Multidisciplinary case conference reviews: Improving outcomes for nursing home residents, carers and health professionals

Aim of study: This study sought to determine whether multidisciplinary case conference reviews improved outcomes for nursing home residents, and the effects of this team approach to resident care on carers, including the hands-on carers employed by the nursing home, and health professionals. Method: 245 residents of three Canberra nursing homes were enrolled in this non-randomised controlled trial. The intervention consisted of sessions of three case conference reviews held between 10/4/96 and 4/12/96. These sessions were attended by the General Practitioners (GPs) of the residents discussed, the GP project officer from the ACT Division of General Practice, a clinical pharmacist, senior nursing staff, other health professionals eg physiotherapist, and occasionally the resident concerned or their representative. At each review, a case presentation by the resident's GP was followed by a multidisciplinary discussion of all aspects, medical and non-medical, of the resident's care. The review concluded with a management plan for the resident. In total 75 residents were reviewed. Main outcome measures: Medication use and cost, and mortality. Results: One month after the reviews were completed comparisons between those who were reviewed and those who were not showed non-significant reductions in medication orders, medication cost, and mortality in the reviewed group. Many of the 92 recommendations in the management plans that were carried out benefited the residents (n=37) and/or carers (n=24). The responses of the GPs and the Directors of Nursing to the reviews were overwhelmingly positive. Conclusion: Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers. Given the support shown by key stakeholders, multidisciplinary conferences should be used more.

Reconsidering the analysis of the uses of ICTs by political parties : an application to the Catalan case

For years a literature on the uses that political parties make of information andcommunication technologies (ICTs) has been developed. It is a rapidly increasing, rich,and interesting field in the forefront of the investigation in political science. Generally,these works start from the expectation that the ICTs have a regenerative potential forliberal democracies and for the political parties as well. In developed societies, politicalparties have experienced some transformations that have leaded them to an increasingdivorce with the public. This divorce is shown by the decay of party adscription andmembership, and also by the decay of the conventional political participation. In thetheoretical discussion this situation has been described as ¿the crisis of the democracy¿(Norris, 1999). According to the more radically oriented scholars this crisis reflects theincapacities of liberal democracies. In this sense, ICTs suppose a great opportunity tosurpass the representative institutions and to institutionalize new forms of directdemocracy. More moderate scholars have considered that ICTs offer the opportunity for¿renaissance¿ for representative institutions, as they can reinforce the bonds between thepublic and its representatives.

Goal sketching and the business case

This paper describes how the business case can be characterized and used to quickly make an initial and structurally complete goal-responsibility model. This eases the problem of bringing disciplined support to key decision makers in a development project in such a way that it can be instantiated quickly and thereafter support all key decision gateways. This process also greatly improves the understanding shared by the key decision makers and helps to identify and manage load-bearing assumptions.

Pipelining considerations for an FPGA case

This paper presents a semi-synchronous pipeline scheme, here referred as single-pulse pipeline, to the problem of mapping pipelined circuits to a Field Programmable Gate Array (FPGA). Area and timing considerations are given for a general case and later applied to a systolic circuit as illustration. The single-pulse pipeline can manage asynchronous worst-case data completion and it is evaluated against two chosen asynchronous pipelining: a four-phase bundle-data pipeline and a doubly-latched asynchronous pipeline. The semi-synchronous pipeline proposal takes less FPGA area and operates faster than the two selected fully-asynchronous schemes for an FPGA case.

Towards the Implementation of First-Order Temporal Resolution: the Expanding Domain Case

First-order temporal logic is a concise and powerful notation, with many potential applications in both Computer Science and Artificial Intelligence. While the full logic is highly complex, recent work on monodic first-order temporal logics has identified important enumerable and even decidable fragments. In this paper, we develop a clausal resolution method for the monodic fragment of first-order temporal logic over expanding domains. We first define a normal form for monodic formulae and then introduce novel resolution calculi that can be applied to formulae in this normal form. We state correctness and completeness results for the method. We illustrate the method on a comprehensive example. The method is based on classical first-order resolution and can, thus, be efficiently implemented.

General practitioner, specialist providers case conferences in palliative care: Lessons learned from 56 case conferences

OBJECTIVE: To describe the utility and acceptability to general practitioners and palliative care staff of case conferences in palliative care. METHOD: Research focussed on case conferences conducted between GPs and staff of three specialist palliative care units (in an inner urban, outer metropolitan and regional setting), at the time of referral of patients to the service. Telephone interviews were conducted with all GPs who participated in a case conference, and focus groups were conducted with palliative care staff. RESULTS: For most GPs, case conferences by teleconference were a time effective and immediate means of information transfer. The best instances for a conference were at time of patient referral, time of discharge to the community, or where the case was complex. General practitioners appreciated access to multiple professionals simultaneously. Workload pressures were a drawback of participation for both GPs and specialists. Palliative care team members thought case conferences gave GPs an appreciation of a team approach, and reduced professional isolation. The usefulness of the case conferences depended on the willingness of the GP to participate. General practitioners would participate again provided they did not have to organise the case conference. Specialist staff were concerned by the financial cost of organising case conferences. DISCUSSION: Case conferences provide useful information exchange between GPs and specialist staff, and are acceptable to both parties. Much depends on the individual GPs attitude toward participation, as well as the timing of the conferences in the course of the patient's illness. Organisation needs to be a task of the specialist units, who would need administrative support to organise them. (author abstract)

Takeovers: Acceptance facilities revisited in the Patrick case

Takeovers undertaken in Australia are highly regulated transactions. Once shareholders in the target accept an offer they have a limited opportunity, if any at all, to reconsider or revoke their acceptance in the light of new circumstances. Arguably, this explains target shareholders reluctance to accept an offer made for their shares under a takeover. The problem of shareholder inertia in takeovers has been identified by bidders, who have sought to induce bid acceptance through the use of innovative mechanisms. The efficacy of the Acceptance Facility mechanism was recently revisited in the Panel decision in Patrick Corporation Ltd’s takeover by Toll Holdings Ltd.