Assessing the Use of Standardized Outcome Measures for Stroke Rehabilitation among Physiotherapists in Ghana

Background. The use of standardized outcome measures is an aspect of good clinical practice and essential to the rehabilitation of patients suffering from stroke. Literature reports regarding the extent of usage of outcome measures in stroke rehabilitation by physiotherapists globally are inconsistent. In addition, the patronage of outcome measures in stroke rehabilitation in low-resourced countries is uncertain. Objective. This study was conducted to assess the current practice of physiotherapists in Ghana regarding the use of standardized outcome measures in the rehabilitation of stroke patients. Method. A descriptive cross-sectional survey, was used involving 105 registered physiotherapists in Ghana. A 35-item adapted questionnaire was used to collect data on some commonly used outcome measures and frequency of use by physiotherapists for stroke patients. Results. A total of 55 (52.4%) physiotherapists did not use outcome measures in their clinical practice. Physiotherapists below 40 years of age use outcome measures (64.7%) more than those 41 years and above (6.7%). Physiotherapists working in public facilities in Ghana are more likely to use outcome measures (56.2%) than those in private facilities (16.2%). Physiotherapists who attend to 1-10 patients in a week used outcome measures more (32.4%) than physiotherapists who attend to more than 30 patients (3.8%) in a week. Conclusion. There is poor usage of outcome measures by Ghanaian physiotherapists, with more than half of the participants not using any standardized outcome measures for rehabilitation of patients in their practice. Physiotherapists who attends to fewer number of patients in a week are more likely to use outcome measures. There is the need for implementation of policy and guidelines on the use of outcome measures by the Allied Health Professions Council and the Ghana Physiotherapy Association

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Are Basic School Head Teachers Transformational Leaders? Views of Teachers

Transformational leadership practice is associated with improved school functioning and quality education delivery through teacher commitment and willingness to exceed targets or educational benchmarks (Balyer, 2012; Nedelcu, 2013).  The establishment of the  Leadership for Learning (LFL) program in Ghana in 2009 aimed at improving the effectiveness of basic school head teachers to better lead schools to promote student learning.  In this study, the perceptions of basic school teachers as to the transformational leadership conduct of head teachers who had received training under the LFL model were collected and reviewed.  The purpose of this qualitative inquiry was to determine from teachers’ perceptions how the conduct of head teachers related to transformational leadership.  From the study results, the findings indicated that while teachers largely perceived their head teachers as transformational leaders, more than the influence of head teachers is required to motivate teachers to give of themselves to improve education outcomes. Recommendations and implications of the study for practice and research were considered

Understanding the Transformational Leadership Practices of Colleges of Education Principals

Leadership is important to the effective functioning of organizations. In education, what leaders do influences pedagogy and student learning. While knowledge on transformational leadership (TL) has been developed from transnational studies, what leaders actually do may not be the same in Ghana due to influences of contextual factors. The specific problem is the lack of knowledge on the TL practices and the factors that influence the leadership practices of the college of education (CoE) principal in Ghana. The purpose of this case study was to identify the nature of the TL practices of Ghana’s CoEs principals, the perceived factors that influence their leadership practices, and how the principals define successful CoE leadership. The study participants comprised eight principals, five vice principals, and three assessment officers. The researcher gathered qualitative data for the study using a semi-structured interview protocol in face-to-face interview sessions. Each interview session was electronically recorded for accurate record keeping and ease of transcription. Following transcription, member checking allowed participants to review and certify the accuracy of the data. Data analysis involved the identification of convergent and divergent points grouped under themes and presented as the study results. The results revealed that Ghana’s CoEs principals engaged in leadership actions under each of Kouzes and Posner’s exemplary leadership practices. Primarily, the principals model the way by focusing on getting the job done; inspire a shared vision through meetings and discussions with stakeholders; challenge the process by outlining work schedules and assigning employees roles to perform; enable others through staff development initiatives; and encourage the heart of others by recognizing and rewarding efforts as well as addressing staff welfare and professional development needs. Also, the results show that two major factors that influence the principals’ leadership practices are their personal characteristics and work contexts. To the participating principals, the number one indicator of successful CoE leadership is the active involvement of stakeholders in decision making processes and college activities. Future research must focus on the extent to which the principals apply TL and the exploration of effective leadership competencies for developing Ghana’s CoEs as the institutions become full-fledged tertiary institutions

The Punishment of the Sabbath Breaker in Numbers 15:32-36

Numbers 15:32-36 describes the stoning of a man who was found gathering wood on the Sabbath day. This passage recalls the Fourth Commandment which requires rest on the Sabbath from routine work (Exod 20:8-11) including the gathering of manna (16:22, 26-27), cooking (vv. 23-25, 29-30), and the kindling of fire (35:2-3). A violation of the Sabbath regulation attracted the death penalty (31:14-15). The incident of the wood-gatherer is one of several instances in the book of Numbers where the penalty is inflicted on persons who disregard the covenant relationship of Yahweh with Israel.1 The death penalty law and its implementation in the Old Testament have received several interpretations. For many the regulation seems harsh or even unjust, but the present study argues that to seek to understand the law solely from the viewpoint of ethics means to lose sight of its covenantal significance (cf. Exod 19-24). Numbers 15 has long been considered one of the difficult passages in the book of Numbers.2 The scholarly discussion centers around three main questions: How does chapter 15 relate to chapters 13-14 and 16-17? What connection is there between the discernable units within chapter 15? And how should the statement פרשׁ לא כּי לו מה־יעשׂה”) because it had not been explained what should be done to him,” 15:34)3 be understood? The first two questions require some analysis of structure as well as the thematic connections within chapters 13-17. The third question requires grammatical analysis of 15:32-36 within its immediate context as well as the larger context of the Fourth Commandment. A fourth question that this study raises borders on theodicy:4 why would a Sabbath breaker be stoned to death, and what continuity/discontinuity is there between the Christian church and the Old Testament regarding the death penalty? In what follows, an attempt is made to answer these questions

Are Basic School Head Teachers Transformational Leaders? Views of Teachers

Transformational leadership practice is associated with improved school functioning and quality education delivery through teacher commitment and willingness to exceed targets or educational benchmarks (Balyer, 2012; Nedelcu, 2013).  The establishment of the  Leadership for Learning (LFL) program in Ghana in 2009 aimed at improving the effectiveness of basic school head teachers to better lead schools to promote student learning.  In this study, the perceptions of basic school teachers as to the transformational leadership conduct of head teachers who had received training under the LFL model were collected and reviewed.  The purpose of this qualitative inquiry was to determine from teachers’ perceptions how the conduct of head teachers related to transformational leadership.  From the study results, the findings indicated that while teachers largely perceived their head teachers as transformational leaders, more than the influence of head teachers is required to motivate teachers to give of themselves to improve education outcomes. Recommendations and implications of the study for practice and research were considered

2000 Payton Lectures: Africa in the New World Christian Order

Fuller Theological Seminary instituted the Payton Lectures in 1948, providing for a series of divinity lectures by a notable scholar outside the regular faculty. The lectureship is named for Dr. John E. and Mrs. Eliza Payton, parents of the late Mrs. Grace Fuller, wife of seminary founder Charles E. Fuller. El Seminario Teológico de Fuller instituyó las Conferencias Payton en 1948, proveyendo una serie de conferencias en divinidades por una persona erudita de renombre fuera de la facultad regular. Las conferencias llevan el nombre del Dr. John E. y la Sra. Eliza Payton, padres de la fallecida Sra. Grace Fuller, esposa del fundador del seminario Charles E. Fuller. 풀러신학대학원은 1948년 페이튼 강좌를 개설하여 정규 교수진 외에 저명한 학자의 신학 강연을 제공해왔습니다. 강좌의 명칭은 학교 설립자 찰스 풀러 (Charles E. Fuller)의 아내인 그레이스 풀러 (Grace Fuller) 부인의 양친 존 페이튼 (John E. Payton) 박사와 엘리자 페이튼 (Eliza Payton) 부인의 이름을 따라 붙여졌습니다