Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

Background: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.

Methods: Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.

Results: On average, large effect sizes (ES≥0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.

Conclusion: Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.

The process of change in offender rehabilitation programmes

Whilst the overall effectiveness of offender rehabilitation programmes in reducing recidivism is now well established, there has been less discussion of the reasons why rehabilitation programmes may be unsuccessful for some offenders. In this paper we suggest that models of change developed in counselling and psychotherapy may have utility in explaining how offender rehabilitation programmes bring about change, and argue that the dominance of cognitive-behavioural treatments in the rehabilitation field means that those offenders who have particularly low levels of problem awareness may be at increased risk of treatment failure. Understanding more about the mechanisms by which programmes help offenders to desist from offending is likely to lead to the development of more responsive and, ultimately, more effective programmes. Some suggestions for those involved in the delivery of offender rehabilitation programmes include: being mindful of the sequence of components of programmes, the development of preparation (or readiness) programmes and offering a broad suite of programmes to cater for different stages of problem awareness and assimilation among offenders.

Brief anger management programs with offenders : outcomes and predictors of change

Anger management interventions with offenders, particularly violent offenders, are a common form of rehabilitative activity. The rationale for addressing anger problems is clear-cut and there is good evidence that anger management can be effective with some client populations. Information relating to effectiveness with serious offenders, however, is sparse. An intervention study is reported in which offenders receiving anger management were compared with waiting list controls on a range of dependent measures. In general, the degree of pre-treatment/post-treatment change was small and experimental versus control differences were not statistically significant. The degree of improvement was found to be predictable from pre-treatment measures of anger and treatment readiness. Explanations of the low impact of anger management on violent offenders are discussed and recommendations made for improving outcomes.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Effect of morphine on the growth rate of Calliphora stygia (Fabricius) (Diptera : Calliphoridae) and possible implications for forensic entomology

Insect specimens collected from decomposing bodies enable forensic entomologists to estimate the minimum post-morten interval (PMI). Drugs and toxins within a corpose may affect the development rate of insects that feed on them and it is vital to quantify these effects to accurately calculate minimum PMI.... This suggests that C. sygia is a reliable model to use to accurately age a corpse containing morphine at any of the concentrations investigated.

Recruitment and selection of Vice-Chancellors for Australian universities

This study addresses the gap in our understanding of the processes used to recruit and select Vice-Chancellors for Australian Universities. There are presently 39 recognised Universities in Australia and between them they provide the nation with the academically qualified leaders of the future. As such one would expect that not only would they be the vessels of our knowledge, but also that they would be managed and led in ways that were similar to those in use in the private sector. The changes that have taken place in the higher education system have meant that additional pressures have been placed upon the senior executive of each University. The transition from a binary system to the current unified system, the advent of the global community, increased technology and new management practices have created the need for University management to adopt recognised management and leadership practices. The Federal government has moved to reduce the dependence of the system upon recurrent funding and there has been an increase in managerialism within Universities. One outcome has been the need for the Chief Executive Officer (Vice-Chancellor) to develop additional management and leadership skills in order to cope with the changes occurring and the rate of change. In the United States, the selection criteria used to recruit Vice-Chancellors (or University Presidents) have changed to reflect the desire for candidates to have backgrounds in management and leadership. The role of the Vice-Chancellor is critical to the success of educational institutions that are now being managed as autonomous business units responsible for budget, growth, mergers as well as maintaining academic credibility. A literature review revealed that the work undertaken by David Sloper formed virtually our entire knowledge base of Vice-Chancellors in Australia. Sloper identified democratic and incumbency patterns, social characteristics, the legal basis for the role and what incumbents actually do. Thus we know quite a deal about the role and incumbents. However the same literature review showed that while this data existed, it did not extend to the processes that were used within the Higher Education system, to target, identify and select suitable candidates. Clearly there was also no examination as to the effectiveness of such processes or how they could be improved if necessary. Given the importance of Universities in Australia and their role in Higher Education, this lack of knowledge provided the basis for this study and the systematic review of all available data. The study also identified a paradox in addition to the lack of research on recruitment and selection practices in this unique microcosm. The paradox concerns the fact that many of the successful candidates do not come from a ‘business’ discipline as may be expected for a role considered to be the Chief Executive Officer of the institution. Yet in Australia, previous research indicated that the ‘rules’ for recruiting Vice-Chancellors have changed little and that traditionally candidates have come from the science disciplines (Sloper, 1994). While this in itself does not indicate that incumbents are lacking in fundamental management and leadership knowledge and expertise, an obvious question arises. Why are Australian Vice-Chancellors not drawn from faculties where this expertise resides or why are they not drawn from the business community? In order to further examine the processes in place and to a lesser extent the paradox, all available data was collected regarding the roles of Vice-Chancellors, the paths they have taken to the position as well as selection criteria, position outlines, job adverts and related material. This was thoroughly examined and then a brief questionnaire was forwarded to current incumbents and other involved stakeholders. Interviews were conducted to clarify specific issues and case studies prepared accordingly. Thus this qualitative study thoroughly researches the recruitment and selection practices in use, attempts to determine their effectiveness and addresses the paradox in order to provide a detailed framework that allows these elements to be explained.

Women, words, and work : a study of change and reconstruction in adult TESOL

My dissertation asserts that the discourses which at the present time construct the world of work for teachers in adult TESOL, are no longer adequate to represent the field in these new and rapidly changing times. For the last forty years the discourses that have constructed the field present a totalising, gender free, liberal humanist view of TESOL, rendering women's experience invisible, no longer speaking to or for women teachers who make up more than ninety percent of the teachers in Victorian adult TESOL programs (Cope & Kalantzis 1993, Brodkey 1991, Fine 1992, Peirce 1995). I begin by exploring the work of women teachers in adult TESOL, focusing on women teaching in the fast growing de-institutionalised settings of adult TESOL programs, which remain marginalised from the central programs in terms of administrative policy and practice. I report the findings of a series of projects undertaken by the teachers and the researcher by which new insights and understandings of teachers beliefs about their work and the changes which are currently reconstructing the field of adult language and literacy education in Australia, have been gained. I questions the discourses of applied linguistics which have for the past forty years constructed the field of adult TESOL in Australia and suggests that these lack a social theory (Candlin 1989). From the research findings I questions the possibility of continuing to work in the ways of the past, in the current climate of reconstruction of the field, rapid policy change and continued erosion of resources. I suggest that the previously loose system which held this field of work together, the ways of working, the understandings of practice, have in the light of these new times, been stretched to the limit and are in real danger of collapse. For the women working in TESOL this continued incursion of the systems into their work and the changes that have taken place, the denial of their ways of working, their local knowledge and gendered experiences, can be read against Habermas' concept of the colonisation of the lifeworld of language teaching (Habermas 1987).

Teachers' stories of change : an interpretive study of behavioural studies teachers' experiences of change in Tasmanian schools and colleges 1984-1994

Major changes in teachers’ work in Tasmania occurred in the decade 1984-1994. Understanding of those changes has, to date, primarily come from the perspective of educational administrators. A different perspective on the changes comes from the stories told by teachers of Behavioural Studies, teaching grades 11 and 12 in government and non-government schools. Twenty teachers participated in taped interviews or videorecorded focus groups. Their stories were transcribed and analysed using an adapted form of grounded theory to explicate the meaning(s) of the changes for these teachers. Interpretation of the teachers' stories has also been framed by understandings drawn from narrative studies of teachers and their work. The core analytic category of the teachers’ stories of educational change is the conflict between the ideologies of teacher professionalism and economic rationalism. The major themes of the teachers’ stories are systemic and administrative change, control, histories of the Behavioural Studies subject, workload, students and stress.

Science education in primary schools in a state of change

Through a longitudinal study of one teacher's science teaching practice set in the context of her base school, this thesis records the effects of the structural and policy changes that have occurred in Victorian education over the past 6-7 years - the 'Kennett era'. Initially, the purpose of the study was to investigate the teacher's practice with the view to improving it. For this, an action research approach was adopted. Across the year 1998, the teacher undertook an innovative science program with two grades, documenting the approach and outcomes. Several other teachers were involved in the project and their personal observations and comments were to form part of the data. This research project was set in the context of a single primary school and case study methodology was used to document the broader situational and daily influences which affected the teacher's practice. It was apparent soon after starting the action research that there were factors which did not allow for the development of the project along the intended lines. By the end of the project, the teacher felt that the action research had been distorted - specifically there had been no opportunity for critical reflection. The collaborative nature of the project did not seem to work. The teacher started to wonder just what had gone wrong. It was only after a break from the school environment that the teacher-researcher had the opportunity to really reflect on what had been happening in her teaching practice. This reflection took into account the huge amount of data generated from the context of the school but essentially reflected on the massive number of changes that were occurring in all schools. Several issues began to emerge which directly affected teaching practice and determined whether teachers had the opportunity to be self-reflective. These issues were identified as changes in curriculum and the teaching role, increased workload, changed power relations and changed security/morale on the professional context. This thesis investigates the structural and policy changes occurring in Victorian education by reference to documentation and the lived experiences of teachers. It studies how the emerging issues affect the practices of teachers, particularly the teacher-researcher. The case study has now evolved to take in the broader context of the policy and structural changes whilst the action research has expanded to look at the ability of a teacher to be self-reflective: a meta-action research perspective. In concluding, the teacher-researcher reflects on the significance of the research in light of the recent change in state government and the increased government importance placed on science education in the primary context.