Identifying the challenges and facilitators of implementing a COPD care bundle.

BACKGROUND: Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. METHODS: An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. RESULTS: Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. CONCLUSIONS: Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges

Comprehensive health assessments during de-institutionalization: An observational study

Background: People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both them and their new GPs as they go through that phase

P-Values as analytical tools in probabilistic forecast assessments.

Much has been written about ?quality? of probabilistic forecasts. Often, providers and users of such forecasts are unclear about what ?quality? entails, leading to confusion and misinformation. Here we try to provide some guidance and suggest a general approach to communicate aspects of probabilistic forecast quality related to discriminatory ability (DA) and skill (S). In our opinion, these two components of forecast quality should be considered independently. DA represents the additional knowledge about future states arising from some forecast system (FS) over and above the total variability of the prognostic variable while S quantifies changes in the agreement between observed and predicted values when using a specific FS instead of a FS based on ?climatology? only. The major concerns are: generally poor distinction between DA and S; inappropriate use of significance testing to quantify DA and use of DA and S measures that do not account for the series lengths and/or number of classes of the FS. To address all of these issues, we propose the use of p-values derived from non-parametric tests as direct measures of DA and S. We illustrate this approach by quantifying DA and S of the Southern Oscillation Index applied to forecasting rainfall across Australia

Peer mentorship and positive effects on student mentor and mentee retention and academic success

This study examined how the introduction of peer mentorship in an undergraduate health and social welfare programme at a large northern university affected student learning. Using an ethnographic case study approach, the study draws upon data collected from a small group of mentors and their mentees over a period of one academic year using interviews, reflective journals, assessment and course evaluation data. Analysis of the data collected identified a number of key findings: peer mentorship improves assessment performance for both mentee and mentor; reduces stress and anxiety, enhances participation and engagement in the academic community, and adds value to student outcomes

Downtown and regional shopping centre retailing in Winnipeg

Report : xi, 90 p.The primary objectives of this study on Winnipeg's retail sector are: 1) to identify and analyze any structural and spatial changes which have occurred in downtown and regional shopping centre retail activity. 2) to attempt to identify some of the impacts/effects on downtown retail trade that could be attributed to regional shopping centre development. 3) to assess the changing physical and economic characteristics of the retail trade in Winnipeg. 4) to identify and analyze the shifts occurring in the types of retail activity within the downtown on a micro-level. 5) to identify and compare public perceptions and attitudes towards shopping downtown and/or at regional shopping centres. 6) to offer recommendations concerning present and future downtown development

Testing a model of antecedents and consequences of defensive pessimism and self-handicapping in school physical education

There has been very limited research on the use of self-worth protection strategies in the achievement context of school physical education (PE). Thus, this study aimed to examine some antecedents and consequences of defensive pessimism and self-handicapping. The sample comprised 534 (females n = 275; males n = 259) British pupils recruited from two schools who responded to established questionnaires. Results of structural equation modelling analysis indicated that self-handicapping and defensive pessimism were positively predicted by fear of failure and negatively predicted by competence valuation. In addition, defensive pessimism was negatively predicted by physical self-concept. In turn, defensive pessimism negatively predicted enjoyment in PE and intentions to participate in future optional PE programs. Self-handicapping did not predict enjoyment or intentions. Results from multi-sample structural equation modelling showed the specified model to be largely invariant across males and females. The findings indicate that although both strategies aim to protect one’s self-worth, some of their antecedents and consequences in PE may differ

Caltech Faint Galaxy Redshift Survey X: A Redshift Survey in the Region of the Hubble Deep Field North

A redshift survey has been carried out in the region of the Hubble Deep Field North using the Low Resolution Imaging Spectrograph at the Keck Observatory. The resulting redshift catalog, which contains 671 entries, is a compendium of our own data together with published LRIS/Keck data. It is more than 92% complete for objects, irrespective of morphology, to $R = 24$ mag in the HDF itself and to $R = 23$ mag in the Flanking Fields within a diameter of 8 arcmin centered on the HDF, an unusually high completion for a magnitude limited survey performed with a large telescope. A median redshift $z = 1.0$ is reached at $R \sim 23.8$. Strong peaks in the redshift distribution, which arise when a group or poor cluster of galaxies intersect the area surveyed, can be identified to $z \sim 1.2$ in this dataset. More than 68% of the galaxies are members of these redshift peaks. In a few cases, closely spaced peaks in $z$ can be resolved into separate groups of galaxies that can be distinguished in both velocity and location on the sky. The radial separation of these peaks in the pencil-beam survey is consistent with a characteristic length scale for the their separation of $\approx$70 Mpc in our adopted cosmology ($h = 0.6, \Omega_M = 0.3$, $\Lambda = 0$). Strong galaxy clustering is in evidence at all epochs back to $z \le 1.1$. (abstract abridged)Comment: Accepted to the ApJ. This version contains all the figures and tables. 2 minor typos in table 2b correcte