Working towards institutional change : an investigation of the transformations and learning in a further education college merger project team in Barbados

This study examined the work practices of a project team that was engaged in the implementation of shared services at three tertiary level educational institutions in Barbados. Using Activity Theory as the underpinning theoretical framework, the researcher employed Development Work Research (DWR) and the Engestromian Change Labs to reveal the tensions and contradictions that occurred in the project team’s work environment. The intent was to reframe their understanding of the work practices from the everyday to the scientific, and develop new work practices to generate organisational change. The study also explored the expansive transformation that took place during the intervention process. The aim of the study was to answer the following question: In what ways, if any, did changes in the work practices of a project team contribute to changes in the planning and implementation of shared services in three Barbadian educational institutions? The research found that there were ruptures and disturbances in the work environment. These were attributed to the historically bureaucratic practices of Government which impacted negatively on the project team by impeding the development of innovative practices. The DWR intervention resulted in the resolution of the contradictions and led to effective change and expansive learning in the staff as well as a change in the approach to the implementation strategies that were being used by the project team. The team was able through dialogue and debate in the Change Labs to create a new form of practice which involved a new communication strategy and model. The new practice was used to overcome the challenge of providing timely and effective communication with the stakeholder institutions with which they were working to implement the shared services.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Working towards institutional change : an investigation of the transformations and learning in a further education college merger project team in Barbados

This study examined the work practices of a project team that was engaged in the implementation of shared services at three tertiary level educational institutions in Barbados. Using Activity Theory as the underpinning theoretical framework, the researcher employed Development Work Research (DWR) and the Engestromian Change Labs to reveal the tensions and contradictions that occurred in the project team’s work environment. The intent was to reframe their understanding of the work practices from the everyday to the scientific, and develop new work practices to generate organisational change. The study also explored the expansive transformation that took place during the intervention process. The aim of the study was to answer the following question: In what ways, if any, did changes in the work practices of a project team contribute to changes in the planning and implementation of shared services in three Barbadian educational institutions? The research found that there were ruptures and disturbances in the work environment. These were attributed to the historically bureaucratic practices of Government which impacted negatively on the project team by impeding the development of innovative practices. The DWR intervention resulted in the resolution of the contradictions and led to effective change and expansive learning in the staff as well as a change in the approach to the implementation strategies that were being used by the project team. The team was able through dialogue and debate in the Change Labs to create a new form of practice which involved a new communication strategy and model. The new practice was used to overcome the challenge of providing timely and effective communication with the stakeholder institutions with which they were working to implement the shared services.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment