Evaluating Niger's experience in strengthening supervision, improving availability of child survival drugs through cost recovery, and initiating training for Integrated Management of Childhood Illness (IMCI)

BACKGROUND: WHO and UNICEF have recently developed the "Integrated Management of Childhood Illness" (IMCI) as an efficient strategy to assist developing countries reduce childhood mortality. Early experience with IMCI implementation suggests that clinical training is essential but not sufficient for the success of the strategy. Attention needs to be given to strengthening health systems, such as supervision and drug supply. RESULTS: This paper presents results of evaluating an innovative approach for implementing IMCI in Niger. It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training. The evaluation documented the effectiveness of the initial IMCI clinical training and referral. CONCLUSIONS: Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training. Longer term follow up is necessary to confirm the impact of the approach on IMCI preparation and implementation

Evaluation of a learner-designed course for teaching health research skills in Ghana

<p>Abstract</p> <p>Background</p> <p>In developing countries the ability to conduct locally-relevant health research and high quality education are key tools in the fight against poverty. The objective of our study was to evaluate the effectiveness of a novel UK accredited, learner-designed research skills course delivered in a teaching hospital in Ghana.</p> <p>Methods</p> <p>Study participants were 15 mixed speciality health professionals from Komfo Anokye Teaching Hospital, Kumasi, Ghana. Effectiveness measures included process, content and outcome indicators to evaluate changes in learners' confidence and competence in research, and assessment of the impact of the course on changing research-related thinking and behaviour. Results were verified using two independent methods.</p> <p>Results</p> <p>14/15 learners gained research competence assessed against UK Quality Assurance Agency criteria. After the course there was a 36% increase in the groups' positive responses to statements concerning confidence in research-related attitudes, intentions and actions. The greatest improvement (45% increase) was in learners' actions, which focused on strengthening institutional research capacity. 79% of paired before/after responses indicated positive changes in individual learners' research-related attitudes (n = 53), 81% in intention (n = 52) and 85% in action (n = 52). The course had increased learners' confidence to start and manage research, and enhanced life-long skills such as reflective practice and self-confidence. Doing their own research within the work environment, reflecting on personal research experiences and utilising peer support and pooled knowledge were critical elements that promoted learning.</p> <p>Conclusion</p> <p>Learners in Ghana were able to design and undertake a novel course that developed individual and institutional research capacity and met international standards. Learning by doing and a supportive peer community at work were critical elements in promoting learning in this environment where tutors were scarce. Our study provides a model for delivering and evaluating innovative educational interventions in developing countries to assess whether they meet external quality criteria and achieve their objectives.</p

Transitional experiences of post-16 sports education: Jack's story

This paper explores the layered transitional experiences of a semi-professional athlete named Jack (a pseudonym) between the fields of professional sport and further and higher education. Our analysis is framed by the quadripartite framework of structuration and focuses on Jack's 'in-situ' practices at his college and university in order to illustrate how these can operate to reproduce, transform, and challenge the habitual discourses and rituals that circulate within these institutions by generating forms of corporeal empowerment for young athletes who have valued conjunctural knowledge. The findings highlight the fragility of the transition process and raise questions regarding how the experiences of young people are shaped by the relationships between employment and post-16 education. Jack's experiences have implications for both policy and practice within further education and higher education. © 2012 © 2012 Taylor & Francis

Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study

OBJECTIVE: This study was to investigate factors influencing the length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit. METHOD: Two comparative studies were embedded in a retrospective cross-sectional clinical file audit. A randomly selected 226 episodes of admissions including 178 patients during a twelve-month period were reviewed. A total of 286 variables were collected and analysed. A case control study was employed in the study of length of stay. A retrospective cohort study was used to investigate the predictors for the risk of readmission. RESULTS: Logistic regression analyses showed that 10 variables were associated with length of stay. Seclusion during the index admission, accommodation problems and living in an area lacking community services predicted longer stay. During the follow-up period 82 patients (46%) were readmitted. Cox regression analyses showed 9 variables were related to the risk of readmission. Six of these variables increased the risk of readmission, including history of previous frequent admission, risk to others at the time of the index admission and alcohol intoxication. More active and assertive treatment in the community post-discharge decreased the risk of readmission. CONCLUSIONS: Length of stay is multifactorially determined. Behavioural manifestations of illness and lack of social support structures predicted prolonged length of stay. Good clinical practice did not necessarily translate to a shorter length of stay. Therefore, length of stay is predictable, but not readily modifiable within the clinical domain. Good clinical practice within the community following discharge likely reduces the risk of readmission. Quality of inpatient care does not influence the risk of readmission, which therefore raises a question about the validity of using the rate of readmission as an outcome measure of psychiatric inpatient care

Embedding employability and enterprise skills in sport degrees through a focused work - based project; a student and employer viewpoint

With graduate employability being high on many universities’ agendas, it becomes vital that a curriculum delivers not only subject knowledge but also the opportunity for students to develop and enhance industry-specific skills. This paper is concerned with how a work-based project can support skill development and considers the views of students and employers as to the application of these skills in the context of a sports undergraduate programme in a UK university. Using a mixed-method approach to data collection, 30 students and 5 project hosts took part in the study. The research findings reported a mismatch between the students’ and hosts’ viewpoints on whether skills were developed as a result of the project. Students appeared to have a lack of understanding how to apply the skills in the context of a sports organisation and were viewed by the employers as having an inflated opinion of their ability

The Role of Individual Variables, Organizational Variables and Moral Intensity Dimensions in Libyan Management Accountants’ Ethical Decision Making

This study investigates the association of a broad set of variables with the ethical decision making of management accountants in Libya. Adopting a cross-sectional methodology, a questionnaire including four different ethical scenarios was used to gather data from 229 participants. For each scenario, ethical decision making was examined in terms of the recognition, judgment and intention stages of Rest’s model. A significant relationship was found between ethical recognition and ethical judgment and also between ethical judgment and ethical intention, but ethical recognition did not significantly predict ethical intention—thus providing support for Rest’s model. Organizational variables, age and educational level yielded few significant results. The lack of significance for codes of ethics might reflect their relative lack of development in Libya, in which case Libyan companies should pay attention to their content and how they are supported, especially in the light of the under-development of the accounting profession in Libya. Few significant results were also found for gender, but where they were found, males showed more ethical characteristics than females. This unusual result reinforces the dangers of gender stereotyping in business. Personal moral philosophy and moral intensity dimensions were generally found to be significant predictors of the three stages of ethical decision making studied. One implication of this is to give more attention to ethics in accounting education, making the connections between accounting practice and (in Libya) Islam. Overall, this study not only adds to the available empirical evidence on factors affecting ethical decision making, notably examining three stages of Rest’s model, but also offers rare insights into the ethical views of practising management accountants and provides a benchmark for future studies of ethical decision making in Muslim majority countries and other parts of the developing world

The use of work-based learning pedagogical perspectives to inform flexible practice within higher education

The renewed emphasis on developing flexible learning practices in higher education underscores the importance of understanding pedagogies for students who are based in the workplace or undertake significant work-related elements of study. This paper draws on research that explores how work-based learning (WBL) pedagogy operates in UK higher education using three main perspectives that help to conceptualise the existing range of practice: discipline-centred, learner-centred and employer-centred. Data was collected from twenty academic practitioners with expertise in WBL using qualitative interviews, documents and observations at fourteen different institutions from seven regions in England. The research findings suggest that there are both commonalities and distinctive attributes across the range of practice that influence how academics develop and orient their pedagogy. It is argued that the characteristics and discursive features of these WBL perspectives present pedagogical approaches that could be adapted to inform more flexible mainstream provision

Antiblackness in English higher education

This article highlights antiblackness pervading English higher education. This antiblackness is attributed to a majoritarian view, which not only upholds the view that education is value-neutral, meritocratic, colour-blind, but also has a cultural disregard for those racialized as Black Minority Ethnic (BME). There has been considerable attention drawn to the achievement gap issue in English higher education in which those racialized as BME are less likely to obtain a ‘good honours’ degree than those identified as white upon graduation. However, there is no critical work, as of yet, which examines university responses to addressing it. This paper sets out to investigate this, as well as the extent of institutions embracing a majoritarian view of race inequalities in education. This is done through reframing the issue by examining race equality action plans of six English universities. These six universities all received positive national recognition for their race equality work. A reframed reading of these institutional policy documents concludes that colour-blind interpretations of inclusion reproduce not only a misrecognition of differences of students of colour but also a rejection of their humanity

Profiling quality of care: Is there a role for peer review?

BACKGROUND: We sought to develop a more reliable structured implicit chart review instrument for use in assessing the quality of care for chronic disease and to examine if ratings are more reliable for conditions in which the evidence base for practice is more developed. METHODS: We conducted a reliability study in a cohort with patient records including both outpatient and inpatient care as the objects of measurement. We developed a structured implicit review instrument to assess the quality of care over one year of treatment. 12 reviewers conducted a total of 496 reviews of 70 patient records selected from 26 VA clinical sites in two regions of the country. Each patient had between one and four conditions specified as having a highly developed evidence base (diabetes and hypertension) or a less developed evidence base (chronic obstructive pulmonary disease or a collection of acute conditions). Multilevel analysis that accounts for the nested and cross-classified structure of the data was used to estimate the signal and noise components of the measurement of quality and the reliability of implicit review. RESULTS: For COPD and a collection of acute conditions the reliability of a single physician review was quite low (intra-class correlation = 0.16–0.26) but comparable to most previously published estimates for the use of this method in inpatient settings. However, for diabetes and hypertension the reliability is significantly higher at 0.46. The higher reliability is a result of the reviewers collectively being able to distinguish more differences in the quality of care between patients (p < 0.007) and not due to less random noise or individual reviewer bias in the measurement. For these conditions the level of true quality (i.e. the rating of quality of care that would result from the full population of physician reviewers reviewing a record) varied from poor to good across patients. CONCLUSIONS: For conditions with a well-developed quality of care evidence base, such as hypertension and diabetes, a single structured implicit review to assess the quality of care over a period of time is moderately reliable. This method could be a reasonable complement or alternative to explicit indicator approaches for assessing and comparing quality of care. Structured implicit review, like explicit quality measures, must be used more cautiously for illnesses for which the evidence base is less well developed, such as COPD and acute, short-course illnesses