Time-differentiated target temperature management after out-of-hospital cardiac arrest: a multicentre, randomised, parallel-group, assessor-blinded clinical trial (the TTH48 trial): study protocol for a randomised controlled trial

BACKGROUND The application of therapeutic hypothermia (TH) for 12 to 24 hours following out-of-hospital cardiac arrest (OHCA) has been associated with decreased mortality and improved neurological function. However, the optimal duration of cooling is not known. We aimed to investigate whether targeted temperature management (TTM) at 33 ± 1 °C for 48 hours compared to 24 hours results in a better long-term neurological outcome. METHODS The TTH48 trial is an investigator-initiated pragmatic international trial in which patients resuscitated from OHCA are randomised to TTM at 33 ± 1 °C for either 24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to treatment allocation and dichotomised to good (CPC 1-2) or poor (CPC 3-5) outcome. Secondary outcomes are: 6-month mortality, incidence of infection, bleeding and organ failure and CPC at hospital discharge, at day 28 and at day 90 following OHCA. Assuming that 50 % of the patients treated for 24 hours will have a poor outcome at 6 months, a study including 350 patients (175/arm) will have 80 % power (with a significance level of 5 %) to detect an absolute 15 % difference in primary outcome between treatment groups. A safety interim analysis was performed after the inclusion of 175 patients. DISCUSSION This is the first randomised trial to investigate the effect of the duration of TTM at 33 ± 1 °C in adult OHCA patients. We anticipate that the results of this trial will add significant knowledge regarding the management of cooling procedures in OHCA patients. TRIAL REGISTRATION NCT01689077.

Key Largo Coral Reef Marine Sanctuary management plan

Mode of access: Internet.

Key Largo national marine sanctuary management plan

Mode of access: Internet.

The opportunities of Executive order 10988; proceedings of the Dept. of Labor Management Institute on Employee-Management Cooperation: a key to more effective management. March 8, 1963.

Mode of access: Internet.

Practitioner perspectives on supply chain management and logistics:a study from the United Kingdom

Purpose: The focus of this paper is the evolution of supply chain management (SCM) and logistics, as well as of the relationship between them. Its purpose is to generate deep insights into practice, particularly in relation to the fundamental issue of how practitioners define these key terms and phrases. Research approach: A largely qualitative study which involved in depth interviews with managers from two third party logistics providers (3PLs)/distributors, two retailers and two manufacturers from the United Kingdom. This interview protocol is based on the template used in a previous study published over a decade ago. Findings and originality: The data collected during the focussed interviews in the United Kingdom is contrasted with results from the earlier study. The findings suggest that there is variation between practitioners particularly in relation to what SCM is specifically concerned with. This variation mirrors to a large extent the differing orientations and emphases evident in the many theoretical definitions of SCM that have been proposed in recent decades. Research impact: The authors introduced the concept of refined replication in SCM research. This allows previous research to be built upon in order to test understanding of SCM theory and its practical implementation among SCM professionals in the United Kingdom. Practical impact: A profile of SCM understanding and adoption by firms in the United Kingdom is presented .

Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

Diversity and Inclusion As the Key to Innovating Talent Management in Law Firms?

In this chapter we argue that there is a need to reconceptualise what we mean by talent in the legal profession beyond a view that the most valuable people are those who have the highest fee-earning potential or the best CV packed with excellent grades and exceptional experiences and extra curricula achievements. And further we need a more sophisticated understanding of how organisational decision-making may be structured to provide developmental opportunities to allow talent to be nurtured and to flourish on individual and team levels. In turn, we suggest that planning, management and accountability cycles within legal entities need to be strengthened so as to ensure creativity and success in a context in which it is possible to deliver on the promise of fair access and promotion. Consequently, this chapter explores the diversity problem within the legal profession(s), further it interrogates what is “talent”, and how and why we should seek to manage and develop it. It then evaluates how talent diversity has been managed in the legal professional context, examined through what we have categorised as three waves of diversity strategies. We interrogate why diversity initiatives have not been more successful given the efforts placed on them by professional bodies and firms themselves. We posit that by using diversity as a case study in talent management legal entities may develop a more effective approach to talent management generally within law firms that will be of benefit to all lawyers and support professionals rather than just those who are from traditionally low participation groups.

Projections of change in key ecosystem indicators for planning and management of marine protected areas: An example study for European seas

Marine Protected Areas (MPAs) are widely used as tools to maintain biodiversity, protect habitats and ensure that development is sustainable. If MPAs are to maintain their role into the future it is important for managers to understand how conditions at these sites may change as a result of climate change and other drivers, and this understanding needs to extend beyond temperature to a range of key ecosystem indicators. This case study demonstrates how spatially-aggregated model results for multiple variables can provide useful projections for MPA planners and managers. Conditions in European MPAs have been projected for the 2040s using unmitigated and globally managed scenarios of climate change and river management, and hence high and low emissions of greenhouse gases and riverborne nutrients. The results highlight the vulnerability of potential refuge sites in the north-west Mediterranean and the need for careful monitoring at MPAs to the north and west of the British Isles, which may be affected by changes in Atlantic circulation patterns. The projections also support the need for more MPAs in the eastern Mediterranean and Adriatic Sea, and can inform the selection of sites.

Projections of change in key ecosystem indicators for planning and management of marine protected areas: An example study for European seas

Marine Protected Areas (MPAs) are widely used as tools to maintain biodiversity, protect habitats and ensure that development is sustainable. If MPAs are to maintain their role into the future it is important for managers to understand how conditions at these sites may change as a result of climate change and other drivers, and this understanding needs to extend beyond temperature to a range of key ecosystem indicators. This case study demonstrates how spatially-aggregated model results for multiple variables can provide useful projections for MPA planners and managers. Conditions in European MPAs have been projected for the 2040s using unmitigated and globally managed scenarios of climate change and river management, and hence high and low emissions of greenhouse gases and riverborne nutrients. The results highlight the vulnerability of potential refuge sites in the north-west Mediterranean and the need for careful monitoring at MPAs to the north and west of the British Isles, which may be affected by changes in Atlantic circulation patterns. The projections also support the need for more MPAs in the eastern Mediterranean and Adriatic Sea, and can inform the selection of sites.