Concentration Of Expertise Research Articles

Regional Strategic Planning of Care in Flanders based on population needs

Introduction: In 2014, Flanders started a process of re-designing the hospital care. This has led let to the recognition of 13 networks of hospitals in 2020. 
 Simultaneous we developed a framework for a Regional Strategic Care Plan (RSCP). The RSCP starts from demographic data and health indicators to determine future needs to which the future supply of the network must be tailored. The networks are asked to make such a RSCP for their network.
 Target: The increase in ageing, multimorbidity, complex disorders, chronic care,… require a new relationship between hospitals and between hospitals and other healthcare providers. With the RSPC we want to match the hospital care to the needs of the population, in consultation with other healthcare providers. More attention will go to task differentiation and new partnerships.
 The main principle has to be that basic care is organised close to the people, whereas more specialised care recruits from a wider environment. All healthcare providers will have to change from a supply-driven organisation of care towards person-centred care based on needs.
 Design: Studies on future population needs, on an optimal spread of the care offer and to create a framework for RSPC, based on future needs, actual demografic figures, …., were executed by a consortium of Deloitte and the Leuven Institute for Healthcare Policy.
 A computermodel was developed to visualise patient flows and to determine logical cooperation.
 The main goal of RSPC:
 
 Stimulate person-centred care
 Stimulate cooperation and networking between hospitals and with other healthcare providers
 Concentration of expertise and restricting the high-tech care supply
 Expenditure should match the current financial context and achieve a health-economic justifiable offer.
 
 Execution: At the moment the hospital networks are developing their RSPC based on the models that are provided to them. This is an intensive process in which the result must also be coordinated with other partners in the region. The RSPC will be evaluated by a committee consisting of representatives of hospitals, primary care and academics.
 Results: Based on the first plans sumitted, we see that the hospital networks will tailor their offer to the needs of the population and that they consult with other care partners in the region. It encourages hospitals to think about their future role and how it is fulfilled. The doctors are also involved to develop a long-term vision.
 On average, acute beds will be reduced by about 7%.
 Lessons learned: It is important to provide hospitals with a framework on which to base themselves to tailor their future offerings to the needs of the population and to encourage them to think about this.
 The division of powers between the federal government and the regions makes it difficult for hospitals to make choices.
 Next steps: Evaluate the current framework to see if improvements can be made and the model can be updated. Certainly in terms of the involvement of other care partners, additional incentives must be given.

A Ten-Year Review of the Management of Medical Patients in the Intensive Care Unit in a Resource-Poor Setting in Southern Nigeria

Purpose: The Intensive Care Unit (ICU) is a specialist ward within a hospital, with a concentration of expertise and resources for the management of critically ill patients. Some clinicians think of the ICU only in relation to surgical practice, maybe because many intensivists are anaesthesiologists and anaesthesia is closely linked to surgery. However, this notion may not be entirely true. This study aims to highlight the importance of the ICU to patients with medical challenges.
 Methodology: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. All patients who were admitted into the ICU with medical diagnosis were included in this study. The information gotten includes history, age, sex, diagnosis, length of admission, and outcome. The data collected was analyzed and presented in tables and charts.
 Findings: The mean age was 51.41±20.12. The highest age was 95 years. The mean bill paid was 80,718.55 Naira and the largest bill paid was 605,500 Naira while the least bill paid was 2000. The mean duration of stay was 6.59 days and ranged from a day to 120 days. The males were 268 (51.8%) while the females were 249(48.2%). Two hundred and sixty-five patients (51.3%) died during the study period. Patients who were transferred out of the ICU spent the highest amount of money and spent the most time (10.19 days) in the ICU. The patient who died spent the least amount of time (4.56 days) in the ICU. A hundred and two patients were discharged from the ICU. Transferring them to a high dependency unit or ward will save cost. As the age increased, the comorbidities also increased with 309 out of 517 having comorbidities. Exacerbation of comorbidity led to admission in the ICU.
 Recommendation: Medical patients admitted into the ICU tend to have a higher mean age and have a higher mortality rate. Older patients tend to have more comorbidity. Proper and effective management of the ICU will save cost. Proper management of comorbidities in older patients can lead to an improvement in health. Patients who are fit, could be transferred to other wards and discharged from there, this will free up beds in the ICU, increase effective use of the ICU and save cost.

Measurability of the mathematics teaching modules on problem solving-skills in the concentration of agribusiness expertise in plantation

Preliminary research involving 30 mathematics teachers at the MGMP VHS of Ketapang district and interviews with business world and plantation industry representatives suggested that 81.7% of respondents voiced concerns over the current mathematics teaching materials, which do not adequately equip students with problem-solving skills in line with their expertise concentration. This issue reflects on the quality of VHS graduates who are expected to be job-ready and skilled. The objective of this study is to develop a measurable teaching module, conceptually and methodologically, that yields quantifiable results in alignment with the concentration of expertise and the requirements of the business and industry world. The research method adopted is a mixed method with a sequential explanatory design through the Van den Akker development study. A quantitative analysis of 20 respondents, comprising mathematics and productive teachers at a center of excellence vocational school, lecturers of Tanjung Pura STKIP, Ketapang State Polytechnic, and a team from the business and industry world in the plantation sector, resulted in a Pearson correlation of Ryx1x2x3=0.949, a determination coefficient [r2] of 0.900, and an F-calculation of 48.06 for the regression equation Y ̂ = 0.566 + 0.444 X1 + 0.278 X2 + 0.135 X3. From these results, it is concluded that the concepts, methods, and outcomes utilized in this teaching module are appropriate. The relationship between concepts, methods, and outcomes in teaching modules on skills to solve mathematical problems is unidirectional. Expert validity on aspects of module content, presentation feasibility, language appropriateness, and problem-solving skills amounted to 96.88% in the Very Valid category. Practicality from the aspects of interest, material, and language places the category at 92.02, which is very practical

Exploring the Role of Positive Leadership for Mobilizing Innovative Practices: A Social Network Approach

An emerging body of literature suggests the importance of positive leadership for school and district improvement (e.g., Cherkowski, 2018; Louis & Murphy, 2018). A number of lines of evidence have converged upon how positive leadership principles can influence behavioral outcomes (e.g., collaboration among school staff), attitudinal outcomes (e.g., job satisfaction), leader-related outcomes (e.g., trust for leadership), and performance outcomes (e.g., collective efficacy), as well as a wide variety of moderating and mediating variables for these outcomes (Murphy & Louis, 2018). At present, there is little evidence about the role of positive leadership in relation to the mobilization of innovative teaching and learning practices, particularly practices that advance well-being and positive mental health for students and teachers. This article reports on a study that examined the associations between school staff perceptions of positive school leadership, their behaviors related to innovative practices, and their connections to other staff within a multi-school network. The question guiding our work was, "How do school staff perceptions of positive leadership alongside information about their school roles and social connections influence the potential for mobilizing innovative practices?" A cross-sectional survey methodolog y combining traditional and social network data collection methods (Carolan, 2014; Groves et al., 2009) was employed to generate an understanding of the interconnectedness of relational patterns within schools, perceptions of positive leadership, and individual efforts toward innovation. The case for this study was a federation comprising three infant schools in Hampshire, England. In total, 31 teaching staff completed the survey: a response rate of 84%. Our analysis suggests that well-being and positive mental health leadership roles are important not only for mobilizing advice about teaching practices and classroom management, but also in galvanizing the expressive social networks that promote self-governance in school staff. Furthermore, expert uses of innovative practices related to well-being appear to be concentrated on the staff holding well-being leadership positions. Although it is intuitively beneficial to have this concentration of expertise in individuals explicitly charged to promote and support well-being, comparisons between the instrumental and expressive networks suggest that some school staff were not strongly influenced by these leaders. We view this finding as reflecting the importance of paying attention to how practices are mobilized throughout school networks. Against the backdrop of positive leadership, mobilizing practices requires that leaders have an authentic understanding of their staff, an attentiveness to their needs, and an ability to attune their behaviors to those needs.

The Limits of Transparency: Expert Knowledge and Meaningful Accountability in Central Banking

AbstractRecent discussions of accountability in contexts of expert knowledge raise questions about the limits of transparency. Against this background, we discuss the nexus between expert knowledge and meaningful accountability – that is, context-sensitive accountability based on a genuine understanding of a situation. We argue that the concentration of expertise in certain institutions makes it difficult to hold those institutions accountable. In particular, three components challenge meaningful accountability: specialization, inaccessibility and potential biases or conflict of interest. We emphasize the role of ‘epistemic communities’ and their impact on the tension between expert knowledge and independence. Drawing on the deliberative systems literature, we discuss how expert knowledge might be communicated to outsiders to enable meaningful accountability. To illustrate our argument, we draw on the European Central Bank, a case study in which states have chosen a delegation design characterized by a high degree of independence and trust in expert knowledge, to the detriment of accountability. We sketch possible avenues for creating the conditions for meaningful accountability even in the case of institutions with highly concentrated expertise.

Advanced Trauma Life Support training. How useful it is?

For more than 20 years, following the changes that took place in Albania in 1992, we receive information from trauma patients in the media about the delivery of trauma services. Police records are worthy of a war balance report. Trauma is estimated to be the cause of deaths in 13.7% / 100,000 people. Every two days three Albanian Citizens die because of Automobile Accidents…
 Changes have already taken place, but the question arises, who cares about the trauma and its management?
 Formerly and now the state ... ok ... but? Is this enough?
 The Ministry of Health should have a “Trauma Committee” if yes… is it active?
 Already of the three years at the heart of these medical emergency management networks is a National Center of Medical Emergency (NCME).
 The trauma service delivery is now evolving along the lines of a central and spoken model with a concentration of expertise and specialization in the center surrounded by smaller units that feed on the center.
 The study showed a 19% increase in the chances of survival since the introduction of these changes. Another 1,600 trauma victims are alive today due to developments in the administration of trauma patients in England over the past six years.
 In this system or mode of organizing what is today the NCME or organizing the transport of traumatized from the scene to the University Hospital of Trauma... by medical staff who have done a substantial part of the PhTLS® course ... How is the educational status of personal in other regions far from Capital? ATLS® student courses in our country have been implemented by few and individually… ASTES, by default rules, has acquired the right to organize ATLS® in Albania…

ATLS® Course Albania Brunch Step by Step

For more than 20 years, following the changes that took place in Albania in 1992, we receive information from trauma patients in the media about the delivery of trauma services. Police records are worthy of a war balance report. Trauma is estimated to be the cause of deaths in 13.7% / 100,000 people. Every two days three Albanian Citizens die because of Automobile Accidents… Changes have already taken place, but the question arises, who cares about the trauma and its management? Formerly and now the state ... ok ... but? Is this enough? The Ministry of Health should have a“Trauma Committee” if yes… is it active? Already of the three years at the heart of these medical emergency management networks is a National Center of Medical Emergency (NCME). The trauma service delivery is now evolving along the lines of a central and spoken model with a concentration of expertise and specialization in the center surrounded by smaller units that feed on the center. The study showed a 19% increase in the chances of survival since the introduction of these changes. Another 1,600 trauma victims are alive today due to developments in the administration of trauma patients in England over the past six years. In this system or mode of organizing what is today the NCME or organizing the transport of traumatized from the scene to theUniversity Hospital of Trauma... by medical staff who have done a substantial part of the PhTLS® course ... How is the educational status of personal in other regions far from Capital? ATLS® student courses in our country have been implemented by few and individually… ASTES, by default rules, has acquired the right to organize ATLS® in Albania…

Parliamentary committees in seventeenth-century Ireland: a brief introduction

ABSTRACT Parliament in early modern Ireland grew in both the size of its membership and its workload, and so as the flow of business put before parliament in the early modern period increased, the parliamentary committee became a more frequent part of the institution. Committees, and the parliamentary conferences conducted by them, were used as a way of dispatching business in an increasingly efficient, targeted, and concentrated manner. The committee allowed for freer debate, concentration of expertise, and timely completion of work. Studying them is useful for our understanding of the development of the institution, but also too for observing the involvement and work-rate of individual parliamentarians, and perhaps political activity too.

Type A Aortic Dissection in the United Kingdom: The Untold Facts

There is a lack of evidence on multiple levels for appropriate recognition, management, and outcome results in Type A aortic dissection management in the United Kingdom. A huge amount of retrospective data exists in the literature which provides nonmeaningful prospect to a service that meets the current era. Electronic searches were performed on PubMed and Cochrane databases with no limits placed on dates. Search terms were charted to MeSH terms and combined using Boolean operations, and also used as key words. Papers were selected on the basis of title and abstract. The reference lists of selected papers were reviewed to identify any relevant papers that might be suitable for inclusion in the study. Papers were selected based on providing primary end points of death, rupture, or dissection and/or information regarding aortic aneurysm growth. Papers were not excluded based on patient population age. We demonstrated the lack of evidence for quality outcomes in type A aortic dissection in the United Kingdom. This highlighted the unwarranted variation seen in this entity and the caveats needed to improve structuring of type A aortic dissection from early identification in emergency departments to arrival at destination site for optimum intervention. Emergency services should be restructured to meet the immediate affirmation of diagnosis with gold standard imaging modality available. Management of this dire disease should be instituted at local hospitals prior to transportation and results should be audited regularly to improve quality outcomes. Attempts should be made to create local area networks to improve the efficiencies and outcomes of the service and transfer to centers with concentration of expertise. Recognition of regional networks by the UK Government Care Quality Commission should in part based on cumulative evidence sought after from virtual multidisciplinary teams. Unwarranted variation is an avenue that requires to be addressed to rise with service provision that meets our patients aspiration and be of current evidence in the 21st era.

Improving Multi-Agency Governance Arrangements Forpreparedness, Planning and Response: Implementing Theintegrated Approach in Australia

Systems of public sector governance are adjusting to the requirements of Digital Age resilience and response. The traditional hierarchical structure of the public sector, in Australia and elsewhere, was optimised for the circumstances of the Industrial Age and for a professional public service model that relied on the concentration of expertise in distinct departments of state. Contemporary pressures for multi-hazard risk-reduction, resilience and crisis response require government, civil society and private sector organisations to coordinate their efforts more effectively. Within the public sector, civilian, military and police officers and officials must develop systems to build national preparedness, share information and work across boundaries for both domestic and offshore contingencies. This paper considers how the lessons of recent offshore operations are shaping the effort to introduce the concept of the Integrated Approach in Australia.

The view from Hong Kong anthropology

Hong Kong has an autonomous anthropology with close ties to Anglo-American traditions. The city has seen anthropology grow since the 1980s, partly as a result of the overall growth in tertiary education, but also because of Hong Kong’s shift from manufacturing to a global city focused on financial services. Its unusual history and autonomous institutions make it a separate example of anthropology in Asia. Teaching and research have focused on Chinese cultures, but increasingly include other parts of Asia. Hong Kong has served as a node in the anthropology of East Asia. Many features of anthropology in Hong Kong are driven by the neoliberal administrative system known as audit culture. Hong Kong’s concentration of expertise on Chinese cultures may increasingly attract students for specialized studies if it can maintain its academic openness and freedom, features that have made it a global city.

Managing Risk in a Cloud Ecosystem

Economies of scale, cutting-edge technology advancements, and higher concentration of expertise enable cloud providers to offer state-of-the-art cloud ecosystems that are resilient, self-regenerating, and secure--far more secure than the environments of consumers who manage their own systems. This has the potential to greatly benefit many organizations. The key to successful implementation of a cloud-based information system is a level of transparency into the cloud provider's service. This article focuses on security risks related to the operation and use of cloud-based information systems.

The early management of patients with multiple injuries

There have been many advances in the resuscitation and early management of patients with severe injuries during the last decade. These have come about as a result of the reorganisation of civilian trauma services in countries such as Germany, Australia and the United States, where the development of trauma systems has allowed a concentration of expertise and research. The continuing conflicts in the Middle East have also generated a significant increase in expertise in the management of severe injuries, and soldiers now survive injuries that would have been fatal in previous wars. This military experience is being translated into civilian practice. The aim of this paper is to give orthopaedic surgeons a practical, evidence-based guide to the current management of patients with severe, multiple injuries. It must be emphasised that this depends upon the expertise, experience and facilities available within the local health-care system, and that the proposed guidelines will inevitably have to be adapted to suit the local resources.

The Fund Management Industry in Hong Kong and Asia-Pacific

Hong Kong has the largest number of fund managers, one of the largest fund management industries in Asia-Pacific, and the largest exchange-traded funds (ETFs) market by trading value in East Asia. Nevertheless this sector in common with some others examined in this study, reveals the huge impact the Chinese mainland has had on Hong Kong in terms of activity created and concurrently a relatively modest development of its international position. Some of the main themes to be developed in what follows turn on the following summary observations:Unlike the two other major regions of the world economy, there is no cooperation infrastructure nor even comparable statistics for the fund management industry in Asia-Pacific. Unlike the United States and Europe that have a national or regional industry association to advocate regulation and policy recommendations to the industry, there is no such kind of regional cooperation in Asia. In turn, is a dire lack of comparable statistics in this area across economies in the region not only impedes research but more importantly hinders the development of initiatives, strategies and policies for the region.Internationalism and diversifications. Hong Kong’s and Singapore’s industry survey reports show that the combined fund management industry is larger in Hong Kong, but (as of 2008) it appears to be more internationalized and diversified in Singapore. However, things have gradually changed. Since 2009 large banks and fund houses have started to expand their teams in Hong Kong and/or relocate senior executives to the city. While this relative but notable reconfiguration in the last year or two appears to result from the impact of the China factor, given the sector’s relative preference for greater concentration of expertise the result is also an improved the level of regional importance and internationalism for the Hong Kong fund management industry.The China factor. The enormous and underdeveloped Chinese market is without doubt one of the biggest opportunities for the Hong Kong fund management industry. China’s capital market is still subject to exchange and capital controls and its fund management industry is short of seasoned fund managers. Hong Kong, an open economy with good financial infrastructure and many experienced fund managers, is in pole position to capture the opportunity to service the Chinese market, particularly its new middle-class and expanding wealthy population. Further, it will be beneficial for Hong Kong to deepen its private investors market. In addition to be the gateway for Chinese funds to invest abroad, Hong Kong should also be the gateway for foreign companies that are interested in the Chinese market. An onshore fund management industry. Following the global financial crisis, there is greater appetite in the region and globally for the use of onshore regulated vehicles, which provide greater investor protection and ability to assess and manage risk. In this connection recent changes in European Union directives on investment funds may have a big impact on the Asian fund management industry, which relies heavily on the European market; indeed the offer of funds originating and sold in Asia but registered and marketed from Europe has expanded notably in the recent past. These developments, alongside the concurrent strengthening of Hong Kong’s fund management industry in the same period noted above, strongly suggest a good opportunity for Hong Kong to develop an onshore fund management industry and to seek to become the centre of Asia domiciled funds. However, there is limited information how local authorities want to pursue these goals.

Primary Hyperoxaluria Type 1: Gene Therapy by Liver Transplantation

Primary Hyperoxaluria Type 1: Gene Therapy by Liver Transplantation

Measuring the performance of an inter-hospital transport service

Most district general hospital (DGH) paediatricians will have referred critically ill children to a retrieval team at some point in their career. Inter-hospital transport services have developed in response to...

Requirements for a Reference or Expert Thalassemia Center: The Structure/model for Centers Dealing with Chronic/hereditary Blood Disorders

Chronic disorders, such as the hemoglobin disorders, have a multi-organ involvement and are subject to complications, requiring multidisciplinary care. Most convenient for the patient is the concentration of expertise under one roof and where routine care, such as blood transfusions, can be provided away from acutely ill patients with episodic infections and other conditions. These specialized centers already exist but as yet the standards, which should designate a center as an expert center or a reference center, have not yet been specified or applied. This article examines standards that have been described by two separate authorities in the United States and Europe and suggests the application of these standards to existing or proposed hemoglobinopathy centers.

Ernest Sibree: a forgotten pioneer and his milieu

An account of what is known of the life and career of Ernest Sibree, who taught Ancient Egyptian at University College Bristol and Bristol University between 1896 and 1927, a period during which a remarkable concentration of expertise in oriental languages was to be found at that then-fledgling institution.

The Role of Information Technology in Building and Sustaining the Relational Base of Communities

The popularity of the concept of communities is growing and so are ideas on how to support these communities with technologies. We can find this particularly in the field of management and organization studies, in which communities are more and more seen as a solution for rigid, hierarchical and conservative bureaucratic structures. In fact, communties can be seen as the latest wave in an ongoing evolution of organizational structures (Wenger, 2000, Lesser, 2000). In the age-old traditional functional organization, concentration of expertise was (and still is) under hierarchical control. In the decades after World War II, and in specific during the seventies, the multi-divisional organization was seen as the answer to the ever-expanding functional organization. Business units were introduced as an organizational structure alternative to the functional division. A decade later, project-based organization entered the organizational landscape. Project teams were designed in order to be closer to the market. Since the mid-nineties, knowledge based organizations have overshadowed the project-based organization, at least that is what popular business press tells us. Communities instead of teams are the dominant structure of the organization, also coined as communities of communities (Brown and Duguid, 1991). Communities differ notably from conventional units of organization, such as teams or work groups. Group theory in general (Hackman, 1990) perceives groups in an organization, as

Early and mid-term outcomes of surgery of the ascending aorta/arch: is there a relationship with caseload?

The relationship between caseload and early outcome remains a subject for debate in cardiac surgery. Surgery of the thoracic aorta is an area of specialist expertise within the adult cardiac surgical field. There is, however, a conflict between the concentration of expertise and the provision of effective emergency cover. This study evaluates the early and mid-term outcomes of patients undergoing surgery of the ascending aorta/aortic arch in a single institution and compares the results of a single higher volume surgeon with lower volume operators. From March 1992 till August 2003, 296 procedures were carried out on 291 patients (aged 17-80, median 62) who underwent operations for replacement of the ascending aorta/aortic arch. One hundred and thirty procedures were carried out by the higher volume surgeon and 160 by one of the six lower volume surgeons (range 10-57). Emergency operation was performed in 138 (47%) patients. One or more other associated cardiac procedures were carried out in 65 patients (22%). The overall early mortality was 37 (12.5%). After adjustment for baseline differences, era and surgical risk/complexity, the risk of in-hospital death was lower in the higher volume group, but not significantly so. For survival to 3 years the overall risk of death was significantly lower for patients in the higher volume group (hazard ratio 0.72; 95% CI 0.54-0.95) Apart from post-operative renal failure no other significant differences between the two groups were observed. Elective surgery of the ascending aorta/arch was associated with low mortality. Outcomes after emergency surgery conformed to contemporary expectations. Only limited differences were identified both with respect to the case profile and early clinical outcomes. Better outcomes in the mid-term in the higher volume group persisted despite adjustment for differences in caseload and are worthy of further study. We believe that these data support our hypothesis that dissemination of appropriate techniques among a group of surgeons represents the most practical method of service provision.