Pro-growth small businesses: learning 'architecture'

Internationally, a certain market failure has become apparent in terms of the effective engagement of small business owner-managers in business support programs, and in the wider concept of life long learning. There exists a cultural gap between support agencies and the small business sector's perceptions of the utility of formal support and learning interventions to the business performance of their business. Therefore, this paper extends knowledge and understanding within this context relative to what constitutes small business owner-managers' learning disposition, means, obstacles and organisation to be confronted and what form of new 'architecture' needs to be designed to support learning. A theoretical framework supports the analysis of findings from a research project based in Melbourne, Australia, which serves to illuminate pertinent issues towards informing more sensitised support interventions with respect to pro-growth small businesses. Specifically, the attribute of a learning culture was identified as a factor contributing to growth in small businesses, and may represent a distinguishing characteristic between effective and non-effective economic performers

The small business assistance dilemma: is the disparity between the offerings of support agencies and the needs of business irreconcilable?

There is a wide range of service providers who have varying motives for supplying assistance to small businesses in Australia. Despite the sizeable numbers of both suppliers and consumers of assistance it is believed that the marketplace for small business assistance operates inefficiently. This inefficiency is described as a disparity or misfit between the learning opportunities offered by service providers to small business and the learning needs of small business owner / operators. This paper provides an analysis of the learning activity that currently exists in the small enterprise sector. The role of communication in bringing supply and demand closer together is discussed and a proposition is developed to alleviate the learning disparity via a more proactive approach to communication by service providers. Two small enterprise projects are used to test the proposition. The findings provide guidance for the more effective functioning of organisations that serve and support small businesses

Performance measurement in small motels in Australia

This research explores the measurement of performance in small motels. There are many challenges facing business performance management in small firms. Most of these challenges are due to resource shortages, lack of functional expertise and environmental instability. Of major importance to firm survival is the small enterprise owner-manager’s ability to monitor the operations performance. Key components of the monitoring process include the ability to identify key performance indicators to track results as well as an understanding of the most suitable measures to use. Specifically, the study focuses on identifying the key constructs of performance for small firms which include the key components of drivers and results. The specific monitoring and measurement activities of small motel owner-operators were identified using a case research approach. The findings of the study indicate that those owner-managers who operate successful motels employ a balanced approach to performance measurement by utilising a small number of key measures to monitor results and to review management activities

Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community : a systematic review and meta-analysis

Background Fall related injuries are the leading cause of accident - related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community - dwelling adults; however, there is lack of evidence for the long - term effects of exercise. Objectives To assess the long-term effect of exercise interventions on preventing falls in community - dwelling older adults. Data Sources Searches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017. Study selection Randomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long - term follow - up (>12 months) of exercise interventions involving community - dwelling older adults (65 and over) compared to a control group. Data extraction/Data synthesis Pairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta - analysis and data were extracted using rate ratio (RaR) and risk ratio (RR). Results Twenty - four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12 - month follow - up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years post - intervention. Conclusions Falls prevention exercise programmes have sustained long - term effects on the number of people falling and the number of falls for up to two years after an exercise intervention

Compassion in nursing : solution or stereotype?

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to be able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straight forward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system-level issues associated with its provision. This has resulted in simplistic presentations of ‘compassion’ as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision

Compassionate care : not easy, not free, not only nurses

Compassion has historically been defined as an underpinning principle of work conducted by health professionals, especially nurses.1 Numerous definitions of compassionate care exist, incorporating a range of elements. Most include a cognitive element: understanding what is important to the other by exploring their perspective; a volitional element: choosing to act to try and alleviate the other’s disquiet; an affective element: actively imagining what the other is going through; an altruistic element: reacting to the other’s needs selflessly; and a moral element: to not show compassion may compound any pain or distress already being experienced by the other

Benzo-pyrones for reducing and controlling lymphoedema of the limbs.

Background Lymphoedema is the accumulation of excess fluid in the body caused by obstruction of the lymphatic drainage mechanisms. Treatment with Benzo-pyrones is thought to reduce fluid forming in the subcutaneous tissues and reduce pain and discomfort of the affected area. Objectives To assess the effectiveness of benzo-pyrones compared to placebo in the management of lymphoedema. Search strategy We searched the Cochrane Breast Cancer Group register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4,2003), MEDLINE, EMBASE, CINAHL, UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and The International Society of Lymphology congress proceedings. Selection criteria Randomised controlled trials comparing Benzo-pyrones with placebo. Data collection and analysis Trials were selected for eligibility and tested for quality by two blinded reviewers who independently extracted data. Meta-analysis was not performed due to the poor quality of the trials. Main results Fifteen trials were included. Three oxerutin trials tested the same dose over 6 months against placebo and included a total of 127 participants (data were available for 81). There were insufficient data from these to calculate the per cent reduction or increase in baseline excess limb volume. One trial testing Cyclo 3 Fort (approved name) was found (57 participants) but insufficient data was provided to allow a proper analysis of its findings. A single trial of Daflon (approved name) was found (104 participants) but this also provided insufficient information to reach a conclusion about the effectiveness of the drug. Three trials of coumarin combined with troxerutin were found which tested two different doses of the drug against each other with no placebo, however participant numbers and baseline data were not provided. Eight trials of coumarin were identified. Two of these reported the same trial and the other potentially also referred to the same trial but this could not be confirmed. A further two papers also appeared to refer to the same trial but again this was unconfirmed. Five studies added anti-filarial drugs to the interventions tested. Participant data could not be extracted and the reporting of outcome measures in most was unclear. Loprinzi's 1999 trial was reported in more detail but its conclusions were very much at odds with other findings. Authors' conclusions It is not possible to draw conclusions about the effectiveness of Benzopyrones in the management of lymphoedema from the current available trials

Experiences of people taking opioid medication for chronic non-malignant pain : a qualitative evidence synthesis using meta-ethnography

Objective To review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them. Design This is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography. Data sources and eligibility criteria We searched selected databases—Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)—for qualitative studies which provide patients’ views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018). Data extraction and synthesis Papers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument. Results We screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of ‘constantly balancing’ emerged from the data. Conclusions People taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always ‘on the same page’ as their healthcare professional and felt changes in opioid use were often challenging