Given the complexity of medicines use in elderly patients, structures and processes of medicines management are key to deriving best outcomes. This research was conducted in hospitals in the United Arab Emirates (UAE) and focused on the patient journey from admission to discharge. The overall aim was to explore the structures and processes of medicines management in elderly hospitalised patients in the UAE, conducted in three phases. Phase 1. Following a review of systematic reviews of aspects of medicines management (e.g. reconciliation), this phase focused on a specific, emerging tool (the Drug Burden Index (DBI)) relating to anticholinergic/sedative agents, which are problematic in the elderly. The aim was to critically appraise, synthesize and present evidence of DBI use. The review protocol was registered with the Joanna Briggs Institute and conducted according to best accepted practice. The key finding was the lack of evidence of DBI use prospectively to identify potentially inappropriate prescribing. Phase 2. Phase 2 employed a qualitative phenomenological design to explore health professionals’ views and experiences of medicines management. Semi-structured interviews were conducted with 27 professionals and analysed using Normalization Process Theory (NPT) and the Theoretical Domains Framework (TDF). Findings revealed little evidence of coherence, cognitive participation, collective action and reflexive monitoring (NPT). TDF domains dominant were: professional role, identity; beliefs about capabilities; beliefs about consequences; environmental context, resources; and knowledge. Phase 3. The Delphi technique in phase 3 aimed to determine consensus around medicines management using an expert panel of policy makers, educators and lead health professionals. Phase 1 and 2 findings were used in construction of validated statements. A high level of consensus (≥70% strongly agree/agree) was obtained for statements other than those for targeting medicines management (rather than all elderly admissions) and tasks linked to professions (rather than trained staff). Overall, this research has generated original findings focused on the entire inpatient hospital journey, particularly the need to more clearly define, refine and agree on healthcare structures and processes across the entire patient journey from admission to discharge. The use of the NPT and TDF has highlighted those individual practitioners and organisational issues which require consideration.

Submitted by Tatiana Lima (tatianasl@ufba.br) on 2015-05-04T20:38:30Z No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / Approved for entry into archive by Tatiana Lima (tatianasl@ufba.br) on 2015-05-05T20:02:26Z (GMT) No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / Made available in DSpace on 2015-05-05T20:02:26Z (GMT). No. of bitstreams: 1 Santana, Douglas Nascimento.pdf: 3136561 bytes, checksum: 73cc9a24a5aeb897962d63db03a8e2ea (MD5) / No Brasil, no período pós-edemocratização, o aumento das exigências quanto à prestação de serviços públicos pela população, bem como os custos crescentes de produção decorrentes das incorporações tecnológicas desafiaram o modelo burocrático de administração pública nacional. A partir de meados da década de 1990, a Segunda Reforma Administrativa do Estado foi iniciada, sob a égide do Novo Gerencialismo e com foco na máxima eficiência na prestação de serviços públicos. Onipresentes na estrutura do Estado, essas mudanças ocorreram no setor saúde com a adoção de Políticas Públicas que aproximaram os serviços públicos de saúde dos entes privados mediante a criação de estruturas gerenciais mistas, como Organizações Sociais e Parcerias Público-Privadas e pela adoção de programas de incentivo ao desempenho. Este trabalho tem por objetivo avaliar em que medida o desempenho dos diferentes hospitais públicos de ensino, organizações estruturantes da rede de saúde pública, respondem, ao longo do tempo, aos estímulos trazidos pelos programas focados no aumento da eficiência. Para tanto, foram realizadas revisão bibliográfica e um estudo empírico, quantitativo, retrospectivo, de 2008 a 2012, no grupo de 44 hospitais credenciados ao Sistema de Avaliação dos Hospitais de Ensino do Estado de São Paulo. Os resultados demonstram que, quando categorizados quanto às estruturas gerenciais, os hospitais da Administração Direta, Autarquias e Organizações Sociais, os três grupos da amostra, apresentaram diferenças no padrão de evolução do desempenho assistencial ao longo dos cinco anos do estudo. Os hospitais da Administração Direta apresentaram padrão de evolução do desempenho predominante estacionário e não responsivo aos estímulos, as Organizações Sociais apresentaram padrão predominante crescente, enquanto as Autarquias apresentaram padrão estacionário em alguns indicadores e crescente em outros. A produtividade das Organizações Sociais foi significativamente maior que a dos demais grupos para todos os indicadores selecionados. O grupo de hospitais da Administração Direta apresentou taxa de infecção hospitalar significativamente menor que a os demais grupos. Entre os hospitais públicos estudados e ao longo do período selecionado, as Autarquias foram os grandes repositórios de alunos e de produção de conhecimento científico do estado de São Paulo. Uma possível explicação para as diferenças no padrão de evolução do desempenho assistencial pode estar na estrutura gerencial dos hospitais públicos, quando categorizados por autonomia administrativa e financeira, regime de vinculação de pessoal e modalidade de contratações. Hospitais sem autonomia administrativa e financeira, com trabalhadores estatutários e obrigados legalmente a contratar por licitações, como os da Administração Direta, ocuparam o polo estacionário do desempenho, enquanto hospitais com autonomia total, trabalhadores celetistas e com diferentes possibilidades para contratações, como as Organizações Sociais, ocuparam o polo crescente do desempenho. In Brazil, in the post-democratization period, increased demands for public services for the population and rising costs of production, resulting from technological developments, challenged the bureaucratic model of national administration. From the mid-1990s, the Second State Administrative Reform was started under the aegis of the New Public Management and focusing on maximum efficiency in delivering public services. Ubiquitous in the State structure, these changes occurred in the health sector by the adoption of Public Policies that brought together the public health services and private entities through the creation of joint management structures, such as Social Organizations and Public-Private Partnerships, and also by the adoption of performance incentive based programs. This paper aims to assess to what extent the performance of different public teaching hospitals, structuring organizations of public health network, respond, over time, to stimuli brought by programs focused on increasing efficiency. For this purpose, literature review and an empirical study, quantitative, retrospective, 2008-2012, in the group of 44 hospitals accredited to the System for the Evaluation of Teaching Hospitals of the state of São Paulo were held. The results show that, when categorized by its managerial structures, Direct Administration hospitals, Autarchy and Social Organizations, the three groups found at the sample, showed differences in the pattern of evolution of healthcare performance over the five years of the study. Direct Administration hospitals showed a predominant steady pattern of performance evaluation and unresponsive to stimuli, Social Organizations showed increasing predominant pattern, while the Autarchy showed a steady pattern in some indicators and growing in others. Productivity of Social Organizations was significantly higher than that of other groups for all selected indicators. The group of Direct Administration hospitals showed markedly lower nosocomial infection index, when compared to other two groups. Among the public hospitals and throughout the selected period, the Autarchy were main repositories of students and production of scientific knowledge of the state of São Paulo. One possible explanation for the differences in the evolution of the performance patterns of healthcare may be management structure of the public hospitals, when categorized by administrative and financial autonomy, workers hiring regime and modality of aquisition of insumes and services. Hospitals without total administrative and financial autonomy, with statutory workers and legally obligated to hire by bids, such as the Direct Administration hospitals, occupied the pole of steady performance, while hospitals with complete autonomy, non statutory workers and market-free possibilities to buy insumes and services, such as Social Organizations hospitals, occupied the increasing performance polo.

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Despite decades of development efforts to combat desertification processes in southern Zimbabwe, a development deadlock occurs. Using the local knowledge systems as a basis, and making an effort to strategically facilitate the revival of their capacity for checks and balances as a development approach, endogenous development could become more realistic. The actor-oriented RAAKS.methodology offers relevant tools for a case study'in which an insight into the processes of innovation is obtained in order to confirm this. The Charurnbira case study shows that many local interfaces hinder development. Although the facilitation of platform processes could enhance endogenous development, the external environment provides a serious constraint. The method employed did ndt permit broad conclusions, but a deeper examination of recent experiences suggested that by giving local people a greater say in natural resource use, local knowledge could be utilized more effectively and better use could be made of traditional management structures. / Development Administration / M.A. (Development Administration)

Despite decades of development efforts to combat desertification processes in southern Zimbabwe, a development deadlock occurs. Using the local knowledge systems as a basis, and making an effort to strategically facilitate the revival of their capacity for checks and balances as a development approach, endogenous development could become more realistic. The actor-oriented RAAKS.methodology offers relevant tools for a case study'in which an insight into the processes of innovation is obtained in order to confirm this. The Charurnbira case study shows that many local interfaces hinder development. Although the facilitation of platform processes could enhance endogenous development, the external environment provides a serious constraint. The method employed did ndt permit broad conclusions, but a deeper examination of recent experiences suggested that by giving local people a greater say in natural resource use, local knowledge could be utilized more effectively and better use could be made of traditional management structures. / Development Administration / M.A. (Development Administration)

The study assessed the effectiveness of environmental management structures and participation process in the upper Pungwe River basin. It looked at the interaction of environment and water management institutions and stakeholder structures in environmental management. A concurrent mixed methods approach was used. Qualitative and quantitative data collection and analysis techniques were employed. Seventeen questionnaires were administered to environmental management committee chairpersons. Interviews were held with three water resources management experts from the ZINWA and PSCC. Another three questionnaires were administered to the EMA, Mutasa RDC and Mutasa District Administrator. Water quality, sediment load and river runoff data for the Pungwe River was analysed using Mann-Kendal and Regression Analysis Statistics to detect trends and predict future levels. River sediment load showed a negative linear relationship with pH levels. Stakeholder participation still require enhancement. Coordination of land/environment and water management institutions and local stakeholders remains the key to achieving sustainable environmental management. / Environmental Sciences / M. Sc. (Environmental Management)

Main intention of the thesis is to name and explain budgeting methods of building constructions with main focus on creating budget for water management and engineering structures. The practical part presents itemized budgets for a wastewater treatment plant and a bicycle trail. After that the price determined of the itemized budget is compared to the price determined by budget indicator.

Быстро меняющиеся условия на финансовом рынке связаны с внедрением новых технологий и вывода на рынок новых продуктов и услуг в ограниченные сроки. Это требует от современных банков высокой гибкости и адаптации к предъявляемым условиям. В частности, российские банки, находясь под усиливающимся контролем со стороны Банка России, а также под влиянием санкционных мер, обязаны не только быстро адаптироваться под новые условия игры мирового рынка, но и обеспечивать высокое качество и надежность оказания финансовых услуг. В противном случае банки рискуют потерять не только требуемую доходность, но и возможность работать на рынке. Организационная структура, являясь основообразующим элементом работы банков, призвана обеспечить высокую скорость адаптации к динамичным условиям внешней среды. Цель диссертации - совершенствование организационной структуры подразделения банка, основанное на принципах реквизитной организации. Научная новизна состоит в учете горизонта планирования, определенного для каждого структурного элемента организации. Применение модели реквизитной организации Эллиота обусловлено развитым методологическим аппаратом в проектировании структуры организации с учетом уровней задач для каждого ее элемента. / Rapidly changing circumstances in the financial market are associated with the implementation of new technologies, products and services in a limited time. This requires high flexibility and adaptation to the claimed conditions from banks. In particular, Russian banks, being under increasing control from the Bank of Russia, as well as under the influence of sanctions measures, are obliged not only to quickly adapt to the new conditions of the world market, but also to ensure the high quality and reliability of financial services. Otherwise, banks risk losing not only the required profitability, but also the opportunity to work in the market. The organizational structure, being the basic element of the banks ' work, is designed to provide a high speed of adaptation to the dynamic conditions of the external environment. The purpose of the dissertation is to improve the organizational structure of the bank's division, based on the principles of requisite organization. Scientific novelty consists in taking into account the planning horizon defined for each structural element of the organization. Applying the Elliot’s model of requisite organization is due to the developed methodological apparatus in the design of organizational structure talking into account target levels for each element.

The South Africa higher education environment has been regulated through the enactment of policies promulgated by the governments of the day since the establishment of South African higher education. Even in the early days, the higher education sector comprised both public and private higher education institutions. Since South Africa’s democratic election in 1994, the higher education environment has been altered by the current government by means of policy enactment. Limited research has been conducted on the impact of the current regulatory context on the management of a private higher education institution. Therefore, the focus of this study was to determine how a private higher education institution within the current higher regulatory context in South Africa is managed. A qualitative research methodology was used to study the phenomenon. For this purpose, a case study, an accredited and registered private higher education institution was identified and individual interviews conducted with its six managers. The study adhered to ethical principles and techniques to enhance the validity/trustworthiness of the findings. The study found that the current regulatory enactment that was initiated under the new democratic government elected in 1994 had far-reaching implications for the private higher education sector. As a consequence, management structures, policies and procedures, quality assurance processes and procedures and management functions were altered. However, some of the regulatory criteria still have an impact on the management functions as private providers still struggle for full recognition by the government. / Educational Studies / M. Ed. (Education Management)

The South Africa higher education environment has been regulated through the enactment of policies promulgated by the governments of the day since the establishment of South African higher education. Even in the early days, the higher education sector comprised both public and private higher education institutions. Since South Africa’s democratic election in 1994, the higher education environment has been altered by the current government by means of policy enactment. Limited research has been conducted on the impact of the current regulatory context on the management of a private higher education institution. Therefore, the focus of this study was to determine how a private higher education institution within the current higher regulatory context in South Africa is managed. A qualitative research methodology was used to study the phenomenon. For this purpose, a case study, an accredited and registered private higher education institution was identified and individual interviews conducted with its six managers. The study adhered to ethical principles and techniques to enhance the validity/trustworthiness of the findings. The study found that the current regulatory enactment that was initiated under the new democratic government elected in 1994 had far-reaching implications for the private higher education sector. As a consequence, management structures, policies and procedures, quality assurance processes and procedures and management functions were altered. However, some of the regulatory criteria still have an impact on the management functions as private providers still struggle for full recognition by the government. / Educational Studies / M. Ed. (Education Management)