Harmony and disharmony in an educational reform conmcert: towards a Parson's inspired dynamic model of tuning

In large-scale educational reforms, many actors play their roles. The diversity of contributions and lack of harmonization prove to be frequently found to cause educational reform failures. Many explanations for these failures focus on differences between the actors and on differences in their contributions to the reform process. In this article, we examine the effects of these differences and emphasize on the need to harmonize these contributions to the reform process. Contributions by several actors to a large-scale curriculum reform undertaken in the Netherlands in the 1990s are mapped for this purpose. This curriculum reform is part of a larger educational reform aimed to introduce a constructivist approach. Education is conceptualised as a social system, and educational reform as the manner in which this social system adapts to immanent and emmanent changes. The actors in the education system are distributed across functional subsystems. In the present analyses, teacher acting within a particular subsystem stands central. The results show adequate exchange and harmonization of the contributions from the different subsystems to be a necessary condition for successful educational reform. To achieve a good exchange and harmonization, the use of an Educational Impact Assessment is recommended

Preliminary results, methodological considerations and recruitment difficulties of a randomised clinical trial comparing two treatment regimens for patients with headache and neck pain.

Contains fulltext : 81904.pdf (publisher's version ) (Open Access)BACKGROUND: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented.We therefore wanted to compare the treatment effects of UC alone and in combination with manual therapy (MT) in patients with a combination of headache and neck pain. UC consisted of a stepped treatment approach according to the Dutch General Practitioners Guideline for headache, the additional MT consisted of articular mobilisations and low load exercises.Due to insufficient enrolment the study was terminated prematurely. We aim to report not only our preliminary clinical findings but also to discuss the encountered difficulties and to formulate recommendations for future research. METHODS: A randomised clinical trial was conducted. Thirty-seven patients were included and randomly allocated to one of both treatment groups. The treatment period was 6 weeks, with follow-up measurements at weeks 7, 12 and 26. Primary outcome measures were global perceived effect (GPE) and the impact of the headache using the Headache Impact Test (HIT-6). Reduction in headache frequency, pain intensity, medication intake, absenteeism and the use of additional professional help were secondary outcome measures RESULTS: Significant improvements on primary and secondary outcome measures were recorded in both treatment groups. No significant differences between both treatment groups were found. The number of recruited patients remained low despite various strategies. CONCLUSION: It appears that both treatment strategies can have equivalent positive influences on headache complaints. Additional studies with larger study populations are needed to draw firm conclusions. Recommendations to increase patient inflow in primary care trials, such as the use of an extended network of participating physicians and of clinical alert software applications, are discussed. TRIAL REGISTRATION NUMBER: NCT00298142