A prospective longitudinal survey of fatigue self-management behaviors in patients with advanced cancer

Background: Fatigue is a distressing symptom experienced by approximately 74-88% of patients with advanced cancer. Although there have been advances in managing fatigue with the use of a range of pharmacologic and non-pharmacologic strategies, fatigue is not well-managed in patients with advanced cancer. Objectives: For patients with advanced cancer, the aims of the study were to examine the self-management (SM) behaviours associated with fatigue; the perceived effectiveness of these SM behaviours, and the socio-demographic and clinical factors influencing the effectiveness of these SM behaviours. Methodology: A prospective longitudinal study was undertaken with 152 patients with metastatic breast, lung, colorectal and prostate cancer experiencing fatigue (>3/10) over a two month period. SM behaviours associated with fatigue, medical/demographic characteristics, social support, depression, anxiety, self-efficacy and other symptoms were assessed. Results: Findings indicate that on most fatigue severity measures, levels of fatigue increased slightly over time. On average, participants used nine fatigue SM behaviours at each time point. Participants reported that the most effective SM behaviours were ‘pacing their activities during the day’, ‘planning activities to make the most of energy’, ‘taking short sleeps’, ‘doing things that distract them from their fatigue’, and ‘doing things to improve sleep at night’. Factors associated with the increased effectiveness of fatigue SM behaviours included higher self-efficacy, higher education level, lower levels of depressive symptoms, and lower functional status. These results can be used to inform the design of future interventions to support the use of effective fatigue SM behaviours in this population.

Malnutrition and chemotherapy : implications for nursing practice

Background: Malnutrition before and during chemotherapy is associated with poor treatment outcomes. The risk of cancer-related malnutrition is exacerbated by common nutrition impact symptoms during chemotherapy, such as nausea, diarrhoea and mucositis. Aim of presentation: To describe the prevalence of malnutrition/ malnutrition risk in two samples of patients treated in a quaternary-level chemotherapy unit. Research design: Cross sectional survey. Sample 1: Patients ≥ 65 years prior to chemotherapy treatment (n=175). Instrument: Nurse-administered Malnutrition Screening Tool to screen for malnutrition risk and body mass index (BMI). Sample 2: Patients ≥ 18 years receiving chemotherapy (n=121). Instrument: Dietitian-administered Patient Generated Subjective Global Assessment to assess malnutrition, malnutrition risk and BMI. Findings Sample 1: 93/175 (53%) of older patients were at risk of malnutrition prior to chemotherapy. 27 (15%) were underweight (BMI <21.9); 84 (48%) were overweight (BMI >27). Findings Sample 2: 31/121 patients (26%) were malnourished; 12 (10%) had intake-limiting nausea or vomiting; 22 (20%) reported significant weight loss; and 20 (18%) required improved nutritional symptom management during treatment. 13 participants with malnutrition/nutrition impact symptoms (35%) had no dietitian contact; the majority of these participants were overweight. Implications for nursing: Patients with, or at risk of, malnutrition before and during chemotherapy can be overlooked, particularly if they are overweight. Older patients seem particularly at risk. Nurses can easily and quickly identify risk with the regular use of the Malnutrition Screening Tool, and refer patients to expert dietetic support, to ensure optimal treatment outcomes.

Sustainable knowledge community precincts : lessons from global best practices

In the era of global knowledge economy, urban regions—seeking to increase their competitive edge, become destinations for talent and investment, and provide prosperity and quality of life to their inhabitants—have little chance achieving their development goals without forming effective knowledge-based urban development (KBUD) strategies. KBUD paradigm suggests that the economic future of cities increasingly depends on the capacity to attract, generate, retain and foster creativity, knowledge and innovation—and make space and place for knowledge generation and knowledge communities. Thus, the paper aims to shed light on the planning and development processes of the KBUD phenomenon with respect to the construction of sustainable knowledge community precincts (KCPs) aimed at making space for knowledge generation and place for knowledge communities—and provide useful lessons for the developing country cities seeking such sustainable and KBUD.

Trends in nurse-administered procedural sedation and analgesia across cardiac catheterisation laboratories in Australia and New Zealand : results of an electronic survey

Background Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. Objective To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. Design A quantitative, cross-sectional, descriptive survey design was used. Methods Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. Results A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n = 58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n = 58). One respondent indicated that propofol was also used. 20% (n = 12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n = 18) indicated that comprehensive education about PSA is provided. 45% (n = 26) indicated that nurses who administer PSA should undergo competency assessment. Conclusion By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand.

Fatigue self-management : a survey of Chinese cancer patients undergoing chemotherapy

Aims and objectives. To examine Chinese cancer patients’ fatigue self-management, including the types of self-management behaviours used, their confidence in using these behaviours, the degree of relief obtained and the factors associated with patients’ use of fatigue self-management behaviours. Background. Fatigue places significant burden on patients with cancer undergoing chemotherapy. While some studies have explored fatigue self-management in Western settings, very few studies have explored self-management behaviours in China. Design. Cross-sectional self- and/or interviewer-administered survey. Methods. A total of 271 participants with self-reported fatigue in the past week were recruited from a specialist cancer hospital in south-east China. Participants completed measures assessing the use of fatigue self-management behaviours, corresponding self-efficacy, perceived relief levels plus items assessing demographic characteristics, fatigue experiences, distress and social support. Results. A mean of 4_94 (_2_07; range 1–10) fatigue self-management behaviours was reported. Most behaviours were rated as providing moderate relief and were implemented with moderate self-efficacy. Regression analyses identified that having more support from one’s neighbourhood and better functional status predicted the use of a greater number of self-management behaviours. Separate regression analyses identified that greater neighbourhood support predicted greater relief from ‘activity enhancement behaviours’ and that better functional status predicted greater relief from ‘rest and sleep behaviours’. Higher self-efficacy scores predicted greater relief from corresponding behaviours. Conclusions. A range of fatigue self-management behaviours were initiated by Chinese patients with cancer. Individual, condition and environmental factors were found to influence engagement in and relief from fatigue self-managementbehaviours. Relevance to clinical practice. Findings highlight the need for nurses to explore patients’ use of fatigue self-management behaviours and the effectiveness of these behaviours in reducing fatigue. Interventions that improve patients’ self-efficacy and neighbourhood supports have the potential to improve outcomes from fatigue self-management behaviours.

Environmental constitutional reform in the developing world : shifting the perspective of international law?

In recent years a growing number of states have chosen to recognise environmental issues in their national constitutions. Some have added declarations about the value of the environment, some have sought to restrict or regulate government’s ability to take action which would potentially harm the environment, while others have proclaimed that citizens possess a right to an environment of a particular quality. A survey of these constitutional provisions reveals that the majority of reform in this area has come from developing states, including a number of states which have been designated as among the least developed countries in the world. The increasing focus on constitutional environmental rights appears to represent a shift in the attitude of developing and emerging economies, which could in turn be influential in setting the tone of the environmental rights debate more broadly, with potential to shape the future development of international law in the area. This chapter examines constitutional environmental rights in an attempt to determine whether consistent state practice can in fact be identified in this area which might form the basis of an emerging norm. It will also analyse some of the potential contributing factors to the proliferation of a constitutional right to a good environment among developing states, and the implications for the development of customary international law.

Business process variability modeling : A survey

It is common for organizations to maintain multiple variants of a given business process, such as multiple sales processes for different products or multiple bookkeeping processes for different countries. Conventional business process modeling languages do not explicitly support the representation of such families of process variants. This gap triggered significant research efforts over the past decade leading to an array of approaches to business process variability modeling. This survey examines existing approaches in this field based on a common set of criteria and illustrates their key concepts using a running example. The analysis shows that existing approaches are characterized by the fact that they extend a conventional process mod- eling language with constructs that make it able to capture customizable process models. A customizable process model represents a family of process variants in a way that each variant can be derived by adding or deleting fragments according to configuration parameters or according to a domain model. The survey puts into evidence an abundance of customizable process modeling languages, embodying a diverse set of con- structs. In contrast, there is comparatively little tool support for analyzing and constructing customizable process models, as well as a scarcity of empirical evaluations of languages in the field.

Practical framework for measuring performance of international construction firms

The internationalization of construction companies has become of significant interest as the global construction market continues to be integrated into a more competitive and turbulent business environment. However, due to the complicated and multifaceted nature of international business and performance, there is as yet no consensus on how to evaluate the performance of international construction firms (ICFs). The purpose of this paper, therefore, is to develop a practical framework for measuring the performance of ICFs. Based on the balanced scorecard (BSC), a framework with detailed measures is developed, investigated, and tested using a three-step research design. In the first step, 27 measures under six dimensions (financial, market, customer, internal business processes, stakeholders, and learning and growth) are determined by literature review, interviews with academics, and seminar discussions. Subsequently, a questionnaire survey is conducted to investigate weights of these 27 performance measures. The questionnaire survey also supports the importance of measuring intangible aspects of international construction performance from the practitioner’s viewpoint. Additionally, a case study is described to test the framework’s robustness and usefulness. This is achieved by benchmarking the performance of a Chinese ICF with nine other counterparts worldwide. It is found that the framework provides an effective basis for benchmarking ICFs to effectively monitor their performance and support the development of strategies for improved competitiveness in the international arena. This paper is the first attempt to present a balanced and practically tested framework for evaluating the performance of ICFs. It contributes to the practice of performance measurement and related internationalization in the construction industry in general.

Understanding requirements of novel healthcare information systems for management of advanced prostate cancer

Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.

Shortfalls in malnutrition coding : a mandate for action

The International Classification of Diseases, Version 10, Australian modification (ICD-10- AM) is commonly used to classify diseases in hospital patients. ICD-10-AM defines malnutrition as “BMI < 18.5 kg/m2 or unintentional weight loss of ≥ 5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting”. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals1. This study determined if malnourished participants were assigned malnutritionrelated codes as per ICD-10-AM. The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants’ nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5kg/m2, SGA-B (moderately malnourished) or SGA-C (severely malnourished). After three months, in this prospective cohort study, hospitals’ health information/medical records department provided coding results for malnourished participants. Although malnutrition was prevalent in 32% (n= 993) of the cohort (N= 3122), a significantly small number were coded for malnutrition (n= 162, 16%, p<0.001). In 21 hospitals, none of the malnourished participants were coded. This is the largest study to provide a snapshot of malnutrition-coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

Review essay -- Weber L and Pickering S (2011) Globalization and borders : death at the global frontier

The pertinence of this book cannot be overemphasised. The world’s refugee crisis has reached a two‐decade high with the United Nations recently announcing that ‘displacement is the new 21st century challenge’ (UNHCR 2013). The transnational movement of dislocated peoples fleeing conflict, persecution and poverty is a global responsibility requiring nation states to collaborate for humanitarian resolutions embedded in human rights. However, in times of human rights expansionism, and the relaxation of borders for maximising free‐trade and fiscal prosperity, the movement of people experiencing immense abuse and deprivation has witnessed an increase in draconian regulation within discourses of intolerance and deterrence. Weber and Pickering cogently and emphatically emphasise the human cost of inhumane and populist government immigration and border‐entry polices underpinned by ideologies of retribution, suspicion, and demonisation. It is a moving and engaging narrative: a book that exposes state prejudice and abuse, whilst advocating for the victims who undertake perilous journeys in search of safety from lives of violence and persecution. Moreover, it is a book that pushes ideological boundaries and seeks new criminological horizons, for which the authors must be sincerely congratulated. It is a text of innovation, inspired thinking and long lasting criminological value.

Culture in global business transformation projects : the discovery of a grounded theory

Presently organisations engage in what is termed as Global Business Transformation Projects [GBTPs], for consolidating, innovating, transforming and restructuring their processes and business strategies while undergoing fundamental change. Culture plays an important role in global business transformation projects as these involve people of different cultural backgrounds and span across countries, industries and disciplinary boundaries. Nevertheless, there is scant empirical research on how culture is conceptualised beyond national and organisational cultures but also on how culture is to be taken into account and dealt with within global business transformation projects. This research is situated in a business context and discovers a theory that aids in describing and dealing with culture. It draws on the lived experiences of thirty-two senior management practitioners, reporting on more than sixty-one global business transformation projects in which they were actively involved. The research method used is a qualitative and interpretive one and applies a grounded theory approach, with rich data generated through interviews. In addition, vignettes were developed to illustrate the derived theoretical models. The findings from this study contribute to knowledge in multiple ways. First, it provides a holistic account of global business transformation projects that describe the construct of culture by the elements of culture types, cultural differences and cultural diversity. A typology of culture types has been developed which enlarges the view of culture beyond national and organisational culture including an industry culture, professional service firm culture and 'theme' culture. The amalgamation of the culture types instantiated in a global business transformation project compromises its project culture. Second, the empirically grounded process for managing culture in global business transformation projects integrates the stages of recognition, understanding and management as well as the enablement providing a roadmap for dealing with culture in global business transformation projects. Third, this study identified contextual variables to global business transformation projects, which provide the means of describing the environment global business transformation projects are situated, influence the construct of culture and inform the process for managing culture. Fourth, the contribution to the research method is the positioning of interview research as a strategy for data generation and the detailed documentation applying grounded theory to discover theory.

On effective accounting information systems in a dynamic business environment : the role of complementing capabilities

The global business environment is witnessing tough times, and this situation has significant implications on how organizations manage their processes and resources. Accounting information system (AIS) plays a critical role in this situation to ensure appropriate processing of financial transactions and availability to relevant information for decision-making. We suggest the need for a dynamic AIS environment for today’s turbulent business environment. This environment is possible with a dynamic AIS, complementary business intelligence systems, and technical human capability. Data collected through a field survey suggests that the dynamic AIS environment contributes to an organization’s accounting functions of processing transactions, providing information for decision making, and ensuring an appropriate control environment. These accounting processes contribute to the firm-level performance of the organization. From these outcomes, one can infer that a dynamic AIS environment contributes to organizational performance in today’s challenging business environment.

Postnatal depression in Central Vietnam

Postnatal depression (PND) is a significant global health issue, which not only impacts maternal wellbeing, but also infant development and family structures. Mental health disorders represent approximately 14% of global burden of disease and disability, including low and middle-income countries (LMIC), and PND has direct relevance to the Millennium Development Goals of reducing child mortality, improving maternal health, and creating global partnerships (United Nations, 2012; Guiseppe, Becker & Farmer, 2011). Emerging evidence suggests that PND in LMIC is similar to, or higher than in high-income countries (HIC), however, less than 10% of LMIC have prevalence data available (Fisher, Cabral de Mello, & Izutsu 2009; Lund et al., 2011). Whilst a small number of studies on maternal mental disorders have been published in Vietnam, only one specifically focuses on PND in a hospital-based sample. Also, community based mental health studies and information on mental health in rural areas of Vietnam is still scarce. The purpose of this study was to determine the prevalence of PND, and its associated social determinants in postnatal women in Thua Thien Hue Province, Central Vietnam. In order to identify social determinants relevant to the Central Vietnamese context, two qualitative studies and one community survey were undertaken. Associations between maternal mental health and infant health outcomes were also explored. The study was comprised of three phases. Firstly, iterative, qualitative interviews with Vietnamese health professionals (n = 17) and postpartum women (n = 15) were conducted and analysed using Kleinman's theory of explanatory models to identify narratives surrounding PND in the Vietnamese context (Kleinman, 1978). Secondly, a participatory concept mapping exercise was undertaken with two groups of health professionals (n = 12) to explore perceived risk and protective factors for postnatal mental health. Qualitative phases of the research elucidated narratives surrounding maternal mental health in the Vietnamese context such as son preference, use of traditional medicines, and the popularity of confinement practices such as having one to three months of complete rest. The qualitative research also revealed the construct of depression was not widely recognised. Rather, postpartum changes in mood were conceptualised as a loss of 'vital strength' following childbirth or 'disappointment'. Most women managed postpartum changes in mood within the family although some sought help from traditional medicine practitioners or biomedical doctors. Thirdly, a cross-sectional study of twelve randomly selected communes (six urban, six rural) in Thua Thien Hue Province was then conducted. Overall, 465 women with infants between 4 weeks and six months old participated, and 431 questionnaires were analysed. Women from urban (n = 216) and rural (n = 215) areas participated. All eligible women completed a structured interview about their health, basic demographics, and social circumstances. Maternal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) as a continuous variable. Multivariate generalised linear regression was conducted using PASW Statistics version 18.0 (2009). When using the conventional EPDS threshold for probable depression (EPDS score ~ 13) 18.1% (n = 78) of women were depressed (Gibson, McKenzie-McHarg, Shakespeare, Price & Gray, 2009). Interestingly, 20.4% of urban women (n = 44) had EPDS scores~ 13, which was a higher proportion than rural women, where 15.8% (n = 34) had EPDS scores ~ 13, although this difference was not statistically significant: t(429) = -0.689, p = 0.491. Whilst qualitative narratives identified infant gender and family composition, and traditional confinement practices as relevant to postnatal mood, these were not statistically significant in multivariate analysis. Rather, poverty, food security, being frightened of your husband or family members, experiences of intimate partner violence and breastfeeding difficulties had strong statistical associations. PND was also associated with having an infant with diarrhoea in the past two weeks, but not infant malnutrition or acute respiratory infections. This study is the first to explore maternal mental health in Central Vietnam, and provides further evidence that PND is a universally experienced phenomenon. The independent social risk factors of depressive symptoms identified such as poverty, food insecurity, experiences of violence and powerlessness, and relationship adversity points to women in a context of social suffering which is relevant throughout the world (Kleinman, Das & Lock, 1997). The culturally specific risk factors explored such as infant gender were not statistically significant when included in a multivariable model. However, they feature prominently in qualitative narratives surrounding PND in Vietnam, both in this study and previous literature. It appears that whilst infant gender may not be associated with PND per se, the reactions of close relatives to the gender of the baby can adversely affect maternal wellbeing. This study used a community based participatory research approach (CBPR) (Israel.2005). This approach encourages the knowledge produced to be used for public health interventions and workforce training in the community in which the research was conducted, and such work has commenced. These results suggest that packages of interventions for LMIC devised to address maternal mental health and infant wellbeing could be applied in Central Vietnam. Such interventions could include training lay workers to follow up postpartum women, and incorporating mental health screening and referral into primary maternal and child health care (Pate! et al., 2011; Rahman, Malik, Sikander & Roberts, 2008). Addressing the underlying social determinants of PND through poverty reduction and violence elimination programs is also recommended.

BioCondition assessment tool : a mobile application to aid vegetation assessment

Environmental degradation has become increasingly aggressive in recent years due to rapid urban development and other land use pressures. This chapter looks at BioCondition, a newly developed vegetation assessment framework by Queensland Department of Resource Management (DERM) and how mobile technology can assist beginners in conducting the survey. Even though BioCondition is designed to be simple, it is still fairly inaccessible to beginners due to its complex, time consuming, and repetitive nature. A Windows Phone mobile application, BioCondition Assessment Tool, was developed to provide on-site guidance to beginners and document the assessment process for future revision and comparison. The application was tested in an experiment at Samford Conservation Park with 12 students studying ecology in Queensland University of Technology.