Unwarranted: The OfS Review of Assessment Practices and the Erosion of Institutional Autonomy

In England, the relationship between the higher education regulator (OfS) and those it purports to regulate is highly strained. A 2023 parliamentary inquiry into the OfS published an excoriating report which found, among other issues, problems with the execution of its statutory duty to protect institutional autonomy. An OfS policy which evidences this is the requirement for universities to assess spelling, punctuation and grammar. In imposing this mandate, the OfS appears to be ultra vires as it has a statutory duty to protect institutional autonomy, specifically defined to include the freedom to determine assessment practices. This paper uses an adapted form of Hyatt’s Critical Higher Education Policy Analysis Framework to examine the policy steers and socio-political contexts from which the assessment mandate emerged. The warrants for the policy are analysed with reference to three epistemic beliefs relating to declining literacy, higher education quality and employment. This paper also analyses the OfS’s interpretations of its statutory duties in issuing this policy. Despite the highly critical findings of the inquiry, no substantive change in regulatory approach looks likely

Born too soon: care for the preterm baby.

As part of a supplement entitled “Born Too Soon”, this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women’s groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent’s voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries

Care of the infant and newborn in Malawi (2017) : the COIN Course - Participants Manual

The majority of deaths in neonates and young infants can be prevented with low-cost interventions. It has been estimated that we can reduce up to half of all preventable neonatal deaths, with optimal treatment of neonatal illness. In addition to providing care to newborns at birth, a district health facility also receives sick young infants with diverse clinical presentations, some of whom are extremely sick and need emergency treatments. This course will deal with the care of newborns at birth, the first few days of life and sick young infants who are likely to be encountered in a secondary level health facility. There is a lot of overlap between the clinical presentation and the management of conditions in the neonate and the young infant (defined as an infant less than two months of age). In this manual, when referring to both age groups we will discuss as the Neonate and Young Infant (NYI). The young infant who requires resuscitation may well be a neonate who is only a few days old. The approach to initial resuscitation is very slightly different between the neonate and young infant but the skills required are the same and you will practice these during this course. This manual is for the candidate participating in a training on the Care of the Young Infant and Newborn (COIN). This manual is supported by course material including lectures, videos, drills and scenarios. The training is targeted at nurses, clinicians and medical assistants and will be useful for any nursing and clinical staff looking after newborns and young infants in health facilities. The course provides an evidence base where available and usual practice where there is no evidence. We have tried to strike the right balance between the best and most pragmatic practice for our setting as well as incorporated current evidence. There are grey areas in medicine and despite the latest evidence, there may be no right answer. In this course, we have tried to give the candidate a clear direction in a given situation. However, these are guidelines and if there is a good clinical reason to deviate from them, then that is also good clinical practice. If unclear about the management of an NYI, the next step is to consult a colleague at your facility or to discuss with colleagues from your central hospital. At the back of the manual, there are wall charts or job aids – intended for printing and placing in all clinical areas where NYI are cared for including the clinic, the ward and the nursery. On the last day of the COIN course, there is an examination which includes an MCQ to test knowledge, a competency based assessment which tests skills. Attitude includes attendance and participation and this is assessed throughout the course.Publisher PD

Care of the infant and newborn in Malawi (2017):the COIN Course - Participants Manual

The majority of deaths in neonates and young infants can be prevented with low-cost interventions. It has been estimated that we can reduce up to half of all preventable neonatal deaths, with optimal treatment of neonatal illness.In addition to providing care to newborns at birth, a district health facility also receives sick young infants with diverse clinical presentations, some of whom are extremely sick and need emergency treatments.This course will deal with the care of newborns at birth, the first few days of life and sick young infants who are likely to be encountered in a secondary level health facility. There is a lot of overlap between the clinical presentation and the management of conditions in the neonate and the young infant (defined as an infant less than two months of age). In this manual, when referring to both age groups we will discuss as the Neonate and Young Infant (NYI). The young infantwho requires resuscitation may well be a neonate who is only a few days old. The approach to initial resuscitation is very slightly different between the neonate and young infant but the skills required are the same and you will practice these during this course. This manual is for the candidate participating in a training on the Care of the Young Infant and Newborn (COIN). This manual is supported by course material including lectures, videos, drills and scenarios. The training is targeted at nurses, clinicians and medical assistants and will be useful for anynursing and clinical staff looking after newborns and young infants in health facilities. The course provides an evidence base where available and usual practice where there is no evidence. We have tried to strike the right balance between the best and most pragmatic practice for our setting as well as incorporated current evidence. There are grey areas in medicine and despite the latest evidence, there may be no right answer. In this course, we have tried to give the candidate a clear direction in a given situation. However, these are guidelines and if there is a good clinical reason to deviate from them, then that is also good clinical practice. If unclear about the management of an NYI, the next step is to consult a colleague at your facility or to discuss with colleagues from your central hospital. At the back of the manual, there are wall charts or job aids – intended for printing and placing in all clinical areas where NYI are cared for including the clinic, the ward and the nursery. On the last day of the COIN course, there is an examination which includes an MCQ to test knowledge, a competency based assessment which tests skills. Attitude includes attendance and participation and this is assessed throughout the course

Care of the infant and newborn in Malawi (2017):the COIN Course - Participants Manual

The majority of deaths in neonates and young infants can be prevented with low-cost interventions. It has been estimated that we can reduce up to half of all preventable neonatal deaths, with optimal treatment of neonatal illness.In addition to providing care to newborns at birth, a district health facility also receives sick young infants with diverse clinical presentations, some of whom are extremely sick and need emergency treatments.This course will deal with the care of newborns at birth, the first few days of life and sick young infants who are likely to be encountered in a secondary level health facility. There is a lot of overlap between the clinical presentation and the management of conditions in the neonate and the young infant (defined as an infant less than two months of age). In this manual, when referring to both age groups we will discuss as the Neonate and Young Infant (NYI). The young infantwho requires resuscitation may well be a neonate who is only a few days old. The approach to initial resuscitation is very slightly different between the neonate and young infant but the skills required are the same and you will practice these during this course. This manual is for the candidate participating in a training on the Care of the Young Infant and Newborn (COIN). This manual is supported by course material including lectures, videos, drills and scenarios. The training is targeted at nurses, clinicians and medical assistants and will be useful for anynursing and clinical staff looking after newborns and young infants in health facilities. The course provides an evidence base where available and usual practice where there is no evidence. We have tried to strike the right balance between the best and most pragmatic practice for our setting as well as incorporated current evidence. There are grey areas in medicine and despite the latest evidence, there may be no right answer. In this course, we have tried to give the candidate a clear direction in a given situation. However, these are guidelines and if there is a good clinical reason to deviate from them, then that is also good clinical practice. If unclear about the management of an NYI, the next step is to consult a colleague at your facility or to discuss with colleagues from your central hospital. At the back of the manual, there are wall charts or job aids – intended for printing and placing in all clinical areas where NYI are cared for including the clinic, the ward and the nursery. On the last day of the COIN course, there is an examination which includes an MCQ to test knowledge, a competency based assessment which tests skills. Attitude includes attendance and participation and this is assessed throughout the course

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

Background In Malawi, preoperative chemotherapy for Wilms tumour is a logical strategy, but detailed information on toxicity and efficacy in such a resource limited setting has been unavailable. Procedure Patients diagnosed with a unilateral Wilms tumour received preoperative chemotherapya two-drug 4-week regimen for localized disease and 6 weeks of a three-drug regimen for metastatic disease. Estimated maximum tumour diameter, decrease in tumour size, resectability, stage distribution and haematological toxicity during therapy were documented. Results At diagnosis, 28% of 72 patients had an estimated maximum tumour diameter of more than 25?cm; 29% of patients had metastases. Eight children (11%) died during preoperative chemotherapy. More than half (59%) of the patients developed moderate neutropenia (neutrophils <1.0?x?109/L; CTC grade 3) and 27% severe neutropenia (CTC grade 4 neutrophils <0.5?x?10.9/L). Grade 4 neutropenia occurred significantly more frequently in children receiving the three-drug regimen compared to the two-drug regimen; 50% (10/20) versus 15% (6/40) (P?=?0.004). Fifty-seven percent of all patients had CTC grade 4 anaemia (Hb? <?6.5?g/dL) during treatment. Most tumours (92%, 56/61) showed a response to chemotherapy but 14% (8/58) remained unresectable. Conclusion Preoperative chemotherapy for Wilms tumour causes considerable haematological toxicity and treatment-related mortality in malnourished Malawian children. A significant number of children have unresectable disease despite preoperative chemotherapy. To reduce treatment related mortality, consideration should be given to starting treatment with reduced doses in acutely malnourished patients. Pediatr Blood Cancer 2012;59:636641. (c) 2012 Wiley Periodicals, In