A systematic review of the literature comparing the practices of dispensing and non-dispensing doctors

Objectives: Some doctors perform the dual roles of prescribing and dispensing pharmaceuticals. The dispensing doctors (DDs) role may give rise to prescribing behaviours that vary from those of non-DDs. The aim of this review was to systematically and comparatively appraise the research evidence related to the practices of DDs. Methods: A systematic search of bibliographic databases and reference lists from selected papers were the sources of the data. Inclusion criteria were papers published in English, between 1970 and 2008 that provided quantitative data comparing the practices of DDs and non-DDs. At least two of the authors abstracted data from all eligible papers using a purpose-made data extraction form. Results: Twenty-one papers were included in this review. Evidence indicated that DDs prescribed more pharmaceutical items and less often generically than non-DDs. There was limited evidence to suggest that DDs prescribed less judiciously and were associated with poor dispensing standards. Patient convenience and access to pharmaceuticals were main reasons for doctors to dispense. Conclusion: DDs can fill an important gap in the provision of pharmaceuticals for their patients especially where health workforce shortages exist. There was evidence the dispensing role influenced prescribing. Patient convenience should be balanced against scarce medical resources, being utilised for dispensing.

Is quality more important if you’re quirky? A review of the literature on differential susceptibility to childcare environments

Evidence concerning the impact of child care on child development suggests that higher-quality environments, particularly those that are more responsive, predict more favourable social and behavioural outcomes. However, the extent of this effect is not as great as might be expected. Impacts on child outcomes are, at best, modest. One recent explanation emerging from a new theoretical perspective of development, differential susceptibility theory, is that a minority of children are more reactive to both positive and negative environments, while the majority are relatively unaffected. These 'quirky' children have temperamental traits that are more extreme, and are often described in research studies as having 'difficult temperaments'. This paper reviews the literature on such children and argues for the need for further research to identify components of childcare environments that optimise the potential of these more sensitive, quirky individuals.

Not all systematic reviews are systematic : a meta-review of the quality of systematic reviews for non-invasive remote monitoring in heart failure

Remote monitoring for heart failure has been evaluated in numerous systematic reviews. The aim of this meta-review was to appraise their quality and synthesise results. We electronically searched online databases, performed a forward citation search and hand-searched bibliographies. Systematic reviews of remote monitoring interventions that were used for surveillance of heart failure patients were included. Seven (41%) systematic reviews pooled results for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Five (29%) focused on telemonitoring. Four (24%) included both non-invasive and invasive technologies. According to AMSTAR criteria, ten (58%) systematic reviews were of poor methodological quality. In high quality reviews, the relative risk of mortality in patients who received remote monitoring ranged from 0.53 (95% CI=0.29-0.96) to 0.88 (95% CI=0.76-1.01). High quality reviews also reported that remote monitoring reduced the relative risk of all-cause (0.52; 95% CI=0.28-0.96 to 0.96; 95% CI=0.90–1.03) and heart failure-related hospitalizations (0.72; 95% CI=0.64–0.81 to RR 0.79; 95% CI=0.67-0.94) and, as a consequence, healthcare costs. As the high quality reviews reported that remote monitoring reduced hospitalizations, mortality and healthcare costs, research efforts should now be directed towards optimising these interventions in preparation for more widespread implementation.

Leadership of public education : an exploration of executive leaders in education Queensland

Education reform aimed at achieving improved student learning is a demanding challenge for leaders at all levels of education across the globe. In Queensland, Australia, Assistant Regional Directors, School Performance (ARD-SP) of public schools are executive leaders at the forefront of this challenge, working with groups, clusters, or networks of schools and one-on-one with principals, focusing on the performance of their schools. The ARD-SP role was recently established to positively impact student learning across the entire public school system in Queensland. The proposed study aimed to capture how ARDs-SP conceptualise and enact their leadership role. The study utilised a micropolitical perspective of leadership to understand the way in which these leaders talked about their leadership practices, their challenges, and the wider contextual factors impacting upon their work. A case study methodology guided the study and allowed ARDs-SP to share their understandings and enactment of executive leadership. A conceptual framework drawing upon the micropolitical leadership framework of Blase and Anderson (1995) was employed to analyse the research data gathered. Data were collected from Education Queensland (EQ) (i.e. that sector of the Department of Education and Training in Queensland responsible for public schools) policy material and reports and two rounds of semi-structured interviews with 18 ARD-SP participants and two senior EQ executives. The findings of this study were initially presented as four themes: performance, supervision, professional challenge, and system sustainability. They were then considered in the light of the literature and explored through the macro, meso, and micro layers within the conceptual framework. The key findings of this study found that ARDs-SP referred to using two different leadership approaches (i.e. an adversarial approach and/or a facilitative approach) when supervising school principals and the approach employed depended primarily upon the perceived performance of the principal. It was also found that the notion of supervision embedded within the role was perceived by ARDs-SP as problematic. These findings imply opportunities to refine the role and in doing so harness other system improvement strategies for EQ. An important contribution of this study was a reconceptualised conceptual framework that showed leadership approaches used by ARDs-SP as falling upon a continuum.

Cost effectiveness of patient education for the prevention of falls in hospital : economic evaluation from a randomized controlled trial

Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service.

Indigenous knowledge and IP food security : a review of concepts and cases

Dáwat, Pamahándí, Tawíd, Ságda, Lampísa, Ibabások, Lapát, Panedlák: for most of us gathered here, these are words that we don’t usually use in our daily lives. Others may consider them as exotic, alien, funny and even backward. However, for indigenous kindred among us, these words denote an intimate identity and deep understanding of the world around them. It constitutes a broader knowledge system, be written or otherwise, which guides them in the management of resources within their ancestral land. This paper will provide a brief theoretical framework of the concepts of indigenous knowledge systems—hereinafter called IKS, and indigenous peoples food security, and hopefully a deeper or continued appreciation in the study of both concepts in general.

Genes and growth performance in crustacean species : a review of relevant genomic studies in crustaceans and other taxa

Global aquaculture has expanded rapidly to address the increasing demand for aquatic protein needs and an uncertain future for wild fisheries. To date, however, most farmed aquatic stocks are essentially wild and little is known about their genomes or the genes that affect important economic traits in culture. Biologists have recognized that recent technological advances including next generation sequencing (NGS) have opened up the possibility of generating genome wide sequence data sets rapidly from non-model organisms at a reasonable cost. In an era when virtually any study organism can 'go genomic', understanding gene function and genetic effects on expressed quantitative trait locus phenotypes will be fundamental to future knowledge development. Many factors can influence the individual growth rate in target species but of particular importance in agriculture and aquaculture will be the identification and characterization of the specific gene loci that contribute important phenotypic variation to growth because the information can be applied to speed up genetic improvement programmes and to increase productivity via marker-assisted selection (MAS). While currently there is only limited genomic information available for any crustacean species, a number of putative candidate genes have been identified or implicated in growth and muscle development in some species. In an effort to stimulate increased research on the identification of growth-related genes in crustacean species, here we review the available information on: (i) associations between genes and growth reported in crustaceans, (ii) growth-related genes involved with moulting, (iii) muscle development and degradation genes involved in moulting, and; (iv) correlations between DNA sequences that have confirmed growth trait effects in farmed animal species used in terrestrial agriculture and related sequences in crustacean species. The information in concert can provide a foundation for increasing the rate at which knowledge about key genes affecting growth traits in crustacean species is gained.

A systematic review of baseline psychosocial characterisation in dietary randomised controlled trials for weight loss

BACKGROUND/OBJECTIVE: To investigate the extent of baseline psychosocial characterisation of subjects in published dietary randomised controlled trials (RCTs) for weight loss. SUBJECTS/METHODS: Systematic review of adequately sized (nX10) RCTs comprising X1 diet-alone arm for weight loss were included for this systematic review. More specifically, trials included overweight (body mass index 425 kg/m2) adults, were of duration X8 weeks and had body weight as the primary outcome. Exclusion criteria included specific psychological intervention (for example, Cognitive Behaviour Therapy (CBT)), use of web-based tools, use of supplements, liquid diets, replacement meals and very-low calorie diets. Physical activity intervention was restricted to general exercise only (not supervised or prescribed, for example, VO2 maximum level). RESULTS: Of 176 weight-loss RCTs published during 2008–2010, 15 met selection criteria and were assessed for reported psychological characterisation of subjects. All studies reported standard characterisation of clinical and biochemical characteristics of subjects. Eleven studies reported no psychological attributes of subjects (three of these did exclude those taking psychoactive medication). Three studies collected data on particular aspects of psychology related to specific research objectives (figure scale rating, satiety and quality-of-life). Only one study provided a comprehensive background on psychological attributes of subjects. CONCLUSION: Better characterisation in behaviour-change interventions will reduce potential confounding and enhance generalisability of such studies.

New media and the transformation of higher education

One set of public institutions that has seen growing discussion about the transformative impact of new media technologies has been universities. The higher education sector, historically one of the more venerable and stable areas of public life, is now the subject of almost continuous speculation about whether it can continue in its current form during the 21st century. Digital media technologies are often seen as being at the forefront of such changes. It has been widely noted that moves towards a knowledge economy generates ‘skills-biased technological change’, that places a premium upon higher education qualifications, and that this earnings gap remains despite the continuing increase in the number of university graduates. As the demand for higher education continues to grow worldwide, there are new discussions about whether technologically-mediated education through new forms such as Massively Open Online Courses (MOOCs) are broadening access to quality learning, or severing the vital connection between teacher and student seen as integral to the learning process. This paper critically appraises such debates in the context of early 21st century higher education. It will discuss ten drivers of change in higher education, many of which are related to themes discussed elsewhere in this book, such as the impact of social media, globalization, and a knowledge economy. It will also consider the issues raised in navigating such developments from the perspective of the ‘Five P’s’: practical issues; personal issues; pedagogical issues; policy issues; and philosophical issues. It also includes a critical evaluation of MOOCs from the point of view of their educational qualities. It will conclude with the observation that while universities will continue to play a significant – and perhaps growing – role in the economy, society and culture, the issues raised about what Clayton Christensen and Henry Eyring term the ‘disruptive university’ (Christensen and Eyring 2011) are nonetheless pressing ones, and that cost and policy pressures in particular are likely to generate significant institutional transformations in higher education worldwide.

The life course of Australian researchers : experiences of applying for research funding

The life course of Australian researchers includes regular funding applications, which incur large personal and time costs. We previously estimated that Australian researchers spent 550 years preparing 3,727 proposals for the 2012 NHMRC Project Grant funding round, at an estimated annual salary cost of AU$66 million. Despite the worldwide importance of funding rounds, there is little evidence on what researchers think of the application process. We conducted a web-based survey of Australian researchers (May–July 2013) asking about their experience with NHMRC Project Grants. Almost all researchers (n=224 at 31 May) supported changes to the application (96%) and peer-review (88%) processes; 73% supported the introduction of shorter initial Expressions of Interest; and half (50%) provided extensive comments on the NHMRC processes. Researchers agreed preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. More than half (57%) provided extensive comments on the ongoing personal impact of concurrent grant-writing and holiday seasons on family, children and other relationships. Researchers with experience on Grant Review Panels (34%) or as External Reviewers (78%) reported many sections of the proposals were rarely or never read, which suggests these sections could be cut with no impact on the quality of peer review. Our findings provide evidence on the experience of Australian researchers as applicants. The process of preparing, submitting and reviewing proposals could be streamlined to minimise the burden on applicants and peer reviewers, giving Australian researchers more time to work on actual research and be with their families.

Why are pedestrian crashes so different in developing countries? A review of relevant factors in relation to their impact in Ethiopia

Much is known about pedestrian behaviour and crash risk in developed countries. In contrast, the literature on pedestrian crash risk in developing countries reveals wide gaps in knowledge and understanding, and a comprehensive assessment is lacking. In particular, pedestrian behaviour in developing countries is fundamentally different in comparison to developed countries, and is influenced by a variety of less well understood contributing factors, leading to difficulty in modelling and predicting pedestrian crash risk and in turn identifying effective safety countermeasures. This paper provides a comprehensive synthesis of the factors known to influence pedestrian crash risk in developing countries, then focuses on Ethiopia as a specific example. The paper identifies where critical gaps in knowledge exist regarding pedestrian crash risk and associated behaviour in developing countries--a set of knowledge gaps which collectively are significant. The paper concludes by articulating a critical research path moving forward, with the aim to achieve an improved understanding of developing country pedestrian crash risk, and an ultimate goal of identifying effective pedestrian safety countermeasures suited to the unique challenges faced by transport system managers in developing countries.

Towards a dignified and sustainable electricity generation sector in Australia : a comparative review of three models

Electricity is the cornerstone of modern life. It is essential to economic stability and growth, jobs and improved living standards. Electricity is also the fundamental ingredient for a dignified life; it is the source of such basic human requirements as cooked food, a comfortable living temperature and essential health care. For these reasons, it is unimaginable that today's economies could function without electricity and the modern energy services that it delivers. Somewhat ironically, however, the current approach to electricity generation also contributes to two of the gravest and most persistent problems threatening the livelihood of humans. These problems are anthropogenic climate change and sustained human poverty. To address these challenges, the global electricity sector must reduce its reliance on fossil fuel sources. In this context, the object of this research is twofold. Initially it is to consider the design of the Renewable Energy (Electricity) Act 2000 (Cth) (Renewable Electricity Act), which represents Australia's primary regulatory approach to increase the production of renewable sourced electricity. This analysis is conducted by reference to the regulatory models that exist in Germany and Great Britain. Within this context, this thesis then evaluates whether the Renewable Electricity Act is designed effectively to contribute to a more sustainable and dignified electricity generation sector in Australia. On the basis of the appraisal of the Renewable Electricity Act, this thesis contends that while certain aspects of the regulatory regime have merit, ultimately its design does not represent an effective and coherent regulatory approach to increase the production of renewable sourced electricity. In this regard, this thesis proposes a number of recommendations to reform the existing regime. These recommendations are not intended to provide instantaneous or simple solutions to the current regulatory regime. Instead, the purpose of these recommendations is to establish the legal foundations for an effective regulatory regime that is designed to increase the production of renewable sourced electricity in Australia in order to contribute to a more sustainable and dignified approach to electricity production.

The effect of consumer education on unit price usage : an early exploratory study

Consumer awareness and usage of Unit Price (UP) information continues to hold academic interest. Originally designed as a device to enable shoppers to make comparisons between grocery products, it is argued consumers still lack a sufficient understanding of the device. Previous research has tended to focus on product choice, effect of time, and structural changes to price presentation. No studies have tested the effect of UP consumer education on grocery shopping expenditure. Supported by distributed learning theories, this is the first study to condition participants over a twenty week period, to comprehend and employ UP information while shopping. A 3x5 mixed factorial design was employed to collect data from 357 shoppers. A 3 (Control, Massed, Spaced) x 5 (Time Point: Week 0, 5, 10, 15 and 20) mixed factorial analysis of variance (ANOVA) was performed to analyse the data. Preliminary results revealed that the three groups differed in their average expenditure over the twenty weeks. The Control group remained stable across the five time points. Results indicated that both intensive (Massed) and less intensive (Spaced) exposure to UP information achieved similar results, with both group reducing average expenditure similarly by Week 5. These patterns held for twenty weeks, with conditioned groups reducing their grocery expenditure by over 10%. This research has academic value as a test of applied learning theories. We argue, retailers can attain considerable market advantages as efforts to enhance customers’ knowledge, through consumer education campaigns, can have a positive and strong impact on customer trust and goodwill toward the organisation. Hence, major practical implications for both regulators and retailers exist.

A wound management education and training needs analysis of health consumers and the relevant health workforce and stocktake of available education and training activities and resources

The goals of this project were to determine the education and training needs of health consumers and the relevant health workforce and to identify and map the available education and training activities and resources. The methods used to collect the data included online surveys and one on one interviews of relevant patients and their carers. The project manager actively sought to engage with the key wound management leaders and advanced clinicians to gain their support and views on the priority education and training issues. The response to all data collection methods was pleasing with almost five hundred responses to the general wound workforce online survey. The data supported the need for more wound management education and training and identified some particular topics of need, such as utilising wound investigations and understanding wound products, pharmaceuticals and devices. The occupational groups with the highest need appear to be those working in primary health care, such as practice nurses and GPs, and those working in residential aged care facilities. The education and training stocktake identified a wide range of activities currently available, the majority being provided in a face to face format. The next stage of the project will be to form some clear and achievable priority action areas based on the available data. An online directory of wound management education and training activities and resources will be developed and further development will be undertaken on a knowledge and skills framework for the wound management workforce. Additionally, transfer of learning factors in the general practice environment will be assessed and strategies will be developed to improve the pre-entry or undergraduate wound management training within relevant higher education programs.

Troubled Times in Australian Teacher Education : 2012-2013

The 2012 OLT National Teaching Fellowship described in this report has mapped and analysed the complex and competing internal and external agencies impacting on the whole-of-curriculum design in contemporary higher education in Australia, particularly on degrees in Education with an emphasis on initial teacher education. The Fellowship was conducted at a time of both heightened public and political scrutiny of teacher education and the imposition of new nationally-consistent accreditation processes. This scrutiny culminated in a call by the previous Federal Government for TEQSA (Tertiary Education Quality Standards Agency) to conduct a comprehensive review of teacher education beginning in 2014 and the incoming Government announcing it will establish a short term ministerial advisory group to report on the “priority issue of improving teacher quality” (Pyne, 2013).