Evidence-based paediatric practice and its relation to the Cochrane Collaboration

Focuses on the relation between evidence-based pediatric practice and the Cochrane Collaboration on health care. Formation of the collaboration; Aim of Cochrane Collaboration; Reaction of pediatricians to the collaboration; Ways by which the collaboration ensures its relevance to pediatrics and child health.

Problem-based learning in an online IT professional practice course

Educational research suggests that Problem-Based Learning (PBL) is a pedagogy that fosters a deeper understanding of the curriculum and provides students with processes and skills for lifelong learning. According to the literature this pedagogy appears to be a suitable one for teaching undergraduate information technology, yet adoption of PBL in information technology tertiary education appears to be slow. This paper discusses characteristics and processes of PBL and describes how the approach will be used in teaching information technology professional practice. The course described will be offered to information technology students in their final year of study and will be delivered wholly online. The course will not only provide best practice aspects of PBL but it will also provide students with the opportunity of undertaking authentic tasks using multimedia resources that simulate the real world.

Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana

Buruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and
understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment-seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non-potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main
reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children’s hospitalization over extended period, delays in being
attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre-ulcerative stage of Buruli lesions.

Better-practice approaches for culture-based fisheries development in Asia

"Culture based fisheries are an effective way of increasing supplies of fish in rural areas. Farmers with relatively little experience in fish culture can productively engage, manage and benefit from culture based fisheries around lakes and reservoirs. This manual will provide guidance to development workers and program planners for integrating community based fisheries into rural development plans"--ACIAR website.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.

Microbial-based therapy of cancer: a new twist to age old practice

The use of bacteria in the regression of tumors has long been known. Various approaches for using bacteria in cancer therapy include the use of bacteria as sensitizing agents for chemotherapy, as delivery agents for cancer drugs and as agents for gene therapy. The tumor regression stimulated by infecting microorganisms has been attributed to activation of the immune system of the host. However, recent studies indicate that when tumor-harboring mice with defective immune systems are infected with certain microorganisms, the regression of the tumor is still observed, suggesting that there are other host factors contributing to the microbial associated regression of tumors. Since the use of live or attenuated bacteria for tumor regression has associated toxic effects, studies are in progress to identify a pure microbial metabolite or any component of the microbial cell that might have anti-cancer activity. It has now been demonstrated that a redox protein from Pseudomonas aeruginosa, a cupredoxin, can enter into human cancer cells and trigger the apoptotic cell death. In vivo, this cupredoxin can lead to the regression of tumor growth in immunodeficient mice harboring xenografted melanomas and breast cancer tumors without inducing significant toxic effects, suggesting that it has potential anti-cancer activity. This bacterial protein interacts with p53 and modulates mammalian cellular activity. Hence, it could potentially be used as an anti-cancer agent for solid tumors and has translational value in tumor-targeted or in combinational-biochemotherapy strategies for cancer treatments. Here, we focus on diverse approaches to cancer biotherapy, including bacteriolytic and bacterially-derived anti-cancer agents with an emphasis on their mechanism of action and therapeutic potential.

Research on school and community-based curriculum practice in aboriginal, multicultural and migrant education

This research studies some key problems in relation to curriculum reform in multicultural and migrant education: social concepts of multicultural education, divergent curriculum theories informing practice, the facilitation process in regard to project self-study and action research and the development of cultural perspectives in general curriculum pedagogy.

An innovation framework based on best practice exemplars from the Australian School Innovation in Science, Technology and Mathematics (ASISTM) project

This report describes research into 16 ASISTM projects selected to be broadly representative of exemplars in innovation. Case studies of each project were constructed from interviews with a range of key participants, and used to develop and refine an innovation framework that is used to make sense of and describe the key features of each project. The major issue binding these projects was found to be that of student interest and engagement, and this was pursued through involving students in contemporary science, technology and mathematics (STM) practices in authentic settings. The findings point to an enriched set of purposes of STM education implicit in these projects, a set of pedagogical practices that are varied and consistent with contemporary educational thinking, and a varied array of 'actors' recruited to these projects.

Client leadership capacity on international projects : exploring the client's complex decision-making environment through a critical cultural political economy lens

The global construction environment offers stakeholders a range of opportunities but is characterised by a high level of risks and uncertainty. Internationalisation is a relatively new field of research in the AEC sector and past research has largely focused on explaining the behaviour of the industry itself. To date there has been little research investigating the client's leadership role. Much effort has been placed on positioning clients towards overall industry performance improvement, however, with little emphasis on the client's capacity to undertake their role. Clients establish the decision-making environment through key early critical decisions including procurement strategy and team membership. To a large extent they establish a unique culture that project team members need to work within and make decisions, which is the social and cultural embedding of the economic activities on projects. This theoretical paper is positioned within a PhD study which undertakes a cultural political economy perspective to investigate the client's central role in setting the boundaries within which decisions affecting budgets, quality, design, project organisational structure and team membership throughout the project lifecycle come to be made. A conceptual model for client leadership on international projects is developed based upon two contextual indicators which seeks to describe and explain the economic decisions clients make, which are deeply embedded in social relationships, shared meanings and cultural norms and the associated power and influence clients have on the political economy of international design and construction practice. This paper also seeks to develop a research question for future empirical testing.