The CUSUM chart method as a tool for continuous monitoring of clinical outcomes using routinely collected data

BACKGROUND: The lack of robust systems for monitoring quality in healthcare has been highlighted. Statistical process control (SPC) methods, utilizing the increasingly available routinely collected electronic patient records, could be used in creating surveillance systems that could lead to rapid detection of periods of deteriorating standards. We aimed to develop and test a CUmulative SUM (CUSUM) based surveillance system that could be used in continuous monitoring of clinical outcomes, using routinely collected data. The low Apgar score (5 minute Apgar score < 7) was used as an example outcome. METHOD: A surveillance system based on the Observed minus Expected (O-E) as well as the 2-sided Log-Likelihood CUSUM charts was developed. The Log-Likelihood chart was designed to detect a 50% rise (deterioration) and halving (improvement) in the odds of low Apgar scores. Baseline rates were calculated from data for 2001 to 2004, and were used to monitor deliveries for 2005. Deliveries for nulliparous and multiparous women were monitored separately. All analyses were retrospective. RESULTS: The CUSUM system detected periods of increased rates of low Apgar scores for each of the nulliparous and multiparous cohorts. The overall rate for 2005 was eventually found to be 0.67%, which was higher than the baseline reference rate of 0.44% from 2001 to 2004. CONCLUSION: CUSUM methods can be used in continuous monitoring of clinical outcomes using routinely collected data. Used prospectively, they could lead to the prompt detection of periods of suboptimal standards

Capital budgeting practices : an empirical study of companies listed on the ALT X

The main focus of this study is the analysis of the capital budgeting practices and techniques implemented by companies listed on the Alternative Exchange (Alt X) of the Johannesburg Securities Exchange (JSE). Dayananda, Iron, Harrison, Herbohn and Rowland (2002) explain that capital budgeting is the process through which companies assess various sizeable investments, both tangible and intangible, to determine the most viable investment projects for the company. Dayananda et al. (2002) further explain that viable investment projects are ventures that correspond with the company’s objective of maximising shareholder wealth. Therefore, the capital budgeting process used by a company is very influential to its long-term sustainability. Ryan and Ryan (2002) add that an effective capital budgeting process employs appropriate measures and accurate techniques that ensure the company invests only in the most lucrative proposed projects. This study commences by presenting a general introduction into the research conducted, offering background insight that explains the need for a study of this nature. The research problem that was identified is discussed, followed by the purpose statement of the study and a definition of all the research objectives that guide the study. Furthermore, the academic value and intended contribution of the study as well as its practical benefits are disclosed. The introductory chapter also consists of the delimitations of the study and the key concepts covered in this study. In order to provide a complete analysis of the capital budgeting practices employed by the companies listed on the Alt X, a comprehensive literature review was conducted. This highlighted the importance of capital budgeting as well as the capital budgeting behaviour of large firms in South Africa and internationally. What emerged from this research was that the capital budgeting practices and techniques implemented by large companies generally tend to align with the recommendations of financial theory which advocates the use of discounted cash flow techniques and a discount rate that accounts for all sources of funds available to the company. The literature review also assesses studies conducted on the capital budgeting practices of small and medium sized enterprises (SMEs), the category under which Alt X listed companies fall. Findings from those studies reveal that SMEs traditionally employ inferior capital budgeting techniques in comparison to their - iii - larger counterparts and use no formal procedures to calculate an acceptable rate of return required from proposed investment projects. The theoretical background gained from the literature review is complimented by an empirical analysis which investigates the actual capital budgeting behaviour of the SMEs listed on the Alt X. Companies included in the study were from all seven sectors represented on the Alt X and selection was limited only to those with an active primary listing on this board. A web-based survey comprising of 28 questions was formulated using Survey Monkey Software to collect and analyse responses. The survey was divided into sections which included questions about respondent demographics, company profiles, capital budgeting practices implemented, capital rationing and the use of discount rates. The survey remained active for a period of eight weeks to allow sufficient time for all respondents invited to participate. A total of 15 responses were obtained from this process when the survey was closed to further responses. The research design, methodology and techniques that guided this study are also disclosed in this dissertation. The final part of this dissertation contains research findings obtained from analysing the primary data gathered through the survey. These findings are analysed and interpreted in isolation, by relating them to findings from comparable studies of the same population as well as to similar studies conducted both locally and internationally. Finally, this dissertation concludes by summarising all research findings derived from the literature review and the empirical study. It also presents recommendations and areas for further study that could be of academic and practical value to the field of finance.Dissertation (LLM)--University of Pretoria, 2012.gm2014Financial Managementunrestricte

Discourse and conflict: examining the occurence, management and resolution of politically motivated conflict in Zimbabwe between 1980 and 1990

Ph.D. -- University of the Witwatersrand, Faculty of Humanties, 2011.The study examined discursive practices followed during the conflict that took place in Zimbabwe between 1980 and 1990. Understanding conflict within discourse theory was the focal point of the study. Using discourse theory and analysis as tools to understand the conflict, the researcher sought to reveal how discourse was used in the conflict. The study sought to understand how discourse was intertwined with actions of the Zimbabwean government in carrying out massacres, detentions and disappearances of civilians. The aim of this study was to examine if there were particular ways in which discourse was harnessed or deployed to engender, provoke, justify, mitigate, legitimise and manage conflict by specifically examining discourses on the occurrence of the Matebeleland and the parts of Midlands Massacres in Zimbabwe between 1980 and 1990. The research questions for the study were as follows: 1.2.2.1 What issues are uncovered in the testimonies from the Consultative Group Process to assist in the construction of the research process? 1.2.2.2 How is discourse harnessed to legitimate conflict and protect the hegemonic space? 1.2.2.3 How is discourse used in the justification of the conflict? 1.2.2.4 In what ways is moral exclusion and othering demonstrated in the text? 1.2.2.5 What are some of the discursive practices followed in the exclusion of the target group? 1.2.2.6 In what ways is conflict managed and resolved? The philosophical underpinnings to the research are that; 1) Conflict is endemic in society though not all conflicts are harmful. 2) Negative conflict is associated with physical violence while positive conflict exists within the normative of social tensions and discomfort. 3) Violent The philosophical underpinnings to the research are that; 1) Conflict is endemic in conflict at macro levels typically arises from repressive systems such as authoritarian leadership, exclusions of the minority from governmental participation, socio-economic deprivation, poor institutional capacity to deal with conflict and lack of political will at State level to manage conflict. 4) What has remained constant in defining conflict across generations is that the conflicting parties ‘tend to have different needs, pursue antagonistic interests, values and access to power and resources is uneven’. The study was a qualitative discursive design, permitting the researcher to explore in depth the information obtained. It sought explanations about issues and commentary of human experience, with the acknowledgement that such experience is mediated. The study is important because the conflict in Zimbabwe still persists. Therefore if we understand how discourses were used in the 1980 to 1990 conflict, we have a better chance of understanding the current context. Using this design permits the construction of meanings to enable one to understand power relations– ideological and institutional arrangements that perpetuate political conflicts. The study analysed data from a Consultative Group Process (explained below) and secondary information from selected documents and newspaper publications from the State owned newspapers, namely The Chronicle and The Herald that were implicated in inciting conflict which led to the detentions and death of many people in Matebeleland and parts of the Midlands in Zimbabwe between 1980 and 1990. The study reviewed the literature on discourse and analysis from a critical perspective. In addition, archival research on key articles was undertaken to provide useful background to the study. During the data collection, the study used a Consultative Group Process. This group’s role was intended to create a framework of data collection that included follow-up of known experiences, stories from the community and documents that informed the researcher of the forms of discourses that developed out of the conflict in Zimbabwe. A consultative group of ten people with in-depth knowledge of Zimbabwe and had lived in the country at the time of the conflict, was recruited for the study. The members of the group were purposively selected based on their experiences of the conflict, using a snowball sampling technique. These people were consulted in the formulation of the research, discussion guide, identification of readings to be analysed, analysis of discourses and commentary on the study. The analysis of the findings both from the group discussions and newspaper reports showed that there was complicity by the State-owned media in the atrocities committed by the government against the civilian populations in Matebeleland and parts of the Midlands. The key social groups alienated and targeted by the state were the Ndebele and ideology (or belief systems), and persistent articulations that conveyed exclusion, domination and elimination of resistance. The most common discourses were drawn from the group discussions and newspaper ZAPU members. Anyone else associated with these groups were also likely to be termed articles. The media discourses were aligned to the government’s pursuit of hegemony. This study outlines the role of psychologists in using discursive psychological approaches. The study argues that psychologists could play a significant role in gathering evidence, through discourse analysis, that is, examining how language is used to influence people’s thought Ndebele and ‘dissident’ or ‘bandit.’ The discursive practices were characterised by processes during the creation of conflict and violence. The elimination of the opposition gave opportunity to ZANU PF to entrench power. Various strategies which included reification, legitimating, dissimilation and fragmentation were used to disintegrate the opposition. PF ZAPU was linked to dissidents in many newspaper articles. During the establishment of the unity process in 987, PF ZAPU would be blamed should there by stalling of the discussions, as evidenced in some articles

Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe

PROBLEM: In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths. APPROACH: We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital. LOCAL SETTING: Maternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff. RELEVANT CHANGES: Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014. LESSONS LEARNT: Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required