Perspectives of carers on medication management in dementia:lessons from collaboratively developing a research proposal

Background: The need for carers to manage medication-related problems for people with dementia living in the community raises dilemmas, which can be identified by carers and people with dementia as key issues for developing carer-relevant research projects.A research planning Public Patient Involvement (PPI) workshop using adapted focus group methodology was held at the Alzheimer's Society's national office, involving carers of people with dementia who were current members of the Alzheimer's Society Research Network (ASRN) in dialogue with health professionals aimed to identify key issues in relation to medication management in dementia from the carer viewpoint. The group was facilitated by a specialist mental health pharmacist, using a topic guide developed systematically with carers, health professionals and researchers. Audio-recordings and field notes were made at the time and were transcribed and analysed thematically. The participants included nine carers in addition to academics, clinicians, and staff from DeNDRoN (Dementias and Neurodegenerative Diseases Research Network) and the Alzheimer's Society. Findings. Significant themes, for carers, which emerged from the workshop were related to: (1) medication usage and administration practicalities, (2) communication barriers and facilitators, (3) bearing and sharing responsibility and (4) weighing up medication risks and benefits. These can form the basis for more in-depth qualitative research involving a broader, more diverse sample. Discussion. The supported discussion enabled carer voices and perspectives to be expressed and to be linked to the process of identifying problems in medications management as directly experienced by carers. This was used to inform an agenda for research proposals which would be meaningful for carers and people with dementia. © 2014 Poland et al.; licensee BioMed Central Ltd.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Children, health and well-being:policy debates and lived experiences

This book brings together new and leading scholars, who demonstrate the importance of research with children and from a child perspective, allowing for a fuller understanding of the meaning and impact of health and illness in children’s lives. •Demonstrates the importance of research with children and research from a child perspective, in order to fully understand the meaning and impact of health and illness in children’s lives •Encourages critical reflection on contemporary health policy and its relationships to culturally specific ways of knowing and understanding children’s health •Brings together new and leading scholars in the field of children’s health and illness •Moves the highly important issue of children’s health into the mainstream sociology of health and illness

Global trends in myopia management attitudes and strategies in clinical practice

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

Emberi erőforrás menedzsment és gyakorlatai a lean termelésben – a tevékenységmenedzsment irodalmának tükrében = Human resource management and practices in lean manufacturing – review of Operations Management’s literature

A lean bevezetése nem korlátozódik a termelés újraértelmezésére, hanem jellemzően a vállalati belső működés (számvitel, emberi erőforrás, beszerzés) és külső kapcsolatok (beszállítók, ellátási lánc) újszervezését is megköveteli. Ezek a kapcsolódási pontok számos, tudományterületek határán fekvő kutatási irányt nyitnak meg. Ebben a tanulmányban a lean termelés és a belső működéshez sorolt emberi erőforrás menedzsment kapcsolatára fókuszálok. Célom, hogy a tevékenységmenedzsment vonatkozó irodalmának áttekintésével bemutassam a lean termelés logikájához illeszkedő emberi erőforrás menedzsmentet, annak jellemző gyakorlatait. = Lean goes beyond manufacturing, implementing its principles usually requires companies to reorganize their companywide internal operations (accounting, human resource, purchasing) and also external relations (supplier, supply chain). This linkages offer several multidisciplinary research directions, this study focuses on the relationship between human resource management and lean production. The main aim of this working paper is to review Operations Management’s literatures on this issue and present the human resource policy and its practices that fit and support lean production.

The role of law and ethics in developing business management as a profession

Currently, business management is far from being recognised as a profession. This paper suggests that a professional spirit should be developed which could function as a filter of commercial reasoning. Broadly, management will not be organised within the framework of a well-established profession unless formal knowledge, licensing, professional autonomy and professional codes of conduct are developed sufficiently. In developing business management as a profession, law may play a key role. Where the idea is that business management should be more professsionalised, managers must show that they are willing to adopt ethical values, while arriving at business decisions. The paper argues that ethics cannot survive without legal regulation, which, in turn, will not be supported by law unless lawyers can find alternative solutions to the large mechanisms of the official society, secured by the monopolised coercion of the nation state. From a micro perspective of law and business ethics, communities can be developed with their own conventions, rules and standards that are generated and sanctioned within the boundaries of the communities themselves.

Leadership jellemvonások és lean menedzsment – elmélet és gyakorlat = Leadership attributes and lean management in theory and practice

A műhelytanulmány két kutatási kérdést vizsgál. Egyrészt kiemelt szakirodalom alapján megvizsgálja, hogy az elméleti ajánlások milyen vezetési stílust és vezetői stílusjegyeket fogalmaznak meg követendőnek egy lean vállalat számára. Másrészt megvizsgálja, hogy a lean menedzsment gyakorlatának alkalmazásában fejlettebb vállalatok vezetői valóban az irodalom által javasolt, kívánatosnak tekintett vezetői stílusjegyeket tekintik-e pozitívnak. Vizsgálatunkat a Versenyképesség Kutató Központ 2009-es kérdőívének adatbázisán végeztük el, melyben mintegy 300 vállalat négy vezetőjének válaszai állnak rendelkezésre. A rendelkezésre álló mintából mi az 50 fő feletti foglalkoztatottal rendelkező, feldolgozóipari vállalatokra fókuszáltunk, esetükben elemeztük a vezérigazgató és a termelésvezető által követendőnek, jónak tartott vezetői stílusjegyek alkalmazását. ----- Abstract: The working paper focuses on two connected research quesions: Ono ne hand based on selected literature it systematically looks at the ideal leadership style and connected leader attributes that help in transforming a company into a real lean organization. On the other hand the paper analyzes whether leaders of companies with more developed lean practice do or do not follow these leadership related suggestions formulated in the literature. The study uses the fourth round of the Hungarian Competitiveness Research Survey from 2009. The survey has 300 valid observations. Four different respondents in each company filled in questionnaires, all of them were top managers (CEO, marketing /sales, finance, production). Plants were quite different alongside the most important organizational dimensions (volume, number of employee, industry, ownership). Previous researches pointed out that lean management is more likely applied by larger manufacturer. Hence, this study is limited to the analysis of questionnaires filled in by producers that have more than 50 employees. We analyze the leadership styles of two managers, namely the CEO and production manager.

A desztináció menedzsment szerepe a desztinációs versenyképességben – Hazai és dán tapasztalatok tükrében = The role of destination management in the destinations’ competitiveness – Hungarian and Danish experiences

A desztináció menedzsment valamennyi desztinációs versenyképesség modell középponti eleme, és „csodaszerként” jelenik meg, különösen azokban az országokban, amelyek a desztináció menedzsment eszközrendszerét a közelmúltban vezették be, annak érdekében, hogy a desztinációk lépést tudjanak tartani a versenytársaikkal, mint ahogyan ez hazánkban is történt. Jelen tanulmány alapját a témában írt PhD Értekezésem (Sziva, I. (2010)) adja, amelynek fókuszában a desztinációs versenyképesség értelmezése, az ex ante oldali tényezők feltárása állt. A téziskutatás során feltárt tényezők, és a Bírálóim konstruktív fejlesztési javaslatai a téma továbbkutatására ösztönöztek. Mindezért tartottam elengedhetetlennek, hogy a tézisemben összefoglalt hazai és osztrák kutatások legfontosabb eredményeit további nemzetközi színtéren, ezúttal Dániában vizsgáljam, jelen esetben a fókuszt a desztináció menedzsment tényezőire, és annak kiemelt kontextusaira helyezve. Jelen tanulmány legfontosabb célja az, hogy egyrészt összefoglalást adjon a desztináció menedzsment szerepéről a desztinációs versenyképesség elméleti megközelítéseit tekintve. Továbbá, hogy a hazai tapasztalatok összevetésre kerüljenek a szakértői interjúk során megismert dán tapasztalatokkal és további kutatási irányok kerüljenek meghatározásra. Ezúton szeretném megköszönni dániai kutatásom interjú-alanyainak részvételét és a Budapesti Corvinus Egyetem TÁMOP 4.2.1.B-09/1/KMR-2010-0005 projekt keretében nyújtott támogatását! _________ Destination management is the central element of the model concerning destinations’ competitiveness, and appears as „wonder medicine”, particularly in those countries, where the tools of destination management was introduced in the near past, as it happened in Hungary. The baseline of this study is given by my PhD Dissertation (Sziva, I. (2010)), which was focusing on interpretation and the ex ante factors of destinations’ competitiveness. The factors identified during my thesis research, and the constructive recommendations of my Reviewer gave the motivation for further analysis. That is why was it important to make further researchers based on the results identified in the Hungarian and Austrian cases of my thesis research, and add further international, this time Danish context to the research, by focusing on destination management among the factors of competitiveness. The aim of the article is to give a summary about the theoretical approach of destination management and compare the Hungarian experiences with that of the results of the Danish research based on experts’ interviews. Hereby I would like to thank my interviewees their participation, and the support of Corvinus University Budapest in the framework of TÁMOP 4.2.1.B-09/1/KMR-2010-0005 project.

Resource management and optimization in wireless mesh networks

A wireless mesh network is a mesh network implemented over a wireless network system such as wireless LANs. Wireless Mesh Networks(WMNs) are promising for numerous applications such as broadband home networking, enterprise networking, transportation systems, health and medical systems, security surveillance systems, etc. Therefore, it has received considerable attention from both industrial and academic researchers. This dissertation explores schemes for resource management and optimization in WMNs by means of network routing and network coding.^ In this dissertation, we propose three optimization schemes. (1) First, a triple-tier optimization scheme is proposed for load balancing objective. The first tier mechanism achieves long-term routing optimization, and the second tier mechanism, using the optimization results obtained from the first tier mechanism, performs the short-term adaptation to deal with the impact of dynamic channel conditions. A greedy sub-channel allocation algorithm is developed as the third tier optimization scheme to further reduce the congestion level in the network. We conduct thorough theoretical analysis to show the correctness of our design and give the properties of our scheme. (2) Then, a Relay-Aided Network Coding scheme called RANC is proposed to improve the performance gain of network coding by exploiting the physical layer multi-rate capability in WMNs. We conduct rigorous analysis to find the design principles and study the tradeoff in the performance gain of RANC. Based on the analytical results, we provide a practical solution by decomposing the original design problem into two sub-problems, flow partition problem and scheduling problem. (3) Lastly, a joint optimization scheme of the routing in the network layer and network coding-aware scheduling in the MAC layer is introduced. We formulate the network optimization problem and exploit the structure of the problem via dual decomposition. We find that the original problem is composed of two problems, routing problem in the network layer and scheduling problem in the MAC layer. These two sub-problems are coupled through the link capacities. We solve the routing problem by two different adaptive routing algorithms. We then provide a distributed coding-aware scheduling algorithm. According to corresponding experiment results, the proposed schemes can significantly improve network performance.^

Not getting by: Poverty management and homelessness in Miami

Urban inequality has emerged as one of the dominant themes of modern life and globalization. More than three million people experienced homelessness in the United States last year; in Miami-Dade, more than 15,000 individuals were homeless. Surviving extreme poverty, and exiting or avoiding homelessness, involves negotiating a complex mix of public and private assistance. However, a range of factors influence what types of help are available and how they can be accessed. Frequently, larger social structures determine which resource are available, leaving many choices entirely out of the individual's control. For single men, who are ineligible for many benefits, homelessness can be difficult to avoid and even harder to exit. My study seeks to better understand how adult, minority men living in extreme poverty in Miami-Dade negotiate their daily survival. Specific research questions address: Do black and Hispanic men who are homeless or at risk of homelessness have different personal characteristics and different experiences in avoiding or exiting homelessness? How does Miami's response to extreme poverty/homelessness, including availability of public benefits and public and private service organizations, either maximize or constrain the choices available to this population? And, what is the actual experience of single, adult men who are homeless or at risk of homelessness, in negotiating their daily survival? A mixed methods approach combines quantitative survey data from 7,605 homeless men, with qualitative data from 54 semi-structured interviews incorporating the visual ethnography techniques of Photo Elicitation Interviewing. Results show the differences experienced by black and Hispanic men who are poor and homeless in Miami. Findings also highlight how the community's official and unofficial responses to homelessness intersect with the actual experiences of the persons targeted by the policies and programs, challenging preconceived notions regarding the lives of persons living in extreme poverty. It adds to the existing body of literature by focusing on the urban Miami context, emphasizing disparities amongst racial and ethnic groups. Findings are intended to provide an empirically grounded thesis that humanizes the subjects and illuminates their personal experiences, helping to inform public policy around the needs of extremely poor populations.

Knowledge, attitudes, and practices affecting health behaviors in the U.S. Army Special Operations Command population of Rangers

Malaria is a threat to United States military personnel operating in endemic areas, from which there have been hundreds of cases reported over the past decade. Each of these cases might have been avoided with proper adherence to malaria chemoprophylaxis medications. Military operations may detract from the strict 100% adherence required of these preventive medications. However, the reasons for non-adherence in military populations are not well understood. This behavior was investigated using a cross sectional study design on a convenience sample of U.S. Army Ranger volunteers (n=150) located at three military instillations. Theoretical support was based on components of the Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Social Cognitive Theory. ^ Data on knowledge, attitudes, and practices, as well as multiple environmental domains was collected using an original yet unvalidated questionnaire. The data was analyzed using bivariate Pearson correlations, binary logistic regression, and moderated logistic regressions employing a 0.05 criterion of statistical significance. Power analyses predicted 96-98% power for this analysis. ^ Multiple significant medium strength Pearson correlation coefficients were identified relative to the two dependent variables Take medications as directed and Intend to take the medications as directed the next time. Binary logistic regression analyses identified multiple variables that may predict behavioral intentions to adhere to these preventive medications, as a proxy for behavioral change. Moderated logistic regression analyses identified Command Support for adherence to these medications as a potential significant moderator that interacts with independent variables within three domains of the survey questionnaire. ^ The findings indicate that there may be potential significant beneficial effects, which may improve this behavior in this population of Rangers through 1) promoting affirmative interpersonal communications that emphasize adherence to these medications, 2) including malaria chemoprophylaxis medications in the mission planning process, and 3) military command support, in the form of including the importance of proper adherence to these medications in the unit safety briefings.^

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

Examining the Crack Epidemic and Subsequent Drug Policy through Identifying Trends in Outpatient Substance Abuse Treatment for Crack Use/Abuse: 1995-2005

Disparities in the crack/cocaine discourse have changed drastically since its inception over 30 years ago. Since the late 1980s, research examining this particular abuse has become more complex as both nationally and globally crack use/abuse has been examined within various contexts. Crack use has often been framed as an African American problem in part resulting from the high volume of African Americans seeking treatment for illnesses associated with their crack-cocaine use, and more African Americans dying from crack-cocaine overdose. This logical fallacy persists despite evidence showing African Americans have lower substance use/abuse compared to Caucasians. Given the impact of the crack epidemic as well as its related drug policies on African American communities and their families, further examination of crack use/abuse is necessary. This study will discuss the crack epidemic historically and examine crack use among clients of a large sample of outpatient substance abuse treatment units over a decade period between 1995 and 2005.

Professional development programs in health promotion : tools and processes to favor new practices

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children’s vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde’s (Une grille d’analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297– 312, 2010) analytical grid to assess deductively the program participants’ use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

An Institutional, Socio-economic, and Legal Analysis of Fisheries Co-management and Regulation in the Gulf of Nicoya, Costa Rica

Marine Areas for Responsible Artisanal Fishing (AMPR) have emerged as a new model for co-managing small-scale fisheries in Costa Rica, one that involves collaboration between fishers, government agencies and NGOs. This thesis aims to examine the context for collective action and co-management by small-scale fishers; evaluate the design, implementation, and enforcement of AMPRs; and conduct a linguistic analysis of fisheries legislation. The present work relies on the analysis of several types of qualitative data, including interviews with 23 key informants, rapid rural assessments, and legal documents. Findings demonstrate the strong influence of economic factors for sustaining collective action, as well as the importance of certain types of external organizations for community development and co-management. Additionally, significant enforcement gaps and institutional deficiencies were identified in the work of regulating agencies. Legal analysis suggests that mechanisms for government accountability are unavailable and that legal discourse reflects some of the most salient problems in management.