Development, implementation and evaluation of a cancer survivor self-management care plan

Aim There is a growing population of people with cancer who experience physiological and psychological effects that persist long after treatment is complete. Interventions that enhance survivors’ self-management abilities might help offset these effects. The aim of this pilot study was to develop, implement and evaluate interventions tailored to assist patients to manage post-treatment health issues effectively. Method In this pre-post intervention cohort study, participants were recruited on completion of cancer treatment. Participants recruited preimplementation, who received usual care, comprised the control group. Participants recruited later formed the intervention group. In the intervention group, the Cancer Care Coordinator developed an individualised, structured Cancer Survivor Self-management Care Plan. Participants were interviewed on completion of treatment (baseline) and at three months. Assessments concerned health needs (CaSUN), self-efficacy in adjusting and coping with cancer and health-related quality of life (FACIT-B or FACT-C). The impact of the intervention was determined by independent t-tests of change scores. Results The intervention (n = 32) and control groups (n = 35) were comparable on demographic and clinical characteristics. Sample mean age was 54 + 10 years. Cancer diagnoses were breast (82%) and colorectal (18%). Statistically significant differences (p < 0.05) indicated improvement in the intervention group for: (a) functional well-being, from the FACIT, (Control: M = −0.69, SE = 0.91; Intervention: M = 3.04, SE = 1.13); and (b) self-efficacy in maintaining social relationships, (Control: M = −0.333, SE = 0.33; Intervention: M = 0.621, SE = 0.27). No significant differences were found in health needs, other subscales of quality of life, the extent and number of strategies used in coping and adjusting to cancer and in other domains of self-efficacy. Conclusions While the results should be interpreted with caution, due to the non-randomised nature of the study and the small sample size, they indicate the potential benefits of tailored self-management interventions warrant further investigation in this context.

Improving the performance of nutrition screening through a series of quality improvement initiatives

Background Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention. Studies have reported incompletion and error rates of 30-90% for a range of commonly used screening tools. This study aims to investigate the incompletion and error rates of 3-Minute Nutrition Screening (3-MinNS) and the effect of quality improvement initiatives in improving the overall performance of the screening tool and the referral process for at risk patients. Methods Annual audits were carried out from 2008-2013 on 4467 patients. Value Stream Mapping, Plan-Do-Check-Act cycle and Root Cause Analysis were used in this study to identify gaps and determine the best intervention. The intervention included 1) implementing a nutrition screening protocol, 2) nutrition screening training, 3) nurse empowerment for online dietetics referral of at-risk cases, 4) closed-loop feedback system and 5) removing a component of 3-MinNS that caused the most error without compromising its sensitivity and specificity. Results Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009 respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After intervention, the latter decreased to 7% (2010), 4% (2011) and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p < 0.001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012) and 5% (2013) and percentage of blank or missing forms reduced to and remained at 1%. Conclusion Quality improvement initiatives are effective in reducing the incompletion and error rates of nutrition screening, and led to sustainable improvements in the referral process of patients at nutritional risk.

Developing Strategic Marketing Plan

This publication is first in a series targeted for Coordinators and Managers within Benefits Planning, Assistance and Outreach Programs concerned with developing continuous quality improvement approaches. This early publication focuses on understanding strategies for market position, strategic planning and provides a tool for conducting an organizational self-assessment along with a stakeholder analysis

Whose ETSIP? National and local ownership of Namibia's education and training sector improvement programme

Tämä työ tarkastelee kansallista ja paikallista omistajuutta Namibian opetussektorin kehittämisohjelmassa. Opetussektorin kehittämisohjelma ETSIP on 15-vuotinen sektoriohjelma vuosille 2005-2015 ja sen tavoitteena on edesauttaa Namibian kehittymistä tietoyhteiskunnaksi. Tutkimuksen tarkoituksena on selvittää miten kansallinen ja paikallinen omistajuus on toteutunut ETSIP prosessin aikana. Erityisesti pyritään selvittämään paikallistason opetussektorin virkamiesten näkemyksiä ETSIP prosessista, heidän roolistaan siinä ja siitä millaisia vaikuttamisen ja hallinnan mahdollisuuksia heillä on ollut prosessin aikana. Tutkimuksen lähtökohta on laadullinen ja lähestymistapa konstruktionistinen: tutkimus tarkastelee todellisuutta ihmisten kokemusten, näkemysten ja toiminnan kautta. Tutkimusaineisto koostuu haastatteluista, epävirallisista keskusteluista, lehtiartikkeleista ja ETSIP dokumenteista. Tutkimus osoittaa että kansallinen omistajuus on epämääräinen käsite sillä kansallisia toimijoita ja näkemyksiä on useita. Tutkimus vahvistaa Castel-Brancon huomion siitä, että omistajuutta on tarkasteltava kontekstissaan: muuttuvana ja kilpailtuna. ETSIPin rinnalle ollaan valmistelemassa uutta strategista ohjelmaa opetusministeriölle mikä saattaa muuttaa omistajuutta ETSIPiin. ETSIP dokumenttien omistajuusretoriikka myötäilee kansainvälisiä sitoumuksia avun vaikuttavuuden parantamiseksi mutta niistä puuttuu syvällisempi analyysi siitä, miten kansallinen ja paikallinen omistajuus toteutuisi käytännössä. Avunantajien näkemys omistajuudesta on suppea: omistajuus nähdään lähinnä sitoutumisena ennalta määrättyyn politiikkaohjelmaan. Haastatteluaineistosta nousee esiin Whitfieldin ja Frazerin jaottelu suppeista ja laajoista omistajuuskäsityksistä. Sitoutumista ETSIP ohjelmaan pidetään tärkeänä mutta riittämättömänä määritteenä omistajuudelle. Paikallisella tasolla sitoutuminen ETSIP ohjelman periaatteisiin ja tavoitteisiin on toteutunut melko hyvin mutta jos omistajuutta tarkastellaan laajemmin vaikutusvallan ja hallinnan käsitteiden kautta voidaan todeta että omistajuus on ollut heikkoa. Paikallisella tasolla ei ole ollut juurikaan vaikutusvaltaa ETSIP ohjelman sisältöön eikä mahdollisuutta hallita ohjelman toteutusta ja päättää siitä mitä hankkeita ohjelman kautta rahoitetaan. Tujanin demokraattisen omistajuuden käsite kuvaa tarvetta muuttaa ja laajentaa omistajuusajattelua huomioiden paikallisen tason paremmin. Tämä tutkimus viittaa siihen että omistajuuden toteutuminen paikallisella tasolla edellyttäisi institutionaalisen kulttuurin muutosta ja institutionaalisen legitimiteetin vahvistamista. Omistajuuden mahdollistamiseksi paikallisella tasolla tarvittaisiin poliittista johtajuutta, luottamusta, vastuullisuuden kulttuurin kehittämistä, tehokkaampaa tiedonjakoa, laajaa osallistumista, vuoropuhelua ja yhteistyötä. Ennen kaikkea tarvittaisiin paikallisen tason vaikutusvaltaa päätöksenteossa ja kontrollia resurssien käytöstä. Tälle muutokselle on selvä tarve ja tilaus.

Application of UPFC for system security improvement under normal and network contingencies

Electric power systems are exposed to various contingencies. Network contingencies often contribute to over-loading of network branches, unsatisfactory voltages and also leading to problems of stability/voltage collapse. To maintain security of the systems, it is desirable to estimate the effect of contingencies and plan suitable measures to improve system security/stability. This paper presents an approach for selection of unified power flow controller (UPFC) suitable locations considering normal and network contingencies after evaluating the degree of severity of the contingencies. The ranking is evaluated using composite criteria based fuzzy logic for eliminating masking effect. The fuzzy approach, in addition to real power loadings and bus voltage violations, voltage stability indices at the load buses also used as the post-contingent quantities to evaluate the network contingency ranking. The selection of UPFC suitable locations uses the criteria on the basis of improved system security/stability. The proposed approach for selection of UPFC suitable locations has been tested under simulated conditions on a few power systems and the results for a 24-node real-life equivalent EHV power network and 39-node New England (modified) test system are presented for illustration purposes.

Plan Estratégico BARCELÓ JANDÍA PLAYA 2015-2017

[ES] Este TFG trata de desarrollar un Plan Estratégico para una organización empresarial determinada inmersa en el sector turístico. Se asemeja a un trabajo de consultoría estratégica para adaptar los conocimientos a soluciones en un caso real.

Salmon action plan. River Ribble - June 2000

In February 1996 A Strategy for the Management of Salmon in England and Wales was launched by the National Rivers Authority. The strategy concentrates on four main objectives for the management of salmon fisheries in England and Wales: (i) Optimise the number of salmon returning to home water fisheries, (ii) Maintain and improve the fitness and diversity of salmon stocks, (iii) Optimise the total economic value of surplus stocks, (iv) Ensure necessary costs are met by beneficiaries. These four objectives will be addressed through local Salmon Action Plans (SAPs) which will be produced for each of the principle salmon rivers in England and Wales by the year 2001. A consultation report was produced for the River Ribble and released publicly in October 1999. This document determined an egg deposition figure of 8.5 million eggs for the Ribble, that would allow maximum gain from the net and rod fisheries; raised a number of issues which are thought to currently limit salmon production; identified actions which may be undertaken by the Environment Agency and other bodies to improve stocks. This action plan re-addresses the issues raised in the consultation document, taking into account the comments received, and also identifies areas of possible improvement in data gathering that would allow more accurate estimation of the spawning target and compliance in future years. The progress of this plan will be monitored and reported annually.

An Improvement on 2× 2 Silicon-on-Insulator Mach-Zehnder Thermo-Optical Switch

An improved 2 ×2 silicon-on-insulator Mach-Zehnder thermo-optical switch is designed and fabricated, which is based on strongly guided multimode interference couplers and single- mode phase-shifting arms. The multimode interference couplers and input/output waveguides are deeply etched to improve coupler performances and coupler-waveguide coupling efficiencies. However, shallow etching is used in the phase-shifting arms to guarantee single-mode property. The strongly guided coupler presents an attractive uniformity about 0. 03 dB and a low propagation loss of -0.6 dB. The 2× 2 switch shows an insertion loss as low as -6.8 dB, where the fiber-waveguide coupling loss of -4.3 dB is included, and the response-time is measured as short as 6.8 μs, which are much better than our previous results.

Improvement in clinical step and shoot intensity modulated radiation therapy delivery accuracy on an integrated linear accelerator control system

Purpose: The dose delivery accuracy of 30 clinical step and shoot intensity modulated radiation therapy plans was investigated using the single integrated multileaf collimator controller of the Varian Truebeam linear accelerator (linac) (Varian Medical Systems, Palo Alto, CA) and compared with the dose delivery accuracy on a previous generation Varian 2100CD C-Series linac.

Methods and Materials: Ten prostate, 10 prostate and pelvic node, and 10 head-and-neck cases were investigated in this study. Dose delivery accuracy on each linac was assessed using Farmer ionization chamber point dose measurements, 2-dimensional planar ionization chamber array measurements, and the corresponding Varian dynamic log files. Absolute point dose measurements, fluence delivery accuracy, leaf position accuracy, and the overshoot effect were assessed for each plan.

Results: Absolute point dose delivery accuracy increased by 1.5% on the Truebeam compared with the 2100CD linac. No improvement in fluence delivery accuracy between the linacs, at a gamma criterion of 3%/3 mm was measured using the 2-dimensional ionization chamber array, with median (interquartile range) gamma passing rates of 98.99% (97.70%-99.72%) and 99.28% (98.26%-99.75%) for the Truebeam and 2100CD linacs, respectively. Varian log files also showed no improvement in fluence delivery between the linacs at 3%/3 mm, with median gamma passing rates of 99.97% (99.93%-99.99%) and 99.98% (99.94%-100%) for the Truebeam and 2100CD linacs, respectively. However, log files revealed improved leaf position accuracy and fluence delivery at 1%/1 mm criterion on the Truebeam (99.87%; 99.78%-99.94%) compared with the 2100CD linac (97.87%; 91.93%-99.49%). The overshoot effect, characterized on the 2100CD linac, was not observed on the Truebeam.

Conclusions: The integrated multileaf collimator controller on the Varian Truebeam improves clinical treatment delivery accuracy of step and shoot intensity modulated radiation therapy fields compared with delivery on a Varian C-series linac. © 2014.

Improvement of Lipton’s business model through wholesalers and traditional supermarkets channel

Field Lab in Entrepreneurial Innovative Ventures

Customer relationship management plan for wrike

Achieving long-term success for companies includes providing customers with exceptional products and ser-vices. It implies investing in Customer Relationship Management (CRM) and building a plan of its implementation. This issue is addressed in present Work Project by conducting interviews with top-management of Wrike and sur-vey with other employees which showed there is space for improvement of company’s current CRM. Results give insights of CRM in Wrike and are the basis of CRM plan proposal. The key effect of the proposed plan can be seen in the increase of the customer’s value and consequently result in Return on Customers.

Copoasú y su plan de negocio

Copoasú será una empresa innovadora en donde se ofrecerán postres típicos colombinos con preparación tradicional y tipo gourmet, combinados con una gran variedad de bebidas típicas y tradicionales que transportarán a las personas a su lugar de origen. El punto de venta de Copoasú estará dividido con decoración que concuerde con las regionales naturales de Colombia, atendido con servicio de excelente calidad para que el cliente se sienta como en casa. Los postres serán elaborados en el mismo punto de venta por practicidad y frescura del producto por lo que el punto de venta va a tener la dotación y personal adecuado para este tipo de preparación, además de unos excelentes insumos que nos permita mantener la misma calidad en el producto. De igual manera se realizarán controles frecuentes con el fin de comprobar que no se está perdiendo la receta original, siempre buscando el mejoramiento continuo de todos y cada uno de los productos ofrecidos por Copoasú. Para la escogencia de la localización del punto de venta, como del mercado, del mercado se realizó una segmentación geográfica, escogiendo la localidad de Chapinero por tener zonas representativas para el mercado de la empresa como lo son la zona T y G .El mercado objetivo son de 345.325 personas de estrato 4,5 y 6 de edades entre 24 y 38 años con ingresos mensuales promedio entre 800.000 y 1’700.000. Se analizaron los principales competidores de Copoasu firmas como Miryam Camhi, quien lleva más de veinte y cinco años en el mercado; H&B con apenas un año de funcionamiento; Rausch, que tiene muy poco tiempo de ingresó al mercado y finalmente Jaques, quien lleva diez años de funcionamiento. Bajo los supuestos conservadores establecidos para el modelo financiero Copoasú, demostró ser viable según el análisis del balance proyectado. El punto IV de equilibrio se alcanza al finalizar el segundo año de operación.

Fase Plan Exportador Continental Trade

Por medio de la metodología suministrada por el CIDEM-MALOKA, se ha elaborado un análisis integral de la compañía, junto a la proyección de tres mercados objetivos a los cuales se puede realizar una exportación efectiva, y como resultado de lo anterior, una serie de actividades que la empresa llevara a cabo para la consecución de sus objetivos tanto a corto como a largo plazo. La Metodología de plan exportador desarrollada por el CIDEM Universidad del rosario se constituye en la realización de procesos de consultoria de cada uno de los procesos productivos de la empresa, esto, con el fin de encontrar estrategias de mejoramiento y capacitación para la penetración del mercado internacional. Dicha metodología se desarrolla a partir de los siguientes componentes: Se describe inicialmente un diagnostico empresarial en el que se definen cada una de las debilidades y fortalezas de la empresa, así como las oportunidades explicitas en el entorno con el fin de realizar planes de acción determinados en las áreas de mejoramiento existentes; luego de esto, la empresa recibe consultoria particular en cada una de sus áreas productivas (descritas inicialmente en el diagnostico), de las cuales surgen nuevas estrategias orientadas a la misión y al visión de la misma pero enfocadas al entorno internacional, se describen en esta nueva fase : área productiva y administrativa y luego de mercadeo dirigida a tres países con clientes potenciales para el producto de exportación y por ultimo comercio exterior y plan exportador, en estas ultimas, cuando la empresa se encuentra preparada para penetrar los mercados internacionales, se establecen estrategias dirigidas a países en los que se encuentran los clientes potenciales de la misma con lo que la empresa logra hacer efectiva su estrategia exportadora. A partir de lo anterior, el presente documento servirá a la empresa continental Trade como una herramienta que preparara a la empresa para realizar su proceso de exportación; permitirá entonces al empresario dar cuenta de las debilidades y fortalezas respecto al funcionamiento actual, con el fin de realizar un redireccionamiento estratégico, y consecutivamente a esto, llevar a cabo su primer proyecto exportador.

Plan exportador Madecol Ltda.

En el presente documento se parte de una descripción y análisis de las debilidades y fortalezas de la empresa, así como de su producto más competitivo a nivel nacional proyectado al mercado internacional. Tal análisis consiste en una observación interna de aspectos organizacionales, de producción, financieros, contables, características de los productos, y gestión de mercadeo de la compañía; y en una observación del mercado en el cual se desarrolla, proveedores, clientes, competidores, oportunidades del gobierno, entre otros. Una vez identificadas las debilidades, fortalezas, oportunidades y amenazas, como fruto del análisis preliminar; y conocidos los objetivos de la empresa, se plantean propuestas de mejoramiento y estrategias nacionales e internacionales, para aprovechar las fortalezas y oportunidades identificadas, así como superar las debilidades y amenazas que enfrenta; con el propósito de cumplir las metas de la compañía.