Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Heterogeneity of heart failure management programs in Australia

Background: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.
Objective: To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.
Method: Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.
Results: All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24–147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.
Conclusion: Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Rethinking profeminist men's behaviour change programs

Many of the programs operating in Australia for men who are violent to their women partners claim to have a profeminist framework. These programs cite the importance of challenging the control that male perpetrators have over women partners. Given the development of policy frameworks, standards manuals and best practice models that espouse a commitment to feminist analyses, women’s safety and accountability, most commentators have concluded that feminist concerns about men’s programs have been adequately responded to in the current climate. This article will review the key axioms underpinning programs that espouse a profeminist analysis to assess the extent to which feminist analyses of men’s violence are incorporated into the principles, theories and strategies for working with violent men.

Assessing programs for monitoring threatened species – a tale of three honeyeaters (Meliphagidae)

We critically evaluated population-monitoring programs for three endangered species of Australian honeyeater: the helmeted honeyeater, Lichenostomus melanops cassidix, the black-eared miner, Manorina melanotis, and the regent honeyeater, Xanthomyza phrygia (Meliphagidae). Our results challenge the common assumption that meaningful monitoring is possible in all species within the five-year lifetime of recovery plans. We found that the precision achievable from monitoring programs not only depends on the monitoring technique applied but also on the species' biology. Relevant life-history attributes include a species' pattern of movement, its home-range size and its distribution. How well understood and predictable these attributes are will also influence monitoring precision. Our results highlight the large degree of variability in precision among monitoring programs and the value of applying power analysis before continuing longer-term studies. They also suggest that managers and funding agencies should be mindful that more easily monitored species should not receive preferential treatment over species that prove more difficult to monitor.

eBusiness and information systems : academic programs in Australia and New Zealand in the e-Age

Universities are increasingly turning to ‘fashionable’ education programs to attract bright, high-quality students to both under-graduate and post-graduate degree programs. Traditional offerings in technology areas, such as Information Systems and Information Technology are being augmented by newer, more marketable degrees in areas such as eCommerce/eBusiness. This paper analyses the eCommerce/eBusiness and Information Systems (IS) / Information Technology (IT) academic programs in Australian and New Zealand universities on the basis of Kotler and Fox's service offering model of educational institutions; and considers what differences exist between these two apparently similar areas of academic endeavour. Finally we look at the trends of academic program delivery in the e-age and question whether universities need to take a more consumer-product approach to the issue of attracting appropriate students.

Teaching HRD personnel : experiences of computer-mediated communication in differently structured environments

This paper will provide an overview of the CMC structure in two different units of study in the Masters of Professional Education and Training at Deakin University. Each of these structures makes a set of demands on participants, and provides differing collaborative learning opportunities. The paper examines the experiences we have had in each of these structures, focusing on student participation, style of contribution to CMC, and the relationship between socialisation processes and knowledge construction.

Employer requirements of economics graduates and the implications for undergraduate economics programs

In recent years there has been considerable debate about the general decline in the number of students undertaking bachelor degrees and majors in economics. The discussion has stemmed mainly from a supply-side perspective of the economics education market. The goal of this paper is to add another dimension to the debate and report the results of a survey of employers of economics graduates. Drawing on the extensive customer services literature it is argued that a market oriented, or demand-side analysis is also an important component in redressing low student enrolments and retention. A first step in adopting a market oriented approach is to determine the skills required of the economics graduates entering the jobs market. With the support of The Economics Society of Au~tralia, twenty-nine public and private sector employers were surveyed in 2002. The aim of the survey was to establish the demand for economics graduates with bachelor and honours degrees, the skills and knowledge required of these graduates, and the performance of such graduates. The study found that economic knowledge and skill were important to employers. However, the skills rated most important by employers were the more general or 'generic' skills of clear writing, data analysis, interpersonal skills and a practical problem-solving orientation. While graduates generally performed satisfactorily in relation to the economic skills required by employers, this was not the case for generic skills. The result of the survey findings have some significant implications for the content and teaching of undergraduate economics programs. This paper outlines these implications and also discusses areas for future research It is argued that such research should aim to utilize both the demand and supplyside perspectives with the development of more precise definitions and measurement of the economic skills required by the various stakeholders in the economics education market.

Micro finance programs: caring for those missed by formal social protection mechanism

In line with the current global trend of economic and social restructuring, it has become essential to address the issue of poverty and social protection for the poorer segment of the population who are not covered by formal social protection mechanisms. Micro finance institutions (MFIs) in developing countries have been working towards poverty alleviation and enhancing social protection for the last few decades. MFI’s provision of financial assistance to the poor has been instrumental in improving the overall quality of the impoverished. Based on an in-depth qualitative study conducted across three different types of NGOs (Non Governmental Organization) in the Philippines, this study found a relationship between micro finance programs and improved social protection. The study reveals that MFIs have the ability to make a positive impact on areas such as entrepreneurship, education, housing, job security and income generation.

Towards an organisational disaster risk management culture and practice for banks

The disaster risk management culture and practice that is evident within banks will significantly impact upon the capability and preparedness of institutions and their personnel to plan for, and respond to, an occurrence that may affect the continuity of critical business functions. The principal outcome of this paper is the development of a structured education and training framework that will support the achievement of banks' disaster risk management objective. The education and training framework comprises three specific programs: 1. an induction/awareness program targeted to all personnel; 2. a contingency planning program - a specialist program for disaster risk management personnel; and 3. an executive program designed for senior management, directors and strategic decision makers.

Crossing boundaries between learning and research : doctoral programs at a distance

Australian distance education, from school to university contexts, typically concerns teaching people the knowledge, values and skills that constitute their chosen courses of study; whereas doctoral courses principally concern candidates learning how to produce – through producing – significant original new knowledge. This paper considers the history and contemporary practices of Australian off-campus doctoral education and argues that these are at the forefront internationally. It is argued that understanding the provision of quality doctoral education at a distance requires a form of conceptual boundary crossing by policymakers, distance educators, and (especially) doctoral education practitioners, in order to develop and/or enhance future practices.

An education and training framework for disaster risk management in banks

Banks are the most significant financial institutions operating within nation-state and the global financial system. These institutions are exposed to a wide range of operational risks. Disaster risk management is a critical component of the wider operational risk management. The Bank for International Settlements, in conjunction with nation-state prudential regulators, is introducing measures that will require banks to identify, measure and manage operational risks within the context of new capital adequacy requirements. An essential part of any risk management process is education and training. This paper presents a structured education and training framework that will support the achievement of banks’ disaster risk management objectives. The education and training framework comprises three specific programs: (1) an induction/awareness program targeted to all personnel, (2) a contingency planning program – a specialist program for disaster risk management personnel, and (3) an executive program designed for senior management, directors and strategic decision makers.

An Australian response to recent developments in the market for audit services

Where the quality - both competence and independence - of an audit is tested, often in the circumstance of a corporate failure, auditors frequently have good defenses as to their competency but rarely do they have equally convincing defenses for the objectivity of their decision-making or the independence of their audit. It is recommended that large audit firms establish an independence board with the authority to define, review and decide upon all threats and potential threats to independence. It would also have responsibility for quality-control and educational programs in respect of audit firm's independence decision-making. Firms would make transparent the processes of the boards, their membership and quality-control procedures. Firms would compete on their independence control processes and not just competence and price. Additionally, firms need to encourage a culture that rewards personnel for seeking counsel on issues pertinent to independence.