What We Have Here is a Failure to Communicate! Improving Communication between Tertiary to Primary Care for Chronic Heart Failure Patients

Background:  The aims of this study were to determine the documentation of pharmacotherapy optimization goals in the discharge letters of patients with the principal diagnosis of chronic heart failure. Methods:  A retrospective practice audit of 212 patients discharged to the care of their local general practitioner from general medical units of a large tertiary hospital. Details of recommendations regarding ongoing pharmacological and non-pharmacological management were reviewed. The doses of medications on discharge were noted and whether they met current guidelines recommending titration of angiotensin-converting enzyme inhibitors and beta-blockers. Ongoing arrangements for specialist follow up were also reviewed. Results:  The mean age of patients whose letters were reviewed was 78.4 years (standard deviation ± 8.6); 50% were men. Patients had an overall median of six comorbidities and eight regular medications on discharge. Mean length of stay for each admission was 6 days. Discharge letters were posted a median of 4 days after discharge, with 25% not posted at 10 days. No discharge letter was sent in 9.4% (20) of the cases. Only six (2.8%) letters had any recommendations regarding future titration of angiotensin-converting enzyme inhibitors and 6.6% (14) for beta-blockers. Recommendations for future non-pharmacological management, for example, diuretic action plans, regular weight monitoring and exercise plans were not found in the letters in this audit. Conclusion:  Hospital discharge is an opportunity to communicate management plans for treatment optimization effectively, and while this opportunity is spurned, implementation gaps in the management of cardiac failure will probably remain.

Crisis preparedness of construction companies

In high-risk industries, companies with well-conceived crisis management plans are at a commercial advantage. While there is some understanding of the risk management practices of construction companies, there is little insight into their crisis preparedness. This paper presents the findings of exploratory research that investigated this issue. Using a diagnostic model of crisis preparedness that has been developed and tested across a broad range of industries, it concludes that if the sample surveyed is typical, then corporate philosophies in construction companies do not support crisis management activities. Furthermore, crisis planning is rudimentary and undertaken in an insular, informal, fragmented fashion, supported by few resources and little strategic guidance. Consequently, many construction companies will have an inadequate understanding of their crisis exposure, of how to cope with crises when they happen, and of how to learn and recover from their aftermath.

Analysing mentoring dialogues for developing a preservice teacher’s classroom management practices

Mentors (cooperating classroom teachers) have a shared responsibility with universities for developing preservice teachers’ pedagogical practices, particularly towards becoming reflective practitioners. Preservice teachers need to participate actively in their own learning, by reflecting and acting on the mentor’s constructive feedback provided during planning and feedback dialogue sessions. This case study uses feedback practices outlined within a five-factor mentoring model to analyse dialogue between a mentor and her respective mentee during different stages in their school-based programs (first practicum). This investigation uses multiple data sources such as video and audio-recorded interviews, archival documents from participants such as lesson plans, reflections and reports to examine preservice teacher’s reflections and implementations of practice as a result of her mentor’s feedback (e.g., establish expectations, review lesson plans, observe teaching then provide oral and written feedback, and evaluate progress). Findings indicated that reflective thinking was more apparent when the mentor did not dominate conversations but instead asked astute pedagogical knowledge questions to facilitate the mentee’s reflections on practice.

Developing sustainable housing through building utilities and transport innovation

Sustainability concerns every citizen. Housing affordability and sustainable solutions are being highlighted in research and practice in many parts of the world. This paper discusses the development of a Commuter Energy and Building Utilities System (CEBUS) in sustainable housing projects as a means of bridging the gap between current median house pricing and target affordable house pricing for low income earners. Similar scales of sustainable housing development cannot be achieved through independent application of current best practice methods in ecologically sustainable development strategies or transit oriented development master plans. This paper presents the initial stage of research on first capital and ongoing utilities and transport cost savings available from these sustainable design methods. It also outlines further research and development of a CEBUS Dynamic Simulation Model and Conceptual Framework for the Australian property development and construction industry.

What determines real-world meal size? Evidence for pre-meal planning

The customary approach to the study of meal size suggests that ‘events’ occurring during a meal lead to its termination. Recent research, however, suggests that a number of decisions are made before eating commences that may affect meal size. The present study sought to address three key research questions around meal size: the extent to which plate cleaning occurs; prevalence of pre-meal planning and its influence on meal size; and the effect of within-meal experiences, notably the development of satiation. To address these, a large-cohort internet-based questionnaire was developed. Results showed that plate cleaning occurred at 91% of meals, and was planned from the outset in 92% of these cases. A significant relationship between plate cleaning and meal planning was observed. Pre meal plans were resistant to modification over the course of the meal: only 18% of participants reported consumption that deviated from expected. By contrast, 28% reported continuing eating beyond satiation, and 57% stated that they could have eaten more at the end of the meal. Logistic regression confirmed pre-meal planning as the most important predictor of consumption. Together, our findings demonstrate the importance of meal planning as a key determinant of meal size and energy intake.

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.

‘I could eat a horse’! : meal planning determines meal size

Evidence that our food environment can affect meal size is often taken to indicate a failure of ‘conscious control’. By contrast, our research suggests that ‘expected satiation’ (fullness that a food is expected to confer) predicts self-selected meal size. However, the role of meal planning as a determinant of actual meal size remains unresolved, as does the extent to which meal planning is commonplace outside the laboratory. Here, we quantified meal planning and its relation to meal size in a large-cohort study. Participants (N= 764; 25.6 yrs, 78% female) completed a questionnaire containing items relating to their last meal. The majority (91%) of meals were consumed in their entirety. Furthermore, in 92% of these cases the participants decided to consume the whole meal, even before it began. A second major objective was to explore the prospect that meal plans are revised based on within-meal experience (e.g., development of satiation). Only 8% of participants reported ‘unexpected’ satiation that caused them to consume less than anticipated. Moreover, at the end of the meal 57% indicated that they were not fully satiated, and 29% continued eating beyond comfortable satiation (often to avoid wasting food). This pattern was neither moderated by BMI nor dieting status, and was observed across meal types. Together, these data indicate that meals are often planned and that planning corresponds closely with amount consumed. By contrast, we find limited evidence for within-meal modification of these plans, suggesting that ‘pre-meal cognition’ is an important determinant of meal size in humans.

Nurses driving change to improve access to education and quality in lcinical teaching : A partnership between Australia and Viet Nam

In Viet Nam, standards of nursing care fail to meet international competency standards. This increases risks to patient safety (eg. hospital acquired infection), consequently the Ministry of Health identified the need to strengthen nurse education in Viet Nam. This paper presents experiences of a piloted clinical teaching model developed in Ha Noi, to strengthen nurse led institutional capacity for in-service education and clinical teaching. Historically 90% of nursing education was conducted by physicians and professional development in hospitals for nurses was limited. There was minimal communication between hospitals and nursing schools about expectations of students and assessment and quality of the learning experience. As a result when students came to the clinical sites, no-one understood how to plan their learning objectives and utilise teaching and learning approaches appropriate to their level. Therefore student learning outcomes were variable. They focussed on procedures and techniques and “learning how to do” rather than learning how to plan, implement and evaluate patient care. This project is part of a multi-component capacity building program designed to improve nurse education in Viet Nam. The project was funded jointly by Queensland University of Technology (QUT) and the Australian Agency for International Development. Its aim was to develop a collaborative clinically-based model of teaching to create an environment that encourages evidence-based, student-centred clinical learning. Accordingly, strategies introduced promoted clinical teaching of competency based nursing practice utilising the regionally endorsed nurse core competency standards. Thirty nurse teachers from Viet Duc University Hospital and Hanoi Medical College participated in the program. These nurses and nurse teachers undertook face to face education in three workshops, and completed three assessment items. Assessment was applied, where participants integrated the concepts learned in each workshop and completed assessment tasks related to planning, implementing and evaluating teaching in the clinical area. Twenty of these participants were then selected to undertake a two week study tour in Brisbane, Australia where the clinical teaching model was refined and an action plan developed to integrate into both organisations with possible implementation across Viet Nam. Participants on this study tour also experienced clinical teaching and learning at QUT by attending classes held at the university, and were able to visit selected hospitals to experience clinical teaching in these settings as well. Effectiveness of the project was measured throughout the implementation phase and in follow up visits to the clinical site. To date changes have been noted on an individual and organisational level. There is also significant planning underway to incorporate the clinical teaching model developed across the organisation and how this may be implemented in other regions. Two participants have also been involved in disseminating aspects of this approach to clinical teaching in Ho Chi Minh, with further plans for more in-depth dissemination to occur throughout the country.

Contributions of knowledge-based foundations of universities in knowledge city formation : a Malaysian case study

Purpose – In the 21st Century, as knowledge, technology and education are widely accepted to play key roles in the local economic development, the importance of making space and place for knowledge production is, therefore, on the rise resulting many city administrations and urban policy-makers worldwide restructuring their cities to become highly competitive and creative. Consequently, this has led to a new type of city form, knowledge city, and a new approach in their development, knowledge-based urban development. In this context, knowledge-based foundations of universities are regarded as one of the key elements for knowledge-based urban development and knowledge city formation due to their ability to provide a strong platform for knowledge generation, marketing and transfer. This paper aims to investigate the role and importance of universities and their knowledge-based foundations in the context of developing countries, particularly in Malaysia, in building prosperous knowledge cities of the era of the knowledge economy. Design/Methodology/Approach – The main methodological techniques employed in this research includes: a thorough review of the literature on the role of universities in spatial and socio-economic development of cities; a best practice analysis and policy review of urban and regional development policies targeting to use of university clusters in leveraging knowledge-based development, and; a case study in Malaysia with a review of various policy documents and strategic plans of the local universities and local and state authorities, interviews with key actors, and a trend analysis of local socio-economic and spatial changes. Originality/Value – This paper reports the findings of a pioneering research on examining the role and impact of universities and their knowledge-based foundations, in the context of Malaysia, in building knowledge cities of the era of the knowledge economy. By undertaking a case study investigation in Bandar Seri Iskandar, which is a newly emerging Malaysian knowledge city, located in Perak, Malaysia, the paper sheds light on an important issue of the 21st Century of how universities contribute to the knowledge-based development of cities. Practical Implications – Universities with their rich knowledge-based foundations are increasingly being recognised as knowledge hubs, exercising a strong influence in the intellectual vitality of the city where they are embedded. This paper reveals that universities, in joint action with business and society at large, are necessary prerequisites for constructing and maintaining knowledge societies and, therefore, building prosperous knowledge cities. In light of the literature and case findings, the paper sheds light on the contribution of knowledge-based foundations of universities in knowledge city formation and provides generic recommendations for cities and regions seeking knowledge city transformation.

The development of Monte Carlo techniques for the verification of radiotherapy treatments

Radiotherapy is a cancer treatment modality in which a dose of ionising radiation is delivered to a tumour. The accurate calculation of the dose to the patient is very important in the design of an effective therapeutic strategy. This study aimed to systematically examine the accuracy of the radiotherapy dose calculations performed by clinical treatment planning systems by comparison againstMonte Carlo simulations of the treatment delivery. A suite of software tools known as MCDTK (Monte Carlo DICOM ToolKit) was developed for this purpose, and is capable of: • Importing DICOM-format radiotherapy treatment plans and producing Monte Carlo simulation input files (allowing simple simulation of complex treatments), and calibrating the results; • Analysing the predicted doses of and deviations between the Monte Carlo simulation results and treatment planning system calculations in regions of interest (tumours and organs-at-risk) and generating dose-volume histograms, so that conformity with dose prescriptions can be evaluated. The code has been tested against various treatment planning systems, linear acceleratormodels and treatment complexities. Six clinical head and neck cancer treatments were simulated and the results analysed using this software. The deviations were greatest where the treatment volume encompassed tissues on both sides of an air cavity. This was likely due to the method the planning system used to model low density media.

Policy analysis of disaster health management in China

Humankind has been dealing with all kinds of disasters since the dawn of time. The risk and impact of disasters producing mass casualties worldwide is increasing, due partly to global warming as well as to increased population growth, increased density and the aging population. China, as a country with a large population, vast territory, and complex climatic and geographical conditions, has been plagued by all kinds of disasters. Disaster health management has traditionally been a relatively arcane discipline within public health. However, SARS, Avian Influenza, and earthquakes and floods, along with the need to be better prepared for the Olympic Games in China has brought disasters, their management and their potential for large scale health consequences on populations to the attention of the public, the government and the international community alike. As a result significant improvements were made to the disaster management policy framework, as well as changes to systems and structures to incorporate an improved disaster management focus. This involved the upgrade of the Centres for Disease Control and Prevention (CDC) throughout China to monitor and better control the health consequences particularly of infectious disease outbreaks. However, as can be seen in the Southern China Snow Storm and Wenchuan Earthquake in 2008, there remains a lack of integrated disaster management and efficient medical rescue, which has been costly in terms of economics and health for China. In the context of a very large and complex country, there is a need to better understand whether these changes have resulted in effective management of the health impacts of such incidents. To date, the health consequences of disasters, particularly in China, have not been a major focus of study. The main aim of this study is to analyse and evaluate disaster health management policy in China and in particular, its ability to effectively manage the health consequences of disasters. Flood has been selected for this study as it is a common and significant disaster type in China and throughout the world. This information will then be used to guide conceptual understanding of the health consequences of floods. A secondary aim of the study is to compare disaster health management in China and Australia as these countries differ in their length of experience in having a formalised policy response. The final aim of the study is to determine the extent to which Walt and Gilson’s (1994) model of policy explains how disaster management policy in China was developed and implemented after SARS in 2003 to the present day. This study has utilised a case study methodology. A document analysis and literature search of Chinese and English sources was undertaken to analyse and produce a chronology of disaster health management policy in China. Additionally, three detailed case studies of flood health management in China were undertaken along with three case studies in Australia in order to examine the policy response and any health consequences stemming from the floods. A total of 30 key international disaster health management experts were surveyed to identify fundamental elements and principles of a successful policy framework for disaster health management. Key policy ingredients were identified from the literature, the case-studies and the survey of experts. Walt and Gilson (1994)’s policy model that focuses on the actors, content, context and process of policy was found to be a useful model for analysing disaster health management policy development and implementation in China. This thesis is divided into four parts. Part 1 is a brief overview of the issues and context to set the scene. Part 2 examines the conceptual and operational context including the international literature, government documents and the operational environment for disaster health management in China. Part 3 examines primary sources of information to inform the analysis. This involves two key studies: • A comparative analysis of the management of floods in China and Australia • A survey of international experts in the field of disaster management so as to inform the evaluation of the policy framework in existence in China and the criteria upon which the expression of that policy could be evaluated Part 4 describes the key outcomes of this research which include: • A conceptual framework for describing the health consequences of floods • A conceptual framework for disaster health management • An evaluation of the disaster health management policy and its implementation in China. The research outcomes clearly identified that the most significant improvements are to be derived from improvements in the generic management of disasters, rather than the health aspects alone. Thus, the key findings and recommendations tend to focus on generic issues. The key findings of this research include the following: • The health consequences of floods may be described in terms of time as ‘immediate’, ‘medium term’ and ‘long term’ and also in relation to causation as ‘direct’ and ‘indirect’ consequences of the flood. These two aspects form a matrix which in turn guides management responses. • Disaster health management in China requires a more comprehensive response throughout the cycle of prevention, preparedness, response and recovery but it also requires a more concentrated effort on policy implementation to ensure the translation of the policy framework into effective incident management. • The policy framework in China is largely of international standard with a sound legislative base. In addition the development of the Centres for Disease Control and Prevention has provided the basis for a systematic approach to health consequence management. However, the key weaknesses in the current system include: o The lack of a key central structure to provide the infrastructure with vital support for policy development, implementation and evaluation. o The lack of well-prepared local response teams similar to local government based volunteer groups in Australia. • The system lacks structures to coordinate government action at the local level. The result of this is a poorly coordinated local response and lack of clarity regarding the point at which escalation of the response to higher levels of government is advisable. These result in higher levels of risk and negative health impacts. The key recommendations arising from this study are: 1. Disaster health management policy in China should be enhanced by incorporating disaster management considerations into policy development, and by requiring a disaster management risk analysis and disaster management impact statement for development proposals. 2. China should transform existing organizations to establish a central organisation similar to the Federal Emergency Management Agency (FEMA) in the USA or the Emergency Management Australia (EMA) in Australia. This organization would be responsible for leading nationwide preparedness through planning, standards development, education and incident evaluation and to provide operational support to the national and local government bodies in the event of a major incident. 3. China should review national and local plans to reflect consistency in planning, and to emphasize the advantages of the integrated planning process. 4. Enhance community resilience through community education and the development of a local volunteer organization. China should develop a national strategy which sets direction and standards in regard to education and training, and requires system testing through exercises. Other initiatives may include the development of a local volunteer capability with appropriate training to assist professional response agencies such as police and fire services in a major incident. An existing organisation such as the Communist Party may be an appropriate structure to provide this response in a cost effective manner. 5. Continue development of professional emergency services, particularly ambulance, to ensure an effective infrastructure is in place to support the emergency response in disasters. 6. Funding for disaster health management should be enhanced, not only from government, but also from other sources such as donations and insurance. It is necessary to provide a more transparent mechanism to ensure the funding is disseminated according to the needs of the people affected. 7. Emphasis should be placed on prevention and preparedness, especially on effective disaster warnings. 8. China should develop local disaster health management infrastructure utilising existing resources wherever possible. Strategies for enhancing local infrastructure could include the identification of local resources (including military resources) which could be made available to support disaster responses. It should develop operational procedures to access those resources. Implementation of these recommendations should better position China to reduce the significant health consequences experienced each year from major incidents such as floods and to provide an increased level of confidence to the community about the country’s capacity to manage such events.

Not-for-profits and risk accountability : insuring the third sector

Not for profit organisations face significant challenges in managing organisational risk. In this regard not-for-profits are not unique but they are distinguishable from their 'for-profit' counterparts in that they are less likely to have the resources to find sufficient risk management strategies and plans, are very vunerable to cyclical changes in the insurance market and are not usually in a position to pass on the costs of increased premiums to third parties such as consumers of their services. This article explores the nature and extent of risks faced by the not-for-profit sector; the appropriateness and scope of risk management to reduce and manage the likelihood and incidence of risk; and the types of insurance and options to cover risks that materialise. It concludes with a recommendation for a potential course of action.

In search of the antecendents for risky driving at railway level crossings

This paper discusses human factors issues of low cost railway level crossings in Australia. Several issues are discussed in this paper including safety at passive level railway crossings, human factors considerations associated with unavailability of a warning device, and a conceptual model for how safety could be compromised at railway level crossings following prolonged or frequent unavailability. The research plans to quantify safety risk to motorists at level crossings using a Human Reliability Assessment (HRA) method, supported by data collected using an advanced driving simulator. This method aims to identify human error within tasks and task units identified as part of the task analysis process. It is anticipated that by modelling driver behaviour the current study will be able to quantify meaningful task variability including temporal parameters, between participants and within participants. The process of complex tasks such as driving through a level crossing is fundamentally context-bound. Therefore this study also aims to quantify those performance-shaping factors that contribute to vehicle train collisions by highlighting changes in the task units and driver physiology. Finally we will also consider a number of variables germane to ensuring external validity of our results. Without this inclusion, such an analysis could seriously underestimate the probabilistic risk assessment.

A human factors investigation into the unavailability of active warnings at railway level crossings

This paper discusses human factors issues of low cost railway level crossings in Australia. Several issues are discussed in this paper including safety at passive level railway crossings, human factors considerations associated with unavailability of a warning device, and a conceptual model for how safety could be compromised at railway level crossings following prolonged or frequent unavailability. The research plans to quantify safety risk to motorists at level crossings using a Human Reliability Assessment (HRA) method, supported by data collected using an advanced driving simulator. This method aims to identify human error within tasks and task units identified as part of the task analysis process. It is anticipated that by modelling driver behaviour the current study will be able to quantify meaningful task variability including temporal parameters, between participants and within participants. The process of complex tasks such as driving through a level crossing is fundamentally context-bound. Therefore this study also aims to quantify those performance-shaping factors that contribute to vehicle train collisions by highlighting changes in the task units and driver physiology. Finally we will also consider a number of variables germane to ensuring external validity of our results. Without this inclusion, such an analysis could seriously underestimate risk.

Analysing mentoring practices to understand how a preservice teacher reflects on practice to advance teaching

Mentors (cooperating classroom teachers) have a shared responsibility with universities for developing preservice teachers’ pedagogical practices, particularly towards becoming reflective practitioners. Preservice teachers need to participate actively in their own learning, by reflecting and acting on the mentor’s constructive feedback provided during planning and feedback dialogue sessions. This case study uses feedback practices outlined within a five-factor mentoring model to analyse dialogue between a mentor and her respective mentee during different stages in their school-based programs (first practicum). This investigation uses multiple data sources such as video and audio-recorded interviews, archival documents from participants such as lesson plans, reflections and reports to examine preservice teacher’s reflections and implementations of practice as a result of her mentor’s feedback (e.g., establish expectations, review lesson plans, observe teaching then provide oral and written feedback, and evaluate progress). Findings indicated that reflective thinking was more apparent when the mentor did not dominate conversations but instead asked astute pedagogical knowledge questions to facilitate the mentee’s reflections on practice.