Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study

Background: To achieve good outcomes in critically ill obstetric patients, it is necessary to identify organ dysfunction rapidly so that life-saving interventions can be appropriately commenced. However, timely access to clinical chemistry results is problematic, even in referral institutions, in the sub-Saharan African region. Reliable point-of-care tests licensed for clinical use are now available for lactate and creatinine. Aim: We aimed to assess whether implementation of point-of-care testing for lactate and creatinine is feasible in the obstetric unit at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, by obtaining the opinions of clinical staff on the use of these tests in practice. Methods: During a two-month evaluation period nurse-midwives, medical interns, clinical officers, registrars, and consultants were given the opportunity to use StatStrip® and StatSensor® (Nova Biomedical, Waltham, USA) devices, for lactate and creatinine estimation, as part of their routine clinical practice in the obstetric unit. They were subsequently asked to complete a short questionnaire. Results: Thirty-seven questionnaires were returned by participants: 22 from nurse-midwives and the remainder from clinicians. The mean satisfaction score for the devices was 7.6/10 amongst clinicians and 8.0/10 amongst nurse-midwives. The majority of participants stated that the obstetric high dependency unit (HDU) was the most suitable location for the devices. For lactate, 31 participants strongly agreed that testing should be continued and 24 strongly agreed that it would influence patient management. For creatinine, 29 strongly agreed that testing should be continued and 28 strongly agreed that it would influence their patient management. Twenty participants strongly agreed that they trust point-of-care devices. Conclusions: Point-of-care clinical chemistry testing was feasible, practical, and well received by staff, and was considered to have a useful role to play in the clinical care of sick obstetric patients at this referral centre.

Solar heating for commercial swimming pools – experiences in south-eastern Australia

Commercial swimming pools, particularly aquatic centres are increasingly common features of large towns and cities in Australia as people are encouraged to increase their levels of physical activity. Swimming is regarded as a low impact form of exercise and use of indoor facilities allows this to continue all-year round. Aquatic centres are large users of energy for water and space heating with an energy intensity which can be up to seven times that of a commercial office building in Australia. Much of the energy is used to heat water to relatively low temperatures and therefore solar energy technology is capable of providing this energy. In the residential sector, solar thermal systems for heating water and swimming pools is well-established. This is not the case for commercial swimming pools i.e. aquatic centres. In Victoria, a program to encourage commercial pool operators to install solar systems was funded in the early 1980s. This paper describes an investigation into the current use of and attitudes to solar systems in commercial pools through a survey of municipal pool operators in Victoria, south-eastern Australia. The survey found that there has been very little increase in the use of solar energy and that barriers to the use of the technology remain the same as they were nearly 30 years ago. Lack of roof area, poor payback periods and an inability of solar to meet pool heating needs are the most common misconceptions. To improve the uptake of solar heating in commercial pools, further research, particularly looking at the feasibility of integrating traditional heat sources with solar collectors using smart control, is required. An incentive programme and the education of the new generation of consultants and aquatic centre operators, unfamiliar with the potential benefits of solar systems, would also help to increase their uptake.

Principal agent problems evident in Chinese PPP infrastructure projects

The demand for infrastructure remains high in China. In order to meet this demand under conditions of limited government funding availability, local governments have increasingly sought private participation through ‘public, private partnerships’ (PPPs). While PPPs are recognised as a reliable mode for delivering infrastructure projects, agency problems are also known to interfere with their success. The nature of these agency problems, along with the types of partnership arrangements under which they occur, is the subject of this research. Semi-structured interviews were conducted with PPP consultants working on infrastructure projects in China. Results suggest that opportunistic behaviour is to be found both within the private sector and within the government sector. While the private sector is shown to take advantage of ‘information asymmetries,’ the government sector is shown to allocate project risks and responsibilities disproportionately in their favour. Results also indicate that PPP arrangements between local government and ‘state owned enterprises’ (SOEs) were less prone to agency abuse, while agency problems in PPP arrangements between local government and private firms were relatively greater.

An exploration of the role and scope of the Clinical nurse consultant (CNC) in a metropolitan health service

Introduction

Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service.

Aim

The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service.

Method

A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes.

Results

Whilst each participant experiences their role individually, there were four themes derived from comments expressed by the participants: ‘Diversity and conflict’, ‘Leaders but powerless’, ‘Support systems’ and ‘The portfolio holder role’.

Conclusion

The role of the Clinical nurse consultant is complex and diverse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

Understanding consumer participation in mental health: issues of power and change

Consumer participation occurs in all Victorian public mental health services. Area mental health services employ consumer consultants to enhance consumer participation across the network. Ongoing support of management is essential to the success of consumer participation. This project aimed to explore understandings of consumer participation from a manager's perspective. Semistructured interviews were conducted with seven participants in this qualitative, interpretive study. The thematic analysis revealed the complexities around defining consumer participation and demonstrated the difficulties and possible reasons as to why there is no real clarity between managers, service providers, and consumers as to what consumer participation should look like. Power and change were the primary themes. Power and the overwhelming consensus that the medical model and those working within it hold the most power was strongly represented in this study. Legislation and workplace settings were seen as considerable factors adding to the disempowerment of consumers within an already disempowering mental health system. Change was the other main theme that emerged, with culture and attitudes of the old ‘institutionalized’ thinking that still pervades some pockets of mental health services being seen as the major barriers to change. The role of the consumer consultant was a prominent subtheme, with their role in training and the education of workers seen as an essential and positive way to progress consumer participation. These findings demonstrate that managers consider there to be hope for consumers, brought about by collective action and lobbying, and through consumer participation in less-restrictive parts of the service (community settings).

Interobserver agreement of Neer and AO classifications for proximal humeral fractures

BACKGROUND:The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management.

METHOD:Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics.

RESULTS:Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40-0.58), than the AO classification, which was fair to moderate (kappa = 0.31-0.54). When simplified, the Neer and AO classification interobserver agreement remained similar.

CONCLUSION:The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.

Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma

Objective: The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma.Methods: A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews.Results: Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients’ requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer.Conclusions: The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making.

Guarding against the erosion of competitive advantage: a knowledge leakage mitigation model

A critical objective of knowledge-intensive organizations is to prevent erosion of their competitive knowledge base through leakage. Our review of the literature highlights the need for a more refined conceptualization of perceived leakage risk. We propose a Knowledge Leakage Mitigation (KLM) model to explain the incongruity between perceived high-risk of leakage and lack of protective actions. We argue that an organization's perceived risk of leakage increases if competitors can benefit from leakage incidents. Further, perceived leakage risk decreases if the organization is shielded from impact due to their diversity of knowledge assets and their ability to reconfigure knowledge resources to refresh their competitive knowledge base. We describe our approach to the design of a large-scale survey instrument that has been tested and refined in two stakeholder communities: 1) knowledge managers responsible for organizational strategy, and 2) Information security management consultants.

Using business intelligence to support the process of organizational sensemaking

Making sense of an organization overwhelmed with data becomes a problem for decision makers at all levels of business planning and operation. Although scholars have suggested several technological solutions such as business intelligence as being useful in helping busy executives to make decisions, we still know little about assisting business stakeholders in the process of understanding their organizational complexity before such decisions could even be formulated. In this paper, we investigate the opportunities in using BI technologies to make sense of a business environment. We analyze the views and opinions of developers, analysts, consultants, and users of business intelligence, who are experienced in using the technology beyond decision making to support organizational sensemaking. Our results highlight the need for creating and maintaining individual; and organizational identity and enacting this identity on the business and its environment.

The applicability of self-regulation theories in sport: Goal adjustment capacities, stress appraisals, coping, and well-being among athletes

We examined a model, informed by self-regulation theories from the health psychology literature, which included goal adjustment capacities, appraisals of challenge and threat, coping, and well-being. Two-hundred and twelve athletes from the United Kingdom (n 147)= or Australia (n = 65), who played team (n = 135) or individual sports (n = 77), and competed at international (n = 7), national (n = 11), county (n = 67), club (n = 84), or beginner (n = 43) levels participated in this study. Participants completed measures of goal adjustment capacities and stress appraisals two days before competing. Athletes also completed coping and well-being questionnaires within three hours of their competition ending.The way an athlete responded to an unattainable goal was associated with his or her well-being in the period leading up to and including the competition. Goal reengagement positively predicted well-being, whereas goal disengagement negatively predicted well-being. Further, goal reengagement was positively associated with challenge appraisals, which in turn was linked to task-oriented coping, and task-oriented coping positively associated with well-being.When highly-valued goals become unattainable, consultants and coaches could encourage athletes to generate alternative approaches to achieve the same goal or help them develop a completely new goal in order to promote well-being among athletes.

Implementation of innovative technologies in small-scale construction firms: five Australian case studies

Purpose - The users of construction technologies such as builders and trades people have been acknowledged as sources of potentially important innovations. These innovations may be in the form of safer, less labour intensive, or cheaper methods and processes. The purpose of this paper is to assess whether the Australian construction industry is providing an environment where user-based innovation is being supported and implemented. Design/methodology/approach - An explorative study was undertaken to provide an insight into actual experiences of the implementation of user-based innovation. The data were collected through faceto- face semi-structured interviews providing case studies on multiple aspects of the implementation of innovative construction technologies. The cases involved a cross section of advances, including product, tool, and system technologies. Findings - The main motivation behind developing the technologies was problem solving. The associated industries of manufacturing and retail, as well as consultants within the construction industry present the greatest barriers to implementation. Originality/value - This research provides a better understanding of the factors that are preventing the successful implementation of user-based innovative construction technologies in small firms.

EQUASS Assurance Certification: The View of Pioneer Adopters

Purpose – The paper examines from a practitioner’s perspective the European Quality in Social Services (EQUASS) Assurance standard, a certification programme for European social service organisations to implement a sector-specific Quality Management System. In particular, it analyses the adoption motives, the internalisation of the standard, the impacts, the satisfaction and the renew intentions. Design/methodology/approach – This study uses a cross-sectional, questionnaire-based survey methodology. From the 381 organisations emailed, 196 responses coming from eight different European countries were considered valid (51.4%). Data from closed-ended questions were analysed using simple descriptive statistical techniques. Content analysis was employed to analyse practitioner’s comments to open-ended questions. Findings – It shows that social service providers typically implement the certification for internal reasons, and internalise EQUASS principles and practices in daily usage. EQUASS Assurance produces benefits mainly at the operational and customer levels, whereas its main pitfalls include increased workload and bureaucracy. The majority of respondents (85.2%) are very satisfied or satisfied with the certification, suggesting that it meets their expectations. Certification renewal intentions are also high but some respondents report that the final decision depends on several factors. The insights gained through the qualitative data are also described. Practical implications – It can be helpful to managers, consultants and Local License Holders working (or planning to work) with this standard. It can inform the work of the EQUASS Technical Working Group in the forthcoming revision of the standard. Originality/value – This is the largest survey conducted so far about EQUASS Assurance in terms of number of respondents, participating countries and topics covered.

Carers in the welfare state : on informal care and support for carers in Sweden

  The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

From human capacity development to national capacity development : a report on capacity development in the economic and public sectors of PNG during 2006-2013

This Report concerns capacity development in the economic and public sectors of PNG. In particular, it focuses on the use of advisers to develop the capacity of PNG counterparts in economic and public sector agencies. Such advisers were funded by the Government of Australia and completed or commenced their placements during the period 2006–2013. The research was commissioned by (then) AusAID and commenced in mid-2012. It was completed in mid-2014 under the auspices of Australian Aid, Department of Foreign Affairs & Trade. The project was overseen by the Economic and Public Sector Program administered by Coffey International. The research addressed several research questions about adviser-counterpart placements: What are the advisers’ and counterparts’ views of the success or otherwise of their partnerships in achieving their placements’ stated aims? What approaches were adopted to enable counterparts to learn what was required to fulfil their placements’ aims? What were the main things learned by counterparts? What can be understood from these experiences and how might capacity development be improved? What were the main enablers of and impediments to the success of the placements? What have been the outcomes of the introduction of other modalities of capacity development including short-term consultants, twinning arrangements, targeted training, grants and research? Do these modalities provide increased efficiencies and effectiveness compared to adviser-counterpart placements? What are the main improvements that can be made to ensure the success of future adviser-counterpart placements? What do major stakeholders in PNG conclude from the evidence produced by this study about the impact and success of adviser-counterpart placements? What may be asserted from the evidence of the worth or otherwise of adviser-counterpart placements and other capacity development modalities undertaken since 2006? What suggestions or recommendations may be made for the future?

Collaboration and student engagement in design education

One of the great paradoxes in design education is that undergraduate students are encouraged to study and model the behaviors and attitudes of famous designers, but without being aware that such esteemed individuals rarely work in isolation. The vast majority of designers work in teams, as part of both the conceptualization and production processes. Even 'design-auteurs' or 'artist-designers' must still interact with, respectively, clients, consultants and contractors, or patrons, curators and publishers. As a result of this, collaboration is widely considered an essential part of the design process and a critical skill for developing a career in the design industries. However, while design practitioners and the professional bodies that represent them acknowledge the importance of groups and teams, there has been a general reluctance (either an unwillingness or inability) to emphasize the importance or team processes, or em­bed the development of team skills, in undergraduate design curricula. There are many reasons for this situation existing, but we cannot underestimate the general attitude, implicit in much design education and promulgated through the design media, that creativity is an individual trait.