Calligraphy and causation : two obstetric management cases - Hirst v Sydney South West Area Health and King v Western Sydney local health network

Two recent decisions of the Supreme Court of New South Wales in the context of obstetric management have highlighted firstly, the importance of keeping legible, accurate and detailed medical records; and secondly, the challenges faced by those seeking to establish causation, particularly where epidemiological evidence is relied upon...

Customer equity management : the impact of strategy drivers and customer data management on customer equity outcomes

This research contributes to the field of customer equity by examining how important the strategy drivers of consumption and customer data management are in contributing to the value of the customer asset. A mixed methods approach focused on one sector: the Australian accommodation hotels. From this research, a deeper understanding of how to theorise, conceptualise and practice customer equity management has been achieved.

A data mining driven risk profiling method for road asset management

Road surface skid resistance has been shown to have a strong relationship to road crash risk, however, applying the current method of using investigatory levels to identify crash prone roads is problematic as they may fail in identifying risky roads outside of the norm. The proposed method analyses a complex and formerly impenetrable volume of data from roads and crashes using data mining. This method rapidly identifies roads with elevated crash-rate, potentially due to skid resistance deficit, for investigation. A hypothetical skid resistance/crash risk curve is developed for each road segment, driven by the model deployed in a novel regression tree extrapolation method. The method potentially solves the problem of missing skid resistance values which occurs during network-wide crash analysis, and allows risk assessment of the major proportion of roads without skid resistance values.

An investigation of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam

Background: In diabetes care, health care professionals need to provide support for their patients. In order to provide good diabetes self-management support for adults with type 2 diabetes in Vietnam, it is important that health care professionals in Vietnam understand the factors influencing diabetes self-management among these people. However, knowledge about factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam is limited. Objectives: This study aimed to investigate factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam. Methodology: A cross-sectional survey with convenience sampling was conducted on 198 adults with type 2 diabetes in VietnamData collection was administeted via interview. Descriptive statistics, simple correlation statistics and structural equation modelling statistics were used for data analysis. Results: Adults with type 2 diabetes in Vietnam had limited diabetes knowledge (Median = 6.0). The majority of the study participants (72.7%) believed that performing diabetes self-management activities was very important or extremely important for controlling their blood glucose levels and for preventing complications from diabetes; about half usually received support from their family and friends’ (48.5%), and around two thirds rarely received support from their health care providers (68.2%). Many of the participants (41.4%) had limited confidence to perform diabetes management activities. The practices of diabetes self-management were limited among the study population (Mean = 96.7, SD = 19.4). Diabetes knowledge (β = 0.17, p < .001), belief in treatment effectiveness (β = 0.13, p < .01), family and friends’ support (β = 0.13, p < .001), health care providers’ support (β = 0.27, p < .001) and diabetes management self-efficacy (β = 0.43, p < .001) directly influenced their diabetes self-management. Diabetes knowledge, and family and friends’ support also indirectly influenced diabetes self-management among these people through their belief in treatment effectiveness and their diabetes management self-efficacy (p < .05). Conclusion: Findings in this study indicated that health care professionals should provide diabetes self-management support for adults with type 2 diabetes in Vietnam in the future. The adapted theory-based model of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam found in this study could be a useful framework to develop this supporting program.

Surveillance Town: Social inclusion-exclusion through surveillance, ‘the dignity of work’ and income management

This paper discusses the situation of welfare claimants, constructed as faulty citizens and flawed welfare subjects at the receiving end of complex and multi-layered, private and public, forms of monitoring and surveillance aimed at securing socially responsible, consuming and compliant behaviours. In Australia as in many other western countries, the rise of neoliberal economic regimes with their harsh and often repressive treatment of welfare claimants operates in tandem with a growing arsenal of CCTV and assorted urban governance measures (Monahan 2008, Maki 2011). The capacity for all forms of surveillance to intensify social inequalities through the lens of CCTV and other modes and methods of electronic monitoring is amply demonstrated in the surveillance studies literature, raising fundamental questions around issues of social justice, equity and the expenditure of societal resources (Norris and Armstrong 1999, Lyon 1994, 2001, Loader 1996).

The concept of congruent patient-centred care for hepatitis C management

Patient-centred care has been touted as the cornerstone of an effective and efficient primary health care system. However, primary care by its nature is a fragmented system. The system co-evolves in response to needs rather than being planned. In recent years, Medicare Locals were formed in Australia with the intention to tap into this pragmatic nature of primary care and foster health services delivery which is responsive to community and individual patient needs i.e. ‘patient-centred care’. However, it remains to be seen what and how theoretical framework/s can inform this work. For this presentation we aim to illustrate with a case study how hepatitis C is currently managed in primary care and hypothesise what a congruent model of patient-centred care for hepatitis C management could look like.

The clinical effectiveness of interventions to assist perioperative temperature management for women undergoing Cesarean Section : a systematic review

Background Women undergoing Cesarean Section (CS) are vulnerable to the adverse effects associated with perioperative core temperature drop, in part due to the tendency for CS to be performed under neuraxial anesthesia, blood and fluid loss, and vasodilation. Inadvertent perioperative hypothermia (IPH) is a common condition that affects patients undergoing surgery of all specialties and is detrimental to all age groups, including neonates. Previous systematic reviews on IPH prevention largely focus on either adult or all ages populations, and have mainly overlooked pregnant or CS patients as a distinct group. Not all recommendations made by systematic reviews targeting all adult patients may be transferable to CS patients. Alternative, effective methods for preventing or managing hypothermia in this group would be valuable. Objectives To synthesize the best available evidence in relation to preventing and/or treating hypothermia in mothers after CS surgery. Types of participants Adult patients over the age of 18 years, of any ethnic background, with or without co-morbidities, undergoing any mode of anesthesia for any type of CS (emergency or planned) at healthcare facilities who have received interventions to limit or manage perioperative core heat loss were included. Types of intervention(s) Active or passive warming methods versus usual care or placebo, that aim to limit or manage core heat loss as applied to women undergoing CS were included. Types of studies Randomized controlled trials (RCTs) that met the inclusion criteria, with reduction of perioperative hypothermia a primary or secondary outcome were considered. Types of outcomes Primary outcome: maternal core temperature measured during the preoperative, intraoperative and postoperative phases of care Secondary outcomes: newborn core temperature at birth, umbilical pH obtained immediately after birth, Apgar scores, length of Post Anesthetic Care Unit (PACU) stay, maternal thermal comfort. Search strategy A comprehensive search was undertaken of the following databases from their inception until May 2012: ProQuest, Web of Science, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Mednar, OpenGrey, Clinical Trials. There were no language restrictions. Methodological quality Retrieved papers were assessed for methodological quality by two independent reviewers prior to inclusion using JBI software. Disagreements were resolved via consultation with the third reviewer. An assessment of quality of the included papers was also made in relation to five key quality factors. Data collection Two independent reviewers extracted data from the included papers using a previously piloted customized data extraction tool. Results 12 studies with a combined total of 719 participants were included. Three broad intervention groups were identified; intravenous (IV) fluid warming, warming devices, leg wrapping. IV fluid warming, whether administered intraoperatively or preoperatively, was found to be effective at maintaining maternal (but not neonatal) temperature and preventing shivering, but does not improve thermal comfort. The effectiveness of IV fluid warming on Apgar scores and umbilical pH remains unclear. Warming devices, including forced air warming and under body carbon polymer mattresses, were effective at preventing hypothermia and reduced shivering, however were most effective if applied preoperatively. The effectiveness of warming devices to improve thermal comfort remains unclear. Preoperative forced air warming appears to aid maintenance of neonatal temperature, while intraoperative forced air warming does not. Forced air warming was not effective at improving Apgar scores and the effects for umbilical pH remain unclear. Conclusions Intravenous fluid warming, by any method, improves maternal temperature and reduces shivering for women undergoing CS. Preoperative body warming devices also improve maternal temperature, in addition to reducing shivering.

Current practice in nutrition assessment for the management of Parkinson’s disease in Australia and Canada

AIM: To document and compare current practice in nutrition assessment of Parkinson’s disease by dietitians in Australia and Canada in order to identify priority areas for review and development of practice guidelines and direct future research. METHODS: An online survey was distributed to DAA members and PEN subscribers through their email newsletters. The survey captured current practice in the phases of the Nutrition Care Plan. The results of the assessment phase are presented here. RESULTS: Eighty-four dietitians responded. Differences in practice existed in the choice of nutrition screening and assessment tools, including appropriate BMI ranges. Nutrition impact symptoms were commonly assessed, but information about Parkinson’s disease medication interactions were not consistently assessed. CONCLUSIONS: he variation in practice related to the use of screening and assessment methods may result in the identification of different goals for subsequent interventions. Even more practice variation was evident for those items more specific to Parkinson’s disease and may be due to the lack of evidence to guide practice. Further research is required to support decisions for nutrition assessment of Parkinson’s disease.

Development and validation of an instrument to measure organizational cultures' support of business process management

The purpose of Business Process Management (BPM) is to increase the efficiency and effectiveness of organizational processes through improvement and innovation. Despite a common understanding that culture is an important element in these efforts, there is a dearth of theoretical and empirical research on culture as a facilitator of successful BPM. We develop the BPM culture construct and propose a validated instrument with which to measure organizational cultures’ support of BPM. The operationalization of the BPM culture concept provides a theoretical foundation for future research and a tool to assist organizations in developing a cultural environment that supports successful BPM.

A framework for cost-aware process management : cost reporting and cost prediction

Organisations are constantly seeking efficiency gains for their business processes in terms of time and cost. Management accounting enables detailed cost reporting of business operations for decision making purposes, although significant effort is required to gather accurate operational data. Process mining, on the other hand, may provide valuable insight into processes through analysis of events recorded in logs by IT systems, but its primary focus is not on cost implications. In this paper, a framework is proposed which aims to exploit the strengths of both fields in order to better support management decisions on cost control. This is achieved by automatically merging cost data with historical data from event logs for the purposes of monitoring, predicting, and reporting process-related costs. The on-demand generation of accurate, relevant and timely cost reports, in a style akin to reports in the area of management accounting, will also be illustrated. This is achieved through extending the open-source process mining framework ProM.

International corporate entrepreneurship among SMEs : a test of Stevenson's notion of entrepreneurial management

Geographical market expansion is included in various definitions of entrepreneurship as it entails the opening up of new markets (for example, Davidsson 2003). Expansion into new international markets and launch of new products in international markets are also consistent with definitions of entrepreneurship which center on the pursuit of opportunities {e.g.\Stevenson, 1983 #922;Gartner, 1993 #931}. Accordingly, the decision by managers of small, internationally active businesses to continue to internationalize can be viewed as an entrepreneurial act. In spite of the fact that both start-ups and existing firms can behave entrepreneurially by expanding into new international markets, the attention of entrepreneurship researchers interested in international activities has largely focused on international new ventures (INVs); that is, business organizations that internationalize from inception (Oviatt, and McDougall 1994; Oviatt, and McDougall 1997). Consequently, pursuit of international opportunities by established small and medium-sized enterprises (SMEs) lacks theoretical understanding and empirical investigation through an entrepreneurship lens. This paper contributes to the body of knowledge at the entrepreneurship-internationalization interface by testing whether Stevenson’s opportunity-based conceptualization of entrepreneurial management (Stevenson 1983; Stevenson and Gumpert 1985; Stevenson and Jarillo 1990) can explain the attainment of continued entrepreneurial outcomes by SMEs operating in foreign markets. We choose Stevenson’s conceptualization as it gauges firm-level characteristics that are theorized to facilitate the pursuit of entrepreneurial opportunities, which arguably is at the heart of SMEs’ continued venturing into international markets.

Understanding requirements of novel healthcare information systems for management of advanced prostate cancer

Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.

Acetylcholine receptor antibody in the diagnosis and management of myasthenia gravis

The relationship of acetylcholine receptor (AchR) antibodies to disease activity in myasthenia gravis (MG) is controversial. Some authors claim a direct correlation with disease activity and treatment, in particular plasmapheresis therapy, whereas others have commented on the poor overall correlation of antibody levels with clinical state. Antibody levels were examined in a population of MG patients and correlated with disease activity and response to treatment. Antibodies to skeletal muscle AchR were found in most patients with generalised MG (24/25) and in about half of the patients with purely ocular MG (6/10) and in neither of 2 patients with congenital MG. There was scant correlation with disease activity or response to treatment. It is concluded that the assay is more useful for diagnosis than for management of MG.

Shaping the conversation : how management consultants engage knowledge boundary processes

This paper aims to contribute to an understanding of what actually takes place during consulting engagements. It draws on data collected from a qualitative case study of eight engagements by a niche consultancy in Australia to describe how consultants actively engage boundary crossing processes to address knowledge boundaries encountered during formal interactions with clients. While consultants actively managed knowledge boundary processes during interactions, by applying techniques such as evoking an ‘ideal state’ for clients, the engagements also yielded many missed opportunities for knowledge transformation.

Composite SaaS resource management in cloud computing using evolutionary computation

Cloud computing is an emerging computing paradigm in which IT resources are provided over the Internet as a service to users. One such service offered through the Cloud is Software as a Service or SaaS. SaaS can be delivered in a composite form, consisting of a set of application and data components that work together to deliver higher-level functional software. SaaS is receiving substantial attention today from both software providers and users. It is also predicted to has positive future markets by analyst firms. This raises new challenges for SaaS providers managing SaaS, especially in large-scale data centres like Cloud. One of the challenges is providing management of Cloud resources for SaaS which guarantees maintaining SaaS performance while optimising resources use. Extensive research on the resource optimisation of Cloud service has not yet addressed the challenges of managing resources for composite SaaS. This research addresses this gap by focusing on three new problems of composite SaaS: placement, clustering and scalability. The overall aim is to develop efficient and scalable mechanisms that facilitate the delivery of high performance composite SaaS for users while optimising the resources used. All three problems are characterised as highly constrained, large-scaled and complex combinatorial optimisation problems. Therefore, evolutionary algorithms are adopted as the main technique in solving these problems. The first research problem refers to how a composite SaaS is placed onto Cloud servers to optimise its performance while satisfying the SaaS resource and response time constraints. Existing research on this problem often ignores the dependencies between components and considers placement of a homogenous type of component only. A precise problem formulation of composite SaaS placement problem is presented. A classical genetic algorithm and two versions of cooperative co-evolutionary algorithms are designed to now manage the placement of heterogeneous types of SaaS components together with their dependencies, requirements and constraints. Experimental results demonstrate the efficiency and scalability of these new algorithms. In the second problem, SaaS components are assumed to be already running on Cloud virtual machines (VMs). However, due to the environment of a Cloud, the current placement may need to be modified. Existing techniques focused mostly at the infrastructure level instead of the application level. This research addressed the problem at the application level by clustering suitable components to VMs to optimise the resource used and to maintain the SaaS performance. Two versions of grouping genetic algorithms (GGAs) are designed to cater for the structural group of a composite SaaS. The first GGA used a repair-based method while the second used a penalty-based method to handle the problem constraints. The experimental results confirmed that the GGAs always produced a better reconfiguration placement plan compared with a common heuristic for clustering problems. The third research problem deals with the replication or deletion of SaaS instances in coping with the SaaS workload. To determine a scaling plan that can minimise the resource used and maintain the SaaS performance is a critical task. Additionally, the problem consists of constraints and interdependency between components, making solutions even more difficult to find. A hybrid genetic algorithm (HGA) was developed to solve this problem by exploring the problem search space through its genetic operators and fitness function to determine the SaaS scaling plan. The HGA also uses the problem's domain knowledge to ensure that the solutions meet the problem's constraints and achieve its objectives. The experimental results demonstrated that the HGA constantly outperform a heuristic algorithm by achieving a low-cost scaling and placement plan. This research has identified three significant new problems for composite SaaS in Cloud. Various types of evolutionary algorithms have also been developed in addressing the problems where these contribute to the evolutionary computation field. The algorithms provide solutions for efficient resource management of composite SaaS in Cloud that resulted to a low total cost of ownership for users while guaranteeing the SaaS performance.