5 resultados para Extension Program

em Deakin Research Online - Australia


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The term ‘program management’, while referred to occasionally in journals, organisation publications and by training consultants, is not a widely acknowledged notion. While literature on project management is plentiful and the concept is well entrenched in both a practical and academic
sense, program management is a term that is used differently by various sectors. Its meaning is less defined and more broadly applied than that of project management. For example, although Program Managers are sometimes recruited under that title, the definition still remains somewhat
obscure. Seen mostly in the health and education public sectors, program management is commonly thought of as separate to project management but, as this paper will suggest, program management is more likely an extension of project management and a complementary tool to achieving
organisational outcomes. This paper attempts to clarify the distinctions between the management approaches by looking at existing literature and comparing it to common practice in a government instrumentality. It will become apparent that further research is needed regarding this significant
step in the evolution of management practices.

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Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

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Anger-management interventions are widely delivered in the criminal justice and forensic mental health systems. Whilst previous research has generally supported the thesis that anger management is an effective intervention for anger problems in general there remains a need to determine its effectiveness with offender populations. This paper reports the results of a controlled outcome study of a 20 h anger-management program offered to offenders. Those receiving treatment showed improvements in their knowledge about anger, but showed little change on measures of anger and anger expression when compared to waiting-list controls. Scores on measures of treatment readiness and level of need for treatment were however, correlated with post-treatment improvement. These findings are discussed in terms of their implications for the assessment and selection of appropriate participants for offender anger-management programs.

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Background:

Exercise during hemodialysis treatments improves physical function, markers of cardiovascular disease and quality of life. However, exercise programs are not a part of standard therapy in the vast majority of hemodialysis clinics internationally. Hemodialysis unit-based accredited exercise physiologists may contribute to an increased intradialytic exercise uptake and improved physical function.

Methods and design:
This is a stepped wedge cluster randomised controlled trial design. A total of 180 participants will be recruited from 15 community satellite hemodialysis clinics in a large metropolitan Australian city. Each clinic will represent a cluster unit. The stepped wedge design will consist of three groups each containing five randomly allocated cluster units, allocated to either 12, 24 or 36 weeks of the intervention. The intervention will consist of an accredited exercise physiologist-coordinated program consisting of six lower body resistance exercises using resistance elastic bands and tubing. The resistance exercises will include leg abduction, plantar flexion, dorsi flexion, straight-leg/bent-knee raise, knee extension and knee flexion. The resistance training will incorporate the principle of progressive overload and completed in a seated position during the first hour of hemodialysis treatment. The primary outcome measure is objective physical function measured by the 30-second sit to stand test. Secondary outcome measures include the 8-foot timed-up-and-go test, the four square step test, quality of life, cost-utility analysis, uptake and involvement in community activity, self-reported falls, fall's confidence, medication use, blood pressure and morbidity (hospital admissions).

Discussion:
The results of this study are expected to determine the efficacy of an accredited exercise physiologist supervised resistance training on the physical function of people receiving hemodialysis and the cost-utility of exercise physiologists in hemodialysis centres. This may contribute to intradialytic exercise as standard therapy using an exercise physiologist workforce model.