Deliberate Self-Poisoning Presenting to an Emergency Medicine Network in South-East Melbourne: A Descriptive Study

Background. Deliberate self-poisoning (DSP) comprises a small but significant proportion of presentations to the emergency department (ED). However, the prevalence and patient characteristics of self-poisoning attendances to EDs in Victoria have not been recently characterised. Aim. To identify and compare the characteristics of adult patients presenting to the three EDs of Monash Health following DSP. Methods. Retrospective clinical audit of adult DSP attendances between 1st July 2009 and 30th June 2012. Results. A total of 3558 cases over three years were identified fulfilling the search criteria. The mean age of patients was 36.3 years with the largest numbers aged between 18 and 30 (38%). About 30% of patients were born overseas. Forty-eight percent were discharged home, 15% were admitted to ED short stay units, and 5% required ICU admission. The median ED length of stay was 359 minutes (IQR 231-607). The most frequently reported substances in DSP were benzodiazepines (36.6%), paracetamol (22.2%), and antipsychotics (12.1%). Exposure to more than one substance for the episode of DSP was common (47%). Conclusion. This information may help identify the trends in poisoning substances used for DSP in Victoria, which in turn may provide clinicians with information to provide more focused and targeted interventions

Determinants of service quality and its effect on customer satisfaction and loyalty: an empirical study of private banking sector

Purpose – The main purpose of this study is to investigate the impact of various service quality dimensions, namely reliability, responsiveness, visibility, employee commitment and access to service on customer satisfaction in the private banking sector of Bangladesh. The research also investigates the relationship between customer satisfaction and loyalty and effect of demographic variables on customer satisfaction. Design/methodology/approach – The researchers distributed 320 self-administered survey questionnaires among private banks’ customers in Bangladesh and obtained 200 useable responses with a 62.5% valid response rate. The research data were analysed using confirmatory factor analysis (CFA) and structural equation modelling (SEM) approaches. Analysis of variance and logistic regression have also been used to obtain the supplementary findings. Findings – The research findings indicate that visibility, responsiveness and employee commitment have positive and significant effect on customer satisfaction, whereas reliability and access to service are found to have insignificant influence on customer satisfaction of private banking services. The findings of this study also revealed that customer satisfaction has positive and significant relationship with customer loyalty. But except respondents’ occupation type, all other demographic variables have no statistically significant relation with customer satisfaction. Research limitations/implications – The research focused solely on the private banking sector of Bangladesh and thus the results may not be applicable to other service sectors. Originality/value – This study conducted on customers’ perception of private banking services based on extended service quality dimensions and its relationship with customer satisfaction towards loyalty. The present research findings are anticipated to offer the guidelines for improving the customer satisfaction and loyalty of private banking services in Bangladesh as well as other countries

A retrospective descriptive study of the characteristics of deliberate self-poisoning patients with single or repeat presentations to an Australian emergency medicine network in a one year period

Background - A proportion of deliberate self-poisoning (DSP) patients present repeatedly to the emergency department (ED). Understanding the characteristics of frequent DSP patients and their presentation is a first step to implementing interventions that are designed to prevent repeated self-poisoning. Methods - All DSP presentations to three networked Australian ED’s were retrospectively identified from the ED electronic medical record and hospital scanned medical records for 2011. Demographics, types of drugs ingested, emergency department length of stay and disposition for the repeat DSP presenters were extracted and compared to those who presented once with DSP in a one year period. Logistic regression was used to analyse repeat versus single DSP data. Results - The study determined 755 single presenters and 93 repeat DSP presenters. The repeat presenters contributed to 321 DSP presentations. They were more likely to be unemployed (61.0% versus 39.9%, p = 0.008) and have a psychiatric illness compared to single presenters (36.6% versus 15.5%, p < 0.001). Repeat presenters were less likely to receive a toxicology consultation (11.5% versus 27.3%, p < 0.001) and were more likely to abscond from the ED (7.5% versus 3.4%, p = 0.004). Repeat presenters were more likely to ingest paracetamol and antipsychotics than single presenters. The defined daily dose for the most common antipsychotic ingested, quetiapine, was less in the repeat presenter group (median 1.9 [IQR: 1.3-3.5]) compared with the single presenter group (4 [1.4-9.5]), (OR 0.85, 95% CI 0.74-0.99). Conclusion - Patients who present repeatedly to the ED with DSP have pre-existing disadvantages, with increased likelihood of being unemployed and having a mental illness. These patients are also more likely to have health service inequities given the greater likelihood to abscond from the ED and lower likelihood of receiving toxicology consultation for their DSP. Early recognition of repeat DSP patients in the ED may facilitate the development of individualised care plans with the aim to reduce repeat episodes of self-poisoning and subsequent risk of successful suicide

Grounded theory : a theory discovery method for accounting research

Social scientists have been recognising the shortcomings of the scientific methodology for quite some time. The main shortcoming, according to them, has been the oversimplified deductive approach to theory development that has been adopted in the scientific methods. The oversimplification occurs because some of the essential variables of reality are assumed to be constants. In a similar vein, reseachers in social science have often been making calls for the adoption of the naturalistic approach to study complex human penomena. We believe the construction of accounting phenomena belongs to this category, and suggest the use of the naturalistic approach to examine them as they may not be examinable by the structured theory driven scientific approach. Within the naturalistic domain, we propose the use of a method of research called the Grounded Theory method. The rationale behind the Grounded Theory method is that theory should be grounded in empirical evidence, i.e. evolve from data, rather than be developed a priori and then be tested. Since its introduction in the 1960s, the grounded theory method has found favour in many other disciplines, such as nursing, sociology and organisation studies. This chapter suggests Grounded Theory method could be a viable alternative available to accounting researchers to examine complex phenomena

Accounting Practice Harmony, Accounting Regulation and Firm Characteristics

32 page(s

Earnings quality in international settings : a comparative study of Japan, Thailand and the U.S.A

The purpose of this study is to investigate how the quality of earnings, vis a vis, the quality of accounting, is related to the idiosyncrasies of specific country settings. We focus our study on pre- and post-Asian financial crisis (AFC) Japan, pre-AFC Thailand and pre- and post-2000-01 recession USA. Japan has a legacy of keiretsu form of interrelated firms and debt financing by keiretsu banks. Thailands companies are predominantly family controlled with their accounting being influenced by tax laws. More specifically, pre-AFC Thailand had a weak accounting institutional setting with laws that favored insiders and a prevalence of short-term debt financing with a large overseas involvement. The US has a classic Bearle and Means setting with fairly clear demarcations between the interests of equity providers, creditors and managers. We observe that in Japan income enhancing discretionary accruals were positively associated with both long-term and short-term financing after the AFC, a period of time when Japanese companies faced challenging circumstances with respect to profitability and several Japanese banks came under the spotlight of international institutions for excessive non-performing loans. We conclude that because of the keiretsu associations between the firms and banks, in difficult times, Japanese banks allow firms to use discretionary accruals for reporting higher earnings. For pre-AFC Thailand, earnings increasing discretionary accruals were positively associated with short-term financing, indicating that earnings were managed to attract short-term debt. For the US, the results support the theory that debt mitigates agency problems by ensuring reporting of better quality earnings. We conclude that the quality of earnings varies among countries depending on financing and corporate arrangements.32 page(s