Improvement of primary care for patients with chronic heart failure: A study protocol for a cluster randomised trial comparing two strategies

<p>Abstract</p> <p>Background</p> <p>Many patients with chronic heart failure (CHF), a common condition with high morbidity and mortality rates, receive treatment in primary care. To improve the management of CHF in primary care, we developed an implementation programme comprised of educational and organisational components, with support by a practice visitor and focus both on drug treatment and lifestyle advice, and on organisation of care within the practice and collaboration with other healthcare providers. Tailoring has been shown to improve the success of implementation programmes, but little is known about what would be best methods for tailoring, specifically with respect to CHF in primary care.</p> <p>Methods/design</p> <p>We describe the study protocol of a cluster randomised controlled trial to examine the effectiveness of tailoring a CHF implementation programme to general practices compared to a standardised way of delivering a programme. The study population will consist of 60 general practitioners (GPs) and the CHF patients they include. GPs are randomised in blocks of four, stratified according to practice size. With a tailored implementation programme GPs prioritise the issues that will form the bases of the support for the practice visits. These may comprise several issues, both educational and organizational.</p> <p>The primary outcome measures are patient's experience of receiving structured primary care for CHF (PACIC, a questionnaire related to the Chronic Care Model), patients' health-related utilities (EQ-5D), and drugs prescriptions using the guideline adherence index. Patients being clustered in practices, multilevel regression analyses will be used to explore the effect of practice size and type of intervention programme. In addition we will examine both changes within groups and differences at follow-up between groups with respect to drug dosages and advice on lifestyle issues. Furthermore, in interviews the feasibility of the programme and goal attainment, organisational changes in CHF care, and formalised cooperation with other disciplines will be assessed.</p> <p>Discussion</p> <p>In the tailoring of the programme we will present the GPs a list with barriers; GPs will assess relevance and possibility to solve these barriers. The list is rigorously developed and tested in various projects. The factors for ordering the barriers are related to the innovation, the healthcare professional, the patient, and the context.</p> <p>CHF patients do not form a homogeneous group. Subgroup analyses will be performed based on the distinction between systolic CHF and CHF with preserved left ventricular function (diastolic CHF).</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN18812755">ISRCTN18812755</a></p

The Kafkaesque Pursuit of ‘World Class’: Audit Culture and the Reputational Arms Race in Academia

Since the 1980s universities have been subjected to a seemingly continuous process of policy reforms designed to make them more economical, efficient and effective, according to yardsticks defined by governments and university managers. The pursuit of ‘excellence’, ‘international standing’ and ‘world class’ status have become key drivers of what Hazelkorn (High Educ Pol 21(2):193–215, 2008) has termed the ‘rankings arms race’ that now dominates the world of academia. These policies are changing the mission and meaning of the public university and, more profoundly, the culture of academia itself. While some authors have sought to capture and analyse these trends in terms of ‘academic capitalism’ and the ‘enterprise university model’, we suggest they might also be usefully understood theoretically as illustrations of the rise of audit culture in higher education and its effects. Drawing on ethnographic examples from the UK, Denmark and New Zealand, we ask: how are higher education institutions being reconfigured by these new disciplinary regimes of audit? How are ranking and performance indicators changing institutional behaviour and transforming academic subjectivities? What possibilities are there for alternative university futures? And what insights can anthropology offer to address these questions

Stories of Value: The Nature of Money in Three Classic British Picture Books

Much of the literature on children’s economic socialisation focuses on exploring three questions: at what point do children acquire a “good grasp of economic reality,” do they become “responsible economic agents,” and do they need to be considered “economically literate” (Furnham, 2014, p. 118)? These concerns often imply a pragmatic understanding of money as a quantitative commodity that facilitates transaction, accounting, and the storing of value (Belk & Wallendorf, 1990). Yet they also imply an appreciation of what is considered to be ‘literate’ and ‘responsible’ behaviour, supposedly informed by a ‘good grasp’ of ‘reality’. Finally, it assumes unproblematic knowledge of what is ‘valuable.

Ecological divergence of Chaetopteryx rugulosa species complex (Insecta, Trichoptera) linked to climatic niche diversification

Climate is often considered to be an important, but indirect driver of speciation. Indeed, environmental factors may contribute to the formation of biodiversity, but to date this crucial relationship remains largely unexplored. Here we investigate the possible role of climate, geological factors, and biogeographical processes in the formation of a freshwater insect species group, the Chaetopteryx rugulosa species complex (Trichoptera) in the Western Balkans. We used multi-locus DNA sequence data to establish a dated phylogenetic hypothesis for the group. The comparison of the dated phylogeny with the geological history of the Western Balkans shows that lineage formation coincided with major past Earth surface and climatic events in the region. By reconstructing present-day habitat conditions (climate, bedrock geology), we show that the lineages of C. rugulosa species complex have distinct climatic but not bedrock geological niches. Without exception, all splits associated with Pliocene/Pleistocene transition led to independent, parallel split into ‘warm’ and ‘cold’ sister lineages. This indicates a non-random diversification on the C. rugulosa species complex associated with late Pliocene climate in the region. We interpreted the results as the diversification of the species complex were mainly driven by ecological diversification linked to past climate change, along with geographical isolation

The new political economy of higher education: between distributional conflicts and discursive stratification

The higher education sector has been undergoing a far-reaching institutional re-orientation during the past two decades. Many adjustments appear to have strengthened the role of competition in the governance of higher education, but the character of the sector?s emerging new political economy has frequently remained unclear. Serving as the introduction for the special issue, this article makes the case for a multidimensional strategy to probe higher education?s competitive transformation. In terms of conceptualizing the major empirical shifts, we argue for analyzing three core phenomena: varieties of academic capitalism, the discursive construction of inequality, and the transformation of hierarchies in competitive settings. With respect to theoretical tools, we emphasize the complementary contributions of institutional, class-oriented, and discourse analytical approaches. As this introduction elaborates and the contributions to the special issue demonstrate, critical dialog among different analytical traditions over the interpretation of change is crucial for improving established understandings. Arguably, it is essential for clarifying the respective roles of capitalist power and hierarchical rule in the construction of the sector?s new order

The competition fetish in higher education:Shamans, mind snares and consequences

Contemporary education reform worldwide appears to be locked in a competition fetish. This article explores the varieties of competition, including traditional academic forms, contests sponsored by governments and international organisations, market competition and status wars intensified by rankings. Resisting interpretations of competition as naturally occurring, it presents various macro and micro actors, referred to as ‘shamans’, that breathe life into the phenomenon and that are responsible for its generation, constitution and reproduction. These include structural drivers associated with political and regulatory regimes; and symbolic drivers constituted by normative and affective pressures. The article focuses on the extent to which the varieties of competition reinforce, displace, mediate or counteract one another and reveals how powerful policy and symbolic drivers interact to power competition, and how competition forecloses alternative means of educational reform. The unintended consequences of competition on social equity, on academic work and on global well-being are highlighted, and suggestions are offered on ways to escape the competition trap.</p

Методология синтеза архитектуры программно-технического комплекса автоматизированной системы мониторинга обстановки

Предложен подход к проектированию архитектуры программно-технического комплекса автоматизированной системы мониторинга обстановки в реальном времени, основанный на классификации решаемых функциональных задач на основе методов кластерного анализа и выбранного множества признаков подобия. Разработанный подход позволяет из множества функций системы выделить подобные (по определенным признакам) и объединить их в архитектурные компоненты (унифицированные функциональные модули).Запропоновано підхід до проектування архітектури центру обробки інформації автоматизованої системи моніторингу середовища в реальному часі, що заснований на класифікації функціональних задач на підставі методів кластерного аналізу і обраної множини ознак схожості. Розроблений підхід дозволяє вибрати із множини функцій системи схожі (за певними ознаками) і поєднати їх в архітектурні компоненти (уніфіковані функціональні модулі).The approach to designing architecture of the information processing complex of the automated real time conditions monitoring system based on classification of functional tasks on the basis of methods of cluster analysis and the chosen set of similarity attributes is offered. The developed approach allows to allocate from a set of functions the systems similar (on certain attributes) and to unite them in architectural components (unified functional modules)

Accounting for Impact? The Journal Impact Factor and the Making of Biomedical Research in the Netherlands

The range and types of performance metrics has recently proliferated in academic settings, with bibliometric indicators being particularly visible examples. One field that has traditionally been hospitable towards such indicators is biomedicine. Here the relative merits of bibliometrics are widely discussed, with debates often portraying them as heroes or villains. Despite a plethora of controversies, one of the most widely used indicators in this field is said to be the Journal Impact Factor (JIF). In this article we argue that much of the current debates around researchers’ uses of the JIF in biomedicine can be classed as ‘folk theories’: explanatory accounts told among a community that seldom (if ever) get systematically checked. Such accounts rarely disclose how knowledge production itself becomes more-or-less consolidated around the JIF. Using ethnographic materials from different research sites in Dutch University Medical Centers, this article sheds new empirical and theoretical light on how performance metrics variously shape biomedical research on the ‘shop floor.’ Our detailed analysis underscores a need for further research into the constitutive effects of evaluative metrics