Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units : cost effectiveness evaluation

Objective: To assess the cost-effectiveness of screening, isolation and decolonisation strategies in the control of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs). Design: Economic evaluation. Setting: England and Wales. Population: ICU patients. Main outcome measures: Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios for alternative strategies, net monetary benefits (NMBs). Results: All strategies using isolation but not decolonisation improved health outcomes but increased costs. When MRSA prevalence on admission to the ICU was 5% and the willingness to pay per QALY gained was between £20,000 and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or following identification by admission and weekly MRSA screening using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction (PCR)-based MRSA detection coupled with isolation was unlikely to be cost-effective unless prevalence was high (10% colonised with MRSA on admission to the ICU). All decolonisation strategies improved health outcomes and reduced costs. While universal decolonisation (regardless of MRSA status) was the most cost-effective in the short-term, strategies using screening to target MRSA carriers may be preferred due to reduced risk of selecting for resistance. Amongst such targeted strategies, universal admission and weekly PCR screening coupled with decolonisation with nasal mupirocin was the most cost-effective. This finding was robust to ICU size, MRSA admission prevalence, the proportion of patients classified as high-risk, and the precise value of willingness to pay for health benefits. Conclusions: MRSA control strategies that use decolonisation are likely to be cost-saving in an ICU setting provided resistance is lacking, and combining universal PCR-based screening with decolonisation is likely to represent good value for money if untargeted decolonisation is considered unacceptable. In ICUs where decolonisation is not implemented there is insufficient evidence to support universal MRSA screening outside high prevalence settings.

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers

Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy. Keywords: case management, caseload, stress

Understanding user differences in open-source workflow management system usage intentions

Open-source software systems have become a viable alternative to proprietary systems. We collected data on the usage of an open-source workflow management system developed by a university research group, and examined this data with a focus on how three different user cohorts – students, academics and industry professionals – develop behavioral intentions to use the system. Building upon a framework of motivational components, we examined the group differences in extrinsic versus intrinsic motivations on continued usage intentions. Our study provides a detailed understanding of the use of open-source workflow management systems in different user communities. Moreover, it discusses implications for the provision of workflow management systems, the user-specific management of open-source systems and the development of services in the wider user community.

Mindfulness-based stress management: Findings from randomized controlled trials

The use of Mindfulness has become increasingly popular in the field of psychotherapy and counselling, and is now finding application in unexpected places. Is it just another therapeutic fad or an evidence-based intervention with lasting value? ROBERT KING provides a timely review of the research literature to provide a summary of the findings of randomised control trials of the clinical efficacy or effectiveness of Mindfulness as a stress reduction intervention.

Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective program for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with ‘usual services’ suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed.

A proposed role for models and simulations in management research

Overall, computer models and simulations have a rather disappointing record within the management sciences as a tool for predicting the future. Social and market environments can be influenced by an overwhelming number of variables, and it is therefore difficult to use computer models to make forecasts or to test hypotheses concerning the relationship between individual behaviours and macroscopic outcomes. At the same time, however, advocates of computer models argue that they can be used to overcome the human mind's inability to cope with several complex variables simultaneously or to understand concepts that are highly counterintuitive. This paper seeks to bridge the gap between these two perspectives by suggesting that management research can indeed benefit from computer models by using them to formulate fruitful hypotheses.

The role of knowledge in the project management office

Both Knowledge Management (KM) and Project Management (PM) are known as crucial factors to develop competitive advantage(CA). PM Office (PMO) is recognized as a strong solution to institutionalize PM practices in organization. However, according to the literature there is a significant gap in addressing KM practices in the PMO. In other words, existing PMO maturity models has not been addressed from KM perceptive. This paper discusses undertaken investigations of both KM and PM as an initial part of PhD research on the role of knowledge in PMO

Management and engineering of process aware information systems : introduction to the special issue

In this editorial letter, we provide the readers of Information Systems with a birds-eye introduction to Process-aware Information Systems (PAIS) – a sub-field of Information Systems that has drawn growing attention in the past two decades, both as an engineering and as a management discipline. Against this backdrop, we briefly discuss how the papers included in this special issue contribute to extending the body of knowledge in this field.

Corporate governance mechanisms and earnings management in transitional countries – evidence from Chinese listed firms

The objective of this thesis is to investigate whether the corporate governance practices adopted by Chinese listed firms are associated with the quality of earnings information. Based on a review of agency and institutional theory, this study develops hypotheses that predict the monitoring effectiveness of the board and the audit committee. Using a combination of univariate and multivariate analyses, the association between corporate governance mechanisms and earnings management are tested from 2004 to 2008. Through analysing the empirical results, a number of findings are summarised as below. First, board independence is weakened by the introduction of government officials as independent directors on the boards. Government officials acting as independent directors, claim that they meet the definition of independent director set by the regulation. However, they have some connection with the State, which is the controlling shareholder in listed SOEs affiliated companies. Consequently, the effect of the independent director’s expertise in constraining earnings management is mitigated as demonstrated by an insignificant association between board expertise and earnings management. An alternative explanation for the inefficiency of board independence may point to the pre-selection of independent directors by the powerful CEO. It is argued that a CEO can manipulate the board composition and choose the "desirable" independent directors to monitor themselves. Second, a number of internal mechanisms, such as board size, board activities, and the separation of the roles of the CEO and chair are found to be significantly associated with discretionary accruals. This result suggests that there are advantages in having a large and active board in the Chinese setting. This can offset the disadvantages associated with large boards, such as increased bureaucracy, and hence, increase the constraining effects of a large and resourceful board. Third, factor analysis identifies two factors: CEO power and board power. CEO power is the factor which consists of CEO duality and turnover, and board power is composed of board size and board activity. The results of CEO power show that if a Chinese listed company has CEO duality and turnover at the same time, it is more likely to have a high level of earnings management. The significant and negative relationship between board power and accruals indicate that large boards with frequent meetings can be associated with low level of earnings management. Overall, the factor analysis suggests that certain governance mechanisms complement each other to become more efficient monitors of opportunistic earnings management. A combination of board characteristics can increase the negative association with earnings management. Fourth, the insignificant results between audit committees and earnings management in Chinese listed firms suggests that the Chinese regulator should strengthen the audit committee functions. This thesis calls for listed firms to disclose more information on audit committee composition and activities, which can facilitate future research on the Chinese audit committee’s monitoring role. Fifth, the interactive results between State ownership and board characteristics show that dominant State ownership has a moderating effect on board monitoring power as the State totally controls 42% of the issued shares. The high percentage of State ownership makes it difficult for the non-controlling institutional shareholders to challenge the State’s dominant status. As a result, the association between non-controlling institutional ownership and earnings management is insignificant in most situations. Lastly, firms audited by the international Big4 have lower abnormal accruals than firms audited by domestic Chinese audit firms. In addition, the inverse U-shape relationship between audit tenure and earnings quality demonstrates the changing effects of audit quality after a certain period of appointment. Furthermore, this thesis finds that listing in Hong Kong Stock Exchanges can be an alternative governance mechanism to discipline Chinese firms to follow strict Hong Kong listing requirements. Management of Hong Kong listed companies are exposed to the scrutiny of international investors and Hong Kong regulators. This in turn reduces their chances of conducting self-interested earnings manipulation. This study is designed to fill the gap in governance literature in China that is related to earnings management. Previous research on corporate governance mechanisms and earnings management in China is not conclusive. The current research builds on previous literature and provides some meaningful implications for practitioners, regulators, academic, and international investors who have investment interests in a transitional country. The findings of this study contribute to corporate governance and earnings management literature in the context of the transitional economy of China. The use of alternative measures for earnings management yields similar results compared with the accruals models and produces additional findings.

Business process management : theory on progression and maturity

Business Process Management (BPM) is a topic that continues to grow in significance as organisations seek to gain and sustain competitive advantage in an increasingly global environment. Despite anecdotal evidence of organisations improving performance by pursuing a BPM approach, there is little theory that explains and substantiates this relationship. This study provides the first theory on the progression and maturity of BPM Initiatives within organisations and provides a vital starting block upon which future research in this area can build. The Researcher starts by clearly defining three key terms (BPM Initiative, BPM Progression and BPM Maturity), showing the relationship between these three concepts and proposing their relationship with Organisational Performance. The Researcher then combines extant literature and use of the Delphi Technique and the case study method to explore the progression and measurement of the BPM Initiatives within organisations. The study builds upon the principles of general theories including the Punctuated Equilibrium Model and Dynamic Capabilities to present theory on BPM Progression and BPM Maturity. Using the BPM Capability Framework developed through an international Delphi study series, the Researcher shows how the specific organisational context influences which capability areas an organisation chooses to progress. By comparing five separate organisations over an extended time the Researcher is able to show that, despite this disparity, there is some evidence of consistency with regard to the capability areas progressed. This suggests that subsequent identification of progression paths may be possible. The study also shows that the approach and scope taken to BPM within each organisation is a likely predictor of such paths. These outcomes result in the proposal of a formative model for measuring BPM Maturity.

Infrastructure asset : developing maintenance management capability

Purpose Maintenance management is a core process in infrastructure asset management. Infrastructure organisations must constantly strive to ensure the effectiveness of this process in order to obtain the greatest lifetime value from their infrastructure assets. This paper aims to investigate how infrastructure organisations can enhance the effectiveness of their maintenance management process. Approach This study utilised multiple case studies as the research approach. The case organisations were asked to identify the challenges faced in the maintenance process and the approaches they have adopted to overcome these challenges. Analysis of these findings, together with deductive reasoning, leads to the development of the proposed capability needed for effective maintenance management process. Findings The case studies reveal that maintenance management process is a core process in ensuring that infrastructure assets are optimally and functionally available to support business operations. However, the main challenge is the lack of skilled and experienced personnel to understand and anticipate maintenance requirement. A second challenge is the reduced window of time available to carry out inspection and maintenance works. To overcome these challenges, the case organisations have invested in technologies. However, technologies available to facilitate this process are complex and constantly changing. Consequently, there is a need for infrastructure organizations to develop their technological absorptive capability, i.e. the ability to embrace and capitalize on new technologies to enhance their maintenance management process. Originality/Value This paper is original in that it provides empirical evidence to identify technological absorptive capability as core to improving the maintenance management process. The findings are valuable because it sheds light on where infrastructure organisation, regardless of whether they are privately or publicly owned, should channel their scarce resources. The development of the core capability will ensure that the maintenance process can contribute value to their organisation.

Planning for SMEs’ Proactive Waste Management in Office Building Retrofit Projects

Office building retrofit projects face many challenges for on-site waste management. While the projects themselves have the potential for a significant level of reuse and recycling from decon-struction and demolition, their unique characteristics often prohibit direct application of existing waste management systems, which are typically based on managing waste generated through new material application in new build projects. Moreover, current waste management plans include no stimuli to involve Small and Medium Enterprises (SMEs) for on-site waste management. As SMEs carry out the majority of on-site work as subcontractors, their active involvements will result in more proactive approaches to waste management and enhance project delivery. This paper discusses the interim results of a continuing research aimed at engaging SMEs in the planning processes of waste management through the collaboration between subcontractors and main contractors of retrofitting projects. It introduces a conceptual model for SMEs to proactively plan and manage on-site waste generation for both deconstruction and construction stages, before traditional waste management plans by the main contractor come into place. The model also suggests a collaboration process between SMEs as subcontractors and large companies as the main contractor to improve the involvement and performance of SMEs in waste management of office building retrofit projects.

Beyond MOF constraints : multiple constraint set metamodelling for lifecycle management

The management of models over time in many domains requires different constraints to apply to some parts of the model as it evolves. Using EMF and its meta-language Ecore, the development of model management code and tools usually relies on the meta- model having some constraints, such as attribute and reference cardinalities and changeability, set in the least constrained way that any model user will require. Stronger versions of these constraints can then be enforced in code, or by attaching additional constraint expressions, and their evaluations engines, to the generated model code. We propose a mechanism that allows for variations to the constraining meta-attributes of metamodels, to allow enforcement of different constraints at different lifecycle stages of a model. We then discuss the implementation choices within EMF to support the validation of a state-specific metamodel on model graphs when changing states, as well as the enforcement of state-specific constraints when executing model change operations.

Non-pharmacological interventions for breathlessness management in patients with lung cancer : A systematic review

The aim is to review the published scientific literature for studies evaluating nonpharmacological interventions for breathlessness management in patients with lung cancer. The following selection criteria were used to systematically search the literature: studies were to be published research or systematic reviews; they were to be published in English and from 1990 to 2007; the targeted populations were adult patients with dyspnoea/breathlessness associated with lung cancer; and the study reported on the outcomes from use of non-pharmacological strategies for breathlessness. This review retrieved five studies that met all inclusion criteria. All the studies reported the benefits of non-pharmacological interventions in improving breathlessness regardless of differences in clinical contexts, components of programmes and methods for delivery. Analysis of the available evidence suggests that tailored instructions delivered by nurses with sufficient training and supervision may have some benefits over other delivery approaches. Based on the results, non-pharmacological interventions are recommended as effective adjunctive strategies in managing breathlessness for patients with lung cancer. In order to refine such interventions, future research should seek to explore the core components of such approaches that are critical to achieving optimal outcomes, the contexts in which the interventions are most effective, and to evaluate the relative benefits of different methods for delivering such interventions.

An integrated knowledge management framework for managing sustainability knowledge in the Australian infrastructure sector

In Australia, it has been increasingly accepted that sustainability needs to be at the top of the agenda when contemplating infrastructure development. In practice however, many companies struggle to find effective ways to embrace sustainable ideas and implement them in real projects beyond minimum compliance. One of the reasons is the lack of underpinning knowledge and evidence to demonstrate and measure the linkage between sustainability implementations and the relevant outcomes. This is compounded by the fact that very often there are no common understandings between the stakeholders on sustainability and there is a big divide between research advancement and real-life applications. Therefore it is both feasible and timely to develop and expand the body of sustainability knowledge on infrastructure development and investigate better ways of communicating with and managing it within the infrastructure sector. Although knowledge management (KM) is a relatively new and emerging discipline, it has shown its value and promise in existing applications in the construction industry. Considering the existing KM mechanisms and tools employed in practice, this research is aimed at establishing a specific KM approach to facilitate sustainability knowledge identification, acquisition, sharing, maintenance and application within the infrastructure sector, and promote integrated decision-making for sustainable infrastructure development. A triangulation of questionnaire survey, semi-structured interviews and case studies was employed in this research to collect required qualitative and quantitative data. The research studied the unique characteristics of the infrastructure sector, the nature of sustainability knowledge, and evaluated and validated the critical elements, key processes, and priority issues of KM for the Australian infrastructure sector. A holistic KM framework was developed to set the overall context for managing sustainability knowledge in the infrastructure sector by outlining (1) the main aims and outcomes of managing sustainability knowledge, (2) the key knowledge activities, (3) effective KM strategies and instruments, and (4) KM enablers. Because of the highly project-oriented nature of the infrastructure sector, knowledge can only add value when it is being used in real projects. Implementation guidelines were developed to help the industry practitioners and project teams to apply sustainability knowledge and implement KM in infrastructure project scenarios. This research provides the Australian infrastructure sector with tools to better understand KM, helps the industry practitioners to prioritize attention on relevant sustainability issues, and recommends effective practices to manage sustainability knowledge, especially in real life implementation of infrastructure projects.