From continuous improvement to collaborative improvement: scope, scale, skill and social networking in collaborative improvement

More than ever, companies are challenged to improve their performance and respond quickly and accurately to changes within the market. As competitive battlefield is moving towards the level of networks of organisations, the individual firm is an inadequate entity for identifying improvements. Therefore the concept of continuous improvement must be applied and used in inter-organisational settings, leading to the concept of collaborative improvement. However the process of applying and transferring CI to inter-organisational settings is fraught with intra- and inter-organisational change issues and working practices. For companies to be able to effectively manage and organise the process of collaborative improvement knowledge and understanding on the process itself is needed

Self-rated health and employment status in patients with multiple sclerosis

Purpose. The aim is to explore the association between self-rated health and employment status in patients with multiple sclerosis (MS) when controlling for age, gender, functional disability, disease duration, anxiety and depression. Method. One hundred eighty-four people with MS completed a sociodemographic questionnaire that included questions on employment status, the first item of the Short Form-36 Health Survey and the Hospital Anxiety and Depression Scale. Functional disability was assessed using the Expanded Disability Status Scale. The probability of good self-rated health in employed persons was investigated using stepwise logistic regression analyses. Results. Patients with MS who reported good self-rated health were 2.46 times more likely to be employed (95% confidence interval [CI]: 1.08-5.59). Patients without anxiety were 2.64 times more likely to be employed (95% CI: 1.23-5.67). Patients with higher EDSS scores were 0.49 times less likely to be employed (95% CI: 0.33-0.70). Age, gender, disease duration and the presence of depression did not show an increased chance of patient employment. Conclusions. Patients with MS with good self-rated health are more likely to be employed, even after adjusting for age, gender, education, functional disability, disease duration, depression and anxiety. Dependent on the findings of longitudinal studies unravelling the relevant causal pahways, self-rated health might be used as a quick and cheap prognostic marker, which could warn about the possible loss of employment, or changes in functional disability

The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (C D S).Design: Cross-sectional study.Setting: Centre for Rehabilitation of the University Medical Center Groningen, The Netherlands.Subjects: Patients after stroke, spinal cord injury, multitrauma, head injury, amputation, rheumatoid arthritis, diabetes mellitus, lung diseases, tuberculosis and coronary artery disease. One hundred and fifty-four patients were included.Measures: The Northwick Park Dependency Score (NPDS), the Barthel Index (BI) and the Care Dependency Scale (CDS).Results: The correlation (rho) between the NPDS and the BI for all groups was - 0.87-1 R-2 = 0.76 (n = 154). Per patient group rho varied from - 0.70 (R-2 = 0.49) to - 0.93 (R-2 = 0.86). The overall correlation between the NPDS and CDS was larger than the criterion of rho = 0.60 (r=- 0.74; R-2 = 0.55) but was &lt;0.60 in the rheumatoid arthritis and tuberculosis group. The overall correlation between BI and CDS exceeded the criterion (r = 0.75; R-2 = 0.56).Conclusions: The NPDS is a generic nursing dependency instrument that can be used as a valid measure across various patient groups in rehabilitation.</p

The Predictive Value of Amplitude-Integrated Electroencephalography in Preterm Infants for IQ and Other Neuropsychological Outcomes at Early School Age

Background: Amplitude-integrated electroencephalography (aEEG) is used increasingly in neonatal intensive care and seems helpful in predicting outcomes at the age of 2 years, Objectives:To determine whether early aEEG patterns in preternn infants are equally useful in predicting outcomes at early school age. Methods: We recorded aEEG in 41 pre-terms (gestational age 26.0-32.9 weeks) at a median postnatal age of 9.7 h (IQR 7.0-25.3) and in 43 preternns on median day 8 (IQR 7-9). We assessed aEEG by pattern recognition and calculated the means of the aEEG amplitude centiles. At a median of 739 years, i.e., early school age, we assessed their motor, cognitive, and behavioral outcomes. Results: Depressed aEEG patterns were not associated with poorer outcomes. Cyclicity directly after birth was associated with a higher total IQ (mean 104 vs. 97, p = 0.05) and higher scores on visual perception (mean percentile 57.1 vs. 40.1, p 0,049) and visual memory (mean percentile 34.5 vs. 19.1, p = 0090). We found some associations between the aEEG amplitude centiles and cognitive outcomes, but none for motor or behavioral outcomes. There was an increased risk of abnormal scores on long-term verbal memory in cases of the lower 5th and 50th aEEG amplitude centiles directly after birth. The odds ratios were 0.65 (95% CI 0,42-0.99, p = 0.040) and 0.71 (95% CI 0.52-0.96, p = 0.025), respectively. Conclusions: In relatively healthy preternn infants the value of aEEG in predicting neuropsychological outcomes at early school age is limited. The presence of cyclicity directly after birth tends to be associated with better cognition. (C) 2018 The Author(s) Published by S. Karger AG, Base

Does Predation Influence the Seasonal and Diel Timing of Moose Calving in Central Ontario, Canada?

Birth synchrony is well documented among ungulates and is hypothesised to maximize neonate survival, either by minimizing the risk of predation through predator swamping or by synchronising birthing with increased seasonal food availability. We used encapsulated vaginal implant transmitters to locate and capture neonatal moose calves and document the seasonal and diel timing of parturition in two adjacent study areas with different predation pressure in central Ontario, Canada. We tested the hypothesis that predation promotes earlier and more synchronous birth of moose calves. Across both areas, proportionately more births occurred during the afternoon and fewer than expected occurred overnight. Mean date of calving averaged 1.5 days earlier and calving was also more synchronous in the study area with heavier predation pressure, despite average green-up date and peak Normalized Difference Vegetation Index date occurring 2 days later in this study area than in the area receiving lighter predation pressure. We encourage analysis of data on timing of parturition from additional study areas experiencing varying degrees of predation pressure to better clarify the influence of predation in driving seasonal and diel timing of parturition in temperate ungulate