Martin Rabey, Sharon Morgans and Cathy Barrett
The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope physiotherapists…
Abstract
Purpose
The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope physiotherapists (ESPs). This paper aims to highlight the extent and appropriateness of surgical and radiological referrals by ESPs working in an adult orthopaedic service.
Design/methodology/approach
The patient pathway following ESP assessment was audited over 31 months. Parameters explored included ESP referral rates to orthopaedic consultants; the percentage of patients where the entire episode of care was managed by the ESP; whether orthopaedic referrals were appropriate in terms of surgical interventions; and numbers of radiology referrals specifically for knee or lumbar complaints.
Findings
Of the patients, 79 per cent had their entire episode of care managed by ESPs. Of the patients, 9 per cent were referred on for a surgical opinion (of which 42 per cent knees, 20 per cent lumbar). 13 per cent were referred for x‐rays, 10 per cent for magnetic resonance imaging. Of the patients referred on for surgical opinion surgical intervention was appropriate in 89 per cent of cases.
Research limitations/implications
Data from an ESP service with broad guiding protocols in a specific hospital are not readily extrapolated to ESPs elsewhere. Appropriateness of onwards referrals was based on the opinions of consultants to whom patients were referred. The potential benefit of a second opinion even if surgery is not offered is not taken into account by this model.
Practical implications
These audits reinforce the impact ESPs have on efficiency within orthopaedics. They document referral rates for x‐rays and magnetic resonance imaging by ESPs for lumbar and knee complaints that may benefit units proposing new ESP services.
Originality/value
This paper reinforces published data on ESP management of the entire episode of care of the majority of referrals to orthopaedics, and on the highly appropriate nature of onwards referrals. Documented for possibly the first time, data regarding investigations for lumbar and knee disorders highlight low referral rates.
Details
Keywords
Martin Kerridge-Weeks and Neil John Langridge
Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic…
Abstract
Purpose
Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.
Design/methodology/approach
A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.
Findings
In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.
Originality/value
Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.
Details
Keywords
With an awareness that the literature is replete with material on leadership, and accepting that the exercise of it is seen as a finger‐post towards personal success, this study…
Abstract
Purpose
With an awareness that the literature is replete with material on leadership, and accepting that the exercise of it is seen as a finger‐post towards personal success, this study aims to establish that one should still recognise that leadership is multi‐faceted, that it is both situational and transient, and that it is only one of the core skills needed by those holding in‐charge positions.
Design/methodology/approach
To consider leadership in a variety of positions and to see both the potential and the limitations arising from and imposed by other factors which can and do influence performance.
Findings
It is not always recognised that the outcomes of leadership action are seldom predictable, that individuals may respond quite differently from the expectations of their performance, and that if the occasion so warrants the influence of the leadership role may be replaced by the authority of management – with the one in charge demonstrating competency in both roles.
Research limitations/implications
Influence arises from many sources and at all levels, it is episodic rather than a constant, and is demonstrated more frequently by those in positions of responsibility. In the latter it shows itself in leadership and in the individual motivation and group morale of the led. In the context of a in loco parentis similarity: managing and leading are conjoined in the persona of the one in charge.
Originality/value
To gain value in one's own environs it is suggested that salient points be the subject of ongoing discussion.
Details
Keywords
Dalia A. Beheiry, Zeinab Shafik and Dalia Aboubakr
The present research aims to explore the relationship between the university's new identity and its architectural design, and to investigate the impact of COVID-19 pandemic on…
Abstract
Purpose
The present research aims to explore the relationship between the university's new identity and its architectural design, and to investigate the impact of COVID-19 pandemic on this model. It also aims to analyze the declared identity of the new Egyptian universities.
Design/methodology/approach
To formulate the hypothesis of the relational model, the research started with the literature related to physical and nonphysical variables of university's identity (organizational and visual identity) and the impact of the pandemic on its identity. Secondly, an online questionnaire targeting academic leaders was conducted to identify the relative importance of the selected variables of university's identity pre- and post-pandemic. Thirdly, a content analysis of the new Egyptian universities' identity was used to track the correlation between the selected variables based on information accessible on universities' websites. Finally, the results of the content analysis and the questionnaire were compared to test the hypothesis.
Findings
The study reveals the most important physical variable of university's new identity pre- and post-pandemic is technological infrastructure and flexible design, while the least important is university's unique design. The results highlight that the universities need to revisit the declared identity to reflect the new challenges posed by COVID-19.
Originality/value
This study is considered one of the first researches that links the physical and nonphysical variables of university's new identity. The current study contributes to analyzing the impact of COVID-19 on university identity and architecture.
Details
Keywords
Dilanthi Amaratunga and David Baldry
The application of performance measurement procedures can provide major benefits to organisations. The broad performance measurement need for management applies in a facilities…
Abstract
The application of performance measurement procedures can provide major benefits to organisations. The broad performance measurement need for management applies in a facilities management (FM) context when FM is considered as a subset of general management. To this can be added need which is applicable more narrowly to FM. This paper presents a case for the need for and benefits of performance measurement systems in FM environments. It is discussed together with relevant trends in the performance measurement literature which identify key opportunities in this area. It further discusses the increasing trend towards performance measurement in FM organisations and illustrates the different ways in which authors perceive the relationship between FM and performance measurement. Both motivational and organisational variables are considered and an attempt is made to identify relationships between these issues and performance measurement in FM.
Details
Keywords
In 1899 the medical practitioners of Dublin were confronted with an outbreak of a peculiar and obscure illness, characterised by symptoms which were very unusual. For want of a…
Abstract
In 1899 the medical practitioners of Dublin were confronted with an outbreak of a peculiar and obscure illness, characterised by symptoms which were very unusual. For want of a better explanation, the disorder, which seemed to be epidemic, was explained by the simple expedient of finding a name for it. It was labelled as “beri‐beri,” a tropical disease with very much the same clinical and pathological features as those observed at Dublin. Papers were read before certain societies, and then as the cases gradually diminished in number, the subject lost interest and was dropped.
Radhalakshmi Ramakrishnan and Maqsood A. Chaudhry
This paper aims to present a design of a single power supply, low voltage (1.2) high performance operational amplifier using 0.13 μm technology whose characteristics are superior…
Abstract
Purpose
This paper aims to present a design of a single power supply, low voltage (1.2) high performance operational amplifier using 0.13 μm technology whose characteristics are superior compared to the other designs available in the literature.
Design/methodology/approach
The authors set out to design an operational amplifier whose characteristics will be superior to the current available designs in the literature. Because of potential applications, a single 1.2 V supply was used. The layout was obtained using Microwind 0.13 μm technology. The design was tested using PSPICE Version 10.0. Various amplifier parameters were obtained and are compared with the other single supply, low voltage amplifiers available in the literature.
Findings
The presented amplifier has better characteristics such as open loop gain, power supply rejection ratio, common mode rejection ratio, etc.
Practical implications
Since, 0.13 μm, 1.2 V technology has become standard in digital VLSI design, there is a great need for high performance operational amplifiers that operate off of 1.2 V for mixed signal applications in such areas as mobile phones.
Originality/value
The presented amplifier has better characteristics compared to few 1.2 V supply voltage amplifiers available in the literature.
Details
Keywords
Brajesh Kumar Kaushik, S. Sarkar and R.P. Agarwal
The performance of a high‐speed chip is highly dependent on the interconnects, which connect different macro cells within a VLSI chip. Delay, power dissipation and cross‐talk are…
Abstract
Purpose
The performance of a high‐speed chip is highly dependent on the interconnects, which connect different macro cells within a VLSI chip. Delay, power dissipation and cross‐talk are the major design constraints for high performance VLSI interconnects. The importance of on‐chip inductance is continuously increasing with higher clock frequency, faster on‐chip rise time, wider wires, ever‐growing length of interconnects and introduction of new materials for low resistance interconnects. In the current scenario, interconnect is modeled as an RLC transmission line. Interconnect width optimization plays an important role in deciding transition delay and power dissipation. This paper aims to optimize interconnect width for a matched condition to reduce power and delay parameters.
Design/methodology/approach
Width optimization is done for two sets of interconnect terminating conditions, namely active gate and passive capacitance. SPICE simulations have been used to validate the findings.
Findings
For a driver interconnect load model terminated by an active gate load, a trade‐off exists between short circuit and dynamic power in inductive interconnects, since with wider lines dynamic power increases, but short circuit power of the load gate decreases due to reduced transient delay. Whereas, for a line terminated by a capacitor, such trade‐off does not exist. Many of the previous researches have modeled the active gate load at the terminating end by its input parasitic gate capacitance.
Practical implications
This paper shows that such modeling leads to inaccuracy in estimation of power, and therefore non‐optimal width selection, especially for large fan‐out conditions.
Originality/value
The finding is that the impedance matching between transmission line at driver and load ends plays an important role in estimation of overall power dissipation and transition delay of a VLSI circuit.