Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

Preliminary experience of allied health assessments delivered face to face and by videoconference to a residential facility for elderly people

We investigated whether allied health assessments carried out via videoconferencing were comparable to assessments carried out face to face. Five allied health therapists (in dietetics, occupational therapy, physiotherapy, podiatry and speech pathology) conducted an assessment of 12 high-dependency residents both face to face and by videoconferencing. On a five-point Likert scale, the therapists' mean ratings for the efficiency and suitability of videoconferencing for assessment were significantly lower than for face to face. Their mean rating for the adequacy of their care plans was also significantly lower for videoconferencing than for face to face. However, in each case the dietician's assessments did not differ significantly between the two modalities. In 35 cases out of 60, two independent raters agreed that the therapists' care plans after the videoconferencing and face-to-face assessments were the same. However, the level of agreement between raters was only moderate (kappa=0.31). Despite the therapists' (natural) preference for face-to-face working, care plans formulated via videoconferencing were reasonably similar to those formulated in face-to-face assessment. Allied health assessments carried out by videoconferencing would therefore seem to be feasible.

Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement

Background: In clinical trials, at the group level, results are usually reported as mean and standard deviation of the change in score, which is not meaningful for most readers. Objective: To determine the minimal clinically important improvement (MCII) of pain, patient's global assessment of disease activity, and functional impairment in patients with knee and hip osteoarthritis (OA). Methods: A prospective multicentre 4 week cohort study involving 1362 outpatients with knee or hip OA was carried out. Data on assessment of pain and patient's global assessment, measured on visual analogue scales, and functional impairment, measured on the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) function subscale, were collected at baseline and final visits. Patients assessed their response to treatment on a five point Likert scale at the final visit. An anchoring method based on the patient's opinion was used. The MCII was estimated in a subgroup of 814 patients ( 603 with knee OA, 211 with hip OA). Results: For knee and hip OA, MCII for absolute ( and relative) changes were, respectively, ( a) -19.9 mm (-40.8%) and -15.3 mm (-32.0%) for pain; ( b) -18.3 mm ( - 39.0%) and -15.2 mm ( -32.6%) for patient's global assessment; ( c) -9.1 ( -26.0%) and -7.9 ( -21.1%) for WOMAC function subscale score. The MCII is affected by the initial degree of severity of the symptoms but not by age, disease duration, or sex. Conclusion: Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients.

GESTÃO DE RELAÇÕES ESTRATÉGICAS INTERPESSOAIS NAS ALIANÇAS CORPORATIVAS (GRE): SINERGIA DE VALOR NA GESTÃO INTEGRADA DE RH

Este trabalho pretende apresentar e compreender o papel da gestão estratégica de pessoas, dentro de uma visão que contempla as relações interorganizacionais fora dos limites tradicionais de seu escopo nas empresas e expandidas além das dimensões formais e fronteiras que permeiam uma organização. Este estudo estabelece a importância e sistemáticas da gestão de atividades de RH, compartilhadas com a cadeia de valor externa, analisando-as nas práticas com os canais de distribuição junto aos clientes. Esta área organizacional é denominada pelo autor de GRE - Gestão das Relações Estratégicas. Baseando-se em uma pesquisa exploratória em 26 empresas, organizada a partir de cinco empresas nodais e seus canais de distribuição, utilizou-se a aplicação de um questionário de pesquisa com escala Likert e entrevistas pessoais semi-estruturadas junto aos gestores e profissionais de diversas áreas, bem como o tratamento estatístico dos dados com o programa SPSS, indicando a confirmação das questões de pesquisa relativas a GRE como sendo uma proposta de expansão das atividades do RH, focando em como se pode e devem entregar valor para a organização, para os aliados estratégicos, os investidores e fundamentalmente para os clientes.(AU)

The impact of performance measurement in strategic planning

Purpose – To investigate the impact of performance measurement in strategic planning process. Design/methodology/approach – A large scale survey was conducted online with Warwick Business School alumni. The questionnaire was based on the Strategic Development Process model by Dyson. The questionnaire was designed to map the current practice of strategic planning and to determine its most influential factors on the effectiveness of the process. All questions were close ended and a seven-point Likert scale used. The independent variables were grouped into four meaningful factors by factor analysis (Varimax, coefficient of rotation 0.4). The factors produced were used to build regression models (stepwise) for the five assessments of strategic planning process. Regression models were developed for the totality of the responses, comparing SMEs and large organizations and comparing organizations operating in slowly and rapidly changing environments. Findings – The results indicate that performance measurement stands as one of the four main factors characterising the current practice of strategic planning. This research has determined that complexity coming from organizational size and rate of change in the sector creates variation in the impact of performance measurement in strategic planning. Large organizations and organizations operating in rapidly changing environments make greater use of performance measurement. Research limitations/implications – This research is based on subjective data, therefore the conclusions do not concern the impact of strategic planning process' elements on the organizational performance achievements, but on the success/effectiveness of the strategic planning process itself. Practical implications – This research raises a series of questions about the use and potential impact of performance measurement, especially in the categories of organizations that are not significantly influenced by its utilisation. It contributes to the field of performance measurement impact. Originality/value – This research fills in the gap literature concerning the lack of large scale surveys on strategic development processes and performance measurement. It also contributes in the literature of this field by providing empirical evidences on the impact of performance measurement upon the strategic planning process.

The UK MPharm (1) - are we over reliant on traditional teaching methods?

Introduction-The design of the UK MPharm curriculum is driven by the Royal Pharmaceutical Society of Great Britain (RPSGB) accreditation process and the EU directive (85/432/EEC).[1] Although the RPSGB is informed about teaching activity in UK Schools of Pharmacy (SOPs), there is no database which aggregates information to provide the whole picture of pharmacy education within the UK. The aim of the teaching, learning and assessment study [2] was to document and map current programmes in the 16 established SOPs. Recent developments in programme delivery have resulted in a focus on deep learning (for example, through problem based learning approaches) and on being more student centred and less didactic through lectures. The specific objectives of this part of the study were (a) to quantify the content and modes of delivery of material as described in course documentation and (b) having categorised the range of teaching methods, ask students to rate how important they perceived each one for their own learning (using a three point Likert scale: very important, fairly important or not important). Material and methods-The study design compared three datasets: (1) quantitative course document review, (2) qualitative staff interview and (3) quantitative student self completion survey. All 16 SOPs provided a set of their undergraduate course documentation for the year 2003/4. The documentation variables were entered into Excel tables. A self-completion questionnaire was administered to all year four undergraduates, using a pragmatic mixture of methods, (n=1847) in 15 SOPs within Great Britain. The survey data were analysed (n=741) using SPSS, excluding non-UK students who may have undertaken part of their studies within a non-UK university. Results and discussion-Interviews showed that individual teachers and course module leaders determine the choice of teaching methods used. Content review of the documentary evidence showed that 51% of the taught element of the course was delivered using lectures, 31% using practicals (includes computer aided learning) and 18% small group or interactive teaching. There was high uniformity across the schools for the first three years; variation in the final year was due to the project. The average number of hours per year across 15 schools (data for one school were not available) was: year 1: 408 hours; year 2: 401 hours; year 3: 387 hours; year 4: 401 hours. The survey showed that students perceived lectures to be the most important method of teaching after dispensing or clinical practicals. Taking the very important rating only: 94% (n=694) dispensing or clinical practicals; 75% (n=558) lectures; 52% (n=386) workshops, 50% (n=369) tutorials, 43% (n=318) directed study. Scientific laboratory practices were rated very important by only 31% (n=227). The study shows that teaching of pharmacy to undergraduates in the UK is still essentially didactic through a high proportion of formal lectures and with high levels of staff-student contact. Schools consider lectures still to be the most cost effective means of delivering the core syllabus to large cohorts of students. However, this does limit the scope for any optionality within teaching, the scope for small group work is reduced as is the opportunity to develop multi-professional learning or practice placements. Although novel teaching and learning techniques such as e-learning have expanded considerably over the past decade, schools of pharmacy have concentrated on lectures as the best way of coping with the huge expansion in student numbers. References [1] Council Directive. Concerning the coordination of provisions laid down by law, regulation or administrative action in respect of certain activities in the field of pharmacy. Official Journal of the European Communities 1985;85/432/EEC. [2] Wilson K, Jesson J, Langley C, Clarke L, Hatfield K. MPharm Programmes: Where are we now? Report commissioned by the Pharmacy Practice Research Trust., 2005.

Recreational Foodservice management: A Delphi study of needed competencies

The purpose of this study was to identify the needed competencies of a Recreational Foodservice manager. A three round Delphi method of iteration was used. Delphi is a research method that utilizes iterating rounds to elicit the opinion of a panel of experts regarding a specific subject.^ A nominating committee of 22 industry leaders was consulted to establish a panel of 40 management experts, of which 35 (87.5%) completed all three rounds of the Delphi study.^ Round One of the study identified 17 specific job functions of a Recreational Foodservice manager. The researcher prepared an instrument detailing 60 competencies derived from an analysis of Round One results and distributed it as a Round Two instrument requesting the panel opinion regarding the relative importance of each listed competency on a five point Likert scale.^ The results of Round Two were tabulated and analyzed to ascertain areas of consensus. A Round Three instrument was prepared advising panelists of all areas of consensus, their dissenting opinions, if any, and a request for a revised opinion.^ A final report was prepared listing the 60 competencies and the panel opinion that eight were of highest priority, 29 of above average priority, and 23 of average priority. No item received two other available ratings, below average priority and lowest priority.^ The implications of these findings suggest necessary areas of curriculum development and industry management development to implement professionalism for Recreational Foodservice managers. ^

The role of death qualification in venirepersons' evaluations of aggravating and mitigating circumstances in capital trials

Death qualification is a part of voir dire that is unique to capital trials. Unlike all other litigation, capital jurors must affirm their willingness to impose both legal standards (either life in prison or the death penalty). Jurors who assert they are able to do so are deemed “death-qualified” and are eligible for capital jury service: jurors who assert that they are unable to do so are deemed “excludable” or “scrupled” and are barred from hearing a death penalty case. During the penalty phase in capital trials, death-qualified jurors weigh the aggravators (i.e., arguments for death) against the mitigators (i.e., arguments for life) in order to determine the sentence. If the aggravating circumstances outweigh the mitigating circumstances, then the jury is to recommend death; if the mitigating circumstances outweigh the aggravating circumstances, then the jury is to recommend life. The jury is free to weigh each aggravating and mitigating circumstance in any matter they see fit. Previous research has found that death qualification impacts jurors' receptiveness to aggravating and mitigating circumstances (e.g., Luginbuhl & Middendorf, 1988). However, these studies utilized the now-defunct Witherspoon rule and did not include a case scenario for participants to reference. The purpose of this study was to investigate whether death qualification affects jurors' endorsements of aggravating and mitigating circumstances when Witt, rather than Witherspoon, is the legal standard for death qualification. Four hundred and fifty venirepersons from the 11 th Judicial Circuit in Miami, Florida completed a booklet of stimulus materials that contained the following: two death qualification questions; a case scenario that included a summary of the guilt and penalty phases of a capital case; a 26-item measure that required participants to endorse aggravators, nonstatutory mitigators, and statutory mitigators on a 6-point Likert scale; and standard demographic questions. Results indicated that death-qualified venirepersons, when compared to excludables, were more likely to endorse aggravating circumstances. Excludable participants, when compared to death-qualified venirepersons, were more likely to endorse nonstatutory mitigators. There was no significant difference between death-qualified and excludable venirepersons with respect to their endorsement of 6 out of 7 statutory mitigators. It would appear that the Furman v. Georgia (1972) decision to declare the death penalty unconstitutional is frustrated by the Lockhart v. McCree (1986) affirmation of death qualification. ^

Teachers' perceptions of the usefulness of Individual Education Plans (IEP)

Since 1997 federal special education policy mandated that all classroom teachers take part in planning and implementation of Individualized Education Plans (IEP) for students with disabilities. This legislation has given teachers new responsibilities because it requires greater participation in the IEP process. The purpose of this study was to examine teachers' perceptions of the usefulness of Individualized Education Plans (IEP). ^ Eighty seven certified Miami-Dade County Public School teachers, 60 general education teachers and 27 special education teachers were surveyed using an updated version of Rheams' (1989) The Teacher Perceptions of the Usefulness of IEPs. Subjects completed a survey form containing a demographic cover page, 18 Likert-scale statements and 3 open ended questions. This study looked at differences in perceptions by teacher group affiliation (general and special), grade level taught (elementary and secondary), and years of experience (<=5 and >5 years). The dependent variables were teacher preparedness; feasibility of IEP implementation; relevancy of IP to classroom instruction; and legal, professional and personal accountability with regard to the IEP. ^ Results of the Multivariate Analysis of Variance (MANOVA) revealed that (a) special education teachers held a more positive perception of overall IEP usefulness than general education teachers, (b) special educators held more positive perceptions concerning issues of feasibility and preparedness, (c) elementary level teachers viewed the IEP more positively than secondary level teachers, specifically in the areas of preparedness and feasibility. ^ Findings of this study indicate that general and secondary educators have not embraced the legislation and incorporated it into their planning and instruction. These findings provide policymakers, institutions of higher education, and school administrators with insight as to how to better translate policy into classroom instructional practice. Consideration should be given to implementing (a) honest communication and shared decision making with regard to IEP directed curriculum and instruction, (b) updated pre and in-service IEP development and implementation training, and (c) opportunities for collaboration and increased plan time, especially on the secondary level. ^

Gender differences in principal motivations

Women have traditionally not attained the position of secondary school principal as frequently as their male counterparts. Research in the field of motivation theory suggests the significance and impact of gender on career paths. Theorists and researchers believe that women face an orientation to life that is different than men. Some see the principalship as satisfying different values and working toward some psychological needs. ^ In this study, two hypotheses were used to explore whether substantive differences existed between men and women with regard to factors that motivate secondary school administrators to become principals in Miami-Dade County Public Schools. The administrators were surveyed during meetings held with them at Region meetings. Participants were asked to rate the motivation factors on a 7-point Likert Scale (1-strongly disagree to 7-strongly agree) and to rank the motivation factors (1-most important to 10-least important) that might discourage one from becoming a principal as well as those that might encourage one to retire from the principalship; and to identify motivation factors that most influenced their decision to become a school administrator. Two hundred twenty-six surveys were returned.^ Quantitative data were collected to measure differences between men and women with respect to their motivation to seek the principalship in terms of their ratings on the Motivation Factors Survey. Based upon a Factor Analysis, four factors (intrinsic satisfiers, extrinsic satisfiers, principalship challenges and job values) were identified. A MANOVA using the factors as dependent variables revealed that, as predicted by research and theory, women were significantly more likely than men to be motivated by intrinsic satisfiers and job values. In support of this finding, open-ended responses to the survey revealed that men found extrinsic satisfiers to be of greater importance than intrinsic satisfiers. ^

A study of teachers' espoused instructional beliefs

The purpose of this study was to investigate teachers' espoused instructional beliefs and whether they differed in relation to schools' socioeconomic status, extent of teachers' educational background, or extent of teachers' classroom experience. The study comprised a total of 242 Miami-Dade County public school educators who responded to a thirty-nine question Likert scale, Literacy Instructional Practices Questionnaire. Eighteen schools, three from each of the six regions, were purposively selected based on the socioeconomic status of students. Nine participants were interviewed using semi-standardized interview procedures and open-ended questioning techniques. ^ Multivariate Analysis of Variance (MANOVA) results revealed that teachers' espoused beliefs concerning the instruction of literacy and forces and influences affecting instruction do not significantly differ depending on schools' socioeconomic status, extent of teachers' educational background, or extent of teachers' classroom experience. The majority of teachers appear to follow a top-down generated direct instruction model. Generally, students are taught as a whole class and ability grouped for specific skill instruction utilizing commercially produced reading and language arts texts. ^ There was no evidence of a relationship between teachers' espoused beliefs concerning the model of instruction that they practice or teachers' espoused beliefs concerning research and its application to practice and the three independent variables. Interview data corroborated much of the information garnered through the questionnaire. However, interview participants espoused the belief that research did not influence their selection of instructional practices. ^ Although teachers perceive of themselves as eclectic in their espoused instructional beliefs, they appear to follow a skills based direct instruction pedagogy in practice. Much of what teachers believe constitutes effective practice, few researchers recommend, affirming the findings of Calderhead (1993) and the National Educational Research Policy and Priorities Board (U.S. Department of Education, 1998, p. 18) that “educators rarely know research, seek it out, or act in accordance with its results.” ^

Early career special education teachers' perceptions of school site induction support

Research highlights teacher attrition as one of the biggest challenges facing public schools and their attempts to provide a quality teacher for every student (Ingersoll & Smith, 2003). The teacher shortage is particularly daunting in special education where teachers are over twice as likely to leave the field. The first few years of teaching are the most critical in determining whether or not a beginning teacher will stay in the teaching profession (Whitaker, 2000). ^ A mixed-methods sequential explanatory design was utilized to examine research questions focused on the components of induction support that early career teachers received at their school site, including what they considered most valuable to their long-term retention in the classroom and their development as a quality teacher. Eighty seven early career special education teachers were surveyed during the first phase of the study and six participants were interviewed during the second phase. ^ Data analysis of the Likert-scale survey used in the study revealed that the majority of the respondents received at least 21 of the 25 listed induction components. Moreover, early career special education teachers indicated that they valued all 25 induction components. In addition, findings revealed that over two thirds of the respondents indicated a desire to remain a special education teacher. Overall, early career special education teachers felt confident in their abilities to teach students with disabilities; however, nearly half of the respondents did not feel satisfied with the induction they received. Independent t-tests showed a statistically significant difference between teachers who indicated a desire to remain in special education and those that did not on the level of satisfaction with their induction experience. ^ The six interviews provided elaboration and clarification of the survey responses. The participants expressed their passion for the art of teaching, their dedication to students with disabilities, and their frustration with being a beginning teacher. Furthermore, it was reported that the overall school culture was not very supportive. Participants offered relevant ideas for additional or alternate induction components that would be more effective.^

A Study of Teachers' Espoused Instructional Beliefs

The purpose of this study was to investigate teachers’ espoused instructional beliefs and whether they differed in relation to schools’ socioeconomic status, extent of teachers’ educational background, or extent of teachers’ classroom experience. The study comprised a total of 242 Miami-Dade County public school educators who responded to a thirty-nine question Likert scale, Literacy Instructional Practices Questionnaire. Eighteen schools, three from each of the six regions, were purposively selected based on the socioeconomic status of students. Nine participants were interviewed using semi-standardized interview procedures and open-ended questioning techniques. Multivariate Analysis of Variance (MANOVA) results revealed that teachers’ espoused beliefs concerning the instruction of literacy and forces and influences affecting instruction do not significantly differ depending on schools’ socioeconomic status, extent of teachers’ educational background, or extent of teachers’ classroom experience. The majority of teachers appear to follow a top-down generated direct instruction model. Generally, students are taught as a whole class and ability grouped for specific skill instruction utilizing commercially produced reading and language arts texts. There was no evidence of a relationship between teachers’ espoused beliefs concerning the model of instruction that they practice or teachers’ espoused beliefs concerning research and its application to practice and the three independent variables. Interview data corroborated much of the information garnered through the questionnaire. However, interview participants espoused the belief that research did not influence their selection of instructional practices. Although teachers perceive of themselves as eclectic in their espoused instructional beliefs, they appear to follow a skills based direct instruction pedagogy in practice. Much of what teachers believe constitutes effective practice, few researchers recommend, affirming the findings of Calderhead (1993) and the National Educational Research Policy and Priorities Board (U.S. Department of Education, 1998, p. 18) that “educators rarely know research, seek it out, or act in accordance with its results.”

Peer Leaders’ Perceptions of Learning Experiences

Peer-Led Team Learning (PLTL) at Florida International University maintains a large volume of student and Peer Leader (PL) participation. Students, who participate in PLTL, on average, perform a letter grade better than their peers who do not participate in PLTL. To analyze PL perspectives on learning, a survey was conducted. The survey had a series of Likert scale statements and free response questions on learning. The nature of the questions are regarding barriers in education, individual learning strengths and weaknesses, and the perception that PLTL improved the learner’s capabilities to overcome these obstacles. Based on the survey responses, PLs perceive an improvement in the way they learn during and/or after becoming a PL. Students participating in PLTL exhibited an increase in course content retention and perceived improvement in study skills. Students in PLTL also perceived the PLTL workshop environment to be comfortable enough to address questions and misconceptions.

Elaboração de uma unidade de ensino potencialmente significativa em Química para abordar a temática água

The evidence of the water theme in news reports is configured as an important topic of interest to contextualize, problematize and/or generate meaning in the midst of discussion of a content from different levels of education and/or disciplines of basic education. The possibilities to use this theme in classroom is also highlighted in Brazilian official documents that guide the practice of teachers of all Brazilian curricular components of this educational level. So, the theme water can be used as subsidy to teach chemistry, since contextualises the teaching of this discipline aiding in the discussion of different chemical concepts. In this perspective, the meaningful learning theory, developed by David Ausubel, has constructivist nature and says that an individual learns significantly when he can relate new information with a specific knowledge structure that integrates the prior knowledge of its structure. In this sense, the use of water as a theme for the approach prior knowledge of chemical concepts has already been characterized as an important topic that can give meaning to the content of education in chemistry. In this dissertation, a teaching unit potentially significant (TUPS) is presented based on meaningful learning theory of David Ausubel approaching the theme water. approaching the theme water. The unit was used in a class of thirty-five students of the 2nd year of high school, a public school in the city of Extremoz-RN, metropolitan region of Natal / RN. Through it was possible to discuss an issue of interest to students of the school to address the chemical contents, such as solutions, physicochemical aspects and stages of water treatment. At first, an initial questionnaire was used to identify the students' previous ideas on the topic under study to the concept of chemical solutions. It was subsequently developed and implemented a series of activities based on students' ideas. To subsidize the sequence, it was prepared four booklets that worked the content of chemical solutions, contextualizing the theme water. The results of this work showed that the alternative conceptions that students have about concepts related to the chemical solutions are similar to the ideas of other students presented in the literature and that the development of the TUPS, allied to the contextualization strategy with the theme water, not only motivated the students for the teaching of chemical content, as yet provided the learning of chemical concepts not in isolation, but making a connection between their ideas and experiences with scientific knowledge. To this, beyond of dialogued lectures, were also used strategies as experimental activities, problem solving, group discussions and construction of concept maps. The final evaluation of the unit was conducted by a questionnaire based on the Likert scale, answered individually by students, who approved the unit as conducive to teaching and learning of chemistry process