A review of three years experience using email and videoconferencing for the delivery of post-acute burns care to children in Queensland

A virtual outpatient service has been established in Queensland for the delivery of post-acute burns care to children living in rural and remote areas of the state. The integration of telepaediatrics as a routine service has reduced the need for patient travel to the specialist burns unit situated in Brisbane. We have conducted 293 patient consultations over a period of 3 years. A retrospective review of our experience has shown that post-acute burns care can be delivered using videoconferencing, email and the telephone. Telepaediatric bums services have been valuable in two key areas. The first area involves a programme of routine specialist clinics via videoconference. The second area relates to ad-hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need. The families of patients have expressed a high degree of satisfaction with the service. Telepaediatric services have helped improve access to specialist services for people living in rural and remote communities throughout Queensland. (C) 2003 Elsevier Ltd and ISBI. All rights reserved.

'I never imagined I'd have to teach these children': Providing authentic learning experiences for secondary pre-service teachers in teaching students with special needs

This article describes a collaborative and cross-curricula initiative undertaken in the School of Education at the University of Queensland, Brisbane, Australia. The project involved developing an integrated approach to providing professional year pre-service secondary teacher education students with experiences that would assist them to develop their knowledge and skills to teach students with special needs in their classrooms. These experiences were undertaken in the authentic teaching and learning context of a post-school literacy program for young adults with intellectual disabilities. In preliminary interviews pre-service teachers revealed that they lacked experience, knowledge and understanding related to teaching students with special needs, and felt that their teacher education program lacked focus in this field. This project was developed in response to these expressed needs. Through participating in the project, pre-service teachers' knowledge and understanding about working with students with diverse learning needs were developed as they undertook real and purposeful tasks in an authentic context.

Motherhood plans among young Australian women - Who Wants children these days?

Fertility rates in the developed world have been below replacement level for 25 years, and it is often assumed that this results from deliberate, unconstrained individual choice. Data from 7448 childless women aged 22 to 27, participating in the Australian Longitudinal Study on Women's Health, indicate that 9 per cent aspire to childlessness, with 72 per cent wanting I or 2 children and 19 per cent more. Differences in psychological functioning disappear after adjustment for socioeconomic variables. Women wanting 1 or 2 children also want paid work, while those wanting many children generally have traditional aspirations. Policy-makers need to consider strategies that support women to negotiate motherhood and paid work.

National audit of post-operative management in spinal surgery

Background: There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. Methods: We conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients. The survey included all surgeons who were members of either the British Association of Spinal Surgeons ( BASS) or the Society for Back Pain Research. Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire. Results: Usable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79%) had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55%) of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons. Conclusion: Demonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.

An n-of-1 trial service in clinical practice: Testing the effectiveness of stimulants for attention-deficit/hyperactivity disorder

OBJECTIVE. We sought to describe the clinical use of n-of-1 trials for attention-deficit/hyperactivity disorder in publicly and privately funded family and specialized pediatric practice in Australia. METHODS. We used a within-patient randomized, double-blind, crossover comparison of stimulant (dexamphetamine or methylphenidate) versus placebo or alternative stimulant using 3 pairs of treatment periods. Trials were conducted from a central location using mail and telephone communication, with local supervision by the patients' clinicians. PATIENTS. Our study population included children with clinically diagnosed attention-deficit/ hyperactivity disorder who were aged 5 to 16 years and previously stabilized on an optimal dose of stimulant. They were selected because treatment effectiveness was uncertain. MAIN OUTCOME MEASURES. Our measures included number of patients recruited, number of doctors who used the service, geographic spread, completion rates, response rate, and post-n-of-1 trial decisions. RESULTS. Forty-five doctors across Australia requested 108 n-of-1 trials, of which 86 were completed. In 69 drug-versus-placebo comparisons, 29 children responded better to stimulant than placebo. Immediately posttrial, 19 of 25 drug-versus-placebo responders stayed on the same stimulant, and 13 of 24 nonresponders ceased or switched stimulants. In 40 of 63 for which data were available, posttrial management was consistent with the trial results. For all types of n-of-1 trials, management changed for 28 of 64 children for whom information was available. DISCUSSION. Attention-deficit/hyperactivity disorder n-of-1 trials can be implemented successfully by mail and telephone communication. This type of trial can be valuable in clarifying treatment effect when it is uncertain, and in this series, they had a noticeable impact on short-term management.

Post-Fordism, the welfare state and the personal social services: A comparison of Australia and Britain

The Post-Fordist welfare state thesis locates contemporary social welfare change within a wider analysis of the transformation of capitalist accumulation regimes. Whilst this analysis is useful in directing attention to macro socio-economic change, it has for the most part contained three shortcomings. First, the Post-Fordist thesis has overemphasized the role of historical 'breaks' in the development of social welfare as it purportedly passes from Fordism to Post-Fordism. Second, the thesis has assumed a degree of convergence between welfare states as a result of global economic forces. In doing so, it has underemphasized the mediating impact of existing institutional arrangements within nations. Third, the thesis has assumed, rather than demonstrated, the specific changes which are alleged to be taking place in various fields of social welfare. As a consequence, aspects of continuity in social welfare have been neglected. These three lacunae are addressed through a comparative analysis of developments in the personal social services in Australia and Britain. Services to older people are employed as the specific context of comparison in relation to three dimensions of measuring transformation along a Post-Fordist trajectory: a shift from a unitary economy to a mixed economy of service provision; changes in the model of service delivery and consumption; and strengthening the governance function of the central state. This comparative analysis suggests the need for refinement of the Post-Fordist welfare state thesis concerning the restructuring of social welfare and its impact on the personal social services.

External audit in the National Health Service in England and Wales:a study of an oversight body's control of auditor remuneration

In the National Health Service (NHS) in England and Wales an oversight body, the Audit Commission (AC), defines the scope of the external auditors’ work, appoints the auditors and has oversight of their fees and audit quality. This heavily regulated audit regime mitigates some of the deficiencies observed in high profile corporate failures. Independence, it has been argued, is influenced by the total auditor remuneration paid by the client. In this study we examine total auditor remuneration in a regulated market which seeks to ensure audit independence and audit quality. In particular we undertake rigorous analysis of auditor remuneration by the type of auditor: We place emphasis on the differentiation between private sector firms and the AC’s in-house auditors (District Audit). Individual private audit firms charge premiums (up to 16%) for particular audit work in identified locations, but no premiums were found when we examined total auditor remuneration. The regime appears to permit efficient operation of the audit market while safeguarding both audit independence and standards.

The post-adoption phase of the broadband in small businesses

In spite of the increasing significance of broadband, many small and medium enterprises (SMEs) are unaware of or unappreciative of its benefits. This is potentially a problem for governments, Internet Service Providers and other supply side institutions. The current study empirically verifies applicability of an extended IS continuance model controlling for organizational variables based on the Technology-Organization-Environment framework to examine factors influencing broadband post-adoption behavior of SMEs in Singapore. Strong support for the model has been manifested by the results, providing insight into influential factors. Results of the study suggest that perceived usefulness is a strong predictor of users’ continuance intention, followed by satisfaction with broadband usage as a significant but weaker predictor. SMEs in a more competitive business environment and whose key executive possesses greater IT knowledge are more likely to use broadband.

Public libraries, citizens and the post democracy

This essay explores the relationship between the development of public libraries in the context of an increasingly market-dominated economy and marketised society. It argues that although neo-liberalism as a policy goal and practice has taken different forms over time, there are common themes in terms of its emphasis on market values, privatisation, and the support of measures that reduce the role of public funding and the state in the provision of public services. This has led some commentators to express concerns that the meaning and practice of citizenship and democracy is being transformed, managed or otherwise diminished. These concerns are compounded by changes effected by new digital technology. Imbricated with this issue are debates surrounding the future of the public library, and attempts by librarians and others to reinvent and reimagine its purpose. With reference to some innovative initiatives in the USA and Scandinavia, it is suggested that public libraries, through their service and spatial rearticulation, can conceivably help strengthen and revitalise public democracy and the public sphere.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

A post-structural analysis of perceptions and experiences of continuity and change within the UK automotive supplier base

Firms acting as suppliers to the British automotive industry have a long history of so doing, with some evidencing histories that predate even the invention of the motor car. In exploring the challenges faced by the descendants of these firms in the 1990s, a review is undertaken of the bodies of literature surrounding the changes wrought through the increased globalisation of the industry; the impact of new manufacturing technologies and techniques; the rising levels of co-operation between firms; and the growing impact of the automotive 'service sector'. Moreover, an exploration is undertaken of the perceived 'realities' of the automotive industry as constructed through discourse, including the ways in which discourse effects a continual reinterpretation and re-evaluation of the historical evolution of the industry. Attention is focused on the implications of the above for the automotive supply chain, and the means for its rationalisation proposed by the major car manufacturers and their partner-suppliers. Post-structuralist approaches are introduced as part of an attempt to establish and appropriate research methodology that can explore and deconstruct the discourses surrounding 'modernity', 'supply chain rationalisation', 'flexible specialisation' and 'globalisation' within the automotive industry. Analytical research is conducted into the small- to medium-sized business that constitute the majority of the supplier base in the United Kingdom, and the findings of this research are compared with those of a similar study conducted a quarter-century ago. In this way, the relationships of these firms with their customers, suppliers, and peers are investigated, as are their perceptions of a changing marketplace and their reactions to the impact of policies such as the 'supply chain rationalisation' pursued by the major automotive manufacturers. Authoritative discourses of industry form, function, and structure are challenged, with voice being granted to the marginalised: small suppliers, 'service sector' firms, or those only partly involved in the automotive industry.

An investigation of the relationships between service quality, customer satisfaction, perceived value and behavioural intentions

Customer satisfaction and service quality are two important concepts in the marketing literature. However, there has been some confusion about the conceptualisation and measurement of these two concepts and the nature of the relationship between them. The primary objective of this research was to develop a more thorough understanding of these concepts, and a model that could help to explain the links between them and their relationships with post-purchase behaviour. A preliminary theoretical model was developed, based on an exhaustive review of the literature. Following exploratory research, the model was revised by incorporating "Perceived Value" and "Perceived Sacrifice" to help explain customer's post-purchase behaviour. A longitudinal survey was conducted in the context of the restaurant industry, and the data were analysed using structural equation modelling. The results provided evidence to support the main research hypotheses. However, the effect of "Normative Expectations" on "Encounter Quality" was insignificant, and "Perceived Value" had a direct effect on "Behavioural Intentions" despite expectations that such an effect would be mediated through "Customer Satisfaction". It was also found that "Normative Expectations" were relatively more stable than "Predictive Expectations". It is argued that the present research significantly contributes to the marketing literature, and in particular the role of perceived value in the formation of customers' post-purchase behaviour. Further research efforts in this area are warranted.

Human resource management, employee attitudes and business performance in Post Office Ltd

Whilst a consistent link between the adoption of human resource management (HRM) practices by organisations and their performance has been confirmed by numerous studies, there is a need for greater understanding of why such effects occur. Recently, the attention of researchers has shifted towards understanding the so-called ‘black box’ linking HRM and business performance. This study focuses on this area of research by testing processes through which HRM may affect performance, in particular the process of HR implementation, mediation mechanisms, and fit with internal and external boundary conditions. This research was based on a sample of 136 Post Office branches in the UK and investigated the role of HR implementation, employee attitudes and competitive environment. The study revealed that HR implementation, a climate for service, job satisfaction and effective organisational commitment predicted independent measures of economic and service performance in branches. Employee attitudes moderated the relationship between implemented HRM and service performance, and both job satisfaction and commitment were found to mediate relationships between a climate for service and service performance. Finally, relative levels of competition faced by branches moderated the relationship between employee attitudes and sales. The findings demonstrate how the process of HR implementation, interactions with employee attitudes and moderation by external competition all influence the impact of HR systems on service and economic performance outcomes. These results illustrate the need for greater attention to processes of internal and external fit within HRM research in order to develop theory relating to why HR systems affect performance.