the urban and remote hospitals in Queensland is Chapter XIX 'Injury and poisoning', and it did not change in the period 211 - 2009.

A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

Background Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission. Methods/Design The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness. Discussion The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.