Co-management Model Research Articles

The change of zooplankton communities in three areas for co-management of coastal fisheries in Can Gio, Ho Chi Minh City

Zooplankton plays a role as a living food source in the food web of water bodies, determining the growth and development of many aquatic species, especially at the larval stage. The study has recorded 52 species of 29 genera, 21 families, 6 classes, 4 phylum and 7 types of larvae in 28 sampling sites of 3 areas for co-management of coastal fisheries. The density of plankton individuals ranged from 49300 individuals/m3 to 272812 individuals/ m3. The number of species and density of plankton individuals in Thanh An area is higher than in the other areas (Long Hoa and Can Thanh). The similarity of the zooplankton communities showed that at 40% of the sampling sites, they were divided into 2 groups as follows: group 1 of water bodies in the co-management model area in Long Hoa and Can Thanh, group 2 included the water bodies of Thanh An area. The Copepoda class is the highest proportion in the sampling sites, showing that it will be an abundant food source for the growth and development of aquatic species that are cultured or live naturally in this ecosystem. It is also an important biological factor that needs to be managed and conserved to create a natural habitat for the sustainability of fish stocks in the area.

Recommendations for Effective Co-Management Model of Small-Scale Grouper (Serranidae) Fishery in South Sulawesi Province

Governance (policy) that regulates fisheries resources needs to involve industry in the supply chain (market) and small-scale grouper fishermen (community) within a co-management framework so that management is more effective while simultaneously supporting the Fisheries Improvement Project (FIP) which is driven by various parties globally (Conservation Alliance, 2021). This study aims to recommend a small-scale grouper fishery co-management model to be carried out in South Sulawesi Province. This study diagnoses the readiness (enabling condition) and willingness (motivation) of stakeholders so that they can be applied and implemented consistently (implementation). The results of this study indicate that the main approaches and strategies for the co-management model of small-scale grouper fisheries include (a) Optimizing the role of the market that promotes traceability and improving governance through a supply chain approach, (b) Synergy and synchronization of the role of government at all levels through an approach technocratic, (c) Strengthening fishermen and local institutions through a participatory approach, (d) Gathering multi-stakeholder support and collaboration through a collaborative approach. The recommended roadmap for small-scale grouper co-management in South Sulawesi Province includes three main stages, namely: (a) Initiation Stage: Commitment, Support, and Organizing, (b) Acceleration Stage: Joint Committee and Co-management Prototype, and (c) Stage Institutionalization: Scaling up and Organizing Fishermen's Forums.

P70: Creative Collaboration through Co-management: Rethinking Care for Left Ventricular Assist Device (LVAD) Readmissions

Background: As a LVAD program supporting 300 patients, a large cohort of those patients will require readmission. The traditional model assigned all LVAD readmissions to a heart failure cardiologist, regardless of presenting diagnoses. This congested the cardiac LVAD cardiologist census, and often resulted in cardiologists directing care for non-cardiac diagnoses. Given more than half of readmissions were not cardiac in nature, a Co-management model utilizing the expertise of the hospitalist service was developed. Methods: An interdisciplinary team of heart failure cardiologists, hospitalists, and heart failure Advanced Practice Providers (APP) partnered together to develop a streamlined process for assigning readmitted LVAD patients to either a heart failure cardiologist or hospitalist. A group of five hospitalists completed a “LVAD bootcamp” to become familiar with the basics of LVAD care. The “Hospitalist LVAD patients” were also cared for by a heart failure APP with in-depth LVAD and heart failure knowledge. A heart failure cardiologist was always available for consultation. Patients were divided between the “Hospitalist LVAD” vs “Cardiac LVAD” team based on admitting diagnoses. A post-implementation survey was conducted and patient data pre and post introduction of the Co-management model was collected for review. Conclusion: The streamlined Co-management system of assigning readmitted LVAD patients based upon their admitting diagnoses to either a “Hospitalist LVAD” or “Cardiac LVAD” team ensured the assigned provider was able to best meet the specific patient care needs. With the support of LVAD coordinators, APPs, and other members of the multidisciplinary team, these patients received comprehensive care throughout the admission. Additionally, this improved process allowed the Cardiac LVAD team time to see patients in the outpatient LVAD clinic and ICU allowing for better utilization of resources. Clinical outcomes remained consistent throughout the implementation of this reimagined workflow. The Co-management model improved provider satisfaction.

A MODEL FOR ENHANCING THE BUDDHIST TOURISM NETWORK DEVELOPMENT NETWORK IN NAKHON PHANOM PROVINCE

This research has the following objectives: 1) to study the enhancement of the Buddhist tourism development network; 2) to study the model for enhancing the Buddhist tourism development network in Nakhon Phanom Province; 3) to propose a model for enhancing the Buddhist tourism development network in Nakhon Phanom Province. This study was carried out by means of qualitative research by using an interview form to collect data from 30 key informants. The obtained data were interpreted by descriptive analysis. The research results were as follows: Enhancing the Buddhist tourism development network: Thailand has Buddhist tourist attractions scattered throughout all provinces. In each context, the area is different. There is a story of the origin of the tourist attraction. To develop tourism, many factors are required, which can be summarized as (1) tourist attractions and good tourism activities; (2) environmental processes; (3) operational organizations; (4) legal and ethical processes; (5) good attitudes; (6) creative development; (7) leaders of a network with knowledge and virtue; (8) continuously creating good activities together; (10) being sincere and serious; (11) equality. A model for enhancing the Buddhist tourism network development network in Nakhon Phanom Province: for a temple that is a Buddhist tourist attraction, related agencies, and communities have jointly developed Buddhist tourism activities in terms of cultural traditions, public relations, conservation, and learning. A model for enhancing the Buddhist tourism development network in Nakhon Phanom Province: there are five types of models for enhancing Buddhist tourism development networks in Nakhon Phanom Province: (1) a model with a temple as a base for developing activities; (2) a model for co-management with the community; (3) an exhibition model as a museum center; (4) a model of web page preparation for monks; (5) a model of management in collaboration with government agencies.

Co-management of community-based natural resources in Ghana: a study on the Buabeng-Fiema monkey sanctuary

ABSTRACT Using a qualitative approach, this study assessed the contribution of state and community initiatives to the sustainable management of the Buabeng-Fiema Monkey Sanctuary (BFMS) in Ghana. The study found an evolving trend in the management of the sanctuary from its earlier ineffective sole community and state-led management models to the current co-management model involving communities’ representatives and state actors. The co-management model was widely seen as being more effective as it facilitates effective planning, policy formulation, revenue mobilization and utilization, monitoring, and evaluation as well as protecting the environment and wildlife resources.

Hospitalist Co-Management of Urethroplasty Patients in an Academic Center: Implementation of a Standardized Postoperative Care Model

Objectives: to evaluate whether hospitalist co-management would lead to improved outcomes and value in patients undergoing urethroplasty (UPL) with a single surgeon for urethral stricture disease (USD). Material: A co-management model with hospitalists was introduced in August 2019 for all patients undergoing UPL for USD with a single surgeon in a United States teaching center. The hospitalist worked closely with the urologic surgeon and the support staff. The hospitalist managed post-operative concerns, such as pain and comorbidities, as well as conducted rounds with the urological team for disposition planning and addressing interdisciplinary needs. Retrospective analysis compared a 42-month period before initiation of co-management (Jan 2016–July 2019) with a 32-month period after initiation (Aug 2019–March 2022). Outcomes assessed were recurrence of stricture, complications, length of stay, readmission, and emergency room visits. Results: A total of 135 patients (71 surgeon-managed, 64 co-managed) underwent urethroplasty from January 2016 to March 2022. Hospitalist co-management did not affect complications, length of stay, readmission, and emergency room visits. Accounting for confounding variables using multivariable analysis, no factors were independently associated with recurrence. There were no demographic, comorbidity, or American Society of Anesthesiologists (ASA) score differences between the two groups. Conclusions: This study suggests that hospitalist care for patients undergoing urethroplasty may be non-inferior to surgeon care, based on similar outcomes between the two groups. There were no significant differences in the total length of stay or blood pressure readings, and the complication rates and hospital readmission rates were also similar.

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management.

Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥65 years with an expected length of stay of ≥2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0-85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0-84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients (p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management.

The orthogeriatric cycle and orthogeriatric taxonomy: definitions, classifications, and conceptual elements for a better clinical practice

The incidence of fragility fractures is increasing. This group of diseases, mainly hip fractures, has enormous clinical, social, organizational, epidemiological, and economic impact. Orthogeriatrics emerged in the 1960s as a response to the impact of hip fractures on health systems. Since then, the cost-effectiveness of co-management models has been demonstrated, and the field of orthogeriatrics has expanded from acute care to prevention, rehabilitation, and follow-up, including involvement from clinical, academic, administrative, and political sectors. This has made associated indicators and standards increasingly complex. Moreover, orthogeriatrics initiatives are quite diverse throughout the world, since they arise due to varied local circumstances. Thus, it is necessary to review the foundations of the specialty to facilitate decision-making, comparison between models, and continuous improvement. In this article, we review current definitions and concepts in orthogeriatrics based on classic publications. We also reviewed the classifications of care models and carried out an evolutionary analysis of the field. Finally, we propose a taxonomic system that considers clinical, evolutionary, and functional aspects.

ALIGN-CARE: IMPLEMENTATION AND FEASIBILITY OF NEW GERIATRIC SURGERY CO-MANAGEMENT MODEL FOR PHYSICAL AND SOCIAL FRAILTY

Abstract Pre-operative geriatric evaluation in frail older patients that addresses both medical and psychosocial needs is often not completed prior to surgery, leaving frail older adults ill prepared for surgery. The ALIGN-CARE interprofessional co-management model uniquely serves to standardize care and coordination amongst the surgeon, geriatrician and social worker in ambulatory settings to allow a greater window of time to intervene for surgical optimization. Program elements include assessment of preoperative medications, functional status, cognition, nutrition, What Matters Most, advance care planning (ACP), and social determinants of health. Recommendations and action items from the geriatric-social work team are presented to surgeon and primary care physicians for follow-up and optimization. Program and process elements recorded in a REDCap database facilitate longitudinal evaluation of ALIGN-CARE model implementation feasibility. Initial data of 9 frail surgical oncology patients indicate increases in meaningful ACP discussions, patient-oriented decisions regarding surgery candidacy, and surgeon referrals for inpatient geriatric consultation post-operatively as a result of ALIGN-CARE. Current analyses to assess feasibility and quality of the program include thematic coding of program documents, semi-structured interviews of key stakeholders (surgeons, geriatricians, social workers, patients), and quantitative analysis of program outcomes, including uptake of program elements and process measures. Planned areas of analytic focus include workflow, cross-specialty coordination, and patient and primary care engagement and activation. We anticipate identifying specific barriers and facilitators of ALIGN-CARE implementation in our evaluation to aid the dissemination and upscaling of interprofessional co-management programs aimed to improve outcomes and quality of life for frail, older surgical patients.

Effects of an Alzheimer's and Dementia Care Co-management Program on Quality, Clinical Outcomes, and Utilization.

The quality of care provided to persons living with dementia (PLWD) and their care partners (CPs) is low, clinical outcomes are poor, and costs are high. Co-management of dementia care by Advance Practice Providers (APPs) has the potential to improve all of these metrics. The UCLA Alzheimer's and Dementia Care (ADC) Program is a health system-based co-management model of APP Specialists (DCSs) working with primary care and specialty physicians that is designed to meet dementia care needs. DCSs approach the PLWD and CP as a dyad, providing support, including community-based resources, to both; behavioral and medication management; and care coordination. The program has provided dementia care for over 3400 PLWD and has a current census of over 750 PLWD who are cared for by 4 nurse practitioner DCSs. Quality of care based on established dementia quality indicators assessed by medical record review was 92%. Based on an analysis of the first 1091 PLWD and their CPs, prior to entering our program, many caregivers were poorly informed about dementia caregiving and felt they were fighting this battle alone. One-third had high stress and more than 10 percent were depressed. By the end of a year in the program, confidence in handling problems and complications of Alzheimer's disease and dementia improved by 72 percent. CP strain (Modified Caregiver Strain Index), distress (Neuropsychological Inventory-Distress), and depression (PHQ-9) were reduced (all P<0.001). Moreover, the program reduced emergency department visits by 20%, days spent in the hospital by 26%, admissions to nursing homes for long-term care by 40%, (all P<0.05) and overall Medicare costs by $2404 per person/year. The ADC Program has been disseminated to 18 sites nationwide and more than 5000 PLWD and their CPs have received ADC care. Dementia co-management with APPs can improve quality and clinical outcomes and reduce health care utilization and costs. The ADC Program can be implemented in diverse health systems indicating the potential for widespread dissemination.

The role of protected areas co-management in enhancing resistance and resilience of deciduous forest ecosystem to extreme climatic events in Bangladesh

Due to ongoing and projected climate change as well as increasing anthropogenic disturbances, the tropical deciduous forest has been experiencing a decline in its biomass and productivity. To mitigate this adverse effect, many tropical countries have adopted forest co-management engaging local communities. However, the effects of co-management on the resistance and resilience of forest ecosystems to extreme climatic events have rarely been tested. The present study investigates the effects of co-management on resistance and resilience to extreme climatic events in two major tropical deciduous forest protected areas of Bangladesh, namely Madhupur National Park (MNP) and Bhawal National Park (BNP), through remotely sensed satellite data. We used the Google Earth Engine platform to access the Landsat images from 1990 to 2020 for a comprehensive assessment of the forest cover condition under two major management regimes (i.e., traditional and co-management). We find that co-management slows down the rate of forest destruction, where the rate of forest destruction was 108 ha year−1 in MNP and 121 ha year−1 in BNP during the year 1990–2008 under traditional forest management system. Under the co-management regime, forest cover increased by 19 ha year−1 and 41 ha year−1 from 2009 to 2020 respectively in MNP and BNP. Our study finds a highly significant correlation between rainfall (p < 0.001) and forest health, although co-management had poor impacts on forest resistance and resilience in case of extreme climatic events, such as drought and heavy rainfall. We find, no significant impacts of co-management on resistance and resilience to drought in MNP, and on resistance and resilience to heavy rainfall in MNP and BNP. In BNP, the impacts of co-management on resistance (p < 0.05) and resilience (p < 0.01) of forest to drought were highly significant. Forest co-management although have the potentials to reduce the deforestation rate by mitigating anthropogenic disturbances, its capacity to tackle the adverse impact of climate change was limited in our study. An adaptive co-management model, therefore, is crucial for mainstreaming the adverse effect of climate change on the tropical deciduous forest to harness the maximum potential of community participation in forest resources management.

Co-Management Reduces Mortality in Post-Sternotomy Mediastinitis.

Background: Post-sternotomy mediastinitis (PSM) is one of the most feared complications of cardiac surgery. The impact of a multidisciplinary management approach on this pathology is yet unknown. Patients and Methods: A multidisciplinary approach based on a co-management model (CMM) of care was initiated in January 2018 because of the incorporation of a hospitalist unit on a cardiac surgery department. An observational retrospective cohort study was designed to evaluate the impact of the CMM of care compared to the standard model (SM) of care in patients diagnosed with PSM. Our primary and secondary outcomes were survival time and treatment failure rate (two or more surgical procedures needed to solve PSM or PSM-related death), respectively. Data related to patient death date were collected from the Spanish National Death Index. A multivariable Cox regression model was created using those variables believed to be clinically relevant. Results: Ninety-one patients developed PSM from January 2010 to June 2020. Regarding the pre-operative clinical status, surgical procedure, and PSM severity, both groups had similar baseline characteristics. Patients were followed for a mean of 27.54 ± 30.5 months. A total of 60.3% of the SM group and 11.1% of the CMM group (p < 0.001) died. Treatment failure occurred in 53 patients (72.6%) in the SM group versus 7 (38.6%) in the CMM group (p = 0.007). The CMM independently reduced overall mortality (hazard ratio [HR], 0.11; 95% confidence interval [CI]. 0.01-0.83) and treatment failure rate (HR, 0.01; 95% CI, 0.001-0.183). Gram-positive bacterial infection (HR, 3.73; 95% CI, .6-8.3), and complete osteosynthesis material removal (HR, 0.47; 95% CI, 0.24-0.91) also influenced mortality in our model. Conclusions: A co-management care model reduced overall mortality in patients diagnosed with post-sternotomy mediastinitis.

Fisheries Resource Management of Lake Tempe Based on Co-Management in Wajo Regency, Southern Sulawesi

One of the most important sectors in Wajo Regency, South Sulawesi is the fisheries sector. This sector contributes to regional income, food security, and job creation. Lake Tempe has several problems such as conflicts between fishermen, unrestricted access to new technology, inadequate management of fisheries resources, uncontrolled fishing, and traditional community-based fisheries management. Co-management is carried out to organize activities in fisheries management. For this reason, it is necessary to strengthen institutions in managing the use of fishery resources and developing networks between fishing communities. This research was conducted using a structured questionnaire to identify and integrate the co-management model in Lake Tempe. There are relevant findings regarding this research, some of which are: (1) Goals, (2) Targets, and (3) Strategies, namely infrastructure strategy, banking services, coordination between authorities, organizational structure, cooperation, formation of cooperatives, training programs, and utilizing local wisdom. Natural resource management is a form of adaptive management, co-management, and change governance. Stakeholder involvement in improving conservation management and taking socio-economic aspects of the characteristics of the Tempe Lake area is an important element in efforts to design and implement co-management in fisheries resource management.

The Implementation of a Geriatrics Co-Management Model of Care Reduces Hospital Length of Stay.

(1) Background: Older adults comprise a large proportion of hospitalized patients. Many are frail and require complex care. Geriatrics has developed models of care specific to this inpatient population. Our objective was to demonstrate the effect of a geriatric co-management team on clinical administrative indicators of care in Clinical Teaching Units (CTUs) that have adopted the Age-friendly Hospital (AFH) principles in Brazilian hospitals. (2) Methods: Following 3 months of implementation of the AFH principles in CTUs, two periods of the same 6 months of two consecutive years were compared. (3) Results: The total number of participants in the study was 641 and 743 in 2015 and 2016, respectively. Average length of patient-stay (length of stay: 8.7 ± 2.7 vs. 5.4 ± 1.7 days) and number of monthly complaints (44.2 ± 6.5 vs. 13.5 ± 2.2) were significantly lower with the co-management model. Number of homecare service referrals/month was also significantly higher (2.5 ± 1 vs. 38.3 ± 6.3). The 30-day readmission rates and total hospital costs per patient remained unchanged. (4) Conclusion: The presence of a geriatric co-management team in CTUs is of added benefit to increase the efficiency of the AFH for vulnerable older inpatients with reduced LOS and increased referrals to homecare services without increasing hospital costs.

S1214 Effectiveness of a Co-Management Team in the Care of Cirrhosis Patients with Spontaneous Bacterial Peritonitis

Introduction: Spontaneous bacterial peritonitis (SBP) is a common complication of portal hypertension in cirrhosis patients, which may be associated with increased mortality. Recognition of this complication mandates inpatient admission and there remains variation in clinical practices. A co-management team in this population may reduce variability and improve overall outcomes. The aim of this study was to evaluate utilization of guideline-based management and outcomes with SBP management by a co-management vs. traditional (consultative) based model. Methods: A retrospective review of 41 patients admitted to the academic medicine service with cirrhosis and SBP from May 1, 2018, to November 17, 2019, was performed. Patients with the aforementioned diagnoses were then distributed to either the co-management team or the other four academic medicine teams. The co-management model consisted of a medicine attending, medicine residents, hepatologist, gastroenterology fellow, and hepatology nurse practitioner. There were formal daily rounds to discuss common patients. The other traditional academic teams interacted indirectly with the hepatology service in consultative form and without formal rounds. Results: A total of 41 patient met the inclusion criteria (28 patients in the co-management team). Under the co-management model, patients were more likely to be initiated on antibiotics within 6 hours of paracentesis (100% vs 76.9%, p = 0.008). Additionally, there was a trend towards improved outcomes based on the following: administration of Day 1 and Day 3 albumin and discharge on SBP antibiotic prophylaxis. Conclusion: Our results show that the co-management model is a promising one for the treatment of chronic liver disease patients. Given the complexity of this patient population and the higher mortality rates associated with portal hypertensive complications, such as SBP, this model may help decrease the variability in clinical practice and provide overall improved care.

Mangrove forest conservation vs shrimp production: Uncovering a sustainable co-management model and policy solution for mangrove greenbelt development in coastal Bangladesh.

Mangrove forests are remarkably diverse and productive ecosystems, with distinctive biophysical environments in intertidal coastal regions of the tropics and subtropics. In these regions, shrimp cultivation is identified as a profitable business and one of the main reasons for clearing of mangroves to construct shrimp farms. Against this backdrop and based on the first author's previous PhD research and other relevant scholarly works, in this commentary we discuss the aspects and contexts of the mangrove-based integrated shrimp farming system. Then, we recommend a model of co-management and a set of policy option towards sustainable silvo-aquaculture to protect/restore the mangrove forests and sustain shrimp production in coastal areas of Bangladesh. Mangroves and shrimp culture are not necessarily incompatible. Many mangrove species have been identified as beneficial for shrimp culture for a number of possible reasons. Most importantly, the nutrients in the leaf litter of several mangrove species have been found to enhance natural food production for shrimp. Besides the nutrient input, the leaf litter also provides surface area for biofilm development, on which different life stages of shrimp can graze. In addition, the combination of mangrove leaf litter and feed has been shown to enhance shrimp production synergistically. Additional economic benefits from mangrove-shrimp co-management include the production of timber (e.g. buildings, boats and fuel woods) and non-timber products (e.g. fruits, honey, fibers, firewood, resins and bark). Thus, mangrove-based aquaculture or silvo-aquaculture system can be considered as a nature-based solution to sustainably revitalize the economy in coastal areas where shrimp has been the economic mainstay. Though there are positive effects, we point out some potential negative impacts of mangrove-based shrimp culture, like the anti-nutrients content in the leaf litter, which might impact shrimp production. In addition, the long term use of mangrove leaf litter might degrade the water quality. Therefore, the co-management policy recommends a controlled practice of mangroves in shrimp culture to balance conservation of mangrove-based ecology and profitable shrimp production. The approach promotes nature-based solutions and fosters sustainable pathways for food production, considering socio-economic and environmental dynamics.

Ecological and Cultural Understanding as a Basis for Management of a Globally Significant Island Landscape

Islands provide the opportunity to explore management regimes and research issues related to the isolation, uniqueness, and integrity of ecological systems. K’gari (Fraser Island) is an Australian World Heritage property listed based on its outstanding natural value, specifically, the unique wilderness characteristics and the diversity of ecosystem types. Our goal was to draw on an understanding of the natural and cultural environment of K’gari as a foundation on which to build a management model that includes First Nations Peoples in future management and research. Our research involved an analysis of papers in the peer-reviewed scientific literature, original reports, letters, and other manuscripts now housed in the K’gari Fraser Island Research Archive. The objectives of the research were: (1) to review key historical events that form the cultural, social, and environmental narrative; (2) review the major natural features of the island and threats; (3) identify the gaps in research; (4) analyse the management and conservation challenges associated with tourism, biosecurity threats, vegetation management practices, and climate change and discuss whether the requirements for sustaining island ecological integrity can be met in the future; and (5) identify commonalities and general management principles that may apply globally to other island systems and other World Heritage sites listed on the basis of their unique natural and cultural features. We found that the characteristics that contribute to island uniqueness are also constraints for research funding and publication; however, they are important themes that warrant more investment. Our review suggests that K’gari is a contested space between tourist visitation and associated environmental impacts, with an island that has rich First Nations history, extraordinary ecological diversity, and breathtaking aesthetic beauty. This juxtaposition is reflected in disparate views of custodianship and use, and the management strategies are needed to achieve multiple objectives in an environmentally sustainable way whilst creating cultural equity in modern times. We offer a foundation on which to build a co-management model that includes First Nations Peoples in governance, management, research, and monitoring.

A framework of the institutional policies and practice environments of nurse practitioner primary care models: A cross-case analysis.

The purpose of this article was to compare the implementation of distinct models of nurse practitioner (NP) integration into primary care offices. A multiple case study design of three NP primary care practice models allowed for in-depth exploration of the management processes supporting the utilization of NPs. At each site, semistructured qualitative interviews, document review, and site tours/observations were conducted and subject to cross-case analysis guided by the NP Primary Care Organizational Framework (NP-PCOF)-developed for this study based on existing theory. Our case study sites represent three distinct NP primary care models. In the restricted practice model, NPs care for same-day/walk-in acute patients. NPs in the independent practice model have an independent panel of patients and interact collegially as independent coworkers. NPs in the comanagement model function on a team (a physician and two NPs), have a team office space, collectively care for a shared panel of patients, and can earn financial bonuses contingent upon meeting team quality metrics. Our cross-case analysis confirmed differences in physical space design, the relational structure of a workplace, and the capacity for innovation via NP compensation and performance metrics across different NP primary care models. Our findings suggest that NP primary care models are supported by complex management systems and the NP-PCOF is a tool to help understand this complexity. The NP-PCOF is a framework to understand the management systems that facilitate the utilization of NPs within primary care organizations.

Transforming an Orthopaedic Unit Into an "Age-Friendly" Unit Through Implementation of the American Geriatrics Society's CoCare: Ortho Program.

To transform an inpatient orthopaedic unit into an age-friendly unit for geriatric fracture center (GFC) patients. Pragmatic dissemination study of a continuous quality improvement intervention with episodic data review. Large quaternary care university hospital with no on-site geriatrics program and no dedicated geriatric inpatient unit. Individuals 60 years of age and older with fragility fracture of the native proximal femur hospitalized from July 2017 to June 2020. A hospital medicine-orthopaedics comanagement model for a GFC was developed using processes, tools, and education provided by the American Geriatrics Society's AGS CoCare: Ortho program to support the age-friendly 4Ms principles: mentation, mobility, medications, and what matters. Delirium reduction strategies included minimizing sleep interruption through changes in blood draw times, order sets for pain management, and nursing education. Mobility specialists were incorporated to improve early mobilization on the orthopaedic unit. Frequency of weight-bearing on postoperative day 1 and frequency of delirium among GFC patients on the orthopaedic unit were compared with those among concurrent GFC patients on other units. Frequency of delirium was 26% among patients on the orthopaedic unit versus 35% among those on other units (P = 0.055). Frequency of weight-bearing on post-operative day 1 was 84% among patients on the orthopaedic unit versus 72% among those on other units (P = 0.003). AGS CoCare: Ortho is an effective dissemination program for establishing a hospital medicine-orthopaedics comanagement program and making an orthopaedic unit age-friendly in a hospital without onsite geriatricians or a dedicated geriatrics unit. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Orthogeriatric Multidisciplinary Co-Management Across Acute and Rehabilitation Care Improves Length of Stay, Functional Outcomes and Complications in Geriatric Hip Fracture Patients.

IntroductionAs the global number of geriatric hip fracture cases continues to proliferate, a newly developed orthogeriatric co-management multidisciplinary care model has been implemented since November 2018 to meet further increases in demand. Our objective was to evaluate the effectiveness of the new pathway in improving the clinical outcomes of fragility hip fractures.MethodsThe data of geriatric hip fracture patients from 1 April 2018 till 30 October 2018 was collected as the conventional orthopaedic care model (pre-orthogeriatric care model) to compare with data from the orthogeriatric co-management model, 1 Feb 2019 till 31 August 2019. Clinical outcomes were analyzed between the groups, with the efficiency of the programme reflected in the total length of stay in acute and convalescent hospitals.Results194 patients were recruited to the conventional group and 207 were recruited to the orthogeriatric group, 290 patients (72.3%) were female. The mean (SD) patient age was 84.2 (7.9) years. The median length of stay in the acute and rehabilitation hospitals decreased by 1 day and 2 days, respectively (P=.001). The orthogeriatric group was associated with a higher Modified Barthel Index score on discharge from the rehabilitation hospital and more patients in the orthogeriatric collaboration group received osteoporosis medication prescription within one year after the index fracture. There was no difference in the 28-days unplanned readmission rate, complication rate, mortality rate or Elderly Mobility Scale scores on discharge from the rehabilitation hospital between the two groups.ConclusionOrthogeriatric collaboration has been proven to be effective in terms of a decreased length of stay in both the acute and the rehabilitation hospitals.