Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Performance management systems and Public Value Strategy: a case study

Purpose
This article aims to analyze the role of performance management systems (PMS) in supporting public value strategies.

Design/methodology/approach
This article draws on the public value dynamic model by Horner and Hutton (2010). It presents the results of a case study of implementation of a PMS model, the ‘Value Pyramid’ (VP).

Findings
The results stress the need for an improved conceptualization of PMS within public value strategy. Through experimentation using the VP, the case site was able to measure and visualize what it considered public value and reflect on the internal/external causes of both creation and destruction of public value.

Research limitations/implication
This article is limited to just one case study, although in-depth and longitudinal.

Originality/value
This article is one of the first attempting to understand the role of PMS within the public value strategy framework, answering the call of Benington and Moore (2010) to consider public value from an accounting perspective.

Voltage over-scaling:A cross-layer design perspective for energy efficient systems

Today's multi-media electronic era is driven by the increasing demand for small multifunctional devices able to support diverse services. Unfortunately, the high levels of transistor integration and performance required by such devices lead to an unprecedented increase of on-chip power that significantly limits the battery lifetime and even poses reliability concerns. Several techniques have been developed to address the power increase, but voltage over-scaling (VOS) is considered to be one of the most effective ones due to the quadratic dependence of voltage on dynamic power consumption. However, VOS may not always be applicable since it increases the delay in all paths of a system and may limit high performance required by today's complex applications. In addition, application of VOS is further complicated since it increases the variations in transistor characteristics imposed by their tiny size which can lead to large delay and leakage variations, making it difficult to meet delay and power budgets. This paper presents a review of various cross-layer design options that can provide solutions for dynamic voltage over-scaling and can potentially assist in meeting the strict power budgets and yield/quality requirements of future systems. © 2011 IEEE.

Automatic extraction of Reduced order models from CFD simulations for building energy modeling

Thermal comfort is defined as “that condition of mind which expresses satisfaction with the thermal environment’ [1] [2]. Field studies have been completed in order to establish the governing conditions for thermal comfort [3]. These studies showed that the internal climate of a room was the strongest factor in establishing thermal comfort. Direct manipulation of the internal climate is necessary to retain an acceptable level of thermal comfort. In order for Building Energy Management Systems (BEMS) strategies to be efficiently utilised it is necessary to have the ability to predict the effect that activating a heating/cooling source (radiators, windows and doors) will have on the room. The numerical modelling of the domain can be challenging due to necessity to capture temperature stratification and/or different heat sources (radiators, computers and human beings). Computational Fluid Dynamic (CFD) models are usually utilised for this function because they provide the level of details required. Although they provide the necessary level of accuracy these models tend to be highly computationally expensive especially when transient behaviour needs to be analysed. Consequently they cannot be integrated in BEMS. This paper presents and describes validation of a CFD-ROM method for real-time simulations of building thermal performance. The CFD-ROM method involves the automatic extraction and solution of reduced order models (ROMs) from validated CFD simulations. The test case used in this work is a room of the Environmental Research Institute (ERI) Building at the University College Cork (UCC). ROMs have shown that they are sufficiently accurate with a total error of less than 1% and successfully retain a satisfactory representation of the phenomena modelled. The number of zones in a ROM defines the size and complexity of that ROM. It has been observed that ROMs with a higher number of zones produce more accurate results. As each ROM has a time to solution of less than 20 seconds they can be integrated into the BEMS of a building which opens the potential to real time physics based building energy modelling.

Automatic extraction of reduced-order models from CFD simulations for building energy modelling

Accurate modelling of the internal climate of buildings is essential if Building Energy Management Systems (BEMS) are to efficiently maintain adequate thermal comfort. Computational fluid dynamics (CFD) models are usually utilised to predict internal climate. Nevertheless CFD models, although providing the necessary level of accuracy, are highly computationally expensive, and cannot practically be integrated in BEMS. This paper presents and describes validation of a CFD-ROM method for real-time simulations of building thermal performance. The CFD-ROM method involves the automatic extraction and solution of reduced order models (ROMs) from validated CFD simulations. ROMs are shown to be adequately accurate with a total error below 5% and to retain satisfactory representation of the phenomena modelled. Each ROM has a time to solution under 20seconds, which opens the potential of their integration with BEMS, giving real-time physics-based building energy modelling. A parameter study was conducted to investigate the applicability of the extracted ROM to initial boundary conditions different from those from which it was extracted. The results show that the ROMs retained satisfactory total errors when the initial conditions in the room were varied by ±5°C. This allows the production of a finite number of ROMs with the ability to rapidly model many possible scenarios.

Governance structures and performance management systems in universities: a comparative study between the UK and Portugal

À semelhança do que aconteceu em muitas instituições públicas, as universidades têm enfrentado pressões crescentes para mudar, tendo de repensar as suas formas de governança e de gestão, dando mais ênfase à implementação de sistemas de gestão do desempenho (SGD). Apesar de existirem vários estudos sobre o desempenho, estes têm ignorado o uso dado à informação recolhida. Além disso, e apesar de terem ocorrido várias reformas na governança destas instituições, existem ainda poucos estudos que relacionam a governança e o desempenho. Assim, esta pesquisa visa explorar a forma como as universidades medem, reportam e gerem o desempenho e como as estruturas de governança se relacionam com estas práticas. Para alcançar o objetivo proposto, um estudo comparativo entre universidades britânicas e portuguesas foi realizado. Os dados foram recolhidos através da utilização de uma metodologia qualitativa, sendo os métodos utilizados a análise documental e entrevistas semi-estruturadas a membros dos órgãos de governo e gestão de cada instituição. A análise dos dados mostrou a inexistência de um sistema completamente integrado de gestão de desempenho (SGD) em ambas as instituições, essencialmente devido à falta de práticas de gestão de desempenho. De facto, apesar de alguns dos entrevistados terem reportado o "uso positivo" de dados sobre o desempenho, alguns relataram o "não uso" desses dados, principalmente em relação ao desempenho individual, e outros o "mau uso" dessa informação, tendo sido reportadas práticas de gaming e deturpação dos resultados. Como forma de ultrapassar alguns destes problemas, verificou-se a co-existência de duas estruturas de governança: uma 'formal', da qual fazem parte todos os órgão de governo, com um valor mais 'simbólico'; e uma estrutura 'paralela', constituída por órgãos mais ágeis, que gerem a universidade no dia a dia. Verificou-se terem sido vários os fatores a afetarem, negativa e positivamente, os SGD em ambas as instituições, tendo sido rotulados de "inibidores" e "determinantes", respetivamente. A pesquisa mostrou que, apesar de as estruturas de governança serem importantes para a implementação e funcionamento de um SGD, há outros fatores que precisam de ser levados em consideração, nomeadamente, o nível de comunicação e o nível de envolvimento dos atores no processo. Estes dois fatores são considerados relevantes para a integração bem sucedida de práticas de medição, reporte e gestão de desempenho. Esta integração, juntamente com outras mudanças que ocorreram em termos de governança, contribuirá certamente para que se passe de um sistema em que se governa o desempenho para um sistema em que se governa para o desempenho.

Evaluation of the human factor in the scheduling of smart appliances in smart grids

Recently there has been an increase of interest in implementing a new set of home appliances, known as Smart Appliances that integrate Information Technologies, the Internet of Things and the ability of communicating with other devices. While Smart Appliances are characterized as an important milestone on the path to the Smart Grid, by being able to automatically schedule their loads according to a tariff or reflecting the power that is generated using renewable sources, there is not a clear understanding on the impact that the behavior of such devices will have in the comfort levels of users, when they shift their working periods to earlier, or later than, a preset time. Given these considerations, in this work we analyse the results of an assessment survey carried out to a group of Home Appliance users regarding their habits when dealing with these machines and the subjective impact in quality caused by either finishing its programs before or after the time limit set by the user. The results of this work are expected to be used as input for the evaluation of load scheduling algorithms running in energy management systems. © 2014 Springer International Publishing.

Energy Management in UK Non-Domestic Buildings - a New Perspective to Provoke Reduced Carbon Emissions

Politicians, industry and the public generally accept the need for energy consumption to be cut to deliver climate change mitigation measures essential for us to avoid climate disaster. For non-domestic fuel users current energy policy has attempted to drive this through rational economic responses to energy cost pressures. This reliance on voluntary action has created an “Energy Inconsistency”, that is a marked difference between energy opportunities that have been proven technically viable, financially rational and retrofit feasible and those actually adopted. Other factors must therefore be involved to influence what appear to be simple carbon and cost saving opportunities. This paper presents a new approach to energy efficiency and consumption in non-domestic buildings, viewing attitudes and behaviours of building owners and users as the key driver of energy consumption. A new framework is proposed as a method to examine the impact of building ownership on the users’ and owners’ abilities to improve energy efficiency and consumption and identify opportunities to overcome the barriers inherent in these ownership structures.

Success or failure in knowledge management systems: a universal issue

This paper takes a sociotechnical viewpoint of knowledge management system (KMS) implementation in organizations considering issues such as stakeholder disenfranchisement, lack of communication, and the low involvement of key personnel in system design asking whether KMS designers could learn from applying sociotechnical principles to their systems. The paper discusses design elements drawn from the sociotechnical principles essential for the success of IS and makes recommendations to increase the success of KMS in organizations. It also provides guidelines derived from Clegg’s Principles (2000) for KMS designers to enhance their designs. Our data comes from the application of a plurality of analysis methods on a large comprehensive global survey conducted from 2007 to 2011 of 1034 participants from 76 countries. The survey covers a variety of organizations of all types and sizes from a comprehensive selection of economic sectors and industries. Our results showed that users were not satisfied with the information and knowledge systems that they were being offered. In addition to multiple technology and usability issues, there were human and organisational barriers that prevented the systems from being used to their full potential. We recommend that users of KMS are integrated into the design team so that these usability and other barriers can be addressed during the feasibility stage as well as the actual design and implementation phases.

A generic model for integration of Quality, Environment and Safety Management Systems

Purpose – The purpose of this paper is to propose a generic model of Integrated Management System of Quality, Environment and Safety (IMS-QES) that can be adapted and progressively to assimilate various Management Systems, of which highlights: ISO 9001 for Quality; ISO 14001 for Environment; OHSAS 18001 for Occupational Health and Safety. Design/methodology/approach – The model was designed in the real environment of a Portuguese Organization and 160 employees were surveyed. The rate response was equal to 86 percent. The conceived model was implemented in a first phase for the integration of Quality, Environment and Safety Management Systems. Findings – Among the main findings of the survey the paper highlights: the elimination of conflicts between individual systems with resources optimization; creation of added value to the business by eliminating several types of wastes; the integrated management of sustainability components in a global market; the improvement of partnerships with suppliers of goods and services; reducing the number of internal and external audits. Originality/value – This case study is one of the first Portuguese empirical researches about IMS-QES and the paper believes that it can be useful in the creation of a Portuguese guideline for integration, namely the Quality Management Systems; Environmental Management Systems and Occupational Health and Safety Management Systems among others.

INTEGRATED MANAGEMENT SYSTEMS: CRITICAL SUCCESS FACTORS

The purpose of this paper is to, in a holistic way, identify and explore the critical success factors (CSFs) that are considered in the context of the growing discussions, movements, proposed models, and case studies about the integration of management systems (MSs). This work is an investigation focused on the integration of MSs into an integrated management system (IMS) and the proposed approach takes into account the literature review as well as the experience gained by the authors on researches about Portuguese enterprises. This qualitative and empirical research, investigated the integration of MSs from existing scientific publications for the period 1999 to 2014, on-going case studies and one inquiry conducted by the authors. This research contributes to a better understanding of the CSFs regarding the integration of MSs and thus provides an insight on the preventive management. This research shows an evident lack of information regarding case studies on CSFs for integrated management systems (IMSs) and has identified a set of relevant CSFs, for MSs integration and associated guidelines that organizations should take as a priority, in order to be able to manage, on a preventive way, the implementation of IMSs, and consequently to become more competitive with added value for the stakeholders.