Maximum recovery after knee replacement - the MARKER study rationale and protocol

Background There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes. Methods/Design In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery. Discussion The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.

Diffusion of corporate governance practices : the Dutch response to pressures for shareholder value

As part of a larger literature focused on identifying and relating the antecedents and consequences of diffusing organizational practices/ideas, recent research has debated the international adoption of a shareholder-value-orientation (SVO). The debate has financial economists characterizing the adoption of an SVO as performance-enhancing and thus inevitable, with behavioral scientists disputing both claims, invoking institutional differences. This study seeks to provide some resolution to the debate (and advance current understanding on the diffusion of practices/ideas) by developing a socio-political perspective that links the antecedents and consequences of an SVO. In particular, we introduce the notion of misaligned elites and misfitted practices in our analysis of how and why differences in the technical and cultural preferences of major owners will influence a firm’s adoption and (un)successful implementation of an SVO among the largest 100 corporations in the Netherlands from 1992-2006. We conclude with a discussion of the implications of our perspective and our findings for future research on corporate governance and the diffusion of organizational practices/ideas.

Challenges in the supervisory boardroom : an exploratory study in the Netherlands

As a consequence of recent corporate governance reforms, the work of supervisory board members in the Dutch two-tier system has become more complex. The objectives of this study are to gain more insight in the current challenges that supervisory board members face and assess whether they are well-equipped to manage them. Based on a combination of an analysis of self-assessment reports, a web-based survey and semi-structured interviews, we conclude that the major challenges of supervisory board members lie in the field of interaction and collaboration with executives. Distinct ‘challenge areas’ were relatively often perceived as problematic as well as important, highlighting the need to improve the current functioning of boards. With regard to the skills that are present on supervisory boards, we find that individual qualities, like integrity, professionalism and knowledge, are better recognized than collective qualities for the supervisory board as a whole. In particular, openness and honesty are seen as important, but often lacking. The paper highlights several implications for scholars and practitioners.

Empirical research in business process management : introduction to the special issue

In this editorial letter, we provide the readers of Information Systems and e-Business Management with an introduction to Business Process Management and the challenges of empirical research in this field. We then briefly describe selected examples of current research efforts in this fields and how the papers accepted for this special issue contribute to extending our body of knowledge.

Green IT : a matter of business and information systems engineering?

This panel discusses the impact of Green IT on information systems and how information systems can meet environmental challenges and ensure sustainability. We wish to highlight the role of green business processes, and specifically the contributions that the management of these processes can play in leveraging the transformative power of IS in order to create an environmentally sustainable society. The management of business processes has typically been thought of in terms of business improvement alongside the dimensions time, cost, quality, or flexibility – the so-called ‘devil’s quadrangle’. Contemporary organizations, however, increasingly become aware of the need to create more sustainable, IT-enabled business processes that are also successful in terms of their economic, ecological, as well as social impact. Exemplary ecological key performance indicators that increasingly find their way into the agenda of managers include carbon emissions, data center energy, or renewable energy consumption (SAP 2010). The key challenge, therefore, is to extend the devil’s quadrangle to a devil’s pentagon, including sustainability as an important fifth dimension in process change.

On the optimality of sample-based estimates of the expectation of the empirical minimizer

We study sample-based estimates of the expectation of the function produced by the empirical minimization algorithm. We investigate the extent to which one can estimate the rate of convergence of the empirical minimizer in a data dependent manner. We establish three main results. First, we provide an algorithm that upper bounds the expectation of the empirical minimizer in a completely data-dependent manner. This bound is based on a structural result due to Bartlett and Mendelson, which relates expectations to sample averages. Second, we show that these structural upper bounds can be loose, compared to previous bounds. In particular, we demonstrate a class for which the expectation of the empirical minimizer decreases as O(1/n) for sample size n, although the upper bound based on structural properties is Ω(1). Third, we show that this looseness of the bound is inevitable: we present an example that shows that a sharp bound cannot be universally recovered from empirical data.

Co-constructing self-efficacy narratives : a study of four mature age university students

This thesis reports on a study in which research participants, four mature aged females starting an undergraduate degree at a regional Australian university, collaborated with the researcher in co-constructing a self-efficacy narrative. For the purpose of the study, self-efficacy was conceptualized as a means by which an individual initiates action to engage in a task or set of tasks, applies effort to perform the task or set of tasks, and persists in the face of obstacles encountered in order to achieve successful completion of the task or set of tasks. Qualitative interviews were conducted with the participants, initially investigating their respective life histories for an understanding of how they made the decision to embark on their respective academic program. Additional data were generated from a written exercise, prompting participants to furnish specific examples of self-efficacy. These data were incorporated into the individual's self-efficacy narrative, produced as the outcome of the "narrative analysis". Another aspect of the study entailed "analysis of narrative" in which analytic procedures were used to identify themes common to the self-efficacy narratives. Five main themes were identified: (a) participants' experience of schooling . for several participants their formative experience of school was not always positive, and yet their narratives demonstrated their agency in persevering and taking on university-level studies as mature aged persons; (b) recognition of family as an early influence . these influences were described as being both positive, in the sense of being supportive and encouraging, as well as posing obstacles that participants had to overcome in order to pursue their goals; (c) availability of supportive persons – the support of particular persons was acknowledged as a factor that enabled participants to persist in their respective endeavours; (d) luck or chance factors were recognised as placing participants at the right place at the right time, from which circumstances they applied considerable effort in order to convert the opportunity into a successful outcome; and (e) self-efficacy was identified as a major theme found in the narratives. The study included an evaluation of the research process by participants. A number of themes were identified in respect of the manner in which the research process was experienced as a helpful process. Participants commented that: (a) the research process was helpful in clarifying their respective career goals; (b) they appreciated opportunities provided by the research process to view their life from a different perspective and to better understand what motivated them, and what their preferred learning styles were; (c) their past successes in a range of different spheres were made more evident to them as they were guided in self-reflection, and their self-efficacious behaviour was affirmed; and (d) the opportunities provided by their participation in the research process to identify strengths of which they had not been consciously aware, to find confirmation of strengths they knew they possessed, and in some instances to rectify misconceptions they had held about aspects of their personality. The study made three important contributions to knowledge. Firstly, it provided a detailed explication of a qualitative narrative method in exploring self-efficacy, with the potential for application to other issues in educational, counselling and psychotherapy research. Secondly, it consolidated and illustrated social cognitive theory by proposing a dynamic model of self-efficacy, drawing on constructivist and interpretivist paradigms and extending extant theory and models. Finally, the study made a contribution to the debate concerning the nexus of qualitative research and counselling by providing guidelines for ethical practice in both endeavours for the practitioner-researcher.

The changing role of the supervisory board chairman: the case of the Netherlands (1997-2007)

Over the last ten years, the corporate governance context in most Western countries has changed as a result of irregularities, increased regulation, heightened societal expectations and shareholder activism. This paper examines the impact of the changing context on the role of chairmen of supervisory boards in the Netherlands. Based on a combination of thirty semi-structured interviews with board members of leading Dutch corporations and secondary data on the position of supervisory board chairmen at the top-100 listed firms in the Netherlands, the study reveals that board chairmen have become increasingly involved in both their control and service roles. While the demographics (i.e., age, tenure, gender and nationality) of chairmen have hardly changed over the last decade, chairmen are spending considerably more time on boards and committees, have reduced the number of board interlocks and have become more active on the forefront of the corporate governance discussion. The paper highlights several implications for scholars and practitioners.

Investigating the development of the internal and external service tasks of non-executive directors: the case of the Netherlands (1997-2005)

During the last decade, globalisation and liberalisation of financial markets, changing societal expectations and corporate governance scandals have increased the attention for the fiduciary duties of non-executive directors. In this context, recent corporate governance reform initiatives have emphasised the control task and independence of non-executive directors. However, little attention has been paid to their impact on the external and internal service tasks of non-executive directors. Therefore, this paper investigates how the service tasks of non-executive directors have evolved in the Netherlands. Data on corporate governance at the top-100 listed companies in the Netherlands between 1997 and 2005 show that the emphasis on non-executive directors' external service task has shifted to their internal service task, i.e. from non-executive directors acting as boundary spanners to non-executive directors providing advice and counselling to executive directors. This shift in board responsibilities affects non-executive directors' ability to generate network benefits through board relationships and has implications for non-executive directors' functional requirements.