Who's really hypertensive? - Quality control issues in the assessment of blood pressure for randomized trials

The characterization of blood pressure in treatment trials assessing the benefits of blood pressure lowering regimens is a critical factor for the appropriate interpretation of study results. With numerous operators involved in the measurement of blood pressure in many thousands of patients being screened for entry into clinical trials, it is essential that operators follow pre-defined measurement protocols involving multiple measurements and standardized techniques. Blood pressure measurement protocols have been developed by international societies and emphasize the importance of appropriate choice of cuff size, identification of Korotkoff sounds, and digit preference. Training of operators and auditing of blood pressure measurement may assist in reducing the operator-related errors in measurement. This paper describes the quality control activities adopted for the screening stage of the 2nd Australian National Blood Pressure Study (ANBP2). ANBP2 is cardiovascular outcome trial of the treatment of hypertension in the elderly that was conducted entirely in general practices in Australia. A total of 54 288 subjects were screened; 3688 previously untreated subjects were identified as having blood pressure >140/90 mmHg at the initial screening visit, 898 (24%) were not eligible for study entry after two further visits due to the elevated reading not being sustained. For both systolic and diastolic blood pressure recording, observed digit preference fell within 7 percentage points of the expected frequency. Protocol adherence, in terms of the required minimum blood pressure difference between the last two successive recordings, was 99.8%. These data suggest that adherence to blood pressure recording protocols and elimination of digit preferences can be achieved through appropriate training programs and quality control activities in large multi-centre community-based trials in general practice. Repeated blood pressure measurement prior to initial diagnosis and study entry is essential to appropriately characterize hypertension in these elderly patients.

The impact of leadership and change management strategy on organizational culture and individual acceptance of change during a merger

This article reports a longitudinal study that examined mergers between three large multi-site public-sector organizations. Both qualitative and quantitative methods of analysis are used to examine the effect of leadership and change management strategies on acceptance of cultural change by individuals. Findings indicate that in many cases the change that occurs as a result of a merger is imposed on the leaders themselves, and it is often the pace of change that inhibits the successful re-engineering of the culture. In this respect, the success or otherwise of any merger hinges on individual perceptions about the manner in which the process is handled and the direction in which the culture is moved. Communication and a transparent change process are important, as this will often determine not only how a leader will be regarded, but who will be regarded as a leader. Leaders need to be competent and trained in the process of transforming organizations to ensure that individuals within the organization accept the changes prompted by a merger.

The contagion of international terrorism and its effects on the firm in an interconnected world

International trade and investment economies are highly integrated and interdependent and can be exploited by organized, international terrorism. The network of inter dependencies in the international economy means that a terrorist attack has the potential to disrupt the functioning of the network, so the effects can reverberate around the world. Governments can control the distributed effects of terrorism by auditing industrial networks to reveal and protect critical hubs and by promoting flexibility in production and distribution of goods and services to improve resilience in the economy. To explain these network effects, the authors draw on the new science of complex networks which has been applied to the physical sciences and is now increasingly being used to explain organizational and economic phenomena.

A software audit framework for spyware risk mitigation

Our research described in this paper identifies a three part premise relating to the spyware paradigm. Firstly the data suggests spyware is proliferating at an exponential rate. Secondly ongoing research confirms that spyware produces many security risks – including that of privacy/confidentiality breaches via illicit data collection and reporting. Thirdly, anti-spyware controls are improving but are still considered problematic for several reasons. Our research then concludes that control measures to counter this very significant challenge should merit compliance auditing – and this auditing may effectively target the vital message passing performed by all illicit data collection spyware. Our research then evolves into an experiment involving the design and implementation of a software audit tool to conduct the desired compliance auditing. The software audit tool is positioned at the protected network’s gateway. The software audit tool uses ‘phone-home’ IP addresses as spyware signatures to detect the presence of the offending software. The audit tool also has the capability to differentiate legitimate message passing software from that produced by spyware – and ‘learn’ both new spyware signatures and new legitimate message passing profiles. The testing stage of the software has proven successful – albeit using very limited levels of network message passing variety and frequency.