Standardising practices improves ambulatory diabetic foot management and reduces amputations : the Queensland Diabetic Foot Innovation Project, 2006 – 2009

Background Diabetic foot complications are recognised as the most common reason for diabetic related hospitalisation and lower extremity amputations. Multi-faceted strategies to reduce diabetic foot hospitalisation and amputation rates have been successful. However, most diabetic foot ulcers are managed in ambulatory settings where data availability is poor and studies limited. The project aimed to develop and evaluate strategies to improve the management of diabetic foot complications in three diverse ambulatory settings and measure the subsequent impact on ospitalisation and amputation. Methods Multifaceted strategies were implemented in 2008, including: multi-disciplinary teams, clinical pathways and training, clinical indicators, telehealth support and surveys. A retrospective audit of consecutive patient records from July 2006 – June 2007 determined baseline clinical indicators (n = 101). A clinical pathway teleform was implemented as a clinical record and clinical indicator analyser in all sites in 2008 (n = 327) and followed up in 2009 (n = 406). Results Prior to the intervention, clinical pathways were not used and multi-disciplinary teams were limited. There was an absolute improvement in treating according to risk of 15% in 2009 and surveillance of the high risk population of 34% and 19% in 2008 and 2009 respectively (p < 0.001). Improvements of 13 – 66% (p < 0.001) were recorded in 2008 for individual clinical activities to a performance > 92% in perfusion, ulcer depth, infection assessment and management, offloading and education. Hospitalisation impacts recorded reductions of up to 64% in amputation rates / 100,000 population (p < 0.001) and 24% average length of stay (p < 0.001) Conclusion These findings support the use of multi-faceted strategies in diverse ambulatory services to standardise practice, improve diabetic foot complications management and positively impact on hospitalisation outcomes. As of October 2010, these strategies had been rolled out to over 25 ambulatory sites, representing 66% of Queensland Health districts, managing 1,820 patients and 13,380 occasions of service, including 543 healed ulcer patients. It is expected that this number will rise dramatically as an incentive payment for the use of the teleform is expanded.

From the editor

Intelligence and context, knowledge, competence, and performance and results summarize the content of the papers presented to readers in this issue of the Journal. This is a very relevant series of papers as, for the past 50 years, project management has become a well-accepted way to manage organizations. The field of project management has evolved from operational research techniques and tools to a discipline of management encompassing various schools of thought (Söderlund, 2002; Turner, Huemann, Anbari, & Bredillet, 2010)...

Mapping the dynamics of the project management field : project management in action (part 6)

This is the sixth part of a Letter from the Editor series where the results are presented of an ongoing research undertaken in order to investigate the dynamic of the evolution of the field of project management and the key trends. Dynamics of networks is a key feature in strategic diagrams analysis. The radical change in the configuration of a network between two periods, or the change at subnetwork level reflects the dynamic of science. I present here an example of subnetwork comparison over the four periods of time considered in this study. I will develop and discuss an example of subnetwork transformation in future Letter from the Editor article..

Mapping the dynamics of the project management field : project management in action (part 5)

This is the fifth part of a Letter From the Editor series where the results are presented of an ongoing research undertaken in order to investigate the dynamic of the evolution of the field of project management and the key trends. I present some general findings and the strategic diagrams generated for each of the time periods introduced herein and discuss what we can learn from them on a general standpoint. I will develop and discuss some detailed findings in future Letter From the Editor articles...

The unresolved struggles between project managers and functional managers in matrix organizations

Having personal that works in projects but belongs to a functional organization is the way that many companies organized their labor force today. Previous research shows that this implies management contradictions and ambiguities between functional manager and project manager; there are unresolved struggles between these two roles in terms of power, accountability, authority and legitimacy. With this paper we aim to analyze those struggles based on previous research and to generate working hypotheses. We first provide a review of the different matrix organizations focusing on the relation between the functional manager and the project manager. We then review the literature concerning temporary organizations and projects as temporary organizations. We conclude by integrating the findings of these perspectives and by identifying working hypotheses and areas for further research.

Project 27 : insights into a production-centred study on art direction and love

This paper offers insight into the development of a PhD in advertising art direction. For over half a century art directors within the advertising industry have been adapting to the changes occurring in media, culture and the corporate sector, toward enhancing professional performance and competitiveness. These professionals seldom offer explicit justification about the role images play in effective communication. It is uncertain how this situation affects advertising performance, because advertising has, nevertheless, evolved in parallel to this as an industry able to fabricate new opportunities for itself. However, uncertainties in the formalization of art direction knowledge restrict the possibilities of knowledge transfer in higher education. The theoretical knowledge supporting advertising art direction has been adapted spontaneously from disciplines that rarely focus on specific aspects related to the production of advertising content, like, for example: marketing communication, design, visual communication, or visual art. Meanwhile, in scholarly research, vast empirical knowledge has been generated about advertising images, but often with limited insight into production expertise. Because art direction is understood as an industry practice and not as an academic discipline, an art direction perspective in scholarly contributions is rare. Scholarly research that is relevant to art direction seldom offers viewpoints to help understand how it is that research outputs may specifically contribute to art direction practices. There is a need to formally understanding the knowledge underlying art direction and using it to explore models for visual analysis and knowledge transfer in higher education. This paper provides insight into the development of a thesis that explored this need. The PhD thesis to which this paper refers is Strategic Aesthetics in Advertising Campaigns: Implications for Art Direction Education.

Evaluation of the quality of diverse teaching practice in higher education research methods

The purpose of this paper is to report on a methods research project investigating the evaluation of diverse teaching practice in Higher Education. The research method is a single site case study of an Australian university with data collected through published documents, surveys, interviews and focus groups. This project provides evidence of the wide variety of evaluation practice and diverse teaching practice across the university. This breadth identifies the need for greater flexibility of evaluation processes, tools and support to assist teaching staff to evaluate their diverse teaching practice. The employment opportunities for academics benchmark the university nationally and position the case study in the field. Finally this reaffirms the institutional responsibility for services to support teaching staff in an ongoing manner.

Discretionary use of open briefings in the Australian continuous reporting environment

The Australian Securities Exchange (ASX) listing rule 3.1 requires listed companies to immediately disclose price sensitive information to the market via the ASX’s Company Announcements Platform (CAP) prior to release through other disclosure channels. Since 1999, to improve the communication process, the ASX has permitted third-party mediation in the disclosure process that leads to the release of an Open Briefing (OB) through CAP. An OB is an interview between senior executives of the firm and an Open Briefing analyst employed by Orient Capital Pty Ltd (broaching topics such as current profit and outlook). Motivated by an absence of research on factors that influence firms to use OBs as a discretionary disclosure channel, this study examines (1) Why do firms choose to release information to the market via OBs?, (2) What are the firm characteristics that explain the discretionary use of OBs as a disclosure channel?, and (3) What are the disclosure attributes that influence firms’ decisions to regularly use OBs as a disclosure channel? Based on agency and information economics theories, a theoretical framework is developed to address research questions. This theoretical framework comprises disclosure environments such as firm characteristics and external factors, disclosure attributes and disclosure consequences. In order to address the first research question, the study investigates (i) the purpose of using OBs, (2) whether firms use OBs to provide information relating to previous public announcements, and (3) whether firms use OBs to provide routine or non-routine disclosures. In relation to the second and third research questions, hypotheses are developed to test factors expected to explain the discretionary use of OBs and firms’ decisions to regularly use OBs, and to explore the factors influencing the nature of OB disclosure. Content analysis and logistic regression models are used to investigate the research questions and test the hypotheses. Data are drawn from a hand-collected population of 1863 OB announcements issued by 239 listed firms between 2000 and 2010. The results show that types of information disclosed via an OB announcement are principally on matters relating to corporate strategies and performance and outlook. Most OB announcements are linked with a previous related announcement, with the lag between announcements significantly longer for loss-making firms than profitmaking firms. The main results show that firms which tend to be larger, have an analyst following, and have higher growth opportunities, are more likely to release OBs. Further, older firms and firms that release OB announcements containing good news, historical information and less complex information tend to be regular OB users. Lastly, firms more likely to disclose strategic information via OBs tend to operate in industries facing greater uncertainty, do not have analysts following, and have higher growth opportunities are less likely to disclose good news, historical information and complex information via OBs. This study is expected to contribute to disclosure literature in terms of disclosure attributes and firm characteristics that influence behaviour in this unique (OB) disclosure channel. With regard to practical significance, regulators can gain an understanding of how OBs are disclosed which can assist them in monitoring the use of OBs and improving the effectiveness of communications with stakeholders. In addition, investors can have a better comprehension of information contained in OB announcements, which may in turn better facilitate their investment decisions.

Improvement of the statutory framework for construction and demolition waste management exemplified in Germany and Australia

Construction and demolition (C&D) waste occupies the largest share of overall waste generation in many countries. However, waste management practices and outcomes may differ between countries. For instance, in Australia, C&D waste recovery is continuously improving during the last years but the amount of C&D waste increases every year, as there has been little improvement in waste avoidance and minimization. In contrast, in Germany, waste generation remains constant over many years despite the continuous economic growth. The waste recycling rate in Germany is one of the highest in the world. However, most waste recycled is from demolition work rather than from waste generated during new construction. In addition, specific laws need to be developed to further reduce landfill of non-recycled waste. Despite of the differences, C&D waste generation and recovery in both countries depend on the effectiveness of the statutory framework, which regulates their waste management practices. This is an issue in other parts of the world as well. Therefore countries can learn from each other to improve their current statutory framework for C&D waste management. By taking Germany and Australia as an example, possible measures to improve current practices of C&D waste management through better statutory tools are identified in this paper. After providing an overview of the statutory framework of both countries and their status in waste generation and recovery, a SWOT analysis is conducted to identify strengths, weaknesses, opportunities and threats of the statutory tools. Recommendations to improve the current statutory frameworks, in order to achieve less waste generation and more waste recovery in the construction industry are provided for the German and Australian government and they can also be transferred to other countries.

An integrated approach to enhance sustainability in industrialised building systems

Building prefabrication is known as Industrialised Building Systems (IBS) in Malaysia. This construction method possesses unique characteristics that are central to sustainable construction. For example, offsite construction enables efficient management of construction wastage by identifying major causes of waste arising during both the design and construction stages. These causes may then be eliminated by the improvement process in IBS component's manufacturing. However, current decisions on using IBS are typically financial driven and hinder the wider ranged adoption. In addition, current IBS misconceptions and the failure of rating schemes in evaluating the sustainability of IBS affect its implementation. A new approach is required to provide better understanding on the sustainability potential of IBS among stakeholders. Such approach should also help project the outcomes of each levels of decision-making to respond to social, economy and environmental challenges. This paper presents interim findings of research aimed at developing a framework for sustainable IBS development and suggests a more holistic approach to achieve sustainability. A framework of embedding sustainability factors is considered in three main phases of IBS construction; 1) Pre-construction, 2) Construction and 3) Post-construction phase. SWOT analysis was used to evaluate the strengths, weaknesses, opportunities and threats involved in the IBS implementations. The action plans are formulated from the analysis of sustainable objectives. This approach will show where and how sustainability should be integrated to improve IBS construction. A mix of quantitative and qualitative methodology was used in this research to explore the potential of IBS in integrating sustainability. The tools used in the study are questionnaires and semi-structured interviews. Outcomes from these tools lead to the identification of viable approaches involving 18 critical factors to improve sustainability in IBS constructions. Finally, guidelines for decision-making are being developed to provide a useful source of information and support to mutual benefit of the stakeholders in integrating sustainability issues and concepts into IBS applications.

Resilience by design: A participatory approach to designing an interactive digital application for promoting children's resilience

The promotion of resilience (the capacity of an individual or community to bounce back and recover from adversity) has become an important area of public health. In recent years it has expanded into the digital domain, and many online applications have been developed to promote children's resilience. In this study, it is argued that the majority of existing applications are limited because they take a didactic approach, and conceive of interaction as providing navigational choices. Because they simply provide information about resilience or replicate offline, scenario-based strategies, the understanding of resilience they provide is confined to a few, predetermined factors. In this study I propose a new, experiential approach to promoting resilience digitally. I define resilience as an emergent, situated and context-specific phenomenon. Using a Participatory Design model in combination with a salutogenic (strength-based) health methodology, this project has involved approximately 50 children as co-designers and co-researchers over two years. The children have contributed to the design of a new set of interactive resilience tools, which facilitate resilience promotion through dialogic and experiential learning. The major outcomes of this study include a new methodology for developing digital resilience tools, a new set of tools that have been developed and evaluated in collaboration with children and a set of design principles to guide future development. Beyond these initial and tangible outcomes, this study has also established that the benefits of introducing Participatory Design into a health promoting model rests primarily in the change of the role of children from "users" of technology and education to co-designers, where they assume a leadership role in both designing the tools and in directing their resilience learning.

The family participation in child care project

Working with families has long been a fundamental tenet of quality child care services. While there is broad agreement that family participation in child care offers multiple benefits to all concerned, many educators continue to identify this as one of the more challenging aspects of their work. There are a number of perceived barriers to participation, including time constraints, different needs and expectations and the lack of confidence and capacity to support genuine participation. What is interesting, and often overlooked, is that these are shared issues and relate to both educators and parents. Recognising the importance and challenge of family participation in child care, the Brisbane South Professional Support Network PSN), a network facilitated by the Health and Community Services Workforce Council is leading a collaborative research project to build educator knowledge and capacity to promote and support relationship building, meaningful dialogue and genuine partnerships in child care. This article reports on findings from the first phase of this study, identifying parent views and experiences of partnership and articipation in child care services. Findings highlight preferred methods of information sharing and seeking, identify barriers to communication and participation and provide insight into parent expectations of partnerships with educators.

Portfolio review

The portfolio can be loosely defined as a collection or collation of achievements, artefacts, creative works or examples of competencies, usually for the purpose of demonstrating a person’s capabilities in a specific field of endeavour. People make and share their portfolios for many reasons: social or cultural recognition, employment, accreditation, and educational qualification. It is this latter purpose that this chapter addresses; the creation and use of a portfolio for educational development and certification.

Increasing physical activity among women with young children: Results from the Proactive Mums Project

Context Evidence from the Australian Longitudinal Study of Women's Health suggests that mothers of young children have lower levels of physical activity (PA) than women of similar age without children. Objectives The aim of the ProActive Mums project was to determine the relative efficacy of two strategies designed to increase the proportion of mothers of young children who are meeting current PA guidelines, utilising child care centres (CCCs) as the setting for recruitment. Study Design The project used a randomised (after stratification to ensure even representation of CCCs from differing socio-economic areas) design incorporating repeated data collection from women in three groups, each consisting of 7 childcare centres (CCCs). Baseline surveys were completed by 554 mothers, with follow-up data collection immediately post-Intervention (8 weeks after baseline) and again 5 months later. Women from CCCs in Group 1 (control) received only the surveys throughout the duration of the project. Women from CCCs in Group 2 (information only) were given a print intervention, and women from CCCs in Group 3 were (in addition to being given the same print intervention as women from CCCs in Group 2) invited to to contribute to the development of, and participate in, strategies for the promotion of PA among mothers of young children. The two intervention strategies were extensively evaluated through a series of surveys and interviews. The Intervention The print intervention prescribed for women from CCCs in Group 2 and Group 3 consisted of an 8-page booklet containing motivational messages and information about physical activity. Women from CCCs in Group 3 were also invited to attend meetings at their CCC to identify strategies for increasing their PA. Contacts were made with key stakeholders in the community, including managers of sporting and recreation facilities, childcare service providers, and local councils. A wide range of strategies was developed during the intervention phase of the project, which specifically focused on the need to increase partner support and self-efficacy (or the confidence to be physically active). Results The mean age of participants was 33 (+ 4.8) years, and the mean number of children per family unit was 2.2 (± 0.9). At baseline, fewer than half the women were meeting current guidelines for adequate PA for health benefit, and there were no significant differences between groups in the proportion of women who were adequately active for health benefit. Women in Group 3 were significantly more likely to meet the guidelines at post-intervention follow-up than controls [OR = 1.71 (1.05-2.77)] after controlling for age and PA at baseline. There was no significant effect of the print intervention alone on meeting guidelines at post-intervention follow-up compared with controls, after controlling for age and PA at baseline [OR = 1.15 (0.70-1.89)]. Changes in Partner Support (PS) and Self Efficacy (SE) significantly predicted meeting current PA guidelines at post-intervention follow-up after controlling for baseline PA [∆ PS: OR = 2.29 (1.46-3.58); ∆ SE: OR = 1.86 (1.17- 2.94)]. The intervention effect in Group 3 was not maintained at long-term follow-up. Conclusions The findings indicate that a community participation approach that facilitates increased partner support and self-efficacy can be effective in increasing PA among mothers of young children. Changes in physical activity were found to be mediated by changes in partner support and self-efficacy for physical activity, suggesting that the intervention successfully targeted the individual characteristics it intended to, and that these variables do play an important role in increasing physical activity among women with young children. It is clear that further work needs to be done to explore methods of translating the short-term intervention effect shown in this study into long-term changes in PA behaviour. This study also provided insight into measurement issues in PA research and raised questions about self-report measures of PA and perceived constraints to being physically active. The results from post-study qualitative interviews suggest that many women at this life-stage experience time constraints which, when accompanied by a lack of partner support and financial constraints, make leisure-time PA virtually impossible for many women. Future strategies might focus on targeting this population immediately prior to this life-stage in an attempt to encourage habitual physical activity before women have children. Increasing PA in this population should also address the entire family unit, and consider the way leisure-time is negotiated among the adults within a household. Social change and increased awareness of the range of benefits of PA for women with children are additional strategies to be considered.