The purpose of this study was to identify any barriers or enablers as influences on wound care self-management by Indigenous people. A qualitative, interpretive study sought to investigate how participants perceived their wounds and their general health, and to identify the influences on them accessing wound care services. There is a dearth of information on culturally appropriate practice in wound management for Indigenous Australians. This research project was therefore significant in attempting to bridge the gap in nursing knowledge of Indigenous clients' perceptions of barriers and enablers for seeking wound care services,especially in relation to lower leg ulcers. The lack of culturally sensitive wound management practices potentially impacts on Indigenous clients' behaviours in seeking treatment from their health service providers. Participant observations and semi-structured interviews with the research participants investigated the management of their wounds, and the ways in which their culture influences wound management. The main aim was to understand participants' comprehension of the importance of wound care through reflection. Understanding the enhancing or obstructive influences on wound management practices was expected to provide a foundation for teaching self care of wounds in Indigenous populations and inform health professionals' approach to health education. The data were analysed using thematic analysis, which generated common themes related to the research questions. These themes are: visibility, of the problem,4 perceived versus actual level of knowledge, acceptance of co-morbid health conditions and pre-determined path of ill health. These findings indicated that in one region, participants' perception of poor health was related to visibility of the problem. Participants chose to have their visible wounds managed by Silver Chain Nursing Association, whereas Diabetes and Hypertension and any other non-visible disorders were seen as appropriate to the Aboriginal Medical Service (AMS). Further to this finding, most participants displayed a sense of helplessness and hopelessness when sharing information about their diagnosis of diabetes, believing this was the norm. Many also believed that having a strong family history of a particular disease resulted in the participants also inheriting the disease. During post interview educational sessions many of the Indigenous participants were surprised by the evidence based-research reported to them by the researcher that diabetes is a manageable disease with life style changes. Another issue highlighted was the perceived level of knowledge the participants had about wound care. Reassurance was given by the participants that their level of knowledge about how to manage their wounds was adequate. However, none of the participants were concerned about the length of time that their wound/s had or were being managed, between 3 months and 5 years. This acceptance that although a wound is not getting any worse and not getting any better was the norm is cause for concern, and indicates a low level of health literacy. This theme was 'perceiving an imbalance in perceptions of wound care knowledge with actual knowledge'. The most important recommendation from the study findings is the need to consider health literacy more carefully in the development of health promotion and health education for Indigenous clients with wounds.

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

Since 1995, a thrombolytic therapy, rt-PA, has been approved for use with acute stroke that significantly reduces, and sometimes reverses, neurological damage. Treatment has to be given within a few hours of the start of symptoms and can only commence once a CT-scan has confirmed a particular type of stroke. In the evidence-based medicine and knowledge translation literature, variations in practice are constituted as a problem to be solved. It is assumed that a physician decides whether or not to use this therapy based on his/her evaluation of the scientific evidence. In this thesis, I demonstrate that what are less evident in many of these claims are issues related to the social production of knowledge. Little attention is paid to who conducts research, who promotes its findings, and who is expected to implement them. The positivist discourse of evidence-based medicine assumes that research produces knowledge that is neutral and can be translated into treatment that is in the patient’s best interest. Yet these assumptions remain empirically unexamined, despite social science critiques of these processes. Institutional Ethnography is an approach in sociology developed by Dorothy Smith. Based on Smith’s understanding of the social organization of knowledge, it allows for an examination of the complex social relations organizing people’s experiences of their everyday working lives. Beginning in the experiences of physicians who provide acute stroke services, this dissertation explores an example of how best practice medicine is developed, translated, and taken up in practice across various sites in the province of Ontario. For Smith, texts mediate and organize people’s experiences. In my study, the discourses of both evidence-based medicine and knowledge translation, designed to improve patient care, come into view as managerial tools designed to control the delivery of care. I render visible how in fact things work as they do in real life settings in a way that links back actual people to the texts, or discourse, organizing their experiences. In so doing, I am able to uncover some of the assumptions and hidden priorities underlying the current emphasis on translating scientific knowledge in medicine into practice.

Course: Business Administration, Master Thesis, Second Level, 30 Credits. Authors: Sara Frännlid and Helena Ramstedt Tutor: Jim Andersén Title: Internet, relationships and loyalty – Best praCtice foR the bankMarket Purpose: The study aims to explain how banks use electronic customer relationship management, eCRM, to create loyal customers. A figure will be created, which will enlighten the factors a bank should focus on when enhancing customer loyalty through the internet. Through interviews with two successful banks is it possible to study how a bank can successfully create loyal customers. Methodology: A qualitative method in terms of semi-structured interviews is used. The empirical results were then analyzed with the theory in order to contribute with a new figure. Theoretical perspective: The theory describes how a bank can create a loyal customer over the Internet. The theory has its output in customer relationship management and how these strategies can be applied to the Internet. Empirical foundation: A study has been made of how two successful banks create loyal customers over the Internet, previous studies in this subject is also used. Conclusion: The primary contribution of this study is a figure, the figure shows which factors are important when a bank wants to create loyal customers over the internet. These factors are: technology, commitment and communication. The bank needs to be imbued with good service to obtain customer loyalty and trust. New in this context is that the study has demonstrated the vital role technology plays on the internet. Keywords: eCRM, loyalty, e-banking, relationship, trust, satisfied customer, Sweden, best practice.

The project was aimed at describing the mixing phenomena relevant for both safety analysis, particularly in steam line break and boron dilution scenarios, and mixing phenomena of interest for economical operation and the structural integrity. Measurement data from a set of mixing experiments, gained by using advanced measurement techniques with enhanced resolution in time and space help to improve the basic understanding of turbulent mixing and to provide data for Computational Fluid Dynamics (CFD) code validation. Slug mixing tests simulating the start-up of the first main circulation pump are performed with two 1:5 scaled facilities: The Rossendorf coolant mixing model ROCOM and the VATTENFALL test facility, modelling a German Konvoi type and a Westinghouse type three-loop PWR, respectively. Additional data on slug mixing in a VVER-1000 type reactor gained at a 1:5 scaled metal mock-up at EDO Gidropress are provided. Experimental results on mixing of fluids with density differences obtained at ROCOM and the FORTUM PTS test facility are made available. Concerning mixing phenomena of interest for operational issues and thermal fatigue, flow distribution data available from commissioning tests (Sizewell-B for PWRs, Loviisa and Paks for VVERs) are used together with the data from the ROCOM facility as a basis for the flow distribution studies. The test matrix on flow distribution and steady state mixing performed at ROCOM comprises experiments with various combinations of running pumps and various mass flow rates in the working loops. Computational fluid dynamics calculations are accomplished for selected experiments with two different CFD codes (CFX-5, FLUENT). Best practice guidelines (BPG) are applied in all CFD work when choosing computational grid, time step, turbulence models, modelling of internal geometry, boundary conditions, numerical schemes and convergence criteria. The BPG contain a set of systematic procedures for quantifying and reducing numerical errors. The knowledge of these numerical errors is a prerequisite for the proper judgement of model errors. The strategy of code validation based on the BPG and a matrix of CFD code validation calculations have been elaborated. Besides of the benchmark cases, additional experiments were calculated by new partners and observers, joining the project later. Based on the "best practice solutions", conclusions on the applicability of CFD for turbulent mixing problems in PWR were drawn and recommendations on CFD modelling were given. The high importance of proper grid generation was outlined. In general, second order discretization schemes should be used to minimise numerical diffusion. First order schemes can provide physically wrong results. With optimised "production meshes" reasonable results were obtained, but due to the complex geometry of the flow domains, no fully grid independent solutions were achieved. Therefore, with respect to turbulence models, no final conclusions can be given. However, first order turbulence models like K-e or SST K-w are suitable for momentum driven slug mixing. For buoyancy driven mixing (PTS scenarios), Reynolds stress models provide better results.

The aim of this study is to determine the extent to which Quality Management Practices has been effectively adopted and implemented by Pakistani manufacturing companies and to identify best practices for adoption by the companies. The study employed primary and secondary data sources to determine the relationship between QM and Productivity. The study used quantitative methodology for data collection and analysis. The survey responses were categorised into foreign owned companies (FOC's) and local owned companies (LOC's). The outcome of the descriptive and statistical analysis of the survey responses and secondary data of the companies found that, although most of the companies were aware of the significance of the QM practices and Productivity, FOC's were found to have performed highly better in the adoption and implementation of QM practices in their companies compared to locally owned companies. The study also revealed that there is positive relationship between quality and productivity of the manufacturing companies. The evidence deduced from the study shows that foreign owned companies have performed better compared to local owned companies in terms of quality and productivity. Furthermore, the evidence from this study also points out that, automobile sector of Pakistan performed well in the adoption and implementation of QM practices. Strong positive link between quality and productivity was found in the case of automobile companies. This study therefore recommends for manufacturing companies in Pakistan to effectively adopt and implement Quality management practices that encapsulate the study's framework for adoption of QM practices (see figure 7.1).

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

Das deutsche Bildungssystem ist noch weit davon entfernt, Inklusion im Schulalltag und im Schulunterricht flächendeckend umzusetzen. Dies ist jedoch eine Verpflichtung, die Deutschland mit dem Beitritt zur Behindertenrechtskonvention eingegangen ist. Die Realisierung einer inklusiven Schulentwicklung gestaltet sich schwierig, da die in der Inklusion erfolgreichen Schulen es einerseits nicht schaffen, den notwendigen Bedarf aufzufangen und es andererseits auch nur in bedingtem Maße gelingt, ihr Wissen und ihre Praxiserfahrungen über Inklusion weiterzugeben. Zugleich zeigt sich im Schulalltag die Notwendigkeit eines Abbaus von Barrieren sowie einer Verbesserung der Lernsituation. Debatten über die Anerkennung der heterogenen Rahmenbedingungen und damit über die Umsetzung eines inklusionspädagogischen Ansatzes dürfen nicht nur theoretisch geführt werden. In dem Beitrag werden daher konkrete Möglichkeiten für den Fremdsprachenunterricht und Gute-Praxis-Beispiele aufgezeigt. Auch wenn ohne Frage umfangreichere finanzielle Mittel für eine Inklusionsumsetzung Voraussetzung wären, wird dabei sichtbar, dass adäquates Handeln und ein entsprechender Wille aus Verwaltung-, Schulleiter-, Lehrer- und Schülerperspektive schon vieles bewegen kann. Es wird aufgezeigt, welche Probleme und Herausforderungen sich in einer inklusiven Praxis ergeben können. / Inclusive education in foreign language teaching: Implementation and examples of best practice The German education system is still far from implementing the concept of inclusive education in its schools and classrooms. However, this is a commitment Germany made when signing the CRPD. The implementation is rather difficult because on the one hand successful schools that exist already all over Germany are not able to serve the needs, and on the other hand, they have only limited resources to pass on their knowledge and practical experience of an inclusive approach. It is important to reduce barriers in everyday school practice and improve the learning situation now. Debates on the recognition of a heterogeneous learning group and thus on the implementation of an inclusive pedagogical approach must not only take place hypothetically. In this paper, therefore, will be presented specific ways as well as best practices of teaching foreign languages in an inclusive education system. Although greater financial resources for implementing inclusive education in schools are necessary, an adequate attitude of the administration, the school headmaster, the teachers and also of the students as well as their voluntary to act accordingly can already change a lot. Problems and challenges that may arise however in an inclusive education practice will also be presented.

Since 1995, a thrombolytic therapy, rt-PA, has been approved for use with acute stroke that significantly reduces, and sometimes reverses, neurological damage. Treatment has to be given within a few hours of the start of symptoms and can only commence once a CT-scan has confirmed a particular type of stroke. In the evidence-based medicine and knowledge translation literature, variations in practice are constituted as a problem to be solved. It is assumed that a physician decides whether or not to use this therapy based on his/her evaluation of the scientific evidence. In this thesis, I demonstrate that what are less evident in many of these claims are issues related to the social production of knowledge. Little attention is paid to who conducts research, who promotes its findings, and who is expected to implement them. The positivist discourse of evidence-based medicine assumes that research produces knowledge that is neutral and can be translated into treatment that is in the patient’s best interest. Yet these assumptions remain empirically unexamined, despite social science critiques of these processes. Institutional Ethnography is an approach in sociology developed by Dorothy Smith. Based on Smith’s understanding of the social organization of knowledge, it allows for an examination of the complex social relations organizing people’s experiences of their everyday working lives. Beginning in the experiences of physicians who provide acute stroke services, this dissertation explores an example of how best practice medicine is developed, translated, and taken up in practice across various sites in the province of Ontario. For Smith, texts mediate and organize people’s experiences. In my study, the discourses of both evidence-based medicine and knowledge translation, designed to improve patient care, come into view as managerial tools designed to control the delivery of care. I render visible how in fact things work as they do in real life settings in a way that links back actual people to the texts, or discourse, organizing their experiences. In so doing, I am able to uncover some of the assumptions and hidden priorities underlying the current emphasis on translating scientific knowledge in medicine into practice.

Abstract Background People with alcohol and other drug (AOD) problems are offered treatment by a variety of organisations in the non-government sector, many of which have religious affiliations. Little is known about the actual treatment offered, and whether the ideology of the organisation has an impact on the choice of treatment provided. Christian churches were amongst the first service-delivery organisations in the Australian AOD sector, and those remaining in the sector appear to have evolved from providing overt Christian-care to providing some evidence-based care in line with the move to best practice under Australia’s National Drug Strategy. It remains to be determined, however, whether the approach to treatment and service provision by religiously-affiliated agencies is influenced by their religious background and orientation. To resolve this gap in knowledge a national survey of non-government AOD agencies was conducted in late 2005–early 2006. Methods Survey participants consisted of all identified non-government AOD agencies in Australia. The operational definition of AOD agencies was in keeping with definitions used in other investigations in the sector. The sample frame was compiled using the most recent directories and databases available. Two questionnaires were posted to 331 agencies throughout Australia. Responses were sought from both the director/coordinator and a staff member working directly with clients. Completed questionnaires were received from 169 (51 per cent) of agencies. A completed questionnaire from both the director/coordinator and an AOD worker was received from 90 of these 169 agencies. Where this was the case, the response from the director/coordinator was taken to be the ‘agency response’. Questions were about the agency’s profile, goals, activities, the respondent’s own view of substance dependence and the respondent’s demographic characteristics. Qualitative methods were also used to gain further information and clarification from key informants, both prior to and after the quantitative survey. Findings There was surprising homogeneity amongst all agencies in their use of the eight treatment orientations studied (12-step, therapeutic community, cognitive behaviour, psychodynamic, rehabilitation, dual diagnosis, medical, and family). Cognitive behaviour therapy was the most popular treatment across all types of agencies in contrast to the 12-step approach which was only a major focus for a small number of agencies. Psychodynamic and therapeutic community orientations were also widely used but family and rehabilitation orientations were amongst the least popular orientations. With the family orientation there was a wide discrepancy between agencies that had family goals but not family activities. In regard to accessing treatment, mothers accompanied by their children and couples were the two groups least likely to be accepted into treatment (44 per cent and 40 per cent respectively did not accept couples). Directors interviewed in this study indicated that not accepting mothers accompanied by their children was due to the cost of providing relevant services. Of the agencies surveyed, 42 per cent were affiliated with a church organisation. Although 85 per cent of church-affiliated agencies indicated that they received some contribution towards policy from a religious organisation, results suggested that there was very little difference between church-affiliated and non-church-affiliated agencies in service delivery. One area of significant difference between church-affiliated and non-church-affiliated agencies was access. Church-affiliated agencies were significantly more likely than non-church-affiliated agencies to not accept couples, Indigenous people, and people referred from the criminal justice system. Church-affiliated agencies were also significantly more likely to take into consideration a prospective client’s motivation to succeed. Across all agencies activities of a spiritual nature (e.g. meditation/prayer, talking with clients about spirituality/religion) were only a major feature for a small number of agencies; although 70 per cent of agencies included developing a client’s spiritual self in their goals. The majority of directors/coordinators indicated that they have a broad set of beliefs about substance use that allows for various social and psychological understandings and treatment responses. Conclusion Overall, there was uniformity in the type of treatment goals and activities offered by the non-government AOD agencies. The findings suggest that churches are becoming indistinguishable from secular organisations in their delivery of AOD services. Where once there may have been faith in religion as a basis of service provision there now appears to be faith in science. This is in the context that the ‘best evidence’ of effective treatments suggests that most treatments are relatively weak predictors of a positive outcome, and that the choice of treatment may not impact on treatment outcomes. The evidence-based medicine movement may have become a form of religion and, in association with a population health approach, is dominating the AOD service delivery sector. Although successful drug treatment programs may well require that the client/patient undergo moral and value changes, these may occur without connection to organised religion. Ideology in the form of religious belief has historically played a central role in treatment choices and it continues to do so in the form of an ideology giving priority to best practice, despite the likelihood that best practice may nevertheless continue to produce poor outcomes.