The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

Objective To summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. Design Cost-effectiveness modelling using the information from a randomised controlled trial. Participants Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. Outcome measures Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. Results For 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery. Conclusions The adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.

iNOS expression and osteocyte apoptosis in idiopathic, non- traumatic osteonecrosis

Background and purpose Non-traumatic osteonecrosis is a progressive disease with multiple etiologies. It affects younger individuals more and more, often leading to total hip arthroplasty. We investigated whether there is a correlation between inducible nitric oxide synthase (iNOS) expression and osteocyte apoptosis in non-traumatic osteonecrosis. Patients and methods We collected and studied 20 human idiopathic, non-traumatic osteonecrosis femoral heads. Subchondral bone samples in the non-sclerotic region (n = 30), collected from osteoarthritis patients, were used as controls. Spontaneously hypertensive rats were used as a model for osteonecrosis in the study. We used scanning electron microscopy, TUNEL assay, and immunohistochemical staining to study osteocyte changes and apoptosis. Results The morphology of osteocytes in the areas close to the necrotic region changed and the number of apoptotic osteocytes increased in comparison with the same region in control groups. The expression of iNOS and cytochrome C in osteocytes increased while Bax expression was not detectable in osteonecrosis samples. Using spontaneously hypertensive rats, we found a positive correlation between iNOS expression and osteocyte apoptosis in the osteonecrotic region. iNOS inhibitor (aminoguanidine) added to the drinking water for 5 weeks reduced the production of iNOS and osteonecrosis compared to a control group without aminoguanidine. Interpretation Our findings show that increased iNOS expression can lead to osteocyte apopotosis in idiopathic, non-traumatic osteonecrosis and that an iNOS inhibitor may prevent the progression of the disease.

The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

Reliability of a wellness inventory for use among adolescent females aged 12-14 years

Background The wellness construct has application in a number of fields including education, healthcare and counseling, particularly with regard to female adolescents. The effective measurement of wellness in adolescents can assist researchers and practitioners in determining lifestyle behaviors in which they are lacking. Behavior change interventions can then be designed which directly aid in the promotion of these areas. Methods The 5-Factor Wellness Inventory (designed to measure the Indivisible Self model of wellness) is a popular instrument for measuring the broad aspects of wellness amongst adolescents. The instrument comprises 97 items contributing to 17 subscales, five dimension scores, four context scores, total wellness score, and a life satisfaction index. This investigation evaluated the test-retest (intra-rater) reliability of the 5 F-Wel instrument in repeated assessments (seven days apart) among adolescent females aged 12-14 years. Percentages of exact agreement for individual items, and the number of respondents who scored within +/-5, +/-7.5 and +/-10 points for total wellness and the five summary dimension scores were calculated. Results Overall, 46 (95.8%) participants responded with complete data and were included in the analysis. Item agreement ranged from 47.8% to 100% across the 97 items (median 69.9%, interquartile range 60.9%-73.9%). The percentage of respondents who scored within +/-5, +/-7.5 and +/-10 points for total wellness at the re-assessment was 87.0%, 97.8% and 97.8% respectively. The percentage of respondents who scored within +/-5, +/-7.5 and +/-10 for the domain scores at the reassessment ranged between 54.3-76.1%, 78.3-95.7% and 89.1-95.7% respectively across the five dimensions. Conclusions These findings suggest there was considerable variation in agreement between the two assessments on some individual items. However, the total wellness score and the five dimension summary scores remained comparatively stable between assessments.

Exploring innovation driven value creation in B2B service firms : The roles of the manager, employees, and customers in value creation

This study adopts the premise that innovation capability underpins a service firm's value creation ability and that management style, employee behaviors and marketing underpin its innovation capability. This study examines the role of managers and employees in the creation and delivery of superior value to customers via the firm's innovation capability. To test this premise the current study examines the role of transformational leadership (TFL) as an aspect of the service firm's management style in creating and delivering value to customers through its services. This study adopts a multi-level study, collecting data from managers, employees and customers of service firms in a Southeast-Asian country, Cambodia. The results show that a service firm's innovation capability has a positive effect on the firm's value offering (VO), the VO has a positive relationship with customer perceived value-in use (PVI), and PVI has a positive relationship with firm performance. This study also finds moderating effects of TFL on the relationship between service innovation capability and VO, and of service marketing capability on the relationship between VO and PVI respectively.

Achieving superior SME performance : overarching role of marketing, innovation, and learning capabilities

While most studies examine the effect of marketing, innovation, and learning capabilities (often separately) on performance, this study develops a unified model to investigate the combined effect of these capabilities on performance. This study further examines the complementary effect of these capabilities on performance. This study draws on the resource-based view theory to examine 171 manufacturing SMEs. The findings suggest that marketing, innovation, and learning capabilities are positively related to SME performance. In addition, these capabilities interact with one another to create great synergy in achieving SME performance.

The role of intellectual resources, product innovation capability, reputational resources and marketing capability combinations in SME growth

This article examines the extent to which combinations of intellectual resources and product innovation capability, and reputational resources and marketing capability, influence the ability of small and medium-sized enterprises (SME) to meet or exceed performance goals. Empirical results drawn from 171 SMEs suggest that when the combination of intellectual resources and product innovation capability in addition to the combination of reputational resources and marketing capability are high, SME growth is enhanced. However, a high level of intellectual resources combined with a low level of product innovation capability as well as a combination of a high level of reputational resources with a low level of marketing capability (and vice versa) are not significantly related to growth. These results imply that a high level of resources cannot compensate for a low level of capabilities (and vice versa).

Achieving superior innovation-based performance outcomes in SMEs through innovation resource–capability complementarity

Firms are increasingly identifying new avenues to enhance their market position. One such effort involves the firms' ability to continuously learn. Learning has the capacity to enable firms to develop and implement more efficient and effective innovation-focused strategies, resulting in the ability to develop and deliver more products in a timelier manner. This study tests the relationship between innovation resource–capability complementarity and innovation-based performance. This study further elaborates that while innovation resource–capability complementarity drives innovation-based performance; their relationship will be enhanced via the firms' possession of superior learning capability. The findings show a significant effect of innovation resource–capability complementarity on innovation-based performance. The results also show that firms that possess superior learning capability are willing to question their operational processes and routines and make adjustments following the feedback obtained from customers and channels; thereby enhancing their abilities to develop more new products and increase their speed in delivering products to the customers.

Consumers persepctive on pharmacists integration into private primary healthcare clinics in Malaysia

Background: Pharmacists are considered medication experts but are underutilised mainly at the periphery of the primary healthcare team. General medical practitioners (GPs) in Malaysian private healthcare clinics are granted rights to prescribe and dispense medications, thus furhter limiting pharmacists involvement in ensuring safe use of medicines. The integration of pharmacist into private primary healthcare clinics has the potential to reduce medication-relation problems. Objective: To explore the views of consumers on the integration of pharmacists within private primary healthcare clinics in Malaysia. Method: A purposive sample of healthcare consumers in Selangor and Kuala Lumpur, Malaysia were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analysed using NVivo 10. Results: A total of 24 healthcare consumers particpated in two focus groups and six semi-structured interviews. Four major themes were identified: (1) Pharmacists role viewed mainly as supplying medications, (2) Readiness to accept pharmacists in private healthcare clinics, (3) Willingness to pay for pharmacy services, and (4) Concerns about GPs resistance to pharmacist integration. Consumers felt that a pharmacist integrated into private prumary healthcare clinics could offer potential benefits such as counter-checking prescriptions to ensure correct medication is supplied and counselling consumers on their medications and the potential side effects. The potential to increase in costs to consumers and GPs reluctance were perceived as barriers to integration. Conclusion: This study provides insights into consumers perspectives on the roles of pharmacists within private primary healthcare clinics in Malaysia. Consumers generally supported pharmacist integration into private primary healthcare clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.

Enterprise systems lifecycle-wide innovation readiness

Enterprise Systems have been touted as a key driver of delivering benefits through innovation in corporate Information Systems. The advent of such systems expects to deliver best practices that improve organizational performance. Yet, most Enterprise System installations struggle to see lifecycle-wide value of it. Considering that Enterprise Systems deliver lifecycle-wide innovation; we observe organizational readiness for lifecycle-wide Enterprise Systems innovation. The A VICTORY apriori model compares contributions of eight constructs for organizational readiness for continuous Enterprise Systems innovation. The model is tested responses of both client and implementation partner. Results indicate that six of the eight constructs of readiness make significant contributions to organizational readiness for Enterprise Systems innovation.

Enterprise system lifecycle-wide innovation - research in progress

Enterprise Systems purport to bring innovation to organizations. Yet, no past studies, neither from innovation nor from ES disciplines have merged their knowledge to understand how ES could facilitate lifecycle-wide innovation. Therefore, this study forms conceptual bridge between the two disciplines. In this research, we seek to understand how ES could facilitate innovation across its lifecycle phases. We associate classifications of innovation such as radical vs. incremental, administrative vs. technical innovation with the three phases of ES lifecycle. We introduce Continuous Restrained Innovation (CRI) as a new type of innovation specific to ES, considering restraints of technology, business processes and organization. Our empirical data collection at the implementation phase, using data from both the client and implementation partner, shows preliminary evidence of CRI. In addition, we state that both parties consider the implementation of ES as a radical innovation yet, are less interest in seeking further innovations through the system.

Innovation in the Australian Spatial Information Industry

Business literature reveals the importance of generating innovative products and services, but much of the innovation research has been conducted in large firms and not replicated in small firms. These firms are likely to have different perspectives on innovation, which means that they will probably behave differently to large firms. Our study aims to unpack how firms in Spatial Information perceive and engage in innovation as a part of their business operation. To investigate these questions we conduct 20 in depth interviews of top management team members in Spatial Information firms in Australia. We find that small firms define innovation very broadly and measure innovation by its effect on productivity or market success. Innovation is seen as crucial to survival and success in a competitive environment. Most firms engage in product and/or service innovations, while some also mentioned marketing, process and organisational innovations. Most innovations were more exploitative rather than exploratory with only a few being radical innovations. Innovation barriers include time and money constraints, corporate culture and Government tendering practices. Our study sheds a light on our understanding of innovation in an under-researched sector; that is spatial information industry.

A digital airport experience : design-led innovation in support of airport strategy

The digital era is proving to be one of disruption, where new technologies matched with innovative business models can be harnessed to attack even the most established of companies. For businesses with the relative certainty of captive customer bases, such as airports, the ability to digitally diversify offers the opportunity to venture into new modes of operation. For an airport, this opportunity can also be leveraged to sustain superior customer support regardless of a customer’s location in the world. This research paper presents a case study of the development of an Australian Airport Corporation’s mobile application as part of a greater digital strategy initiative using a design-led approach to innovate. An action research method provides the platform for an intensive embedded practice and study of design-led innovation within the major Australian Airport Corporation. The findings reveal design-led innovation to be a crucial in-house idea generation and concept development capability enabling the bridging of distinct corporate domains associated with commercialisation, operations and customer experience. A Digital Innovation Checklist is presented as an output of this research which structures an organizational approach toward digital channel innovation. The practitioner’s checklist is designed to aid in the future development of digital channels within the broader spectrum of strategy by addressing business assumptions.

Design research for the real world : a design-led innovation model for action research

The aim of this paper is to aid researchers in undertaking action research within industry with a particular focus on the study of design-led innovation. This paper presents the research design of a case study shaped to solve real world problems concerning a major Australian Airport Corporation by bridging the chasm between academia and industry. The researcher’s role is one of design-innovation catalyst, facilitating the integration of design as a new strategic capability and innovation approach within an organisation’s fabric. A discussion of the researcher experience within industry will provide evidence on the challenges facing such a research role, with strategies for overcoming these barriers presented. Based on the authors’ experience as a researcher within industry and reflection within practice, a project progression model for action research is presented to enable the improved management of industry based research.

Design innovation catalyst tools to facilitate organisational change

Organisations have recently looked to design to become more customer oriented and co-create a new kind of value and service offering. This requires changes in the organisation mindset, involving the entire company, innovation processes and often its business model. One tool that has been successful in facilitating this has been Osterwalder and Pigneur (2010) ‘Business Model Canvas’ and more importantly the design process that supports the use of this tool. The aim of this paper is to explore the role design tools play in the translation and facilitation process of innovation in firms. Six ‘Design Innovation Catalysts’ (Wrigley, 2013) were interviewed in regards to their approach and use of design tools in order to better facilitate innovation. Results highlight the value of tools expands beyond their intended use to include; facilitation of communicating, permission to think creatively, and learning and teaching through visualisation. Findings from this research build upon the role of the Design Innovation Catalyst and provide additional implications for organisations.