A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not

Background: Methodological challenges such as recruitment problems and participant burden make clinical trials in palliative care difficult. In 2001-2004, two community-based randomized controlled trials (RCTs) of case conferences in palliative care settings were independently conducted in Australia-the Queensland Case Conferences trial (QCC) and the Palliative Care Trial (PCT). Design: A structured comparative study of the QCC and PCT was conducted, organized by known practical and organizational barriers to clinical trials in palliative care. Results: Differences in funding dictated study designs and recruitment success; PCT had 6 times the budget of QCC. Sample size attainment. Only PCT achieved the sample size goal. QCC focused on reducing attrition through gatekeeping while PCT maximized participation through detailed recruitment strategies and planned for significant attrition. Testing sustainable interventions. QCC achieved a higher percentage of planned case conferences; the QCC strategy required minimal extra work for clinicians while PCT superimposed conferences on normal work schedules. Minimizing participant burden. Differing strategies of data collection were implemented to reduce participant burden. QCC had short survey instruments. PCT incorporated all data collection into normal clinical nursing encounters. Other. Both studies had acceptable withdrawal rates. Intention-to-treat analyses are planned. Both studies included substudies to validate new outcome measures. Conclusions: Health service interventions in palliative care can be studied using RCTs. Detailed comparative information of strategies, successes and challenges can inform the design of future trials. Key lessons include adequate funding, recruitment focus, sustainable interventions, and mechanisms to minimize participant burden.

High- and low-volume resistance training similarly enhances functional performance in older adults

It is well known that resistance training improves muscle strength in older adults and may enhance or preserve functional performance. However, it is unclear if the volume of work undertaken in the elderly alters the response in functional performance. PURPOSE: To investigate the effect of a high- versus low-volume resistance training program on functional performance in older adults. METHODS: Thirty-two healthy men and women aged 65-78 years were randomly assigned to either a single-set (SS, n = 16) or 3-set (MS, n = 16) progressive resistance training program for 20 weeks. Groups trained 2 days per week using machine weights at 8 repetitions maximum (8-RM) for 7 upper and lower body exercises. Muscle strength was assessed by the 1-RM and functional performance by a battery of tests (repeated chair rise, usual and fast 6-m walk, 6-m backwards walk, floor rise to standing, stair climb, and 400-m walk time). RESULTS: Twenty-eight subjects completed the study. There was no difference between groups at baseline in muscle strength or functional performance. Whole body muscle strength significantly increased in both groups with greater gains in the 3-set group (MS 32.9 ± 3.1%; SS 18.6 ± 2.7%, mean ± SE; P < 0.01). Significant improvement (time effect, P < 0.01) occurred for both groups in the chair rise (MS 13.6 ± 3.2%; SS 10.2 ± 3.0%), 6-m backwards walk (MS 14.9 ± 3.3%; SS 14.3 ± 4.2%), stair climb (MS 6.4 ± 2.8%; SS 7.7 ± 3.1%) and 400-m walk (MS 7.4 ± 1.4%; SS 3.9 ± 1.2%). There were no interaction (group × time) effects for functional performance and no differences by sex. CONCLUSION: Resistance training that utilizes either a singleset or 3-set regimen may significantly and similarly improve functional performance in community-dwelling older adults. Enhancement of functional performance may prolong independence and improve quality of life. ©2004The American College of Sports Medicine

Dissecting query performance in logical data models: Parsimony vs. greater ontological clarity

Even when data repositories exhibit near perfect data quality, users may formulate queries that do not correspond to the information requested. Users’ poor information retrieval performance may arise from either problems understanding of the data models that represent the real world systems, or their query skills. This research focuses on users’ understanding of the data structures, i.e., their ability to map the information request and the data model. The Bunge-Wand-Weber ontology was used to formulate three sets of hypotheses. Two laboratory experiments (one using a small data model and one using a larger data model) tested the effect of ontological clarity on users’ performance when undertaking component, record, and aggregate level tasks. The results indicate for the hypotheses associated with different representations but equivalent semantics that parsimonious data model participants performed better for component level tasks but that ontologically clearer data model participants performed better for record and aggregate level tasks.

Antecedents and consequences of service quality in consumer evaluation of self-service internet technologies

Advances in technology coupled with increasing labour costs have caused service firms to explore self-service delivery options. Although some studies have focused on self-service and use of technology in service delivery, few have explored the role of service quality in consumer evaluation of technology-based self-service options. By integrating and extending the self-service quality framework the service evaluation model and the Technology Acceptance Model the authors address this emerging issue by empirically testing a comprehensive model that captures the antecedents and consequences of perceived service quality to predict continued customer interaction in the technology-based self-service context of Internet banking. Important service evaluation constructs like perceived risk, perceived value and perceived satisfaction are modelled in this framework. The results show that perceived control has the strongest influence on service quality evaluations. Perceived speed of delivery, reliability and enjoyment also have a significant impact on service quality perceptions. The study also found that even though perceived service quality, perceived risk and satisfaction are important predictors of continued interaction, perceived customer value plays a pivotal role in influencing continued interaction.

Improving performance? The adoption and implementation of quality systems in U.K. nonprofits

There are increasing and multiple pressures on nonprofit organizations to demonstrate excellence in performance. Although there is a growing literature on the various approaches to performance improvement taken by nonprofits, little is known about the processes involved in the adoption and implementation of specific approaches. This article is about the adoption and use of one approach to performance improvement, quality systems, in the U.K. nonprofit sector. We report findings about factors that encourage nonprofits to adopt quality systems. We also analyze the distinctive challenges of implementing quality approaches in a nonprofit sector context and suggest critical success factors. The article concludes with a discussion of the organizational and policy implications of applying the management concepts of quality and performance to the nonprofit sector.

The strategic role of relational capabilities in the business-to-business service profit chain

This paper extends the original service profit chain by examining the role of relational capabilities with employees, customers and strategic partners on process and performance outcomes in a business-to-business context. More specifically, we demonstrate how satisfied and loyal employees are better in developing relationships with customers and strategic partners. These relationships enable firms to be more responsive towards customers and become more innovative, which increase customer satisfaction and loyalty and, ultimately, financial performance. Our results provide support for the development of relational capabilities in a business-to-business environment by extending the service profit chain (SPC) model. However, we find that while the development of strong customer relationships contributes to an improved service responsiveness of the firm, strategic partners do not.

Reputation and performance in large law firms

Reputation is a signalling device that serves as a proxy for the quality of a firm’s products, strategies and employees relative to its competitors, when communicating with clients and other stakeholders. It is especially important for professional service firms because of the complex and intangible nature of their service and because of the advantages it confers in the market for high-quality professional staff. This paper extends and refines existing research on reputation which shows positive returns to reputation for professional service firms. We use different rankings of the top 50 law firms in the UK to measure reputation and examine their relationship with financial performance as expressed in firm revenue and profits. We find positive but diminishing returns to reputation even within this group and we find a stronger relationship between reputation and profits than fee income. We conclude that reputation may be an important source of competitive advantage for leading firms but it seems to offer little leverage for others. If these results are generalizable across other professional sectors this raises the question of how the majority of firms can differentiate themselves.

Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

Process and performance in international collaborative research

Motivated by policy goals to develop international research capability and our experiences of collaborative research, we wanted to learn more about the factors that influence success in collaborative research. This article presents a review of the academic literature on collaborative research, focusing on multinational teams doing international comparative research. We address the question ‘what accounts for variation in process and performance of collaborative research projects?’, through 11 themes: context; vision; reward and commitment; leadership; structure; contract; task capability; sociability; communication; finance; rhythm and pace. We then propose an agenda for future research with an analytic framework and, finally, our conclusions.

Trade marks and performance in UK firms:evidence of Schumpeterian competition through innovation

This paper uses novel data on trade mark activity of UK manufacturing and service sector firms to investigate whether trade marks improve the profitability and productivity of firms. We first analyse Tobin`s q, the ratio of stock market value to book value of tangible assets. We then investigate the relationship between trade mark activity and productivity, using a value added production function. Finally we examine interactions between firms IP activity, to explore creative destruction and growth via innovation. We find trade marks are positively related to both Tobin`s q and to productivity. Also in the short run greater IP activity by other firms in the industry reduces the value added of the firm, but this same competitive pressure has later benefits via productivity growth, also reflected in higher stock market value. This describes the Schumpeterian process of competition through innovation, restraining profit margins while increasing product variety and quality.

Pushing the Quality Level in Networked News Business: Semantic-Based Content Retrieval and Composition in International News Publishing

Electronic publishing exploits numerous possibilities to present or exchange information and to communicate via most current media like the Internet. By utilizing modern Web technologies like Web Services, loosely coupled services, and peer-to-peer networks we describe the integration of an intelligent business news presentation and distribution network. Employing semantics technologies enables the coupling of multinational and multilingual business news data on a scalable international level and thus introduce a service quality that is not achieved by alternative technologies in the news distribution area so far. Architecturally, we identified the loose coupling of existing services as the most feasible way to address multinational and multilingual news presentation and distribution networks. Furthermore we semantically enrich multinational news contents by relating them using AI techniques like the Vector Space Model. Summarizing our experiences we describe the technical integration of semantics and communication technologies in order to create a modern international news network.

Munkaszervezés a lean termelésben – mit magyaráznak a termelésmenedzsment koncepciók = Work organization in lean production – what production concepts explain

A tanulmány a lean termelés munkaszervezését három termelésmenedzsment koncepció segítségével vizsgálja. Az egyes koncepciók a szervezet eltérő metszeteit érintik: (1) a termék-folyamat mátrix (Hayes és Wheelwright, 1979) a termék és a folyamat jellemzőit helyezi középpontba. A lean hatására a szervezet a mátrixban a nagyobb választék és a folyamat alapú működés (nagyobb függőség) irányába mozdul el. Az elmozdulást üzemi szinten a magas elkötelezettségű munkavégzési rendszer gyakorlatainak bevezetése kíséri, mivel azok támogatják a rugalmas működést, a gyors kommunikációt és problémamegoldást. Az elmozdulás „minősége” és így a munkaszervezési gyakorlatok használata (mélyég, száma, munkavállalók bevonása) nagyban függ a termelési stratégiától és a lean érettségtől. (2) A termelési stratégia szakaszai (Wheelwright és Hayes, 1985) a termelés üzleti stratégiában játszott szerepét elemzik. A lean termelés összeegyeztethető a termelési stratégia harmadik szakaszának „command és control” szemléletmódjával. Az ilyen lean termelők költégfókuszúak, a hagyományos munkaerőképben gondolkodnak és körükben kevésbé jellemző az új emberi erőforrás gyakorlatok használata. A lean termelés adaptálása ösztönözheti a vállalatokat a termelési stratégia negyedik szintje felé. A negyedik szint a bevonásra, problémamegoldásra és tanulásra épít, amely megfelel a lean „emberek tisztelete” pillérének. (3) A lean érettségi modell (Hines és társai, 2004) a lean szervezeten belüli elmélyülését és terjedését mutatja be. A lean utazás során a vállalatok az eszköz alapú megközelítéstől a komplex értékrendszerben gondolkodó lean szervezet felé haladnak. A technikai tudásanyag egyre szélesebb körűvé válik, ami rávilágít a tudásátadás (személyek közöttire, de akár struktúrákba, folyamatokba építése is) képességének jelentőségére. Az emberi erőforrás gyakorlatok folyamatosan jelennek meg. De csak a legfejlettebb szakasz, a lean tanuló szervezet megjelenése teszi valóban szükségessé a munkavállalói kép újragondolását is. = This paper examines work organization in lean production with the help of three production concepts. These concepts embrace different dimensions of the organization: (1) the product-process matrix (Hayes and Wheelwright, 1979) is about product and process characteristics. Due to the lean the organization shifts within the matrix – towards higher variability and flow (higher level of interdependencies). On the shop floor the shift is accompanied by the introduction of high commitment work system’s practices, since those support flexible operations, fast communication and problem-solving. The „quality” of the shift and hence the application of these work practices (number of practices, their embeddeness, employee involvement) highly depends on manufacturing strategy and lean maturity. (2) The concept of stages of manufacturing strategy (Wheelwright and Hayes, 1985) analyzes the role of the manufacturing function in the business strategy. Lean production is compatible with the „command and control” approach of the third stage of manufacturing strategy. These lean producers are cost-driven, they have the traditional approach of employees and apply new work organization practices to a less extent. However, the implementation of lean production may drive these companies to the fourth stage. The fourth stage of manufacturing strategy is based on employee involvement, problem-solving and learning. This stage is in full accordance with the „respect for people” pillar of lean production. (3) Lean maturity (Hines et al., 2004) shows the path how lean management deepens and expands within an organization. During the lean journey, companies progress from the tool-based approach to the complex lean value system. The technical knowledge of lean becomes more and more comprehensive and it points out the crucial importance of knowledge conversion capabilities (intrapersonal or even how to build knowledge into structures, processes). Work organization practices constantly appear with the progress, but the review of the traditional approach of employees is only essential at the most advanced stage, when an organization becomes lean learning organization.