Training general practitioners in flexible sigmoidoscopy to screen for colorectal cancer

Background: A screening programme to detect polyps or early carcinoma would significantly reduce the mortality and morbidity of colorectal cancer (CRC). The aims of the present study were to evaluate: (i) the feasibility of training general practitioners in flexible sigmoidoscopy (FS) for CRC screening; (ii) the acceptability of screening by faecal occult blood testing (FOBT) and FS in asymptomatic standard risk Australians aged over 50 years; and (iii) the yield of such screening. Methods: Subjects were recruited by general practitioner (GP) referral, newspaper advertisement or by a direct approach to retirement villages. Participants were mailed a FOBT kit and a prescreening questionnaire. Flexible sigmoidoscopy was performed by a GP supervised by an experienced endoscopist. Subjects then completed a second questionnaire. General practitioners were assessed after 50 unassisted procedures. Results: A total of 264 individuals contacted the study coordinator; 169 were screened. Screening was accepted well by the participants. Fifteen per cent of subjects had polyps and 4% had a positive FOBT. Training in FS was adversely affected by the availability of resources. Three GPs completed 50 unassisted procedures over a 15-month period, but none were able to reliably assess the distal bowel. Conclusions: Although the three trainees and their supervisors did not consider that the GPs were adequately trained after 50 unassisted procedures, training was adversely affected by limited resources within the Victorian public hospital system. Screening by FOBT and FS was considered to be acceptable by the patients undergoing these procedures. Existing facilities are not adequate if GPs are to be trained in FS as part of a national CRC screening program.

Effect of six weeks of dura disc and mini-trampoline balance training on postural sway in athletes with functional ankle instability

Lateral ankle sprain (LAS) is one of the most common injuries incurred during sporting activities, and effective rehabilitation programs for this condition are challenging to develop. The purpose of this research was to compare the effect of 6 weeks of balance training on either a mini-trampoline or a dura disc on postural sway and to determine if the mini-trampoline or the dura disc is more effective in improving postural sway. Twenty subjects (11 men, 9 women) with a mean age of 25.4 ± 4.2 years were randomly allocated into a control group, a dura disc training (DT) group, or a mini-trampoline (MT) group. Subjects completed 6 weeks of balance training. Postural sway was measured by subjects performing a single limb stance on a force plate. The disbursement of the center of pressure was obtained from the force plate in the medial-lateral and the anterior-posterior sway path and was subsequently used for pretest and posttest analysis. After the 6-week training intervention, there was a significant (p < 0.05) difference in postural sway between pre- and posttesting for both the MT (pretest = 56.8 ± 20.5 mm, posttest = 33.3 ± 8.5 mm) and DT (pretest = 41.3 ± 2.6 mm, posttest = 27.2 ± 4.8 mm) groups. There was no significant (p > 0.05) difference detected for improvements between the MT and DT groups. These results indicate that not only is the mini-trampoline an effective tool for improving balance after LAS, but it is equally as effective as the dura disc.

Implementing training packages in a TAFE institute: perceptions and concerns of staff

The advent of training packages is a further change to the vocational education and training sector and is currently being implemented by teaching professionals. This paper outlines the findings of a project involving teachers in a TAFE institution as they begin the process of implementing the cross-industry Laboratory Operations Training Package into their teaching centre. The impetus for the research was the recognition that the change brought about by the new initiative would present a challenge for the teachers and a further change to their role in vocational education and training (VET). The research was qualitative in the form of a case study. Findings demonstrated that the implementation required a significant change in the philosophy of educational practice within the centre and that the implementation process was causing the teachers anxiety and confusion.

Cross-national agreement on disability weights:the Eurpoean disability weights project

Background: Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods.

Methods: Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS); the time trade-off technique (TTO); and the person trade-off technique (PTO). Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC) in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed.

Results: A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52–0.62] with PTO to 0.72 [0.70–0.74] with VAS and 0.72 [0.69–0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58–0.68] with PTO to 0.73 [0.71–0.75] with VAS and 0.74 [0.72–0.77] with TTO.

Conclusions: Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation.

Community-based monitoring of Victoria´s marine national parks and marine sanctuaries

This study investigated community-based monitoring in Victoria’s Marine National Parks (MNPs) and Sanctuaries (MSs) from January to May 2004. The primary aim of this study was to evaluate the potential for community-based monitoring projects to assist in the collection of data for the management of Victoria’s MNPs and MSs. The pilot habitats that were assessed included subtidal reefs at the Merri MS, intertidal reefs at Ricketts Point MS and seagrass beds at Corner Inlet MNP. The three main objectives for this study were to:
 - Develop a template for the monitoring of marine habitats by community groups.
 - Assess the quality and integrity of data collected by community volunteers.
 - Determine a sustainable model for community monitoring of marine habitats.
Three standard operating procedures (SOPs) in the form of a “how to” manual, were developed for each habitat type. The SOPs were adapted from scientifically robust studies and developed in consultation with community volunteer groups by means of field trials. Volunteer feedback assisted in the final SOP design. The SOP will allow Parks Victoria Rangers to develop community-based programs within the parks. The SOPs are accessible as Parks Victoria Technical Series Numbers 16, 17 and 18. Data collected by volunteers across the three habitat sites were assessed and compared to that collected by scientists. It was found that data quality collected by volunteers was dependent on habitat type and the type of measurement the volunteer was required to assess. Volunteer estimation measurements were highly variable across all three habitat sites, compared to quantitative data collection. Subtidal monitoring had the greatest potential for inconsistency in data collection. Intertidal monitoring is the most sustainable of the three habitat monitoring procedures. Sustainability of community-based monitoring programs is dependent on continued support and training by the management authority of Victoria’s MNPs and MSs. For the expansion of the monitoring programs to other MNPs and MSs, the management authority could expand strong relationships with the community volunteer groups.

An urgent challenge: new training opportunities for junior medical officers

There will be a massive increase in the number of medical school graduates over the next 5–10 years — there were 1287 Australian resident graduates in 2004, and there will be more than 3000 by the middle of the next decade.

A workshop held during the 11th National Prevocational Medical Education Forum explored ways to provide the additional prevocational training posts that will be required.

Four possible sites for additional training posts were discussed:
         • expansion of public hospital training posts;
         • general practice;
         • private hospitals; and
         • other sites, including private rooms and community placements.

Current accreditation procedures will need to be amended to accommodate more interns.

There will be limited access to prevocational training posts for non-resident (full-fee-paying) graduates and international medical graduates.

There is an urgent need for postgraduate medical councils, state health departments, the federal government, and medical boards to work together to identify, develop and accredit new training posts.

International standards of business conduct: framework and illustration

Purpose: – The purpose of this paper is to describe the insights and a proposal into the structure of standards of business conduct and its intended applications.

Design/methodology/approach: – The case study is based upon an inductive content analysis of corporate ethics artefacts.

Findings: – It is concluded that the standards of business conduct may be highly prescriptive in world wide corporations, but that there should be an explicit commitment to a flexible and dynamic approach to the application of standards of business conduct.

Research limitations/implications: – An examination of the actual behaviour of a corporation's operations was beyond the scope of the present research, but such a study has potential for future research. This would open up the wider question of how corporations can minimise the gap between corporate intentions and actual outcomes in business operations across national and cultural boundaries.

Practical implications: – These diverse national and cultural contexts that world wide corporations encounter must be taken into consideration in the content of their standards of business conduct.

Originality/value: – The authors emphasise the concern of recognising that the contexts surrounding standards of business conduct are dynamic. Corporate codes of ethics should be regarded as dynamic artefacts. A framework of application is proposed.

Designing effective training programs for investigative interviewers of children

'Best-practice' guidelines for conducting investigative interviews with children are well established in the literature, yet few investigative interviewers actually adhere to such guidelines in the field. One of the problems is that little discussion has focused on how such guidelines are learned and sustained by professionals. To address this concern, the current article reviews the key elements of interview training programs that are known to promote competent interviewing. These elements include: (i) the establishment of key principles or beliefs that underpin effective interviewing, (ii) the adoption of an interview framework that maximises narrative detail, (iii) clear instruction in relation to the application of the interview framework, (iv) effective ongoing practice, (v) expert feedback and (vi) regular evaluation of interviewer performance. A description and justification of each element is provided, followed by broad recommendations regarding how these elements can be implemented by police and human service organisations in a cost-effective manner.

Building information modelling project decision support framework

Building Information Modelling (BIM) is an information technology [IT] enabled approach to managing design data in the AEC/FM (Architecture, Engineering and Construction/ Facilities Management) industry. BIM enables improved interdisciplinary collaboration across distributed teams, intelligent documentation and information retrieval, greater consistency in building data, better conflict detection and enhanced facilities management. Despite the apparent benefits the adoption of BIM in practice has been slow. Workshops with industry focus groups were conducted to identify the industry needs, concerns and expectations from participants who had implemented BIM or were BIM “ready”. Factors inhibiting BIM adoption include lack of training, low business incentives, perception of lack of rewards, technological concerns, industry fragmentation related to uneven ICT adoption practices, contractual matters and resistance to changing current work practice. Successful BIM usage depends on collective adoption of BIM across the different disciplines and support by the client. The relationship of current work practices to future BIM scenarios was identified as an important strategy as the participants believed that BIM cannot be efficiently used with traditional practices and methods. The key to successful implementation is to explore the extent to which current work practices must change. Currently there is a perception that all work practices and processes must adopt and change for effective usage of BIM. It is acknowledged that new roles and responsibilities are emerging and that different parties will lead BIM on different projects. A contingency based approach to the problem of implementation was taken which relies upon integration of BIM project champion, procurement strategy, team capability analysis, commercial software availability/applicability and phase decision making and event analysis. Organizations need to understand: (a) their own work processes and requirements; (b) the range of BIM applications available in the market and their capabilities (c) the potential benefits of different BIM applications and their roles in different phases of the project lifecycle, and (d) collective supply chain adoption capabilities. A framework is proposed to support organizations selection of BIM usage strategies that meet their project requirements. Case studies are being conducted to develop the framework. The results of the preliminary design management case study is presented for contractor led BIM specific to the design and construct procurement strategy.

The three delays as a framework for examining safe motherhood in Kafa zone, SNNPR, Ethiopia

The study examines delay as a crucial factor contributing to maternal mortality, using the conceptual framework of the Three Phases of Delay to explore factors that hinder the provision and utilisation of high quality, timely obstetric care in Kafa Zone, SNNPR, in Ethiopia. The Three Delays constitute the delay in deciding to seek medical care during an obstetric emergency, in reaching a medical facility, and in receiving suitable treatment in a health facility. Various aspects of the Three Delays are evaluated to examine problems of delay, transportation, and the referral system that is considered a vital element of the Ethiopian 'National Reproductive Health Strategy'.

Drop-out from parenting training programmes : a retrospective study

Objective: Parent training programmes are a well-established treatment approach for children and adolescents with disruptive behaviour disorders. However, dropout from treatment is a common problem that confounds research on the efficacy of this approach, and wastes important mental health resources. This study sought to further our understanding of the reasons why parents drop out of parent training programmes.

Method: Nine parents of children with disruptive behaviour disorders who had dropped out of a parent training programme were interviewed to investigate why they discontinued the programme.

Results: Parents who dropped out of treatment believed that their children were more difficult than other children with the same disorder and may have been better suited to a child-focused intervention. The parents themselves had very stressful lives, with the majority being single mothers with little support. Dropout parents also had difficulty with the group context and putting strategies into place. Practical concerns included parking, timing of session and the length and number of sessions.

Conclusions: The findings are discussed in terms of what modifications can be made to these programmes to increase retention.

A holistic model of corporate governance - a new research framework

Purpose – The purpose of this paper is to propose a new model of corporate governance that is holistic – incorporating internal and macro perspectives across legal, regulatory, sociological, ethical, human resource management, behavioural and corporate strategic frameworks. Researchers have signalled the need for “new theoretical perspectives and new models of governance” due to a dearth of research that is context-driven, empirical, and encapsulating the full spectrum of reasons and actions contributing to corporate crises.

Design/methodology/approach – The approach consists of theory building by reviewing the literature and examining the gaps and limitations.

Findings – The proposed model is a distinctive contribution to theory and practice in three ways. First, it integrates the firm-specific, micro factors with the country-specific, macro factors to illustrate the holistic nature of corporate governance. Second, shareholders and stakeholders are shown to be only one component of the model. Third, it veers away from singular approaches, to dealing with corporate governance using a multi-disciplinary perspective. The paper argues that such a holistic and integrated view is a necessity for understanding governance systems.

Research limitations/implications – The challenge is to operationalize the model and test it empirically.

Practical implications – The model is instructive and of use for practitioners in attempting to understand, explain and develop governance models that are appropriate to their national and industry settings.

Originality/value – This paper argues that narrow-based models are limited in their approach and in a sound and integrative review of the up-to-date literature contributes to theory-building on corporate governance.