Most relevant strategies for preventing surgical site infection after total hip arthroplasty : guideline recommendations and expert opinion

BACKGROUND: Numerous strategies are available to prevent surgical site infections in hip arthroplasty, but there is no consensus on which might be the best. This study examined infection prevention strategies currently recommended for patients undergoing hip arthroplasty. METHODS: Four clinical guidelines on infection prevention/orthopedics were reviewed. Infection control practitioners, infectious disease physicians, and orthopedic surgeons were consulted through structured interviews and an online survey. Strategies were classified as "highly important" if they were recommended by at least one guideline and ranked as significantly or critically important by >/=75% of the experts. RESULTS: The guideline review yielded 28 infection prevention measures, with 7 identified by experts as being highly important in this context: antibiotic prophylaxis, antiseptic skin preparation of patients, hand/forearm antisepsis by surgical staff, sterile gowns/surgical attire, ultraclean/laminar air operating theatres, antibiotic-impregnated cement, and surveillance. Controversial measures included antibiotic-impregnated cement and, considering recent literature, laminar air operating theatres. CONCLUSIONS: Some of these measures may already be accepted as routine clinical practice, whereas others are controversial. Whether these practices should be continued for this patient group will be informed by modeling the cost-effectiveness of infection prevention strategies. This will allow predictions of long-term health and cost outcomes and thus inform decisions on how to best use scarce health care resources for infection control.

Combining elicited expert knowledge into Bayesian priors

Information that is elicited from experts can be treated as `data', so can be analysed using a Bayesian statistical model, to formulate a prior model. Typically methods for encoding a single expert's knowledge have been parametric, constrained by the extent of an expert's knowledge and energy regarding a target parameter. Interestingly these methods have often been deterministic, in that all elicited information is treated at `face value', without error. Here we sought a parametric and statistical approach for encoding assessments from multiple experts. Our recent work proposed and demonstrated the use of a flexible hierarchical model for this purpose. In contrast to previous mathematical approaches like linear or geometric pooling, our new approach accounts for several sources of variation: elicitation error, encoding error and expert diversity. Of interest are the practical, mathematical and philosophical interpretations of this form of hierarchical pooling (which is both statistical and parametric), and how it fits within the subjective Bayesian paradigm. Case studies from a bioassay and project management (on PhDs) are used to illustrate the approach.

Submission to expert panel on constitutional recognition of Indigenous people

Submission recommended addition of a new 'self-enacting' preamble and enacting words to the Commownealth Constitution, and replacement of the 'race power' by a series of more specific powers relating to the recognition of native title and laws of the indigenous people.

What is an expert? A systems perspective on expertise

1. Expert knowledge continues to gain recognition as a valuable source of information in a wide range of research applications. Despite recent advances in defining expert knowledge, comparatively little attention has been given to how to view expertise as a system of interacting contributory factors, and thereby, to quantify an individual’s expertise. 2. We present a systems approach to describing expertise that accounts for many contributing factors and their interrelationships, and allows quantification of an individual’s expertise. A Bayesian network (BN) was chosen for this purpose. For the purpose of illustration, we focused on taxonomic expertise. The model structure was developed in consultation with professional taxonomists. The relative importance of the factors within the network were determined by a second set of senior taxonomists. This second set of experts (i.e. supra-experts) also provided validation of the model structure. Model performance was then assessed by applying the model to hypothetical career states in the discipline of taxonomy. Hypothetical career states were used to incorporate the greatest possible differences in career states and provide an opportunity to test the model against known inputs. 3. The resulting BN model consisted of 18 primary nodes feeding through one to three higher-order nodes before converging on the target node (Taxonomic Expert). There was strong consistency among node weights provided by the supra-experts for some nodes, but not others. The higher order nodes, “Quality of work” and “Total productivity”, had the greatest weights. Sensitivity analysis indicated that although some factors had stronger influence in the outer nodes of the network, there was relatively equal influence of the factors leading directly into the target node. Despite differences in the node weights provided by our supra-experts, there was remarkably good agreement among assessments of our hypothetical experts that accurately reflected differences we had built into them. 4. This systems approach provides a novel way of assessing the overall level of expertise of individuals, accounting for multiple contributory factors, and their interactions. Our approach is adaptable to other situations where it is desirable to understand components of expertise.

How would you recognise an expert coach if you saw one?

A review of the literature that frames coaching practice and specifically the formation and determination of expert coaching practice reveals a body of research that lacks continuity. It has recently been argued that much of the instability surrounding our professional interpretation of coaching practice stems from a penchant for subjective investigation. This analysis draws on a review of over 100 peer reviewed articles, chapters and books – all published within the last 35 years, that address the notion of coaching practice. The findings of this analysis suggests that much of the research used to establish conceptual clarity fails to distinguish between highly organised or efficient coaching practice and expert coaching practice. This paper concludes with some recommendations from alternate paradigms which suggest that expertise in interceptive sports coaching may be better theorised and suitably identified through a lens of the growing ideas surrounding ‘emergence’.

Monitoring and benchmarking government policies and actions to improve the healthiness of food environments : a proposed Government Healthy Food Environment Policy Index

Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a ‘policy’ component with seven domains on specific aspects of food environments, and an ‘infrastructure support’ component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.

Acquisition of expertise in cricket fast bowling : perceptions of expert players and coaches

Objectives: Experiential knowledge of elite athletes and coaches was investigated to reveal insights on expertise acquisition in cricket fast bowling. Design: Twenty-one past or present elite cricket fast bowlers and coaches of national or international level were interviewed using an in-depth, open-ended, semi-structured approach. Methods: Participants were asked about specific factors which they believed were markers of fast bowling expertise potential. Of specific interest was the relative importance of each potential component of fast bowling expertise and how components interacted or developed over time. Results: The importance of intrinsic motivation early in development was highlighted, along with physical, psychological and technical attributes. Results supported a multiplicative and interactive complex systems model of talent development in fast bowling, in which component weightings were varied due to individual differences in potential experts. Dropout rates in potential experts were attributed to misconceived current talent identification programmes and coaching practices, early maturation and physical attributes, injuries and lack of key psychological attributes and skills. Conclusions: Data are consistent with a dynamical systems model of expertise acquisition in fast bowling, with numerous trajectories available for talent development. Further work is needed to relate experiential and theoretical knowledge on expertise in other sports.

Experiential knowledge of expert coaches can help identify informational constraints on performance of dynamic interceptive actions

Coordination of dynamic interceptive movements is predicated on cyclical relations between an individual's actions and information sources from the performance environment. To identify dynamic informational constraints, which are interwoven with individual and task constraints, coaches’ experiential knowledge provides a complementary source to support empirical understanding of performance in sport. In this study, 15 expert coaches from 3 sports (track and field, gymnastics and cricket) participated in a semi-structured interview process to identify potential informational constraints which they perceived to regulate action during run-up performance. Expert coaches’ experiential knowledge revealed multiple information sources which may constrain performance adaptations in such locomotor pointing tasks. In addition to the locomotor pointing target, coaches’ knowledge highlighted two other key informational constraints: vertical reference points located near the locomotor pointing target and a check mark located prior to the locomotor pointing target. This study highlights opportunities for broadening the understanding of perception and action coupling processes, and the identified information sources warrant further empirical investigation as potential constraints on athletic performance. Integration of experiential knowledge of expert coaches with theoretically driven empirical knowledge represents a promising avenue to drive future applied science research and pedagogical practice.

Major issues in business process management : an expert perspective

Study Approach The results presented in this report are part of a larger global study on the major issues in BPM. Only one part of the larger study is reported here, viz. interviews with BPM experts. Interviews of BPM tool vendors together with focus group studies involving user organizations were conducted in parallel and set the groundwork for the identification of BPM issues on a global scale. Through this multi-method approach, we identify four distinct sets of outcomes. First, as is the focus of this report, we identify the BPM issues as perceived by BPM experts. Second, the research design allows us to gain insight into the opinions of organizations deploying BPM solutions. Third, an understanding of organizations’ misconceptions of BPM technologies, as confronted by BPM tool vendors, is obtained. Last, we seek to gain an understanding of BPM issues on a global scale, together with knowledge of matters of concern. This final outcome is aimed to produce an industry-driven research agenda that will inform practitioners and, in particular, the research community worldwide on issues and challenges that are prevalent or emerging in BPM and related areas...

Facilitator for joint expert conference

Interlocutory judgment of the NSW Supreme Court in a medical negligence claim - circumstances under which a facilitator may be appointed to assist in the conduct of a joint expert conference - background - jurisdiction of the Court to appoint a facilitator - analysis of decision.

From expert to tasks, expert nursing practice redefined?

Aim The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.

Defining the expert ICU nurse

This paper explores the concept of expertise in intensive care nursing practice from the perspective of its relationship to the current driving forces in healthcare. It discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. It argues that nursing expertise which focuses on the provision of individualised, holistic care and which is based largely on intuitive decision-making cannot and should not be reduced to being articulated in positivist terms. The principles of abduction or fuzzy logic, derived from computer science, may be useful in assisting nurses to explain in terms, which others can comprehend, the value of nursing expertise.

The Credit Act Advisory System (CAAS) : conversion from an expert system prototype to a C++ commercial system

CAAS is a rule-based expert system, which provides advice on the Victorial Credit Act 1984. It is currently in commercial use, and has been developed in conjunction with a law firm. It uses an object-oriented hybrid reasoning approach. The system was initially prototyped using the expert system shell NExpert Object, and was then converted into the C++ language. In this paper we describe the advantages that this methodology has, for both commercial and research development.