DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Does Inappropriate Quality Control Demotivate Workers

The construction industry requires quality control and regulation of its contingent,unpredictable environment. However, taking too much control from workers candisempower and demotivate. In the 1970s Deci and Ryan developed selfdeterminationtheory which states that in order to be intrinsically motivated, threecomponents are necessary - competence, autonomy and relatedness. This study aimsto examine the way in which the three ‘nutriments’ for intrinsic motivation may beundermined by heavy-handed quality control. A critical literature review analysesconstruction, psychological and management research regarding the control andmotivation of workers, using self-determination theory as a framework. Initialfindings show that quality management systems do not always work as designed.Workers perceive that unnecessary, wasteful and tedious counter checking of theirwork implies that they are not fully trusted by management to work without oversight.Control of workers and pressure for continual improvement may lead to resistanceand deception. Controlling mechanisms can break the link between performance andsatisfaction, reducing motivation and paradoxically reducing the likelihood of thequality they intend to promote. This study will lead to a greater understanding ofcontrol and motivation, facilitating further research into improvements in theapplication of quality control to maintain employee motivation.

The management of workplace conflict: Contrasting pathways in the HRM literature.

This paper reviews the human resource management literature on the management of workplace conflict. It suggests that workplace conflict is commonly viewed in the literature as a symptom of management failure: the notion that conflict may be intrinsic to the nature of work because employees and managers have hard-to-reconcile competing interests is given short-shrift. At the same time, the paper identifies important differences in the literature, which the authors call ‘pathways’, about the best methods to manage problems at the workplace. It is argued that four contrasting pathways can be detected in the literature with regard to how organizations approach workplace conflict management practices. Each pathway is examined fully and their respective strengths and weaknesses are assessed.

Projeto de mestrado para implementação de um sistema de gestão da qualidade em farmácia comunitária

Nos últimos anos, a Qualidade em Instituições de saúde tem sido um tema relevante. O conceito de qualidade tem várias definições, sendo um conceito difícil de medir e definir. A Qualidade é uma ferramenta cada vez mais almejada pelas instituições que prestam cuidados de saúde e neste caso particular pela Farmácia Comunitária. Essa procura advém da necessidade de garantir um atendimento aos utentes cada vez mais eficaz e eficiente, capaz de satisfazer as suas reais necessidades e expectativas, por meio da otimização de processos e economização de recursos, tornando-se, por isso, uma prioridade nas áreas onde os farmacêuticos operam. O objetivo deste projeto é clarificar e explicar as etapas para a implementação de um Sistema de Gestão da Qualidade, com base na Norma ISO 9001:2008, numa Farmácia Comunitária, encorajando toda a equipa e promovendo o empenho e envolvência de todos nas práticas de gestão integrada da qualidade e nas estratégias de melhoria contínua. A Implementação de um Sistema de Gestão da Qualidade com base na norma ISO 9001:2008 poderá ter um impacto muito positivo, contribuindo não apenas para a melhoria da qualidade interna da organização, nas suas diversas vertentes, como também para a focalização nos seus clientes, melhorando ainda mais a qualidade dos serviços prestados, demonstrando ser relevante para a saúde, para a forma como os recursos humanos se organizam em torno do trabalho e para racionalização dos recursos. Desta forma se demonstra o valor desta ferramenta na gestão, eficácia e segurança no sistema de utilização do medicamento em Farmácia Comunitária.

Diagnostic Tests and their Application in the Management of Soil- and Water-borne Oomycete Pathogen Species

Oomycete diseases cause significant losses across a broad range of crop and aquaculture commodities worldwide. These losses can be greatly reduced by disease management practices steered by accurate and early diagnoses of pathogen presence. Determinations of disease potential can help guide optimal crop rotation regimes, varietal selections, targeted control measures, harvest timings and crop post-harvest handling. Pathogen detection prior to infection can also reduce the incidence of disease epidemics. Classical methods for the isolation of oomycete pathogens are normally deployed only after disease symptom appearance. These processes are often-time consuming, relying on culturing the putative pathogen(s) and the availability of expert taxonomic skills for accurate identification; a situation that frequently results in either delayed application, or routine ‘blanket’ over-application of control measures. Increasing concerns about pesticides in the environment and the food chain, removal or restriction of their usage combined with rising costs have focussed interest in the development and improvement of disease management systems. To be effective, these require timely, accurate and preferably quantitatve diagnoses. A wide range of rapid diagnostic tools, from point of care immunodiagnostic kits to next generation nucleotide sequencing have potential application in oomycete disease management. Here we review currently-available as well as promising new technologies in the context of commercial agricultural production systems, considering the impacts of specific biotic and abiotic and other important factors such as speed and ease of access to information and cost effectiveness

Rathbun Lake Special Project: BMPs for priority land in Targeted Sub-Watershed 2012 1221-010, Final Report 2013-2061,

The Rathbun Land and Water Alliance and partners have undertaken a highly effective approach to water quality protection through the Rathbun Lake Special Project. This approach is achieving a significant reduction in the sediment and phosphorus that impair water quality in Rathbun Lake and its tributaries as a result of the targeted application of best management practices (BMPs) for priority land in the watershed. This project application proposes to assist landowners to apply BMPs that will reduce sediment and phosphorus delivery from priority land in three targeted sub-watersheds as part of the Rathbun Lake Special Project. Features of this project are: (1) use of geographic information system (GIS) analysis to identify priority land that requires BMPs; (2) assistance for landowners to apply BMPs for 1,200 acres that will reduce the annual delivery of sediment by 1,800 tons and phosphorus by 6,000 pounds; (3) evaluation of the benefits from BMP application using GIS analysis and water quality monitoring; and (4) watershed outreach activities that encourage landowners to apply BMPs for priority land to protect water quality.

Rathbun Lake Special Project BMPs for Priority Land in Targeted Sub-Watersheds 2012: Final Report: 1221-010, 2013-2016, June 27, 2016

The Rathbun Land and Water Alliance and partners have undertaken a highly effective approach to water quality protection through the Rathbun Lake Special Project. This approach is achieving a significant reduction in the sediment and phosphorus that impair water quality in Rathbun Lake and its tributaries as a result of the targeted application of best management practices (BMPs) for priority land in the watershed. This project application proposes to assist landowners to apply BMPs that will reduce sediment and phosphorus delivery from priority land in three targeted sub-watersheds as part of the Rathbun Lake Special Project. Features of this project are:(1) use of geographic information system (GIS) analysis to identify priority land that requires BMPs;(2) assistance for landowners to apply BMPs for 1,200 acres that will reduce the annual delivery of sediment by 1,800 tons and phosphorus by 6,000 pounds;(3) evaluation of the benefits from BMP application using GIS analysis and water quality monitoring; and (4) watershed outreach activities that encourage landowners to apply BMPs for priority land to protect water quality.

Ecology and physical condition of red deer in the Iberian Peninsula: implications for management

The red deer (Cervus elaphus) is currently one of the most widespread and abundant wild ungulates in the Iberian Peninsula and is extremely important both ecologically, as a key species for the functioning of the ecosystems, and economically, as a major game species. In Iberia, red deer populations are subjected to different management systems that may affect the physical condition of the individuals, with further consequences for population dynamics. Studies investigating the effects of management practices and environmental conditions on the performance of red deer are still rare regarding Mediterranean ecosystems. Much of the knowledge concerning the ecology of red deer and the impact of management on its physical condition is based on studies conducted in northern and central regions of Europe, where climatological features and management practices differ from those observed in the Mediterranean areas of Iberia. Studies on a biogeographical scale can provide important insights into the relationships between species and a particular environment and contribute to the development of more targeted and appropriate management practices. The optimisation of sampling procedures and the fine-tuning of pre-existing analytical techniques are also fundamental to a more cost-effective monitoring and, therefore, are of enormous value to wildlife managers. In this context, the main aims of this thesis were: 1) to optimise the procedures used to assess the physical condition of red deer; and 2) to identify relevant management and environmental factors affecting the nutritional condition and stress physiology of red deer in the Mediterranean ecosystems of Iberia, as well as any potential interactions between those factors. Two studies with a methodological focus, presented in the first part of the thesis, demonstrated that the physical condition of red deer can be evaluated more simply, using more cost- and time-effective procedures than those traditionally used: i) it was shown that only one kidney and its associated fat is enough to assess nutritional condition in red deer; and ii) the feasibility of using near infrared spectroscopy to predict the concentrations of stress hormone metabolites was demonstrated using faeces of red deer for the first time. Subsequently, two large-scale observational studies, conducted in representative red deer populations found in Mediterranean Iberia, highlighted the importance of considering seasonal environmental variations and variables related to hunting management practices to better understand the nutritional and physiological ecology of red deer. High population densities had adverse effects on the nutritional condition of the deer and were associated with increased stress levels in natural populations without supplementary feeding. Massive hunting events involving the use of hounds were also identified as a potential source of chronic stress in red deer. The research presented in this thesis has clear implications regarding the management and monitoring of red deer populations in Mediterranean environments and is intended to help wildlife managers to implement more effective monitoring programmes and sustainable management practices.

Earnings management nas instituições particulares de solidariedade social

A manipulação contabilística constitui-se como uma problemática atual, relatada sob os mais diversos contextos. Este estudo descritivo pretende verificar a existência de Earnings Management no contexto das Instituições Particulares de Solidariedade Social (IPSS) e averiguar as razões (motivações) que levam a estas práticas. A amostra para este estudo é constituída por 14 instituições portuguesas, num total de 58 observações situadas entre os anos 2009 e 2014. Para a análise dos dados foi utilizada uma abordagem quantitativa, primeiramente através de estatística descritiva e correlacional. Para testar a existência de Earnings Management utilizou-se um modelo baseado no estudo de accruals agregados (Modelo de Jones - 1991) e um modelo complementar baseado na distribuição de frequência de resultados (Burgstahler e Dichev -1997). Os resultados permitem inferir a existência destas práticas neste setor e as motivações estarão relacionadas com a rendibilidade das instituições.

O marketing em um hospital universitário na relação com o trabalho da enfermagem: um estudo de caso

No setor hospitalar, o marketing compõe um grupo interdependente de serviços e tem como objetivo principal aproximar clientes - externos, internos e corpo gestor -, através de estratégias específicas que promovem satisfação e qualidade. Esta organização possui uma larga diversidade de profissionais da saúde e o marketing, neste sentido, auxilia no processamento de seus serviços de forma a lapidá-los sob a ótica do cliente, buscando efetividade e produtividade. Neste cenário encontra-se o enfermeiro, cujo trabalho é composto pelas dimensões cuidar, gerenciar, educar/pesquisar, que se entrelaçam e caracterizam o serviço deste profissional. No entanto, costumeiramente, a enfermagem não declara o marketing como uma ferramenta estratégica ao seu processo de trabalho – fato verificável na exploração de publicações científicas -, e, paralelamente, depara-se com empecilhos na execução de seu trabalho que podem comprometer a sua excelência. Assim, este estudo busca analisar a relação do marketing com o trabalho do enfermeiro nas dimensões cuidar, gerenciar, ensinar/pesquisar. Para sua efetivação, optou-se pelo referencial metodológico Estudo de Caso, onde o fenômeno é verificado como ocorre em seu cenário real. Assim, a coleta, caracterizada por pesquisador e unidade únicos, ocorreu em um hospital universitário, geral e público no sul do país que declara publica e virtualmente o marketing institucional. Como fontes de evidência, foram utilizadas: entrevista focada com quatro sujeitos de áreas estratégicas para esta pesquisa; análise de documentação criada pela assessoria de marketing e observação direta. O tratamento e a análise dos dados ocorreram por meio da Análise Temática, que possibilitou a exposição dos resultados através de dois artigos: “A relação do marketing com o processo de trabalho do enfermeiro na dimensão cuidar” e “A relação do marketing com o processo de trabalho do enfermeiro nas dimensões gerenciar e educar/pesquisar”. Os resultados evidenciaram que o marketing no cuidar - auxilia a efetividade do cuidado através de novas estratégias de comunicação com o usuário, produz materiais elucidativos, lúdicos para sua continuação e manutenção e o divulga no meio intra e extra-hospitalar; no gerenciar - auxilia a o enfermeiro a ter um método mais inovador e criativo, a focar no cliente e no bom relacionamento interpessoal com a equipe; no educar/pesquisar - cria canais de comunicação interna e campanhas únicas que, além de auxiliar na realização da educação permanente e na atualização de enfermeiros, propicia meios para transmitir novos achados científicos à prática da enfermagem hospitalar. Através deste estudo, percebeu-se que ações de marketing podem contribuir para a efetividade do trabalho do enfermeiro em suas facetas dimensionais, aproximando este agente de saúde do usuário ao qual seu serviço é destinado e da gestão da organização, propiciando a este profissional maior visibilidade e valorização no espaço hospitalar e social.

Some biological and ecological considerations for research in the management of the fisheries of Lakes Victoria and Kyoga

There is little doubt that the exploitation of the current fisheries of Lakes Victoria and Kyoga requires close monitoring with a view to enforce adherence to prudent management practices. Many indigenous fishes have gradually disappeared from the commercial fishery of both lakes. In the Uganda portion of Lake Victoria for instance Okaronon and Wadanya (in press) have shown that:- 1. The once preponderant haplochromiine taxon ceased to feature in the commercial catches in 1979. 2. The lung-fish (Protopterus aethiopicus) which formerly contributed significantly to the commercial landings had declined to minor species status by the mid 1980s. 3. The catfishes Clarias mossambicus and Bagrus docmac, formerly major fish species, contributed insignificant quantities to the commercial fishery since the early and mid 1980s, respectively. Similar trend have been "reported in the Kenya and Tanzania portions of Lake Victoria (Bwathondi, 1985; Mainga, 1985, Witte and Goudswaard, 1985). On the other hand since their establishment all round the lake in the early to mid 1980s some introduced fishes namely Nile perch (Lates niloticus) and Nile tilapia (Oreochromis niloticus) built up impressive stocks in Lake Victoria (Ssentongo and Welcomme, 1985, Okaronon et al. 1985; Okaronon and Wadanya, in press). Togetther with the native pelagic cyprinid Rastrineobola argentea or Dagaa/Mukene the introduced fishes have contributed unprecidented catches, stimulating vibrant commercial fisheries which have yielded significant social economic benefits to the peoples of the three states riparian to the Lake (Reynolds and Greboval, 1988; Kudhongania et al in press). The impressive landings particularly of the Nile perch and Nile tilapia have also led to rapid industrialisation of fish processing in East Africa mainly for the export market. Fish export has now the potential of a major foreign exchange enterprise in the region.

Use of business analysis in beef businesses to direct management practice change for climate adaptation outcomes

Beef businesses in northern Australia are facing increased pressure to be productive and profitable with challenges such as climate variability and poor financial performance over the past decade. Declining terms of trade, limited recent gains in on-farm productivity, low profit margins under current management systems and current climatic conditions will leave little capacity for businesses to absorb climate change-induced losses. In order to generate a whole-of-business focus towards management change, the Climate Clever Beef project in the Maranoa-Balonne region of Queensland trialled the use of business analysis with beef producers to improve financial literacy, provide a greater understanding of current business performance and initiate changes to current management practices. Demonstration properties were engaged and a systematic approach was used to assess current business performance, evaluate impacts of management changes on the business and to trial practices and promote successful outcomes to the wider industry. Focus was concentrated on improving financial literacy skills, understanding the business’ key performance indicators and modifying practices to improve both business productivity and profitability. To best achieve the desired outcomes, several extension models were employed: the ‘group facilitation/empowerment model’, the ‘individual consultant/mentor model’ and the ‘technology development model’. Providing producers with a whole-of-business approach and using business analysis in conjunction with on-farm trials and various extension methods proved to be a successful way to encourage producers in the region to adopt new practices into their business, in the areas of greatest impact. The areas targeted for development within businesses generally led to improvements in animal performance and grazing land management further improving the prospects for climate resilience.

The role of knowledge management and renewal in building innovation performance

Tämän työn tavoitteena oli selvittää tietojohtamisen eri käytäntöjen vaikutusta oppimiseen, uudistumiseen sekä yrityksen innovaatiokyvykkyyteen. Työssä on keskitytty erityisesti sellaisiin tietojohtamisen käytäntöihin, jotka edistävät oppimista ja uusiutumista yrityksissä. Työssä on käytetty tilastollisia menetelmiä, muun muassa faktorianalyysia, korrelaatioanalyysia sekä regressiota, analysoitaessa 259 suomalaisesta yrityksestä kerättyä kyselydataa niiden tietojohtamisen käytöntöihin ja aineettomaan pääomaan liittyen. Analyysi osoittaa, että useat tietojohtamisen käytännöt vaikuttavat positiivisesti yrityksen uudistumiseen ja sitä kautta innovaatiokyvykkyyteen. Henkilöstön kouluttaminen sekä parhaiden käytäntöjen kerääminen ja soveltaminen yrityksessä ovat positiivisesti yhteydessä innovaatiokyvykkyyteen. Henkilöstön kouluttamisella on merkittävin suora vaikutus innovaatiokyvykkyyteen ja tässä työssä on esitetty, että koulutuksen tarjoamisen suurin vaikutus on oppimismyönteisen kulttuurin kehittyminen yrityksiin sen sijaan, että koulutuksella pyrittäisiin vain parantamaan tehtäväkenttään liittyviä taitoja ja tietoja. Henkilöstön kouluttaminen, parhaat käytännöt sekä sosialisaatiossa tapahtuva tiedon vaihto ja suhteiden solmiminen vaikuttavat positiivisesti uudistumispääomaan. Työn tulosten perusteella uudistumispääomalla on merkittävä rooli innovaatioiden syntymisessä yrityksissä. Uudistumispääoma medioi koulutuksen, parhaiden käytäntöjen ja mahdollisesti myös sosialisaation vaikutusta innovaatiokyvykkyyteen ja on näin merkittävä osa innovaatioiden syntyä yrityksissä. Innovaatiokyvykkyyden osatekijöiden ymmärtäminen voi auttaa johtajia ja esimiehiä keskittämään huomionsa tiettyihin tietojohtamisen käytäntöihin edistääkseen innovaatioiden syntymistä yrityksessä sen sijaan, että he pyrkisivät vain vaikuttamaan innovaatioprosessiin.

Técnicas de manejo agropecuário sustentável

The competitiveness in the rural sector and the need to make viable and sustainable property, direct the farmer to seek new production strategies. In this sense, the book Techniques of sustainable agricultural management has as objective contributed information on concepts, management practices, technological innovations, which are applicable in the agricultural production. The same is composed of 13 chapters, topics covered in aquaculture production, management and dairy production, as general aspects of hematology fish; dynamics of decision-making and adaptive flow dairy production systems; importance of performance measures and body biometrics in small ruminants; milk production in beef cows; parasitism in beef cattle; performance of dairy cows in production; efficiency of cross beef cattle in finishing phase; development of Marchangus: five years; and, bovine growth efficiency. In vegetable production area are addressed matters relating on management and olive cultivation, species of great economic importance and diversification as alternative on the property; functional foods in fruit and vegetables; influence of environmental factors, harvesting and drying in the production and composition of essential oils of Mentha spp; and, implication of the contamination of corn grain by mycotoxins in livestock production. At the end of the book, the expectation of the authors is to have contributed with relevant themes of Brazilian agriculture, which could reflect positively on knowledge, values and quality of available material.

Effect of sugarcane cropping systems on herbicide losses in surface runoff

Herbicide runoff from cropping fields has been identified as a threat to the Great Barrier Reef ecosystem. A field investigation was carried out to monitor the changes in runoff water quality resulting from four different sugarcane cropping systems that included different herbicides and contrasting tillage and trash management practices. These include (i) Conventional - Tillage (beds and inter-rows) with residual herbicides used; (ii) Improved - only the beds were tilled (zonal) with reduced residual herbicides used; (iii) Aspirational - minimum tillage (one pass of a single tine ripper before planting) with trash mulch, no residual herbicides and a legume intercrop after cane establishment; and (iv) New Farming System (NFS) - minimum tillage as in Aspirational practice with a grain legume rotation and a combination of residual and knockdown herbicides. Results suggest soil and trash management had a larger effect on the herbicide losses in runoff than the physico-chemical properties of herbicides. Improved practices with 30% lower atrazine application rates than used in conventional systems produced reduced runoff volumes by 40% and atrazine loss by 62%. There were a 2-fold variation in atrazine and >10-fold variation in metribuzin loads in runoff water between reduced tillage systems differing in soil disturbance and surface residue cover from the previous rotation crops, despite the same herbicide application rates. The elevated risk of offsite losses from herbicides was illustrated by the high concentrations of diuron (14mugL-1) recorded in runoff that occurred >2.5months after herbicide application in a 1st ratoon crop. A cropping system employing less persistent non-selective herbicides and an inter-row soybean mulch resulted in no residual herbicide contamination in runoff water, but recorded 12.3% lower yield compared to Conventional practice. These findings reveal a trade-off between achieving good water quality with minimal herbicide contamination and maintaining farm profitability with good weed control.