Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis.

PubMed

Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

2015-01-01

To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. All seven programmes involved bottom-up innovation driven by local needs and included: (1) a single point of entry, (2) holistic care assessments, (3) comprehensive care planning, (4) care co-ordination and (5) a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the 'business case' for integrated health and social care and to ensure successful generalization of local successes.

Partners for the optimal organisation of the healthcare continuum for high users of health and social services: protocol of a developmental evaluation case study design.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Couture, Martine; Brousselle, Astrid; Couture, Eva Marjorie; Dubois, Marie-France; Fortin, Martin; Freund, Tobias; Loignon, Christine; Mireault, Jean; Pluye, Pierre; Roberge, Pasquale; Rodriguez, Charo

2014-12-02

Case management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the clienteles and programmes that contribute to positive impacts. The purpose of this project is thus to describe and evaluate the case management programmes of four health and social services centres in the Saguenay-Lac- Saint-Jean region of Québec, Canada, in order to inform their improvement while creating knowledge on case management that can be useful in other contexts. This research relies on a multiple embedded case study design based on a developmental evaluation approach. We will work with the case management programme for high users of hospital services of each centre. Three different units of analysis will be interwoven to obtain an in-depth understanding of each case, that is: (1) health and social services centre and local services network, (2) case management programme and (3) patients who are high users of services. Two strategies for programme evaluation (logic models and implementation analysis) will guide the mixed data collection based on qualitative and quantitative methods. This data collection will rely on: (1) individual interviews and focus groups; (2) participant observation; (3) document analysis; (4) clinical and administrative data and (5) questionnaires. Description and comparison of cases, and integration of qualitative and quantitative data will be used to guide the data analysis. The study protocol was approved by the Ethics Research Boards of the four health and social services centres (HSSCs) involved. Findings will be disseminated by publications in peer-reviewed journals, conferences, and policy and practice partners in local and national government. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Programmable and Configurable Mixed-Mode FPAA SoC

DTIC Science & Technology

2016-03-17

A Programmable and Configurable Mixed-Mode FPAA SoC Sahil Shah, Sihwan Kim, Farhan Adil, Jennifer Hasler, Suma George, Michelle Collins, Richard...Abstract: The authors present a Floating-Gate based, System-On-Chip large-scale Field- Programmable Analog Array IC that integrates divergent concepts...Floating-Gate, SoC, Command Word Classification This paper presents a Floating-Gate (FG) based, System- On-Chip (SoC) large-scale Field- Programmable

The development and evaluation of a web-based programme to support problem-solving skills following brain injury.

PubMed

Powell, Laurie Ehlhardt; Wild, Michelle R; Glang, Ann; Ibarra, Summer; Gau, Jeff M; Perez, Amanda; Albin, Richard W; O'Neil-Pirozzi, Therese M; Wade, Shari L; Keating, Tom; Saraceno, Carolyn; Slocumb, Jody

2017-10-24

Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury. We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study. Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions. Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury. Implications for Rehabilitation People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts. Research supports problem solving skills training following brain injury. Assistive technology for cognition (smartphones, selected apps) offers a means of supporting problem solving for this population. This project demonstrated the feasibility of a web-based programme to address this need.

A Rationale for Mixed Methods (Integrative) Research Programmes in Education

ERIC Educational Resources Information Center

Niaz, Mansoor

2008-01-01

Recent research shows that research programmes (quantitative, qualitative and mixed) in education are not displaced (as suggested by Kuhn) but rather lead to integration. The objective of this study is to present a rationale for mixed methods (integrative) research programs based on contemporary philosophy of science (Lakatos, Giere, Cartwright,…

Key parameters for behaviour related to source separation of household organic waste: A case study in Hanoi, Vietnam.

PubMed

Kawai, Kosuke; Huong, Luong Thi Mai

2017-03-01

Proper management of food waste, a major component of municipal solid waste (MSW), is needed, especially in developing Asian countries where most MSW is disposed of in landfill sites without any pretreatment. Source separation can contribute to solving problems derived from the disposal of food waste. An organic waste source separation and collection programme has been operated in model areas in Hanoi, Vietnam, since 2007. This study proposed three key parameters (participation rate, proper separation rate and proper discharge rate) for behaviour related to source separation of household organic waste, and monitored the progress of the programme based on the physical composition of household waste sampled from 558 households in model programme areas of Hanoi. The results showed that 13.8% of 558 households separated organic waste, and 33.0% discharged mixed (unseparated) waste improperly. About 41.5% (by weight) of the waste collected as organic waste was contaminated by inorganic waste, and one-third of the waste disposed of as organic waste by separators was inorganic waste. We proposed six hypothetical future household behaviour scenarios to help local officials identify a final or midterm goal for the programme. We also suggested that the city government take further actions to increase the number of people participating in separating organic waste, improve the accuracy of separation and prevent non-separators from discharging mixed waste improperly.

The effect of skill mix in non-nursing assistants on work engagements among home visiting nurses in Japan.

PubMed

Naruse, Takashi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Sakai, Mahiro; Watai, Izumi; Murashima, Sachiyo

2015-05-01

This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial. © 2014 John Wiley & Sons Ltd.

Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database

PubMed Central

Hutchison, Colin A; Crowe, Alex V; Stevens, Paul E; Harrison, David A; Lipkin, Graham W

2007-01-01

Introduction This report describes the case mix, outcome and activity for admissions to intensive care units (ICUs) of patients who require prior chronic renal dialysis for end-stage renal failure (ESRF), and investigates the effect of case mix factors on outcome. Methods This was a secondary analysis of a high-quality clinical database, namely the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, which includes 276,731 admissions to 170 adult ICUs across England, Wales and Northern Ireland from 1995 to 2004. Results During the eight year study period, 1.3% (n = 3,420) of all patients admitted to ICU were receiving chronic renal dialysis before ICU admission. This represents an estimated ICU utilization of six admissions (32 bed-days) per 100 dialysis patient-years. The ESRF group was younger (mean age 57.3 years versus 59.5 years) and more likely to be male (60.2% versus 57.9%) than those without ESRF. Acute Physiology and Chronic Health Evaluation II score and Acute Physiology Score revealed greater severity of illness on admission in patients with ESRF (mean 24.7 versus 16.6 and 17.2 versus 12.6, respectively). Length of stay in ICU was comparable between groups (median 1.9 days versus 1.8 days) and ICU mortality was only slightly elevated in the ESRF group (26.3% versus 20.8%). However, the ESRF group had protracted overall hospital stay (median 25 days versus 17 days), and increased hospital mortality (45.3% versus 31.2%) and ICU readmission (9.0% vs. 4.7%). Multiple logistic regression analysis adjusted for case mix identified the increased hospital mortality to be associated with increasing age, emergency surgery and nonsurgical cases, cardiopulmonary resuscitation before ICU admission and extremes of physiological norms. The adjusted odds ratio for ultimate hospital mortality associated with chronic renal dialysis was 1.24 (95% confidence interval 1.13 to 1.37). Conclusion Patients with ESRF admitted to UK ICUs are more likely to be male and younger, with a medical cause of admission, and to have greater severity of illness than the non-ESRF population. Outcomes on the ICU were comparable between the two groups, but those patients with ESRF had greater readmission rates, prolonged post-ICU hospital stay and increased post-ICU hospital mortality. This study is by far the largest comparative outcome analysis to date in patients with ESRF admitted to the ICU. It may help to inform clinical decision-making and resource requirements for this patient population. PMID:17451605

Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol

PubMed Central

Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno

2015-01-01

Introduction The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. Methods and analysis The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers’ performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. Discussion We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. Ethics and dissemination The study was approved by the Ethical Committee at Rennes University Hospital, France. Results will be published in scientific journals, and communicated to respondents and relevant institutions. PMID:25631314

Multicopy programmable discrimination of general qubit states

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sentis, G.; Bagan, E.; Calsamiglia, J.

2010-10-15

Quantum state discrimination is a fundamental primitive in quantum statistics where one has to correctly identify the state of a system that is in one of two possible known states. A programmable discrimination machine performs this task when the pair of possible states is not a priori known but instead the two possible states are provided through two respective program ports. We study optimal programmable discrimination machines for general qubit states when several copies of states are available in the data or program ports. Two scenarios are considered: One in which the purity of the possible states is a priorimore » known, and the fully universal one where the machine operates over generic mixed states of unknown purity. We find analytical results for both the unambiguous and minimum error discrimination strategies. This allows us to calculate the asymptotic performance of programmable discrimination machines when a large number of copies are provided and to recover the standard state discrimination and state comparison values as different limiting cases.« less

Countdown to 2015 country case studies: systematic tools to address the "black box" of health systems and policy assessment.

PubMed

Singh, Neha S; Huicho, Luis; Afnan-Holmes, Hoviyeh; John, Theopista; Moran, Allisyn C; Colbourn, Tim; Grundy, Chris; Matthews, Zoe; Maliqi, Blerta; Mathai, Matthews; Daelmans, Bernadette; Requejo, Jennifer; Lawn, Joy E

2016-09-12

Evaluating health systems and policy (HSP) change and implementation is critical in understanding reproductive, maternal, newborn and child health (RMNCH) progress within and across countries. Whilst data for health outcomes, coverage and equity have advanced in the last decade, comparable analyses of HSP changes are lacking. We present a set of novel tools developed by Countdown to 2015 (Countdown) to systematically analyse and describe HSP change for RMNCH indicators, enabling multi-country comparisons. International experts worked with eight country teams to develop HSP tools via mixed methods. These tools assess RMNCH change over time (e.g. 1990-2015) and include: (i) Policy and Programme Timeline Tool (depicting change according to level of policy); (ii) Health Policy Tracer Indicators Dashboard (showing 11 selected RMNCH policies over time); (iii) Health Systems Tracer Indicators Dashboard (showing four selected systems indicators over time); and (iv) Programme implementation assessment. To illustrate these tools, we present results from Tanzania and Peru, two of eight Countdown case studies. The Policy and Programme Timeline tool shows that Tanzania's RMNCH environment is complex, with increased funding and programmes for child survival, particularly primary-care implementation. Maternal health was prioritised since mid-1990s, yet with variable programme implementation, mainly targeting facilities. Newborn health only received attention since 2005, yet is rapidly scaling-up interventions at facility- and community-levels. Reproductive health lost momentum, with re-investment since 2010. Contrastingly, Peru moved from standalone to integrated RMNCH programme implementation, combined with multi-sectoral, anti-poverty strategies. The HSP Tracer Indicators Dashboards show that Peru has adopted nine of 11 policy tracer indicators and Tanzania has adopted seven. Peru costed national RMNCH plans pre-2000, whereas Tanzania developed a national RMNCH plan in 2006 but only costed the reproductive health component. Both countries included all lifesaving RMNCH commodities on their essential medicines lists. Peru has twice the health worker density of Tanzania (15.4 vs. 7.1/10,000 population, respectively), although both are below the 22.8 WHO minimum threshold. These are the first HSP tools using mixed methods to systematically analyse and describe RMNCH changes within and across countries, important in informing accelerated progress for ending preventable maternal, newborn and child mortality in the post-2015 era.

An Innovative Method of Teaching Electronic System Design with PSoC

ERIC Educational Resources Information Center

Ye, Zhaohui; Hua, Chengying

2012-01-01

Programmable system-on-chip (PSoC), which provides a microprocessor and programmable analog and digital peripheral functions in a single chip, is very convenient for mixed-signal electronic system design. This paper presents the experience of teaching contemporary mixed-signal electronic system design with PSoC in the Department of Automation,…

Bridging the qualitative-quantitative divide: Experiences from conducting a mixed methods evaluation in the RUCAS programme.

PubMed

Makrakis, Vassilios; Kostoulas-Makrakis, Nelly

2016-02-01

Quantitative and qualitative approaches to planning and evaluation in education for sustainable development have often been treated by practitioners from a single research paradigm. This paper discusses the utility of mixed method evaluation designs which integrate qualitative and quantitative data through a sequential transformative process. Sequential mixed method data collection strategies involve collecting data in an iterative process whereby data collected in one phase contribute to data collected in the next. This is done through examples from a programme addressing the 'Reorientation of University Curricula to Address Sustainability (RUCAS): A European Commission Tempus-funded Programme'. It is argued that the two approaches are complementary and that there are significant gains from combining both. Using methods from both research paradigms does not, however, mean that the inherent differences among epistemologies and methodologies should be neglected. Based on this experience, it is recommended that using a sequential transformative mixed method evaluation can produce more robust results than could be accomplished using a single approach in programme planning and evaluation focussed on education for sustainable development. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluating the implementation of a national clinical programme for diabetes to standardise and improve services: a realist evaluation protocol.

PubMed

McHugh, S; Tracey, M L; Riordan, F; O'Neill, K; Mays, N; Kearney, P M

2016-07-28

Over the last three decades in response to the growing burden of diabetes, countries worldwide have developed national and regional multifaceted programmes to improve the monitoring and management of diabetes and to enhance the coordination of care within and across settings. In Ireland in 2010, against a backdrop of limited dedicated strategic planning and engrained variation in the type and level of diabetes care, a national programme was established to standardise and improve care for people with diabetes in Ireland, known as the National Diabetes Programme (NDP). The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. This realist evaluation protocol sets out the approach that will be used to identify and explain which aspects of the programme are working, for whom and in what circumstances to produce the outcomes intended. This mixed method realist evaluation will develop theories about the relationship between the context, mechanisms and outcomes of the diabetes programme. In stage 1, to identify the official programme theories, documentary analysis and qualitative interviews were conducted with national stakeholders involved in the design, development and management of the programme. In stage 2, as part of a multiple case study design with one case per administrative region in the health system, qualitative interviews are being conducted with frontline staff and service users to explore their responses to, and reasoning about, the programme's resources (mechanisms). Finally, administrative data will be used to examine intermediate implementation outcomes such as service uptake, acceptability, and fidelity to models of care. This evaluation is using the principles of realist evaluation to examine the implementation of a national programme to standardise and improve services for people with diabetes in Ireland. The concurrence of implementation and evaluation has enabled us to produce formative feedback for the NDP while also supporting the refinement and revision of initial theories about how the programme is being implemented in the dynamic and unstable context of the Irish healthcare system.

Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol.

PubMed

Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno

2015-01-28

The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers' performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. The study was approved by the Ethical Committee at Rennes University Hospital, France. Results will be published in scientific journals, and communicated to respondents and relevant institutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mixed methods evaluation of the Getting it Right First Time programme - improvements to NHS orthopaedic care in England: study protocol.

PubMed

Barratt, Helen; Turner, Simon; Hutchings, Andrew; Pizzo, Elena; Hudson, Emma; Briggs, Tim; Hurd, Rob; Day, Jamie; Yates, Rachel; Gikas, Panagiotis; Morris, Stephen; Fulop, Naomi J; Raine, Rosalind

2017-01-23

Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. The Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. We will examine whether the planned changes have delivered improvements in the quality of care and patient outcomes. We will also study the processes involved in developing and implementing changes to care, and professional and organisational factors influencing these processes. In doing so, we will identify lessons to guide future improvement work in other services. We will evaluate the implementation of the GIRFT programme, and its impact on outcomes and cost, using a mixed methods design. Qualitative methods will be used to understand the programme theory underlying the approach and study the effect of the intervention on practice, using a case study approach. This will include an analysis of the central GIRFT programme and local provider responses. Data will be collected via semi-structured interviews, non-participant observation, and documentary analysis. Quantitative methods will be used to examine 'what works and at what cost?' We will also conduct focus groups with patients and members of the public to explore their perceptions of the GIRFT programme. The research will draw on theories of adoption, diffusion, and sustainability of innovation; its characteristics; and contextual factors at provider-level that influence implementation. We will identify generalisable lessons to inform the organisation and delivery of future improvement programmes, to optimise their implementation and impact, both within the UK and internationally. Potential challenges involved in conducting the evaluation include the phased implementation of the intervention in different provider organisations; the inclusion of both retrospective and prospective components; and the effects of ongoing organisational turbulence in the English NHS. However, these issues reflect the realities of service change and its evaluation.

Less fog on the Tyne? Programme budgeting in Newcastle and North Tyneside.

PubMed

Miller, P; Parkin, D; Craig, N; Lewis, D; Gerard, K

1997-06-01

Programme Budgeting (PB) has been widely promoted as a model for the better conduct of the work of Health Authorities in the National Health Service in the United Kingdom. This paper reports on a project which looked at the development of PB in Newcastle and North Tyneside Health Authority (NNTHA), concentrating on the construction of a computerised tool for the compilation and analysis of programme budgets. The main activities carried out were a survey of user requirements for PB, a survey of data availability, the collection of data to construct programme budgets, and development of a relational database for storing and manipulating PB information. The main source of data was the Contract Minimum Data Set, which was supplemented by data from a number of other sources to give comprehensive information on spending in NNTHA. Costed activity data were produced, which could be aggregated in a large number of ways, such as by care setting (inpatient, outpatient, community, general practice, etc.), disease group (ICD9 chapter headings), case mix (Healthcare Resource Groups) and socio-demographic variables (age/sex, locality of GPs practice).

Digitally programmable microfluidic automaton for multiscale combinatorial mixing and sample processing†

PubMed Central

Jensen, Erik C.; Stockton, Amanda M.; Chiesl, Thomas N.; Kim, Jungkyu; Bera, Abhisek; Mathies, Richard A.

2013-01-01

A digitally programmable microfluidic Automaton consisting of a 2-dimensional array of pneumatically actuated microvalves is programmed to perform new multiscale mixing and sample processing operations. Large (µL-scale) volume processing operations are enabled by precise metering of multiple reagents within individual nL-scale valves followed by serial repetitive transfer to programmed locations in the array. A novel process exploiting new combining valve concepts is developed for continuous rapid and complete mixing of reagents in less than 800 ms. Mixing, transfer, storage, and rinsing operations are implemented combinatorially to achieve complex assay automation protocols. The practical utility of this technology is demonstrated by performing automated serial dilution for quantitative analysis as well as the first demonstration of on-chip fluorescent derivatization of biomarker targets (carboxylic acids) for microchip capillary electrophoresis on the Mars Organic Analyzer. A language is developed to describe how unit operations are combined to form a microfluidic program. Finally, this technology is used to develop a novel microfluidic 6-sample processor for combinatorial mixing of large sets (>26 unique combinations) of reagents. The digitally programmable microfluidic Automaton is a versatile programmable sample processor for a wide range of process volumes, for multiple samples, and for different types of analyses. PMID:23172232

Unpacking (In)formal Learning in an Academic Development Programme: A Mixed-Method Social Network Perspective

ERIC Educational Resources Information Center

Rienties, Bart; Hosein, Anesa

2015-01-01

How and with whom academics develop and maintain formal and informal networks for reflecting on their teaching practice has received limited attention even though academic development (AD) programmes have become an almost ubiquitous feature of higher education. The primary goal of this mixed-method study is to unpack how 114 academics in an AD…

Foam-Mixing-And-Dispensing Machine

NASA Technical Reports Server (NTRS)

Chong, Keith Y.; Toombs, Gordon R.; Jackson, Richard J.

1996-01-01

Time-and-money-saving machine produces consistent, homogeneously mixed foam, enhancing production efficiency. Automatically mixes and dispenses polyurethane foam in quantities specified by weight. Consists of cart-mounted, air-driven proportioning unit; air-activated mechanical mixing gun; programmable timer/counter, and controller.

Analog Module Architecture for Space-Qualified Field-Programmable Mixed-Signal Arrays

NASA Technical Reports Server (NTRS)

Edwards, R. Timothy; Strohbehn, Kim; Jaskulek, Steven E.; Katz, Richard

1999-01-01

Spacecraft require all manner of both digital and analog circuits. Onboard digital systems are constructed almost exclusively from field-programmable gate array (FPGA) circuits providing numerous advantages over discrete design including high integration density, high reliability, fast turn-around design cycle time, lower mass, volume, and power consumption, and lower parts acquisition and flight qualification costs. Analog and mixed-signal circuits perform tasks ranging from housekeeping to signal conditioning and processing. These circuits are painstakingly designed and built using discrete components due to a lack of options for field-programmability. FPAA (Field-Programmable Analog Array) and FPMA (Field-Programmable Mixed-signal Array) parts exist but not in radiation-tolerant technology and not necessarily in an architecture optimal for the design of analog circuits for spaceflight applications. This paper outlines an architecture proposed for an FPAA fabricated in an existing commercial digital CMOS process used to make radiation-tolerant antifuse-based FPGA devices. The primary concerns are the impact of the technology and the overall array architecture on the flexibility of programming, the bandwidth available for high-speed analog circuits, and the accuracy of the components for high-performance applications.

Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

PubMed

Harris, Fiona M; Maxwell, Margaret; O'Connor, Rory; Coyne, James C; Arensman, Ella; Coffey, Claire; Koburger, Nicole; Gusmão, Ricardo; Costa, Susana; Székely, András; Cserhati, Zoltan; McDaid, David; van Audenhove, Chantal; Hegerl, Ulrich

2016-03-15

The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these. A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection. All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention. The QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.

Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise.

PubMed

Carmont, Michael R; Highland, Adrian M; Blundell, Christopher M; Davies, Mark B

2009-11-01

Ruptures of the Achilles tendon are common however simultaneous ruptures occur less frequently. Eccentric loading exercise programmes have been used to successfully treat Achilles tendinopathy. We report a case of simultaneous bilateral Achilles tendon rupture in a patient predisposed to rupture due to longstanding raised serum lipoprotein and recently introduced therapeutic statin medication. The patient was also a keen rock climber and had regularly undertaken loading exercise. This case illustrates that the therapeutic effect of mixed loading exercises for the Achilles tendon may not be adequate to overcome the predisposition to rupture caused by hyperlipidaemia and statin medication.

Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database

PubMed Central

Kolhe, Nitin V; Stevens, Paul E; Crowe, Alex V; Lipkin, Graham W; Harrison, David A

2008-01-01

Introduction This study pools data from the UK Intensive Care National Audit and Research Center (ICNARC) Case Mix Programme (CMP) to evaluate the case mix, outcome and activity for 17,326 patients with severe acute kidney injury (AKI) occurring during the first 24 hours of admission to intensive care units (ICU). Methods Severe AKI admissions (defined as serum creatinine ≥300 μmol/l and/or urea ≥40 mmol/l during the first 24 hours) were extracted from the ICNARC CMP database of 276,326 admissions to UK ICUs from 1995 to 2004. Subgroups of oliguric and nonoliguric AKI were identified by daily urine output. Data on surgical status, survival and length of stay were also collected. Severity of illness scores and mortality prediction models were compared (UK Acute Physiology and Chronic Health Evaluation [APACHE] II, Stuivenberg Hospital Acute Renal Failure [SHARF] T0, SHARF II0 and the Mehta model). Results Severe AKI occurred in 17,326 out of 276,731 admissions (6.3%). The source of admission was nonsurgical in 83.7%. Sepsis was present in 47.3% and AKI was nonoliguric in 63.9% of cases. Admission to ICU with severe AKI accounted for 9.3% of all ICU bed-days. Oliguric AKI was associated with longer length of stay for survivors and shorter length of stay for nonsurvivors compared with nonoliguric AKI. Oliguric AKI was associated with significantly greater ICU and hospital mortality (55.8% and 77.3%, respectively) compared with nonoliguric AKI (33.4% and 49.3%, respectively). Surgery during the 1 week before admission or during the first week in the CMP unit was associated with decreased odds of mortality. UK APACHE II and the Mehta scores under-predicted the number of deaths, whereas SHARF T0 and SHARF II0 over-predicted the number of deaths. Conclusions Severe AKI accounts for over 9% of all bed-days in adult, general ICUs, representing a considerable drain on resources. Although nonoliguric AKI continues to confer a survival benefit, overall survival from AKI in the ICU and survival to leave hospital remains poor. The use of APACHE II score measured during the first 24 hours of ICU stay performs well as compared with SHARF T0, SHARF II0 and the Mehta score, but it lacks perfect calibration. PMID:19105800

Education across the Divide: Shared Learning of Separate Jewish and Arab Schools in a Mixed City in Israel

ERIC Educational Resources Information Center

Payes, Shany

2018-01-01

This article examines the impact of contact-based educational encounter strategies of shared learning on Jewish-Arab relations in Israel. It analyses a programme of education for shared life that takes place in a mixed (75% Jewish/25% Arab) city at the centre of Israel since 2012. The programme aims to mitigate Jewish-Arab relations in the city…

Enhancing Entrepreneurial Self-Efficacy through Vocational Entrepreneurship Education Programmes

ERIC Educational Resources Information Center

Maritz, Alex; Brown, Chris

2013-01-01

The purpose of this study is to report the results of a longitudinal evaluation of a vocational entrepreneurship education programme (EEP) using entrepreneurial self-efficacy (ESE) measures. An empirical, mixed methods longitudinal and effectuation scale was used to measure ESE scores. Results indicate that participation in the programme had a…

The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries.

PubMed

Singh, Debra; Negin, Joel; Otim, Michael; Orach, Christopher Garimoi; Cumming, Robert

2015-07-14

Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context. The objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs. Both volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.

Rubella elimination programme strengthened through measles elimination programme in Catalonia.

PubMed

Domínguez, Angela; Torner, Nuria; Martínez, Ana; Costa, Josep; Plans, Pere; Ciruela, Pilar; Salleras, Lluís

2006-02-27

The drastic fall in rubella cases recorded in Catalonia from 1988 on, when the second dose of Measles-Mumps-Rubella (MMR) vaccine was implemented, and especially from 1998, when the measles elimination programme began, led to the introduction, in May 2002, of the rubella and congenital rubella syndrome elimination by 2005 programme. From May 2002 to May 2004, 13 suspected rubella cases were reported to the Statutory Disease Reporting System; of these, one postnatal case and one congenital rubella case were confirmed (15.4%), both being imported cases. Through the screening of viruses established in the measles elimination programme, 28 possible cases were analyzed and six (21.4%) confirmed imported postnatal rubella cases were detected. The small number and imported nature of the cases of rubella and the detection of the majority of the confirmed cases through the measles elimination programme, strongly suggests that both programmes should continue.

Training Programme for Secondary School Principals: Evaluating its Effectiveness and Impact

ERIC Educational Resources Information Center

Hutton, Disraeli M.

2013-01-01

The article presents the evaluation of the training programme for secondary school principals conducted in the period between 2006 and 2009. A mixed method approach was used to conduct the summative evaluation with 28 graduate participants. For the impact evaluation, 15 of the graduates were interviewed three years after the programme was…

A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control

PubMed Central

2011-01-01

Introduction The STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives. Methods We undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives. Results Twelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were the dominant category. The literature review yielded information on 22 projects in which 'private-for-profit qualified clinical providers' were again the dominant category. The contributions made by 'private-for-profit qualified clinical providers' and 'Non Governmental Organisation qualified clinical providers', were assessed against the four global PPM objectives. Reporting on tuberculosis case detection and treatment outcomes was generally good and demonstrated important PPM contributions in these areas. Reporting on equity, access and reduced patient costs was often lacking or inconclusive. Conclusions PPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed. PMID:22074377

Evaluation of a group based cognitive behavioural therapy programme for menstrual pain management in young women with intellectual disabilities: protocol for a mixed methods controlled clinical trial

PubMed Central

2014-01-01

Background Menstrual pain which is severe enough to impact on daily activities is very common amongst menstruating females. Research suggests that menstrual pain which impacts on daily functioning may be even more prevalent amongst those with intellectual disabilities. Despite this, little research attention has focused on pain management programmes for those with intellectual disabilities. The aims of this pilot study were to develop and evaluate a theory-based cognitive behavioural therapy (CBT) programme for menstrual pain management in young women with intellectual disabilities. Methods/Design The study utilised a mixed methods controlled clinical trial to evaluate elements from a CBT programme called Feeling Better (McGuire & McManus, 2010). The Feeling Better programme is a modular, manualised intervention designed for people with an intellectual disability and their carers. The programme was delivered to 36 young women aged 12 – 30 years who have a Mild - Moderate Intellectual Disability, split between two conditions. The treatment group received the Feeling Better intervention and the control group received treatment as usual. To evaluate the effectiveness of the programme, measures were taken of key pain variables including impact, knowledge, self-efficacy and coping. Process evaluation was conducted to examine which elements of the programme were most successful in promoting change. Discussion Participants in the intervention group were expected to report the use of a greater number of coping strategies and have greater knowledge of pain management strategies following participation in the intervention and at three month follow-up, when compared to control group participants. A significant advantage of the study was the use of mixed methods and inclusion of process evaluation to determine which elements of a cognitive behavioural therapy programme work best for individuals with intellectual disabilities. Trial registration Current Controlled Trials ISRCTN75567759 PMID:25201648

Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes.

PubMed

Burnett, Susan; Benn, Jonathan; Pinto, Anna; Parand, Anam; Iskander, Sandra; Vincent, Charles

2010-08-01

Patient safety has been high on the agenda for more than a decade. Despite many national initiatives aimed at improving patient safety, the challenge remains to find coherent and sustainable organisation-wide safety-improvement programmes. In the UK, the Safer Patients' Initiative (SPI) was established to address this challenge. Important in the success of such an endeavour is understanding 'readiness' at the organisational level, identifying the preconditions for success in this type of programme. This article reports on a case study of the four NHS organisations participating in the first phase of SPI, examining the perceptions of organisational readiness and the relationship of these factors with impact by those actively involved in the initiative. A mixed-methods design was used, involving a survey and semistructured interviews with senior executive leads, the principal SPI programme coordinator and the four operational leads in each of the SPI clinical work areas in all four organisations taking part in the first phase of SPI. This preliminary work would suggest that prior to the start of organisation-wide quality- and safety-improvement programmes, organisations would benefit from an assessment of readiness with time spent in the preparation of the organisational infrastructure, processes and culture. Furthermore, a better understanding of the preconditions that mark an organisation as ready for improvement work would allow policymakers to set realistic expectations about the outcomes of safety campaigns.

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation

PubMed Central

2012-01-01

Background Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. Methods The intervention was based on the WHO’s Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Results Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students’ anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals, parents and students. A minority of teachers complained that there was inadequate information sharing about the programme and mentioned reservations about the capacities of the lay health counsellor. Preliminary evidence of the positive effects of the programme included the correction of vision problems detected in health screening camps, and qualitative evidence of changes in health-related knowledge and behaviour of students. Conclusion A task-shifting approach of delegating school health promotion activities to lay school health counsellors rather than education or health professionals shows promise of effectiveness as a scalable model for promoting the health and well being of school based adolescents in resource constrained settings. PMID:22630607

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation.

PubMed

Rajaraman, Divya; Travasso, Sandra; Chatterjee, Achira; Bhat, Bhargav; Andrew, Gracy; Parab, Suraj; Patel, Vikram

2012-05-25

Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. The intervention was based on the WHO's Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students' anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals, parents and students. A minority of teachers complained that there was inadequate information sharing about the programme and mentioned reservations about the capacities of the lay health counsellor. Preliminary evidence of the positive effects of the programme included the correction of vision problems detected in health screening camps, and qualitative evidence of changes in health-related knowledge and behaviour of students. A task-shifting approach of delegating school health promotion activities to lay school health counsellors rather than education or health professionals shows promise of effectiveness as a scalable model for promoting the health and well being of school based adolescents in resource constrained settings.

Introducing auto-disable syringes to the national immunization programme in Madagascar.

PubMed Central

Drain, Paul K.; Ralaivao, Josoa S.; Rakotonandrasana, Alexander; Carnell, Mary A.

2003-01-01

OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage. PMID:14576886

A Review of the Linkage between Student Participation in the International Baccalaureate Continuum and Student Learning Attributes

ERIC Educational Resources Information Center

Bryant, Darren A.; Walker, Allan; Lee, Moosung

2016-01-01

Given the rapid growth in the number of students completing the International Baccalaureate (IB) Diploma Programme and the potential for students to be educated entirely through IB programmes, it is important to understand associations between programme participation and cognitive and non-cognitive learning attributes. Through a mixed methods…

The evaluation of student-centredness of teaching and learning: a new mixed-methods approach.

PubMed

Lemos, Ana R; Sandars, John E; Alves, Palmira; Costa, Manuel J

2014-08-14

The aim of the study was to develop and consider the usefulness of a new mixed-methods approach to evaluate the student-centredness of teaching and learning on undergraduate medical courses. An essential paradigm for the evaluation was the coherence between how teachers conceptualise their practice (espoused theories) and their actual practice (theories-in-use). The context was a module within an integrated basic sciences course in an undergraduate medical degree programme. The programme had an explicit intention of providing a student-centred curriculum. A content analysis framework based on Weimer's dimensions of student-centred teaching was used to analyze data collected from individual interviews with seven teachers to identify espoused theories and 34h of classroom observations and one student focus group to identify theories-in-use. The interviewees were identified by purposeful sampling. The findings from the three methods were triangulated to evaluate the student-centredness of teaching and learning on the course. Different, but complementary, perspectives of the student-centredness of teaching and learning were identified by each method. The triangulation of the findings revealed coherence between the teachers' espoused theories and theories-in-use. A mixed-methods approach that combined classroom observations with interviews from a purposeful sample of teachers and students offered a useful evaluation of the extent of student-centredness of teaching and learning of this basic science course. Our case study suggests that this new approach is applicable to other courses in medical education.

The evaluation of student-centredness of teaching and learning: a new mixed-methods approach

PubMed Central

Lemos, Ana R.; Sandars, John E.; Alves, Palmira

2014-01-01

Objectives The aim of the study was to develop and consider the usefulness of a new mixed-methods approach to evaluate the student-centredness of teaching and learning on undergraduate medical courses. An essential paradigm for the evaluation was the coherence between how teachers conceptualise their practice (espoused theories) and their actual practice (theories-in-use). Methods The context was a module within an integrated basic sciences course in an undergraduate medical degree programme. The programme had an explicit intention of providing a student-centred curriculum. A content analysis framework based on Weimer’s dimensions of student-centred teaching was used to analyze data collected from individual interviews with seven teachers to identify espoused theories and 34h of classroom observations and one student focus group to identify theories-in-use. The interviewees were identified by purposeful sampling. The findings from the three methods were triangulated to evaluate the student-centredness of teaching and learning on the course. Results Different, but complementary, perspectives of the student-centredness of teaching and learning were identified by each method. The triangulation of the findings revealed coherence between the teachers’ espoused theories and theories-in-use. Conclusions A mixed-methods approach that combined classroom observations with interviews from a purposeful sample of teachers and students offered a useful evaluation of the extent of student-centredness of teaching and learning of this basic science course. Our case study suggests that this new approach is applicable to other courses in medical education. PMID:25341225

Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy.

PubMed

Holl, Katsiaryna; Sauboin, Christophe; Amodio, Emanuele; Bonanni, Paolo; Gabutti, Giovanni

2016-10-21

Varicella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget. Scenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years. Both one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10-14 years old reduced varicella cases by 27-43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27-31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2-5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination. Vaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme.

Using mixed methods to investigate factors influencing reporting of livestock diseases: a case study among smallholders in Bolivia.

PubMed

Limon, Georgina; Lewis, Elisa G; Chang, Yu-Mei; Ruiz, Hugo; Balanza, Maria Elba; Guitian, Javier

2014-02-01

Livestock disease surveillance is particularly challenging in resource-scarce settings, where disease events are often unreported. Surveillance performance is determined as much by the quantifiable biological attributes of the disease, as it is by motivations and barriers perceived by livestock keepers for disease reporting. Mixed methods designs, which integrate the collection, analysis and interpretation of qualitative and quantitative data in a single study, are increasingly used across different disciplines. These designs allow for a deeper exploration of the topic under investigation, than can be achieved by either approach alone. In this study a mixed methods design was used in order to gain a greater understanding of the factors that influence reporting of livestock diseases in Bolivia. There is a need to strengthen passive surveillance in this country, among other reasons as part of an eradication programme for Foot and Mouth Disease (FMD). Findings revealed livestock keepers in the study area were extremely unlikely to report the occurrence of livestock health events to the Official Veterinary Services (OVS). Communication outside the local community occurs more often through alternative routes and this is positively correlated with disease awareness. The main barriers to disease reporting identified were a lack of institutional credibility and the conflicting priorities of the OVS and livestock keepers. As for other animal and human diseases across the developing world, passive surveillance of livestock diseases in Bolivia should be enhanced; this is urgent in view of the current FMD eradication programme. Increasing timeliness and smallholders' participation requires a detailed understanding of their likely actions and perceived barriers towards disease reporting. These insights are most likely to be developed through a holistic mixed methods approach of quantitative and qualitative analyses. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

RNTCP 2007: looking ahead to future challenges.

PubMed

Chauhan, L S

2007-04-01

The largest TB control programme in terms of patients treated is India's Revised National Tuberculosis Control Programme (RNTCP). The treatment success of new smear positive TB cases under RNTCP has exceeded the global benchmark of 85%. Also there are some challenges in TB control programme eg, addressing TB in HIV-infected persons and accurate diagnosis and management of multidrug resistant TB (MDR-TB). Diagnosis of MDR-TB requires sophisticated laboratories. If MDR-TB is not managed effectively, then there is possibility to emerge drug-resistant TB which is virtually untreatable. The Public-Private mix initiatives of RNTCP attempt to make quality assured treatment for TB for all patients, regardless of healthcare providers they choose. The International Standards of TB Care (ISTC) is an international effort which has articulated the diagnostic, treatment and public health standards which all providers should hold themselves and their peers accountable to. For providers the path to practise the ISTC is to diagnose and treat patients in collaboration with RNTCP. The IMA has taken up the cause of TB control in India very seriously. This organisation of the doctors (IMA) deserves recognition for becoming the first professional association to endorse the ISTC in India. All health providers should work with and support the RNTCP, so that the programme can be made into a genuine mass movement to fight TB.

Examining the Sustainability of Teacher Learning Following a Year-Long Science Professional Development Programme for Inservice Primary School Teachers

ERIC Educational Resources Information Center

Drits-Esser, Dina; Gess-Newsome, Julie; Stark, Louisa A.

2017-01-01

This two-year, mixed-methods study explored teacher learning during a year-long professional development programme and during the year following the programme. The study examined patterns of change in primary school teachers' inquiry practices, inquiry beliefs and physical science content knowledge during both years as well as the effects of…

Contribution of a Professional Development Programme to the Quality and Retention of Teachers in an Urban Environment

ERIC Educational Resources Information Center

Gaikhorst, Lisa; Beishuizen, Jos J.; Zijlstra, Bonne J. H.; Volman, Monique L. L.

2015-01-01

This study examined the effects of a professional development programme aimed at equipping teachers for the challenges of teaching in urban schools. The contribution of the programme to teacher quality and teacher retention was evaluated using a mixed research design in which both quantitative (N?=?133) and qualitative (N?=?42) approaches were…

Reducing the blame culture through clinical audit in nuclear medicine: a mixed methods study.

PubMed

Ross, P; Hubert, J; Wong, W L

2017-02-01

To identify the barriers and facilitators of doctors' engagement with clinical audit and to explore how and why these factors influenced doctors' decisions to engage with the NHS National Clinical Audit Programme. A single-embedded case study. Mixed methods sequential approach with explorative pilot study and follow-up survey. Pilot study comprised 13 semi-structured interviews with purposefully selected consultant doctors over a six-month period. Interview data coded and analysed using directed thematic content analysis with themes compared against the study's propositions. Themes derived from the pilot study informed the online survey question items. Exploratory factor analysis using STATA and descriptive statistical methods applied to summarise findings. Data triangulation techniques used to corroborate and validate findings across the different methodological techniques. NHS National PET-CT Clinical Audit Programme. Doctors reporting on the Audit Programme. Extent of engagement with clinical audit, factors that influence engagement with clinical audit. Online survey: 58/59 doctors responded (98.3%). Audit was found to be initially threatening (79%); audit was reassuring (85%); audit helped validate professional competence (93%); participation in audit improved reporting skills (76%). Three key factors accounted for 97.6% of the variance in survey responses: (1) perception of audit's usefulness, (2) a common purpose, (3) a supportive blame free culture of trust. Factor 1 influenced medical engagement most. The study documents performance feedback as a key facilitator of medical engagement with clinical audit. It found that medical engagement with clinical audit was associated with reduced levels of professional anxiety and higher levels of perceived self-efficacy.

The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care

PubMed Central

Sheringham, Jessica; Solmi, Francesca; Ariti, Cono; Baim-Lance, Abigail; Morris, Steve; Fulop, Naomi J.

2017-01-01

Background Programmes have had limited success in improving guideline adherence for chronic disease. Use of theory is recommended but is often absent in programmes conducted in ‘real-world’ rather than research settings. Materials and methods This mixed-methods study tested a retrospective theory-based approach to evaluate a ‘real-world’ programme in primary care to improve adherence to national guidelines for chronic obstructive pulmonary disease (COPD). Qualitative data, comprising analysis of documents generated throughout the programme (n>300), in-depth interviews with planners (clinicians, managers and improvement experts involved in devising, planning, and implementing the programme, n = 14) and providers (practice clinicians, n = 14) were used to construct programme theories, experiences of implementation and contextual factors influencing care. Quantitative analyses comprised controlled before-and-after analyses to test ‘early’ and evolved’ programme theories with comparators grounded in each theory. ‘Early’ theory predicted the programme would reduce emergency hospital admissions (EHA). It was tested using national analysis of standardized borough-level EHA rates between programme and comparator boroughs. ‘Evolved’ theory predicted practices with higher programme participation would increase guideline adherence and reduce EHA and costs. It was tested using a difference-in-differences analysis with linked primary and secondary care data to compare changes in diagnosis, management, EHA and costs, over time and by programme participation. Results Contrary to programme planners’ predictions in ‘early’ and ‘evolved’ programme theories, admissions did not change following the programme. However, consistent with ‘evolved’ theory, higher guideline adoption occurred in practices with greater programme participation. Conclusions Retrospectively constructing theories based on the ideas of programme planners can enable evaluators to address some limitations encountered when evaluating programmes without a theoretical base. Prospectively articulating theory aided by existing models and mid-range implementation theories may strengthen guideline adoption efforts by prompting planners to scrutinise implementation methods. Benefits of deriving programme theory, with or without the aid of mid-range implementation theories, however, may be limited when the evidence underpinning guidelines is flawed. PMID:28328942

'Never heard of it'- understanding the public's lack of awareness of a new electronic patient record.

PubMed

Bratan, Tanja; Stramer, Katja; Greenhalgh, Trisha

2010-12-01

The introduction of electronic patient records that are accessible by multiple providers raises security issues and requires informed consent - or at the very least, an opportunity to opt out. Introduction of the Summary Care Record (SCR) (a centrally stored electronic summary of a patient's medical record) in pilot sites in the UK was associated with low awareness, despite an intensive public information programme that included letters, posters, leaflets, and road shows. To understand why the public information programme had limited impact and to learn lessons for future programmes. Linguistic and communications analysis of components of the programme, contextualized within a wider mixed-method case study of the introduction of the SCR in pilot sites. Theoretical insights from linguistics and communication studies were applied. The context of the SCR pilots and the linked information programme created inherent challenges which were partially but not fully overcome by the efforts of campaigners. Much effort was put into designing the content of a mail merge letter, but less attention was given to its novelty, linguistic style, and rhetorical appeal. Many recipients viewed this letter as junk mail or propaganda and discarded it unread. Other components of the information programme were characterized by low visibility, partly because only restricted areas were participating in the pilot. Relatively little use was made of interpersonal communication channels. Despite ethical and legal imperatives, informed consent for the introduction of shared electronic records may be difficult to achieve through public information campaigns. Success may be more likely if established principles of effective mass and interpersonal communication are applied. © 2010 Blackwell Publishing Ltd.

Public-private mix for TB and TB-HIV care in Lagos, Nigeria.

PubMed

Daniel, O J; Adedeji Adejumo, O; Abdur-Razzaq, H A; Ngozi Adejumo, E; Salako, A A

2013-09-01

Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.

PLC based automatic control of pasteurize mix in ice cream production

NASA Astrophysics Data System (ADS)

Yao, Xudong; Liang, Kai

2013-03-01

This paper describes the automatic control device of pasteurized mix in the ice cream production process.We design a scheme of control system using FBD program language and develop the programmer in the STEP 7-Micro/WIN software, check for any bugs before downloading into PLC .These developed devices will able to provide flexibility and accuracy to control the step of pasteurized mix. The operator just Input the duration and temperature of pasteurized mix through control panel. All the steps will finish automatically without any intervention in a preprogrammed sequence stored in programmable logic controller (PLC). With the help of this equipment we not only can control the quality of ice cream for various conditions, but also can simplify the production process. This control system is inexpensive and can be widely used in ice cream production industry.

Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial.

PubMed

Bravo-Escobar, Raquel; González-Represas, Alicia; Gómez-González, Adela María; Montiel-Trujillo, Angel; Aguilar-Jimenez, Rafael; Carrasco-Ruíz, Rosa; Salinas-Sánchez, Pablo

2017-02-20

Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk. A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life. No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme. The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life. Retrospectively registered NCT02796404 (May 23, 2016).

The Mixed Proportion of Business Knowledge Courses and English Language Courses in Business English Curriculum Design in China

ERIC Educational Resources Information Center

Zhu, Wenzhong; Liu, Xuyang

2014-01-01

Business English in China has evolved into a degree programme from an ESP teaching programme in the past decades. The degree programme of Business English major intends to cultivate multi-skilled talents of foreign language to better satisfy the real needs of society and economy through curriculum design and teaching method innovation activities.…

Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls.

PubMed

Irvine, Lisa; Conroy, Simon P; Sach, Tracey; Gladman, John R F; Harwood, Rowan H; Kendrick, Denise; Coupland, Carol; Drummond, Avril; Barton, Garry; Masud, Tahir

2010-11-01

multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed. economic evaluation alongside pragmatic randomised controlled trial. randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists. self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve. in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted. the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.

Barriers encountered using skill-mix to deliver caries prevention in dental practices.

PubMed

Hatim, Eman; Kendall, Nick

2012-04-01

This opinion paper provides an analysis of the barriers and successes experienced when developing and implementing a pilot scheme to deliver caries prevention using skill-mix in the National Health Service (NHS) General Dental Services. A training programme was initiated to develop the skills of extended duties dental nurses to deliver fluoride varnish to patients in selected dental practices in Croydon, London, UK. In the light of the evaluation of this programme, a recommendation is made that similar preventive schemes should be delivered in the future within the NHS dental contract.

Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

PubMed

Liang, Li-Lin

2015-04-01

This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

Informing the design of a randomised controlled trial of an exercise-based programme for long term stroke survivors: lessons from a before-and-after case series study

PubMed Central

2013-01-01

Background To inform the design of a randomised controlled trial (RCT) of an exercise-based programme for long term stroke survivors, we conducted a mixed methods before-and-after case series with assessment at three time points. We evaluated Action for Rehabilitation from Neurological Injury (ARNI), a personalised, functionally-focussed programme. It was delivered through 24 hours of one-to-one training by an Exercise Professional (EP), plus at least 2 hours weekly unsupervised exercise, over 12- 14 weeks. Assessment was by patient-rated questionnaires addressing function, physical activity, confidence, fatigue and health-related quality of life; objective assessment of gait quality and speed; qualitative individual interviews conducted with participants. Data were collected at baseline, 3 months and 6 months. Fidelity and acceptability was assessed by participant interviews, audit of participant and EP records, and observation of training. Findings Four of six enrolled participants completed the exercise programme. Quantitative data demonstrated little change across the sample, but marked changes on some measures for some individuals. Qualitative interviews suggested that small benefits in physical outcomes could be of great psychological significance to participants. Participant-reported fatigue levels commonly increased, and non-completers said they found the programme too demanding. Most key components of the intervention were delivered, but there were several potentially important departures from intervention fidelity. Discussion The study provided data and experience that are helping to inform the design of an RCT of this intervention. It suggested the need for a broader recruitment strategy; indicated areas that could be explored in more depth in the qualitative component of the trial; and highlighted issues that should be addressed to enhance and evaluate fidelity, particularly in the preparation and monitoring of intervention providers. The experience illustrates the value of even small sample before-and-after studies in the development of trials of complex interventions. PMID:23941470

Academic Workload Planning for Open and Distance Learning (ODL) Universities: The Experience of National Open University of Nigeria (NOUN)

ERIC Educational Resources Information Center

Inegbedion, Juliet Obhajajie

2017-01-01

The quality of the programmes and courses in ODL depends on the academics that plan the programmes, develop the curriculum, manage courses and programmes and carry out administrative duties. It is observed that the academics often complain of work overload. It also appears there is a mix-up in integrating the mode of planning workload in the…

Theory of plasmonic effects in nonlinear optics: the case of graphene

NASA Astrophysics Data System (ADS)

Rostami, Habib; Katsnelson, Mikhail I.; Polini, Marco; Mikhail I. Katsnelson Collaboration; Habib Rostami; Marco Polini Collaboration

The nonlinear optical properties of two-dimensional electronic systems are beginning to attract considerable interest both in the theoretical and experimental sectors. Recent experiments on the nonlinear optical properties of graphene reveal considerably strong third harmonic generation and four-wave mixing of this single-atomic-layer electronic system. We develop a large-N theory of electron-electron interaction corrections to multi-legged Feynman diagrams describing second- and third-order nonlinear response functions. Our theory is completely general and is useful to understand all second- and third-order nonlinear effects, including harmonic generation, wave mixing, and photon drag. We apply our theoretical framework to the case of graphene, by carrying out microscopic calculations of the second- and third-order nonlinear response functions of an interacting two-dimensional gas of massless Dirac fermions. We compare our results with recent measurements, where all-optical launching of graphene plasmons has been achieved. This work was supported by Fondazione Istituto Italiano di Tecnologia, the European Union's Horizon 2020 research and innovation programme under Grant agreement No. 696656 GrapheneCore, and the ERC Advanced Grant 338957 FEMTO/NANO (M.I.K.).

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences.

PubMed

Naqvi, S A; Naseer, M; Kazi, A; Pethani, A; Naeem, I; Zainab, S; Fatmi, Z

2012-06-01

Six towns of Karachi, Pakistan. 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting. A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate. The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully. Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

On demand nanoliter-scale microfluidic droplet generation, injection, and mixing using a passive microfluidic device

PubMed Central

Tangen, Uwe; Sharma, Abhishek

2015-01-01

We here present and characterize a programmable nanoliter scale droplet-on-demand device that can be used separately or readily integrated into low cost single layer rapid prototyping microfluidic systems for a wide range of user applications. The passive microfluidic device allows external (off-the-shelf) electronically controlled pinch valves to program the delivery of nanoliter scale aqueous droplets from up to 9 different inputs to a central outlet channel. The inputs can be either continuous aqueous fluid streams or microliter scale aqueous plugs embedded in a carrier fluid, in which case the number of effective input solutions that can be employed in an experiment is no longer strongly constrained (100 s–1000 s). Both nanoliter droplet sequencing output and nanoliter-scale droplet mixing are reported with this device. Optimization of the geometry and pressure relationships in the device was achieved in several hardware iterations with the support of open source microfluidic simulation software and equivalent circuit models. The requisite modular control of pressure relationships within the device is accomplished using hydrodynamic barriers and matched resistance channels with three different channel heights, custom parallel reversible microfluidic I/O connections, low dead-volume pinch valves, and a simply adjustable array of external screw valves. Programmable sequences of droplet mixes or chains of droplets can be achieved with the device at low Hz frequencies, limited by device elasticity, and could be further enhanced by valve integration. The chip has already found use in the characterization of droplet bunching during export and the synthesis of a DNA library. PMID:25759752

On demand nanoliter-scale microfluidic droplet generation, injection, and mixing using a passive microfluidic device.

PubMed

Tangen, Uwe; Sharma, Abhishek; Wagler, Patrick; McCaskill, John S

2015-01-01

We here present and characterize a programmable nanoliter scale droplet-on-demand device that can be used separately or readily integrated into low cost single layer rapid prototyping microfluidic systems for a wide range of user applications. The passive microfluidic device allows external (off-the-shelf) electronically controlled pinch valves to program the delivery of nanoliter scale aqueous droplets from up to 9 different inputs to a central outlet channel. The inputs can be either continuous aqueous fluid streams or microliter scale aqueous plugs embedded in a carrier fluid, in which case the number of effective input solutions that can be employed in an experiment is no longer strongly constrained (100 s-1000 s). Both nanoliter droplet sequencing output and nanoliter-scale droplet mixing are reported with this device. Optimization of the geometry and pressure relationships in the device was achieved in several hardware iterations with the support of open source microfluidic simulation software and equivalent circuit models. The requisite modular control of pressure relationships within the device is accomplished using hydrodynamic barriers and matched resistance channels with three different channel heights, custom parallel reversible microfluidic I/O connections, low dead-volume pinch valves, and a simply adjustable array of external screw valves. Programmable sequences of droplet mixes or chains of droplets can be achieved with the device at low Hz frequencies, limited by device elasticity, and could be further enhanced by valve integration. The chip has already found use in the characterization of droplet bunching during export and the synthesis of a DNA library.

Multiple and mixed methods in formative evaluation: Is more better? Reflections from a South African study.

PubMed

Odendaal, Willem; Atkins, Salla; Lewin, Simon

2016-12-15

Formative programme evaluations assess intervention implementation processes, and are seen widely as a way of unlocking the 'black box' of any programme in order to explore and understand why a programme functions as it does. However, few critical assessments of the methods used in such evaluations are available, and there are especially few that reflect on how well the evaluation achieved its objectives. This paper describes a formative evaluation of a community-based lay health worker programme for TB and HIV/AIDS clients across three low-income communities in South Africa. It assesses each of the methods used in relation to the evaluation objectives, and offers suggestions on ways of optimising the use of multiple, mixed-methods within formative evaluations of complex health system interventions. The evaluation's qualitative methods comprised interviews, focus groups, observations and diary keeping. Quantitative methods included a time-and-motion study of the lay health workers' scope of practice and a client survey. The authors conceptualised and conducted the evaluation, and through iterative discussions, assessed the methods used and their results. Overall, the evaluation highlighted programme issues and insights beyond the reach of traditional single methods evaluations. The strengths of the multiple, mixed-methods in this evaluation included a detailed description and nuanced understanding of the programme and its implementation, and triangulation of the perspectives and experiences of clients, lay health workers, and programme managers. However, the use of multiple methods needs to be carefully planned and implemented as this approach can overstretch the logistic and analytic resources of an evaluation. For complex interventions, formative evaluation designs including multiple qualitative and quantitative methods hold distinct advantages over single method evaluations. However, their value is not in the number of methods used, but in how each method matches the evaluation questions and the scientific integrity with which the methods are selected and implemented.

Perspectives on the policy 'black box': a comparative case study of orthopaedics services in England.

PubMed

McLeod, Hugh; Millar, Ross; Goodwin, Nick; Powell, Martin

2014-10-01

There has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led 'central control' programme theory, to one based on 'market forces', on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy 'black box' across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners' ability to influence demand appeared limited with providers' incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms.

The Problem with Reform from the Bottom up: Instructional practises and teacher beliefs of graduate teaching assistants following a reform-minded university teacher certificate programme

NASA Astrophysics Data System (ADS)

Addy, Tracie M.; Blanchard, Margaret R.

2010-05-01

Reform-minded practices are widely encouraged during pre-service science teacher education in concert with national reform documents. This contrasts to the nature of instruction within university science laboratories in which pre-service teachers enrol, which are largely confirmatory in nature. Undergraduate science laboratories are taught predominantly by graduate teaching assistants (GTAs) with minimal teacher preparation. The purpose of this mixed-methods study is to investigate the instructional practices and teacher beliefs of eight GTAs at a university with very high research activity who completed a reform-minded Teacher Certificate Programme, asking: What are their beliefs about teaching? How are their practices described? Do their beliefs and practices differ from one another? Do their teaching beliefs correspond with their practices? Findings indicate that GTAs held moderately reform-minded "transitional" beliefs of teaching following the programme, yet displayed fairly traditional instruction. Cross-case findings highlight similar patterns across subscales of the RTOP that draw attention to underlying constraints of the laboratory curriculum structure. We suggest that GTA professional development is best undertaken concurrent with laboratory course revision.

Health risk behaviours amongst school adolescents: protocol for a mixed methods study.

PubMed

El Achhab, Youness; El Ammari, Abdelghaffar; El Kazdouh, Hicham; Najdi, Adil; Berraho, Mohamed; Tachfouti, Nabil; Lamri, Driss; El Fakir, Samira; Nejjari, Chakib

2016-11-29

Determining risky behaviours of adolescents provides valuable information for designing appropriate intervention programmes for advancing adolescent's health. However, these behaviours are not fully addressed by researchers in a comprehensive approach. We report the protocol of a mixed methods study designed to investigate the health risk behaviours of Moroccan adolescents with the goal of identifying suitable strategies to address their health concerns. We used a sequential two-phase explanatory mixed method study design. The approach begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. In the first phase, the global school-based student health survey (GSHS) was administered to 800 students who were between 14 and 19 years of age. The second phase engaged adolescents, parents and teachers in focus groups and assessed education documents to explore the level of coverage of health education in the programme learnt in the middle school. To obtain opinions about strategies to reduce Moroccan adolescents' health risk behaviours, a nominal group technique will be used. The findings of this mixed methods sequential explanatory study provide insights into the risk behaviours that need to be considered if intervention programmes and preventive strategies are to be designed to promote adolescent's health in the Moroccan school.

Reducing the blame culture through clinical audit in nuclear medicine: a mixed methods study

PubMed Central

Ross, P; Hubert, J

2017-01-01

Objectives To identify the barriers and facilitators of doctors’ engagement with clinical audit and to explore how and why these factors influenced doctors’ decisions to engage with the NHS National Clinical Audit Programme. Design A single-embedded case study. Mixed methods sequential approach with explorative pilot study and follow-up survey. Pilot study comprised 13 semi-structured interviews with purposefully selected consultant doctors over a six-month period. Interview data coded and analysed using directed thematic content analysis with themes compared against the study’s propositions. Themes derived from the pilot study informed the online survey question items. Exploratory factor analysis using STATA and descriptive statistical methods applied to summarise findings. Data triangulation techniques used to corroborate and validate findings across the different methodological techniques. Setting NHS National PET-CT Clinical Audit Programme. Participants Doctors reporting on the Audit Programme. Main Outcome measures Extent of engagement with clinical audit, factors that influence engagement with clinical audit. Results Online survey: 58/59 doctors responded (98.3%). Audit was found to be initially threatening (79%); audit was reassuring (85%); audit helped validate professional competence (93%); participation in audit improved reporting skills (76%). Three key factors accounted for 97.6% of the variance in survey responses: (1) perception of audit’s usefulness, (2) a common purpose, (3) a supportive blame free culture of trust. Factor 1 influenced medical engagement most. Conclusions The study documents performance feedback as a key facilitator of medical engagement with clinical audit. It found that medical engagement with clinical audit was associated with reduced levels of professional anxiety and higher levels of perceived self-efficacy. PMID:28210493

Implementing a Plurilingual Programme in a University in France

ERIC Educational Resources Information Center

Starkey-Perret, Rebecca; Narcy-Combes, Marie-Françoise

2017-01-01

This contribution gives an account of the results of an action research in which a task-based plurilingual programme was implemented with postgraduate students of Foreign Languages and International Business. Using a mixed-methods approach, combining questionnaire, interview and observation data, we sought to explore the degree to which the…

Integrated Learning with International Banking Executives

ERIC Educational Resources Information Center

Zinke, Sabine; Briault, Steve

2007-01-01

The article describes an in-house executive development programme run by the authors in a leading banking group in the CEE region. The programme attempts to follow a systemic approach to learning and contains a mix of elements including action learning, classroom teaching, study, peer support and feedback and "learning visits" to…

Do children's health resources differ according to preschool physical activity programmes and parental behaviour? A mixed methods study.

PubMed

Sterdt, Elena; Pape, Natalie; Kramer, Silke; Liersch, Sebastian; Urban, Michael; Werning, Rolf; Walter, Ulla

2014-02-26

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family-children's central social microsystems-can lead to differences in children's health resources. Using a cross-sectional mixed methods approach, contrast analyses of "preschools with systematic physical activity programmes" versus "preschools without physical activity programmes" were conducted to assess the extent to which children's physical activity, quality of life and social behaviour differ between preschools with systematic and preschools without physical activity programmes. Differences in children's physical activity according to parental behaviour were likewise assessed. Data on child-related outcomes and parent-related factors were collected via parent questionnaires and child interviews. A qualitative focused ethnographic study was performed to obtain deeper insight into the quantitative survey data. Two hundred and twenty seven (227) children were interviewed at 21 preschools with systematic physical activity programmes, and 190 at 25 preschools without physical activity programmes. There was no significant difference in children's physical activity levels between the two preschool types (p = 0.709). However, the qualitative data showed differences in the design and quality of programmes to promote children's physical activity. Data triangulation revealed a strong influence of parental behaviour. The triangulation of methods provided comprehensive insight into the nature and extent of physical activity programmes in preschools and made it possible to capture the associations between systematic physical activity promotion and children's health resources in a differential manner.

The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes.

PubMed

Smith Gueye, Cara; Newby, Gretchen; Tulloch, Jim; Slutsker, Laurence; Tanner, Marcel; Gosling, Roland D

2016-09-22

A malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework. Countries are considering the strategies and tools that will enable progress towards malaria goals. The eliminating malaria case-study series reports were reviewed to identify successful programme management components using a cross-case study analytic approach. Nine out of ten case-study reports were included in the analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for malaria elimination programme management was developed and data were extracted and synthesized. Findings were reviewed at a consultative workshop, which led to a revision of the framework and further data extraction and synthesis. Success factors of implementation, programme choices and changes, and enabling factors were distilled. Decentralized programmes enhanced engagement in malaria elimination by sub-national units and communities. Integration of the malaria programme into other health services was also common. Decentralization and integration were often challenging due to the skill and experience levels of newly tasked staff. Accountability for programme impact was not clarified for most programmes. Motivation of work force was a key factor in maintaining programme quality but there were few clear, detailed strategies provided. Different incentive schemes targeted various stakeholders. Training and supervision, although not well described, were prioritized by most programmes. Multi-sectoral collaboration helped some programmes share information, build strategies and interventions and achieve a higher quality of implementation. In most cases programme action was spurred by malaria outbreaks or a new elimination goal with strong leadership. Some programmes showed high capacity for flexibility through introduction of new strategies and tools. Several case-studies described methods for monitoring implementation quality and coverage; however analysis and feedback to those implementing malaria elimination in the periphery was not well described. Political commitment and sustained financing contributed to malaria programme success. Consistency of malaria programmes depends on political commitment, human and financial resources, and leadership. Operational capacity of the programme and the overall health system structure and strength are also important aspects. Malaria eradication will require adaptive, well-managed malaria programmes that are able to tailor implementation of evidence-based strategies, founded upon strong sub-national surveillance and response, with adequate funding and human resources.

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme

PubMed Central

Nathan, Sally; Rawstorne, Patrick; Hayen, Andrew; Bryant, Joanne; Baldry, Eileen; Ferry, Mark; Williams, Megan; Shanahan, Marian; Jayasinha, Ranmalie

2016-01-01

Introduction Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner. Methods and analysis This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme. Ethics and dissemination Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people. PMID:27225650

Computer-Assisted Learning in UK Engineering Degree Programmes: Lessons Learned from an Extensive Case Study Programme

ERIC Educational Resources Information Center

Rothberg, S. J.; Lamb, F. M.; Willis, L.

2006-01-01

This paper gives a synopsis of an extensive programme of case studies on real uses of computer-assisted learning (CAL) materials within UK engineering degree programmes. The programme was conducted between 2000 and 2003 and followed a questionnaire-based survey looking at CAL use in the UK and in Australia. The synopsis reveals a number of key…

Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment.

PubMed

McLean, R C; Morrison, D S; Shearer, R; Boyle, S; Logue, J

2016-04-01

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2)  = 0.094, P < 0.001 and r(2)  = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes. © 2016 World Obesity.

Effect of horticultural therapy on wellbeing among dementia day care programme participants: A mixed-methods study (Innovative Practice).

PubMed

Hall, Jodi; Mitchell, Gary; Webber, Catherine; Johnson, Karen

2016-04-11

Fourteen people attending an adult day programme were recruited to a structured horticultural therapy programme which took place over 10 weeks. The effects were assessed using Dementia Care Mapping and questionnaires completed by family carers. High levels of wellbeing were observed while the participants were engaged in horticultural therapy, and these were sustained once the programme was completed. This study adds to the growing evidence on the benefits of horticultural therapy for people with dementia who have enjoyed gardening in the past. © The Author(s) 2016.

Sexual Health Promotion Programme: Participants' Perspectives on Capacity Building

ERIC Educational Resources Information Center

Keogh, Brian; Daly, Louise; Sharek, Danika; De Vries, Jan; McCann, Edward; Higgins, Agnes

2016-01-01

Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in…

Participating in the International Baccalaureate Diploma Programme: Developing International Mindedness and Engagement with Local Communities

ERIC Educational Resources Information Center

Belal, Susie

2017-01-01

Although the rapidly expanding International Baccalaureate Diploma Programme (IBDP) is a well-recognized program perceived to offer best practices in education, including developing international mindedness in students and engaging with the local communities, there is little empirical evidence to support these outcomes. This mixed methods case…

An Exploratory Product Evaluation of the Manchester Motor Skills Programme

ERIC Educational Resources Information Center

Lodal, Katherine; Bond, Caroline

2017-01-01

This study is an exploratory product evaluation of the Manchester Motor Skills Programme (MMSP). A mixed methodology was used to explore intended, unintended, positive and negative outcomes for four Key Stage 2 (KS2) children with motor skills difficulties who participated in the MMSP. The children's motor skills, social skills and self-esteem…

Designing and Developing a Programme-Focused Assessment Strategy: A Case Study

ERIC Educational Resources Information Center

Brunton, James; Brown, Mark; Costello, Eamon; Walsh, Elaine

2016-01-01

This case study describes the process that the Humanities Programme Team, in Dublin City University's Open Education Unit, has undertaken with regard to developing a systematic, programme-focused assessment strategy. It charts the development of an Assessment Matrix that facilitated the enhancement of programme coherence in the context of a…

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

PubMed

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.

Programmable Oscillator

NASA Technical Reports Server (NTRS)

Quirk, Kevin J.; Patawaran, Ferze D.; Nguyen, Danh H.; Lee, Clement G.; Nguyen, Huy

2011-01-01

A programmable oscillator is a frequency synthesizer with an output phase that tracks an arbitrary function. An offset, phase-locked loop circuit is used in combination with an error control feedback loop to precisely control the output phase of the oscillator. To down-convert the received signal, several stages of mixing may be employed with the compensation for the time-base distortion of the carrier occurring at any one of those stages. In the Goldstone Solar System Radar (GSSR), the compensation occurs in the mixing from an intermediate frequency (IF), whose value is dependent on the station and band, to a common IF used in the final stage of down-conversion to baseband. The programmable oscillator (PO) is used in the final stage of down-conversion to generate the IF, along with a time-varying phase component that matches the time-base distortion of the carrier, thus removing it from the final down-converted signal.

How can web-based training facilitate a more carer friendly practice in community-based health and social care services in Norway? Staff experiences and implementation challenges.

PubMed

Hanssen, Helene; Norheim, Anne; Hanson, Elizabeth

2017-03-01

It is a central feature of current Norwegian health and social care policy to see informal carers as active partners. However, research has revealed that carers often experience a lack of recognition by professionals. In 2010, the Norwegian Directorate of Health initiated a web-based competence-building programme (CBP) for health and social care practitioners aimed at facilitating collaboration with carers. The programme comprised case presentations, e-lectures, exercises and topics for discussion, and was introduced in 2012. It was flexible and free of charge. This article is based on a study (2012-2013) that followed the piloting of this CBP in four settings. The study aimed to explore factors that influenced the implementation of the programme and whether or not using it affected health and social care practitioners' attitudes and perceived capacity for collaboration with carers. The study employed a mixed-methods design. A questionnaire was distributed to all staff before and 5 months after the CBP was introduced, followed by focus group interviews with a sample of staff members and individual interviews with the leadership in the involved settings and those who introduced the programme. The quantitative data were analysed using descriptive statistics, which subsequently formed the basis for the focus group interviews. The qualitative data were analysed by means of content analysis. The programme's introduction was similar across all research settings. Nevertheless, whether or not it was adopted depended to a large extent on leadership commitment and engagement. In settings where the programme's use was monitored, supported by management and formed part of on-the-job training, there seemed to be a positive impact on staff attitudes concerning collaboration with carers. Participant staff reported that their awareness of, motivation for and confidence in collaboration with carers were all strengthened. In contrast, the programme was of minimal benefit in settings with low leadership engagement. © 2016 John Wiley & Sons Ltd.

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness. © 2016 Nordic College of Caring Science.

[Model project for updating neonatal screening in Bavaria: concept and initial results].

PubMed

Liebl, B; Fingerhut, R; Röschinger, W; Muntau, A; Knerr, I; Olgemöller, B; Zapf, A; Roscher, A A

2000-04-01

The newborn screening programme in Bavaria was confronted with several problems. Number of disorders and process quality no longer complied with screening guidelines. Mixed financing, distributed between the state (PKU, galactosaemia) and health insurances (hypothyroidism) had promoted an increasing dissipation of the system. Notified participation rates had dropped to < 80%. Increasing need for a second screening due to early discharge was an additional challenge. To overcome these problems, and considering the availability of improved screening methodology (tandem mass spectrometry) the programme was reorganised. The project, which started on Jan 1, 1999, is based on a cooperation model between laboratory (logistics, analysis), universities (treatment, scientific evaluation), and public health services (coordination, tracking). Time of blood sampling was predated to the third day of life. Screening was extended to biotinidase deficiency, congenital adrenal hyperplasia (CAH) and by introduction of tandem mass spectrometry for screening of many other disorders (besides PKU). Insurances now finance complete laboratory analysis which was transferred to the private sector. To enable all newborn to participate, the names of screened children are matched against birth lists by public health services on a regional basis. Recalls and conspicuous results are consistently followed up until disorders are either excluded or confirmed. Two clinical hotlines were established in the children's hospitals of the universities in Munich (Southern Bavaria) and in Erlangen (Northern Bavaria). Written consent is required for participation in the programme. Participation in the new programme could be continually increased; coverage is > 95% since April. In several cases screening was made up for not tested children by contacting their parents. Omitted screening was mostly due to misunderstandings regarding testing responsibility or lost samples. Altogether 52 cases of disorder were found in the 87,000 newborn screened until August 1999. Hence, the detection rate of children affected by inborn errors of metabolism was about twice as high than before changes. Among the newly screened diseases CAH was detected most often (11 cases). In 22 cases diagnosis was based on the use of tandem mass spectrometry. Among these (besides PKU, 9 cases) MCAD deficiency (6 cases) was detected most frequently. Whereas recall rates of most disorders were < 0.1%, screening for CAH still revealed a high recall rate, particularly in premature births. Second screening due to early discharge (< 48 h) was required in 1.3%. About 20% of pending recalls required contacting birth hospitals, doctors, midwives or parents. So far all affected children could be brought to treatment in time.

Genome analysis of Legionella pneumophila strains using a mixed-genome microarray.

PubMed

Euser, Sjoerd M; Nagelkerke, Nico J; Schuren, Frank; Jansen, Ruud; Den Boer, Jeroen W

2012-01-01

Legionella, the causative agent for Legionnaires' disease, is ubiquitous in both natural and man-made aquatic environments. The distribution of Legionella genotypes within clinical strains is significantly different from that found in environmental strains. Developing novel genotypic methods that offer the ability to distinguish clinical from environmental strains could help to focus on more relevant (virulent) Legionella species in control efforts. Mixed-genome microarray data can be used to perform a comparative-genome analysis of strain collections, and advanced statistical approaches, such as the Random Forest algorithm are available to process these data. Microarray analysis was performed on a collection of 222 Legionella pneumophila strains, which included patient-derived strains from notified cases in The Netherlands in the period 2002-2006 and the environmental strains that were collected during the source investigation for those patients within the Dutch National Legionella Outbreak Detection Programme. The Random Forest algorithm combined with a logistic regression model was used to select predictive markers and to construct a predictive model that could discriminate between strains from different origin: clinical or environmental. Four genetic markers were selected that correctly predicted 96% of the clinical strains and 66% of the environmental strains collected within the Dutch National Legionella Outbreak Detection Programme. The Random Forest algorithm is well suited for the development of prediction models that use mixed-genome microarray data to discriminate between Legionella strains from different origin. The identification of these predictive genetic markers could offer the possibility to identify virulence factors within the Legionella genome, which in the future may be implemented in the daily practice of controlling Legionella in the public health environment.

A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery.

PubMed

Dai, Ying; Livesley, Joan

2018-05-13

To explore the effectiveness of preoperative psychological preparation programmes aimed to reduce paediatric preoperative anxiety and the potential factors that could have an impact on parent and children's acceptance of such interventions. Various preoperative psychological preparation programmes are available to address paediatric preoperative anxiety. No mixed-method review has been conducted to explore the effectiveness and acceptability of these programmes. A mixed-method systematic review. Seven bibliographic databases were searched from inception to September 2016, complemented by hand searching of key journals, the reference lists of relevant reviews, search for grey literature and the contacting of associated experts. The review process was conducted based on the framework developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. A narrative summary and a thematic synthesis were developed to synthesise the quantitative and qualitative data respectively, followed by a third synthesis to combine the previous syntheses. Nineteen controlled trials and eleven qualitative studies were included for data synthesis. The controlled trials reveal that educational multimedia applications and web-based programmes may reduce paediatric preoperative anxiety, while the effectiveness of therapeutic play and books remains uncertain. Qualitative studies showed parent-child dyads seek different levels of information. Providing matched information provision to each parent and child, actively involving children and their parents and teaching them coping skills, may be the essential hallmarks of a successful preoperative psychological preparation. Further research is necessary to confirm the effectiveness of therapeutic play and books. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Can Education Innovations Be Sustained after the End of Donor Funding? The Case of a Reading Intervention Programme in Zambia

ERIC Educational Resources Information Center

Kombe, Charity Lengwe Meki Kombe; Herman, Chaya

2017-01-01

This article explores the sustainability of donor-supported innovations in the education sector. Accordingly, a case study was conducted of a programme (Primary Reading Programme) implemented in Zambian primary schools which was intended to improve literacy levels. The programme was initially supported by the Department for International…

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

PubMed

Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca

2017-06-01

To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.

Investigating the Differential Effectiveness of a Teacher Professional Development Programme for Rural and Urban Classrooms in Indonesia

ERIC Educational Resources Information Center

Soebari, Titien; Aldridge, Jill M.

2016-01-01

This article reports on the differential effectiveness of a teacher professional development programme for teachers in urban and rural schools in Indonesia. The study employed an embedded mixed methods design that involved the concurrent collection of both quantitative and qualitative data. The quantitative component involved a pre-post design in…

Design and Effects of an Academic Development Programme on Leadership for Educational Change

ERIC Educational Resources Information Center

Grunefeld, Hetty; van Tartwijk, Jan; Jongen, Havva; Wubbels, Theo

2015-01-01

This article describes and assesses the design and effects of one of the first academic development programmes on Leadership for Educational Change. The participants are senior academics, involved in leadership of teaching and learning. We report on an evaluation using a mixed-method approach employing a self-report questionnaire administered to…

Student Perceptions of Academic Service Learning: Using Mixed Content Analysis to Examine the Effectiveness of the International Baccalaureate Creativity, Action, Service Programme

ERIC Educational Resources Information Center

Hatziconstantis, Christos; Kolympari, Tania

2016-01-01

The International Baccalaureate Diploma Programme for secondary education students requires the successful completion of the Creativity, Action, Service (CAS) component (more recently renamed Creativity, Activity, Service) which is based on the philosophy of experiential learning and Academic Service Learning. In this article, the technique of…

Implementation of the World Starts with Me, a Comprehensive Rights-Based Sex Education Programme in Uganda

ERIC Educational Resources Information Center

Rijsdijk, Liesbeth E.; Bos, Arjan E. R.; Lie, Rico; Leerlooijer, Joanne N.; Eiling, Ellen; Atema, Vera; Gebhardt, Winifred A.; Ruiter, Robert A. C.

2014-01-01

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation…

Engendering Entrepreneurial Competencies in the Youth of Today: A Teacher's Perspective

ERIC Educational Resources Information Center

Birdthistle, Naomi; Costin, Yvonne; Hynes, Briga

2016-01-01

Purpose: The purpose of this paper is to examine the creation of realistic, engaging entrepreneurial competencies in second-level students in the Republic of Ireland through the Student Enterprise Awards (SEA) programme. The focus of the paper will be on the interaction of teachers with the programme. Design/methodology/approach: A mixed-methods…

Postgraduate Work-Based Learning Programmes in English Higher Education: Exploring Case Studies of Organizational Practice

ERIC Educational Resources Information Center

Smith, Paul; Preece, David

2009-01-01

The first part of the paper outlines and discusses the nature of work-based learning (WBL) and WBL programmes, and the overall direction of government strategy towards WBL programmes in Higher Education (HE) in England, with particular reference to postgraduate programmes, policy documents, and the WBL literature. Drawing upon case study research,…

Distributed Simulation as a modelling tool for the development of a simulation-based training programme for cardiovascular specialties.

PubMed

Kelay, Tanika; Chan, Kah Leong; Ako, Emmanuel; Yasin, Mohammad; Costopoulos, Charis; Gold, Matthew; Kneebone, Roger K; Malik, Iqbal S; Bello, Fernando

2017-01-01

Distributed Simulation is the concept of portable, high-fidelity immersive simulation. Here, it is used for the development of a simulation-based training programme for cardiovascular specialities. We present an evidence base for how accessible, portable and self-contained simulated environments can be effectively utilised for the modelling, development and testing of a complex training framework and assessment methodology. Iterative user feedback through mixed-methods evaluation techniques resulted in the implementation of the training programme. Four phases were involved in the development of our immersive simulation-based training programme: ( 1) initial conceptual stage for mapping structural criteria and parameters of the simulation training framework and scenario development ( n  = 16), (2) training facility design using Distributed Simulation , (3) test cases with clinicians ( n  = 8) and collaborative design, where evaluation and user feedback involved a mixed-methods approach featuring (a) quantitative surveys to evaluate the realism and perceived educational relevance of the simulation format and framework for training and (b) qualitative semi-structured interviews to capture detailed feedback including changes and scope for development. Refinements were made iteratively to the simulation framework based on user feedback, resulting in (4) transition towards implementation of the simulation training framework, involving consistent quantitative evaluation techniques for clinicians ( n  = 62). For comparative purposes, clinicians' initial quantitative mean evaluation scores for realism of the simulation training framework, realism of the training facility and relevance for training ( n  = 8) are presented longitudinally, alongside feedback throughout the development stages from concept to delivery, including the implementation stage ( n  = 62). Initially, mean evaluation scores fluctuated from low to average, rising incrementally. This corresponded with the qualitative component, which augmented the quantitative findings; trainees' user feedback was used to perform iterative refinements to the simulation design and components (collaborative design), resulting in higher mean evaluation scores leading up to the implementation phase. Through application of innovative Distributed Simulation techniques, collaborative design, and consistent evaluation techniques from conceptual, development, and implementation stages, fully immersive simulation techniques for cardiovascular specialities are achievable and have the potential to be implemented more broadly.

Optical triple-in digital logic using nonlinear optical four-wave mixing

NASA Astrophysics Data System (ADS)

Widjaja, Joewono; Tomita, Yasuo

1995-08-01

A new programmable optical processor is proposed for implementing triple-in combinatorial digital logic that uses four-wave mixing. Binary-coded decimal-to-octal decoding is experimentally demonstrated by use of a photorefractive BaTiO 3 crystal. The result confirms the feasibility of the proposed system.

Oral Narrative Intervention for Children with Mixed Reading Disability

ERIC Educational Resources Information Center

Westerveld, Marleen F.; Gillon, Gail T.

2008-01-01

Ten children (aged between 7;11 and 9;2) with mixed reading disability participated in an oral narrative intervention programme that focused on enhancing children's story structure knowledge. The participants had all demonstrated persistent reading and oral narrative comprehension and production difficulties in a two-year longitudinal study prior…

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme.

PubMed

Nathan, Sally; Rawstorne, Patrick; Hayen, Andrew; Bryant, Joanne; Baldry, Eileen; Ferry, Mark; Williams, Megan; Shanahan, Marian; Jayasinha, Ranmalie

2016-05-25

Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner. This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme. Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

"You Have to Be a Bit Brave": Barriers to Scottish Student-Teachers' Participation in Study-Abroad Programmes

ERIC Educational Resources Information Center

Santoro, Ninetta; Sosu, Edward; Fassetta, Giovanna

2016-01-01

This article reports on a study that examined Scottish student teachers' attitudes to study-abroad and the reasons underpinning their reluctance to participate in these programmes. Data collection comprised a mixed-methods approach consisting of a survey of 318 student-teachers in one Scottish university followed by semi-structured interviews with…

A Mixed-Methods Evaluation of the Longer-Term Implementation and Utility of a Teacher Classroom Management Training Programme in Irish Primary Schools

ERIC Educational Resources Information Center

Leckey, Yvonne; Hyland, Lynda; Hickey, Gráinne; Lodge, Anne; Kelly, Paul; Bywater, Tracey; Comiskey, Catherine; Donnelly, Michael; McGilloway, Sinéad

2016-01-01

Inappropriate, aggressive and disruptive behaviour in the classroom can be detrimental to child and teacher well-being. This study involved a longer-term evaluation of the "Incredible Years Teacher [Classroom Management]" programme (IYTP) undertaken mainly within disadvantaged schools in south-west Ireland. The IYTP is designed to…

Educator Perspectives on the Use of Alternative Assessment Methods within Taught Masters Programmes: An Exploratory Study Using Activity Theory and Q Methodology

ERIC Educational Resources Information Center

Deignan, Tim; Brown, Sally

2016-01-01

This article reports on an exploratory two-stage sequential mixed methods research study that investigated the views of university educators on the introduction of assessment methods other than essays, exams and dissertations within taught Masters programmes. In the first stage, interviews were conducted internationally with 45 participants and…

The need for theory evaluation in global citizenship programmes: The case of the GCSA programme.

PubMed

Goodier, Sarah; Field, Carren; Goodman, Suki

2018-02-01

Many education programmes lack a documented programme theory. This is a problem for programme planners and evaluators as the ability to measure programme success is grounded in the plausibility of the programme's underlying causal logic. Where the programme theory has not been documented, conducting a theory evaluation offers a foundational evaluation step as it gives an indication of whether the theory behind a programme is sound. This paper presents a case of a theory evaluation of a Global Citizenship programme at a top-ranking university in South Africa, subsequently called the GCSA Programme. This evaluation highlights the need for documented programme theory in global citizenship-type programmes for future programme development. An articulated programme theory produced for the GCSA Programme, analysed against the available social science literature, indicated it is comparable to other such programmes in terms of its overarching framework. What the research found is that most other global citizenship programmes do not have an articulated programme theory. These programmes also do not explicitly link their specific activities to their intended outcomes, making demonstrating impact impossible. In conclusion, we argue that taking a theory-based approach can strengthen and enable outcome evaluations in global citizenship programmes. Copyright © 2017. Published by Elsevier Ltd.

A mixed method, multiperspective evaluation of a near peer teaching programme.

PubMed

Lydon, Sinéad; O'Connor, Paul; Mongan, Orla; Gorecka, Miroslawa; McVicker, Lyle; Stankard, Aiden; Byrne, Dara

2017-09-01

Peer teaching (PT) has become increasingly popular. PT may offer benefits for students, tutors and institutions. Although resistance to PT has been identified among faculty, research has typically focused on students' experiences and perceptions, rather than those of the peer tutors or senior doctors/medical faculty. The current study comprised of a comprehensive, multiperspective evaluation of a near PT programme delivered by interns to final-year medical students in the Republic of Ireland. This study employed a mixed methods design, using both interviews and questionnaires to assess students' (n=130), interns' (n=49) and medical faculty's or senior doctors' (n=29) perceptions of the programme. All three groups were emphatic about the programme's benefits, although senior doctors and faculty reported significantly more positive attitudes than the others. Mean ratings of the programme's value, out of 10, were 8.2 among students, 8.2 among interns and 9.1 among senior doctors and faculty. Challenges identified were largely organisational in nature. Perceived benefits for students included the informality of teaching sessions, increased opportunities in the clinical environment and improvements in exam preparedness. Perceived benefits for the interns included improvements in knowledge and teaching ability and experience as a role model. PT programmes have been posited as an 'easy fix' to growing numbers of students. However, it is apparent that PT has substantial value outside of this. Future research that conducts economic evaluations of such programmes and that collects objective data on teaching quality and student learning would be of much interest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care.

PubMed

Newby, J M; Mackenzie, A; Williams, A D; McIntyre, K; Watts, S; Wong, N; Andrews, G

2013-12-01

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have the highest co-morbidity rates within the internalizing disorders cluster, yet no Internet-based cognitive behavioural therapy (iCBT) programme exists for their combined treatment. We designed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression. Study 1 was a randomized controlled trial (RCT) comparing the iCBT programme (n = 46) versus wait-list control (WLC; n = 53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the Patient Health Questionnaire nine-item scale (depression), Generalized Anxiety Disorder seven-item scale (generalized anxiety), Kessler 10-item Psychological Distress scale (distress) and 12-item World Health Organization Disability Assessment Schedule II (disability). The iCBT group was followed up at 3 months post-treatment. In study 2, we investigated the adherence to, and efficacy of the same programme in a primary care setting, where patients (n = 136) completed the programme under the supervision of primary care clinicians. The RCT showed that the iCBT programme was more effective than WLC, with large within- and between-groups effect sizes found (>0.8). Adherence was also high (89%), and gains were maintained at 3-month follow-up. In study 2 in primary care, adherence to the iCBT programme was low (41%), yet effect sizes were large (>0.8). Of the non-completers, 30% experienced benefit. Together, the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the 'real world'. Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.

Extracurricular leadership development programme to prepare future Saudi physicians as leaders.

PubMed

Ayuob, Nasra Naeim; Al Sayes, Faten Mohamed; El Deek, Basem Salama

2016-06-01

To describe and evaluate an innovative approach for developing leadership skills in a cohort of medical students through an extracurricular programme. The study was conducted at King Abdulaziz University, Jeddah, Saudi Arabia, from April to June of the academic year 2014-15, and comprised medical students from all batches. Mixed-method design was used to evaluate the leadership development programme. Pre- and post-tests were conducted to assess students' learning and their satisfaction was evaluated at the end of the programme. Focus groups were conducted to assess the programme's impact on participants' behaviour. Data analysis was done using SPSS 16. Of the 55 participants, 45(82%) responded to the evaluation survey. Of them, 29(65%) reported intended changes in their leadership practices immediately after the programme, with 8(28%) of them reporting more than one change. The mean students' satisfaction with the overall performance of the speakers and programme organisation was high at 4.12±0.91 and 4.54±0.89, respectively. Early experience of the leadership development programme produced positive results. An intense programme analysis is required to fully understand this significant organisational need.

Performance of the National Tuberculosis Control Program in the post conflict Liberia.

PubMed

Desta, Kassaye Tekie; Masango, T E; Nkosi, Zerish Zethu

2018-01-01

Tuberculosis is a major public health problem in Liberia. According to the World Health Organization (WHO), the incidence of tuberculosis in Liberia is significantly increasing from year to year. However, little is known about the performance of the programme and the challenges after the 14 years of civil war which ended in 2003.The purpose of the study was to evaluate the performance of the TB programme of Liberia. The study utilised mixed research design; both quantitative and qualitative methods were used in this study conducted from 2013 to 2014. For the quantitative part of the study, a questionnaire, laboratory performance and eleven years TB programme data (2003-2013) were used. For the performance of tuberculosis laboratory testing, all the 107 functional tuberculosis microscopy centers in Liberia were included. For the qualitative part of the study, an interview of 10 informants and two focus group discussions (FGDs) were also conducted, each comprising of eight people. Themes and subthemes emerged from the two FGDs. Data was analysed in line with the Donabedian model. Quantitative findings were analysed and presented using both descriptive and inferential statistics. The study findings pointed out that there was overall improvement in the performance of the tuberculosis control programme in Liberia from 2003 to 2013. The percentage of cured patients was 60% in 2005 and 62% in 2013. Percentage of treatment completed was 16% in 2005 and 21% in 2013. The case detection rate was 57% and treatment success rate 80% in 2013. The default rate was 11% in 2013. Of the 139 participants, 120 (86%) completed TB treatment while 19 (14%) did not. Between 2003 and 2013, the National Leprosy and Tuberculosis Control Programme (NLTCP) succeeded in restoring the TB services and improving some of the TB treatment outcomes including the Directly observed treatment short courses(DOTS) coverage. Despite these improvements, the TB treatment, laboratory services and human resource capacity lagged behind. The TB programme of Liberia needs to develop new strategies to address its challenges.

Collaborative Learning from Personal Cases in a Principal Preparation Programme

ERIC Educational Resources Information Center

Shaked, Haim; Schechter, Chen; Michalsky, Tova

2018-01-01

Existing preparation programmes for school principals have been widely criticized for failing to prepare their students adequately for their future roles. This study investigated a workshop at a principal preparation programme which focused on collaborative learning from personal real-life cases, exploring its potential contribution to the…

Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.

PubMed

Gopinathan, Unni; Lewin, Simon; Glenton, Claire

2014-12-01

To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout. © 2014 John Wiley & Sons Ltd.

Narrowing the Gender Gap:Empowering Women through Literacy Programmes: Case Studies from the UNESCO Effective Literacy and Numeracy Practices Database (LitBase) http://www.unesco.org/uil/litbase/. 2nd Edition

ERIC Educational Resources Information Center

Hanemann, Ulrike, Ed.

2015-01-01

UIL has published a second edition of a collection of case studies of promising literacy programmes that seek to empower women. "Narrowing the Gender Gap: Empowering Women through Literacy Programmes" (originally published in 2013 as "Literacy Programmes with a Focus on Women to Reduce Gender Disparities") responds to the…

Fighting malaria in Madhya Pradesh (Central India): Are we loosing the battle?

PubMed Central

Singh, Neeru; Dash, Aditya P; Thimasarn, Krongthong

2009-01-01

Malaria control in Madhya Pradesh is complex because of vast tracts of forest with tribal settlement. Fifty four million individuals of various ethnic origins, accounting for 8% of the total population of India, contributed 30% of total malaria cases, 60% of total falciparum cases and 50% of malaria deaths in the country. Ambitious goals to control tribal malaria by launching "Enhanced Malaria Control Project" (EMCP) by the National Vector Borne Disease Control Programme (NVBDCP), with the World Bank assistance, became effective in September 1997 in eight north Indian states. Under EMCP, the programme used a broader mix of new interventions, i.e. insecticide-treated bed nets, spraying houses with effective residual insecticides, use of larvivorous fishes, rapid diagnostic tests for prompt diagnosis, treatment of the sick with effective radical treatment and increased public awareness and IEC. However, the challenge is to scale up these services. A retrospective analysis of data on malaria morbidity and associated mortality reported under the existing surveillance system of the Madhya Pradesh (Central India) for the years 1996–2007 was carried out to determine the impact of EMCP on malaria morbidity and associated mortality. Analysis revealed that despite the availability of effective intervention tools for the prevention and control of malaria, falciparum malaria remains uncontrolled and deaths due to malaria have increased. Precisely, the aim of this epidemiological analysis is to draw lessons applicable to all international aid efforts, bureaucracy, policy makers and programme managers in assessing its project performance as a new Global Malaria Action Plan is launched with ambitious goal of reducing malaria and its elimination by scaling up the use of existing tools. PMID:19419588

Do Children’s Health Resources Differ According to Preschool Physical Activity Programmes and Parental Behaviour? A Mixed Methods Study

PubMed Central

Sterdt, Elena; Pape, Natalie; Kramer, Silke; Liersch, Sebastian; Urban, Michael; Werning, Rolf; Walter, Ulla

2014-01-01

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family—children’s central social microsystems—can lead to differences in children’s health resources. Using a cross-sectional mixed methods approach, contrast analyses of “preschools with systematic physical activity programmes” versus “preschools without physical activity programmes” were conducted to assess the extent to which children’s physical activity, quality of life and social behaviour differ between preschools with systematic and preschools without physical activity programmes. Differences in children’s physical activity according to parental behaviour were likewise assessed. Data on child-related outcomes and parent-related factors were collected via parent questionnaires and child interviews. A qualitative focused ethnographic study was performed to obtain deeper insight into the quantitative survey data. Two hundred and twenty seven (227) children were interviewed at 21 preschools with systematic physical activity programmes, and 190 at 25 preschools without physical activity programmes. There was no significant difference in children’s physical activity levels between the two preschool types (p = 0.709). However, the qualitative data showed differences in the design and quality of programmes to promote children’s physical activity. Data triangulation revealed a strong influence of parental behaviour. The triangulation of methods provided comprehensive insight into the nature and extent of physical activity programmes in preschools and made it possible to capture the associations between systematic physical activity promotion and children’s health resources in a differential manner. PMID:24577283

Mixed methods evaluation of an interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability.

PubMed

Higgins, Agnes; Sharek, Danika; Nolan, Maeve; Sheerin, Barbara; Flanagan, Paul; Slaicuinaite, Sniguole; Mc Donnell, Sinead; Walsh, Heather

2012-11-01

.  To report a study evaluating the effectiveness of a 1-day interdisciplinary sexuality education programme for staff working with people with acquired physical disability.   Changes associated with an acquired physical disability can diminish a person's self-esteem, sense of attractiveness, relationships, and sexual functioning. Research suggests that people are dissatisfied with the quality of information and support around sexuality during their rehabilitation.   A mixed methods design was used, involving pretest and posttest questionnaires and interviews. Questionnaire data were analysed using descriptive statistics and paired samples t-tests to evaluate the effects of the programme on knowledge, skills, and comfort. Interview data were analyzed thematically, with particular emphasis on participants' opinions about the application of the course within practice. Participants were working in the area of acquired disability and rehabilitation, and were drawn from a number of disciplines. Data were collected between 2008-2009.   Comparison of the pre- and postmeasures, based on paired samples t-tests, showed that the programme statistically significantly increased participants' knowledge, skills, and comfort. Participants felt positive and enthusiastic about the programme and reported numerous incidents where they were more willing to raise issues for discussion and create a supportive listening space for patients to talk about their concerns around sexuality.   Providing healthcare practitioners with a 1-day programme leads to positive changes in knowledge, skills, and comfort towards sexuality. Sexuality education may be an ideal topic for bringing practitioners together within an interdisciplinary education context. © 2012 Blackwell Publishing Ltd.

[Assessment of geriatric patients' care needs based on sosia classification: the reality of the lombardy region in nursing home.

PubMed

Vanalli, Mariangela

2016-11-01

The increased demand to care that originates from demographic changes called in Italy a rapid development in Nursing Home with particular emergency the problem of programme the welfare response. It is essential the development of a classification system able to describe the stratification of the case mix on the basis of the care requirements, allowing a remuneration in function of the complexity care. Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty. In the present study the agreement between SOSIA classification and other well documented instruments, including Barthel Index, Mini-Mental State Examination on the basis of three indicators (mobility, cognition, comorbidity) is evaluated in eight classes of frailty. However, it is not any research project was published in order to assess the agreement between SOSIA classification and other measuring instruments. Although various methods exist by which researchers have attempted to measure the need for nursing care, there is no nationally accepted system for determining the total amount of registered nursing resources required by residents in long-term care. The aim of this study was to evaluate the correlation between SOSIA and filing systems widely used, such as the degree of Barthel disability rating scale, the Mini-Mental State Examination to offer care appropriate for the case-mix. Only the higher complexity care has classified in the first two classes, while the remaining levels has categorized in the lowest paid. Misclassification therefore induces an underestimation of the real care needs and, consequently, inadequate remuneration.

Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme - a mixed-methods study in stroke care.

PubMed

Loft, M I; Esbensen, B A; Kirk, K; Pedersen, L; Martinsen, B; Iversen, H; Mathiesen, L L; Poulsen, I

2018-01-01

During the past two decades, attempts have been made to describe nurses' contributions to the rehabilitation of inpatients following stroke. There is currently a lack of interventions that integrate the diversity of nurses' role and functions in stroke rehabilitation and explore their effect on patient outcomes. Using a systematic evidence- and theory-based design, we developed an educational programme, Rehabilitation 24/7, for nursing staff working in stroke rehabilitation aiming at two target behaviours; working systematically with a rehabilitative approach in all aspects of patient care and working deliberately and systematically with patients' goals. The aim of this study was to assess nursing staff members' self-perceived outcome related to their capability, opportunity and motivation to work with a rehabilitative approach after participating in the stroke Rehabilitation 24/7 educational programme. A convergent mixed-method design was applied consisting of a survey and semi-structured interviews. Data collection was undertaken between February and June 2016. Data from the questionnaires ( N  = 33) distributed before and after the intervention were analysed using descriptive statistics and Wilcoxon sign rank test. The interviews ( N  = 10) were analysed using deductive content analysis. After analysing questionnaires and interviews separately, the results were merged in a side by side comparison presented in the discussion. The results from both the quantitative and qualitative analyses indicate that the educational programme shaped the target behaviours that we aimed to change by addressing the nursing staff's capability, opportunity and motivation and hence could strengthen the nursing staff's contribution to inpatient stroke rehabilitation. A number of behaviours changed significantly, and the qualitative results indicated that the staff experienced increased focus on their role and functions in rehabilitation practice. Our study provides an understanding of the outcome of the Rehabilitation 24/7 educational programme on nursing staff's behaviours. A mixed-methods approach provided extended knowledge of the changes in the nursing staff members' self-percived behaviours after the intervention. These changes suggest that educating the nursing staff on rehabilitation using the Rehabilitation 24/7 programme strengthened their knowledge and beliefs about rehabilitation, goal-setting as well as their role and functions .

`Discover, Understand, Implement, and Transfer': Effectiveness of an intervention programme to motivate students for science

NASA Astrophysics Data System (ADS)

Schütte, Kerstin; Köller, Olaf

2015-09-01

Considerable research has focused on how best to satisfy modern societies' needs for skilled labour in the field of science. The present study evaluated an intervention programme designed to increase secondary school students' motivation to pursue a science career. Students from 3 schools of the highest educational track participated for up to 2 years in the intervention programme, which was implemented as an elective in the school curriculum. Our longitudinal study design for evaluating the effectiveness of the intervention programme included all students at the grade levels involved in the programme with students who did not participate serving as a control group. Mixed-model analyses of variance showed none of the intended effects of the intervention programme on science motivation; latent growth models corroborated these results. When the programme began, students who enrolled in the science elective (n = 92) were already substantially more motivated than their classmates (n = 228). Offering such an intervention programme as an elective did not further increase the participating students' science motivation. It seems worthwhile to carry out intervention programmes with talented students who show (comparatively) little interest in science at the outset rather than with highly motivated students who self-select into the programme.

Measuring interdisciplinary research and education outcomes in the Vienna Doctoral Programme on Water Resource Systems

NASA Astrophysics Data System (ADS)

Carr, Gemma; Loucks, Daniel Pete; Blaschke, Alfred Paul; Bucher, Christian; Farnleitner, Andreas; Fürnkranz-Prskawetz, Alexia; Parajka, Juraj; Pfeifer, Norbert; Rechberger, Helmut; Wagner, Wolfgang; Zessner, Matthias; Blöschl, Günter

2015-04-01

The interdisciplinary postgraduate research and education programme - the Vienna Doctoral Programme on Water Resource Systems - was initiated in 2009. To date, 35 research students, three post-docs and ten faculty members have been engaged in the Programme, from ten research fields (aquatic microbiology, hydrology, hydro-climatology, hydro-geology, mathematical economics, photogrammetry, remote sensing, resource management, structural mechanics, and water quality). The Programme aims to develop research students with the capacity to work across the disciplines, to conduct cutting edge research and foster an international perspective. To do this, a variety of mechanisms are adopted that include research cluster groups, joint study sites, joint supervision, a basic study programme and a research semester abroad. The Programme offers a unique case study to explore if and how these mechanisms lead to research and education outcomes. Outcomes are grouped according to whether they are tangible (publications with co-authors from more than one research field, analysis of graduate profiles and career destinations) or non-tangible (interaction between researchers, networks and trust). A mixed methods approach that includes bibliometric analysis combined with interviews with students is applied. Bibliometric analysis shows that as the Programme has evolved the amount of multi-disciplinary work has increased (32% of the 203 full papers produced by the programme's researchers have authors from more than one research field). Network analysis to explore which research fields collaborate most frequently show that hydrology plays a significant role and has collaborated with seven of the ten research fields. Hydrology researchers seem to interact the most strongly with other research fields as they contribute understanding on water system processes. Network analysis to explore which individuals collaborate shows that much joint work takes place through the five research cluster groups (water resource management, land-surface processes, Hydrological Open Air Laboratory, water and health, modelling and risk). Student interviews highlight that trust between colleagues and supervisors, and the role of spaces for interaction (joint study sites, cluster group meetings, shared offices etc.) are important for joint work. Graduate analysis shows that students develop skills and confidence to work across disciplines through collaborating on their doctoral research. Working collaboratively during the doctorate appears to be strongly correlated with continuing to work in this way after graduation.

Paediatric cardiac intensive care unit: current setting and organization in 2010.

PubMed

Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

2010-10-01

Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

The Case for an Integrated Approach to Transition Programmes at South Africa's Higher Education Institutions

ERIC Educational Resources Information Center

Young, Dallin George

2016-01-01

This paper advocates an integrated approach to transition programmes at South Africa's higher education institutions through drawing on the US literature on the first-year student experience and specific reference to behavioural interaction theory. The case for developing intentional and vertically integrated transition programmes is tied to: the…

Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study

PubMed Central

Walker, Jane; Burke, Katy; Sevdalis, Nick; Richardson, Alison; Mulick, Amy; Frost, Chris; Sharpe, Michael

2017-01-01

Introduction There is growing awareness that cancer services need to address patients’ well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients’ symptoms including depression using a ‘Symptom Monitoring Service’ and (2) providing treatment for those with major depression using a programme called ‘Depression Care for People with Cancer’. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients’ and clinicians’ experience of the programmes. Methods and analysis This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016–December 2018): ‘Pre-implementation’ (setting up of the new programmes), ‘Early Implementation’ (implementation of the programmes in a small number of clinics) and ‘Implementation and Maintenance’ (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. Ethics and dissemination The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford’s Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences. PMID:28674143

Alternative perspectives of safety in home delivered health care: a sequential exploratory mixed method study.

PubMed

Jones, Sarahjane

2016-10-01

The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. A sequential, exploratory mixed method design. A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients (n = 9) and carers (n = 6) and three focus groups with nurses (n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management. © 2016 John Wiley & Sons Ltd.

Mixed-Age Grouping in Early Childhood--Creating the Outdoor Learning Environment

ERIC Educational Resources Information Center

Rouse, Elizabeth

2015-01-01

Children attending centre-based early childhood care and education programmes across Australia are most likely to be grouped according to age and development. While multi- or mixed-age grouping has been seen to have positive benefits on young children's learning and pro-social behaviours, this approach is not usually adopted in the organisation of…

Joint programmes in paediatric cardiothoracic surgery: a survey and descriptive analysis.

PubMed

DeCampli, William M

2011-12-01

Joint programmes, as opposed to regionalisation of paediatric cardiac care, may improve outcomes while preserving accessibility. We determined the prevalence and nature of joint programmes. We sent an online survey to 125 paediatric cardiac surgeons in the United States in November, 2009 querying the past or present existence of a joint programme, its mission, structure, function, and perceived success. A total of 65 surgeon responses from 65 institutions met the criteria for inclusion. Of the 65 institutions, 22 currently or previously conducted a joint programme. Compared with primary institutions, partner institutions were less often children's hospitals (p = 0.0004), had fewer paediatric beds (p = 0.005), and performed fewer cardiac cases (p = 0.03). Approximately 47% of partner hospitals performed fewer than 50 cases per year. The median distance range between hospitals was 41-60 miles, ranging from 5 to 1000 miles. Approximately 54% of partner hospitals had no surgeon working primarily on-site, and 31% of the programmes conducted joint conferences. Approximately 67% of the programmes limited the complexity of cases at the partner hospital, and 83% of the programmes had formal contracts between hospitals. Of the six programmes whose main mission was to increase referrals to the primary hospital, three were felt to have failed. Of the nine programmes whose mission was to increase regional quality, eight were felt to be successful. Joint programmes in paediatric cardiac surgery are common but are heterogeneous in structure and function. Programmes whose mission is to improve the quality of regional care seem more likely to succeed. Joint programmes may be a practical alternative to regionalisation to achieve better outcomes.

Development of a self-managed loaded exercise programme for rotator cuff tendinopathy.

PubMed

Littlewood, Chris; Malliaras, Peter; Mawson, Sue; May, Stephen; Walters, Stephen

2013-12-01

This paper describes a self-managed loaded exercise programme which has been designed to address the pain and disability associated with rotator cuff tendinopathy. The intervention has been developed with reference to current self-management theory and with reference to the emerging benefit of loaded exercise for tendinopathy. This self-managed loaded exercise programme is being evaluated within the mixed methods SELF study (ISRCTN 84709751) which includes a pragmatic randomised controlled trial conducted within the UK National Health Service. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Quality versus Quantity Debate in Swimming: Perceptions and Training Practices of Expert Swimming Coaches.

PubMed

Nugent, Frank J; Comyns, Thomas M; Warrington, Giles D

2017-06-01

The debate over low-volume, high-intensity training versus high-volume, low-intensity training, commonly known as Quality versus Quantity, respectively, is a frequent topic of discussion among swimming coaches and academics. The aim of this study was to explore expert coaches' perceptions of quality and quantity coaching philosophies in competitive swimming and to investigate their current training practices. A purposeful sample of 11 expert swimming coaches was recruited for this study. The study was a mixed methods design and involved each coach participating in 1 semi-structured interview and completing 1 closed-ended questionnaire. The main findings of this study were that coaches felt quality training programmes would lead to short term results for youth swimmers, but were in many cases more appropriate for senior swimmers. The coaches suggested that quantity training programmes built an aerobic base for youth swimmers, promoted technical development through a focus on slower swimming and helped to enhance recovery from training or competition. However, the coaches continuously suggested that quantity training programmes must be performed with good technique and they felt this was a misunderstood element. This study was a critical step towards gaining a richer and broader understanding on the debate over Quality versus Quantity training from an expert swimming coaches' perspective which was not currently available in the research literature.

System-wide effects of Global Fund investments in Nepal.

PubMed

Trägård, Anna; Shrestha, Ishwar Bahadur

2010-11-01

Nepal, with a concentrated HIV epidemic and high burden of tuberculosis (TB) and malaria, was perceived to have immensely benefited from grants by the Global Fund to Fight AIDS, Tuberculosis and Malaria in addressing the three diseases, amounting to total approved funding of US$80 million. This paper looks at the interaction and integration of Global Fund-supported programmes and national health systems. A mixed method 'case study' approach based on the Systemic Rapid Assessment Toolkit (SYSRA) was used to systematically analyse across the main health systems functional domains. The Country Coordinating Mechanism has been credited with providing the stewardship in attracting additional resources and providing oversight. The involvement of civil society for delivering key HIV and malaria interventions targeting high-risk groups was perceived to be highly beneficial. TB and malaria services were found to be well integrated into the public health care delivery system, while HIV services targeting at-risk groups were often delivered using parallel structures. Political instability, absence of continuity in leadership and sub-optimal investments in health were together perceived to have led to fragmentation of financing and planning activities, especially in HIV the programme. The demand for timely programmatic and financial reporting for donor-supported programmes has contributed to the creation of parallel monitoring and evaluation structures, with missed opportunities for strengthening and utilizing the national health management information systems.

Quality versus Quantity Debate in Swimming: Perceptions and Training Practices of Expert Swimming Coaches

PubMed Central

Nugent, Frank J; Comyns, Thomas M; Warrington, Giles D

2017-01-01

Abstract The debate over low-volume, high-intensity training versus high-volume, low-intensity training, commonly known as Quality versus Quantity, respectively, is a frequent topic of discussion among swimming coaches and academics. The aim of this study was to explore expert coaches’ perceptions of quality and quantity coaching philosophies in competitive swimming and to investigate their current training practices. A purposeful sample of 11 expert swimming coaches was recruited for this study. The study was a mixed methods design and involved each coach participating in 1 semi-structured interview and completing 1 closed-ended questionnaire. The main findings of this study were that coaches felt quality training programmes would lead to short term results for youth swimmers, but were in many cases more appropriate for senior swimmers. The coaches suggested that quantity training programmes built an aerobic base for youth swimmers, promoted technical development through a focus on slower swimming and helped to enhance recovery from training or competition. However, the coaches continuously suggested that quantity training programmes must be performed with good technique and they felt this was a misunderstood element. This study was a critical step towards gaining a richer and broader understanding on the debate over Quality versus Quantity training from an expert swimming coaches’ perspective which was not currently available in the research literature. PMID:28713467

An evaluation of a leadership development coaching and mentoring programme.

PubMed

Le Comte, Lyndsay; McClelland, Beverley

2017-07-03

Purpose The purpose of this paper was to determine the value and impact of the Leadership Development - Coaching and Mentoring Programme at Counties Manukau Health and understand how the skills gained are applied. Design/methodology/approach Mixed-methods approach including surveys of programme participants and senior staff and semi-structured interviews with programme participants. Findings The survey response rate was 24.4 per cent for programme participants and 30 per cent for senior staff. Eight programme participants participated in semi-structured interviews. Of the 70 programme participants, 69 utilised their learning from the programme; 45 of 70 changed their approach to managing staff; and 40 of 68 programme participants reported that meeting with peers for triad group coaching was the most challenging aspect of the programme. Key themes identified through interviews included: working with others; not owning others' problems; professional support and development; coaching and mentoring; future participants. Practical implications The majority of participants changed their leadership behaviours as a result of the programme, which has resulted in improved communication, a more supportive culture and distributed leadership. These changes contribute to better patient care. Originality value There is a paucity of evidence in the literature about the impact of coaching and mentoring programme on leadership development and how the skills gained in such programmes are applied in practice in a healthcare context. This evaluation helps to address that gap.

Meeting Teacher Expectations in a DL Professional Development Programme--A Case Study for Sustained Applied Competence as Programme Outcome

ERIC Educational Resources Information Center

Kruger, Cornè Gerda; Van Rensburg, Ona Janse; De Witt, Marike W.

2016-01-01

Meeting teacher expectations for a professional development programme (PDP) is expected to strengthen sustainable applied competence as programme outcome since teachers will be more motivated to apply the programme content in practice. A revised distance learning (DL) programme was augmented by a practical component comprising a work-integrated…

The RoboCup Mixed Reality League - A Case Study

NASA Astrophysics Data System (ADS)

Gerndt, Reinhard; Bohnen, Matthias; da Silva Guerra, Rodrigo; Asada, Minoru

In typical mixed reality systems there is only a one-way interaction from real to virtual. A human user or the physics of a real object may influence the behavior of virtual objects, but real objects usually cannot be influenced by the virtual world. By introducing real robots into the mixed reality system, we allow a true two-way interaction between virtual and real worlds. Our system has been used since 2007 to implement the RoboCup mixed reality soccer games and other applications for research and edutainment. Our framework system is freely programmable to generate any virtual environment, which may then be further supplemented with virtual and real objects. The system allows for control of any real object based on differential drive robots. The robots may be adapted for different applications, e.g., with markers for identification or with covers to change shape and appearance. They may also be “equipped” with virtual tools. In this chapter we present the hardware and software architecture of our system and some applications. The authors believe this can be seen as a first implementation of Ivan Sutherland’s 1965 idea of the ultimate display: “The ultimate display would, of course, be a room within which the computer can control the existence of matter …” (Sutherland, 1965, Proceedings of IFIPS Congress 2:506-508).

Conforming to partnership values: a qualitative case study of public-private mix for TB control in Ghana.

PubMed

Amo-Adjei, Joshua

2016-01-01

Public-private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Although the respondents' perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers' failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are 'soft' or standard contracts.

Conforming to partnership values: a qualitative case study of public–private mix for TB control in Ghana

PubMed Central

Amo-Adjei, Joshua

2016-01-01

Background Public–private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. Design This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Results Although the respondents’ perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers’ failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Conclusions Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are ‘soft’ or standard contracts. PMID:26739783

Difficulties Experienced in Setting and Achieving Goals by Participants of a Falls Prevention Programme: A Mixed-Methods Evaluation

PubMed Central

Mason, Wendy; Haines, Terry P.

2014-01-01

ABSTRACT Purpose: To evaluate the ability of participants of a falls prevention programme to set and achieve goals. Methods: The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. Results: A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Conclusions: Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered. PMID:25922563

Difficulties experienced in setting and achieving goals by participants of a falls prevention programme: a mixed-methods evaluation.

PubMed

Haas, Romi; Mason, Wendy; Haines, Terry P

2014-01-01

To evaluate the ability of participants of a falls prevention programme to set and achieve goals. The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered.

Measuring the loss of consumer choice in mandatory health programmes using discrete choice experiments.

PubMed

Parkinson, Bonny; Goodall, Stephen; Norman, Richard

2013-04-01

Economic evaluation of mandatory health programmes generally do not consider the utility impact of a loss of consumer choice upon implementation, despite evidence suggesting that consumers do value having the ability to choose. The primary aim of this study was to explore whether the utility impact of a loss of consumer choice from implementing mandatory health programmes can be measured using discrete choice experiments (DCEs). Three case studies were used to test the methodology: fortification of bread-making flour with folate, mandatory influenza vaccination of children, and the banning of trans-fats. Attributes and levels were developed from a review of the literature. An orthogonal, fractional factorial design was used to select the profiles presented to respondents to allow estimation of main effects. Overall, each DCE consisted of 64 profiles which were allocated to four versions of 16 profiles. Each choice task compared two profiles, one being voluntary and the other being mandatory, plus a 'no policy' option, thus each respondent was presented with eight choice tasks. For each choice task, respondents were asked which health policy they most preferred and least preferred. Data was analysed using a mixed logit model with correlated coefficients (200 Halton draws). The compensating variation required for introducing a programme on a mandatory basis (versus achieving the same health impacts with a voluntary programme) that holds utility constant was estimated. Responses were provided by 535 participants (a response rate of 83 %). For the influenza vaccination and folate fortification programmes, the results suggested that some level of compensation may be required for introducing the programme on a mandatory basis. Introducing a mandatory influenza vaccination programme required the highest compensation (Australian dollars [A$] 112.75, 95 % CI -60.89 to 286.39) compared with folate fortification (A$18.05, 95 % CI -3.71 to 39.80). No compensation was required for introducing the trans-fats programme (-A$0.22, 95 % CI -6.24 to 5.80) [year 2010 values]. In addition to the type of mandatory health programme, the compensation required was also found to be dependent on a number of other factors. In particular, the study found an association between the compensation required and stronger libertarian preferences. DCEs can be used to measure the utility impact of a loss of consumer choice. Excluding the utility impact of a loss of consumer choice from an economic evaluation taking a societal perspective may result in a sub-optimal, or incorrect, funding decision.

Instilling hope for a brighter future: A mixed-method mentoring support programme for individuals with and recovered from anorexia nervosa.

PubMed

Ramjan, Lucie M; Fogarty, Sarah; Nicholls, Daniel; Hay, Phillipa

2018-03-01

To investigate the feasibility of a 13-week mentoring programme in providing social support to promote hope for recovery in anorexia nervosa. With no clear first-line psychological treatment for people with anorexia nervosa, mentoring support programmes, as an adjunct to treatment, may provide the social support necessary to promote hope for recovery. A mixed-method study; participatory action research. Women (n = 11), recovering and who had recovered from anorexia nervosa, participated in the programme and completed self-report questionnaires related to quality of life, distress and the mentoring relationship at different time points. Qualitative feedback from logbooks, workshop evaluation questionnaires, interviews and focus groups was also collected to assess the programme's acceptability. General compliance for completing most study outcome questionnaires was 90%; however, the mentoring relationship questionnaires were not completed to the same degree. Five key themes emerged from the focus group/interview data: (i) she understands me and could relate to me; (ii) reconnecting with the world-asking questions and being challenged; (iii) mentors' altruistic motivations and the transformation and discovery of self; (iv) instilling hope-recovery is possible; and (v) effective communication-the key to successful mentoring. Further research is needed; however, the results provide preliminary support for the mentoring programme's feasibility as an adjunct to treatment. We found that having someone who understands, to talk and share with, met a clear need for people with anorexia nervosa. While further research is warranted mentoring support or recovered mentors, may play a potentially valuable role in supporting those in community settings. © 2017 John Wiley & Sons Ltd.

Translating childhood tuberculosis case management research into operational policies.

PubMed

Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O

2011-08-01

The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

Active case detection for malaria elimination: a survey among Asia Pacific countries

PubMed Central

2013-01-01

Background Moving from malaria control to elimination requires national malaria control programmes to implement strategies to detect both symptomatic and asymptomatic cases in the community. In order to do this, malaria elimination programmes follow up malaria cases reported by health facilities to carry out case investigations that will determine the origin of the infection, whether it has been imported or is due to local malaria transmission. If necessary, the malaria programme will also carry out active surveillance to find additional malaria cases in the locality to prevent further transmission. To understand current practices and share information on malaria elimination strategies, a survey specifically addressing country policies on case investigation and reactive case detection was carried out among fourteen countries of the Asia Pacific Malaria Elimination Network (APMEN). Methods A questionnaire was distributed to the malaria control programme managers amongst 14 countries in the Asia Pacific who have national or sub-national malaria elimination goals. Results Results indicate that there are a wide variety of case investigation and active case detection activities employed by the 13 countries that responded to the survey. All respondents report conducting case investigation as part of surveillance activities. More than half of these countries conduct investigations for each case. Over half aim to accomplish the investigation within one to two days of a case report. Programmes collect a broad array of demographic data during investigation procedures and definitions for imported cases are varied across respondents. Some countries report intra-national (from a different province or district) importation while others report only international importation (from a different country). Reactive case detection in respondent countries is defined as screening households within a pre-determined radius in order to identify other locally acquired infections, whether symptomatic or asymptomatic. Respondents report that reactive case detection can be triggered in different ways, in some cases with only a single case report and in others if a defined threshold of multiple cases occurs. The spatial range of screening conducted varies from a certain number of households to an entire administrative unit (e g, village). Some countries target symptomatic people whereas others target all people in order to detect asymptomatic infections. The majority of respondent programmes collect a range of information from those screened for malaria, similar to the range of information collected during case investigation. Conclusion Case investigation and reactive case detection are implemented in the malaria elimination programmes in the Asia Pacific, however practices vary widely from country to country. There is little evidence available to support countries in deciding which methods to maintain, change or adopt for improved effectiveness and efficiency. The development and use of common evaluation metrics for these activities will allow malaria programmes to assess performance and results of resource-intensive surveillance measures and may benefit other countries that are considering implementing these activities. PMID:24103345

Submillimetre spectroscopy on La Silla.

NASA Astrophysics Data System (ADS)

Krügel, E.; Schulz, A.

1985-06-01

Who would play a Stradivari violin at a country dance? Or who would mix very old Scotch with Coca-Cola? Not uso But we do things that look equally improper in the eyes of many astronomers. We employ fine optical telescopes to observe at submillimetre wavelengths, although for our purposes the surface accuracy of the mirror could be 1,000 times worse. One excuse which we (and the ESO Observing Programmes Committee) can ofter is that at present there are no submillimetre telescopes that we could use instead of the optical ones. We believe that one can get information about starforming regions through submillimetre observations that cannot be obtained by other means. This article is an attempt to convince you that this is the case.

Community immunization programme in response to an outbreak of invasive Neisseria meningitidis serogroup C infection in the Trent region of England 1995-1996.

PubMed

Irwin, D J; Miller, J M; Milner, P C; Patterson, T; Richards, R G; Williams, D A; Insley, C A; Stuart, J M

1997-06-01

Between 8 December 1995 and 16 January 1996 seven laboratory confirmed cases of septicaemia owing to infection with Neisseria meningitidis serogroup C strains and one highly probable case of meningococcal septicaemia occurred in three electoral wards in south Rotherham and the Retford area of north Nottinghamshire. All cases occurred among children aged 1-17 years. One patient died. The public health response to this outbreak was the largest community prophylactic antibiotic and immunization programme against meningococcal infection, to date, in the United Kingdom. The target group for each Health Authority was 8900 for Rotherham Health Authorities and 8000 for North Nottinghamshire Health. Local logistical factors led to differences in the implementation of the programme by each Health Authority. At the completion of each programme, 8320 doses of vaccine had been administered (92.5 per cent coverage) during the Rotherham Health Authorities programme and 7660 (95.7 per cent coverage) during the North Nottinghamshire Health programme. The additional financial cost of the exercise amounted to approximately Pounds 125000 for each Health Authority. This paper describes the evolution of the outbreak, the decision-making process resulting in the immunization programme in each Health Authority, the implementation of each programme, problems identified and lessons learned.

Global Fund financing of public-private mix approaches for delivery of tuberculosis care.

PubMed

Lal, S S; Uplekar, Mukund; Katz, Itamar; Lonnroth, Knut; Komatsu, Ryuichi; Yesudian Dias, Hannah Monica; Atun, Rifat

2011-06-01

To map the extent and scope of public-private mix (PPM) interventions in tuberculosis (TB) control programmes supported by the Global Fund. We reviewed the Global Fund's official documents and data to analyse the distribution, characteristics and budgets of PPM approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. We supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report. Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with 'for-profit' private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus. Average and median spending on PPM within grants was 10% and 5% respectively, ranging from 0.03% to 69% of the total grant budget. In China, India, Nigeria and the Philippines, PPM contributed to detecting more than 25% TB cases while maintaining high treatment success rates. In spite of evidence of cost-effectiveness, PPM constitutes only a modest part of overall TB control activities. Scaling up PPM across countries could contribute to expanding access to TB care, increasing case detection, improving treatment outcomes and help achieve the global TB control targets. © 2011 Blackwell Publishing Ltd.

How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review

PubMed Central

Francis, Linda; Dunt, David; Cadilhac, Dominique A

2016-01-01

Objectives Programmes to address chronic disease are a focus of governments worldwide. Despite growth in ‘implementation science’, there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. Settings A scoping review of the literature spanning 1985–2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Participants Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Primary and secondary outcome measures Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Results Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with ‘maintenance of programme activities’ most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Conclusions Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses. PMID:27246000

Clinical case management for patients with schizophrenia with high care needs.

PubMed

Mas-Expósito, Laia; Amador-Campos, Juan Antonio; Gómez-Benito, Juana; Mauri-Mas, Lluís; Lalucat-Jo, Lluís

2015-02-01

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effects.

A mixed methods approach to assess animal vaccination programmes: The case of rabies control in Bamako, Mali.

PubMed

Mosimann, Laura; Traoré, Abdallah; Mauti, Stephanie; Léchenne, Monique; Obrist, Brigit; Véron, René; Hattendorf, Jan; Zinsstag, Jakob

2017-01-01

In the framework of the research network on integrated control of zoonoses in Africa (ICONZ) a dog rabies mass vaccination campaign was carried out in two communes of Bamako (Mali) in September 2014. A mixed method approach, combining quantitative and qualitative tools, was developed to evaluate the effectiveness of the intervention towards optimization for future scale-up. Actions to control rabies occur on one level in households when individuals take the decision to vaccinate their dogs. However, control also depends on provision of vaccination services and community participation at the intermediate level of social resilience. Mixed methods seem necessary as the problem-driven transdisciplinary project includes epidemiological components in addition to social dynamics and cultural, political and institutional issues. Adapting earlier effectiveness models for health intervention to rabies control, we propose a mixed method assessment of individual effectiveness parameters like availability, affordability, accessibility, adequacy or acceptability. Triangulation of quantitative methods (household survey, empirical coverage estimation and spatial analysis) with qualitative findings (participant observation, focus group discussions) facilitate a better understanding of the weight of each effectiveness determinant, and the underlying reasons embedded in the local understandings, cultural practices, and social and political realities of the setting. Using this method, a final effectiveness of 33% for commune Five and 28% for commune Six was estimated, with vaccination coverage of 27% and 20%, respectively. Availability was identified as the most sensitive effectiveness parameter, attributed to lack of information about the campaign. We propose a mixed methods approach to optimize intervention design, using an "intervention effectiveness optimization cycle" with the aim of maximizing effectiveness. Empirical vaccination coverage estimation is compared to the effectiveness model with its determinants. In addition, qualitative data provide an explanatory framework for deeper insight, validation and interpretation of results which should improve the intervention design while involving all stakeholders and increasing community participation. This work contributes vital information for the optimization and scale-up of future vaccination campaigns in Bamako, Mali. The proposed mixed method, although incompletely applied in this case study, should be applicable to similar rabies interventions targeting elimination in other settings. Copyright © 2016 Elsevier B.V. All rights reserved.

Piloting a programme tool to evaluate malaria case investigation and reactive case detection activities: results from 3 settings in the Asia Pacific.

PubMed

Cotter, Chris; Sudathip, Prayuth; Herdiana, Herdiana; Cao, Yuanyuan; Liu, Yaobao; Luo, Alex; Ranasinghe, Neil; Bennett, Adam; Cao, Jun; Gosling, Roly D

2017-08-22

Case investigation and reactive case detection (RACD) activities are widely-used in low transmission settings to determine the suspected origin of infection and identify and treat malaria infections nearby to the index patient household. Case investigation and RACD activities are time and resource intensive, include methodologies that vary across eliminating settings, and have no standardized metrics or tools available to monitor and evaluate them. In response to this gap, a simple programme tool was developed for monitoring and evaluating (M&E) RACD activities and piloted by national malaria programmes. During the development phase, four modules of the RACD M&E tool were created to assess and evaluate key case investigation and RACD activities and costs. A pilot phase was then carried out by programme implementers between 2013 and 2015, during which malaria surveillance teams in three different settings (China, Indonesia, Thailand) piloted the tool over a period of 3 months each. This study describes summary results of the pilots and feasibility and impact of the tool on programmes. All three study areas implemented the RACD M&E tool modules, and pilot users reported the tool and evaluation process were helpful to identify gaps in RACD programme activities. In the 45 health facilities evaluated, 71.8% (97/135; min 35.3-max 100.0%) of the proper notification and reporting forms and 20.0% (27/135; min 0.0-max 100.0%) of standard operating procedures (SOPs) were available to support malaria elimination activities. The tool highlighted gaps in reporting key data indicators on the completeness for malaria case reporting (98.8%; min 93.3-max 100.0%), case investigations (65.6%; min 61.8-max 78.4%) and RACD activities (70.0%; min 64.7-max 100.0%). Evaluation of the SOPs showed that knowledge and practices of malaria personnel varied within and between study areas. Average monthly costs for conducting case investigation and RACD activities showed variation between study areas (min USD $844.80-max USD $2038.00) for the malaria personnel, commodities, services and other costs required to carry out the activities. The RACD M&E tool was implemented in the three pilot areas, identifying key gaps that led to impacts on programme decision making. Study findings support the need for routine M&E of malaria case reporting, case investigation and RACD activities. Scale-up of the RACD M&E tool in malaria-eliminating settings will contribute to improved programme performance to the high level that is required to reach elimination.

Teaching Data Use and School Leadership

ERIC Educational Resources Information Center

Vanover, Charles; Hodges, Olivia

2015-01-01

This case study uses evidence collected for accreditation and programme improvement at a small university Master's and certification programme in Educational Leadership Development to describe efforts to help leadership candidates use data during the programme's final internship experience. Programme features supporting the growth of candidates'…

Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts.

PubMed

Onoka, Chima A; Hanson, Kara; Mills, Anne

2016-08-01

There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Analysis of mixing-layer height retrieval methods using backscatter lidar returns and microwave-radiometer temperature observations in the context of synergy

NASA Astrophysics Data System (ADS)

Saeed, Umar; Rocadenbosch, Francesc

2017-04-01

Mixing Layer Height (MLH) is an important parameter in many different atmospheric and meteorological applications. However, there does not exist a single instrument or method which provides accurate and physically consistent estimates of MLH. Instead, there are several methods for MLH estimation based on the measurements of different atmospheric tracers using different instruments [1, 2]. In this work, MLH retrieval methods using backscattered lidar signals and Microwave Radiometer (MWR)-retrieved potential-temperature profiles are compared in terms of their associated uncertainties. The Extended Kalman Filter (EKF) is used for MLH retrieval from backscattered lidar signals [3] and parcel method [4] is used for MLH retrieval from MWR-retrieved potential-temperature profiles. Measurement and retrieval errors are revisited and incorporated into the MLH estimation methods used. Uncertainties on MLH estimates from the two methods are compared along with a combined MLH-retrieval discussion case. The uncertainty analysis is validated using long-term lidar and MWR measurement data, under different atmospheric conditions, from the HD(CP)2 Observational Prototype Experiment (HOPE) campaign at Jülich, Germany [5]. MLH estimates from a Doppler wind lidar and radiosondes are used as reference. This work has received funding from the European Union Seventh Framework Programme, FP7 People, ITN Marie Curie Actions Programme (2012-2016) in the frame of ITaRS project (GA 289923), H2020 programme under ACTRIS-2 project (GA 654109), the Spanish Ministry of Economy and Competitiveness - European Regional Development Funds under TEC2015-63832-P project, and from the Generalitat de Catalunya (Grup de Recerca Consolidat) 2014-SGR-583. [1] S. Emeis, Surface-based Remote Sensing of the Atmospheric Boundary Layer. 978-90-481-9339-4, Springer, 2010. [2] P. Seibert, F. Beyrich, S.-E. Gryning, S. Joffre, A. Rasmussen, and P. Tercier, "Review and intercomparison of operational methods for the determination of the mixing height," Atmospheric Environment, vol. 34, pp. 1352-2310, 2000. [3] D. Lange, J. Tiana-Alsina, U. Saeed, S. Tomás, and F. Rocadenbosch, "Atmospheric-boundary-layer height monitoring using a Kalman filter and backscatter lidar returns," IEEE Transactions on Geoscience and Remote Sensing, vol. 52, no. 8, pp. 4717-4728, 2014. [4] G. Holzworth, "Estimates of mean maximum mixing depths in the contiguous United States," Monthly Weather Review, vol. 92, pp. 235-242, 1964. [5] U. Löhnert, J. H. Schween, C. Acquistapace, K. Ebell, M. Maahn, M. Barrera-Verdejo, A. Hirsikko, B. Bohn, A. Knaps, E. O'Connor, C. Simmer, A. Wahner, and S. Crewell, "JOYCE: Jülich Observatory for Cloud Evolution," Bull. Amer. Meteor. Soc., vol. 96, no. 7, pp. 1157-1174, 2015.

Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper.

PubMed

Vandijck, Dominique; Cleemput, Irina; Hellings, Johan; Vogelaers, Dirk

2013-11-01

This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views

PubMed Central

Pound, Pandora; Denford, Sarah; Shucksmith, Janet; Tanton, Clare; Johnson, Anne M; Owen, Jenny; Hutten, Rebecca; Mohan, Leanne; Bonell, Chris; Abraham, Charles; Campbell, Rona

2017-01-01

Objectives Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. Design This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Settings Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Results Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE. PMID:28669970

Progress and Impact of 13 Years of the Global Programme to Eliminate Lymphatic Filariasis on Reducing the Burden of Filarial Disease

PubMed Central

Ramaiah, K. D.; Ottesen, Eric A.

2014-01-01

Background A Global Programme to Eliminate Lymphatic Filariasis was launched in 2000, with mass drug administration (MDA) as the core strategy of the programme. After completing 13 years of operations through 2012 and with MDA in place in 55 of 73 endemic countries, the impact of the MDA programme on microfilaraemia, hydrocele and lymphedema is in need of being assessed. Methodology/Principal findings During 2000–2012, the MDA programme made remarkable achievements – a total of 6.37 billion treatments were offered and an estimated 4.45 billion treatments were consumed by the population living in endemic areas. Using a model based on empirical observations of the effects of treatment on clinical manifestations, it is estimated that 96.71 million LF cases, including 79.20 million microfilaria carriers, 18.73 million hydrocele cases and a minimum of 5.49 million lymphedema cases have been prevented or cured during this period. Consequently, the global prevalence of LF is calculated to have fallen by 59%, from 3.55% to 1.47%. The fall was highest for microfilaraemia prevalence (68%), followed by 49% in hydrocele prevalence and 25% in lymphedema prevalence. It is estimated that, currently, i.e. after 13 years of the MDA programme, there are still an estimated 67.88 million LF cases that include 36.45 million microfilaria carriers, 19.43 million hydrocele cases and 16.68 million lymphedema cases. Conclusions/Significance The MDA programme has resulted in significant reduction of the LF burden. Extension of MDA to all at-risk countries and to all regions within those countries where MDA has not yet reached 100% geographic coverage is imperative to further reduce the number of microfilaraemia and chronic disease cases and to reach the global target of interrupting transmission of LF by 2020. PMID:25412180

The Impact of an Online Intervention (Brainology) on the Mindset and Resiliency of Secondary School Pupils: A Preliminary Mixed Methods Study

ERIC Educational Resources Information Center

Donohoe, Claire; Topping, Keith; Hannah, Elizabeth

2012-01-01

This preliminary study investigated the impact of the online interactive programme Brainology (which aimed to encourage a growth mindset) on the mindset, resiliency and sense of mastery of secondary school pupils. A quasi-experimental pre-, post- and follow-up mixed-methods study was carried out with 33 participants aged 13-14 years. The measures…

A Mixed-Methods Evaluation of the "Move It Move It!" Before-School Incentive-Based Physical Activity Programme

ERIC Educational Resources Information Center

Garnett, Bernice R.; Becker, Kelly; Vierling, Danielle; Gleason, Cara; DiCenzo, Danielle; Mongeon, Louise

2017-01-01

Objective: Less than half of young people in the USA are meeting the daily physical activity requirements of at least 60 minutes of moderate or vigorous physical activity. A mixed-methods pilot feasibility assessment of "Move it Move it!" was conducted in the Spring of 2014 to assess the impact of a before-school physical activity…

The impact of leadership development on GP mental health commissioning.

PubMed

Dickerson, Emma; Fenge, Lee-Ann; Rosenorn-Lanng, Emily

2017-07-03

Purpose This paper aims to explore the learning needs of general practitioners (GPs) involved in commissioning mental health provision in England, and offer an evaluation of a leadership and commissioning skills development programme for Mental Health Commissioners. Design/methodology/approach Retrospective mixed method, including online mixed method survey, rating participants' knowledge, skills, abilities, semi-structured telephone interviews and third-party questionnaires were used. Results were analysed for significant differences using the Wilcoxon Signed Ranks test. Open-ended responses and interview transcripts were analysed thematically. Findings Indicative results showed that participants perceived significant impacts in ability across eight key question groups evaluated. Differences were found between the perceived and observed impact in relation to technical areas covered within the programme which were perceived as the highest scoring impacts by participants. Research limitations/implications The indicative results show a positive impact on practice has been both perceived and observed. Findings illustrate the value of this development programme on both the personal development of GP Mental Health Commissioners and commissioning practice. Although the findings of this evaluation increase understanding in relation to an important and topical area, larger scale, prospective evaluations are required. Impact evaluations could be embedded within future programmes to encourage higher participant and third-party engagement. Future evaluations would benefit from collection and analysis of attendance data. Further research could involve patient, service user and carer perspectives on mental health commissioning. Originality value Results of this evaluation could inform the development of future learning programmes for mental health commissioners as part of a national approach to improve mental health provision.

Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education.

PubMed

Ross, Alastair J; Anderson, Janet E; Kodate, Naonori; Thomas, Libby; Thompson, Kellie; Thomas, Beth; Key, Suzie; Jensen, Heidi; Schiff, Rebekah; Jaye, Peter

2013-06-01

This paper describes the evaluation of a 2-day simulation training programme for staff designed to improve teamwork and inpatient care and compassion in an older persons' unit. The programme was designed to improve inpatient care for older people by using mixed modality simulation exercises to enhance teamwork and empathetic and compassionate care. Healthcare professionals took part in: (a) a 1-day human patient simulation course with six scenarios and (b) a 1-day ward-based simulation course involving five 1-h exercises with integrated debriefing. A mixed methods evaluation included observations of the programme, precourse and postcourse confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training. Observations showed enjoyment of the course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human patient simulation (t=9; df=56; p<0.001) and ward-based exercises (t=9.3; df=76; p<0.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients. Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons. The study demonstrated that simulation is an effective method for encouraging dignified care and compassion for older persons by teaching team skills and empathetic and sensitive communication with patients and relatives.

CPSP/HSE Postgraduate Overseas Rotational Programme: Residents' Perspective.

PubMed

Gondal, Khalid Masood; Iqbal, Uzma; Arif, Seema; Ahmed, Arslan; Khan, Umair Ahmed

2016-04-01

To get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme. Mixed methods qualitative research study. CPSP, Regional Office, Lahore, in June 2015. It is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed. The mean age of residents was 29.9 &plusmn;1.1 years, 7 (21.2%) were females and 24 (72.7%) respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making (mean score of 3.3 &plusmn;1.2) and enhanced professionalism (mean score of 3.6 &plusmn;1.1). They disagreed that training has polished their procedural skills (mean score 2.4 &plusmn;1.2). The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules. Residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues.

Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique.

PubMed

Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio

2014-12-01

We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care-seeking within 24 hours and care-seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers' ability to assess and treat illnesses can lead to improved care-seeking and utilisation, and community ownership for iCCM.

Rationale, design and baseline data of a mixed methods study examining the clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: the DON'T RETARD project.

PubMed

Hilderson, Deborah; Westhovens, Rene; Wouters, Carine; Van der Elst, Kristien; Goossens, Eva; Moons, Philip

2013-12-02

To describe (1) the content of a transition programme for young people with juvenile idiopathic arthritis (JIA) designed as a brief intervention, (2) the rationale and design of a mixed-methods study evaluating the clinical impact of this transition programme and (3) to provide baseline data of the intervention group. An 'embedded experimental' design is used for the evaluation of the transition programme. A 'one-group pretest-posttest, with a non-equivalent posttest-only comparison group design' is used to quantitatively evaluate the impact of the transition programme, applying both longitudinal and comparative analyses. Subsequently, experiences of adolescents and their parents who participated in the experimental group will be analysed qualitatively using content analysis. Participants in the intervention are recruited at a tertiary care centre in Belgium. The comparison group participants are recruited from one tertiary and three secondary care centres in Belgium. The intervention group consists of 33 young people (25 females; 8 males) with a median age of 16 years. Main diagnoses are persistent or extended oligoarticular JIA (33%), polyarticular JIA (30%), enthesitis-related JIA (21%) or systemic arthritis (15%). The transition programme comprises eight key components: (1) transition coordinator; (2) providing information and education; (3) availability by telephone; (4) information about and contact with an adult care programme; (5) guidance of parents; (6) meeting with peers; (7) transfer plan; and (8) actual transfer to adult care. The primary outcome is health status, as perceived by the adolescents. Secondary outcomes are health status, as perceived by the parents; medication adherence; illness-related knowledge; quality of life; fatigue; promotion of independence; support of autonomy; behavioural control and psychological control. At baseline, the median score was 69.2 (Q1=60.0;Q3=92.9) on psychosocial health and 68.8 (Q1=56.3; Q3=89.1) on physical health. Rheumatic-specific health scores ranged from 62.5 to 100. We present the rationale and design of a study intended to evaluate a transition programme for adolescents with JIA as a brief intervention.

Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study.

PubMed

Wanat, Marta; Walker, Jane; Burke, Katy; Sevdalis, Nick; Richardson, Alison; Mulick, Amy; Frost, Chris; Sharpe, Michael

2017-07-02

There is growing awareness that cancer services need to address patients' well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients' symptoms including depression using a 'Symptom Monitoring Service' and (2) providing treatment for those with major depression using a programme called 'Depression Care for People with Cancer'. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients' and clinicians' experience of the programmes. This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016-December 2018): 'Pre-implementation' (setting up of the new programmes), 'Early Implementation' (implementation of the programmes in a small number of clinics) and 'Implementation and Maintenance' (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford's Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

'I Have Learnt to Love the Child and Give Opportunities to Play with Peers': A Feasibility Study of the Training Programme to Support Parents of Young Children with Visual Impairment in Malawi

ERIC Educational Resources Information Center

Lynch, Paul; Gladstone, Melissa; McLinden, Michael; Douglas, Graeme; Jolley, Emma; Schmidt, Elena; Chimoyo, Josephine

2018-01-01

This is a first mixed-methods study, which created, adapted and tested the feasibility of a training programme targeted at parents, community professionals, specialist teachers and volunteers to provide advice on developmental stimulation for children with visual impairment in their homes in rural and urban settings of Malawi. The study followed…

Active mixing of complex fluids at the microscale

DOE PAGES

Ober, Thomas J.; Foresti, Daniele; Lewis, Jennifer A.

2015-09-22

Mixing of complex fluids at low Reynolds number is fundamental for a broad range of applications, including materials assembly, microfluidics, and biomedical devices. Of these materials, yield stress fluids (and gels) pose the most significant challenges, especially when they must be mixed in low volumes over short timescales. New scaling relationships between mixer dimensions and operating conditions are derived and experimentally verified to create a framework for designing active microfluidic mixers that can efficiently homogenize a wide range of complex fluids. As a result, active mixing printheads are then designed and implemented for multimaterial 3D printing of viscoelastic inks withmore » programmable control of local composition.« less

Active mixing of complex fluids at the microscale

PubMed Central

Ober, Thomas J.; Foresti, Daniele; Lewis, Jennifer A.

2015-01-01

Mixing of complex fluids at low Reynolds number is fundamental for a broad range of applications, including materials assembly, microfluidics, and biomedical devices. Of these materials, yield stress fluids (and gels) pose the most significant challenges, especially when they must be mixed in low volumes over short timescales. New scaling relationships between mixer dimensions and operating conditions are derived and experimentally verified to create a framework for designing active microfluidic mixers that can efficiently homogenize a wide range of complex fluids. Active mixing printheads are then designed and implemented for multimaterial 3D printing of viscoelastic inks with programmable control of local composition. PMID:26396254

The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: a sequential mixed methods evaluation.

PubMed

Carter, Tim; Callaghan, Patrick; Khalil, Elizabeth; Morres, Ioannis

2012-03-13

People with mental illness are more likely to suffer physical health problems than comparable populations who do not have mental illness. There is evidence to suggest that exercise, as well has having obvious physical benefits, also has positive effects on mental health. There is a distinct paucity of research testing its effects on young people seeking help for mental health issues. Additionally, it is generally found that compliance with prescribed exercise programmes is low. As such, encouraging young people to exercise at levels recommended by national guidelines may be unrealistic considering their struggle with mental health difficulties. It is proposed that an exercise intervention tailored to young people's preferred intensity may improve mental health outcomes, overall quality of life, and reduce exercise attrition rates. A sequential mixed methods design will be utilised to assess the effectiveness of an individually tailored exercise programme on the mental health outcomes of young people with depression. The mixed methods design incorporates a Randomised Controlled Trial (RCT), focus groups and interviews and an economic evaluation. 158 young people (14-17 years) recruited from primary care and voluntary services randomly allocated to either the intervention group or control group. Intervention group: PARTICIPANTS will undertake a 12 week exercise programme of 12 × 60 minutes of preferred intensity aerobic exercise receiving motivational coaching and support throughout. PARTICIPANTS will also be invited to attend focus groups and 1-1 interviews following completion of the exercise programme to illicit potential barriers facilitators to participation. PARTICIPANTS will receive treatment as usual. Depression using the Children's Depression Inventory 2 (CDI-2). Quality of Life (EQ-5D), physical fitness (Borg RPE scale, heart rate), incidents of self-harm, treatment received and compliance with treatment, and the cost effectiveness of the intervention. Outcome measures will be taken at baseline, post intervention and 6 month follow up. The results of this study will inform policy makers of the effectiveness of preferred intensity exercise on the mental health outcomes of young people with depression, the acceptability of such an intervention to this population and its cost effectiveness. ClinicalTrials.gov: NCT01474837.

Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains.

PubMed

Blanas, Demetri A; Ndiaye, Youssoupha; Nichols, Kim; Jensen, Andrew; Siddiqui, Ammar; Hennig, Nils

2013-03-14

Health workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs. This study evaluates communities' perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field. The study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers. Communities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage. This study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Design and implementation of a reconfigurable mixed-signal SoC based on field programmable analog arrays

NASA Astrophysics Data System (ADS)

Liu, Lintao; Gao, Yuhan; Deng, Jun

2017-11-01

This work presents a reconfigurable mixed-signal system-on-chip (SoC), which integrates switched-capacitor-based field programmable analog arrays (FPAA), analog-to-digital converter (ADC), digital-to-analog converter, digital down converter , digital up converter, 32-bit reduced instruction-set computer central processing unit (CPU) and other digital IPs on a single chip with 0.18 μm CMOS technology. The FPAA intellectual property could be reconfigured as different function circuits, such as gain amplifier, divider, sine generator, and so on. This single-chip integrated mixed-signal system is a complete modern signal processing system, occupying a die area of 7 × 8 mm 2 and consuming 719 mW with a clock frequency of 150 MHz for CPU and 200 MHz for ADC/DAC. This SoC chip can help customers to shorten design cycles, save board area, reduce the system power consumption and depress the system integration risk, which would afford a big prospect of application for wireless communication. Project supported by the National High Technology and Development Program of China (No. 2012AA012303).

Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru.

PubMed

Shah, L; Rojas, M; Mori, O; Zamudio, C; Kaufman, J S; Otero, L; Gotuzzo, E; Seas, C; Brewer, T F

2017-04-01

We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

Mothering at a Distance: what incarcerated mothers value about a parenting programme.

PubMed

Rossiter, Chris; Power, Tamara; Fowler, Cathrine; Jackson, Debra; Hyslop, Deirdre; Dawson, Angela

2015-01-01

Children with incarcerated mothers experience adverse health, social and emotional circumstances, and are a particularly vulnerable group. Mothers in custody face significant challenges in parenting their children. The study aimed to identify participants' views on impact of a parenting support programme for incarcerated mothers in NSW Australia. The mixed-methods study examined 134 responses to open and closed questions on a questionnaire for programme participants. Participants found the programme worthwhile, engaging and relevant. It enhanced their parenting knowledge and confidence. Open-ended responses highlighted program elements which participants valued, specifically support for their parenting role in complicated circumstances, greater understanding of child development and perspectives, and practical strategies for facilitating connections with their children during their incarceration. The study informs nurses working with women who have experienced incarceration and their children, both in custodial and community settings.

On-demand generation and mixing of liquid-in-gas slugs with digitally-programmable composition and size

PubMed Central

Chen, Yi-Chun; Liu, Kan; Shen, Clifton Kwang-Fu; van Dam, R. Michael

2017-01-01

Microscopic droplets or slugs of mixed reagents provide a convenient platform for performing large numbers of isolated biochemical or chemical reactions for many screening and optimization applications. Myriad microfluidic approaches have emerged for creating droplets or slugs with controllable size and composition, generally using an immiscible carrier fluid to assist with the formation or merging processes. We report a novel device for generation of liquid slugs in air when the use of a carrier liquid is not compatible with the application. The slug generator contains two adjacent chambers, each of which has a volume that can be digitally adjusted by closing selected microvalves. Reagents are filled into the two chambers, merged together into a contiguous liquid slug, ejected at the desired time from the device using gas pressure, and mixed by flowing in a downstream channel. Programmable size and composition of slugs is achieved by dynamically adjusting the volume of each chamber prior to filling. Slug formation in this fashion is independent of fluid properties and can easily be scaled to mix larger numbers of reagents. This device has already been used to screen monomer ratios in supramolecular nanoparticle assembly and radiolabeling conditions of engineered antibodies, and here we provide a detailed description of the underlying device. PMID:29167603

The Cockcroft difference: an analysis of the impact of a nursing leadership development programme.

PubMed

Chappell, Kate K; Willis, Leah

2013-03-01

Identifying impact areas of nursing leadership development programmes is needed to determine if there are measureable effects on participants. These impact areas help to identify measures to substantiate the benefits of nursing leadership programmes for organization leaders making decisions about support and implementation of such opportunities for their emerging leaders. Using mixed qualitative/quantitative methods, the impact of a nursing leadership development programme, the Amy V. Cockcroft Fellowship, is examined to determine if there are measureable influences. Themes of four areas of impact: improved conflict resolution/negotiation skills, communication skills, personal development and career action or change were identified through content analysis. These themes provide the basis for creating measureable indicators for nursing organizations to use in determining the value of nursing leadership development programmes such as the Amy V. Cockcroft Fellowship. Based on the findings established in this research article, nurse managers can focus on developing themselves and their peer groups through nursing leadership development programmes to prepare for leading in the present and future healthcare environment. © 2012 Blackwell Publishing Ltd.

Soft System Methodology as a Tool to Understand Issues of Governmental Affordable Housing Programme of India: A Case Study Approach

NASA Astrophysics Data System (ADS)

Ghosh, Sukanya; Roy, Souvanic; Sanyal, Manas Kumar

2016-09-01

With the help of a case study, the article has explored current practices of implementation of governmental affordable housing programme for urban poor in a slum of India. This work shows that the issues associated with the problems of governmental affordable housing programme has to be addressed to with a suitable methodology as complexities are not only dealing with quantitative data but qualitative data also. The Hard System Methodologies (HSM), which is conventionally applied to address the issues, deals with real and known problems which can be directly solved. Since most of the issues of affordable housing programme as found in the case study are subjective and complex in nature, Soft System Methodology (SSM) has been tried for better representation from subjective points of views. The article explored drawing of Rich Picture as an SSM approach for better understanding and analysing complex issues and constraints of affordable housing programme so that further exploration of the issues is possible.

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study.

PubMed

Kinley, Julie; Preston, Nancy; Froggatt, Katherine

2018-06-01

The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. A mixed-methods study. Nursing care homes in south-east England. Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by 'following a thread'. This paper reports study data in relation to facilitation. Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and 'being present' facilitation. 'Being present' facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a 'being present' approach to facilitation. Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study 'being present' facilitation, when supported by multi-layered learning, was the only approach that initiated the change required. Copyright © 2018. Published by Elsevier Ltd.

Stated Uptake of Physical Activity Rewards Programmes Among Active and Insufficiently Active Full-Time Employees.

PubMed

Ozdemir, Semra; Bilger, Marcel; Finkelstein, Eric A

2017-10-01

Employers are increasingly relying on rewards programmes in an effort to promote greater levels of activity among employees; however, if enrolment in these programmes is dominated by active employees, then they are unlikely to be a good use of resources. This study uses a stated-preference survey to better understand who participates in rewards-based physical activity programmes, and to quantify stated uptake by active and insufficiently active employees. The survey was fielded to a national sample of 950 full-time employees in Singapore between 2012 and 2013. Participants were asked to choose between hypothetical rewards programmes that varied along key dimensions and whether or not they would join their preferred programme if given the opportunity. A mixed logit model was used to analyse the data and estimate predicted uptake for specific programmes. We then simulated employer payments based on predictions for the percentage of each type of employee likely to meet the activity goal. Stated uptake ranged from 31 to 67% of employees, depending on programme features. For each programme, approximately two-thirds of those likely to enrol were insufficiently active. Results showed that insufficiently active employees, who represent the majority, are attracted to rewards-based physical activity programmes, and at approximately the same rate as active employees, even when enrolment fees are required. This suggests that a programme with generous rewards and a modest enrolment fee may have strong employee support and be within the range of what employers may be willing to spend.

Implementing a successful tuberculosis programme within primary care services in a conflict area using the stop TB strategy: Afghanistan case study

PubMed Central

2014-01-01

Introduction Afghanistan has faced health consequences of war including those due to displacement of populations, breakdown of health and social services, and increased risks of disease transmission for over three decades. Yet it was able to restructure its National Tuberculosis Control Programme (NTP), integrate tuberculosis treatment into primary health care and achieve most of its targets by the year 2011. What were the processes that enabled the programme to achieve its targets? More importantly, what were the underpinning factors that made this success possible? We addressed these important questions through a case study. Case description We adopted a processes and outcomes framework for this study, which began with examining the change in key programme indicators, followed by backwards tracing of the processes and underlying factors, responsible for this change. Methods included review of the published and grey literature along with in-depth interviews of 15 key informants involved with the care of tuberculosis patients in Afghanistan. Discussion and evaluation TB incidence and mortality per 100,000 decreased from 325 and 92 to 189 and 39 respectively, while case notification and treatment success improved during the decade under study. Efficient programme structures were enabled through high political commitment from the Government, strong leadership from the programme, effective partnership and coordination among stakeholders, and adequate technical and financial support from the development partners. Conclusions The NTP Afghanistan is an example that public health programmes can be effectively implemented in fragile states. High political commitment and strong local leadership are essential factors for such programmes. To ensure long-term effectiveness of the NTP, the international support should be withdrawn in a phased manner, coupled with a sequential increase in resources allocated to the NTP by the Government of Afghanistan. PMID:24507446

Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt’s hepatocellular cancer epidemic: simulation of alternatives

PubMed Central

Ma, Wenkang; Soliman, Amr S; Anwar, Wagida A; Hablas, Ahmed; El Din, Tamer B; Ramadan, Mohamed; Seifeldin, Ibrahim A; Wilson, Mark L

2018-01-01

Background Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC. Methods A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the ‘new’ and ‘old’ scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15–59 years in 2008, healthy people aged 5–59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed. Results Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050. Discussion By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt’s HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention. PMID:29707244

Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt's hepatocellular cancer epidemic: simulation of alternatives.

PubMed

Ma, Wenkang; Soliman, Amr S; Anwar, Wagida A; Hablas, Ahmed; El Din, Tamer B; Ramadan, Mohamed; Seifeldin, Ibrahim A; Wilson, Mark L

2018-01-01

Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC. A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the 'new' and 'old' scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15-59 years in 2008, healthy people aged 5-59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed. Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050. By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt's HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention.

Learning Problems in Transnational Business Education and Training: The Case of the MBA in Thailand

ERIC Educational Resources Information Center

Pimpa, Nattavud

2009-01-01

The transnational Master of Business Administration (MBA) programme has been one of the most popular official business training programmes amongst Thai business practitioners. Although the numbers of transnational business schools and MBA programmes are rapidly increasing, the programmes face numerous challenges from both local and global factors.…

Learning in and beyond Small Business Advisory Programmes

ERIC Educational Resources Information Center

Parker, Rachel Louise; Hine, Damian

2012-01-01

The purpose of this paper is to analyse how participants learn in small business advisory programmes and to explore the impact of these learning programmes on the development of reflective learning dispositions in participants. The research involves two case studies of small business advisory programmes in Queensland, a state of Australia. One…

Case Studies in Australian Adult Education.

ERIC Educational Resources Information Center

Clark, Ralph J., Ed.; Rooth, S. John, Ed.

This publication contains the following 24 case studies of adult education in Australia: "NSW Department of Agriculture Home Study Programme" (O'Neill); "Self-Help Adult Education: The University of the Third Age at the Brisbane CAE" (Swindell); "Marriage Enrichment Programme" (D. Kerr, C. Kerr); "Carringbush…

Individual polyp detection rate in routine daily endoscopy practice depends on case-mix.

PubMed

Loffeld, R J L F; Liberov, B; Dekkers, P E P

2015-07-01

The adenoma detection rate (ADR), a marker of endoscopic quality, is confounded by selection bias. It is not known what the ADR is in normal daily practice. To study the polyp detection rate (PDR) in different endoscopists in the course of years. All consecutive endoscopies of the colon done in 11 years were included. Endoscopies in the regular surveillance programme after polyp removal and after surgery because of colorectal cancer or diverticular disease were scored separately. The number of yearly procedures per endoscopist and presence of polyps, anastomoses, surveillance and cancer were noted. In the period of 11 years, 14,908 consecutive endoscopies of colon and rectum were done by four endoscopists. Two endoscopists had a significantly lower PDR than the other two (p < 0.001), these two had the longest careers in endoscopy. The two younger endoscopists did significantly less often procedures in patients with anastomoses and because of surveillance (p < 0.001, respectively). One endoscopist detected significantly less colorectal cancers than the other three endoscopists (p < 0.001). This study presents the PDR in normal routine daily endoscopy practice. It can be concluded that the PDR, implicating the ADR, in unselected patients can be lower in individual endoscopists than recommended in the literature. This highly depends on the case-mix of patients presented for endoscopy. This result debates the use of the ADR as quality indicator for individual endoscopists.

Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique

PubMed Central

Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio

2014-01-01

Aim We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. Methods We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Results Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care–seeking within 24 hours and care–seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. Conclusions iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers’ ability to assess and treat illnesses can lead to improved care–seeking and utilisation, and community ownership for iCCM. PMID:25520800

A process evaluation of the 'Aware' and 'Supportive Communities' gambling harm-minimisation programmes in New Zealand.

PubMed

Kolandai-Matchett, Komathi; Bellringer, Maria; Landon, Jason; Abbott, Max

2018-04-01

The Gambling Act 2003 mandated a public health strategy for preventing and minimising gambling harm in New Zealand. Aware Communities and Supportive Communities are two public health programmes subsequently implemented nationwide. These programmes differed from common health promotion initiatives such as media or education campaigns as they were community-action based (requiring community involvement in programme planning and delivery). We carried out a process evaluation to determine their implementation effectiveness and inform improvement and future programme planning. Our qualitative dominant mixed methods design comprised analysis of over a hundred implementer progress reports (submitted July 2010 - June 2013), a staff survey and a staff focus group interview. The programmes demonstrated capacity to not only achieve expected outcomes (e.g. enhanced community awareness about harmful gambling), but also to enhance social sustainability at the community level (e.g. established trustful relationships) and achieve some programme sustainability (e.g. community ownership over ongoing programme delivery). The evaluation noted the potential for a sustainable gambling harm-minimisation model. Community-action based harm-minimisation programmes offer programme sustainability potential which in turn offers funding cost-effectiveness when there are continual public health outcomes beyond initial funding. Although resource intensive, the community-action based approach enables culturally appropriate public health programmes suitable for societies where specific ethnic groups have higher gambling risk. Recognition of such harm-minimisation programmes' contribution to social sustainability is important considering the potential for broader public health outcomes (e.g. better life quality, lesser social problems) within socially sustainable societies.

The Use of CASE to Bridge the Transition between Primary and Secondary School Science in Ireland

ERIC Educational Resources Information Center

McCormack, Lorraine

2016-01-01

This article describes how the Cognitive Acceleration through Science Education (CASE) programme was implemented in the final year of primary school and the first year of secondary school in a number of schools in Ireland. The original CASE programme, pioneered in the 1980s, proved successful in its aim to develop the science-reasoning abilities…

[Pay for performance in rehabilitation after stroke - results of a pilot project 2001-2008].

PubMed

Gerdes, N; Funke, U-N; Schüwer, U; Kunze, H; Walle, E; Kleinfeld, A; Reiland, M; Jäckel, W H

2009-08-01

The project aimed at developing and testing a new payment system which provides financial incentives for rehabilitation centers to achieve the best outcomes possible for their patients but does not create additional costs for the insurance funds. The system is conceived as a "quality competition" organized by the centers among themselves with a scientific institute acting as a "referee". Centers with outcomes above average receive a bonus financed by a corresponding malus from the centers below average. In a stepwise process which started in 2001 and was continually accompanied by a scientific institute, we developed the methodological and organizational prerequisites for the new payment system and tested them in two multicentric studies with large case numbers (n=1,058 and n=700, respectively). As a first step, a new assessment instrument (SINGER) was developed and validated in order to measure the outcomes in a reliable, valid, and change-sensitive way. In the second phase, we developed a regression analytic model which predicted the central outcome variable with >84% variance explained. With this model, the different case-mix in the participating centers can be controlled, so that comparisons of outcomes across centers can take place under fair conditions. In the recently completed third phase, we introduced an internet-based programme SINGER-online into which the centers can enter all relevant data. This programme ensures a high quality of all data and makes comparisons of outcomes across all centers possible at any chosen time. The programme contains a special module accessible to the medical services of the health insurance only, which allows sample checks of the data entered by the clinics and helps to ensure that all centers keep to the principles of a fair competition for better quality for their patients. After successful testing of these elements, a functioning model of pay-for-performance in rehabilitation after stroke is now available. (c) Georg Thieme Verlag KG Stuttgart, New York.

How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study

PubMed Central

Honein-AbouHaidar, Gladys N; Stuart-McEwan, Terri; Waddell, Tom; Salvarrey, Alexandra; Smylie, Jennifer; Dobrow, Mark J; Brouwers, Melissa C; Gagliardi, Anna R

2017-01-01

Objectives Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs. Design A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model. Setting 4 DAPs at 2 teaching and 2 community hospitals in Canada. Participants 22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks. Results Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural–remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes. Conclusions This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes. PMID:28235969

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

PubMed Central

Kapata, Nathan; Maboshe, Mwendaweli; Michelo, Charles; Babaniyi, Olusegun

2015-01-01

Background Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates. Aim We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB. Setting This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. Methods We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities. Results Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications. Conclusion Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS). PMID:26245591

Marathon Kids UK: study design and protocol for a mixed methods evaluation of a school-based running programme

PubMed Central

Routen, Ash C; Harris, Jo P; Cale, Lorraine A; Gorely, Trish; Sherar, Lauren B

2018-01-01

Introduction Schools are promising settings for physical activity promotion; however, they are complex and adaptive systems that can influence the quality of programme implementation. This paper presents an evaluation of a school-based running programme (Marathon Kids). The aims of this study are (1) to identify the processes by which schools implement the programme, (2) identify and explain the contextual factors affecting implementation and explications of effectiveness and (3) examine the relationship between the level of implementation and perceived outcomes. Methods Using a realist evaluation framework, a mixed method single-group before-and-after design, strengthened by multiple interim measurements, will be used. Year 5 (9–10 years old) pupils and their teachers will be recruited from six state-funded primary schools in Leicestershire, UK. Data will be collected once prior to implementation, at five discrete time points during implementation and twice following implementation. A weekly implementation log will also be used. At time point 1 (TP1) (September 2016), data on school environment, teacher and pupil characteristics will be collected. At TP1 and TP6 (July 2017), accelerometry, pupil self-reported physical activity and psychosocial data (eg, social support and intention to be active) will be collected. At TP2, TP3 and TP5 (January, March and June 2017), observations will be conducted. At TP2 and TP5, there will be teacher interviews and pupil focus groups. Follow-up teacher interviews will be conducted at TP7 and TP8 (October 2017 and March 2018) and pupil focus group at TP8. In addition, synthesised member checking will be conducted (June 2018) with a mixed sample of schools. Ethics and dissemination Ethical approval for this study was obtained through Loughborough University Human Participants Ethics Subcommittee (R16-P032 & R16-P116). Findings will be disseminated via print, online media and dissemination events as well as practitioner and/or research journals. PMID:29764890

Outcomes and Impact of Training and Development in Health Management and Leadership in Relation to Competence in Role: A Mixed-Methods Systematic Review Protocol

PubMed Central

Ayeleke, Reuben Olugbenga; North, Nicola; Wallis, Katharine Ann; Liang, Zhanming; Dunham, Annette

2016-01-01

Background: The need for competence training and development in health management and leadership workforces has been emphasised. However, evidence of the outcomes and impact of such training and development has not been systematically assessed. The aim of this review is to synthesise the available evidence of the outcomes and impact of training and development in relation to the competence of health management and leadership workforces. This is with a view to enhancing the development of evidence-informed programmes to improve competence. Methods and Analysis: A systematic review will be undertaken using a mixed-methods research synthesis to identify, assess and synthesise relevant empirical studies. We will search relevant electronic databases and other sources for eligible studies. The eligibility of studies for inclusion will be assessed independently by two review authors. Similarly, the methodological quality of the included studies will be assessed independently by two review authors using appropriate validated instruments. Data from qualitative studies will be synthesised using thematic analysis. For quantitative studies, appropriate effect size estimate will be calculated for each of the interventions. Where studies are sufficiently similar, their findings will be combined in meta-analyses or meta-syntheses. Findings from quantitative syntheses will be converted into textual descriptions (qualitative themes) using Bayesian method. Textual descriptions and results of the initial qualitative syntheses that are mutually compatible will be combined in mixed-methods syntheses. Discussion: The outcome of data collection and analysis will lead, first, to a descriptive account of training and development programmes used to improve the competence of health management and leadership workforces and the acceptability of such programmes to participants. Secondly, the outcomes and impact of such programmes in relation to participants’ competence as well as individual and organisational performance will be identified. If possible, the relationship between health contexts and the interventions required to improve management and leadership competence will be examined PMID:28005551

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

Pre-departure preparation and co-curricular activities for Students' intercultural exchange: A mixed-methods study.

PubMed

Chan, E Angela; Liu, Justina Yat Wa; Fung, Keith Hin Kee; Tsang, Pak Lik; Yuen, John

2018-04-01

Nurses are required to be culturally competent to provide quality care to an increasingly diverse and ageing population. International exchange programmes were developed to support the traditional nursing curriculum. These programmes have often overlooked the importance of pre-departure preparation and co-curricular activities to the development of intercultural competency. To explore the influence of pre-departure and co-curricular activities on the intercultural learning experiences of both exchange and host students in a short-term international summer programme. A mixed-methods study. Students were recruited from international and mainland exchange partners, with host students as ambassadors. The international summer programme involved a week of online pre-departure activities and two weeks of face-to-face meetings. A convenience sample of 62 students from diverse cultural backgrounds was recruited on a voluntary basis. The participants were aged between 19 and 27. Data were collected from students' pre- and post-visit questionnaires, discussions within the workshops, their online discussion threads, and focus group discussions. The quantitative findings suggested that students' cultural intelligence improved significantly after the exchange programme. Qualitatively, three themes emerged as: 1) Students' motivation to engage in intercultural learning; 2) Barriers to intercultural communication; 3) Enablers of intercultural communication. Pre-departure preparation enabled students to discuss their common goals and expectations, while exploring differences, asked for practical living information, and used the basic intercultural concepts in their discussion on the care of elderly. This virtual encounter has lay the foundation for students' subsequent discussions about the why and how the differences that inform their own practices and about global ageing and poverty issues during their co-curricular activities. While the pre-departure preparation could serve as a stimulus, the value of this programme for intercultural learning also rests with the importance of debriefing to further students' reflective and experiential learning. Copyright © 2018 Elsevier Ltd. All rights reserved.

A mixed method evaluation of adult tier 2 lifestyle weight management service provision across a county in Northern England.

PubMed

Ells, L; Watson, P; Carlebach, S; O'Malley, C; Jones, D; Machaira, T; Whittaker, V; Clements, H; Walker, P; Needham, K; Summerbell, C; Coulton, V; Araujo-Soares, V

2018-06-01

Adult obesity in the UK remains a public health priority. Current guidance recommends local areas provide multicomponent interventions to treat adults with overweight and obesity; however, there is currently a dearth of published evidence on the evaluation of these programmes. This study reports on a mixed method evaluation of seven tier 2 weight management programmes funded by a local authority in the North of England through their public health grant (a lifestyle multicomponent weight management programme for the treatment of adults with overweight and obesity, but not severe obesity, or obesity with severe co-morbidities). Data collected from over 2000 participants demonstrated that the proportion of participants achieving 5% initial body weight loss was comparable to that reported in recent UK weight management trials. Two services exceeded national criteria of 30% of participants achieving 5% initial body weight loss at 12 weeks, although long term data was limited. Greater weight loss was also observed in participants aged 35-44 and those without co-morbidities. This study provides important learning points for improvements in real world weight management services, these include: standardised data collection and management tools; staff training and communication requirements; the importance of programmes that are joined up to wider support services; and the importance of providing ongoing peer and provider support, continuous monitoring and feedback, and physical activities tailored to user needs. © 2018 World Obesity Federation.

Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol.

PubMed

Smith, Stephanie L; Misago, Claire Nancy; Osrow, Robyn A; Franke, Molly F; Iyamuremye, Jean Damascene; Dusabeyezu, Jeanne D'Arc; Mohand, Achour A; Anatole, Manzi; Kayiteshonga, Yvonne; Raviola, Giuseppe J

2017-02-28

Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system. A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members. This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?-a scoping review.

PubMed

Francis, Linda; Dunt, David; Cadilhac, Dominique A

2016-05-31

Programmes to address chronic disease are a focus of governments worldwide. Despite growth in 'implementation science', there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. A scoping review of the literature spanning 1985-2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with 'maintenance of programme activities' most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 4 2014-01-01 2014-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 4 2013-01-01 2013-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 4 2012-01-01 2012-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study.

PubMed

Jesson, Julie; Masson, David; Adonon, Arsène; Tran, Caroline; Habarugira, Capitoline; Zio, Réjane; Nicimpaye, Léoncie; Desmonde, Sophie; Serurakuba, Goreth; Kwayep, Rosine; Sare, Edith; Konate, Tiefing; Nimaga, Abdoulaye; Saina, Philemon; Kpade, Akossiwa; Bassuka, Andrée; Gougouyor, Gustave; Leroy, Valériane

2015-05-26

The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa. A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition. Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5 years); and mixed malnutrition with male gender, age (<5 years), severe immunodeficiency and recent ART initiation (<6 months). Orphanhood and Cotrimoxazole prophylaxis were not associated with any type of malnutrition. The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a priority to improve health care of HIV-infected children in Africa.

Community Environmental Education as a Model for Effective Environmental Programmes

ERIC Educational Resources Information Center

Blair, Morag

2008-01-01

The benefits of community environmental education outlined in environmental education literature are supported by the findings and implications of a research study undertaken in New Zealand. Evidence from a two-case case study suggests that environmental programmes guided by the key principles and practices of community environmental education,…

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of risk-adjusted mortality data with an E-O plot and a risk-adjusted p chart is feasible and allows the rapid detection of changes in risk-adjusted outcome of intensive care patients. This complements the centralised national database, which is more archival and comparative in nature.

Towards an Analytical Framework for Understanding the Development of a Quality Assurance System in an International Joint Programme

ERIC Educational Resources Information Center

Zheng, Gaoming; Cai, Yuzhuo; Ma, Shaozhuang

2017-01-01

This paper intends to construct an analytical framework for understanding quality assurance in international joint programmes and to test it in a case analysis of a European--Chinese joint doctoral degree programme. The development of a quality assurance system for an international joint programme is understood as an institutionalization process…

An international survey of cerebral palsy registers and surveillance systems

PubMed Central

Goldsmith, Shona; McIntyre, Sarah; Smithers-Sheedy, Hayley; Blair, Eve; Cans, Christine; Watson, Linda; Yeargin-Allsopp, Marshalyn

2016-01-01

AIM To describe cerebral palsy (CP) surveillance programmes and identify similarities and differences in governance and funding, aims and scope, definition, inclusion/exclusion criteria, ascertainment and data collection, to enhance the potential for research collaboration. METHOD Representatives from 38 CP surveillance programmes were invited to participate in an online survey and submit their data collection forms. Descriptive statistics were used to summarize information submitted. RESULTS Twenty-seven surveillance programmes participated (25 functioning registers, two closed owing to lack of funding). Their aims spanned five domains: resource for CP research, surveillance, aetiology/prevention, service planning, and information provision (in descending order of frequency). Published definitions guided decision making for the definition of CP and case eligibility for most programmes. Consent, case identification, and data collection methods varied widely. Ten key data items were collected by all programmes and a further seven by at least 80% of programmes. All programmes reported an interest in research collaboration. INTERPRETATION Despite variability in methodologies, similarities exist across programmes in terms of their aims, definitions, and data collected. These findings will facilitate harmonization of data and collaborative research efforts, which are so necessary on account of the heterogeneity and relatively low prevalence of CP. PMID:26781543

Community participation in disease control.

PubMed

Bermejo, A; Bekui, A

1993-05-01

The main determinants of community participation in disease control programmes are identified and a framework with eleven variables is developed. Attention is drawn to the political background, community characteristics, the managerial capacity of the provider and the epidemiology of the disease. The framework is designed to guide health professionals in the systematic assessment and monitoring of participation in disease control programmes. Analysis of the Ghanaian Guinea Worm Eradication Programme and the Nicaraguan Tuberculosis Control Programme are presented as case studies. They show that political support does not guarantee community participation in disease control programmes and stress the importance of other determinants such as commitment to PHC, intersectoral coordination, the project approach and human resources. The relevance of the epidemiology of the disease in determining what degree of community participation will be most effective is highlighted by the case studies.

Rationale, design and baseline data of a mixed methods study examining the clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: the DON'T RETARD project

PubMed Central

Hilderson, Deborah; Westhovens, Rene; Wouters, Carine; Van der Elst, Kristien; Goossens, Eva; Moons, Philip

2013-01-01

Objectives To describe (1) the content of a transition programme for young people with juvenile idiopathic arthritis (JIA) designed as a brief intervention, (2) the rationale and design of a mixed-methods study evaluating the clinical impact of this transition programme and (3) to provide baseline data of the intervention group. Design An ‘embedded experimental’ design is used for the evaluation of the transition programme. A ‘one-group pretest-posttest, with a non-equivalent posttest-only comparison group design’ is used to quantitatively evaluate the impact of the transition programme, applying both longitudinal and comparative analyses. Subsequently, experiences of adolescents and their parents who participated in the experimental group will be analysed qualitatively using content analysis. Setting Participants in the intervention are recruited at a tertiary care centre in Belgium. The comparison group participants are recruited from one tertiary and three secondary care centres in Belgium. Participants The intervention group consists of 33 young people (25 females; 8 males) with a median age of 16 years. Main diagnoses are persistent or extended oligoarticular JIA (33%), polyarticular JIA (30%), enthesitis-related JIA (21%) or systemic arthritis (15%). Intervention The transition programme comprises eight key components: (1) transition coordinator; (2) providing information and education; (3) availability by telephone; (4) information about and contact with an adult care programme; (5) guidance of parents; (6) meeting with peers; (7) transfer plan; and (8) actual transfer to adult care. Primary and secondary outcomes The primary outcome is health status, as perceived by the adolescents. Secondary outcomes are health status, as perceived by the parents; medication adherence; illness-related knowledge; quality of life; fatigue; promotion of independence; support of autonomy; behavioural control and psychological control. Results At baseline, the median score was 69.2 (Q1=60.0;Q3=92.9) on psychosocial health and 68.8 (Q1=56.3; Q3=89.1) on physical health. Rheumatic-specific health scores ranged from 62.5 to 100. Conclusions We present the rationale and design of a study intended to evaluate a transition programme for adolescents with JIA as a brief intervention. PMID:24302502

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial.

PubMed

Wang, Yao; Xiao, Lily Dongxia; Ullah, Shahid; He, Guo-Ping; De Bellis, Anita

2017-02-01

The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services. To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme. A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme. Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme. A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis. Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice. A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Development of a competency mapping tool for undergraduate professional degree programmes, using mechanical engineering as a case study

NASA Astrophysics Data System (ADS)

Holmes, David W.; Sheehan, Madoc; Birks, Melanie; Smithson, John

2018-01-01

Mapping the curriculum of a professional degree to the associated competency standard ensures graduates have the competence to perform as professionals. Existing approaches to competence mapping vary greatly in depth, complexity, and effectiveness, and a standardised approach remains elusive. This paper describes a new mapping software tool that streamlines and standardises the competency mapping process. The available analytics facilitate ongoing programme review, management, and accreditation. The complete mapping and analysis of an Australian mechanical engineering degree programme is described as a case study. Each subject is mapped by evaluating the amount and depth of competence development present. Combining subject results then enables highly detailed programme level analysis. The mapping process is designed to be administratively light, with aspects of professional development embedded in the software. The effective competence mapping described in this paper enables quantification of learning within a professional degree programme, and provides a mechanism for holistic programme improvement.

Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses.

PubMed

Cole, Donald C; Johnson, Nancy; Mejia, Raul; McCullough, Hazel; Turcotte-Tremblay, Anne-Marie; Barnoya, Joaquin; Falabella Luco, María Soledad

2016-10-01

Mentoring experiences and programmes are becoming increasingly recognised as important by those engaged in capacity strengthening in global health research. Using a primarily qualitative study design, we studied three experiences of mentorship and eight mentorship programmes for early career global health researchers based in high-income and low- and middle-income countries. For the latter, we drew upon programme materials, existing unpublished data and more formal mixed-method evaluations, supplemented by individual email questionnaire responses. Research team members wrote stories, and the team assembled and analysed them for key themes. Across the diverse experiences and programmes, key emergent themes included: great mentors inspire others in an inter-generational cascade, mentorship is transformative in personal and professional development and involves reciprocity, and finding the right balance in mentoring relationships and programmes includes responding creatively to failure. Among the challenges encountered were: struggling for more level playing fields for new health researchers globally, changing mindsets in institutions that do not have a culture of mentorship and building collaboration not competition. Mentoring networks spanning institutions and countries using multiple virtual and face-to-face methods are a potential avenue for fostering organisational cultures supporting quality mentorship in global health research.

Shared decision-making for psychiatric medication: A mixed-methods evaluation of a UK training programme for service users and clinicians.

PubMed

Ramon, Shulamit; Morant, Nicola; Stead, Ute; Perry, Ben

2017-12-01

Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health. Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators. The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews. Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users' decisional conflict and perceptions of practitioners' interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users' and care co-ordinators confidence to explore medication experience, and group-based training was valued. The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions.

Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses

PubMed Central

Cole, Donald C.; Johnson, Nancy; Mejia, Raul; McCullough, Hazel; Turcotte-Tremblay, Anne-Marie; Barnoya, Joaquin; Falabella Luco, (María) Soledad

2016-01-01

ABSTRACT Mentoring experiences and programmes are becoming increasingly recognised as important by those engaged in capacity strengthening in global health research. Using a primarily qualitative study design, we studied three experiences of mentorship and eight mentorship programmes for early career global health researchers based in high-income and low- and middle-income countries. For the latter, we drew upon programme materials, existing unpublished data and more formal mixed-method evaluations, supplemented by individual email questionnaire responses. Research team members wrote stories, and the team assembled and analysed them for key themes. Across the diverse experiences and programmes, key emergent themes included: great mentors inspire others in an inter-generational cascade, mentorship is transformative in personal and professional development and involves reciprocity, and finding the right balance in mentoring relationships and programmes includes responding creatively to failure. Among the challenges encountered were: struggling for more level playing fields for new health researchers globally, changing mindsets in institutions that do not have a culture of mentorship and building collaboration not competition. Mentoring networks spanning institutions and countries using multiple virtual and face-to-face methods are a potential avenue for fostering organisational cultures supporting quality mentorship in global health research. PMID:26234691

An end to "See one, do one and teach one" residency training programme - impact of the training, education, surgical accreditation and assessment (TESA) programme on medical care and patients' safety.

PubMed

Tan, Thiam-Chye; Tan, Kim-Teng; Tee, John Cs

2007-09-01

The delivery of optimal and safe medical care is critical in healthcare. The traditional practice of "See one, do one and teach one" residency training programme is no longer acceptable. In the past, there was no structured residency training programme in our hospital. There were several cases of organ injuries from surgeries performed by the residents. In 2005, we conducted a pilot study to organise a structured teaching, education, surgical accreditation and assessment (TESA) residency programme for 15 residents in the Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital. We performed a written questionnaire survey of the residents on the new programme and patients' expectation (n = 2926) as subjective outcomes in the 1-year follow-up. We also studied the complication rates of all minor and major surgeries performed by the residents in 2004 and 2005 as an objective outcome. All the residents (n = 15) surveyed supported the TESA programme. Patients' expectation improved significantly from 71% in 2004 (n = 1559) to 83% in 2005 (n = 1367) (P = 0.03). There were 10,755 surgeries in 2004 and 10,558 surgeries in 2005 performed by our residents, with 6 cases (5.6%) of organ injuries in 2004 compared to 3 cases (2.8%) in 2005. This reduction was not statistically significant. The TESA residency programme in our hospital has an impact on the delivery of optimal and safe medical care while ensuring the training of residents to be competent specialists.

Progress towards malaria control targets in relation to national malaria programme funding

PubMed Central

2013-01-01

Background Malaria control has been dramatically scaled up the past decade, mainly thanks to increasing international donor financing since 2003. This study assessed progress up to 2010 towards global malaria impact targets, in relation to Global Fund, other donor and domestic malaria programme financing over 2003 to 2009. Methods Assessments used domestic malaria financing reported by national programmes, and Global Fund/OECD data on donor financing for 90 endemic low- and middle-income countries, WHO estimates of households owning one or more insecticide-treated mosquito net (ITN) for countries in sub-Saharan Africa, and WHO-estimated malaria case incidence and deaths in countries outside sub-Saharan Africa. Results Global Fund and other donor funding is concentrated in a subset of the highest endemic African countries. Outside Africa, donor funding is concentrated in those countries with highest malaria mortality and case incidence rates over the years 2000 to 2003. ITN coverage in 2010 in Africa, and declines in case and death rates per person at risk over 2004 to 2010 outside Africa, were greatest in countries with highest donor funding per person at risk, and smallest in countries with lowest donor malaria funding per person at risk. Outside Africa, all-source malaria programme funding over 2003 to 2009 per case averted ($56-5,749) or per death averted ($58,000-3,900,000) over 2004 to 2010 tended to be lower (more favourable) in countries with higher donor malaria funding per person at risk. Conclusions Increases in malaria programme funding are associated with accelerated progress towards malaria control targets. Associations between programme funding per person at risk and ITN coverage increases and declines in case and death rates suggest opportunities to maximize the impact of donor funding, by strategic re-allocation to countries with highest continued need. PMID:23317000

Contemplating case mix: A primer on case mix classification and management.

PubMed

Costa, Andrew P; Poss, Jeffery W; McKillop, Ian

2015-01-01

Case mix classifications are the frameworks that underlie many healthcare funding schemes, including the so-called activity-based funding. Now more than ever, Canadian healthcare administrators are evaluating case mix-based funding and deciphering how they will influence their organization. Case mix is a topic fraught with technical jargon and largely relegated to government agencies or private industries. This article provides an abridged review of case mix classification as well as its implications for management in healthcare. © 2015 The Canadian College of Health Leaders.

oneED: Embedding a mindfulness-based wellness programme into an emergency department.

PubMed

Braganza, Shahina; Young, Jessica; Sweeny, Amy; Brazil, Victoria

2018-03-30

ED staff are subject to many stressors, but there are few descriptions of collective approaches to enhancing wellness in this setting. We aim to describe a programme developed to address these issues at department level, to report the feasibility and sustainability of the programme, and its impact on staff. The oneED programme was developed and delivered in a tertiary ED. The programme included a 1 day mindfulness workshop, followed by ongoing mindfulness activities embedded in clinical areas over the subsequent 12 months. A mixed-methods evaluation of the programme was conducted, which included quantitative validated psychological tools to measure anxiety, depression and emotional exhaustion, and pragmatic evaluation using surveys of participants and iterative appreciative inquiry. Eighty staff members attended the mindfulness workshop; 66 from ED. Following the workshop, understanding and frequency of mindfulness practice increased significantly in 47% of participants. Free-text survey results demonstrated that staff found the programme to be acceptable (80% survey participants) and of perceived value to themselves (50%) and the ED (60%). Appreciative inquiry led to modification of the programme: the 4 min pause is now conducted weekly rather than daily, the pause consists of a variety of activities, and group activities are made more overtly optional. A departmental wellness programme embedding mindfulness practice is feasible and sustainable. Potential for success is enhanced by an approach that is open to modification according to each institution's culture. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Implementing case-based teaching strategies in a decentralised nursing management programme in South Africa.

PubMed

Nkosi, Zethu; Pillay, Padmini; Nokes, Kathleen M

2013-01-01

Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. The objectives of the study was to describe a decentralised nursing management education programme located in Durban, South Africa and describe the perceptions of nursing faculty facilitators regarding implementation of this teaching method. Data was collected through the use of one-on-one interviews and also focus groups amongst the fifteen facilitators who were using a case-based curriculum to teach the programme content. The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse for between 11 and 20 years; slightly more than half had worked as a facilitator for three or more years. The facilitators identified themes related to the student learners, the learning environment, and strengths and challenges of using facilitation to teach the content through cases. Decentralised nursing management educational programmes can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services. Nursing faculty facilitators need knowledgeable and accessible contact with centrally based full-time nursing faculty in order to promote high quality educational programmes.

Nursing home costs, Medicaid rates, and profits under alternative Medicaid payment systems.

PubMed Central

Schlenker, R E

1991-01-01

This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems. PMID:1743972

Case mix, quality, and cost relationships in Colorado nursing homes.

PubMed

Schlenker, R E; Shaughessy, P W

1984-01-01

The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.

Challenges of Designing Interdisciplinary Postgraduate Curricula: Case Studies of Interdisciplinary Master's Programmes at a Research-Intensive UK University

ERIC Educational Resources Information Center

Gantogtokh, Orkhon; Quinlan, Kathleen M.

2017-01-01

This study, based on case study analyses of two interdisciplinary programmes in a research-intensive university in the UK, focuses on the challenges involved in designing, coordinating, and leading interdisciplinary postgraduate curricula, including workload, student heterogeneity, and difficulties in achieving coherence. Solutions and approaches…

Evaluation of the Start Programme: Case-Study Report

ERIC Educational Resources Information Center

MacLeod, Shona; Sharp, Caroline; Weaving, Harriet; Smith, Robert; Wheater, Rebecca

2014-01-01

This report presents five case studies of long-term partnerships (over three years) between arts organisations and schools. The Start programme enables arts venues and schools to work together to offer disadvantaged young people opportunities to engage in creative activities that inspire them and enhance their experience of the arts. It is…

Introducing integrated product and process development into the education of science and engineering undergraduates: a lecture course with an accompanying case-study programme at the ETH chemistry department.

PubMed

Fenner, K; Jödicke, G; Alean-Kirkpatrick, P; Hungerbühler, K

2001-04-01

Increased quality requirements in the development of chemical products and a growing awareness within society of the activities of chemical companies present a new challenge to the education of young scientists. Nowadays, the teaching of chemists, chemical engineers and environmental scientists at universities has to go beyond the traditional, discipline-orientated knowledge acquisition. The students also have to learn to work and communicate in interdisciplinary teams, to solve application-oriented tasks and to integrate scientific, economical, ecological and social aspects into their work. For this reason, a case-study programme was launched at the chemistry department of the Swiss Federal Institute of Technology. In this paper, we describe the organisational aspects of the programme, its inclusion into academic and industrial environments and summarise some of the scientific methodologies applied. One of the seven case-studies, an assessment of a modern insecticide, is presented in more detail. Finally, we discuss how far the case-study programme is suitable for introducing a new mode of knowledge production to universities.

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh.

PubMed

Paul, Sukanta; Akter, Rahima; Aftab, Afzal; Khan, Antora M; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika

2015-01-31

Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.

Public engagement in Malawi through a health-talk radio programme ' Umoyo nkukambirana': A mixed-methods evaluation.

PubMed

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O'byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2018-02-01

Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ' Umoyo nkukambirana' was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings.

Public engagement in Malawi through a health-talk radio programme ‘Umoyo nkukambirana’: A mixed-methods evaluation

PubMed Central

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O’byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2016-01-01

Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ‘Umoyo nkukambirana’ was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings. PMID:27365364

Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India

PubMed Central

Schneider, Helen

2014-01-01

The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two ‘blocks’, purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women’s collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the explanatory framework may provide general lessons for programmes in similar contexts. PMID:25274643

[Effects of a 'theory of mind' cognitive development pilot programme in three children with autism: emotional component].

PubMed

Villanueva-Bonilla, Cristian; Bonilla-Santos, Jasmín; Arana-Guzmán, Fernanda; Ninco-Cuenca, Ingrid; Quintero-Lozano, Andrea

2016-03-16

Theory of mind is defined as the capacity to predict, understand and act when faced with other people's behaviour, their knowledge, their intentions, their emotions and their beliefs. It is proposed as a feasible alternative for establishing a programme adapted to the characteristics of children diagnosed with autism spectrum disorder. The effect of a 'theory of mind' cognitive development pilot programme on the emotional skills of three children with autism spectrum disorder is reported. Case 1: 9-year-old boy, with scarce emotional identification and expression, as well as difficulties to hold fluent and coherent conversations. Case 2: 10-year-old boy, with mechanical, not very fluent language, and difficulties to start and maintain a conversation. Case 3: 8-year-old girl who presents deficits in the non-verbal communicative behaviours used in social interaction and difficulties to adapt to situations other than everyday ones. In the three cases there is an improvement in the emotional capacities following implementation of the programme; moreover, their parents, teachers or therapists perceived positive changes in the children's adaptive skills. The methodological and structural aspects of the cognitive development programme were well-suited to the children with autism who took part in the research study. Due to the preliminary nature of this study, it is suggested that future research should utilise a larger sample and a double-blind design with randomised case-controls that allow the findings to be generalised.

Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system.

PubMed

Hollenbeak, Christopher S; Rubin, Robert J; Tzivelekis, Spiros; Stephens, J Mark

2015-06-01

The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008. Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence. Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+. Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

PubMed

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

Geriatric consultation service in emergency department: how does it work?

PubMed

Yuen, Terry Man Yue; Lee, Larry Lap Yip; Or, Ikea Lai Chun; Yeung, Kwai Lin; Chan, Jimmy Tak Shing; Chui, Catherine Pui Yuk; Kun, Emily Wai Lin

2013-03-01

Hong Kong is having a significant prevalence of geriatric patients who usually require admission after presentation to the hospital through emergency departments. The geriatric consultation programme 'We Care' aims at lowering acute geriatric medical admission. The study aims at analysing the impact of the geriatric consultation service on the acute medical admission, and to study the characteristics and outcome of geriatric patients. Retrospective study. Patients who received geriatric consultations during 1 January 2009 to 1 March 2011 were enrolled. The demographic information, diseases case mix, venue of discharge, clinical severity, community nursing service referrals and adverse outcomes were retrieved and analysed. The incidence of adverse outcomes under the presence of each factor was studied. 2202 geriatric patients were referred. Their age ranged from 45 to 99 (mean 79.91, SD 7.45, median 80). These cases were categorised into: (1) chronic pulmonary disease (n=673; 30.6%), (2) debilitating cardiac disease (n=526; 23.9%), (3) geriatric syndromes (n=147; 6.7%), (4) neurological problems (n=416; 18.9%), (5) diabetes-related problems (n=146; 6.6%), (6) terminal malignancy (n=39; 1.8%), (7) electrolyte or input/output disturbance (n=137; 6.2%), (8) non-respiratory infections (n=36, 1.6%) and (9) others (n=82; 3.7%). Acute medical admission was evaded in 84.7% of all consultations with 1039 (47.2%) patients discharged home and 825 patients (37.5%) admitted to convalescent hospital. The incidence rate of adverse outcomes was 1.6%. Programme 'We Care' provided comprehensive geriatric assessment to suitable geriatric patients, resulting in an effective reduction of acute geriatric hospital admission.

Gender counts: A systematic review of evaluations of gender-integrated health interventions in low- and middle-income countries.

PubMed

Schriver, Brittany; Mandal, Mahua; Muralidharan, Arundati; Nwosu, Anthony; Dayal, Radhika; Das, Madhumita; Fehringer, Jessica

2017-11-01

As a result of new global priorities, there is a growing need for high-quality evaluations of gender-integrated health programmes. This systematic review examined 99 peer-reviewed articles on evaluations of gender-integrated (accommodating and transformative) health programmes with regard to their theory of change (ToC), study design, gender integration in data collection, analysis, and gender measures used. Half of the evaluations explicitly described a ToC or conceptual framework (n = 50) that guided strategies for their interventions. Over half (61%) of the evaluations used quantitative methods exclusively; 11% used qualitative methods exclusively; and 28% used mixed methods. Qualitative methods were not commonly detailed. Evaluations of transformative interventions were less likely than those of accommodating interventions to employ randomised control trials. Two-thirds of the reviewed evaluations reported including at least one specific gender-related outcome (n = 18 accommodating, n = 44 transformative). To strengthen evaluations of gender-integrated programmes, we recommend use of ToCs, explicitly including gender in the ToC, use of gender-sensitive measures, mixed-method designs, in-depth descriptions of qualitative methods, and attention to gender-related factors in data collection logistics. We also recommend further research to develop valid and reliable gender measures that are globally relevant.

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders' views.

PubMed

Pound, Pandora; Denford, Sarah; Shucksmith, Janet; Tanton, Clare; Johnson, Anne M; Owen, Jenny; Hutten, Rebecca; Mohan, Leanne; Bonell, Chris; Abraham, Charles; Campbell, Rona

2017-07-02

Sex and relationship education (SRE) is regarded as vital to improving young people's sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a 'life skills' approach and not focus on abstinence. Young people advocated a 'sex-positive' approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Reforming a Bachelor of Music Programme: A Case Study

ERIC Educational Resources Information Center

Carey, Gemma; Lebler, Don

2012-01-01

In 2010, the authors conducted a formal review of the Queensland Conservatorium's Bachelor of Music programme to determine to what extent the programme prepared graduates for professional life in the 21st century. The process was informed by comprehensive performance indicator data and substantial feedback from staff, students, and other…

Who Attends Physical Activity Programmes in Deprived Neighbourhoods?

ERIC Educational Resources Information Center

Withall, J.; Jago, R.; Fox, K. R.

2011-01-01

Objective: Physical activity can reduce the risk of several chronic diseases. Such diseases are most prevalent in economically-disadvantaged groups where physical activity levels are consistently lower. There is a need to engage disadvantaged groups in programmes to increase physical activity. This case study examined programmes on offer in a…

Assessing Leadership Knowledge in a Principalship Preparation Programme

ERIC Educational Resources Information Center

Seong, David Ng Foo

2013-01-01

Purpose: The purpose of this paper is to assess leadership learning in a principalship development programme. Design/methodology/approach: This case study adopted Popper's three worlds as an analytical framework to assess leadership learning in a principalship development programme. The unit of assessment of learning is knowledge--more…

A Case Study of a College-Wide First-Year Undergraduate Engineering Course

ERIC Educational Resources Information Center

Aloul, Fadi; Zualkernan, Imran; Husseini, Ghaleb; El-Hag, Ayman; Al-Assaf, Yousef

2015-01-01

Introductory engineering courses are either programme specific or expose students to engineering as a broad discipline by including materials from various engineering programmes. A common introductory engineering course that spans different engineering programmes raises challenges, including the high cost of resources as well as the lack of…

School Inclusion Programmes (SIPS)

ERIC Educational Resources Information Center

Drossinou-Korea, Maria; Matousi, Dimitra; Panopoulos, Nikolaos; Paraskevopoulou, Aikaterini

2016-01-01

The purpose of this work was to understand the school inclusion programmes (SIPs) for students with special educational needs (SEN). The methodology was conducted in the field of special education (SE) and focuses on three case studies of students who was supported by SIPs. The Targeted, Individual, Structured, Inclusion Programme for students…

Understanding Learning Transfer in Employment Preparation Programmes for Adults with Low Skills

ERIC Educational Resources Information Center

Taylor, Maurice C.; Ayala, Gabriel E.; Pinsent-Johnson, Christine

2009-01-01

This Canadian study investigated how the transfer of learning occurred in an employment preparation programme for adults with low literacy skills using a multi-site case study research design. Four different programmes involving trainees, instructors and workplace supervisors participated in the investigation. Results indicated that the transfer…

Context Matters in Programme Implementation

ERIC Educational Resources Information Center

Clarke, Aleisha M.; O'Sullivan, Maeve; Barry, Margaret M.

2010-01-01

Purpose: This paper seeks to report on the evaluation of Zippy's Friends, an international emotional wellbeing programme, for primary school children in disadvantaged schools in Ireland. The paper aims to present case studies of the profile and ethos of two specific schools participating in the programme, their links with the local community, the…

Promoting mental wellbeing: developing a theoretically and empirically sound complex intervention.

PubMed

Millar, S L; Donnelly, M

2014-06-01

This paper describes the development of a complex intervention to promote mental wellbeing using the revised framework for developing and evaluating complex interventions produced by the UK Medical Research Council (UKMRC). Application of the first two phases of the framework is described--development and feasibility and piloting. The theoretical case and evidence base were examined analytically to explicate the theoretical and empirical foundations of the intervention. These findings informed the design of a 12-week mental wellbeing promotion programme providing early intervention for people showing signs of mental health difficulties. The programme is based on the theoretical constructs of self-efficacy, self-esteem, purpose in life, resilience and social support and comprises 10 steps. A mixed methods approach was used to conduct a feasibility study with community and voluntary sector service users and in primary care. A significant increase in mental wellbeing was observed following participation in the intervention. Qualitative data corroborated this finding and suggested that the intervention was feasible to deliver and acceptable to participants, facilitators and health professionals. The revised UKMRC framework can be successfully applied to the development of public health interventions. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The management of cardiovascular disease in the Netherlands: analysis of different programmes

PubMed Central

Cramm, Jane M.; Tsiachristas, Apostolos; Walters, Bethany H.; Adams, Samantha A.; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P.M.H.; Nieboer, Anna P.

2013-01-01

Background Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. Methods To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Results Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Conclusions Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs. PMID:24167456

The management of cardiovascular disease in the Netherlands: analysis of different programmes.

PubMed

Cramm, Jane M; Tsiachristas, Apostolos; Walters, Bethany H; Adams, Samantha A; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna P

2013-01-01

Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs.

A leadership programme for critical care.

PubMed

Crofts, Linda

2006-08-01

This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

Research capacity building in midwifery: Case study of an Australian Graduate Midwifery Research Intern Programme.

PubMed

Hauck, Yvonne L; Lewis, Lucy; Bayes, Sara; Keyes, Louise

2015-09-01

Having the research capacity to identify problems, create new knowledge and most importantly translate this knowledge into practice is essential within health care. Midwifery, as well as other health professions in Australia, is challenged in building its research capacity to contribute evidence to inform clinical practice. The aim of this project was to evaluate an innovative Graduate Midwifery Research Intern Programme offered at a tertiary obstetric hospital in Western Australia, to determine what was working well and how the programme could be improved. A case study approach was used to gain feedback from graduate midwives within a Graduate Research Intern (GRI) Programme. In addition outcomes were compiled of all projects the GRI midwives contributed to. Six GRI midwives participated in a survey comprising of four open ended questions to provide feedback about the programme. Findings confirm that the GRI programme increased the graduates understanding of how research works, its capacity to define a problem, generate new knowledge and inform clinical practice. The GRI midwives' feedback suggested the programme opened their thinking to future study and gave them enhanced insight into women's experiences around childbirth. To grow our knowledge as a professional group, midwives must develop and promote programmes to build our pool of research capable midwives. By sharing our programme evaluation we hope to entice other clinical settings to consider the value in replicating such a programme within their context. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Programme for providing innovative mental health care in rural communities in India.

PubMed

Maulik, P K; Devarapalli, S; Kallakuri, S; Praveen, D; Jha, V; Patel, A

2015-01-01

India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India. The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators. This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.

Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

PubMed

Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

2011-10-01

Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.

Impact of Health Research Capacity Strengthening in Low- and Middle-Income Countries: The Case of WHO/TDR Programmes

PubMed Central

Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

2011-01-01

Background Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. Methodology and Principal Findings A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. Conclusion The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs. PMID:22022630

PIAAC Skills and Economic Inequality

ERIC Educational Resources Information Center

Pena, Anita Alves

2016-01-01

Mixed findings characterize the literature on skills and economic distributions within and across countries. The Programme for the International Assessment of Adult Competencies (PIAAC) offers new, internationally comparable data on literacy, numeracy, and digital problem-solving skills that can be combined with wage information. This paper…

Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes.

PubMed

Dalziel, Kim; Segal, Leonie

2012-09-01

There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.

Organising, Providing and Evaluating Technical Training for Early Career Researchers: A Case Study

ERIC Educational Resources Information Center

van Besouw, Rachel M.; Rogers, Katrine S.; Powles, Christopher J.; Papadopoulos, Timos; Ku, Emery M.

2013-01-01

This paper considers the importance of providing technical training opportunities for Early Career Researchers (ECRs) worldwide through the case study of a MATLAB training programme, which was proposed, organised, managed and evaluated by a team of five ECRs at the University of Southampton. The effectiveness of the programme in terms of the…

Exploring the Dimensions of Brand Reputation in Higher Education--A Case Study of a Finnish Master's Degree Programme

ERIC Educational Resources Information Center

Suomi, Kati

2014-01-01

This exploratory study examines the dimensions that are relevant to brand reputation, particularly in the context of master's degree programmes. The data analysis is based on Vidaver-Cohen's "Business school quality dimensions and reputational attributes". The qualitative data for the case study comprise a student questionnaire and…

Procedures and Claims among US Evidence-Producing Organisations: The Case of the Incredible Years Programme

ERIC Educational Resources Information Center

Karlsson, Patrik; Bergmark, Anders; Lundström, Tommy

2014-01-01

We explore how four evidence-producing organisations in the US go ahead when they rate the evidence base for psychosocial interventions, using the Incredible Years programme as our case study. The findings demonstrate variation in the procedures and resulting evidence claims across the organisations, with some organisations being strict and some…

Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data.

PubMed

Gelli, Aulo; Masset, Edoardo; Folson, Gloria; Kusi, Anthoni; Arhinful, Daniel K; Asante, Felix; Ayi, Irene; Bosompem, Kwabena M; Watkins, Kristie; Abdul-Rahman, Lutuf; Agble, Rosanna; Ananse-Baden, Getrude; Mumuni, Daniel; Aurino, Elisabetta; Fernandes, Meena; Drake, Lesley

2016-01-20

'Home-grown' school feeding programmes are complex interventions with the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including smallholder farmers and women's groups. There is limited rigorous evidence, however, that this is the case in practice. This evaluation will examine explicitly, and from a holistic perspective, the simultaneous impact of a national school meals programme on micronutrient status, alongside outcomes in nutrition, education and agriculture domains. The 3-year study involves a cluster-randomised control trial designed around the scale-up of the national school feeding programme, including 116 primary schools in 58 districts in Ghana. The randomly assigned interventions are: 1) a school feeding programme group, including schools and communities where the standard government programme is implemented; 2) 'home-grown' school feeding, including schools and communities where the standard programme is implemented alongside an innovative pilot project aimed at enhancing nutrition and agriculture; and 3) a control group, including schools and households from communities where the intervention will be delayed by at least 3 years, preferably without informing schools and households. Primary outcomes include child health and nutritional status, school participation and learning, and smallholder farmer income. Intermediate outcomes along the agriculture and nutrition pathways will also be measured. The evaluation will follow a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders. The baseline survey was completed in August 2013 and the endline survey is planned for November 2015. The tests of balance show significant differences in the means of a number of outcome and control variables across the intervention groups. Important differences across groups include marketed surplus, livestock income, per capita food consumption and intake, school attendance, and anthropometric status in the 2-5 and 5-15 years age groups. In addition, approximately 19 % of children in the target age group received some form of free school meals at baseline. Designing and implementing the evaluation of complex interventions is in itself a complex undertaking, involving a multi-disciplinary research team working in close collaboration with programme- and policy-level stakeholders. Managing the complexity from an analytical and operational perspective is an important challenge. The analysis of the baseline data indicates that the random allocation process did not achieve statistically comparable treatment groups. Differences in outcomes and control variables across groups will be controlled for when estimating treatment effects. ISRCTN66918874 (registered on 5 March 2015).

Medicaid case-mix nursing home reimbursement in three states.

PubMed

Swan, James H; Pickard, Ruth B

2003-01-01

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

Critical interactions between Global Fund-supported programmes and health systems: a case study in Indonesia.

PubMed

Desai, Monica; Rudge, James W; Adisasmito, Wiku; Mounier-Jack, Sandra; Coker, Richard

2010-11-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria has played an important role in financing the response to HIV/AIDS and tuberculosis (TB) in Indonesia. As part of a series of case studies, we assessed the nature and extent of integration of Global Fund portfolios into the national HIV and TB programmes, integration of the HIV and TB programmes within the general health system, and system-wide effects of Global Fund support on the health care system in Indonesia. The study relied on a literature review and interviews with 22 key informants using the Systemic Rapid Assessment Toolkit and thematic analysis. Global Fund programmes in Indonesia are highly vertical and centralized, in contrast with the decentralized nature of the Indonesian health system. Consequently, there is more integration of all functions at local levels than centrally. There is a high level of integration of planning of Global Fund HIV and TB portfolios into the National AIDS and TB programmes and some limited integration of these programmes with other disease programmes, through joint working groups. Other synergies include strengthening of stewardship and governance and increased staff recruitment encouraged by incentive payments and training. Monitoring and evaluation functions of the Global Fund programmes are not integrated with the disease programmes, with parallel indicators and reporting systems. System-wide effects include greater awareness of governance and stewardship in response to the temporary suspension of Global Fund funding in 2008, and increased awareness of the need to integrate programme planning, financing and service delivery. Global Fund investment has freed up resources for other programmes, particularly at local levels. However, this may hinder a robust exit strategy from Global Fund funding. Furthermore, Global Fund monetary incentives may result in staff shifting into HIV and TB programmes.

Current Situation of Leprosy in India and its Future Implications.

PubMed

Rao, P Narasimha; Suneetha, Sujai

2018-01-01

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication.

Current Situation of Leprosy in India and its Future Implications

PubMed Central

Rao, P. Narasimha; Suneetha, Sujai

2018-01-01

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication. PMID:29644191

Challenges of rehabilitation case mix measurement in Ontario hospitals.

PubMed

Sutherland, Jason Murray; Walker, Jan

2008-03-01

Case mix classification systems have been adopted in many countries as a method to manage and finance healthcare in acute care settings; the most popular systems are based on diagnosis related groups. The most successful of those case mix systems differentiate patient types by reflecting both the intensity of resources consumed and patient acuity. Case mix systems for use with non-acute hospital activity have not been as wide-spread; other than in the United States, little attention has been directed towards case mix classification for rehabilitation activity. In a province with over 13 million inhabitants with 2496 rehabilitation beds, inpatient rehabilitation is an important component of hospital care in Ontario, Canada, and consists of the spectrum of intensive rehabilitation activities intended to restore function. Although case mix adjusted activity has been the currency in Ontario's Integrated Population Based Allocation hospital funding formula, rehabilitation activity has not been subjected to case mix measurement. A project to examine case mix classification for adult inpatient rehabilitation activity was initiated by the Ontario Ministry of Health and Long-Term Care whose outcome was a case mix system and associated cost weights that would result in rehabilitation activity being incorporated into the hospital funding formula. The process described in this study provides Ontario's provincial government with a case mix classification system for adult inpatient rehabilitation activity although there remain areas for improvement.

Using Cultural Capital as a Resource for Negotiating Participation in a Teacher Community of Practice: A Case Study

ERIC Educational Resources Information Center

Maistry, Suriamurthee

2010-01-01

Continuing professional development (CPD) initiatives for teachers in South Africa take on various forms, ranging from formalised, structured, credit-bearing certification programmes to informal, relatively unstructured, situated learning programmes. While many formal programmes can claim success by measuring throughput rates, there is still much…

An Impact Evaluation of the "FoodMate" Programme: Perspectives of Homeless Young People and Staff

ERIC Educational Resources Information Center

Meiklejohn, Sarah J.; Barbour, Liza; Palermo, Claire E.

2017-01-01

Objectives: Food insecurity remains an issue for vulnerable populations in developed countries. The potential dietary and food security impacts of nutrition education programmes in Australia remain largely undocumented. This study investigated the impacts of an eight-session nutrition education programme delivered within community case management…

Embedding Enterprise: A Business School Undergraduate Course with an Enterprise Focus

ERIC Educational Resources Information Center

Jones, Paul; Jones, Amanda; Skinner, Heather; Packham, Gary

2013-01-01

This study profiles, through a case study of an undergraduate business programme, how a business school has embedded the theme of enterprise in its core undergraduate programme. Key participants in the development of the strategy and programme tutors and students were interviewed, to provide information for an analysis of the principle objectives…

What Do Primary Students Say about School-Based Social Work Programmes?

ERIC Educational Resources Information Center

Testa, Doris

2014-01-01

This article focuses on primary school children's experiences of school-based social work programmes. These students, aged between 6 and 11, and drawn from a student population comprising 28 different cultural backgrounds and from low socio-economic backgrounds, participated in a case study that researched a school-based social work programme, the…

Student Learning Support Programmes That Demonstrate Tangible Impact on Retention, Pass Rates & Completion. 2nd Edition

ERIC Educational Resources Information Center

Manalo, Emmanuel, Ed.; Marshall, Jenny, Ed.; Fraser, Cath, Ed.

2010-01-01

This report comprises summations and brief case descriptions of some of the effective programmes and other support mechanisms that New Zealand Tertiary Learning Advisors (TLAs) provide for students in universities, polytechnics, institutes of technology, and other tertiary institutions. The programmes demonstrate tangible impact on student…

Economic evaluation of occupational health and safety programmes in health care.

PubMed

Guzman, J; Tompa, E; Koehoorn, M; de Boer, H; Macdonald, S; Alamgir, H

2015-10-01

Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Emerging models for mobilizing family support for chronic disease management: a structured review.

PubMed

Rosland, Ann-Marie; Piette, John D

2010-03-01

We identify recent models for programmes aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease and rheumatologic disease. Programmes with three separate foci were identified: (1) Programmes that guide family members in setting goals for supporting patient self-care behaviours have led to improved implementation of family support roles, but have mixed success improving patient outcomes. (2) Programmes that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviours. (3) Programmes that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. The next generation of programmes to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programmes, the most effective combinations of support strategies, and how best to integrate family support programmes into comprehensive models of chronic disease care.

The Perception of Art among Patients and Staff on a Renal Dialysis Unit.

PubMed

Corrigan, C; Peterson, L; McVeigh, C; Lavin, P J; Mellotte, G J; Wall, C; Baker Kerrigan, A; Barnes, L; O'Neill, D; Moss, H

2017-10-10

This study investigated the purpose and effectiveness of giving outpatients an opportunity to engage in art activities while receiving dialysis treatment. A mixed method study was conducted. 21 semi-structured interviews were conducted with outpatients attending the dialysis unit and 13 surveys of clinicians were completed. The principle reasons to partake in the art activity programme included: to pass time, to relieve boredom, to be creative, to try something new, distraction from concerns, to stay positive and to achieve something new. Patients who did not participate in the programme pass their time primarily by watching TV or sleeping. All staff who partook in the survey were satisfied with the programme and wanted it to continue. Our findings indicate that the creative arts programme is viewed positively by staff and patients alike, and might be useful in other hospital departments. Further in depth qualitative research would be useful to interrogate the potential effect of engagement in art on positive mental health and quality of life for patients with chronic conditions.

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review.

PubMed

Kelleher, E; Davoren, M P; Harrington, J M; Shiely, F; Perry, I J; McHugh, S M

2017-02-01

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition. © 2016 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Mixed case complaints. 268.302 Section 268.302... RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case complaint is a complaint of employment discrimination filed with the Board based on race, color, religion...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Mixed case complaints. 268.302 Section 268.302... RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case complaint is a complaint of employment discrimination filed with the Board based on race, color, religion...

The GIS map coloring support decision-making system based on case-based reasoning and simulated annealing algorithm

NASA Astrophysics Data System (ADS)

Deng, Shuang; Xiang, Wenting; Tian, Yangge

2009-10-01

Map coloring is a hard task even to the experienced map experts. In the GIS project, usually need to color map according to the customer, which make the work more complex. With the development of GIS, more and more programmers join the project team, which lack the training of cartology, their coloring map are harder to meet the requirements of customer. From the experience, customers with similar background usually have similar tastes for coloring map. So, we developed a GIS color scheme decision-making system which can select color schemes of similar customers from case base for customers to select and adjust. The system is a BS/CS mixed system, the client side use JSP and make it possible for the system developers to go on remote calling of the colors scheme cases in the database server and communicate with customers. Different with general case-based reasoning, even the customers are very similar, their selection may have difference, it is hard to provide a "best" option. So, we select the Simulated Annealing Algorithm (SAA) to arrange the emergence order of different color schemes. Customers can also dynamically adjust certain features colors based on existing case. The result shows that the system can facilitate the communication between the designers and the customers and improve the quality and efficiency of coloring map.

Tuberculosis--triumph and tragedy.

PubMed

Singh, M M

2003-03-01

Tuberculosis has been making havoc worldwide with an 11.9 million cases to be involved by the year 2005. In India, about 2 million cases are infected every year. Regarding triumphs and tragedies in the control of tuberculosis some points as follows are discussed. (1) Tuberculosis Control Programmes from National Tuberculosis Programme (NTP) to Revised National Tuberculosis Control Programme (RNTCP) and Directly Observed Treatment, Short course (DOTS). (2) Problem of multidrug resistance (MDR) tuberculosis and (3) HIV and tuberculosis. DOTS being largely based on Indian research. It is now being applied worldwide. MDR is strictly a man made problem. Poor prescriptions, poor case management, lack of coordinated education and haphazard treatment research result in drug resistance. Treatment of MDR is difficult. The drug acceptability, tolerance and toxicity have to be considered. HIV and tuberculosis form a deadly duo. They mean more cases, more costs and more national losses.

Do weight management programmes delivered at professional football clubs attract and engage high risk men? A mixed-methods study.

PubMed

Hunt, Kate; Gray, Cindy M; Maclean, Alice; Smillie, Susan; Bunn, Christopher; Wyke, Sally

2014-01-21

The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes. Developing weight management programmes which are appealing and acceptable to men is a public health priority. Football Fans in Training (FFIT), a men-only weight management programme delivered to groups of men at top professional football clubs, encourages men to lose weight by working with, not against, cultural ideals of masculinity. To inform further development of interventions in football club settings, the current study explored who is attracted to FFIT and why overweight/obese men choose to take part. A mixed-methods study analysing baseline data on 747 men aged 35-65 years with BMI ≥ 28 kg/m2 who were participants in a randomised controlled trial of FFIT, and data from 13 focus group discussions with 63 men who had attended the programme. Objectively-measured mean body mass index was 35.3 kg/m2 (sd 4.9). Overall over 90% of participants were at very high or extremely high risk of future ill-health. Around three-quarters of participants in all age groups were at 'very high' risk of type 2 diabetes, hypertension and cardiovascular disease (72%, 73% and 80% of men aged 35-44, 45-54 and 55-64 years respectively). A further 21%, 16% and 13% were at 'extremely high' risk. Qualitative data revealed that the powerful 'draw' of the football club attracted men otherwise reluctant to attend existing weight management programmes. The location and style of delivery of early FFIT sessions fostered team spirit; men appreciated being with others 'like them' and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly, the football club. The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health. The setting enabled men to join a weight management programme in circumstances that felt 'right' rather than threatening to themselves as men. FFIT is an example of how to facilitate health promotion activities in a way that is consistent with, rather than challenging to, common ideals of masculinity.

The effects of a mindfulness-based lifestyle programme for adults with Parkinson's disease: protocol for a mixed methods, randomised two-group control study.

PubMed

Advocat, Jenny; Russell, Grant; Enticott, Joanne; Hassed, Craig; Hester, Jennifer; Vandenberg, Brooke

2013-10-10

Parkinson's disease (PD) is the second most common neurodegenerative disorder in developed countries. There is an increasing interest in the use of mindfulness-related interventions in the management of patients with a chronic disease. In addition, interventions that promote personal control, stress-management and other lifestyle factors, such as diet and exercise, assist in reducing disability and improving quality of life in people with chronic illnesses. There has been little research in this area for people with PD. A prospective mixed-method randomised clinical trial involving community living adults with PD aged <76 years and with moderate disease severity (Hoehn and Yahr stage 2) PD. Participants will be randomised into the ESSENCE 6-week programme or a matched wait list control group. ESSENCE is a multifaceted, healthy lifestyle and mindfulness programme designed to improve quality of life. We aim to determine whether participation in a mindfulness and lifestyle programme could improve PD-related function and explore self-management related experiences and changing attitudes towards self-management. The outcome measures will include 5 self-administered questionnaires: PD function and well-being questionnaire (PDQ39), Health Behaviours, Mental health, Multidimensional locus of control, and Freiburg mindfulness inventory. An embedded qualitative protocol will include in-depth interviews with 12 participants before and after participation in the 6-week programme and a researcher will observe the programme and take notes. Repeated measures of Analysis of Variance (ANOVA) will examine the outcome measures for any significant effects from the group allocation, age, sex, adherence score and attendance. Qualitative data will be analysed thematically. We will outline the benefits of, and barriers to, the uptake of the intervention. This protocol has received ethics approval from the Monash University Human Research Ethics Committee project number CF11/2662-2011001553. This is the first research of its kind in Australia involving a comprehensive, lifestyle-based programme for people with PD and has the potential to involve a broader range of providers than standard care. The findings will be disseminated through peer reviewed journals, primary care conferences in Australia as well as abroad and through the Parkinson's community. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820.

The effects of a mindfulness-based lifestyle programme for adults with Parkinson’s disease: protocol for a mixed methods, randomised two-group control study

PubMed Central

Advocat, Jenny; Russell, Grant; Enticott, Joanne; Hassed, Craig; Hester, Jennifer; Vandenberg, Brooke

2013-01-01

Introduction Parkinson's disease (PD) is the second most common neurodegenerative disorder in developed countries. There is an increasing interest in the use of mindfulness-related interventions in the management of patients with a chronic disease. In addition, interventions that promote personal control, stress-management and other lifestyle factors, such as diet and exercise, assist in reducing disability and improving quality of life in people with chronic illnesses. There has been little research in this area for people with PD. Methods A prospective mixed-method randomised clinical trial involving community living adults with PD aged <76 years and with moderate disease severity (Hoehn and Yahr stage 2) PD. Participants will be randomised into the ESSENCE 6-week programme or a matched wait list control group. ESSENCE is a multifaceted, healthy lifestyle and mindfulness programme designed to improve quality of life. We aim to determine whether participation in a mindfulness and lifestyle programme could improve PD-related function and explore self-management related experiences and changing attitudes towards self-management. The outcome measures will include 5 self-administered questionnaires: PD function and well-being questionnaire (PDQ39), Health Behaviours, Mental health, Multidimensional locus of control, and Freiburg mindfulness inventory. An embedded qualitative protocol will include in-depth interviews with 12 participants before and after participation in the 6-week programme and a researcher will observe the programme and take notes. Analysis Repeated measures of Analysis of Variance (ANOVA) will examine the outcome measures for any significant effects from the group allocation, age, sex, adherence score and attendance. Qualitative data will be analysed thematically. We will outline the benefits of, and barriers to, the uptake of the intervention. Ethics This protocol has received ethics approval from the Monash University Human Research Ethics Committee project number CF11/2662–2011001553. Dissemination This is the first research of its kind in Australia involving a comprehensive, lifestyle-based programme for people with PD and has the potential to involve a broader range of providers than standard care. The findings will be disseminated through peer reviewed journals, primary care conferences in Australia as well as abroad and through the Parkinson's community. Registration details Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820. PMID:24114370

Do weight management programmes delivered at professional football clubs attract and engage high risk men? A mixed-methods study

PubMed Central

2014-01-01

Background The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes. Developing weight management programmes which are appealing and acceptable to men is a public health priority. Football Fans in Training (FFIT), a men-only weight management programme delivered to groups of men at top professional football clubs, encourages men to lose weight by working with, not against, cultural ideals of masculinity. To inform further development of interventions in football club settings, the current study explored who is attracted to FFIT and why overweight/obese men choose to take part. Methods A mixed-methods study analysing baseline data on 747 men aged 35–65 years with BMI ≥ 28 kg/m2 who were participants in a randomised controlled trial of FFIT, and data from 13 focus group discussions with 63 men who had attended the programme. Results Objectively-measured mean body mass index was 35.3 kg/m2 (sd 4.9). Overall over 90% of participants were at very high or extremely high risk of future ill-health. Around three-quarters of participants in all age groups were at ‘very high’ risk of type 2 diabetes, hypertension and cardiovascular disease (72%, 73% and 80% of men aged 35–44, 45–54 and 55–64 years respectively). A further 21%, 16% and 13% were at ‘extremely high’ risk. Qualitative data revealed that the powerful ‘draw’ of the football club attracted men otherwise reluctant to attend existing weight management programmes. The location and style of delivery of early FFIT sessions fostered team spirit; men appreciated being with others ‘like them’ and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly, the football club. Conclusions The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health. The setting enabled men to join a weight management programme in circumstances that felt ‘right’ rather than threatening to themselves as men. FFIT is an example of how to facilitate health promotion activities in a way that is consistent with, rather than challenging to, common ideals of masculinity. PMID:24443845

Communication partner training for health care professionals in an inpatient rehabilitation setting: A parallel randomised trial.

PubMed

Heard, Renee; O'Halloran, Robyn; McKinley, Kathryn

2017-06-01

The purpose of this study is to determine if the E-Learning Plus communication partner training (CPT) programme is as effective as the Supported Conversation for Adults with Aphasia (SCA TM ) CPT programme in improving healthcare professionals' confidence and knowledge communicating with patients with aphasia. Forty-eight healthcare professionals working in inpatient rehabilitation participated. Participants were randomised to one of the CPT programmes. The three outcome measures were self-rating of confidence, self-rating of knowledge and a test of knowledge of aphasia. Measures were taken pre-, immediately post- and 3-4 months post-training. Data were analysed using mixed between within ANOVAs. Homogeneity of variance was adequate for self-rating of confidence and test of knowledge of aphasia data to continue analysis. There was a statistically significant difference in self-rating of confidence and knowledge of aphasia for both interventions across time. No statistically significant difference was found between the two interventions. Both CPT interventions were associated with an increase in health care professionals' confidence and knowledge of aphasia, but neither programme was superior. As the E-Learning Plus CPT programme is more accessible and sustainable in the Australian healthcare context, further work will continue on this CPT programme.

Preventing childhood obesity in Asia: an overview of intervention programmes.

PubMed

Uijtdewilligen, L; Waters, C N; Müller-Riemenschneider, F; Lim, Y W

2016-11-01

The rapid economic growth in Asia in the past few decades has contributed to the global increase in childhood obesity prevalence. Yet, little is known about obesity prevention efforts in this region. This systematic review provides an overview of child obesity prevention programmes in Asia. Searches were performed in six electronic databases. Out of 4,234 studies, 17 were included, among them 11 controlled trials (of which five were randomized). Only one study was published before 2007. Identified studies were predominantly conducted in China and Thailand and targeted primary school children in a school setting. Most studies implemented different programmes, frequently targeting behavioural modification through nutrition/health education lectures and/or physical activity sessions. Programme effects related to obesity outcome measures were mixed. Most substantial effects were found for outcomes such as improved health knowledge and/or favourable lifestyle practices. The relatively small number of relevant publications in Asia highlights the need for scientific evaluations of existing and future programmes. This will help ensure the implementation and dissemination of evidence-based approaches that have been proven to be effective in the Asian context. Targeting preschool settings and applying a comprehensive multisectoral approach may increase the effectiveness and sustainability of childhood obesity prevention programmes. © 2016 World Obesity.

Using the RE-AIM framework to evaluate a school-based municipal programme tripling time spent on PE.

PubMed

Nielsen, Jonas Vestergaard; Skovgaard, Thomas; Bredahl, Thomas Viskum Gjelstrup; Bugge, Anna; Wedderkopp, Niels; Klakk, Heidi

2018-06-01

Documenting the implementation of effective real-world programmes is considered an important step to support the translation of evidence into practice. Thus, the aim of this study was to identify factors influencing the adoption, implementation and maintenance of the Svendborgproject (SP) - an effective real-world programme comprising schools to implement triple the amount of physical education (PE) in pre-school to sixth grade in six primary schools in the municipality of Svendborg, Denmark. SP has been maintained for ten years and scaled up to all municipal schools since it was initiated in 2008. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was applied as an analytic tool through a convergent mixed method triangulation design. Results show that SP has been implemented with high fidelity and become an established part of the municipality and school identity. The successful implementation and dissemination of the programme has been enabled through the introduction of a predominantly bottom-up approach combined with simple non-negotiable requirements. The results show that this combination has led to a better fit of programmes to the individual school context while still obtaining high implementation fidelity. Finally, the early integration of research has legitimated and benefitted the programme. Copyright © 2018 Elsevier Ltd. All rights reserved.

Marathon Kids UK: study design and protocol for a mixed methods evaluation of a school-based running programme.

PubMed

Chalkley, Anna E; Routen, Ash C; Harris, Jo P; Cale, Lorraine A; Gorely, Trish; Sherar, Lauren B

2018-05-14

Schools are promising settings for physical activity promotion; however, they are complex and adaptive systems that can influence the quality of programme implementation. This paper presents an evaluation of a school-based running programme (Marathon Kids). The aims of this study are (1) to identify the processes by which schools implement the programme, (2) identify and explain the contextual factors affecting implementation and explications of effectiveness and (3) examine the relationship between the level of implementation and perceived outcomes. Using a realist evaluation framework, a mixed method single-group before-and-after design, strengthened by multiple interim measurements, will be used. Year 5 (9-10 years old) pupils and their teachers will be recruited from six state-funded primary schools in Leicestershire, UK.Data will be collected once prior to implementation, at five discrete time points during implementation and twice following implementation. A weekly implementation log will also be used. At time point 1 (TP1) (September 2016), data on school environment, teacher and pupil characteristics will be collected. At TP1 and TP6 (July 2017), accelerometry, pupil self-reported physical activity and psychosocial data (eg, social support and intention to be active) will be collected. At TP2, TP3 and TP5 (January, March and June 2017), observations will be conducted. At TP2 and TP5, there will be teacher interviews and pupil focus groups. Follow-up teacher interviews will be conducted at TP7 and TP8 (October 2017 and March 2018) and pupil focus group at TP8. In addition, synthesised member checking will be conducted (June 2018) with a mixed sample of schools. Ethical approval for this study was obtained through Loughborough University Human Participants Ethics Subcommittee (R16-P032 & R16-P116). Findings will be disseminated via print, online media and dissemination events as well as practitioner and/or research journals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Integrating ICT in Kenyan Secondary Schools: An Exploratory Case Study of a Professional Development Programme

ERIC Educational Resources Information Center

Tondeur, Jo; Krug, Don; Bill, Mike; Smulders, Maaike; Zhu, Chang

2015-01-01

This study explores the introduction of Information and Communication Technology (ICT) in Kenyan secondary schools. Specifically, it is a case study of four schools with no previous access to ICT. The professional development programme from which data for this study were drawn was designed to support teachers learning to integrate ICT in the…

Diversifying Counsellor Education: A Case Study of U.S. Students of Colour

ERIC Educational Resources Information Center

Hipolito-Delgado, Carlos P.; Estrada, Diane; Garcia, Marina

2017-01-01

Due to limited research on the experiences of students of colour in counselling programmes, counsellor educators are ill-equipped to implement strategies to promote the graduation of students of colour. In this case study, we explored the protective and risk factors for students of colour enrolled in a counselling programme in the Western U.S.…

A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods.

PubMed

Downing, Julia; Batuli, Mwazi; Kivumbi, Grace; Kabahweza, Josephine; Grant, Liz; Murray, Scott A; Namukwaya, Elizabeth; Leng, Mhoira

2016-04-08

Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46% of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96% had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit -MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews. A significant difference was seen in nurses' confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86%) and referred 334 (14%) to MPCU. Clinical guidelines/protocols were utilised in 50% of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013). The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.

Improving child nutrition and development through community-based childcare centres in Malawi - The NEEP-IE study: study protocol for a randomised controlled trial.

PubMed

Gelli, Aulo; Margolies, Amy; Santacroce, Marco; Sproule, Katie; Theis, Sophie; Roschnik, Natalie; Twalibu, Aisha; Chidalengwa, George; Cooper, Amrik; Moorhead, Tyler; Gladstone, Melissa; Kariger, Patricia; Kutundu, Mangani

2017-06-19

The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial. Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children's Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children's ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders. Assessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes. ISRCTN registry, ID: ISRCTN96497560 . Registered on 21 September 2016.

Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports.

PubMed

Drezner, Jonathan A; Toresdahl, Brett G; Rao, Ashwin L; Huszti, Ella; Harmon, Kimberly G

2013-12-01

Sudden cardiac arrest (SCA) is the leading cause of death in athletes during exercise. The effectiveness of school-based automated external defibrillator (AED) programmes has not been established through a prospective study. A total of 2149 high schools participated in a prospective observational study beginning 1 August 2009, through 31 July 2011. Schools were contacted quarterly and reported all cases of SCA. Of these 95% of schools confirmed their participation for the entire 2-year study period. Cases of SCA were reviewed to confirm the details of the resuscitation. The primary outcome was survival to hospital discharge. School-based AED programmes were present in 87% of participating schools and in all but one of the schools reporting a case of SCA. Fifty nine cases of SCA were confirmed during the study period including 26 (44%) cases in students and 33 (56%) in adults; 39 (66%) cases occurred at an athletic facility during training or competition; 55 (93%) cases were witnessed and 54 (92%) received prompt cardiopulmonary resuscitation. A defibrillator was applied in 50 (85%) cases and a shock delivered onsite in 39 (66%). Overall, 42 of 59 (71%) SCA victims survived to hospital discharge, including 22 of 26 (85%) students and 20 of 33 (61%) adults. Of 18 student-athletes 16 (89%) and 8 of 9 (89%) adults who arrested during physical activity survived to hospital discharge. High school AED programmes demonstrate a high survival rate for students and adults who suffer SCA on school campus. School-based AED programmes are strongly encouraged.

Reliability and Validity in Hospital Case-Mix Measurement

PubMed Central

Pettengill, Julian; Vertrees, James

1982-01-01

There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogenous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix. PMID:10309909

Impact of five years of rotavirus vaccination in Finland - And the associated cost savings in secondary healthcare.

PubMed

Leino, Tuija; Baum, Ulrike; Scott, Peter; Ollgren, Jukka; Salo, Heini

2017-10-09

This study aimed to estimate the impact of the national rotavirus (RV) vaccination programme, starting 2009, on the total hospital-treated acute gastroenteritis (AGE) and severe RV disease burden in Finland during the first five years of the programme. This study also evaluated the costs saved in secondary healthcare by the RV vaccination programme. The RV related outcome definitions were based on ICD10 diagnostic codes recorded in the Care Register for Health Care. Incidences of hospitalised and hospital outpatient cases of AGE (A00-A09, R11) and RVGE (A08.0) were compared prior (1999-2005) and after (2010-2014) the start of the programme among children less than five years of age. The reduction in disease burden in 2014, when all children under five years of age have been eligible for RV vaccination, was 92.9% (95%CI: 91.0%-94.5%) in hospitalised RVGE and 68.5% (66.6%-70.3%) in the total hospitalised AGE among children less than five years of age. For the corresponding hospital outpatient cases, there was a reduction of 91.4% (82.4%-96.6%) in the RVGE incidence, but an increase of 6.3% (2.7%-9.9%) in the AGE incidence. The RV vaccination programme prevented 2206 secondary healthcare AGE cases costing €4.5 million annually. As the RV immunisation costs were €2.3 million, the total net savings just in secondary healthcare costs were €2.2 million, i.e. €33 per vaccinated child. The RV vaccination programme clearly controlled the severe, hospital-treated forms of RVGE. The total disease burden is a more valuable end point than mere specifically diagnosed cases as laboratory confirmation practises usually change after vaccine introduction. The RV vaccination programme annually pays for itself at least two times over. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies.

PubMed

Clavier, Carole; Gendron, Sylvie; Lamontagne, Lise; Potvin, Louise

2012-07-01

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme-context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004-2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent-child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Mixed Methods Sampling Methodology for a Multisite Case Study

ERIC Educational Resources Information Center

Sharp, Julia L.; Mobley, Catherine; Hammond, Cathy; Withington, Cairen; Drew, Sam; Stringfield, Sam; Stipanovic, Natalie

2012-01-01

The flexibility of mixed methods research strategies makes such approaches especially suitable for multisite case studies. Yet the utilization of mixed methods to select sites for these studies is rarely reported. The authors describe their pragmatic mixed methods approach to select a sample for their multisite mixed methods case study of a…

The Case for Programmable Calculators in Schools.

ERIC Educational Resources Information Center

Inglis, Norman J.

1981-01-01

Programmable calculators are useful tools in the classroom that are often overlooked. This report gives examples of problems and activities that can be brought within the scope of such calculators. (MP)

Adapting Nepal's polio eradication programme.

PubMed

Paudel, Krishna P; Hampton, Lee M; Gurung, Santosh; Bohara, Rajendra; Rai, Indra K; Anaokar, Sameer; Swift, Rachel D; Cochi, Stephen

2017-03-01

Many countries have weak disease surveillance and immunization systems. The elimination of polio creates an opportunity to use staff and assets from the polio eradication programme to control other vaccine-preventable diseases and improve disease surveillance and immunization systems. In 2003, the active surveillance system of Nepal's polio eradication programme began to report on measles and neonatal tetanus cases. Japanese encephalitis and rubella cases were added to the surveillance system in 2004. Staff from the programme aided the development and implementation of government immunization policies, helped launch vaccination campaigns, and trained government staff in reporting practices and vaccine management. Nepal eliminated indigenous polio in 2000, and controlled outbreaks caused by polio importations between 2005 and 2010. In 2014, the surveillance activities had expanded to 299 sites, with active surveillance for measles, rubella and neonatal tetanus, including weekly visits from 15 surveillance medical officers. Sentinel surveillance for Japanese encephalitis consisted of 132 sites. Since 2002, staff from the eradication programme have helped to introduce six new vaccines and helped to secure funding from Gavi, the Vaccine Alliance. Staff have also assisted in responding to other health events in the country. By expanding the activities of its polio eradication programme, Nepal has improved its surveillance and immunization systems and increased vaccination coverage of other vaccine-preventable diseases. Continued donor support, a close collaboration with the Expanded Programme on Immunization, and the retention of the polio eradication programme's skilled workforce were important for this expansion.

Cost effectiveness of the Oregon quitline "free patch initiative".

PubMed

Fellows, Jeffrey L; Bush, Terry; McAfee, Tim; Dickerson, John

2007-12-01

We estimated the cost effectiveness of the Oregon tobacco quitline's "free patch initiative" compared to the pre-initiative programme. Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy. Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22-$353) per life year saved. Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.

Trilingual Education in China: Perspectives from a University Programme for Minority Students

ERIC Educational Resources Information Center

Liu, Jie; Edwards, Viv

2017-01-01

Attention to trilingual education programmes in China has tended to focus on basic education; there had been little attention to date on the higher education sector. This paper will attempt to bridge this gap by exploring a Yi-English-Chinese trilingual education programme through case studies of three Yi students, using the "River of…

Curriculum, Culture, Ideology and Ownership: The Case of the Exploring Masculinities Programme

ERIC Educational Resources Information Center

McCormack, Orla; Gleeson, Jim

2012-01-01

This article considers curriculum ownership, contestation and the relationship between curriculum and culture through the lens of the Exploring Masculinities (EM) programme. The programme was developed in the late 1990s to meet the social and personal needs of young men. As its dissemination was being planned, it became the subject of critical…

Structures and Programme Supports for Creativity, Action, Service in the International Baccalaureate Diploma Programme: An Implementation Study in Turkey

ERIC Educational Resources Information Center

Martin, Robin Ann; Tanyu, Manolya; Perry, Stirling

2016-01-01

This qualitative multiple-case study examined the implementation of an experiential learning component of an academic curriculum in six high schools in Turkey. Structures and supports that influenced programme implementation were examined using an implementation framework adapted from Durlak and Dupre. The study describes how the experiential…

Content and Language Integrated Learning Next in Asia: Evidence of Learners' Achievement in CLIL Education from a Taiwan Tertiary Degree Programme

ERIC Educational Resources Information Center

Yang, Wenhsien

2015-01-01

This study investigates learners' performance in a Taiwanese tertiary content and language integrated learning (CLIL) programme. Learners' English proficiency was measured immediately after entering the programme and before their industrial placement, i.e. after two years. As in previously reported cases, the learners showed a significant…

Sexuality Education: Findings and Recommendations from an Analysis of 10 United States Programmes

ERIC Educational Resources Information Center

Cushman, Nicole; Kantor, Leslie M.; Schroeder, Elizabeth; Eicher, Lesley; Gambone, Gina

2014-01-01

In this study, we identified 10 sexuality education programmes from different locations in the USA that aim to give young people knowledge and skills to develop healthy relationships, as well as avoid pregnancy and disease. We conducted in-depth interviews with programme administrators to develop a series of case studies and provide concrete…

Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India.

PubMed

Nandi, Sulakshana; Schneider, Helen

2014-09-01

The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two 'blocks', purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women's collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the explanatory framework may provide general lessons for programmes in similar contexts. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Globalisation and MATESOL Programmes in the UK

ERIC Educational Resources Information Center

Hasrati, Mostafa; Tavakoli, Parvaneh

2015-01-01

This article reports the results of a mixed-methods approach to investigating the association between globalisation and MATESOL in UK universities. Qualitative and quantitative data collected from academic staff through eight emails, four interviews and 41 questionnaires indicate that the globalised context of higher education has affected these…

Computation and Dynamics: Classical and Quantum

NASA Astrophysics Data System (ADS)

Kisil, Vladimir V.

2010-05-01

We discuss classical and quantum computations in terms of corresponding Hamiltonian dynamics. This allows us to introduce quantum computations which involve parallel processing of both: the data and programme instructions. Using mixed quantum-classical dynamics we look for a full cost of computations on quantum computers with classical terminals.

Development and evaluation of a wheelchair service provision training of trainers programme

PubMed Central

2017-01-01

Background In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner. Objectives To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers. Method An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots. Results Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package. Conclusion The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers. PMID:28936423

Review of performance-based incentives in community-based family planning programmes

PubMed Central

Bellows, Nicole M; Askew, Ian; Bellows, Benjamin

2015-01-01

Background One strategy for improving family planning (FP) uptake at the community level is the use of performance-based incentives (PBIs), which offer community distributors financial incentives to recruit more users of FP. This article examines the use of PBIs in community-based FP programmes via a literature search of the peer-reviewed and grey literature conducted in April 2013. Results A total of 28 community-based FP programmes in 21 countries were identified as having used PBIs. The most common approach was a sales commission model where distributors received commission for FP products sold, while a referral payment model for long-term methods was also used extensively. Six evaluations were identified that specifically examined the impact of the PBI in community-based FP programmes. Overall, the results of the evaluations are mixed and more research is needed; however, the findings suggest that easy-to-understand PBIs can be successful in increasing the use of FP at the community level. Conclusion For future use of PBIs in community-based FP programmes it is important to consider the ethics of incentivising FP and ensuring that PBIs are non-coercive and choice-enhancing. PMID:25037703

The effectiveness of exercise programmes in patients with multiple myeloma: A literature review.

PubMed

Gan, J H; Sim, C Y L; Santorelli, L A

2016-02-01

A limited number of clinical studies have investigated the effectiveness of participation in exercise training programmes for patients with multiple myeloma (MM), exploring the different biomedical, physical, psychological and quality of life. The aim of this literature review is to evaluate current quantitative and qualitative evidence concerning the effectiveness of participation in exercise programmes for patients with MM in improving physiological and/or psychological status. A literature search encompassing studies published between January 1998 and July 2013 was conducted through ten electronic databases. This search was further expanded through citation chaining, manual grey literature searches, and peer review consultation. In total, seven interventional studies were identified and appraised using Critical Appraisal Skill Programme (CASP) or Centre for Evidence-Based Management of Amsterdam (CEBMa). Though the majority of the studies presented encouraging data, however, three studies that implemented individualized exercise interventions for patients at different stages of MM and myeloablative treatment showed mixed results. In conclusion, the effectiveness of participation in exercise programmes remains unclear for patients with MM, as the studies reviewed were flawed by relatively weak methodological approaches. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Understanding geographic origins and history of admixture among chimpanzees in European zoos, with implications for future breeding programmes.

PubMed

Hvilsom, C; Frandsen, P; Børsting, C; Carlsen, F; Sallé, B; Simonsen, B T; Siegismund, H R

2013-06-01

Despite ample focus on this endangered species, conservation planning for chimpanzees residing outside Africa has proven a challenge because of the lack of ancestry information. Here, we analysed the largest number of chimpanzee samples to date, examining microsatellites in >100 chimpanzees from the range of the species in Africa, and 20% of the European zoo population. We applied the knowledge about subspecies differentiation throughout equatorial Africa to assign origin to chimpanzees in the largest conservation management programme globally. A total of 63% of the genotyped chimpanzees from the European zoos could be assigned to one of the recognized subspecies. The majority being of West African origin (40%) will help consolidate the current breeding programme for this subspecies and the identification of individuals belonging to the two other subspecies so far found in European zoos can form the basis for breeding programmes for these. Individuals of various degree of mixed ancestry made up 37% of the genotyped European zoo population and thus highlight the need for appropriate management programmes guided by genetic analysis to preserve maximum genetic diversity and reduce hybridization among subspecies.

Understanding geographic origins and history of admixture among chimpanzees in European zoos, with implications for future breeding programmes

PubMed Central

Hvilsom, C; Frandsen, P; Børsting, C; Carlsen, F; Sallé, B; Simonsen, B T; Siegismund, H R

2013-01-01

Despite ample focus on this endangered species, conservation planning for chimpanzees residing outside Africa has proven a challenge because of the lack of ancestry information. Here, we analysed the largest number of chimpanzee samples to date, examining microsatellites in >100 chimpanzees from the range of the species in Africa, and 20% of the European zoo population. We applied the knowledge about subspecies differentiation throughout equatorial Africa to assign origin to chimpanzees in the largest conservation management programme globally. A total of 63% of the genotyped chimpanzees from the European zoos could be assigned to one of the recognized subspecies. The majority being of West African origin (40%) will help consolidate the current breeding programme for this subspecies and the identification of individuals belonging to the two other subspecies so far found in European zoos can form the basis for breeding programmes for these. Individuals of various degree of mixed ancestry made up 37% of the genotyped European zoo population and thus highlight the need for appropriate management programmes guided by genetic analysis to preserve maximum genetic diversity and reduce hybridization among subspecies. PMID:23531981

Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba.

PubMed

Baly, Alberto; Toledo, Maria E; Rodriguez, Karina; Benitez, Juan R; Rodriguez, Maritza; Boelaert, Marleen; Vanlerberghe, Veerle; Van der Stuyft, Patrick

2012-01-01

To assess the economic cost of routine Aedes aegypti control in an at-risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January-July) and during an outbreak (August-December). Data sources were bookkeeping records, direct observations and interviews. The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non-medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In-depth studies should assess which mix of activities and actors could maximize the effectiveness and cost-effectiveness of routine Aedes control and dengue prevention. © 2011 Blackwell Publishing Ltd.

Monitoring and evaluation of strategic change programme implementation-Lessons from a case analysis.

PubMed

Neumann, Jan; Robson, Andrew; Sloan, Diane

2018-02-01

This study considered the monitoring and evaluation of a large-scale and domestic and global strategic change programme implementation. It considers the necessary prerequisites to overcome challenges and barriers that prevent systematic and effective monitoring and evaluation to take place alongside its operationalisation. The work involves a case study based on a major industrial company from the energy sector. The change programme makes particular reference to changes in business models, business processes, organisation structures as well as Enterprise Resource Planning infrastructure. The case study focussed on the summative evaluation of the programme post-implementation. This assessment involved 25 semi-structured interviews with employees across a range of managerial strata capturing more than 65 roles within the change programme at both local and global levels. Data relating to their perception of evaluation effectiveness and shortcomings were analysed by means of template analysis. The study identifies responsibilities for executing an evaluation alongside various methods and tools that are appropriate, thereby focussing on the "Who" (roles, responsibility for particular activities) and "How" (methods and tools) rather than "What" to monitor and evaluate. The findings are presented generically so they offer new insights and transferability for practitioners involved in managing strategic change and its associated evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Development of a scalable mental healthcare plan for a rural district in Ethiopia

PubMed Central

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

2016-01-01

Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174

Stability of Programmable Shunt Valve Settings with Simultaneous Use of the Optune Transducer Array: A Case Report.

PubMed

Chan, Andrew K; Birk, Harjus S; Winkler, Ethan A; Viner, Jennifer A; Taylor, Jennie W; McDermott, Michael W

2016-07-07

The Optune® transducer array (Novocure Ltd., Haifa, Israel) is an FDA-approved noninvasive regional therapy that aims to inhibit the growth of glioblastoma multiforme (GBM) cells via utilization of alternating electric fields. Some patients with GBM may develop hydrocephalus and benefit from subsequent shunt placement, but special attention must be paid to patients in whom programmable valves are utilized, given the potential effect of the magnetic fields on valve settings. We present the first case report illustrating the stability of programmable shunt valve settings in a neurosurgical patient undergoing therapy with the Optune device. In this study, shunt valve settings were stable over a period of five days despite Optune therapy. This is reassuring for patients with GBM who require simultaneous treatment with both the Optune device and a programmable shunt system.

Tuberculosis control in Asia and the western Pacific: a role for computer modelling.

PubMed

Brewer, T F; Heymann, S J; Harris, J B

1997-09-01

Despite the availability of effective treatment, tuberculosis (TB) causes more deaths than any other infection. Most of the world's TB cases and deaths occur in Asia and the Western Pacific, and the growing prevalence of multiple drug-resistant TB and the spread of human immunodeficiency virus (HIV) present ever greater obstacles to effective TB control. The management of TB remains difficult, and epidemiologic studies to assess control programmes require significant time and expense and may not be generalizable to other regions. Computer models are powerful and relatively inexpensive tools for rapidly planning and evaluating TB control strategies. Models have demonstrated the value of targeted chemoprophylaxis strategies for the prevention of TB among HIV-infected individuals, and programmes to ensure that all HIV-infected individuals receive TB chemoprophylaxis should be considered in Asia and the Western Pacific. Though directly observed therapy (DOT) is effective when designed to be attractive to patients, modelling has shown that DOT, if poorly accepted by patients, may lead to fewer patients seeking care and thus to paradoxical rises in TB case rates. Models may be used to make accurate predictions of TB morbidity and programme costs using local epidemiologic and demographic inputs. The use of models in Asia and the Western Pacific offers a low-cost way to compare programmes, to improve the evaluation of programmes, to project future cases, and to examine programme needs while providing insights into TB control helpful to countries in and out of the region.

University of Wolverhampton Case Study: Embedding Practical Work-Based Modules into a Traditionally, Theoretical Programme

ERIC Educational Resources Information Center

Nicholls, Emma; Walsh, Margaret

2007-01-01

Purpose: This case study aims to provide a critical evaluation of the decision by the University of Wolverhampton's School of Legal Studies to develop a number of work-based learning modules, offered as part of the undergraduate programme. It seeks to examine why the School has taken the approach of embedding work-based learning into what has…

Student Teachers of Technology and Design into Industry: A Northern Ireland Case Study

ERIC Educational Resources Information Center

Gibson, Ken

2013-01-01

This paper, based in Northern Ireland, is a case study of an innovative programme which places year 3 B.Ed. post-primary student teachers of Technology and Design into industry for a five-day period. The industrial placement programme is set in an international context of evolving pre-service field placements and in a local context defined by the…

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

PubMed Central

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L

2012-01-01

Objectives Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Design/setting Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Main outcome measures Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Results Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. Conclusions While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio-demographic groups. PMID:22626735

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

PubMed

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L; Roland, Martin

2012-08-01

Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.

Computerized microfluidic cell culture using elastomeric channels and Braille displays.

PubMed

Gu, Wei; Zhu, Xiaoyue; Futai, Nobuyuki; Cho, Brenda S; Takayama, Shuichi

2004-11-09

Computer-controlled microfluidics would advance many types of cellular assays and microscale tissue engineering studies wherever spatiotemporal changes in fluidics need to be defined. However, this goal has been elusive because of the limited availability of integrated, programmable pumps and valves. This paper demonstrates how a refreshable Braille display, with its grid of 320 vertically moving pins, can power integrated pumps and valves through localized deformations of channel networks within elastic silicone rubber. The resulting computerized fluidic control is able to switch among: (i) rapid and efficient mixing between streams, (ii) multiple laminar flows with minimal mixing between streams, and (iii) segmented plug-flow of immiscible fluids within the same channel architecture. The same control method is used to precisely seed cells, compartmentalize them into distinct subpopulations through channel reconfiguration, and culture each cell subpopulation for up to 3 weeks under perfusion. These reliable microscale cell cultures showed gradients of cellular behavior from C2C12 myoblasts along channel lengths, as well as differences in cell density of undifferentiated myoblasts and differentiation patterns, both programmable through different flow rates of serum-containing media. This technology will allow future microscale tissue or cell studies to be more accessible, especially for high-throughput, complex, and long-term experiments. The microfluidic actuation method described is versatile and computer programmable, yet simple, well packaged, and portable enough for personal use.

Computerized microfluidic cell culture using elastomeric channels and Braille displays

PubMed Central

Gu, Wei; Zhu, Xiaoyue; Futai, Nobuyuki; Cho, Brenda S.; Takayama, Shuichi

2004-01-01

Computer-controlled microfluidics would advance many types of cellular assays and microscale tissue engineering studies wherever spatiotemporal changes in fluidics need to be defined. However, this goal has been elusive because of the limited availability of integrated, programmable pumps and valves. This paper demonstrates how a refreshable Braille display, with its grid of 320 vertically moving pins, can power integrated pumps and valves through localized deformations of channel networks within elastic silicone rubber. The resulting computerized fluidic control is able to switch among: (i) rapid and efficient mixing between streams, (ii) multiple laminar flows with minimal mixing between streams, and (iii) segmented plug-flow of immiscible fluids within the same channel architecture. The same control method is used to precisely seed cells, compartmentalize them into distinct subpopulations through channel reconfiguration, and culture each cell subpopulation for up to 3 weeks under perfusion. These reliable microscale cell cultures showed gradients of cellular behavior from C2C12 myoblasts along channel lengths, as well as differences in cell density of undifferentiated myoblasts and differentiation patterns, both programmable through different flow rates of serum-containing media. This technology will allow future microscale tissue or cell studies to be more accessible, especially for high-throughput, complex, and long-term experiments. The microfluidic actuation method described is versatile and computer programmable, yet simple, well packaged, and portable enough for personal use. PMID:15514025

Evaluation of current Australian health service accreditation processes (ACCREDIT-CAP): protocol for a mixed-method research project.

PubMed

Hinchcliff, Reece; Greenfield, David; Moldovan, Max; Pawsey, Marjorie; Mumford, Virginia; Westbrook, Johanna Irene; Braithwaite, Jeffrey

2012-01-01

Accreditation programmes aim to improve the quality and safety of health services, and have been widely implemented. However, there is conflicting evidence regarding the outcomes of existing programmes. The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork-Current Accreditation Processes (ACCREDIT-CAP) project is designed to address key gaps in the literature by evaluating the current processes of three accreditation programmes used across Australian acute, primary and aged care services. The project comprises three mixed-method studies involving documentary analyses, surveys, focus groups and individual interviews. Study samples will comprise stakeholders from across the Australian healthcare system: accreditation agencies; federal and state government departments; consumer advocates; professional colleges and associations; and staff of acute, primary and aged care services. Sample sizes have been determined to ensure results allow robust conclusions. Qualitative information will be thematically analysed, supported by the use of textual grouping software. Quantitative data will be subjected to a variety of analytical procedures, including descriptive and comparative statistics. The results are designed to inform health system policy and planning decisions in Australia and internationally. The project has been approved by the University of New South Wales Human Research Ethics Committee (approval number HREC 10274). Results will be reported to partner organisations, healthcare consumers and other stakeholders via peer-reviewed publications, conference and seminar presentations, and a publicly accessible website.

Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study.

PubMed

Burden, Sarah; Topping, Anne Elizabeth; O'Halloran, Catherine

2018-05-01

To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Competence assessment is a significant component of pre-registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. A two-stage sequential embedded mixed-methods design. Data collected 2012-2013. This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision-making. Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an "idealized student" by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression-based nature of mentor decision-making questions the reliability and validity of competency-based assessments used in nursing pre-registration programmes. © 2017 John Wiley & Sons Ltd.

Dilemmas and tensions facing a faith-based organisation promoting HIVprevention among young people in South Africa.

PubMed

Casale, Marisa; Nixon, Stephanie; Flicker, Sarah; Rubincam, Clara; Jenney, Angelique

2010-06-01

Faith-based organisations (FBOs) are receiving growing attention for their roles in addressing HIV and AIDS in southern Africa. These roles, however, are not without philosophical challenges. Yet, to date, most references to the successes or limitations of FBOs have remained the domain of theoretical and, often, ideological debate. In this context, discussions about the roles of faith and FBOs in responding to HIV and AIDS often evoke extreme positions-either advocating for or critiquing their involvement. In place of this there is a need for empirical evidence and analyses that shed light on both the challenges and opportunities of faith-based HIV-prevention programming. This article presents a critical sociological analysis of the complexities confronting one FBO in its effort to deliver an abstinence-focused HIV-prevention programme to school-going adolescents in a poor peri-urban area of South Africa. As one aspect of a larger mixed-methods evaluation, this analysis is based on 11 focus group discussions, variously held with parents, teachers, learners and programme facilitators, in an effort to determine how and why the participants perceived the programme to work. We present and analyse four sources of tension appearing within the data which relate to the programme's faith-based orientation: a) enthusiasm for sexual abstinence despite awareness of the structural constraints; b) a dichotomous framing of behaviours (i.e. good versus bad); c) mixed messages about condoms; and d) administering faith-based programming within secular public schools. Through this analysis we aim to identify opportunities and challenges for faith-based HIV-prevention efforts more broadly. We argue that any assessment of faith-based HIV-prevention programming ought to respect and reflect its complexity as well as the complexity of the context within which it operates.

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour

PubMed Central

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-01-01

Objectives Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Design Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. Setting England, UK. Participants All English women invited to participate in the cervical (age group 25–49 and 50–64) and breast (age group 50–64) screening programmes. Outcomes Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Results Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. Discussion These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on ‘what works’. PMID:26209119

Social capital and adverse treatment outcomes of tuberculosis: a case-control study.

PubMed

Deshmukh, P R; Mundra, A; Dawale, A

2017-08-01

'Social capital' refers to social norms, relationships, networks and values that affect the functioning and development of society. Social capital influences health positively, but its role in the treatment outcomes of tuberculosis (TB) is not known. To study the role of social capital in determining adverse TB treatment outcomes. Of 516 patients registered under the Revised National Tuberculosis Control Programme in 2014 in Wardha Tuberculosis Unit, Wardha, India, we included 88 patients with adverse treatment outcomes as cases and 187 controls from among those without adverse outcomes. Multiple logistic regression was used to compare standardised Z-scores. A greater proportion of controls than cases belonged to higher quartiles of social capital and its domains than cases, and the mean standardised Z-score was also consistently higher among controls than cases. Respectively 47% and 15% of cases and controls were in the poorest quartile of social capital, whereas respectively 10% and 33% of cases and controls were in the richest quartile. Each unit increase in Z-score of overall social capital reduced the odds of adverse treatment outcomes by 63.1%. Appropriate interventions for building social capital for TB patients and linking them with the programme would improve programme performance.

Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project.

PubMed

Pizzi, Laura T; Waisbourd, Michael; Hark, Lisa; Sembhi, Harjeet; Lee, Paul; Crews, John E; Saaddine, Jinan B; Steele, Deon; Katz, L Jay

2018-02-01

Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres. The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded. 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273. Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE).

PubMed

Paquette-Warren, Jann; Harris, Stewart B; Naqshbandi Hayward, Mariam; Tompkins, Jordan W

2016-10-01

Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real-world evaluation. Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real-world comprehensive evaluations in health care settings. The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub-steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built-in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale-up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE)

PubMed Central

Harris, Stewart B.; Naqshbandi Hayward, Mariam; Tompkins, Jordan W.

2016-01-01

Abstract Rationale, aims and objectives Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real‐world evaluation. Method Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real‐world comprehensive evaluations in health care settings. Results The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub‐steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built‐in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. Conclusions This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale‐up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. PMID:26804339

Description and evaluation of an initiative to develop advanced practice nurses in mainland China.

PubMed

Wong, Frances Kam Yuet; Peng, Gangyi; Kan, Eva C; Li, Yajie; Lau, Ada T; Zhang, Liying; Leung, Annie F; Liu, Xueqin; Leung, Vilna O; Chen, Weiju; Li, Ming

2010-05-01

This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs. Copyright 2009 Elsevier Ltd. All rights reserved.

Sustaining Institution-Wide Induction for Sessional Staff in a Research-Intensive University: The Strength of Shared Ownership

ERIC Educational Resources Information Center

Matthews, Kelly E.; Duck, Julie M.; Bartle, Emma

2017-01-01

The "Tutors@UQ" programme provides an example of a formalised, institution-wide, cross-discipline, academic development programme to enhance the quality of teaching that has been maintained for seven years despite a pattern of substantial organisational change. We present a case study of the programme framed around a four-phase model of…

"For Some Reason, I'm Just Tired": Women Domestic Workers Persisting in Community-Based Programmes

ERIC Educational Resources Information Center

Cuban, Sondra

2007-01-01

A study of women migrant domestic workers in the USA and their reasons for participating and persisting in community-based literacy and ESOL programmes is presented. Case studies and themes were developed about the women's experiences of work life and how it connected to their programme participation. The findings revealed that the women had…

Quality Regulation in Expansion of Educational Systems: A Case of Privately Sponsored Students' Programme in Kenya's Public Universities

ERIC Educational Resources Information Center

Yego, Helen J. C.

2016-01-01

This paper examines the expansion and management of quality of parallel programmes in Kenya's public universities. The study is based on Privately Sponsored Students Programmes (PSSP) at Moi University and its satellite campuses in Kenya. The study was descriptive in nature and adopted an ex-post facto research design. The study sample consisted…

Applicability of Non-Modular Assessment in Construction Management and Allied Undergraduate Programmes: Perspective of the Academics Involved

ERIC Educational Resources Information Center

Wedawatta, Gayan

2018-01-01

Undergraduate programmes on construction management and other closely related built environment disciplines are currently taught and assessed on a modular basis. This is the case in the UK and in many other countries globally. However, it can be argued that professionally oriented programmes like these are better assessed on a non-modular basis,…

Harnessing the Potential of ICTs: Literacy and Numeracy Programmes Using Radio, TV, Mobile Phones, Tablets and Computers. 2nd Edition

ERIC Educational Resources Information Center

Hanemann, Ulrike, Ed.; Scarpino, Cassandra, Ed.

2016-01-01

The UNESCO Institute for Lifelong Learning (UIL) has published a second edition of "Harnessing the Potential of ICTs: Literacy and Numeracy Programmes Using Radio, TV, Mobile Phones, Tablets and Computers." This compilation of case studies from all world regions presents promising literacy and numeracy programmes that use information and…

The Evolution and Impact of Literacy Campaigns and Programmes, 2000-2014. UIL Research Series: No. 1

ERIC Educational Resources Information Center

Hanemann, Ulrike

2015-01-01

The paper analyses the status and characteristics of adult literacy campaigns and programmes since 2000. Global trends are analysed in terms of the ten key aspects of the suggested framework for successful literacy campaigns and programmes. Four case studies on major literacy campaigns in Brazil, India, South Africa and Indonesia are used to…

English-Medium Programmes at Austrian Business Faculties: A Status Quo Survey on National Trends and a Case Study on Programme Design and Delivery

ERIC Educational Resources Information Center

Unterberger, Barbara

2012-01-01

Internationalisation processes have accelerated the implementation of English-medium programmes (EMPs) across European higher education institutions. The field of business and management studies has been particularly affected by this trend (Wachter & Maiworm 2008: 46) with numerous new EMPs introduced each year. This paper presents key…

Adult Discrimination against Children: The Case of Abstinence-Only Education in Twenty-First-Century USA

ERIC Educational Resources Information Center

Greslé-Favier, Claire

2013-01-01

This paper analyses abstinence-only education programmes and discourses within the frame of theories of adult discrimination against children. To begin with, a definition of abstinence-only programmes and of the political context in which they were created will be provided. These programmes will then be analysed through the lens of children's…

The Chilean Rural Practitioner Programme: a multidimensional strategy to attract and retain doctors in rural areas

PubMed Central

Peña, Sebastian; Ramirez, Jorge; Becerra, Carlos; Carabantes, Jorge

2010-01-01

Abstract Developing countries currently face internal and external migration of their health workforce and interventions are needed to attract and retain health professionals in rural areas. Evidence of multidimensional interventions, however, is scarce. This study explores a long-standing strategy to attract and retain doctors to rural areas in Chile: the Rural Practitioner Programme. The main objective is to describe the programme, characterize its multidimensional set of incentives and appraise preliminary programme outcomes. Retrospective national data were employed to examine recruitment, retention and incentives provided to extend the length of stay and motivate non-clinical work. The programme has successfully recruited a large number of applicants, with acceptance rates close to 100%. Retention rates are nearly 100% (drop-outs are exceptional), but only 58% of participants stay for the maximum period. Areas with greater work difficulty are attracting the best-ranked applicants, but incentives to engage in community projects, management responsibilities, continuous medical education and research have achieved mixed results. Rural doctors are satisfied with their experience and 70% plan to practise as specialists in a referral hospital. The programme has successfully matched the interests of physicians in specialization with the country’s need for rural doctors. However, a gap might be forming between the demand for certain specialties and what the programme can offer. There is a need to conciliate both parties, which will require a more refined strategy than before. This should be grounded in robust knowledge based on programme outcomes and evidence of the interests and motivations of health professionals. PMID:20461139

Healthier food choices as a result of the revised healthy diet programme Krachtvoer for students of prevocational schools.

PubMed

Bessems, Kathelijne M H H; van Assema, Patricia; Martens, Marloes K; Paulussen, Theo G W M; Raaijmakers, Lieke G M; de Rooij, Mark; de Vries, Nanne K

2012-05-24

Krachtvoer is a Dutch healthy diet programme for prevocational schools, developed in 2001 and revised for a broader target group in 2007, based on the findings of an evaluation of the first version. The goal of this study was to report on the short- and longer-term total and subgroup effects of the revised programme on students' fruit, fruit juice, breakfast, and snack consumption. Schools were randomized to the experimental condition, teaching the Krachtvoer programme, or to the control condition teaching the regular nutrition lessons. Self-reported consumption of fruit, fruit juice, breakfast and snacks was measured at baseline directly before programme implementation, one to four weeks after finishing programme implementation, and after six months. Mixed linear and logistic regression analyses were conducted. In total 1117 students of 13 experimental schools and 758 students of 11 control schools participated in the study. Short- and longer-term favourable intervention effects were found on fruit consumption (mean difference between experimental and control group 0.15 servings at both posttests). Regarding fruit juice consumption, only short-term favourable effects were revealed (mean difference between experimental and control group 0.05 glasses). Intervention effects on breakfast intakes were limited. No changes in snack frequency were reported, but students made healthier snack choices as a result of the programme. Some favourable as well as unfavourable effects occurred in subgroups of students. The effects on fruit consumption and snack choices justify the current nationwide dissemination of the programme. Achieving changes in breakfast consumption may, however, require other strategies.

On the Preparation of Buffer Solutions.

ERIC Educational Resources Information Center

Thomson, Bruce M.; Kessick, Michael A.

1981-01-01

Presents a method, suitable for use on programmable calculators, which allows calculation of the pH and ionic strength (I) of a mixed solution of salts of an acid or amounts necessary to produce a solution of a particular pH and I. Includes limitations when using the calculations described. (SK)

Big Books and Small Marvels

ERIC Educational Resources Information Center

Stanistreet, Paul

2012-01-01

The Reader Organisation's Get into Reading programme is all about getting people together in groups to engage with serious books. The groups are mixed and the participants sometimes challenging, but the outcomes are often remarkable. Jane Davis, who founded the Reader Organisation and continues to oversee Get into Reading, has witnessed a massive…

The Rise of the Information Society amongst European Academics

ERIC Educational Resources Information Center

Salajan, Florin D.

2008-01-01

This study investigates the information society discourse in the European Union in relation to the European Commission's eLearning programmes, based on selected academics' conceptualisation of the term. It reveals a mixed picture of the perceptions that academics have of the information society in their respective countries. The findings indicate…

An Evaluation of Health Information and Wellness Priorities among Socioeconomically Disadvantaged Students

ERIC Educational Resources Information Center

Morris-Paxton, Angela A.; Van Lingen, Johanna M.; Elkonin, Diane

2017-01-01

Objective: A critical evaluation of a salutogenic, wellness education programme was conducted with a group of first-year socioeconomically disadvantaged higher education students, in order to assess the value they placed on health information and wellness priorities. Methods: This study took a mixed-methods approach utilising a…

Misconceptions about case-mix payments for nursing homes.

PubMed

Grimaldi, P L

1987-04-01

Despite the increasing use of case-mix payment systems for skilled and intermediate nursing home care (at least 10 state Medicaid programs have adopted or are considering adopting such a system), misconceptions about such systems still exist. Unless these inaccurate perceptions are corrected, a state may adopt a system that fails to realize its goals. Some of these misconceptions include the beliefs that case-mix payment systems: Apply to all nursing homes costs; Will benefit hospital-based facilities; Will resolve the access problems of heavy care public patients; Will result in higher statewide payment rates because patient characteristics are factored directly into the calculations. In fact, case-mix adjustments are applied only to costs that can be traced directly to patients' impairments. Nursing services and some ancillary services are dependent on case mix, while administrative and support services are largely independent of case mix. Capital costs usually can be ignored in formulating the case-mix adjustment. Although hospital-based facilities frequently have sicker patients than freestanding facilities, studies show that only a portion of the cost differential is explained by case-mix differences. In the case of heavy-care patients, some believe that case-mix payment systems will resolve access problems by paying higher rates in response to the higher treatment costs. Access may not improve, however, if the new rates are lower than those paid by comparable private patients. Perhaps a loosening in the certificate-of-need process will also be needed to resolve the access problem.(ABSTRACT TRUNCATED AT 250 WORDS)

The virtual continuity in learning programme: results.

PubMed

Wood, Eleanor; Tso, Simon

2012-08-01

The implementation of the European Working Time Directive and specialty-driven care has resulted in the loss of continuity of patient care, and thus a loss of continuity in learning. We proposed a potential solution to this fragmentation of junior doctor workplace learning in the Virtual Continuity in Learning Programme (VCLP). The VCLP enables the doctor to follow the virtual patient journey (of an actual patient who is no longer under their care) using the Virtual Consulting Room (VcR), and to understand the rationale behind clinical decision making prior to completing their case-based discussion (CbD) work-based assessments. Fifty-seven out of 62 (92%) of foundation doctors (Homerton University Hospital, London, UK) consented to participate in the study. Web-tracking software was used. Fifty-three out of 57 (93%) doctors completed an initial questionnaire. Twenty-nine out of 57 (51%) doctors returned a follow-up questionnaire 6 months later. Eleven doctors were interviewed in three focus groups: the VcR user group; the VcR non-user group; and a mixed group. The data was analysed qualitatively. Tracking showed 33.3 per cent (19/57) of doctors used the VcR over a 6-month period. Interestingly doctors used the VcR in a range of situations, not solely as instructed. Results enabled us to understand how doctors learn and their perception of using the VCLP to support their learning and completion of work-based assessments. Foundation doctors use the educational resources available, including the VcR, to help structure their workplace learning. The majority of VcR users found it particularly useful for just-in-time learning. The VCLP offers support to junior doctors learning during their preparation for case-based discussion. © Blackwell Publishing Ltd 2012.

Effects of the X:IT smoking intervention: a school-based cluster randomized trial.

PubMed

Andersen, Anette; Krølner, Rikker; Bast, Lotus Sofie; Thygesen, Lau Caspar; Due, Pernille

2015-12-01

Uptake of smoking in adolescence is still of major public health concern. Evaluations of school-based programmes for smoking prevention show mixed results. The aim of this study was to examine the effect of X:IT, a multi-component school-based programme to prevent adolescent smoking. Data from a Danish cluster randomized trial included 4041 year-7 students (mean age: 12.5) from 51 intervention and 43 control schools. Outcome measure 'current smoking' was dichotomized into smoking daily, weekly, monthly or more seldom vs do not smoke. Analyses were adjusted for baseline covariates: sex, family socioeconomic position (SEP), best friend's smoking and parental smoking. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. At baseline, 4.7% and 6.8% of the students at the intervention and the control schools smoked, respectively. After 1 year of the intervention, the prevalence was 7.9% and 10.7%, respectively. At follow-up, 553 students (13.7%) did not answer the question on smoking. Available case analyses: crude odds ratios (OR) for smoking at intervention schools compared with control schools: 0.65 (0.48-0.88) and adjusted: 0.70 (0.47-1.04). ITT analyses: crude OR for smoking at intervention schools compared with control schools: 0.67 (0.50-0.89) and adjusted: 0.61 (0.45-0.82). Students at intervention schools had a lower risk of smoking after a year of intervention in year 7. This multi-component intervention involving educational, parental and context-related intervention components seems to be efficient in lowering or postponing smoking uptake in Danish adolescents. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Interdisciplinary research and education in the Vienna Doctoral Programme on Water Resource Systems: a framework for evaluation

NASA Astrophysics Data System (ADS)

Bloeschl, G.; Carr, G.; Loucks, D. P.

2017-12-01

Greater understanding of how interdisciplinary research and education evolves is critical for identifying and implementing appropriate programme management strategies. We propose a program evaluation framework that is based on social learning processes (individual learning, interdisciplinary research practices, and interaction between researchers with different backgrounds); social capital outcomes (ability to interact, interpersonal connectivity, and shared understanding); and knowledge and human capital outcomes (new knowledge that integrates multiple research fields). The framework is tested on established case study doctoral program: the Vienna Doctoral Program on Water Resource Systems. Data are collected via mixed qualitative/quantitative methods that include semi-structured interviews, publication co-author analysis, analysis of research proposals, categorisation of the interdisciplinarity of publications and graduate analysis. Through the evaluation and analysis, several interesting findings about how interdisciplinary research evolves and can be supported are identified. Firstly, different aspects of individual learning seem to contribute to a researcher's ability to interact with researchers from other research fields and work collaboratively. These include learning new material from different research fields, learning how to learn new material and learning how to integrate different material. Secondly, shared interdisciplinary research practices can be identified that may be common to other programs and support interaction and shared understanding between different researchers. They include clarification and questioning, harnessing differences and setting defensible research boundaries. Thirdly, intensive interaction between researchers from different backgrounds support connectivity between the researchers, further enabling cross-disciplinary collaborative work. The case study data suggest that social learning processes and social capital outcomes precede new interdisciplinary research findings and are therefore a critical aspect to consider in interdisciplinary program management.

Clinical educators' experiences of facilitating learning when speaking a different language from both the student and client.

PubMed

Keeton, Nicola; Kathard, Harsha; Singh, Shajila

2017-11-02

Worldwide there is an increasing responsibility for clinical educators to help students from different language backgrounds to develop the necessary skills to provide health care services to a linguistically diverse client base. This study describes the experiences of clinical educators who facilitate learning in contexts where they are not familiar with the language spoken between students and their clients. A part of the qualitative component of a larger mixed methods study is the focus of this paper. Semi-structured interviews were conducted with eight participants recruited from all audiology university programmes in South Africa. Thematic analysis allowed for an in depth exploration of the research question. Member checking was used to enhance credibility. It is hoped that the findings will inform training programmes and in so doing, optimize the learning of diverse students who may better be able to provide appropriate services to the linguistically diverse population they serve. Participants experienced challenges with fair assessment of students and with ensuring appropriate client care when they were unable to speak the language shared between the client and the student. In the absence of formal guidelines, clinical educators developed unique coping strategies that they used on a case-by-case basis to assess students and ensure adequate client management when they experienced such language barriers while supervising. Coping strategies included engaging other students as interpreters, having students role-play parts of a session in English in advance and requesting real-time translations from the student during the session. They expressed concern about the fairness and efficacy of the coping strategies used. While clinical educators use unique strategies to assess students and to ensure suitable client care, dilemmas remain regarding the fairness of assessment and the ability to ensure the quality of client care.

Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network.

PubMed

Takian, Amirhossein; Doshmangir, Leila; Rashidian, Arash

2013-10-01

The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran. We conducted a qualitative study involving 71 semi-structured interviews at national, provincial and local levels, and three focus group discussions at local level, plus a purposeful content analysis of documents of various types. We used a mixed inductive/deductive framework approach for data analysis. We identified seven main aspects related to the existing primary health network, which contributed to the implementation of FP programme: 'a respected and functioning PHC network', 'accessibility and geographical coverage', 'efficient hierarchy', 'the only possible host', 'a remedy for chronic challenges in the rural PHC', 'FP as the gatekeeper?' and 'the role of the private sector'. The existence of a functioning PHC was pivotal in driving policy makers' decision to implement FP programme. Implementing a new policy depends on its hosting context. In regards to FP programme and rural insurance in Iran, the existing PHC network proved to be a fundamental asset in facilitating the implementation of FP programme in rural areas.

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

Issues in Developing Programmes to Support Teachers of Philology in Using Information and Communications Technologies in Greek Schools: A Case Study

ERIC Educational Resources Information Center

Fragkouli, Elpiniki; Hammond, Michael

2007-01-01

This paper reports on a case study of an in-service teacher-training programme for Greek philology teachers, from 2002 to 2003, which was designed to develop the use of information and communications technologies in their teaching. It draws on questionnaires and interviews with 34 teachers who took part in the training. In addition, the three…

"Sorry, but They Don't Want Chinese Americans to Participate": A Case Study of Tracking in an Ivy League Chinese Language Programme

ERIC Educational Resources Information Center

Tian, Ye

2017-01-01

This study examines a Chinese language programme in an Ivy League institution through the lens of Tracking to re-conceptualise the achievement gap between Chinese heritage language learners (CHLLs) and non-heritage language learners. Like most prestigious universities in the U.S., Chinese language learners in this case study are put on one of two…

Long-term epidemiological observation of asbestos-related diseases in Poland, 1970-2015.

PubMed

Swiatkowska, B; Szeszenia-Dabrowska, N

2017-04-01

Occupational exposure to asbestos constitutes a major public health concern. Despite this in many countries, data and registration systems for occupational asbestos-related diseases are non-existent or poorly developed. To analyse the incidence of occupational asbestos-related diseases in Poland between the years 1970 and 2015, with particular emphasis on the periods after introduction of a ban on asbestos and following introduction of a surveillance programme. Analysis based on all medically recognized cases, certified as occupational diseases and reported obligatorily from all over the country to the Central Register of Occupational Diseases. During the period 1970-2015, 4983 cases were reported as asbestos-related diseases. The most prevalent were asbestosis, lung cancer, diseases of pleura or pericardium and mesothelioma. A considerable increase in the number of such cases from the beginning of their registration until 2004 occurred after introduction of the Amiantus programme, a nationwide programme of periodic medical examinations for former asbestos workers. Introduction of a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study.

PubMed

Honein-AbouHaidar, Gladys N; Stuart-McEwan, Terri; Waddell, Tom; Salvarrey, Alexandra; Smylie, Jennifer; Dobrow, Mark J; Brouwers, Melissa C; Gagliardi, Anna R

2017-02-23

Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs. A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model. 4 DAPs at 2 teaching and 2 community hospitals in Canada. 22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks. Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural-remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes. This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[„Kids’ Skills” by Ben Furman – Description and Research Review].

PubMed

Perband, Anke; Haupts, Nadja; Rogner, Josef

2016-01-01

The article describes the programme „Kids’ Skills“ by the Finnish psychiatrist Ben Furman. „Kids’ Skills“ was developed to address behavioural issues in children. It is based on the assumption that children’s behavioural problems should not be pathologized, but can instead be corrected by learning a corresponding skill. The programme is characterised by its focus on strengths and its humorous and playful approach. The 15 steps of “Kids’ Skills” are intended to identify the specific skill, help generate a learning process and continue motivating the child. The authors describe the steps of the programme using a case study. They also address the limited number of existing studies, which have included a telephone and an online survey of practitioners using the programme, as well as case studies. The results of these studies are discussed with regard to their basis in evidence and practical relevance. Continuing research is recommended and possible implementations are suggested.

The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa.

PubMed

Walsh, C M; Dannhauser, A; Joubert, G

2002-02-01

The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. Initially 536 children were measured and, after two years of intervention, 815. Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes.

PubMed

Haverkate, M; D'Ancona, F; Giambi, C; Johansen, K; Lopalco, P L; Cozza, V; Appelgren, E

2012-05-31

This report provides an updated overview of recommended and mandatory vaccinations in the European Union (EU), Iceland and Norway, considering the differences in vaccine programme implementation between countries. In 2010, the Vaccine European New Integrated Collaboration Effort (VENICE) network, conducted a survey among the VENICE project gatekeepers to learn more about how national vaccination programmes are implemented, whether recommended or mandatory. Information was collected from all 27 EU Member States, Iceland and Norway. In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some countries have a mixed strategy of recommended and mandatory vaccinations. Mandatory vaccination may be considered as a way of improving compliance to vaccination programmes. However, compliance with many programmes in Europe is high, using only recommendations. More information about the diversity in vaccine offer at European level may help countries to adapt vaccination strategies based on the experience of other countries. However, any proposal on vaccine strategies should be developed taking into consideration the local context habits.

Programmable Logic Application Notes

NASA Technical Reports Server (NTRS)

Katz, Richard

1999-01-01

This column will be provided each quarter as a source for reliability, radiation results, NASA capabilities, and other information on programmable logic devices and related applications. This quarter the focus is on some experimental data on low voltage drop out regulators to support mixed 5 and 3.3 volt systems. A discussion of the Small Explorer WIRE spacecraft will also be given. Lastly, we show take a first look at robust state machines in Hardware Description Languages (VHDL) and their use in critical systems. If you have information that you would like to submit or an area you would like discussed or researched, please give me a call or e-mail.

Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.

PubMed

Carle, C; Alexander, P; Columb, M; Johal, J

2013-04-01

We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

The effect of state medicaid case-mix payment on nursing home resident acuity.

PubMed

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

2006-08-01

To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness.

PubMed

Pantoja, A; Lönnroth, K; Lal, S S; Chauhan, L S; Uplekar, M; Padma, M R; Unnikrishnan, K P; Rajesh, J; Kumar, P; Sahu, S; Wares, F; Floyd, K

2009-06-01

Bangalore City, India. To assess the cost and cost-effectiveness of public-private mix (PPM) for tuberculosis (TB) care and control when implemented on a large scale. DOTS implementation under the Revised National TB Control Programme (RNTCP) began in 1999, PPM was introduced in mid-2001 and a second phase of intensified PPM began in 2003. Data on the costs and effects of TB treatment from 1999 to 2005 were collected and used to compare the two distinct phases of PPM with a scenario of no PPM. Costs were assessed in 2005 $US for public and private providers, patients and patient attendants. Sources of data included expenditure records, medical records, interviews with staff and patient surveys. Effectiveness was measured as the number of cases successfully treated. When PPM was implemented, total provider costs increased in proportion to the number of successfully treated TB cases. The average cost per patient treated from the provider perspective when PPM was implemented was stable, at US$69, in the intensified phase compared with US$71 pre-PPM. PPM resulted in the shift of an estimated 7200 patients from non-DOTS to DOTS treatment over 5 years. PPM implementation substantially reduced costs to patients, such that the average societal cost per patient successfully treated fell from US$154 to US$132 in the 4 years following the initiation of PPM. Implementation of PPM on a large scale in an urban setting can be cost-effective, and considerably reduces the financial burden of TB for patients.

Early warning systems and rapid response to the deteriorating patient in hospital: A realist evaluation.

PubMed

McGaughey, Jennifer; O'Halloran, Peter; Porter, Sam; Trinder, John; Blackwood, Bronagh

2017-12-01

To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice. Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. Realist evaluation. The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5 years from 2003-2008. Data were analysed using NiVivo8 and SPPS. A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes. Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning. © 2017 John Wiley & Sons Ltd.

Exploring the Relationship between Modularization Ability and Performance in the C++ Programming Language: The Case of Novice Programmers and Expert Programmers

ERIC Educational Resources Information Center

Vodounon, Maurice A.

2006-01-01

The primary purpose of the study was to determine if a treatment that concentrates on building programs from previously written modules can improve the decomposition processes of novice programmers in the C++ programming language and, hence, programming performance. For purposes of performance analysis, a subsample of 23 students was divided into…

Developing Learning Identities in and through Music: A Case Study of the Outcomes of a Music Programme in an Australian Juvenile Detention Centre

ERIC Educational Resources Information Center

Barrett, Margaret S.; Baker, Jane S.

2012-01-01

The last decades have witnessed significant growth in music programmes targeted at various populations in detention, including those in male and female prisons and juvenile detention centres. The aspirations of such programmes have included a concern to improve detainees' mental and physical health and well-being, develop pro-social behaviours…

Bridging Policy Implementation Gaps in Nigerian Education System: A Case Study of Universal Basic Education Programme in Cross River State, Nigeria

ERIC Educational Resources Information Center

Ogbiji, Joseph Etiongbie; Ogbiji, Sylvanus Achua

2016-01-01

This research focuses on identifying policy gaps in the implementation of Universal Basic Education (UBE) programme in Nigeria, with Cross River State being the study area. The three research questions used for the research center on the extent of the freeness of the UBE, the extent to which the programme has stimulated educational consciousness…

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

PubMed Central

Lalla-Edward, Samanta Tresha; Fobosi, Siyabulela Christopher; Hankins, Catherine; Case, Kelsey; Venter, W. D. Francois; Gomez, Gabriela

2016-01-01

Background Truck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population’s health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes. Methods We searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects). Results Thirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed positive changes in risk behaviours, knowledge, and attitudes. Our conclusions were robust in sensitivity analyses. Conclusion Diverse healthcare programmes tailored to the needs of truck drivers implemented in 30 sub-Saharan African countries have shown potential benefits. However, information gaps about availability of services and their effects impede further planning and implementation of effective healthcare programmes for truck drivers. PMID:27333301

Attraction, recruitment and distribution of health professionals in rural and remote Australia: early results of the Rural Health Professionals Program.

PubMed

Morell, Anna L; Kiem, Sandra; Millsteed, Melanie A; Pollice, Almerinda

2014-03-06

Australians living in rural and remote communities experience relatively poor health status in comparison to the wider Australian population (Med J Aust 185:37-38, 2006). This can be attributed in part to issues of access to health services arising from difficulties in recruiting and retaining health professionals in these areas. The Rural Health Professionals Program is an initiative designed to increase the number of allied health and nursing professionals in rural and remote Australia by providing case managed recruitment and retention support services. This paper reports on early analysis of available programme data to build knowledge of factors related to the recruitment and distribution of health professionals in rural and remote Australia. Administrative programme data were collected monthly from 349 health professionals over the first 13 months of programme operation. These data were collated and quantitative analysis was conducted using SPSS software. Sixty-nine percent of recruits were women, and recruits had a mean age of 32.85 (SD = 10.92). Sixty percent of recruits were domestically trained, and the top two professions recruited were nurses (29%) and physiotherapists (21%). Eighty-seven percent were recruited to regional areas, with the remaining 13% recruited to remote areas. Among reasons for interest in the programme, financial support factors were most commonly cited by recruits (51%). Recruitment to a remote location was associated with being domestically trained, having previously lived in a rural or remote location, being a nurse (as opposed to an allied health professional) and older age. The findings provide early support for a case managed recruitment programme to improve distribution of health professionals, and some directions for future marketing and promotion of the programme. It is recommended that an outcome evaluation be conducted to determine the impact of the programme on recruitment and distribution outcomes. The findings herein begin to address gaps in the literature relating to the effectiveness of interventions to improve the distribution of health professionals. While this provides some preliminary indication that case managed recruitment and retention programmes have capacity to improve distribution, further research and evaluation is required to confirm the impact of the programme on retention.

Creating global networks through an online engineering graduate programme

NASA Astrophysics Data System (ADS)

Murray, M. H.

2011-03-01

Internationally, the railway industry is facing a severe shortage of engineers with high-level, relevant, professional and technical knowledge and abilities, in particular amongst engineers involved in the design, construction and maintenance of railway infrastructure. A unique graduate level programme has been created to meet that global need via a fully online, distance education format. The development and operation of this Master of Engineering degree is proposed as a model of the process needed for industry-relevance, flexible delivery, international networking and professional development required for a successful graduate engineering programme in the twenty-first century. In particular, this paper demonstrates how a mix of new and more familiar technologies are utilised through a variety of tasks to overcome the huge distances and multiple time zones that separate the participants across a growing number of countries, successfully achieving close and sustained interaction amongst the participants and railway experts.

Levels of cardiovascular disease risk factors in Singapore following a national intervention programme.

PubMed Central

Cutter, J.; Tan, B. Y.; Chew, S. K.

2001-01-01

OBJECTIVE: To evaluate the impact of the National Healthy Lifestyle Programme, a noncommunicable disease intervention programme for major cardiovascular disease risk factors in Singapore, implemented in 1992. METHODS: The evaluation was carried out in 1998 by the Singapore National Health Survey (NHS). The reference population was 2.2 million multiracial Singapore residents, 18-69 years of age. A population-based survey sample (n = 4723) was selected by disproportionate stratified and systematic sampling. Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis. FINDINGS: The 1998 results suggest that the National Healthy Lifestyle Programme significantly decreased regular smoking and increased regular exercise over 1992 levels and stabilized the prevalence of obesity and diabetes mellitus. However, the prevalence of high total blood cholesterol and hypertension increased. Ethnic differences in the prevalence of diabetes mellitus, hypertension, and smoking; and in lipid profile and exercise levels were also observed. CONCLUSION: The intervention had mixed results after six years. Successful strategies have been continued and strengthened. PMID:11693972

ISIBINDI, creating circles of care for orphans and vulnerable children in South Africa: post-programme outcomes.

PubMed

Visser, Maretha; Zungu, Nompumelelo; Ndala-Magoro, Nkateko

2015-01-01

This paper presents the evaluation of post-programme outcomes of the ISIBINDI model, a community-based intervention to promote physical and psychosocial well-being of orphans and vulnerable children (OVC) in South Africa. A mixed methods quasi-experimental design was used to investigate the differences between former ISIBINDI participants (18 years and older) and a control group of similar background. ISIBINDI ex-participants at 12 sites (n=427) and a control group of non-participants (n=177) completed a questionnaire which explored level of education and employment, psychosocial well-being and HIV risk behaviour. Focus group discussions were conducted with various stakeholders. Ex-participants reported higher self-esteem and problem-solving abilities, family support and lower HIV risk behaviour than the control group. High levels of unemployment especially in rural areas resulted in unemployment of out-of-school OVC which creates new forms of vulnerability. The benefits of the programme may be compromised by the lack of community resources. An effective exit strategy is needed to contribute to financial independence of OVC after exiting the programme.

An assessment of the impact of the NHS Health Technology Assessment Programme.

PubMed

Hanney, S; Buxton, M; Green, C; Coulson, D; Raftery, J

2007-12-01

To consider how the impact of the NHS Health Technology Assessment (HTA) Programme should be measured. To determine what models are available and their strengths and weaknesses. To assess the impact of the first 10 years of the NHS HTA programme from its inception in 1993 to June 2003 and to identify the factors associated with HTA research that are making an impact. Main electronic databases from 1990 to June 2005. The documentation of the National Coordinating Centre for Health Technology Assessment (NCCHTA). Questionnaires to eligible researchers. Interviews with lead investigators. Case study documentation. A literature review of research programmes was carried out, the work of the NCCHTA was reviewed, lead researchers were surveyed and 16 detailed case studies were undertaken. Each case study was written up using the payback framework. A cross-case analysis informed the analysis of factors associated with achieving payback. Each case study was scored for impact before and after the interview to assess the gain in information due to the interview. The draft write-up of each study was checked with each respondent for accuracy and changed if necessary. The literature review identified a highly diverse literature but confirmed that the 'payback' framework pioneered by Buxton and Hanney was the most widely used and most appropriate model available. The review also confirmed that impact on knowledge generation was more easily quantified than that on policy, behaviour or especially health gain. The review of the included studies indicated a higher level of impact on policy than is often assumed to occur. The survey showed that data pertinent to payback exist and can be collected. The completed questionnaires showed that the HTA Programme had considerable impact in terms of publications, dissemination, policy and behaviour. It also showed, as expected, that different parts of the Programme had different impacts. The Technology Assessment Reports (TARs) for the National Institute for Health and Clinical Excellence (NICE) had the clearest impact on policy in the form of NICE guidance. Mean publications per project were 2.93 (1.98 excluding the monographs), above the level reported for other programmes. The case studies revealed the large diversity in the levels and forms of impacts and the ways in which they arise. All the NICE TARs and more than half of the other case studies had some impact on policy making at the national level whether through NICE, the National Screening Committee, the National Service Frameworks, professional bodies or the Department of Health. This underlines the importance of having a customer or 'receptor' body. A few case studies had very considerable impact in terms of knowledge production and in informing national and international policies. In some of these the principal investigator had prior expertise and/or a research record in the topic. The case studies confirmed the questionnaire responses but also showed how some projects led to further research. This study concluded that the HTA Programme has had considerable impact in terms of knowledge generation and perceived impact on policy and to some extent on practice. This high impact may have resulted partly from the HTA Programme's objectives, in that topics tend to be of relevance to the NHS and have policy customers. The required use of scientific methods, notably systematic reviews and trials, coupled with strict peer reviewing, may have helped projects publish in high-quality peer-reviewed journals. Further research should cover more detailed, comprehensive case studies, as well as enhancement of the 'payback framework'. A project that collated health research impact studies in an ongoing manner and analysed them in a consistent fashion would also be valuable.

Rehabilitation of the central executive component of working memory: a re-organisation approach applied to a single case.

PubMed

Duval, J; Coyette, F; Seron, X

2008-08-01

This paper describes and evaluates a programme of neuropsychological rehabilitation which aims to improve three sub-components of the working memory central executive: processing load, updating and dual-task monitoring, by the acquisition of three re-organisation strategies (double coding, serial processing and speed reduction). Our programme has two stages: cognitive rehabilitation (graduated exercises subdivided into three sub-programmes each corresponding to a sub-component) which enables the patient to acquire the three specific strategies; and an ecological rehabilitation, including analyses of scenarios and simulations of real-life situations, which aims to transfer the strategies learned to everyday life. The programme also includes information meetings. It was applied to a single case who had working memory deficits after a surgical operation for a cerebral tumour on his left internal temporal ganglioglioma. Multiple baseline tests were used to measure the effectiveness of the rehabilitation. The programme proved to be effective for all three working memory components; a generalisation of its effects to everyday life was observed, and the effects were undiminished three months later.

Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

PubMed

Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

2008-05-01

To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

10 best resources on ... mixed methods research in health systems.

PubMed

Ozawa, Sachiko; Pongpirul, Krit

2014-05-01

Mixed methods research has become increasingly popular in health systems. Qualitative approaches are often used to explain quantitative results and help to develop interventions or survey instruments. Mixed methods research is especially important in low- and middle-income country (LMIC) settings, where understanding social, economic and cultural contexts are essential to assess health systems performance. To provide researchers and programme managers with a guide to mixed methods research in health systems, we review the best resources with a focus on LMICs. We selected 10 best resources (eight peer-reviewed articles and two textbooks) based on their importance and frequency of use (number of citations), comprehensiveness of content, usefulness to readers and relevance to health systems research in resource-limited contexts. We start with an overview on mixed methods research and discuss resources that are useful for a better understanding of the design and conduct of mixed methods research. To illustrate its practical applications, we provide examples from various countries (China, Vietnam, Kenya, Tanzania, Zambia and India) across different health topics (tuberculosis, malaria, HIV testing and healthcare costs). We conclude with some toolkits which suggest what to do when mixed methods findings conflict and provide guidelines for evaluating the quality of mixed methods research.

Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis.

PubMed

Paton, Fiona; Chambers, Duncan; Wilson, Paul; Eastwood, Alison; Craig, Dawn; Fox, Dave; Jayne, David; McGinnes, Erika

2014-07-22

To assess the evidence on the impact of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings in the UK. Rapid evidence synthesis. Eight databases were searched from 1990 to March 2013 without language restrictions. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. Systematic reviews, RCTs not included in the systematic reviews, economic evaluations and UK NHS cost analysis, implementation case studies and surveys of patient experience in a UK setting were eligible for inclusion. We assessed the impact of enhanced recovery programmes on health or cost-related outcomes, and assessed implementation case studies and patient experience in UK settings. Studies were quality assessed where appropriate using the Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects critical appraisal process. 17 systematic reviews and 12 additional RCTs were included. Ten relevant economic evaluations were included. No cost analysis studies were identified. Most of the evidence focused on colorectal surgery. 14 innovation case studies and 15 implementation case studies undertaken in National Health Service settings described factors critical to the success of an enhanced recovery programme. Evidence for colorectal surgery suggests that enhanced recovery programmes may reduce hospital stays by 0.5-3.5 days compared with conventional care. There were no significant differences in reported readmission rates. Other surgical specialties showed greater variation in reductions in length of stay reflecting the limited evidence identified. Findings relating to other outcomes were hampered by a lack of robust evidence and poor reporting. There is consistent, albeit limited, evidence that enhanced recovery programmes can reduce length of patient hospital stay without increasing readmission rates. The extent to which managers and clinicians considering implementing enhanced recovery programmes in UK settings can realise savings will depend on length of stay achieved under their existing care pathway. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The World Starts With Me: using intervention mapping for the systematic adaptation and transfer of school-based sexuality education from Uganda to Indonesia.

PubMed

Leerlooijer, Joanne N; Ruiter, Robert A C; Reinders, Jo; Darwisyah, Wati; Kok, Gerjo; Bartholomew, L Kay

2011-06-01

Evidence-based health promotion programmes, including HIV/AIDS prevention and sexuality education programmes, are often transferred to other cultures, priority groups and implementation settings. Challenges in this process include the identification of retaining core elements that relate to the programme's effectiveness while making changes that enhances acceptance in the new context and for the new priority group. This paper describes the use of a systematic approach to programme adaptation using a case study as an example. Intervention Mapping, a protocol for the development of evidence-based behaviour change interventions, was used to adapt the comprehensive school-based sexuality education programme 'The World Starts With Me'. The programme was developed for a priority population in Uganda and adapted to a programme for Indonesian secondary school students. The approach helped to systematically address the complexity and challenges of programme adaptation and to find a balance between preservation of essential programme elements (i.e. logic models) that may be crucial to the programme's effectiveness, including key objectives and theoretical behaviour change methods, and the adaptation of the programme to be acceptable to the new priority group and the programme implementers.

"To Improve Language, You Have to Mix": Teachers' Perceptions of Language Learning in an Overseas Immersion Environment

ERIC Educational Resources Information Center

Roskvist, Annelies; Harvey, Sharon; Corder, Deborah; Stacey, Karen

2014-01-01

The overseas immersion environment has long been considered a superior context for language learning, supposedly providing unlimited exposure to target language (TL) input and countless opportunities for authentic interaction with expert users. This article focuses on immersion programmes (IPs) for in-service language teachers--a relatively…

Exploring and Challenging Pupil Disaffection: An Evaluation of a Motivational Interviewing-Based Intervention Delivered by Paraprofessionals

ERIC Educational Resources Information Center

Snape, Laura; Atkinson, Cathy

2015-01-01

Research suggests motivational interviewing (MI) techniques can be useful in educational settings for improving motivation in disaffected pupils. This exploratory mixed methods study sought to investigate whether implementing an MI-based programme through school-based paraprofessionals would be effective in improving pupil motivation. Five pupils…

Making Sense of the Combined Degree Experience: The Example of Criminology Double Degrees

ERIC Educational Resources Information Center

Wimshurst, Kerry; Manning, Matthew

2017-01-01

Little research has been undertaken on student experiences of combined degrees. The few studies report that a considerable number of students experienced difficulty with the contrasting epistemic/disciplinary demands of the component programmes. A mixed-methods approach was employed to explore the experiences of graduates from four double degrees…

Independent component analysis algorithm FPGA design to perform real-time blind source separation

NASA Astrophysics Data System (ADS)

Meyer-Baese, Uwe; Odom, Crispin; Botella, Guillermo; Meyer-Baese, Anke

2015-05-01

The conditions that arise in the Cocktail Party Problem prevail across many fields creating a need for of Blind Source Separation. The need for BSS has become prevalent in several fields of work. These fields include array processing, communications, medical signal processing, and speech processing, wireless communication, audio, acoustics and biomedical engineering. The concept of the cocktail party problem and BSS led to the development of Independent Component Analysis (ICA) algorithms. ICA proves useful for applications needing real time signal processing. The goal of this research was to perform an extensive study on ability and efficiency of Independent Component Analysis algorithms to perform blind source separation on mixed signals in software and implementation in hardware with a Field Programmable Gate Array (FPGA). The Algebraic ICA (A-ICA), Fast ICA, and Equivariant Adaptive Separation via Independence (EASI) ICA were examined and compared. The best algorithm required the least complexity and fewest resources while effectively separating mixed sources. The best algorithm was the EASI algorithm. The EASI ICA was implemented on hardware with Field Programmable Gate Arrays (FPGA) to perform and analyze its performance in real time.

Mix-and-match nanobiosensor design: Logical and spatial programming of biosensors using self-assembled DNA nanostructures.

PubMed

Liu, Ying; Kumar, Sriram; Taylor, Rebecca E

2018-04-06

The evergrowing need to understand and engineer biological and biochemical mechanisms has led to the emergence of the field of nanobiosensing. Structural DNA nanotechnology, encompassing methods such as DNA origami and single-stranded tiles, involves the base pairing-driven knitting of DNA into discrete one-, two-, and three-dimensional shapes at nanoscale. Such nanostructures enable a versatile design and fabrication of nanobiosensors. These systems benefit from DNA's programmability, inherent biocompatibility, and the ability to incorporate and organize functional materials such as proteins and metallic nanoparticles. In this review, we present a mix-and-match taxonomy and approach to designing nanobiosensors in which the choices of bioanalyte and transduction mechanism are fully independent of each other. We also highlight opportunities for greater complexity and programmability of these systems that are built using structural DNA nanotechnology. This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Diagnostic Tools > Biosensing Biology-Inspired Nanomaterials > Nucleic Acid-Based Structures Nanotechnology Approaches to Biology > Nanoscale Systems in Biology. © 2018 Wiley Periodicals, Inc.

Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study from Bhopal, India

PubMed Central

Singh, Akash Ranjan; Kharate, Atul; Bhat, Prashant; Kokane, Arun M; Bali, Surya; Sahu, Swaroop; Verma, Manoj; Nagar, Mukesh; Kumar, Ajay MV

2017-01-01

Abstract Objective We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers’ and parents’ perspectives in Bhopal, India. Methods A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents). Results Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation. Conclusion National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT. PMID:28082666

Patient level cost of diabetes self-management education programmes: an international evaluation

PubMed Central

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-01-01

Objectives The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Setting Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Participants Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary and secondary measures Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. Results We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. Conclusions This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. PMID:28583913

A pre-post test evaluation of the impact of the PELICAN MDT-TME Development Programme on the working lives of colorectal cancer team members

PubMed Central

2010-01-01

Background The PELICAN Multidisciplinary Team Total Mesorectal Excision (MDT-TME) Development Programme aimed to improve clinical outcomes for rectal cancer by educating colorectal cancer teams in precision surgery and related aspects of multidisciplinary care. The Programme reached almost all colorectal cancer teams across England. We took the opportunity to assess the impact of participating in this novel team-based Development Programme on the working lives of colorectal cancer team members. Methods The impact of participating in the programme on team members' self-reported job stress, job satisfaction and team performance was assessed in a pre-post course study. 333/568 (59%) team members, from the 75 multidisciplinary teams who attended the final year of the Programme, completed questionnaires pre-course, and 6-8 weeks post-course. Results Across all team members, the main sources of job satisfaction related to working in multidisciplinary teams; whilst feeling overloaded was the main source of job stress. Surgeons and clinical nurse specialists reported higher levels of job satisfaction than team members who do not provide direct patient care, whilst MDT coordinators reported the lowest levels of job satisfaction and job stress. Both job stress and satisfaction decreased after participating in the Programme for all team members. There was a small improvement in team performance. Conclusions Participation in the Development Programme had a mixed impact on the working lives of team members in the immediate aftermath of attending. The decrease in team members' job stress may reflect the improved knowledge and skills conferred by the Programme. The decrease in job satisfaction may be the consequence of being unable to apply these skills immediately in clinical practice because of a lack of required infrastructure and/or equipment. In addition, whilst the Programme raised awareness of the challenges of teamworking, a greater focus on tackling these issues may have improved working lives further. PMID:20587062

A pre-post test evaluation of the impact of the PELICAN MDT-TME Development Programme on the working lives of colorectal cancer team members.

PubMed

Taylor, Cath; Sippitt, Joanna M; Collins, Gary; McManus, Chris; Richardson, Alison; Dawson, Jeremy; Richards, Michael; Ramirez, Amanda J

2010-06-29

The PELICAN Multidisciplinary Team Total Mesorectal Excision (MDT-TME) Development Programme aimed to improve clinical outcomes for rectal cancer by educating colorectal cancer teams in precision surgery and related aspects of multidisciplinary care. The Programme reached almost all colorectal cancer teams across England. We took the opportunity to assess the impact of participating in this novel team-based Development Programme on the working lives of colorectal cancer team members. The impact of participating in the programme on team members' self-reported job stress, job satisfaction and team performance was assessed in a pre-post course study. 333/568 (59%) team members, from the 75 multidisciplinary teams who attended the final year of the Programme, completed questionnaires pre-course, and 6-8 weeks post-course. Across all team members, the main sources of job satisfaction related to working in multidisciplinary teams; whilst feeling overloaded was the main source of job stress. Surgeons and clinical nurse specialists reported higher levels of job satisfaction than team members who do not provide direct patient care, whilst MDT coordinators reported the lowest levels of job satisfaction and job stress. Both job stress and satisfaction decreased after participating in the Programme for all team members. There was a small improvement in team performance. Participation in the Development Programme had a mixed impact on the working lives of team members in the immediate aftermath of attending. The decrease in team members' job stress may reflect the improved knowledge and skills conferred by the Programme. The decrease in job satisfaction may be the consequence of being unable to apply these skills immediately in clinical practice because of a lack of required infrastructure and/or equipment. In addition, whilst the Programme raised awareness of the challenges of teamworking, a greater focus on tackling these issues may have improved working lives further.

Patient level cost of diabetes self-management education programmes: an international evaluation.

PubMed

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-06-04

The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Case for Case-Mix: A New Construct for Hospital Management

PubMed Central

Plomann, Marilyn Peacock; Garzino, Fred R.

1981-01-01

Case-mix is a useful methodology for health care management, planning and control. It provides managers with a powerful tool by providing a framework for relating resource consumption profiles with specific treatment patterns. In the long run, it will assist hospital planners in analyzing the demands which different classes of patients bring to the hospital. Decisions concerning capital financing, facilities planning, new services, and the medical and financial implications of physician activities are more efficiently analyzed within a case-mix framework. In the near term, inventory management, staffing policies and the on-going need for the astute management of cash flow will be postively and decisively affected by the use of case-mix measures. The benefits derived from a case-mix system are not limited to hospitals possessing sophisticated management information systems. The case-mix methodology also provides a useful tool for hospitals with less advanced data processing systems and management practices in applying a variety of management science techniques to their planning and control activities.

The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident Acuity

PubMed Central

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

2006-01-01

Objective To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. PMID:16899009

Corporate social responsibility and mental health: the Premier League football Imagine Your Goals programme.

PubMed

Henderson, Claire; O'Hara, Stefanie; Thornicroft, Graham; Webber, Martin

2014-08-01

Football is increasingly used to facilitate recovery in mental health services, often in partnership with football clubs. However, few clubs have made mental health part of their corporate social responsibility programmes until recently. We report the impact on participants of the 'Imagine Your Goals' programme, run by 16 Premier League football clubs in conjunction with England's Time to Change programme to reduce mental health-related stigma and discrimination. Mixed methods evaluation used pre/post measures of well-being, access to social capital, focus groups held early on and towards the end of the two-year programmes, and questionnaires for coaching staff. There were no significant changes to participants' mental well-being scores between baseline and follow-up, nor to the total number of social resources accessible through their networks. However, there was a statistically significant increase at follow-up in the mean score of the personal skills subscale of the Resource Generator-UK. Participants' individual skills were also higher at follow-up. Qualitative data showed programmes had largely met participants' expectations in terms of socializing, providing structure and improving fitness levels, exceeded expectations in relationships with coaching staff and additional activities, but did not always meet them in improving football skills. Participants varied in their knowledge of exit opportunities, depending on which club's programme they attended. A minority of clubs reported difficulties in recruitment and concerns about planning for the future of the projects. Football clubs and the charitable foundations they set up can successfully deliver programmes to people with mental health problems which improve access to personal skills social capital and have other potential benefits.

Leadership scheme to develop the careers of talented candidates.

PubMed

Lynas, Karen

2012-02-01

The Top Leaders programme supports career development by identifying talented staff and equipping them with a range of management skills and approaches. The programme uses a diagnostic test to help candidates assess their strengths, leadership styles and development needs, and offers them 360 degrees feedback. This enables them to identify areas they need to develop to be effective and supportive leaders. Two case studies illustrate the programme in action.

Review of performance-based incentives in community-based family planning programmes.

PubMed

Bellows, Nicole M; Askew, Ian; Bellows, Benjamin

2015-04-01

One strategy for improving family planning (FP) uptake at the community level is the use of performance-based incentives (PBIs), which offer community distributors financial incentives to recruit more users of FP. This article examines the use of PBIs in community-based FP programmes via a literature search of the peer-reviewed and grey literature conducted in April 2013. A total of 28 community-based FP programmes in 21 countries were identified as having used PBIs. The most common approach was a sales commission model where distributors received commission for FP products sold, while a referral payment model for long-term methods was also used extensively. Six evaluations were identified that specifically examined the impact of the PBI in community-based FP programmes. Overall, the results of the evaluations are mixed and more research is needed; however, the findings suggest that easy-to-understand PBIs can be successful in increasing the use of FP at the community level. For future use of PBIs in community-based FP programmes it is important to consider the ethics of incentivising FP and ensuring that PBIs are non-coercive and choice-enhancing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews.

PubMed

Berkhof, Marianne; van Rijssen, H Jolanda; Schellart, Antonius J M; Anema, Johannes R; van der Beek, Allard J

2011-08-01

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians. PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn. Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions. Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies. To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Students' and lecturers' perceptions of support in a UK pre-registration midwifery programme.

PubMed

McIntosh, Annette Elizabeth; Gidman, Janice; McLaughlin, Andrea

2013-11-01

This paper reports on a study that explored the perceptions of students and lecturers regarding support within a pre-registration midwifery programme in one Higher Education Institution in England. A mixed method design was used: questionnaires were completed by first year and third year students and lecturers, complemented by focus groups with each of the three sets of participants. The findings showed that there are multi-focal challenges for student midwives in undertaking their programme of study. The main theme that emerged was of the difficulties involved in maintaining an appropriate work-life balance, especially within what was seen as a relatively inflexible programme structure. The value of peer support was also highlighted as a key factor in helping the students succeed in their studies. There were a number of implications for midwifery educators to consider in optimising support for students. These include ensuring that students have realistic expectations at the outset of their studies, formalising peer support mechanisms and reviewing programmes to provide more flexibility to better underpin the maintenance of an appropriate work-life balance. Further study is warranted to explore perceptions of support in practice and to identify the factors that help students to persevere in their studies. Copyright © 2013 Elsevier Ltd. All rights reserved.

'I'm actually being the grown-up now': leadership, maturity and professional identity development.

PubMed

Miskelly, Philippa; Duncan, Lindsay

2014-01-01

This study reports on an evaluation of an in-house nursing and midwifery leadership programme within a New Zealand District Health Board aimed at improving leadership capacity within clinical environments. The programme associated with this study is based on Practice Development concepts which aim to improve patient care and service delivery as well as empower practitioners to foster and support a transformational culture. Mixed methods were used. Evidence indicated participants' self-confidence improved leading to a 'growing up'. This was demonstrated in a number of ways: taking more responsibility for individual clinical practice, undertaking quality and safety roles as well as postgraduate study. These findings can be constructed in terms of linking leadership training with the development of professional identity. This study provides evidence that in-house leadership programmes can provide front-line nurses and midwives with opportunities to enhance their professional identity and expand their skills in a variety of ways. Organisational investment in in-house programmes aimed at leadership skills have the potential to enhance patient care as well as improve the work environment for nurses and midwives. However, in-house programmes should be considered as augmenting rather than replacing tertiary education institutions' leadership courses and qualifications. © 2013 John Wiley & Sons Ltd.

HIV quality report cards: impact of case-mix adjustment and statistical methods.

PubMed

Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

2014-10-15

There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Using existing case-mix methods to fund trauma cases.

PubMed

Monakova, Julia; Blais, Irene; Botz, Charles; Chechulin, Yuriy; Picciano, Gino; Basinski, Antoni

2010-01-01

Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases. The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.

The PIG in sPrInG: evidence on letter grouping from the reading of buried words.

PubMed

Humphreys, Glyn W; Mayall, Kate; Cooper, Adam C G

2003-12-01

We introduce a novel procedure for investigating factors that determine selective attention to letters in words. Participants were presented with words (in Experiments 1 and 3) and nonwords (in Experiment 2) that contained a buried word whose letters differed in color relative to the other letters present (e.g., pig, in spring). The strings were presented in single case or mixed case, keeping the letters of the buried words in one case (SpRiNg). The time in which the whole stimulus was named was shorter for same-case than for mixed-case strings (for spring: spring < SpRiNg). In contrast, the time in which buried words were named was shorter in mixed- than in same-case strings (for pig: spring > SpRiNg). Across items, the effects of case mixing were negatively correlated across the two tasks. The positive effect of case mixing for buried words also occurred irrespective of whether the whole string was a word or a nonword, and there were contributions from similarity of both letter size and case. The results suggest that case mixing can facilitate selective attention to letters, which is otherwise disrupted by size- and case-based grouping across letter strings. The study provides evidence for letter grouping using size and case information.

Health governance by collaboration: a case study on an area-based programme to tackle health inequalities in the Dutch city of the Hague.

PubMed

Plochg, Thomas; Schmidt, Melanie; Klazinga, Niek S; Stronks, Karien

2013-12-01

Area-based programmes are seen as a promising strategy for tackling health inequalities. In these programmes, local authorities and other local actors collaborate to employ health promoting interventions and policies. Little is known about the underlying processes of collaborative governance. To unravel this black box, we explored how the authority of The Hague, The Netherlands, developed a programme tackling health inequalities drawing on a collaborative mode of governance. Case study drawing on qualitative semi-structured interviews and document review. Data were inductively analysed against the concept of collaborative governance. The authority's ambition was to co-produce a programme on tackling health inequalities with local actors. Three stages could be distinguished in the governing process: (i) formulating policy objectives, (ii) translating policy objectives into interventions and (iii) executing health interventions. In the stage of formulating policy objectives, the collaboration led to a reframing of the initial objectives. Furthermore, the translation of the policy objectives into health interventions was rather pragmatic and loosely based on health needs and/or evidence. As a result, the concrete actions that ensued from the programme did not necessarily reflect the initial objectives. In a local system of health governance by collaboration, factors other than the stated policy objectives played a role, eventually undermining the effectiveness of the programme in reducing health inequalities. To be effective, the processes of collaborative governance underlying area-based programmes require the attention of the local authority, including the building and governing of networks, a competent public health workforce and supportive infrastructures.

Stakeholders' perceptions of programme sustainability: findings from a community-based fall prevention programme.

PubMed

Hanson, H M; Salmoni, A W

2011-08-01

Sustainability of health promotion and injury prevention programmes is a goal of practitioners and an increasingly common requirement of funding bodies. However, less is known about the views held by individual stakeholders involved in such programmes regarding their perceptions of facilitators and barriers to achieving sustainability. This paper aims to share the perceptions of programme sustainability held by key stakeholders involved in a community-based fall prevention programme in three Ontario demonstration communities in Canada. A qualitative case study research design. A holistic multiple case study method was employed. In total, 45 stakeholders involved in various aspects of the project participated from three demonstration sites. Stakeholders' perceptions were gathered on the individual actions they took in an effort to promote sustainability, and the barriers they perceived as preventing or limiting sustainability. Stakeholders reported taking a number of actions to aid programme sustainability, with some actions deemed to be more functional in aiding sustainability than others. Common actions reported by stakeholders included partnership formation, networking and increasing community capacity. Stakeholders also perceived a number of barriers to achieving sustainability, including insufficient human and financial resources, lack of co-ordination and buy-in, heavy reliance on volunteers and an inability to mobilize physicians. Stakeholders' perceptions of sustainability were used to develop recommendations for sustainability for both communities and funding bodies. The views and experiences shared by the stakeholders in this project can serve as lessons learnt to aid in the sustainability of other health promotion and injury prevention programmes in the future. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Management of organisational changes in a case of de-institutionalisation.

PubMed

Parlalis, Stavros K

2011-01-01

This paper seeks to explore the development of a discharge programme in one learning disability hospital in Scotland. The study aims to concentrate on organisational developmental changes in that institution. The model of the management during the discharge programme was investigated. The aim of the study is to explore how the discharge programme developed, as seen under the lens of organisational change, in order to find out what kind of model of management is more suitable in similar programmes. A case study was employed. Data were collected by means of interviews. The interviews followed a structured format. The sample of the study had to be a purposive sample and the method of snowball sampling was used; finally, 28 interviews were conducted. A grounded approach was adopted for the data analysis. The software program QSR "NUD*IST" (version "N6") was used as a technical tool, in order to facilitate the data analysis. The findings of this study show that various management models were adopted in the four phases of the discharge programme. These different models represent a "quest" by the institution's management regarding the most appropriate model for managing the discharge programme. This study shows that this goes on continuously in organisations under transition until they settle down to a more permanent state. It was concluded that management models, which are composed of characteristics from the organic theory of organisational management, could apply in discharge programmes. The data gathered enabled the researcher to arrive at a model of management which is suitable for managing organisational changes in discharge programmes, the named "stakeholder management model".

Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

PubMed

Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

2015-08-01

When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Public hospital resource allocations in El Salvador: accounting for the case mix of patients.

PubMed

Fiedler, J L; Schmidt, R M; Wight, J B

1998-09-01

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

The way to a man's heart is through his stomach?: a mixed methods study on causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence.

PubMed

Buller, Ana Maria; Hidrobo, Melissa; Peterman, Amber; Heise, Lori

2016-06-08

Intimate partner violence (IPV) is highly prevalent and has detrimental effects on the physical and mental health of women across the world. Despite emerging evidence on the impacts of cash transfers on intimate partner violence, the pathways through which reductions in violence occur remain under-explored. A randomised controlled trial of a cash and in-kind food transfer programme on the northern border of Ecuador showed that transfers reduced physical or sexual violence by 30 %. This mixed methods study aimed to understand the pathways that led to this reduction. We conducted a mixed methods study that combined secondary analysis from a randomised controlled trial relating to the impact of a transfer programme on IPV with in-depth interviews and focus group discussions with male and female beneficiaries. A sequential analysis strategy was followed, whereby qualitative results guided the choice of variables for the quantitative analysis and qualitative insights were used to help interpret the quantitative findings. We found qualitative and quantitative evidence that the intervention led to reductions in IPV through three pathways operating at the couple, household and individual level: i) reduced day-to-day conflict and stress in the couple; ii) improved household well-being and happiness; and iii) increased women's decision making, self-confidence and freedom of movement. We found little evidence that any type of IPV increased as a result of the transfers. While cash and in-kind transfers can be important programmatic tools for decreasing IPV, the positive effects observed in this study seem to depend on circumstances that may not exist in all settings or programmes, such as the inclusion of a training component. Moreover, the programme built upon rather than challenged traditional gender roles by targeting women as transfer beneficiaries and framing the intervention under the umbrella of food security and nutrition - domains traditionally ascribed to women. Transfers destined for food consumption combined with nutrition training reduced IPV among marginalised households in northern Ecuador. Evidence suggests that these reductions were realised by decreasing stress and conflict, improving household well-being, and enhancing women's decision making, self-confidence and freedom of movement. ClinicalTrials.gov NCT02526147 . Registered 24 August 2015.

Outcomes and Impact of Training and Development in Health Management and Leadership in Relation to Competence in Role: A Mixed-Methods Systematic Review Protocol.

PubMed

Ayeleke, Reuben Olugbenga; North, Nicola; Wallis, Katharine Ann; Liang, Zhanming; Dunham, Annette

2016-10-17

The need for competence training and development in health management and leadership workforces has been emphasised. However, evidence of the outcomes and impact of such training and development has not been systematically assessed. The aim of this review is to synthesise the available evidence of the outcomes and impact of training and development in relation to the competence of health management and leadership workforces. This is with a view to enhancing the development of evidence-informed programmes to improve competence. A systematic review will be undertaken using a mixed-methods research synthesis to identify, assess and synthesise relevant empirical studies. We will search relevant electronic databases and other sources for eligible studies. The eligibility of studies for inclusion will be assessed independently by two review authors. Similarly, the methodological quality of the included studies will be assessed independently by two review authors using appropriate validated instruments. Data from qualitative studies will be synthesised using thematic analysis. For quantitative studies, appropriate effect size estimate will be calculated for each of the interventions. Where studies are sufficiently similar, their findings will be combined in meta-analyses or meta-syntheses. Findings from quantitative syntheses will be converted into textual descriptions (qualitative themes) using Bayesian method. Textual descriptions and results of the initial qualitative syntheses that are mutually compatible will be combined in mixed-methods syntheses. The outcome of data collection and analysis will lead, first, to a descriptive account of training and development programmes used to improve the competence of health management and leadership workforces and the acceptability of such programmes to participants. Secondly, the outcomes and impact of such programmes in relation to participants' competence as well as individual and organisational performance will be identified. If possible, the relationship between health contexts and the interventions required to improve management and leadership competence will be examined. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-03-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-01-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mitecontaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan. © 2014 Japanese Society of Allergology.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2013-12-25

Background: Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. Methods: In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Results: Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Conclusions: Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Restructuring in response to case mix reimbursement in nursing homes: A contingency approach

PubMed Central

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2013-01-01

Background Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. Purpose The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. Methodology/Approach The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Findings Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Practice Implications Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring. PMID:18360162

Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

PubMed

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2008-01-01

Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring.

Do Financial Incentives of Introducing Case Mix Reimbursement Increase Feeding Tube Use in Nursing Home Residents?

PubMed Central

Teno, Joan M.; Feng, Zhanlian; Mitchell, Susan L.; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

2013-01-01

OBJECTIVES To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. DESIGN Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states’ adoption of case mix reimbursement. SETTING NHs in the United States. PARTICIPANTS NH residents at the time of NH inspection between 1993 and 2004. MEASUREMENTS Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. RESULTS Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. CONCLUSION The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use. PMID:18331293

Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study.

PubMed

Kumar, Arunaz; Sturrock, Sam; Wallace, Euan M; Nestel, Debra; Lucey, Donna; Stoyles, Sally; Morgan, Jenny; Neil, Peter; Schlipalius, Michelle; Dekoninck, Philip

2018-02-17

The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants' perception of usefulness of PROMPT in their clinical practice. Mixed methods approach with a pre-test/post-test design. Healthcare network providing obstetric care in Victoria, Australia. Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011-2012 (n=15 361 births) and 2014-2015 (n=12 388 births). Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills. Clinical outcomes compared before and after embedding PROMPT in educational practice. Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice. There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies. Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Protocol for a mixed-methods longitudinal study to identify factors influencing return to work in the over 50s participating in the UK Work Programme: Supporting Older People into Employment (SOPIE)

PubMed Central

Brown, Judith; Neary, Joanne; Katikireddi, Srinivasa Vittal; Thomson, Hilary; McQuaid, Ronald W; Leyland, Alastair H; Frank, John; Jeavons, Luke; de Pellette, Paul; Kiran, Sibel; Macdonald, Ewan B

2015-01-01

Introduction Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how best to support this group back to work. The Work Programme is the UK Government's flagship policy to facilitate return to work (RTW) among those at risk of long-term unemployment. ‘Supporting Older People Into Employment’ (SOPIE) is a mixed-methods longitudinal study involving a collaboration between academics and a major Work Programme provider (Ingeus). The study will investigate the relationship between health, worklessness and the RTW process for the over 50s. Methods and analysis There are three main study components. Embedded fieldwork will document the data routinely collected by Ingeus and the key interventions/activities delivered. The quantitative study investigates approximately 14 000 individuals (aged 16–64 years, with 20% aged over 50) who entered the Ingeus Work Programme (referred to as ‘clients’) in a 16-month period in Scotland and were followed up for 2 years. Employment outcomes (including progression towards work) and how they differ by client characteristics (including health), intervention components received and external factors will be investigated. The qualitative component will explore the experiences of clients and Ingeus staff, to better understand the interactions between health and (un)employment, Work Programme delivery, and how employment services can be better tailored to the needs of the over 50s. Ethics and dissemination Ethical approval was received from the University of Glasgow College of Social Sciences Research Ethics Committee (application number 400140186). Results Results will be disseminated through journal articles, national and international conferences. Findings will inform current and future welfare-to-work and job retention initiatives to extend healthy working lives. PMID:26674507

Protocol for a mixed-methods longitudinal study to identify factors influencing return to work in the over 50s participating in the UK Work Programme: Supporting Older People into Employment (SOPIE).

PubMed

Brown, Judith; Neary, Joanne; Katikireddi, Srinivasa Vittal; Thomson, Hilary; McQuaid, Ronald W; Leyland, Alastair H; Frank, John; Jeavons, Luke; de Pellette, Paul; Kiran, Sibel; Macdonald, Ewan B

2015-12-16

Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how best to support this group back to work. The Work Programme is the UK Government's flagship policy to facilitate return to work (RTW) among those at risk of long-term unemployment. 'Supporting Older People Into Employment' (SOPIE) is a mixed-methods longitudinal study involving a collaboration between academics and a major Work Programme provider (Ingeus). The study will investigate the relationship between health, worklessness and the RTW process for the over 50s. There are three main study components. Embedded fieldwork will document the data routinely collected by Ingeus and the key interventions/activities delivered. The quantitative study investigates approximately 14,000 individuals (aged 16-64 years, with 20% aged over 50) who entered the Ingeus Work Programme (referred to as 'clients') in a 16-month period in Scotland and were followed up for 2 years. Employment outcomes (including progression towards work) and how they differ by client characteristics (including health), intervention components received and external factors will be investigated. The qualitative component will explore the experiences of clients and Ingeus staff, to better understand the interactions between health and (un)employment, Work Programme delivery, and how employment services can be better tailored to the needs of the over 50s. Ethical approval was received from the University of Glasgow College of Social Sciences Research Ethics Committee (application number 400140186). Results will be disseminated through journal articles, national and international conferences. Findings will inform current and future welfare-to-work and job retention initiatives to extend healthy working lives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Programmable Logic Application Notes

NASA Technical Reports Server (NTRS)

Katz, Richard

2000-01-01

This column will be provided each quarter as a source for reliability, radiation results, NASA capabilities, and other information on programmable logic devices and related applications. This quarter will start a series of notes concentrating on analysis techniques with this issues section discussing worst-case analysis requirements.

42 CFR 484.240 - Methodology used for the calculation of the outlier payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for each case-mix group. (b) The outlier threshold for each case-mix group is the episode payment... the same for all case-mix groups. (c) The outlier payment is a proportion of the amount of estimated...

The use of programme planning and social marketing models by a state public health agency: a case study.

PubMed

Kohr, J M; Strack, R W; Newton-Ward, M; Cooke, C H

2008-03-01

To investigate the use of planning models and social marketing planning principles within a state's central public health agency as a means for informing improved planning practices. Qualitative semi-structured interviews were conducted with 30 key programme planners in selected division branches, and a quantitative survey was distributed to 63 individuals responsible for programme planning in 12 programme-related branches. Employees who have an appreciation of and support for structured programme planning and social marketing may be considered the 'low hanging fruit' or 'early adopters'. On the other hand, employees that do not support or understand either of the two concepts have other barriers to using social marketing when planning programmes. A framework describing the observed factors involved in programme planning on an individual, interpersonal and organizational level is presented. Understanding the individual and structural barriers and facilitators of structured programme planning and social marketing is critical to increase the planning capacity within public health agencies.

Economic impact analysis of an end-of-life programme for nursing home residents.

PubMed

Teo, W-S Kelvin; Raj, Anusha Govinda; Tan, Woan Shin; Ng, Charis Wei Ling; Heng, Bee Hoon; Leong, Ian Yi-Onn

2014-05-01

Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs. Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life. The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3). This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.

Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation

PubMed Central

Vareilles, Gaëlle; Marchal, Bruno; Kane, Sumit; Petrič, Taja; Pictet, Gabriel; Pommier, Jeanine

2015-01-01

Objectives This paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacity-building intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda. Method Given the complexity of the intervention, we adopted realist evaluation as our methodological approach and the case study as our study design. Data collection included document review, participant observation and interviews. The constant comparative method was used for the analysis. Two contrasted cases were selected within the five Kampala districts. Each case covers the management of the immunisation programme implemented at a RC branch. In each case, a programme manager and 15 RC volunteers were interviewed. The selection of the volunteers was purposive. Results We found that a capacity-building programme including supervision supportive of autonomy, skills and knowledge enhancement, and adapted to the different subgroups of volunteers, leads to satisfaction of the three key drivers of volunteer motivation: feelings of autonomy, competence and connectedness. This contributes to higher retention, and better task performance and well-being among the volunteers. Enabling contextual conditions include the responsiveness of the Uganda Red Cross Society (URCS) to community needs, and recognition of the work of the volunteers, from the URCS and the community. Conclusions A management approach that caters for the different motivational states and changing needs of the volunteers will lead to better performance. The findings will inform not only the management of community health volunteers, but also the management of all kinds of health workers. PMID:26525721

Staff Development Practices of Open and Distance Learning Institutions in Ghana: The Case of the Distance Education Programme of University of Education, Winneba, Ghana

ERIC Educational Resources Information Center

Owusu-Mensah, Francis; Anyan, Jerry Addison; Denkyi, Charles

2015-01-01

Staff development plays a crucial role in Open and Distance learning programmes because most of the staff working on these programmes are products of the conventional face to face system. Lack of proper training of staff in ODL can lead to high dropout rate among distance learners. The purpose of this study was to investigate staff development…

Can post-acute care programmes for older people reduce overall costs in the health system? A case study using the Australian Transition Care Programme.

PubMed

Hall, C J; Peel, N M; Comans, T A; Gray, L C; Scuffham, P A

2012-01-01

There is an increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases. To reduce pressure and costs in the hospital system, community-based post-acute care discharge services for older people have evolved as one method of reducing length of stay in hospital and preventing readmissions. However, it is unclear whether they reduce overall episode cost or expenditure in the health system at a more general level. In this paper, we review the current evidence on the likely costs and benefits of these services and consider whether they are potentially cost-effective from a health services perspective, using the Australian Transition Care Programme as a case study. Evaluations of community-based post-acute services have demonstrated that they reduce length of stay, prevent some re-hospitalisations and defer nursing home placement. There is also evidence that they convey some additional health benefits to older people. An economic model was developed to identify the maximum potential benefits and the likely cost savings from reduced use of health services from earlier discharge from hospital, accelerated recovery, reduced likelihood of readmission to hospital and delayed entry into permanent institutional care for participants of the Transition Care Programme. Assuming the best case scenario, the Transition Care Programme is still unlikely to be cost saving to a healthcare system. Hence for this service to be justified, additional health benefits such as quality of life improvements need to be taken into account. If it can be demonstrated that this service also conveys additional quality of life improvements, community-based programmes such as Transition Care could be considered to be cost-effective when compared with other healthcare programmes. © 2011 Blackwell Publishing Ltd.

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs.

PubMed

Rosen, Amy K; Loveland, Susan A; Rakovski, Carter C; Christiansen, Cindy L; Berlowitz, Dan R

2003-01-01

Although case-mix adjustment is critical for provider profiling, little is known regarding whether different case-mix measures affect assessments of provider efficiency. We examine whether two case-mix measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), result in different assessments of efficiency across service networks within the Department of Veterans Affairs (VA). Three profiling indicators examine variation in resource use. Although results from the ACGs and DCGs generally agree on which networks have greater or lesser efficiency than average, assessments of individual network efficiency vary depending upon the case-mix measure used. This suggests that caution should be used so that providers are not misclassified based on reported efficiency.

A scoping review of intimate partner violence assistance programmes within health care settings.

PubMed

Sprague, Sheila; Scott, Taryn; Garibaldi, Alisha; Bzovsky, Sofia; Slobogean, Gerard P; McKay, Paula; Spurr, Hayley; Arseneau, Erika; Memon, Muzammil; Bhandari, Mohit; Swaminathan, Aparna

2017-01-01

Background : The lifetime prevalence of intimate partner violence (IPV) for women presenting to health care settings is estimated to be 38-59%. With the goal of providing help to victims of abuse, numerous IPV assistance programmes have been developed and evaluated across multiple health care settings. Objective : Our scoping review provides an overview of this literature to identify key areas for potential evidence-based recommendations and to focus research priorities. Methods : We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated the effectiveness of IPV assistance programmes delivered within health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data. Results : Forty-three studies met all eligibility criteria and were included in our scoping review. Nine categories of assistance programmes were identified: counselling/advocacy, safety assessment/planning, referral, providing IPV resources, home visitation, case management, videos, provider cueing, and system changes. Characteristics of programmes amongst studies frequently reporting positive results included those in which one type of active assistance was used (77.8% of studies reported positive results), a counsellor, community worker, or case manager provided the intervention (83.3% of studies reported positive results), and programmes that were delivered over more than five sessions (100.0% of studies reported positive results). Conclusions : IPV assistance programmes are heterogeneous with regards to the types of assistance they include and how they are delivered and evaluated. This heterogeneity creates challenges in identifying which IPV assistance programmes, and which aspects of these programmes, are effective. However, it appears that many different types of IPV assistance programmes can have positive impacts on women.

A scoping review of intimate partner violence assistance programmes within health care settings

PubMed Central

Sprague, Sheila; Scott, Taryn; Garibaldi, Alisha; Bzovsky, Sofia; Slobogean, Gerard P.; McKay, Paula; Spurr, Hayley; Arseneau, Erika; Memon, Muzammil; Bhandari, Mohit; Swaminathan, Aparna

2017-01-01

ABSTRACT Background: The lifetime prevalence of intimate partner violence (IPV) for women presenting to health care settings is estimated to be 38–59%. With the goal of providing help to victims of abuse, numerous IPV assistance programmes have been developed and evaluated across multiple health care settings. Objective: Our scoping review provides an overview of this literature to identify key areas for potential evidence-based recommendations and to focus research priorities. Methods: We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated the effectiveness of IPV assistance programmes delivered within health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data. Results: Forty-three studies met all eligibility criteria and were included in our scoping review. Nine categories of assistance programmes were identified: counselling/advocacy, safety assessment/planning, referral, providing IPV resources, home visitation, case management, videos, provider cueing, and system changes. Characteristics of programmes amongst studies frequently reporting positive results included those in which one type of active assistance was used (77.8% of studies reported positive results), a counsellor, community worker, or case manager provided the intervention (83.3% of studies reported positive results), and programmes that were delivered over more than five sessions (100.0% of studies reported positive results). Conclusions: IPV assistance programmes are heterogeneous with regards to the types of assistance they include and how they are delivered and evaluated. This heterogeneity creates challenges in identifying which IPV assistance programmes, and which aspects of these programmes, are effective. However, it appears that many different types of IPV assistance programmes can have positive impacts on women. PMID:28649297

The effects of Medicaid reimbursement method and ownership on nursing home costs, case mix, and staffing.

PubMed

Cohen, J W; Dubay, L C

1990-01-01

In this study we analyze the effects of ownership and Medicaid cost containment initiatives on nursing home costs, payer mix, case mix, and staffing, using 1981 Medicare cost reports and Medicare/Medicaid Automated Certification files. As Medicaid cost containment incentives become stronger, nursing homes respond by decreasing case mix and commensurately decreasing staffing. When these incentives are especially strong, staffing is reduced beyond the apparently appropriate level, given the case mix. In addition, while chain facilities have lower costs than other types of facilities, these lower costs do not appear to come from either increased cream-skimming or reduced staffing levels.

Self-Recovery Experiments in Extreme Environments Using a Field Programmable Transistor Array

NASA Technical Reports Server (NTRS)

Stoica, Adrian; Keymeulen, Didier; Arslan, Tughrul; Duong, Vu; Zebulum, Ricardo; Ferguson, Ian; Guo, Xin

2004-01-01

Temperature and radiation tolerant electronics, as well as long life survivability are key capabilities required for future NASA missions. Current approaches to electronics for extreme environments focus on component level robustness and hardening. However, current technology can only ensure very limited lifetime in extreme environments. This paper describes novel experiments that allow adaptive in-situ circuit redesign/reconfiguration during operation in extreme temperature and radiation environments. This technology would complement material/device advancements and increase the mission capability to survive harsh environments. The approach is demonstrated on a mixed-signal programmable chip (FPTA-2), which recovers functionality for temperatures until 28 C and with total radiation dose up to 250kRad.

Implementing a Cancer Fast-track Programme between primary and specialised care in Catalonia (Spain): a mixed methods study

PubMed Central

Prades, J; Espinàs, J A; Font, R; Argimon, J M; Borràs, J M

2011-01-01

Background: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. Methods: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006–2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. Results: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. Conclusion: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care. PMID:21829194

Problem-based learning in dental education: what's the evidence for and against...and is it worth the effort?

PubMed

Winning, T; Townsend, G

2007-03-01

All Australian dental schools have introduced problem-based learning (PBL) approaches to their programmes over the past decade, although the nature of the innovations has varied from school to school. Before one can ask whether PBL is better than the conventional style of education, one needs to consider three key issues. Firstly, we need to agree on what is meant by the term PBL; secondly, we need to decide what "better" means when comparing educational approaches; and thirdly, we must look carefully at how PBL is implemented in given situations. It is argued that PBL fulfils, at least in theory, some important principles relating to the development of new knowledge. It also represents a change in focus from teachers and teaching in conventional programmes to learners and learning. Generally, students enjoy PBL programmes more than conventional programmes and feel they are more nurturing. There is also some evidence of an improvement in clinical and diagnostic reasoning ability associated with PBL curricula. The main negative points raised about PBL are the costs involved and mixed reports of insufficient grounding of students in the basic sciences. Financial restraints will probably preclude the introduction of pure or fully integrated PBL programmes in Australian dental schools. However, our research and experience, as well as other published literature, indicate that well-planned hybrid PBL programmes, with matching methods of assessment, can foster development of the types of knowledge, skills and attributes that oral health professionals will need in the future.

Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

PubMed

John, Denny; Parikh, Rajul

2017-07-01

Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

National tuberculosis programme review: experience over the period 1990-95.

PubMed Central

Pio, A.; Luelmo, F.; Kumaresan, J.; Spinaci, S.

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies. PMID:9509630

National tuberculosis programme review: experience over the period 1990-95.

PubMed

Pio, A; Luelmo, F; Kumaresan, J; Spinaci, S

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies.

Highly active antiretroviral therapy and tuberculosis control in Africa: synergies and potential.

PubMed Central

Harries, Anthony D.; Hargreaves, Nicola J.; Chimzizi, Rehab; Salaniponi, Felix M.

2002-01-01

HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and TB (tuberculosis) are two of the world's major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. It could be delivered by means of a structure based on the five-point strategy called DOTS, which has been adopted for TB control. However, it may be unrealistic to give TB control programmes the responsibility for running such a programme. A better approach might be to deliver highly active antiretroviral therapy within a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. TB programmes could contribute towards the development and implementation of this strategy. PMID:12132003

Community-based prevention of hepatitis-B-related liver cancer: Australian insights

PubMed Central

Kansil, Melanie Q; Porwal, Mamta; Penman, Andrew G; George, Jacob

2014-01-01

Abstract Problem Although most primary hepatocellular cancers (HCCs) are attributable to chronic viral hepatitis and largely preventable, such cancers remain a leading cause of cancer-related mortality wherever chronic hepatitis B is endemic. Approach Many HCCs could be prevented by increasing awareness and knowledge of hepatitis B, optimizing the monitoring of chronic hepatitis B and using antiviral treatments – but there are gaps in the implementation of such strategies. Local setting The “B Positive” programme, based in Sydney, Australia, is designed to improve hepatitis-B-related health outcomes among immigrants from countries with endemic hepatitis B. The programme offers information about disease screening, vaccination and treatment options, as well as optimized access to care. Relevant changes The B Positive programme has been informed by economic modelling. The programme offers culturally tailored education on chronic hepatitis B to target communities and their health practitioners and regular follow-up through a population-based registry of cases. Lessons learnt As the costs of screening for chronic hepatitis B and follow-up are relatively low and less than one in every four cases may require antiviral drugs, optimizing access to treatment seems an appropriate and cost-effective management option. The identification and accurate staging of cases and the judicious use of antiviral medications are predicated upon an informed and educated health workforce. As establishing community trust is a lengthy process, delaying the implementation of programmes against chronic hepatitis B until antiviral drugs become cheaper is unwarranted. PMID:24839327

Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme

PubMed Central

Marks, Michael; Taotao-Wini, Betty; Satorara, Lorraine; Engelman, Daniel; Nasi, Titus; Mabey, David C.; Steer, Andrew C.

2015-01-01

Introduction Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. Methods We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. Results Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. Discussion We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts. PMID:26624616

Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme.

PubMed

Marks, Michael; Taotao-Wini, Betty; Satorara, Lorraine; Engelman, Daniel; Nasi, Titus; Mabey, David C; Steer, Andrew C

2015-12-01

Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.

The important role of food composition in policies and programmes for better public health: A South African case study.

PubMed

Schönfeldt, Hettie C; Hall, Nicolette; Pretorius, B

2018-01-01

Most governments have committed to the set of Sustainable Development Goals established by the United Nations (UN) to be achieved by 2030. Subsequently the governments have drafted, or are in process of drafting, policies and programmes which aim to answer to these global requests. South Africa provides a unique case study: despite economic growth, undernutrition has not improved when compared to other industrialised nations, while at the same time, diet-related non-communicable diseases and obesity have exponentially increased. Access to healthy food is a constitutional right of all South Africans, and towards increasing food security and improving population health, various policies, programmes and regulations have been developed and implemented by the government to rectify the situation. The paper presents an overview of food composition within these public health policies, programmes and regulations and unpacks the important role of accurate food composition data. Copyright © 2017 Elsevier Ltd. All rights reserved.

The effect of misclassification errors on case mix measurement.

PubMed

Sutherland, Jason M; Botz, Chas K

2006-12-01

Case mix systems have been implemented for hospital reimbursement and performance measurement across Europe and North America. Case mix categorizes patients into discrete groups based on clinical information obtained from patient charts in an attempt to identify clinical or cost difference amongst these groups. The diagnosis related group (DRG) case mix system is the most common methodology, with variants adopted in many countries. External validation studies of coding quality have confirmed that widespread variability exists between originally recorded diagnoses and re-abstracted clinical information. DRG assignment errors in hospitals that share patient level cost data for the purpose of establishing cost weights affects cost weight accuracy. The purpose of this study is to estimate bias in cost weights due to measurement error of reported clinical information. DRG assignment error rates are simulated based on recent clinical re-abstraction study results. Our simulation study estimates that 47% of cost weights representing the least severe cases are over weight by 10%, while 32% of cost weights representing the most severe cases are under weight by 10%. Applying the simulated weights to a cross-section of hospitals, we find that teaching hospitals tend to be under weight. Since inaccurate cost weights challenges the ability of case mix systems to accurately reflect patient mix and may lead to potential distortions in hospital funding, bias in hospital case mix measurement highlights the role clinical data quality plays in hospital funding in countries that use DRG-type case mix systems. Quality of clinical information should be carefully considered from hospitals that contribute financial data for establishing cost weights.

Coding response to a case-mix measurement system based on multiple diagnoses.

PubMed

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

The current screening programme for congenital transmission of Chagas disease in Catalonia, Spain.

PubMed

Basile, L; Oliveira, I; Ciruela, P; Plasencia, A

2011-09-22

Due to considerable numbers of migrants from Chagas disease-endemic countries living in Catalonia, the Catalonian Health Department has recently implemented a screening programme for preventing congenital transmission, targeting Latin American pregnant women who attend antenatal consultations. Diagnosis of Trypanosoma cruzi infection in women is based on two positive serological tests. Screening of newborns from mothers with positive serology is based on a parasitological test during the first 48 hours of life and/or conventional serological analysis at the age of nine months. If either of these tests is positive, treatment with benznidazole is started following the World Health Organization's recommendations. The epidemiological surveillance of the programme is based on the Microbiological Reporting System of Catalonia, a well established network of laboratories. Once a positive case is reported, the responsible physician is asked to complete a structured epidemiological questionnaire. Clinical and demographic data are registered in the Voluntary Case Registry of Chagas Disease, a database administered by the Catalonian Health Department. It is expected that this programme will improve the understanding of the real burden of Chagas disease in the region. Furthermore, this initiative could encourage the implementation of similar programmes in other regions of Spain and even in other European countries.

Complex adaptive systems: a tool for interpreting responses and behaviours.

PubMed

Ellis, Beverley

2011-01-01

Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes. To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics. Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective. Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements. Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.

An Evaluation of Specialist Mentoring for University Students with Autism Spectrum Disorders and Mental Health Conditions

ERIC Educational Resources Information Center

Lucas, Rebecca; James, Alana I.

2018-01-01

Mentoring is often recommended to universities as a way of supporting students with Autism Spectrum Disorders (ASD) and/or mental health conditions (MHC), but there is little literature on optimising this support. We used mixed-methods to evaluate mentees' and mentors' experiences of a specialist mentoring programme. Mentees experienced academic,…

Analysing Instrument Mixes in Quality Assurance: The Czech and Slovak Accreditation Commissions in the Era of Mass Higher Education

ERIC Educational Resources Information Center

Kohoutek, Jan

2014-01-01

Utilising insights from policy instrument theory, the article analyses the design, functioning and effects of the tools used by the Czech Accreditation Commission (CAC) and the Slovak Accreditation Commission (SAC) in the 2000s. Aside from programme accreditation, the other tools analysed are: institutional approval, institutional evaluations,…

Professional Learning in Initial Teacher Education: Vision in the Constructivist Conception of Teaching and Learning

ERIC Educational Resources Information Center

Tang, Sylvia Y. F.; Wong, Angel K. Y.; Cheng, May M. H.

2012-01-01

With the constructivist view of learning as a conceptual lens, this paper examines student teachers' professional learning in initial teacher education (ITE). A mixed-method study was conducted with student teachers of a Bachelor of Education Programme in Hong Kong. The quantitative element of the study reveals that student teachers held a…

Stepping Back to Move Forward? Exploring Outdoor Education Students' Fresher and Graduate Identities and Their Impact on Employment Destinations

ERIC Educational Resources Information Center

Stott, Tim; Zaitseva, Elena; Cui, Vanessa

2014-01-01

This four-year mixed method longitudinal study utilises data collected from four cohorts of Outdoor Education (OE) students to compare "fresher" and "graduate" identities and to explore the impact of identity on graduate employment. Findings demonstrate that compared to other programmes, and the university as a whole, OE…

The Impact of a Multi-Component Physical Activity Programme in Low-Income Elementary Schools

ERIC Educational Resources Information Center

Massey, William V.; Stellino, Megan B.; Holliday, Megan; Godbersen, Travis; Rodia, Rachel; Kucher, Greta; Wilkison, Megan

2017-01-01

Objective: To identify the effects of a structured and multifaceted physical activity and recess intervention on student and adult behaviour in school. Design: Mixed-methods and community-based participatory approach. Setting: Large, urban, low-income school district in the USA. Methods: Data were collected at three time points over a 1-year…

Perceptions about Forest Schools: Encouraging and Promoting Archimedes Forest Schools

ERIC Educational Resources Information Center

Nawaz, Haq; Blackwell, Sarah

2014-01-01

The aim of this study was to find out parents' and children's perception of outdoor learning programmes with specific reference to Archimedes Forest Schools, known as Forest Schools. A review of existing research showed that there had been no rigorous evaluation of perception of forest schools. The study was conducted in the UK and mixed method…

A Comparison of Aphasia Therapy Outcomes before and after a Very Early Rehabilitation Programme Following Stroke

ERIC Educational Resources Information Center

Godecke, Erin; Ciccone, Natalie A.; Granger, Andrew S.; Rai, Tapan; West, Deborah; Cream, Angela; Cartwright, Jade; Hankey, Graeme J.

2014-01-01

Background: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results. Aims: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke)…

Informal Learning in Action: The Domains of Music Teaching and Their Pedagogic Modes

ERIC Educational Resources Information Center

Narita, Flávia Motoyama

2017-01-01

Green's informal learning pedagogy was adapted for a mixed-mode distance education of music teachers in Brazil. Designed as an 8-week module within the Open University of Brazil programme and implemented three times, this research involved 20 tutors and 73 student teachers, across a period of 2 years. Taking the form of a…

Secret Keepers: Children's Theory of Mind and Their Conception of Secrecy

ERIC Educational Resources Information Center

Colwell, Malinda J.; Corson, Kimberly; Sastry, Anuradha; Wright, Holly

2016-01-01

In this mixed methods study, semi-structured interviews were conducted with 3-5-year-olds (n?=?21) in a university-sponsored preschool programme and children completed a theory of mind (ToM) task. After grouping children into pass/no pass groups for the ToM tasks, analyses using interpretive phenomenology indicated that preschool children explain…

The Educationalising of Early Childhood in Aotearoa New Zealand: Tracking "Free Play" 1940s-2010

ERIC Educational Resources Information Center

Stover, Sue

2016-01-01

Geographically isolated in the south-west Pacific but intellectually and culturally connected to Western Europe, Aotearoa New Zealand's early childhood education sector is a unique mix of influences. The imprint of progressive education is evident in a legacy of "free play" programmes, yet its national curriculum is built on the…

Becoming an Interdisciplinary Scientist: An Analysis of Students' Experiences in Three Computer Science Doctoral Programmes

ERIC Educational Resources Information Center

Calatrava Moreno, María del Carmen; Danowitz, Mary Ann

2016-01-01

The aim of this study was to identify how and why doctoral students do interdisciplinary research. A mixed-methods approach utilising bibliometric analysis of the publications of 195 students identified those who had published interdisciplinary research. This objective measurement of the interdisciplinarity, applying the Rao-Stirling index to Web…

Using an Iterative Mixed-Methods Research Design to Investigate Schools Facing Exceptionally Challenging Circumstances within Trinidad and Tobago

ERIC Educational Resources Information Center

De Lisle, Jerome; Seunarinesingh, Krishna; Mohammed, Rhoda; Lee-Piggott, Rinnelle

2017-01-01

In this study, methodology and theory were linked to explicate the nature of education practice within schools facing exceptionally challenging circumstances (SFECC) in Trinidad and Tobago. The research design was an iterative quan>QUAL-quan>qual multi-method research programme, consisting of 3 independent projects linked together by overall…

Wellness and Academic Outcomes among Disadvantaged Students in South Africa: An Exploratory Study

ERIC Educational Resources Information Center

Morris-Paxton, Angela A.; Van Lingen, Johanna M.; Elkonin, Diane

2017-01-01

Objective: The aim of this study was to measure possible impacts of a salutogenic lifestyle education programme on wellness and academic outcomes in a group of socioeconomically disadvantaged students in the first year of higher education. Setting: University in the Eastern Cape Province, South Africa. Methods: A mixed-methods approach was…

Guided Interaction as Intercultural Learning: Designing Internationalisation into a Mixed Delivery Teacher Education Programme

ERIC Educational Resources Information Center

Spiro, Jane

2011-01-01

In this paper the process of building an international student community is explored. Strategies discussed include guided interaction within a virtual environment between home students studying in their own culture and international students studying at a distance. The context includes both the state and private sector in South East Asia, Latin…

Social Effects of Collaborative Learning in Primary Schools

ERIC Educational Resources Information Center

Tolmie, Andrew Kenneth; Topping, Keith J.; Christie, Donald; Donaldson, Caroline; Howe, Christine; Jessiman, Emma; Livingston, Kay; Thurston, Allen

2010-01-01

There is conflicting evidence on whether collaborative group work leads to improved classroom relations, and if so how. A before and after design was used to measure the impact on work and play relations of a collaborative learning programme involving 575 students 9-12 years old in single- and mixed-age classes across urban and rural schools. Data…

Attracting Mature Students into Higher Education: The Impact of Approaches to Learning and Social Identity

ERIC Educational Resources Information Center

Howard, Chris; Davies, Peter

2013-01-01

This paper reports on data collected during an evaluation of two higher education courses designed to attract mature entrants aged between 21 and 60 to undergraduate degree programmes. Employing an evaluation design informed by a critical realist approach, the study utilised a mix of quantitative and qualitative methods to investigate the outcomes…

Drug prevention programmes for young people: where have we been and where should we be going?

PubMed

Midford, Richard

2010-10-01

Substance use by young people has long been a concern of western society, but opinion is mixed as to which prevention approach offers the greatest benefit, and whether indeed there is any benefit at all. This paper reviews the nature of prevention programmes, the research evidence that underpins these programmes and the prevention objectives against which effectiveness is measured. The aim of this is to create better understanding of the elements that maximize programme effectiveness, what can be achieved by prevention programmes and how programmes can be improved. There is a range of prevention approaches for which there is evidence of effectiveness. Some are classroom-based; some focus upon parenting; some have substantial whole-of-school and community elements; and some target risk and protective factors in early childhood. All, however, are based substantially on the social influence model. In an attempt to improve practice lists of effective programmes have been developed, but there are concerns about the science behind selection. On balance, there is consistent evidence that social influence prevention programmes do have a small, positive effect on drug use, but this then raises the question as to whether harm, rather than use, would be the more worthwhile target for prevention. Prevention that seeks to reduce harm has been demonstrably effective, but has found little support in some jurisdictions. Research has created a progressively better understanding of how to optimize programme effectiveness and what can be achieved realistically by even the most effective programmes. However, further research is required to identify which, if any, particular approach offers greater promise. The effectiveness of harm reduction should be compared with more traditional abstinence and the additional effects of whole of school, parent and community elements need to be measured more accurately. Contemporary social influence prevention programmes are flawed, but the approach is still the best way of influencing drug use behaviour in young people as a whole. Evidence-based refinement is the best option for greater benefit. © 2009 The Author, Addiction © 2009 Society for the Study of Addiction.

A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster-randomised clinical trial.

PubMed

van Schijndel-Speet, M; Evenhuis, H M; van Wijck, R; van Montfort, K C A G M; Echteld, M A

2017-01-01

The physical activity level of older adults with intellectual disabilities (ID) is extremely low, and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people. A physical activity programme, including an education programme, was developed for older adults with ID using behaviour change techniques. The programme aimed at improving or maintaining adequate levels of physical activity (primary outcome measure) and motor fitness, cardio respiratory fitness, morphologic and metabolic fitness, activities of daily living, cognitive functioning and depressive symptoms (secondary outcome measures). The programme's efficacy was evaluated in a cluster-randomised clinical trial among people aged 43 years and over with mild-moderate levels of ID. Five day-activity centres were randomised to the participation group. In these centres, 81 older adults participated in groups of 8 to 10 in the programme, three times a week during 8 months. The programme was executed by physical activity instructors and staff of day-activity centres. Five other day-activity centres were randomised to the control group; 70 older adults in these centres received care as usual. The generalised linear model with mixed effects was used to test the programme's effectiveness. Significant effects were found on physical activity, muscle strength, systolic and diastolic blood pressure, serum cholesterol level and cognitive functioning, in favour of the programme's participants. No significant improvements were found on balance, serum glucose, weight, waist circumference, walking speed, mobility, depression or instrumental activities of daily living. The physical activity and fitness programme has established small but significant effects in this sample, but generalising the findings to other settings is difficult due to significant participant dropout. Implementation of evidence-based physical activity programmes among older adults with ID is recommended. Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Preceptors' perceptions of a preceptorship programme for newly qualified nurses.

PubMed

Muir, Jenny; Ooms, Ann; Tapping, Jen; Marks-Maran, Di; Phillips, Sonia; Burke, Linda

2013-06-01

A study was undertaken into preceptors' perceptions of a preceptorship programme for newly-qualified nurses. The preceptorship programme is designed to enable newly qualified nurses to make the transition from student to registered nurse. Preceptors undergo a training programme to take on the role of preceptor. To evaluate the preceptors' perception of the preceptorship programme. Mixed method evaluative research design was used. This study took place in one National Health Service Healthcare Trust in South West London, UK. Ninety preceptors were invited to participate in the study and the response rate was 44.4% (n=40). The study took place in 2011. Qualitative and quantitative data were collected through questionnaires and one-to-one interviews with a convenience sample of preceptors. Quantitative data were analysed using SPSS, version 18; qualitative data were analysed using the Framework Method. From the quantitative data seven themes emerged. These were preceptors' perceptions of: the personal development of preceptees; the role development of preceptees; the communication skills development of preceptees; the clinical development of preceptees; the development of professional relationships by preceptees; value of the preceptorship programme to the organisation and value of being a preceptor in terms of their own professional development. Qualitative analysis confirmed many of the findings from the statistical analysis and was used to triangulate those findings. The preceptors largely viewed the preceptorship programme and their role within this programme positively. Although difficulties in making time to meet with preceptees was an issue, the preceptorship experience was perceived to have a positive impact on several aspects of preceptee development as well as on the organisation and on the preceptors' own development. The study is unique when mapped against other research studies because there is little in the literature about studies into preceptors' perceptions of preceptorship programmes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluating the delivery, impact, costs and benefits of an active lives programme for older people living in the community.

PubMed

Gandy, Rob; Bell, Amelia; McClelland, Bob; Roe, Brenda

2017-03-01

Aim Age UK Lancashire received Big Lottery funding to deliver an active lives programme from January 2012 to December 2014 to the population of West Lancashire aged over 50 years. The overall aims of the associated evaluation were to measure older people's experiences of participating in the programme, identify the impacts on their health and well-being and their suggestions for services development, and establish the costs and benefits of the programme. The World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers. A mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish people's experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation. Findings The active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available.

Cost of malaria control in China: Henan's consolidation programme from community and government perspectives.

PubMed Central

Jackson, Sukhan; Sleigh, Adrian C.; Liu, Xi-Li

2002-01-01

OBJECTIVE: To assist with strategic planning for the eradication of malaria in Henan Province, China, which reached the consolidation phase of malaria control in 1992, when only 318 malaria cases were reported. METHODS: We conducted a prospective two-year study of the costs for Henan's malaria control programme. We used a cost model that could also be applied to other malaria programmes in mainland China, and analysed the cost of the three components of Henan's malaria programme: suspected malaria case management, vector surveillance, and population blood surveys. Primary cost data were collected from the government, and data on suspected malaria patients were collected in two malaria counties (population 2 093 100). We enlisted the help of 260 village doctors in six townships or former communes (population 247 762), and studied all 12 325 reported cases of suspected malaria in their catchment areas in 1994 and 1995. FINDINGS: The average annual government investment in malaria control was estimated to be US$ 111 516 (case-management 59%; active blood surveys 25%; vector surveillance 12%; and contingencies and special projects 4%). The average cost (direct and indirect) for patients seeking treatment for suspected malaria was US$ 3.48, equivalent to 10 days' income for rural residents. Each suspected malaria case cost the government an average of US$ 0.78. CONCLUSION: Further cuts in government funding will increase future costs when epidemic malaria returns; investment in malaria control should therefore continue at least at current levels of US$ 0.03 per person at risk. PMID:12219157

Selective Hepatitis B Virus Vaccination Has Reduced Hepatitis B Virus Transmission in The Netherlands

PubMed Central

Koedijk, Femke; van Ballegooijen, Marijn; Cremer, Jeroen; Bruisten, Sylvia; Coutinho, Roel

2013-01-01

Background & Aims In the Netherlands, a selective hepatitis B virus (HBV) vaccination programme started in 2002 for men having sex with men, drug users, commercial sex workers and heterosexuals with frequent partner changes. We assessed the programme's effectiveness to guide policy on HBV prevention. Methods We analysed reports of acute HBV infection in the Netherlands between 2004 and 2010 requesting serum from patients for HBV-genome S- and C-region sequencing. We used coalescence analyses to assess genetic diversity of nonimported genotype-A cases over time. Results 1687 patients with acute HBV infection were reported between 2004 and 2010. The incidence of reported acute HBV infection decreased from 1.8 to 1.2 per 100,000 inhabitants, mostly due to a reduction in the number of cases in men who have sex with men. Men were overrepresented among cases with an unknown route of transmission, especially among genotype A2 cases mainly associated with transmission through male homosexual contact. The genetic diversity of nonimported genotype-A strains obtained from men who have sex with men decreased from 2006 onwards, suggesting HBV incidence in this group decreased. Conclusions The selective HBV-vaccination programme for behavioural high-risk groups very likely reduced the incidence of HBV infection in the Netherlands mainly by preventing HBV infections in men who have sex with men. A considerable proportion of cases in men who did not report risk behaviour was probably acquired through homosexual contact. Our findings support continuation of the programme, and adopting similar approaches in other countries where HBV transmission is focused in high-risk adults. PMID:23922651

Results of implementing programmes for modifying unsafe behaviour in Polish companies.

PubMed

Pęciłło, Małgorzata

2012-01-01

This article presents the results of 3 Polish companies implementing programmes for modifying unsafe behaviour. Those programmes involved training workers and supervisors, and observing, registering and analysing the workers' behaviour. They focused on the quality of life and safety culture as factors key to the level of unsafe behaviour and, thus, to the level of safety in an organisation. To assess the effectiveness of the programmes, the quality of life and safety culture were studied before, during and after the intervention. The implementation of the programmes resulted in a higher level of safety culture and workers' well-being and fewer cases of unsafe behaviour. The improved level of safety culture and well-being was different in each company.

Impact of pandemic flu training on ability of medical personnel to recognize an index case of avian influenza.

PubMed

Adini, Bruria; Goldberg, Avishay; Cohen, Robert; Bar-Dayan, Yaron

2012-04-01

This study investigated the relationship between training programmes for pandemic flu and level of knowledge of health-care professionals with performance in an avian flu exercise. Training programmes of all general hospitals in Israel for managing a pandemic influenza were evaluated. Spearman's ρ correlation was used to analyse the relationship between training scores and level of knowledge of medical personnel with performance in an avian flu exercise. Hospital preparedness levels were evaluated at two time points and Wilcoxon signed-rank test was used to determine if overall preparedness scores improved over time. Evaluation of training programmes for pandemic influenza showed high to very high scores in most hospitals (mean 85, SD 22). Significant correlations between training and performance in the exercise were noted for: implementation of training programmes 0.91, P = 0.000; designating personnel for training 0.87, P = 0.000; content of training 0.61, P = 0.001; and training materials 0.36, P = 0.05. Overall reliability of the evaluation scores was 0.82 and reliability for two of the sub-scales was: implementation of the programme 0.78; and designating personnel for training 0.37. No significant correlation was found between level of knowledge and performance in the exercise. Training programmes for hospital personnel for pandemic flu have a significant role in improving performance in case of pandemic flu. The key component of the training programme appears to be the implementation of the programme. Use of knowledge tests should be further investigated, as they do not appear to correlate with the level of emergency preparedness for pandemic influenza.

Evaluation of the colorectal cancer screening Programme in the Basque Country (Spain) and its effectiveness based on the Miscan-colon model.

PubMed

Idigoras, I; Arrospide, A; Portillo, I; Arana-Arri, E; Martínez-Indart, L; Mar, J; de Koning, H J; Lastra, R; Soto-Gordoa, M; van der Meulen, M; Lansdorp-Vogelaar, I

2017-08-01

The population-based Basque Colorectal Cancer (CRC) Screening Programme started in 2009 with a biennial immunochemical quantitative test (FIT) biennial and colonoscopy under sedation in positive cases. The population target of 586,700 residents was from 50 to 69 years old and the total coverage was reached at the beginning of 2014. The aim of our study was to determine possible scenarios in terms of incidence, mortality and reduction of Life-years-Lost (L-y-L) in the medium and long term of CRC. Invitations were sent out by the Programme from 2009 to 2014, with combined organizational strategies. Simulation was done by MISCAN-colon (Microsimulation Screening Analysis) over 30 years comparing the results of screening vs no-screening, taking the population-based Cancer Registry into account. Lifetime population and real data from the Programme were used from 2008 to 2012. The model was run differentially for men and women. 924,416 invitations were sent out from 2009 to 2014. The average participation rate was 68.4%, CRC detection rate was 3.4% and the Advanced Adenoma detection rate was 24.0‰, with differences observed in sex and age. Future scenarios showed a higher decrease of incidence (17.2% vs 14.7%), mortality (28.1% vs 22.4%) and L-y-L (22.6% vs 18.4%) in men than women in 2030. The Basque Country CRC Programme results are aligned to its strategy and comparable to other programmes. MISCAN model was found to be a useful tool to predict the benefits of the programme in the future. The effectiveness of the Programme has not been formally established as case control studies are required to determine long term benefits from the screening strategy.

Proxy case mix measures for nursing homes.

PubMed

Cyr, A B

1983-01-01

Nursing home case mix measures are needed for the same purposes that spurred the intensive development of case mix measures for hospitals: management and planning decisions, organizational performance research, and reimbursement policy analysis. This paper develops and validates a pair of complementary measures that are simple to compute, are easy to interpret, and use generally available data. They are not, however, definitive. A secondary purpose of this paper is thus to galvanize the development of data bases that will give rise to superior case mix measures for nursing homes.

Molecular Analysis of Mixed Endometrial Carcinomas Shows Clonality in Most Cases.

PubMed

Köbel, Martin; Meng, Bo; Hoang, Lien N; Almadani, Noorah; Li, Xiaodong; Soslow, Robert A; Gilks, C Blake; Lee, Cheng-Han

2016-02-01

Mixed endometrial carcinoma refers to a tumor that comprises 2 or more distinct histotypes. We studied 18 mixed-type endometrial carcinomas-11 mixed serous and low-grade endometrioid carcinomas (SC/EC), 5 mixed clear cell and low-grade ECs (CCC/EC), and 2 mixed CCC and SCs (CCC/SC), using targeted next-generation sequencing and immunohistochemistry to compare the molecular profiles of the different histotypes present in each case. In 16 of 18 cases there was molecular evidence that both components shared a clonal origin. Eight cases (6 EC/SC, 1 EC/CCC, and 1 SC/CCC) showed an SC molecular profile that was the same in both components. Five cases (3 CCC/EC and 2 SC/EC) showed a shared endometrioid molecular profile and identical mismatch-repair protein deficiency in both components. A single SC/EC case harbored the same POLE exonuclease domain mutation in both components. One SC/CCC and 1 EC/CCC case showed both shared and unique molecular features in the 2 histotype components, suggesting early molecular divergence from a common clonal origin. In 2 cases, there were no shared molecular features, and these appear to be biologically unrelated synchronous tumors. Overall, these results show that the different histologic components in mixed endometrial carcinomas typically share the same molecular aberrations. Mixed endometrial carcinomas most commonly occur through morphologic mimicry, whereby tumors with serous-type molecular profile show morphologic features of EC or CCC, or through underlying deficiency in DNA nucleotide repair, with resulting rapid accrual of mutations and intratumoral phenotypic heterogeneity. Less commonly, mixed endometrial carcinomas are the result of early molecular divergence from a common progenitor clone or are synchronous biologically unrelated tumors (collision tumors).

Molecular analysis of mixed endometrial carcinomas shows clonality in most cases

PubMed Central

Hoang, Lien N.; Almadani, Noorah; Li, Xiaodong; Soslow, Robert A; Gilks, C. Blake; Lee, Cheng-Han

2016-01-01

Mixed endometrial carcinoma refers to a tumor that is comprised of two or more distinct histotypes. We studied 18 mixed-type endometrial carcinomas - 11 mixed serous and low-grade endometrioid carcinomas (SC/EC), 5 mixed clear cell and low-grade endometrioid carcinomas (CCC/EC), and 2 mixed clear cell and serous carcinoma (CCC/SC), using targeted next generation sequencing and immunohistochemistry to compare the molecular profiles of the different histotypes present in each case. In 16 of 18 cases there was molecular evidence that both components shared a clonal origin. Eight cases (6 EC/SC, 1 EC/CCC and 1 SC/CCC) showed a serous carcinoma molecular profile that was the same in both components. Five cases (3 CCC/EC and 2 SC/EC) showed a shared endometrioid molecular profile and identical mismatch repair protein (MMR) deficiency in both components. A single SC/EC case harbored the same POLE exonuclease domain mutation in both components. One SC/CCC and one EC/CCC case showed both shared and unique molecular features in the two histotype components, suggesting early molecular divergence from a common clonal origin. In two cases, there were no shared molecular features and these appear to be biologically unrelated synchronous tumors. Overall, these results show that the different histologic components in mixed endometrial carcinomas typically share the same molecular aberrations. Mixed endometrial carcinomas most commonly occur through morphological mimicry, whereby tumors with serous-type molecular profile show morphological features of endometrioid or clear cell carcinoma, or through underlying deficiency in DNA nucleotide repair, with resulting rapid accrual of mutations and intratumoral phenotypic heterogeneity. Less commonly, mixed endometrial carcinomas are the result of early molecular divergence from a common progenitor clone or are synchronous biologically unrelated tumors (collision tumors). PMID:26492180

An Integrated Approach to Environmental Education: A Case Study

ERIC Educational Resources Information Center

du Preez, Nicolaas P.; Mohr-Swart, Maryna

2004-01-01

In 1994, the Executive Management Committee (EMC) of Technikon Pretoria took a strategic decision to develop educational programmes in environmental management and sustainable development. The EMC also decided to integrate these programmes with the development and implementation of an environmental management policy for Technikon Pretoria. This…

Adaptation, Evaluation and Inclusion

ERIC Educational Resources Information Center

Basson, R.

2011-01-01

In this article I reflect on a recent development currently shaping programme evaluation as field, which makes the case for evaluators facilitating evaluation training evaluees to self-evaluate and improve the programmes they teach. Fetterman argues persuasively that the practice was incipient in the field and required formalization and acceptance…

Conceptualizing Programme Evaluation

ERIC Educational Resources Information Center

Hassan, Salochana

2013-01-01

The main thrust of this paper deals with the conceptualization of theory-driven evaluation pertaining to a tutor training programme. Conceptualization of evaluation, in this case, is an integration between a conceptualization model as well as a theoretical framework in the form of activity theory. Existing examples of frameworks of programme…

Study on Chinese common allergens of contact dermatitis.

PubMed

Fan, W X; Zhao, B

1990-01-01

Patch tests were performed according to the European Standard Allergens (ESA) in 204 cases suspected of contact dermatitis. The reaction was positive in 58.33% of the cases. The common allergens were nickel (15.7%), fragrance mix (11.8%) p-phenylenediamine (8.8%), colophony (6.9%), benzocaine (6.4%), formaldehyde (5.9%), black rubber mix (4.9%), cobalt (4.4%), balsam of Peru (3.9%), potassium dichromate (3.4%), thiuram mix (2.9%) and mercapto mix (2.9%). In 85 cases of negative reaction to the European Standard Allergens, 36 were patch tested to suspected agents based on the individual case histories, of which 21 positively reacted. The common sensitizing agents were ampicillin and thiomersal. Of 204 cases, 107 were cases of facial contact dermatitis. Patch tests showed that the most common allergens were p-phenylenediamine (15.9%), nickel (13.1%) and fragrance mix (14.95%).

Introduction of shared electronic records: multi-site case study using diffusion of innovation theory.

PubMed

Greenhalgh, Trisha; Stramer, Katja; Bratan, Tanja; Byrne, Emma; Mohammad, Yara; Russell, Jill

2008-10-23

To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale information technology projects in health care. Multi-site, mixed method case study applying utilisation focused evaluation. Four early adopter sites for the SCR in England-three in urban areas of relative socioeconomic deprivation and the fourth in a relatively affluent rural area. Data sources and analysis Data included 250 staff interviews, 1500 hours of ethnographic observation, interviews and focus groups with 170 patients and carers, 2500 pages of correspondence and documentary evidence, and incorporation of relevant surveys and statistics produced by others. These were analysed by using a thematic approach drawing on (and extending) a theoretical model of complex change developed in a previous systematic review. Main findings The mixed fortunes of the SCR programme in its first year were largely explained by eight interacting influences. The first was the SCR's material properties (especially technical immaturity and lack of interoperability) and attributes (especially the extent to which potential adopters believed the benefits outweighed the risks). The second was adopters' concerns (especially about workload and the ethicality of sharing "confidential" information on an implied consent model). The third influence was interpersonal influence (for example, opinion leaders, champions, facilitators), and the fourth was organisational antecedents for innovation (for example past experience with information technology projects, leadership and management capacity, effective data capture systems, slack resources). The fifth was organisational readiness for the SCR (for example, innovation-system fit, tension for change, power balances between supporters and opponents, baseline data quality). The sixth was the implementation process (including the nature of the change model and the extent to which new routines associated with the SCR aligned with existing organisational routines). The seventh influence was the nature and quality of links between different parts of the system, and the final one was the wider environment (especially the political context of the programme). Shared electronic records are not plug-in technologies. They are complex innovations that must be accepted by individual patients and staff and also embedded in organisational and inter-organisational routines. This process is heavily influenced at the micro-level by the material properties of the technology, individuals' attitudes and concerns, and interpersonal influence; at the meso-level by organisational antecedents, readiness, and operational aspects of implementation; and at the macro-level by institutional and socio-political forces. A case study approach and multi-level theoretical analysis can illuminate how contextual factors shape, enable, and constrain new, technology supported models of patient care.

Introduction of shared electronic records: multi-site case study using diffusion of innovation theory

PubMed Central

Stramer, Katja; Bratan, Tanja; Byrne, Emma; Mohammad, Yara; Russell, Jill

2008-01-01

Objective To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale information technology projects in health care. Design Multi-site, mixed method case study applying utilisation focused evaluation. Setting Four early adopter sites for the SCR in England—three in urban areas of relative socioeconomic deprivation and the fourth in a relatively affluent rural area. Data sources and analysis Data included 250 staff interviews, 1500 hours of ethnographic observation, interviews and focus groups with 170 patients and carers, 2500 pages of correspondence and documentary evidence, and incorporation of relevant surveys and statistics produced by others. These were analysed by using a thematic approach drawing on (and extending) a theoretical model of complex change developed in a previous systematic review. Main findings The mixed fortunes of the SCR programme in its first year were largely explained by eight interacting influences. The first was the SCR’s material properties (especially technical immaturity and lack of interoperability) and attributes (especially the extent to which potential adopters believed the benefits outweighed the risks). The second was adopters’ concerns (especially about workload and the ethicality of sharing “confidential” information on an implied consent model). The third influence was interpersonal influence (for example, opinion leaders, champions, facilitators), and the fourth was organisational antecedents for innovation (for example past experience with information technology projects, leadership and management capacity, effective data capture systems, slack resources). The fifth was organisational readiness for the SCR (for example, innovation-system fit, tension for change, power balances between supporters and opponents, baseline data quality). The sixth was the implementation process (including the nature of the change model and the extent to which new routines associated with the SCR aligned with existing organisational routines). The seventh influence was the nature and quality of links between different parts of the system, and the final one was the wider environment (especially the political context of the programme). Conclusion Shared electronic records are not plug-in technologies. They are complex innovations that must be accepted by individual patients and staff and also embedded in organisational and inter-organisational routines. This process is heavily influenced at the micro-level by the material properties of the technology, individuals’ attitudes and concerns, and interpersonal influence; at the meso-level by organisational antecedents, readiness, and operational aspects of implementation; and at the macro-level by institutional and socio-political forces. A case study approach and multi-level theoretical analysis can illuminate how contextual factors shape, enable, and constrain new, technology supported models of patient care. PMID:18948344

Empowering caregivers: impact analysis of FamilyLink Education Programme (FLEP) in Hong Kong, Taipei and Bangkok.

PubMed

Chiu, Marcus Y L; Wei, Grace F W; Lee, Sing; Choovanichvong, Somrak; Wong, Frank H T

2013-02-01

Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants. One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested. FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy. Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.

Programmable Quantitative DNA Nanothermometers.

PubMed

Gareau, David; Desrosiers, Arnaud; Vallée-Bélisle, Alexis

2016-07-13

Developing molecules, switches, probes or nanomaterials that are able to respond to specific temperature changes should prove of utility for several applications in nanotechnology. Here, we describe bioinspired strategies to design DNA thermoswitches with programmable linear response ranges that can provide either a precise ultrasensitive response over a desired, small temperature interval (±0.05 °C) or an extended linear response over a wide temperature range (e.g., from 25 to 90 °C). Using structural modifications or inexpensive DNA stabilizers, we show that we can tune the transition midpoints of DNA thermometers from 30 to 85 °C. Using multimeric switch architectures, we are able to create ultrasensitive thermometers that display large quantitative fluorescence gains within small temperature variation (e.g., > 700% over 10 °C). Using a combination of thermoswitches of different stabilities or a mix of stabilizers of various strengths, we can create extended thermometers that respond linearly up to 50 °C in temperature range. Here, we demonstrate the reversibility, robustness, and efficiency of these programmable DNA thermometers by monitoring temperature change inside individual wells during polymerase chain reactions. We discuss the potential applications of these programmable DNA thermoswitches in various nanotechnology fields including cell imaging, nanofluidics, nanomedecine, nanoelectronics, nanomaterial, and synthetic biology.

[Disease management for chronic heart failure patient].

PubMed

Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

2011-02-01

Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

Evaluation of a clinical leadership programme for nurse leaders.

PubMed

Martin, Jacqueline S; McCormack, Brendan; Fitzsimons, Donna; Spirig, Rebecca

2012-01-01

This is an evaluation study of the impact of the adapted RCN Clinical Leadership Programme on the development of leadership competencies of nurse leaders in Switzerland. Transformational leadership competencies are essential for delivering high-quality care within health-care organizations. However, many countries have identified a lack of leadership skills in nurse leaders. Consequently, the development of leadership competencies is a major objective for health-care centres. This article describes the quantitative results of a mixed methods study. A one-group pre-test-post-test quasi-experimental design was used. A convenience sample of 14 ward leaders were assessed three times using the Leadership Practices Inventory (LPI). Descriptive and inferential data analysis techniques were employed. In total 420 observer-assessment questionnaires and 42 self-assessment questionnaires were distributed. Our main finding was that nurse leaders following the programme, demonstrated significant improvement in two subscales of the LPI -'inspiring a shared vision' and 'challenging the process'. This study showed improvement in two leadership practices of nurse leaders following a programme that has been adapted to Swiss health care. Findings concur with others studies that suggest that investments in educational programs to facilitate leadership skills in nurse leaders are justified. © 2011 Blackwell Publishing Ltd.

Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach.

PubMed

Araci, David; Clarke, Isabel

2017-08-01

Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measure t-tests demonstrated significant decrease in distress (p < 0.0005) and significant increase in confidence in self-management of mental health (p < 0.0005). Evaluation shows that ISP can be delivered in routine care in an acute mental health service and results in improvement in self management skills and facilitation of recovery.

An evaluation of the tuberculosis control programme of Selangor State, Malaysia for the year 2001.

PubMed

Venugopalan, B

2004-03-01

In the year 2001, 1459 Tuberculosis (TB) cases (43.1/100,000 population) were notified in Selangor. The highest age specific incidence rate was among those aged above 60 years and foreigners accounted for 15% of the cases notified. Fifteen percent of the TB cases were treated in the private sector where treatment efficacy and compliance could not be evaluated. Co- infection of Human Immunodeficiency Virus (HIV) infection with TB accounted for 51% of the TB deaths notified. Screening programmes in prisons and drug rehabilitation centres had detected 11.7% of HIV/TB coinfection among HIV positive inmates screened in these institutions.

Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men.

PubMed

Robertson, Clare; Archibald, Daryll; Avenell, Alison; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Boyers, Dwayne; Stewart, Fiona; Boachie, Charles; Fioratou, Evie; Wilkins, David; Street, Tim; Carroll, Paula; Fowler, Colin

2014-05-01

Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services. The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base. Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted. Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis. From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two linked reports, and 22 qualitative studies were included. Men were more likely than women to benefit if physical activity was part of a weight-loss programme. Reducing diets tended to produce more favourable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise programme -3.2 kg, 95% CI -4.8 kg to -1.6 kg). The type of reducing diet did not affect long-term weight loss. A reducing diet plus physical activity and behaviour change gave the most effective results. Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training gave the most effective long-term weight change in men [-5.2 kg (standard error 0.2 kg) after 4 years]. Such trials may prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men joined weight-loss programmes, once recruited they were less likely to drop out than women (difference 11%, 95% CI 8% to 14%). The perception of having a health problem (e.g. being defined as obese by a health professional), the impact of weight loss on health problems and desire to improve personal appearance without looking too thin were motivators for weight loss amongst men. The key components differ from those found for women, with men preferring more factual information on how to lose weight and more emphasis on physical activity programmes. Interventions delivered in social settings were preferred to those delivered in health-care settings. Group-based programmes showed benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assisted weight loss in some studies. Generally, men preferred interventions that were individualised, fact-based and flexible, which used business-like language and which included simple to understand information. Preferences for men-only versus mixed-sex weight-loss group programmes were divided. In terms of context, programmes which were cited in a sporting context where participants have a strong sense of affiliation showed low drop out rates and high satisfaction. Although some men preferred weight-loss programmes delivered in an NHS context, the evidence comparing NHS and commercial programmes for men was unclear. The effect of family and friends on participants in weight-loss programmes was inconsistent in the evidence reviewed - benefits were shown in some cases, but the social role of food in maintaining relationships may also act as a barrier to weight loss. Evidence on the economics of managing obesity in men was limited and heterogeneous. The main limitations were the limited quantity and quality of the evidence base and narrow outcome reporting, particularly for men from disadvantaged and minority groups. Few of the studies were undertaken in the UK. Weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content. Future studies should include cost-effectiveness analyses in the UK setting. This project was funded by the NIHR Health Technology Assessment programme.

Informationist programme in support of biomedical research: a programme description and preliminary findings of an evaluation

PubMed Central

Whitmore, Susan C.; Grefsheim, Suzanne F.; Rankin, Jocelyn A.

2008-01-01

Background The informationist programme at the Library of the National Institutes of Health (NIH) in Bethesda, MD, USA has grown to 14 informationists working with 40 clinical and basic science research teams. Purpose This case report, intended to contribute to the literature on informationist programmes, describes the NIH informationist programme including implementation experiences, the informationists' training programme, their job responsibilities and programme outcomes. Brief description The NIH informationist programme was designed to enhance the library's service capacity. Over time, the steps for introducing the service to new groups were formalized to ensure support by leadership, the team being served and the library. Job responsibilities also evolved from traditional library roles to a wide range of knowledge management activities. The commitment by the informationist, the team and the library to continuous learning is critical to the programme's success. Results/outcomes NIH scientists reported that informationists saved them time and contributed to teamwork with expert searching and point-of-need instruction. Process evaluation helped refine the programme. Evaluation method High-level, preliminary outcomes were identified from a survey of scientists receiving informationist services, along with key informant interviews. Process evaluation examined service implementation, informationists' training, and service components. Anecdotal evidence has also indicated a favorable response to the programme. PMID:18494648

Informationist programme in support of biomedical research: a programme description and preliminary findings of an evaluation.

PubMed

Whitmore, Susan C; Grefsheim, Suzanne F; Rankin, Jocelyn A

2008-06-01

The informationist programme at the Library of the National Institutes of Health (NIH) in Bethesda, MD, USA has grown to 14 informationists working with 40 clinical and basic science research teams. This case report, intended to contribute to the literature on informationist programmes, describes the NIH informationist programme, including implementation experiences, the informationists' training programme, their job responsibilities and programme outcomes. The NIH informationist programme was designed to enhance the library's service capacity. Over time, the steps for introducing the service to new groups were formalized to ensure support by leadership, the team being served and the library. Job responsibilities also evolved from traditional library roles to a wide range of knowledge management activities. The commitment by the informationist, the team and the library to continuous learning is critical to the programme's success. RESULTS / OUTCOMES: NIH scientists reported that informationists saved them time and contributed to teamwork with expert searching and point-of-need instruction. Process evaluation helped refine the programme. High-level, preliminary outcomes were identified from a survey of scientists receiving informationist services, along with key informant interviews. Process evaluation examined service implementation, informationists' training and service components. Anecdotal evidence has also indicated a favourable response to the programme.

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour.

PubMed

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-07-24

Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. England, UK. All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes. Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study

PubMed Central

Nijhuis-van der Sanden, Maria W G; Driehuis, Femke; Heerkens, Yvonne F; van der Vleuten, Cees P M; van der Wees, Philip J

2017-01-01

Objectives To evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement. Design Mixed methods study. Participants and setting 64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands. Methods The programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2. Results We identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication. Conclusions This study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study. PMID:28188156

Employability and career experiences of international graduates of MSc Public Health: a mixed methods study.

PubMed

Buunaaisie, C; Manyara, A M; Annett, H; Bird, E L; Bray, I; Ige, J; Jones, M; Orme, J; Pilkington, P; Evans, D

2018-05-08

This article aims to describe the public health career experiences of international graduates of a Master of Science in Public Health (MSc PH) programme and to contribute to developing the evidence base on international public health workforce capacity development. A sequential mixed methods study was conducted between January 2017 and April 2017. Ninety-seven international graduates of one UK university's MSc PH programme were invited to take part in an online survey followed by semistructured interviews, for respondents who consented to be interviewed. We computed the descriptive statistics of the quantitative data obtained, and qualitative data were thematically analysed. The response rate was 48.5%. Most respondents (63%) were employed by various agencies within 1 year after graduation. Others (15%) were at different stages of doctor of philosophy studies. Respondents reported enhanced roles after graduation in areas such as public health policy analysis (74%); planning, implementation and evaluation of public health interventions (74%); leadership roles (72%); and research (70%). The common perceived skills that were relevant to the respondents' present jobs were critical analysis (87%), multidisciplinary thinking (86%), demonstrating public health leadership skills (84%) and research (77%). Almost all respondents (90%) were confident in conducting research. Respondents recommended the provision of longer public health placement opportunities, elective courses on project management and advanced statistics, and 'internationalisation' of the programme's curriculum. The study has revealed the relevance of higher education in public health in developing the career prospects and skills of graduates. International graduates of this MSc PH programme were satisfied with the relevance and impact of the skills they acquired during their studies. The outcomes of this study can be used for curriculum reformation. Employers' perspectives of the capabilities of these graduates, however, need further consideration. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.