The use of online health techniques to assist with the delivery of specialist paediatric diabetes services in Queensland

We have tested an alternative method of delivering health services to regional areas of Queensland. By integrating telepaediatrics into an existing outreach programme for children with diabetes and endocrine conditions, we were able to reduce travel for specialist hospital staff while maintaining (and sometimes increasing) the contact patients had with the specialist team. In the first 28 months, we facilitated 160 patient consultations and 10 education sessions via videoconference through the telepaediatric service. By the end of the study, site visits were taking place annually and routine videoconference clinics were scheduled quarterly for the review of new patients and follow-up. Telepaediatric services in endocrinology and diabetes were established at three levels: the coordination of routine specialist clinics via videoconference; ad hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need; and the delivery of education to staff and patients throughout the state. The net result was improved access to specialist services from rural and remote areas of Queensland.

Factors influencing PRN medication use in nursing homes

Objective: To identify determinants of PRN ( as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use. Method: Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs. Main outcome measures: The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period. Results: Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use. Conclusion: The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.

The functions of societies and the evolution of group living: Spider societies as a test case

Many models have been advanced to suggest how different expressions of sociality have evolved and are maintained. However these models ignore the function of groups for the particular species in question. Here we present a new perspective on sociality where the function of the group takes a central role. We argue that sociality may have primarily a reproductive, protective, or foraging function, depending on whether it enhances the reproductive, protective or foraging aspect of the animal's life (sociality may serve a mixture of these functions). Different functions can potentially cause the development of the same social behaviour. By identifying which function influences a particular social behaviour we can determine how that social behaviour will change with changing conditions, and which models are most pertinent. To test our approach we examined spider sociality, which has often been seen as the poor cousin to insect sociality. By using our approach we found that the group characteristics of eusocial insects is largely governed by the reproductive function of their groups, while the group characteristics of social spiders is largely governed by the foraging function of the group. This means that models relevant to insects may not be relevant to spiders. It also explains why eusocial insects have developed a strict caste system while spider societies are more egalitarian. We also used our approach to explain the differences between different types of spider groups. For example, differences in the characteristics of colonial and kleptoparasitic groups can be explained by differences in foraging methods, while differences between colonial and cooperative spiders can be explained by the role of the reproductive function in the formation of cooperative spider groups. Although the interactions within cooperative spider colonies are largely those of a foraging society, demographic traits and colony dynamics are strongly influenced by the reproductive function. We argue that functional explanations help to understand the social structure of spider groups and therefore the evolutionary potential for speciation in social spiders.

Thermal biofeedback, locus of control and precompetitive anxiety in young athletes

Small groups of athletes (maximum size 8) were taught to voluntarily control their finger temperature, in a test of the feasibility of thermal biofeedback as a tool for coaches. The objective was to decrease precompetitive anxiety among the 140 young, competitive athletes (track and field, N=61; swimming, N=79), 66 females and 74 males, mean age 14.8 years, age range 8.9-20.5 years, from local high schools and swimming clubs. The biofeedback (visual and auditory) was provided by small, battery-powered devices that were connected to thermistors attached to the middle finger of the dominant hand. An easily readable digital LCD display, in 0.01 degrees C increments, provided visual feedback, while a musical tone, which descended in pitch with increased finger temperature, provided the audio component via small headphones. Eight twenty minute sessions were scheduled, with 48 hours between sessions. The measures employed in this prestest-posttest study were Levenson's locus of control scale (IPC), and the Competitive Sport Anxiety Inventory (CSAI-2). The results indicated that, while significant control of finger temperature was achieved, F(1, 160)=5.30, p

Realtime telemedicine for paediatric otolaryngology pre-admission screening

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaedliatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.

Recent advances in alcohol-induced adduct formation

This article presents the proceedings of a symposium presented at the ISBRA 12th World Congress on Biomedical Alcohol Research, held in Heidelberg/Mannheim, Germany, September 29 through October 2, 2004. The organizers of the symposium were Simon Worrall and Victor Preedy, and the symposium was chaired by Onni Niemelä and Geoffrey Thiele. The presentations scheduled for this symposium were (1) Adduct chemistry and mechanisms of adduct formation, by Thomas L. Freeman; (2) Malondialdehyde- acetaldehyde adducts: the 2004 update, by Geoffrey Thiele; (3) Adduct formation in the liver, by Simon Worrall; (4) Protein adducts in alcoholic cardiomyopathy, by Onni Niemelä; and (5) Alcoholic skeletal muscle myopathy: a role for protein adducts, by Victor R. Preedy.

Test-retest reliability and practice effects of a rapid screen of mild traumatic brain injury

Test-retest reliabilities and practice affects of measures from the Rapid Screen of Concussion (RSC), in addition to the Digit Symbol Substitution Test (Digit Symbol), were examined. Twenty five male participants were tested three times; each testing session scheduled a week apart. The test-retest reliability estimates for most measures were reasonably good, ranging from .79 to .97. An exception was the delayed word recall test, which has had a reliability estimate of .66 for the first retest, and .59 for the second retest. Practice effects were evident from Times 1 to 2 on the sentence comprehension and delayed recall subtests of the RSC, Digit Symbol and a composite score. There was also a practice effect of the same magnitude found from Time 2 to Time 3 on Digit Symbol, delayed recall and the composite score. Statistics on measures for both the first and second retest intervals, with associated practice affects, are presented to enable the calculation of reliable change indices (RCI). The RCI may be used to assess any improvement in cognitive functioning after mild Traumatic Brain Injury.

Polyethism and comparability of termite choice assays in a model system using Microcerotermes turneri (Termitidae : Termitinae): Implications for standardised testing techniques

Traditional measures of termite food preference assess consequences of foraging behavior such as wood consumption, aggregation and/or termite survivorship. Although studies have been done to investigate the specifics of foraging behavior this is not generally integrated into choice assay experiments. Here choice assays were conducted with small isolated (orphaned) groups of workers and compared with choice assays involving foragers from whole nests (non-orphaned) in the laboratory. Aggregation to two different wood types was used as a measure of preference. Specific worker caste and instars participating in initial exploration were compared between assay methods, with samples of termites taken from nest carton material and sites where termites were feeding. Aggregation results differ between choice assay techniques. Castes and instars responsible for initial exploration, as determined in whole nest trials, were not commonly found exploring in isolated group trials, nor were they numerous in termites taken from active feeding sites. Consequently the use of small groups of M. turneri worker termites extracted from active feeding sites may not be appropriate for use in choice assays.

A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly

Background. Postoperative cognitive dysfunction (POCD) after coronary artery bypass graft surgery is a common complication for which, despite many clinical investigations, no definitive etiology has been found. The current use of both high and low-dose fentanyl as anesthetic techniques allowed us to investigate the effect of fentanyl on the incidence of POCD. Methods. Three hundred fifty patients scheduled to undergo elective coronary artery bypass graft surgery were randomized to receive either high-dose fentanyl (50 mu g/kg) or low-dose fentanyl (10 mu g/kg) as the basis of the anesthetic. All patients underwent neuropsychological testing before surgery and at 1 week, 3 months, and 12 months after surgery. Results. One hundred sixty-eight patients in the low-dose group and 158 patients in the high-dose group were included in the final analysis. Neuropsychological testing was performed on 88%, 93%, and 92% of patients at 1 week, 3 months, and 12 months, respectively. There was no difference between group mean scores at any of the three testing times. Analysis of individual patients by the 20% rule did not detect any differences between groups. The one SD rule, which has fewer false-positive results, detected significantly more patients with POCD in the low-dose group than in the high-dose group at 1 week (23.6% vs. 13.7%; P = 0.03) but not at the other testing times. Patients with POCD spent an average of 1.2 days longer in the hospital than those without POCD (P = 0.021). Conclusions: High-dose fentanyl is not associated with a difference in the incidence of POCD at 3 or 12 months after surgery. Low-dose fentanyl leads to shorter postoperative ventilation times and may be associated with a greater incidence of POCD 1 week after surgery. Early POCD is associated with an increased duration of stay in the hospital.

GESTÃO DO CONHECIMENTO EM ARRANJOS PRODUTIVOS LOCAIS ESTUDO DE CASO DO PÓLO BRASILEIRO DE COSMÉTICO EM DIADEMA

Esta pesquisa apresenta um estudo de caso cujo objetivo é analisar se arranjos produtivos locais realizam a prática da gestão do conhecimento. A pesquisa foi realizada junto ao Pólo Brasileiro de Cosmético em Diadema, organização sem fins lucrativos, que articula as ações de micro, pequenas e médias empresas organizadas em fabricantes de cosméticos, produtores de bens e serviços, fornecedores de matéria-prima, prestadores de consultoria, comercializadores, clientes e parceiros. Para atender ao objetivo proposto recorreu-se a recursos quantitativo e qualitativo, com a utilização de formulários eletrônicos estruturados, disponibilizados na internet e técnicas da observação participante, envolvendo visitas previamente agendadas ao Pólo de Cosmético. O material de análise utilizou a pesquisa bibliográfica sobre arranjo produtivo local e gestão do conhecimento, caracterização da região do grande ABC e da cidade de Diadema, dados oficiais, políticas governamentais e entrevistas com o corpo diretivo do Pólo. Foi aplicado o instrumento de Terra (2005) que a partir de sete dimensões (estratégia e alta administração, sistemas de informação e comunicação, cultura organizacional, organização e processos de trabalho, políticas e práticas para a administração de recursos humanos e mensuração de resultados), avaliou se as organizações do arranjo produtivo realizam a prática da gestão do conhecimento. Os resultados obtidos apontaram a existência de práticas de gestão do conhecimento, com índices acima da média, convergindo para o entendimento de que se trata de um processo de gestão empresarial, além de confirmar, a partir de um sistema de intercâmbio social a origem do Pólo e seu desenvolvimento.(AU)

DETERMINANTE DE COMPOSIÇÃO DE CONSELHO DE ADMINISTRAÇÃO EM PEQUENAS E MÉDIAS EMPRESAS DE SOCIEDADE ANÔNIMA DE CAPITAL FECHADO DA REGIÃO DO ABC

O principal objetivo deste estudo é analisar os determinantes de composição de Conselho de Administração em pequenas e médias empresas de sociedade anônima de capital fechado da região do ABC paulista. A razão de iniciar este trabalho, surgiu devido à constatação de que no Brasil existem poucos artigos e dissertações que tratam de composição de Conselho e os elaborados no exterior se centralizaram na composição em termos de tamanho e tipos de diretores, de desempenho financeiro, de independência etc., mas nenhum deles focou nas determinantes de composição de pequena e média empresa. Portanto, baseando-se nas observações acima, se efetuou pesquisa de campo para responder à seguinte problemática Que determinante(s) estabelece(m) a composição de Conselho de Administração de Pequenas e Médias Empresas de Sociedade Anônima de Empresas da Região do ABC paulista? Partindo dessa problemática, se estabeleceu as seguintes hipóteses: se o poder e a influência do CEO/Presidente do Conselho em empresas de pequeno e médio porte são grandes, então existem baixas possibilidades de ter Conselheiros Externos; se houver segregação de cargos entre o CEO e o Presidente do Conselho e o CEO estiver interessado em preservar a sua atuação, então há probabilidade de escolher Conselheiros Internos; se houver segregação de cargos entre o CEO e o Presidente do Conselho e o CEO estiver interessado na eficiência, orientação e na necessidade de recursos externos, então há probabilidade de escolher Conselheiros Externos; se a empresa está no Ciclo de Vida Expansão e Maturidade- , então há possibilidades de adotarem Conselheiros Externos.(AU)

MANEJO TÉCNICO DO ATENDIMENTO PSICOLÓGICO EM AMBULATÓRIO DE REPRODUÇÃO HUMANA ASSISTIDA

O presente estudo teve por objetivos: descrever o manejo técnico do atendimento psicológico, ilustrado pelo caso de uma paciente infértil de um ambulatório de reprodução humana assistida; descrever as vicissitudes no campo analítico nestes atendimentos; e sistematizar esse manejo técnico em intervenções ambulatoriais em que se privilegia a compreensão das relações transferenciais. O instrumento utilizado para a coleta de dados foram os próprios atendimentos, ou entrevistas psicológicas, baseadas no método clínico de abordagem psicanalítica. A análise e a discussão dos resultados se basearam na apresentação de um único caso, que ilustrou a técnica que se objetivou sistematizar e descrever. É apresentado o caso da Sra. S., uma mulher de 41 anos, com parceiro em união estável há cinco anos, que realizava tratamento de infertilidade no ambulatório de reprodução humana. A paciente foi atendida pela psicóloga no próprio ambulatório durante o período da segunda tentativa de gravidez. Foram realizados efetivamente três (3) atendimentos e, no período de dois meses, a paciente não compareceu a três (3) sessões. Foram criadas cinco (5) categorias de análise: 1) Escuta; 2) Configuração de Queixa Psicológica; 3) Manejo dos Conflitos; 4) Manejo da Transferência; e 5) Enquadre. Estas categorias representaram elementos do atendimento. A divisão do atendimento em categorias teve propósito didático, no entanto, a sistematização do manejo deu-se a partir do desenvolvimento destas categorias, mas não numa ordem pré-estabelecida. A Escuta refere-se à capacidade do psicoterapeuta compreender a relação estabelecida com o paciente, assim como os elementos metapsicológicos depositados no campo, a partir de seu quadro de referência teórico-metodológico. A Configuração de Queixa Psicológica refere-se à aproximação do sofrimento psíquico e dos conflitos que subjazem à queixa orgânica ou manifesta. O Manejo dos Conflitos representa o modo como são interpretados e devolvidos a um paciente os conteúdos trazidos para a sessão. Ressalta-se, no manejo dos conflitos, a eleição de um foco de trabalho em que se privilegia a situação atual da vida do paciente relacionada especificamente à sua queixa. O Manejo da Transferência refere-se à forma como os aspectos transferenciais são compreendidos e devolvidos ao paciente. A neurose e psicose de transferência são evitadas e o trabalho é preferencialmente desenvolvido a partir da interpretação de situações extra-transferenciais. Por fim, o Enquadre engloba todos os aspectos formais e dinâmicos que constituem o campo emocional sobre o qual se trabalha. Este tipo de atendimento pode ser situado entre a entrevista psicológica e o atendimento em psicoterapia breve com objetivos e tempo limitados, variando de acordo com a qualidade adaptativa do paciente e sua motivação para o atendimento psicológico. Concluímos que este modelo de atendimento ambulatorial engloba aspectos tanto diagnósticos quanto de intervenção e que o papel do psicólogo neste contexto é auxiliar o paciente atendido a compreender sua queixa em seus aspectos latentes e manifestos, além de propiciar um espaço de escuta em que os conteúdos trazidos podem ser pensados e compreendidos

Project time risk analysis through simulation

An inherent weakness in the management of large scale projects is the failure to achieve the scheduled completion date. When projects are planned with the objective of time achievement, the initial planning plays a vital role in the successful achievement of project deadlines. Cost and quality are additional priorities when such projects are being executed. This article proposes a methodology for achieving time duration of a project through risk analysis with the application of a Monte Carlo simulation technique. The methodology is demonstrated using a case application of a cross-country petroleum pipeline construction project.

Diabetes service provision:a qualitative study of newly diagnosed Type 2 diabetes patients' experiences and views

Aims: To explore newly diagnosed Type 2 diabetes patients' views about Scottish diabetes services at a time when these services are undergoing a major reorganization. To provide recommendations to maximize opportunities brought by the devolvement of services from secondary to primary healthcare settings. Methods: Qualitative panel study with 40 patients newly diagnosed with Type 2 diabetes, recruited from hospital clinics and general practices in Lothian, Scotland. Patients were interviewed three times over 1 year. The study was informed by grounded theory, which involves concurrent data collection and analysis. Results: Patients were generally satisfied with diabetes services irrespective of the types of care received. Most wanted their future care/review to be based in general practice for reasons of convenience and accessibility, although they dis-liked it when appointments were scheduled for different days. Many said they lacked the knowledge/confidence to know how to manage their diabetes in particular situations, and needed access to healthcare professionals who could answer their questions promptly. Patients expressed a need for primary care professionals who had diabetes expertise, but who had more time and were more accessible than general practitioners. Patients who had encountered practice lead nurses for diabetes spoke particularly positively of these professionals. Conclusions: Nurses with diabetes training are particularly well placed to provide information and support to patients in primary care. Ideally, practices should run 'one-stop' diabetes clinics to provide structured care, with easily accessible dietetics, podiatry and retinopathy screening. Newly diagnosed patients may benefit from being made more aware of specific services provided by charitable organizations such as Diabetes UK. © 2005 Diabetes UK.

Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non‐parametric methods

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospitalspecific and national DRG casemix rates. Since implementation in 1990, the percentage of each hospitals budget based on hospital specific costs was to decrease, while the percentage based on DRG casemix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospitalspecific cost basis. While all other nonNHS third party payers are currently paying based on DRGs, the adoption of DRG casemix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a twostage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992–1994, using both parametric and nonparametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.