943 resultados para Expertise médicale


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More than ever, research is playing an important part in supporting proposed tax reforms and finding solutions to Australia’s tax system. Also, for tax academics the importance of quality research is critical in an increasingly competitive tertiary environment. However, life for an academic can be an isolating experience at time, especially if one’s expertise is in an area that many of their immediate colleagues do not share an interest in. Collegiately and the ability to be able to discuss research is seen as critical in fostering the next generation of academics. It is with this in mind that on the 5th of July 2010 the Inaugural Queensland Tax Teachers’ Symposium was hosted by Griffith University at its Southbank campus. The aim was to bring together for one day tax academics in Queensland, and further afield, to present their current research projects and encourage independent tax research. If was for this reason that the symposium was later re-named the Queensland Tax Researchers’ Symposium (QTRS) to reflect its emphasis. The Symposium has been held annually mid-year on four occasions with in excess of 120 attendees over this period. The fifth QTRS is planned for June 2014 to be hosted by James Cook University.

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The Advanced Pharmacy Practice Framework Steering Committee (now replaced by the Pharmacy Practitioner Development Committee) undertook work to develop an advanced pharmacy practice recognition model. As part of that work, and to assure clarity and consistency in the terminology it uses, the Committee collated the definitions used in literature sources consulted. Most recently, this involved a review of the meaning attributed to the terms ‘advanced’ and ‘extended’ when used in the context of describing aspects of professional practice. Both terms encompass the acquisition of additional expertise. While ‘advanced’ practice involves the acquisition of additional expertise to achieve a higher performance level, ‘extended’ practice relates specifically to scope of practice and involves the acquisition of additional expertise sufficient to provide services or perform tasks that are outside the usual scope of practice of the profession. Performance level operates independently of scope of practice but both must be elucidated to fully describe the professional practice of an individual practitioner.

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Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

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Connected learning, as a design approach, does not restrict learning to a dedicated learning space (school, university, etc.), but considers it to be an aggregation of individual experiences made through intrinsically motivated, active participation in and across various socio-cultural, every-day life environments. Urban places for meeting, interacting and connected learning with people from diverse backgrounds, cultures and areas of expertise are highly significant in the knowledge economy of our 21st century. However, little is yet known about best practices to design and curate such hubs that attract and support interest-driven and socially embedded learning experiences. The research study presented in this paper investigates design aspects that contribute to successful place-based spaces for connected learning. The paper reports findings from observations as well as interviews with users and managers of three different types of local, community-led learning environments, i.e., coworking spaces, hackerspaces, and meetup groups across Australia. The findings reveal social, spatial and technological interventions that these spaces apply to nourish a culture of connected learning, sharing and peer interaction. The discussion suggests a set of design implications for designers, managers and decision makers that have an interest in nourishing a connected learning culture among their user community.

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There is an ongoing debate about the reasons for and factors contributing to healthcare-associated infection (HAI). Different solutions have been proposed over time to control the spread of HAI, with more focus on hand hygiene than on other aspects such as preventing the aerial dissemination of bacteria. Yet, it emerges that there is a need for a more pluralistic approach to infection control; one that reflects the complexity of the systems associated with HAI and involves multidisciplinary teams including hospital doctors, infection control nurses, microbiologists, architects, and engineers with expertise in building design and facilities management. This study reviews the knowledge base on the role that environmental contamination plays in the transmission of HAI, with the aim of raising awareness regarding infection control issues that are frequently overlooked. From the discussion presented in the study, it is clear that many unknowns persist regarding aerial dissemination of bacteria, and its control via cleaning and disinfection of the clinical environment. There is a paucity of good-quality epidemiological data, making it difficult for healthcare authorities to develop evidence-based policies. Consequently, there is a strong need for carefully designed studies to determine the impact of environmental contamination on the spread of HAI.

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Objectives The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). Methods A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. Results In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. Conclusions This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated.

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With the increasing competitiveness in global markets, many developing nations are striving to constantly improve their services in search for the next competitive edge. As a result, the demand and need for Business Process Management (BPM) in these regions is seeing a rapid rise. Yet there exists a lack of professional expertise and knowledge to cater to that need. Therefore, the development of well-structured BPM training/ education programs has become an urgent requirement for these industries. Furthermore, the lack of textbooks or other self-educating material, that go beyond the basics of BPM, further ratifies the need for case based teaching and related cases that enable the next generation of professionals in these countries. Teaching cases create an authentic learning environment where complexities and challenges of the ‘real world’ can be presented in a narrative, enabling students to evolve crucial skills such as problem analysis, problem solving, creativity within constraints as well as the application of appropriate tools (BPMN) and techniques (including best practices and benchmarking) within richer and real scenarios. The aim of this paper is to provide a comprehensive teaching case demonstrating the means to tackle any developing nation’s legacy government process undermined by inefficiency and ineffectiveness. The paper also includes thorough teaching notes The article is presented in three main parts: (i) Introduction - that provides a brief background setting the context of this paper, (ii) The Teaching Case, and (iii) Teaching notes.

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Provides an accessible foundation to Bayesian analysis using real world models This book aims to present an introduction to Bayesian modelling and computation, by considering real case studies drawn from diverse fields spanning ecology, health, genetics and finance. Each chapter comprises a description of the problem, the corresponding model, the computational method, results and inferences as well as the issues that arise in the implementation of these approaches. Case Studies in Bayesian Statistical Modelling and Analysis: •Illustrates how to do Bayesian analysis in a clear and concise manner using real-world problems. •Each chapter focuses on a real-world problem and describes the way in which the problem may be analysed using Bayesian methods. •Features approaches that can be used in a wide area of application, such as, health, the environment, genetics, information science, medicine, biology, industry and remote sensing. Case Studies in Bayesian Statistical Modelling and Analysis is aimed at statisticians, researchers and practitioners who have some expertise in statistical modelling and analysis, and some understanding of the basics of Bayesian statistics, but little experience in its application. Graduate students of statistics and biostatistics will also find this book beneficial.

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Purpose A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues. Design/methodology/approach A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending. Findings The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU. Research limitations/implications – The research findings highlight urgency for a National PICU/HDU clinical practice guideline. Practical implications A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area. Social implications Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery. Originality/value Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.

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Without question a child’s death is a devastating event for parents and their families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents, and families on this painful journey. A delicate and sensitive area of practice, it has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of well-being. Aim To explore health professionals’ perceptions of bereavement support surrounding the loss of a child. Methods The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz’s (2006) approach. Results For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs . Analysis of the narratives also revealed health professionals’ perceptions of their support provision. Conclusion Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.

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The marginalisation that Indigenous secondary students experience in zoology science lessons can be attributed to a chasm they experience between their life in community and the classroom. The study found that the integration of Indigenous and Western science knowledge can provide transformative learning experiences for students which work to strengthen their sense of belonging to community and school. Using action research, the study investigated the integration of both-ways science education into students' zoology lessons. It privileged the community's cultural expertise, practices and connections with students and their families, which worked to enhance student engagement in their learning.

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The CJNN is one of only two international nursing journals with a focus on neuroscience nursing. We at CJNN (the editorial staff and CANN board of directors) have had to make the difficult decision to reduce publication frequency from quarterly (four times per year) down to three editions per year. The reason behind this decision relates to the current lack of submitted articles for peer review and potential publication in the journal; it is difficult to put out a quality edition with only one or two new manuscripts. We would like to encourage Canadian neuroscience nurses to share their insights and expertise with colleagues by writing about challenges and achievements in patient care, experiences encountered on a daily basis, or about unique/interesting cases that may inform others in their practice.

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Experiences showed that developing business applications that base on text analysis normally requires a lot of time and expertise in the field of computer linguistics. Several approaches of integrating text analysis systems with business applications have been proposed, but so far there has been no coordinated approach which would enable building scalable and flexible applications of text analysis in enterprise scenarios. In this paper, a service-oriented architecture for text processing applications in the business domain is introduced. It comprises various groups of processing components and knowledge resources. The architecture, created as a result of our experiences with building natural language processing applications in business scenarios, allows for the reuse of text analysis and other components, and facilitates the development of business applications. We verify our approach by showing how the proposed architecture can be applied to create a text analytics enabled business application that addresses a concrete business scenario. © 2010 IEEE.

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There is widespread agreement that entrepreneurial skills are crucial for young people today, yet there are few studies of high school students engaging in entrepreneurship education that might prepare them for music industry careers. This study has been developed in response to these challenges. It explores a group of high school students (15 – 17 years) who alongside their teacher, have co-designed, developed and driven a new business venture, Youth Music Industries (YMI) since 2010. This venture staged cycles of differently scaled events featuring young artists for a young audience. The project was designed to give students a real business situation for developing their project management skills and a broader understanding of working in the music industry. Informed by concepts of social capital and communities of practice, the study examines the process of learning with and through others. This high-stakes environment increased their sense of presence and participation and made it possible for these young people to distribute expertise and learn from each other in a reciprocal and more democratic way. The ongoing success of this organisation can be attributed to the entrepreneurial competencies students developed. The resulting model and design principles talk to an ongoing challenge that has been identified in music education, and creative industries more generally. These principles offer a way forward for other music and creative industries educators or researchers interested in developing models of, and designs for, nurturing an entrepreneurial mindset.

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One of the aims of Deleuze. Guattari. Schizoanalysis. Education. is to focus on the radical reconfiguration that education is undergoing, impacting educator, administrator, institution and ‘sector’ alike. More to the point, it is the responses to that process of reconfiguration - this newly emerging assemblage - that are a key focal point in this issue. Essential to these responses, we propose, is Deleuze and Guattari’s method of schizonalysis, which offers a way to not only understand the rules of this new game, but also, hopefully, some escape from the promise of a brave new world of continuous education and motivation. A brave new world of digitised courses, impersonal and corporate expertise, updatable performance metrics, Massive Open Online Courses (MOOCs), learning analytics, transformative teaching and learning, online high-stakes testing in the name of transforming and augmenting human capital overlays the corporeal practices of institutional surveillance, examination and categorical sorting. A brave new world, importantly, where people’s continuous education is instituted less, or not simply, through disciplinary practices, and increasingly through a constant and continuous sampling and profiling of not simply performance but their activity, measured against the profiled activity of a ‘like’ age group, person, or an institution. This continuous education, including the sampling that accompanies it, we are all informed through various information and marketing campaigns, is in our best interest. An interest that is driven and governed by an ever-increasing corporatisation and monetisation of ‘the knowledge sector’, as well as an interest that is sustained through an ever-increasing, as well as continuous, debt.