PRN Sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service

Objective: To identify utilisation rates of prn (pro re nata) sedation in children and adolescents receiving inpatient psychiatric treatment, and to compare correlates of prn prescribing and administration. Method A retrospective chart review examined 122 medical charts from a child and youth mental health inpatient service. Results 71.3% of patients were prescribed prn sedation and 50.8% were administered prn sedation. Patients received an average of 8.0 doses of prn sedation, with 9.8% receiving 10 or more doses. Chlorpromazine and diazepam were the most commonly utilised agents. Prescribing of prn sedation was only related to use of regular medications (p < 0.01), and non-parent carers (p < 0.01). In contrast, administration of prn sedation was associated with multiple diagnoses (p < 0.01), pervasive development disorder (p < 0.01), mental retardation (p < 0.01) ADHD (p < 0.01), longer hospital admission (p < 0.01), use of atypical antipsychotics (p < 0.01) and polypharmacy (p < 0.01). Conclusions Despite lack of data to inform practice, prn sedation is widely utilised, especially in complex patients. Future research in this area needs to incorporate nurses and examine whether patients benefit from prn sedation, which drugs and dosing patterns optimise safety and efficacy, and what is the role of prn sedation in the context of other medication.

The diagnostic interview for psychoses (DIP): development, reliability and applications

Background. We describe the development, reliability and applications of the Diagnostic Interview for Psychoses (DIP), a comprehensive interview schedule for psychotic disorders. Method. The DIP is intended for use by interviewers with a clinical background and was designed to occupy the middle ground between fully structured, lay-administered schedules, and semi-structured., psychiatrist-administered interviews. It encompasses four main domains: (a) demographic data; (b) social functioning and disability; (c) a diagnostic module comprising symptoms, signs and past history ratings; and (d) patterns of service utilization Lind patient-perceived need for services. It generates diagnoses according to several sets of criteria using the OPCRIT computerized diagnostic algorithm and can be administered either on-screen or in a hard-copy format. Results. The DIP proved easy to use and was well accepted in the field. For the diagnostic module, inter-rater reliability was assessed on 20 cases rated by 24 clinicians: good reliability was demonstrated for both ICD-10 and DSM-III-R diagnoses. Seven cases were interviewed 2-11 weeks apart to determine test-retest reliability, with pairwise agreement of 0.8-1.0 for most items. Diagnostic validity was assessed in 10 cases, interviewed with the DIP and using the SCAN as 'gold standard': in nine cases clinical diagnoses were in agreement. Conclusions. The DIP is suitable for use in large-scale epidemiological studies of psychotic disorders. as well as in smaller Studies where time is at a premium. While the diagnostic module stands on its own, the full DIP schedule, covering demography, social functioning and service utilization makes it a versatile multi-purpose tool.

Essays on Development Policy and the Political Economy of Conflict

Electoral Rules and Leader Selection: Experimental Evidence from Ugandan Community Groups. Despite a large body of work documenting how electoral systems affect policy outcomes, less is known about their impact on leader selection. We study this by comparing two types of participatory decision making in Ugandan community groups: (i) vote by secret ballot and (ii) open discussion with consensus. Random assignment allows us to estimate the causal impact of the rules on leader types and social service delivery. Vote groups are found to elect leaders more similar to the average member while discussion group leaders are positively selected on socio-economic characteristics. Further, dropout rates are significantly higher in discussion groups, particularly for poorer members. After 3.5 years, vote groups are larger in size and their members save less and get smaller loans. We conclude that the secret ballot vote creates more inclusive groups while open discussion groups favor the already economically successful. Preparing for Genocide: Community Meetings in Rwanda. How do political elites prepare the civilian population for participation in violent conflict? We empirically investigate this question using data from the Rwandan Genocide in 1994. Every Saturday before 1994, Rwandan villagers had to meet to work on community infrastructure. The practice was highly politicized and, according to anecdotal evidence, regularly used by the political elites for spreading propaganda in the years before the genocide. This paper presents the first quantitative evidence of this abuse of the community meetings. To establish causality, we exploit cross-sectional variation in meeting intensity induced by exogenous weather fluctuations. We find that an additional rainy Saturday resulted in a five percent lower civilian participation rate in genocide violence. Selection into Borrowing: Survey Evidence from Uganda. In this paper, I study how changes to the standard credit contract affect loan demand and selection into borrowing, using a representative sample of urban micro enterprises, most with no borrowing experience. Hypothetical loan demand questions are used to test whether firm owners respond to changes in loans' contractual terms and whether take-up varies by firms' risk type and other firm owner characteristics. The results indicate that contracts with lower interest rates and less stringent collateral requirements attract less risky borrowers, suggesting that there is scope for improvement of standard financial contract terms. Credit Contract Structure and Firm Growth: Evidence from a Randomized Control Trial. We study the effects of credit contract structure on firm outcomes among small and medium sized firms. A randomized control trial was carried out to distinguish between some of the key constraints to efficient credit use connected to the firms' business environment and production function, namely (i) backloaded returns (ii) uncertain returns and (iii) indivisible fixed costs. Each firm was followed for the 1-year loan cycle. We describe the experiment and present preliminary results from the first 754 out of 2,340 firms to have completed the loan cycle. Firms offered a grace period have higher profits and higher household income than firms receiving a rebate later on as well as the control group. They also increased the number of paid employees  and reduced the number of unpaid employees, an effect also found among firms that received a cash subsidy at the beginning of the loan cycle. We discuss potential mechanisms behind these effects.

Causes of tension in post-observation feedback in pre-service teacher training: an alternative view

A central component in pre-service teacher training is teaching practice and feedback. In some cases, feedback results in disquiet and tension (Brandt, 2008). Many researchers attribute this tension to the incompatibility of the assessment and development roles that the trainer must perform. The research reported on here, however, suggests that tension may also be rooted in a difference in expectation amongst trainers and trainees about the purpose and performance of feedback. This can result in trainees not playing by the rules of the game (Roberts & Sarangi, 2001) either because they do not understand them or because they wish to challenge them.

Information system planning in drug service:a case study

The development of an information system in Caribbean public sector organisations is usually seen as a matter of installing hardware and software according to a directive from senior management, without much planning. This causes huge investment in procuring hardware and software without improving overall system performance. Increasingly, Caribbean organisations are looking for assurances on information system performance before making investment decisions not only to satisfy the funding agencies, but also to be competitive in this dynamic and global business world. This study demonstrates an information system planning approach using a process-reengineering framework. Firstly, the stakeholders for the business functions are identified along with their relationships and requirements. Secondly, process reengineering is carried out to develop the system requirements. Accordingly, information technology is selected through detailed system requirement analysis. Thirdly, cost-benefit analysis, identification of critical success factors and risk analysis are carried out to strengthen the selection. The entire methodology has been demonstrated through an information system project in the Barbados drug service, a public sector organisation in the Caribbean.

The service leadership scale:a substantive validity test

The authors report results from preliminary stages of the development and validation of a scale of service leadership. Firstly, items generated from qualitative interviews are discussed and the conceptual dimensions of the service leadership scale are formulated. Following this, results from the application of Anderson and Gerbing’s (1991) substantive validity test are examined and interpreted, giving indication of further scale development issues. Finally, conclusions and future research directions are presented.

The digital divide and ICT learning in rural communities:examples of good practice service delivery

This article aims to gain a greater understanding of relevant and successful methods of stimulating an ICT culture and skills development in rural areas. The paper distils good practice activities, utilizing criteria derived from a review of the rural dimensions of ICT learning, from a range of relevant initiatives and programmes. These good practice activities cover: community resource centres providing opportunities for ‘tasting’ ICTs; video games and Internet Cafe´s as tools removing ‘entry barriers’; emphasis on ‘user management’ as a means of creating ownership; service delivery beyond fixed locations; use of ICT capacities in the delivery of general services; and selected use of financial support.

Intra-industry foreign direct investment, uneven development and globalization:the legacy of Stephen Hymer

This paper revisits the issue of intra-industry foreign direct investment (FDI). This issue was considered in Stephen Hymer's early work, but was not subsequently developed, and was largely ignored in the literature for some time. Using the example of the UK, this paper traces the patterns of intra-industry FDI, both across countries and industries, for both the manufacturing and service sectors. Despite the undoubted increase in the integration of goods and factor markets since the time of Hymer's writing, the analysis presented here shows that the pattern has changed little in the last 40 years. The paper then goes on to discuss the motives for intra-industry FDI, relating it to technology flows and factor cost differentials. Finally, we present some analysis relating intra-industry FDI to uneven development, both between developed and developing countries, and between regions of a developed country. It is clear that intra-industry FDI is still very much a developed country phenomenon, as Hymer suggested, with both developing countries and poorer regions of developed countries unlikely to reap any of the benefits. In this context, one-way and two-way FDI must be seen as different phenomena within the debate on globalisation. © The Author 2005. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved.

Organizational resources enabling service responsiveness:evidence from Greece

This article examines the implementation of relationship marketing strategy based on a sample of business-to-business firms operating in Greece. Organizational resources, including a focus on learning and flexibility/adaptation in strategic planning, are demonstrated to be antecedents of effective relationship marketing strategies. The possession of these resources lead to superior customer performance (as measured by customer satisfaction and loyalty) and, ultimately, superior financial performance (as measured by profit levels, profit margin, and ROI). Our results provide support for the development of organizational resources that foster and enable relationship marketing in business-to-business environments since such resources are linked with improved firm performance. © 2003 Elsevier Inc. All rights reserved.

The strategic role of relational capabilities in the business-to-business service profit chain

This paper extends the original service profit chain by examining the role of relational capabilities with employees, customers and strategic partners on process and performance outcomes in a business-to-business context. More specifically, we demonstrate how satisfied and loyal employees are better in developing relationships with customers and strategic partners. These relationships enable firms to be more responsive towards customers and become more innovative, which increase customer satisfaction and loyalty and, ultimately, financial performance. Our results provide support for the development of relational capabilities in a business-to-business environment by extending the service profit chain (SPC) model. However, we find that while the development of strong customer relationships contributes to an improved service responsiveness of the firm, strategic partners do not.

Exploring value through integrated service solutions:the case of e-grocery shopping

Purpose – The purpose of this paper is to demonstrate the need for an improved understanding of consumer value for online grocery purchases and to propose the notion of “integrated service solution” packages as a strategy for growing and successfully sustaining the channel to guide both marketing strategy and policy. Design/methodology/approach – This paper integrates and synthesises research from retailing, consumer behaviour and service quality literatures in order to develop a conceptual framework for understanding the value of e-grocery shopping to aid practitioners to address the critical needs, expectations and concerns of consumers for the development of grocery shopping within the online environment. Findings – This paper offers an alternative approach to allow e-grocery to become a mainstream retail channel in its own right and not to compete with the in-store offerings. The research demonstrates the need for a progressive approach that follows contemporary consumer needs and habits at the household level. The conjecture is that shopping for fast-moving consumer goods follows a learning path that needs to be replicated in the online context. Moreover, it is suggested that consumer resistance to the adoption of the new channel should be addressed not only from a technological perspective but also from the social aspects of online shopping. Originality/value – The research provides a practical framework for both retailers and policy makers on how the “next generation” of online services can be developed using a “bottom up” consumer perspective. This paper also advocates a non-technological bias to e-grocery retailing strategy.