Management of delirium in medicine : experience of a close observation unit

Objective(s): A new model of care for the management of patients with delirium was developed and evaluated. Method: A 4-bedded Close Observation Unit (COU) was introduced. The model comprised an education strategy for assistants in nursing (AIN), environmental adaptations and AIN to patient ratio of 1:4. Outcomes in all patients with delirium before and after introduction of the new model of care were compared. Results: 105 patients were admitted to COU, of whom 100 (95%) were diagnosed with delirium. In-hospital mortality improved after introduction of the unit (15% versus 5%; p=0.002) without significant change in length of stay, discharge destination or falls frequency. Conclusion: A dedicated unit for delirium management within medicine achieved a reduction in mortality.

How fit is your organizational culture for business process management?

While business transformations often primarily focus on technological and methodological solutions, there is consensus that having the right organizational culture is critical for the successful change of business processes.

Application of Resilience concept for enhanced management of water supply systems

This paper presents an approach to developing indicators for expressing resilience of a generic water supply system. The system is contextualised as a meta-system consisting of three subsystems to represent the water catchment and reservoir, treatment plant and the distribution system supplying the end-users. The level of final service delivery to end-users is considered as a surrogate measure of systemic resilience. A set of modelled relationships are used to explore relationships between system components when placed under simulated stress. Conceptual system behaviour of specific types of simulated pressure is created for illustration of parameters for indicator development. The approach is based on the hypothesis that an in-depth knowledge of resilience would enable development of decision support system capability which in turn will contribute towards enhanced management of a water supply system. In contrast to conventional water supply system management approaches, a resilience approach facilitates improvement in system efficiency by emphasising awareness of points-of-intervention where system managers can adjust operational control measures across the meta-system (and within subsystems) rather than expansion of the system in entirety in the form of new infrastructure development.

Adapting wheat sowing dates to projected climate change in the Australian subtropics: analysis of crop water use and yield

Projected increases in atmospheric carbon dioxide concentration ([CO2]) and air temperature associated with future climate change are expected to affect crop development, crop yield, and, consequently, global food supplies. They are also likely to change agricultural production practices, especially those related to agricultural water management and sowing date. The magnitude of these changes and their implications to local production systems are mostly unknown. The objectives of this study were to: (i) simulate the effect of projected climate change on spring wheat (Triticum aestivum L. cv. Lang) yield and water use for the subtropical environment of the Darling Downs, Queensland, Australia; and (ii) investigate the impact of changing sowing date, as an adaptation strategy to future climate change scenarios, on wheat yield and water use. The multimodel climate projections from the IPCC Coupled Model Intercomparison Project (CMIP3) for the period 2030–2070 were used in this study. Climate scenarios included combinations of four changes in air temperature (08C, 18C, 28C, and 38C), three [CO2] levels (380 ppm, 500 ppm, and 600 ppm), and three changes in rainfall (–30%, 0%, and +20%), which were superimposed on observed station data. Crop management scenarios included a combination of six sowing dates (1 May, 10 May, 20 May, 1 June, 10 June, and 20 June) and three irrigation regimes (no irrigation (NI), deficit irrigation (DI), and full irrigation (FI)). Simulations were performed with the model DSSAT4.5, using 50 years of daily weather data.Wefound that: (1) grain yield and water-use efficiency (yield/evapotranspiration) increased linearly with [CO2]; (2) increases in [CO2] had minimal impact on evapotranspiration; (3) yield increased with increasing temperature for the irrigated scenarios (DI and FI), but decreased for the NI scenario; (4) yield increased with earlier sowing dates; and (5) changes in rainfall had a small impact on yield for DI and FI, but a high impact for the NI scenario.

Peer-led diabetes self-management programme for community-dwelling older people in China : study protocol for a quasi-experimental design

Aim. A protocol for a new peer-led self-management programme for communitydwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi-experimental. Methods. This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks,is especially promising considering healthcare resource shortage in China.

Information support for health management in regional Sri Lanka : health managers’ perspectives

Good management, supported by accurate, timely and reliable health information, is vital for increasing the effectiveness of Health Information Systems (HIS). When it comes to managing the under resourced health systems of developing countries, information-based decision making is particularly important. This paper reports findings of a self-report survey that investigated perceptions of local health managers (HMs) of their own regional HIS in Sri Lanka. Data were collected through a validated, pre-tested postal questionnaire, and distributed among a selected group of HMs to elicit their perceptions of the current HIS in relation to information generation, acquisition and use, required reforms to the information system and application of information and communication technology (ICT). Results based on descriptive statistics indicated that the regional HIS was poorly organised and in need of reform; that management support for the system was unsatisfactory in terms of relevance, accuracy, timeliness and accessibility; that political pressure and community and donor requests took precedence over vital health information when management decisions were made; and use of ICT was unsatisfactory. HIS strengths included user-friendly paper formats, a centralised planning system and an efficient disease notification system; weaknesses were lack of comprehensiveness, inaccuracy, and lack of a feedback system. Responses of participants indicated that HIS would be improved by adopting an internationally accepted framework and introducing ICT applications. Perceived barriers to such improvements were high initial cost of educating staff to improve computer literacy, introduction of ICTs, and HIS restructure. We concluded that the regional HIS of Central Province, Sri Lanka had failed to provide much needed information support to HMs. These findings are consistent with similar research in other developing countries and reinforce the need for further research to verify causes of poor performance and to design strategic reforms to improve HIS in regional Sri Lanka.

Pain management

Regardless of the setting in which they work, nurses are responsible for the assessment and management of clients with pain. Pain is a key consideration in all patient care, and nurses play a critical role in pain management. Indeed, throughout history nurses have made important contributions to our understanding and management of pain through research and clinical practice. This chapter aims to provide an introduction to some key concepts in pain management and to encourage you to reflect on some of your own assumptions about pain.

Improving asset management process modelling and integration

Asset management (AM) processes play an important role in assisting enterprises to manage their assets more efficiently. To visualise and improve AM processes, the processes need to be modelled using certain process modelling methodologies. Understanding the requirements for AM process modelling is essential for selecting or developing effective AM process modelling methodologies. However, little research has been done on analysing the requirements. This paper attempts to fill this gap by investigating the features of AM processes. It is concluded that AM process modelling requires intuitive representation of its processes, ‘fast’ implementation of the process modelling, effective evaluation of the processes and sound system integration.

Space management in Malaysian government property: A case study

Cost implications related to the physical resources such as land and building in organisation is significant. Management entity of government or private sectors has often ignored the importance and the contribution gained from the physical resources towards their organisation. This source is a precious asset that can generate income if properly managed. This paper aims to explore the current trends in space management internationally, both from the government and private sector perspectives. A case study is conducted to study the level of effectiveness of space management in one of the government institutions in Malaysia. The findings from the case study will be compared with the current international trend of space management. The study will enrich the current understanding of space management in government properties, as well as to compare the level of space management effectiveness of government properties in Malaysia with the international trends and proposed suggestions to improve current practices of space management of Malaysian government’s properties. Keywords:

Third international workshop on empirical research in business process management (ER-BPM 2012)

Empirical research in business process management(BPM) is coming of age. In 2009, when the inaugural ER-BPM workshop was held, the field of BPM research was characterized by a strong emphasis on solution development, but also by an increasing demand for insights or evaluations of BPM technology based on dedicated empirical research strategies. The ER-BPM workshop series was created to provide an international forum for researchers to discuss and present such research.

Nambour : the model rural school

This paper examines the Rural Schools of Queensland. Starting with Nambour in 1917, the scheme incorporated thirty schools, and operated for over forty years. The rhetoric of the day was that boys and girls from the senior classes of primary school would be provided with elementary instruction of a practical character. In reality, the subjects taught were specifically tailored to provide farm skills to children in rural centres engaged in farming, dairying or fruit growing. Linked to each Rural School was a number of smaller surrounding schools, students from which travelled to the Rural School for special agricultural or domestic instruction. Through this action, the Queensland Department of Public Instruction left no doubt it intended to provide educational support for agrarian change and development within the state; in effect, they had set in motion the creation of a Queensland yeoman class. The Department’s intention was to arrest or reverse the trend toward urbanisation — whilst increasing agricultural productivity — through the making of a farmer born of the land and accepting of the new scientific advances in agriculture.

Upper-body morbidity after breast cancer : incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care

The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.

The significance of the resident’s knowledge management in managing the residential property

Most commonly, residents are always arguing about the satisfaction of sustainability and quality of their high rise residential property. Often, all the shortcomings and weaknesses will be blamed on the developers without considering the lack of knowledge management from the residents themselves. It is important, therefore, to show that knowledge management of the residents should be taken into account in relation to the satisfactory and the quality of the high rise residential property. This paper aims to discuss the resident’s knowledge management level of the high rise residential property in showing that resident’s knowledge management is really important to maintain the property at least. To evaluate this situation, the questionnaire surveys are being conducted. The paper analyses and structures the social science research on the importance of knowledge as a resource. The survey evidence demonstrates that, the resident’s knowledge management level was highly related in having high quality and sustainable high rise residential property in Johor Bahru.

Wound Management Innovation Cooperative Research Centre - a new model for inter-disciplinary wound research

Wound research is a complex multidimensional activity most effectively conducted by inter-disciplinary teams that connect studies in basic wound biology, devices and biomaterials with clinical practice. These complexities have been recognised in a new initiative through the establishment of an inter-disciplinary wound research centre in Australia; the Wound Management Innovation Cooperative Research Centre (WMI CRC). The centre is funded by the Australian Government's Cooperative Research Centre Program and a consortium of 22 participants and has a resource of US$108 million over 8 years...