Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of ��-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended ���evidence-based practice��� diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

ICU nurses' experiences and perspectives of caring for obstetric patients in intensive care: A qualitative study

Aims and objectives.��� The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Background.��� Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. Design.��� This study used a descriptive qualitative design. Methods.��� Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. Results.��� The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. Conclusion.��� The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Relevance to clinical practice.��� Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.

Implementing dance in a Queensland primary school : a descriptive case study

This research documents and analyses the modes of implementation of the Dance component of The Arts Essential Learnings in a Queensland school. The research identifies what makes good practice in dance education and the multiple modes of implementation that support this practice. The primary purpose of this research is to describe the factors that influence dance education, as it is delivered, in a Queensland primary school to inform the development of further support for primary teachers and to improve the quality of dance education in Prep -7 schooling. The literature review investigates dance education both in Queensland, Australia and internationally, identifying current issues related to the delivery of dance in a primary school environment including barriers to implementation of dance, authentic learning and integrated approaches to learning. Based on Engestrom.s reformulation of Vygotsky.s theory of socially mediated learning, the implementation of dance education curriculum was explored through descriptive case study method. The case study was conducted in a regional Queensland school identified as delivering the dance curriculum in a variety of ways. The research project provided opportunities to observe, document and analyse how teachers deal with pedagogical dilemmas and solve logistical problems associated with teaching the dance component of the Arts curriculum in this school. Teachers. practices were contextualised through investigation of the whole school context of dance curriculum development. The findings revealed a range of teaching approaches that influenced teachers. interpretation and children.s experience of the dance curriculum. The features of a supportive whole school and cultural environment for dance were identified. These have been captured in a reworked version of Engestrom.s Second Generation Activity Theory that can be applied to the implementation of dance education in primary schools.

A case study of how primary school teachers in Papua New Guinea understand outcomes-based education

This case study explored how a group of primary school teachers in Papua New Guinea (PNG) understood Outcomes-based Education (OBE). OBE measures students. learning against specific outcomes. These outcomes are derived from a country.s vision of the kind of citizen that the education system should produce. While countries such as Australia, South Africa, New Zealand and the United States have abandoned OBE, others such as PNG have adopted it in various ways. How teachers understand OBE in PNG is important because such understandings are likely to influence how they implement the OBE curriculum. There has been no research to date which has investigated PNG primary school teachers. understandings and experiences with OBE. This study used a single exploratory case study design to investigate how twenty primary school teachers from the National Capital District (NCD) in PNG understood OBE. The study, underpinned by an intepretivist paradigm, explored the research question: How do primary school teachers understand outcomes-based education in PNG? The data comprised surveys, in-depth interviews and documents. Data were analysed thematically and using explanation building techniques. The findings revealed that OBE is viewed by teachers as a way to equip them with additional strategies for planning and programming, teaching and learning, and assessment. Teachers also described how OBE enabled both students and teachers to become more engaged and develop positive attitudes towards teaching and learning. There was also a perception that OBE enhanced students. future life skills through increased local community support. While some teachers commented on how the OBE reforms provided them with increased professional development opportunities, the greatest impediment to implementing OBE was perceived to be a lack of sufficient teaching and learning resources. The process of planning and programming classroom activities was also regarded as onerous. Some teachers indicated that they had been required to implement OBE without adequate in-service training support. The social constructivist theory of knowledge which underpins OBE.s student-centred pedagogy can cause tensions within PNG.s cultural contexts of teaching and learning. Teachers need to be aware of these tensions when conducting peer or group learning under OBE in PNG. By exploring how these PNG primary teachers understood OBE, the study highlighted how teachers engaged with OBE concepts when interpreting syllabus documents and how they applied these concepts to curriculum. Identifying differences in teacher understanding of OBE provides guidance for both the design of materials to support the implementation of OBE and for the design of in-service training. Thus, the outcomes of this study will inform educators about the implementation of OBE in PNG. In addition, the outcomes will provide much needed insight into how a mandated curriculum and pedagogical reform impacts teachers��� practices in PNG.

Clinical factors and technological barriers as determinants for the intention to use wireless handheld technology in healthcare environment: an Indian case study

Abstract]: Traditional technology adoption models identified ���ease of use��� and ���usefulness��� as the dominating factors for technology adoption. However, recent studies in healthcare have established that these two factors are not always reliable on their own and other factors may influence technology adoption. To establish the identity of these additional factors, a mixed method approach was used and data were collected through interviews and a survey. The survey instrument was specifically developed for this study so that it is relevant to the Indian healthcare setting. We identified clinical management and technological barriers as the dominant factors influencing the wireless handheld technology adoption in the Indian healthcare environment. The results of this study showed that new technology models will benefit by considering the clinical influences of wireless handheld technology, in addition to known factors. The scope of this study is restricted to wireless handheld devices such as PDAs, smart phones, and handheld PCs Gururajan, Raj and Hafeez-Baig, Abdul and Gururajan, Vijaya

Managing knowledge for enterprise systems in indian organizations: Case study insights

Many Enterprise Systems (ES) projects have reported nil or detrimental impacts despite the substantial investment in the system. Having expected positive outcomes for the organization and its functions through the weighty spend, the effective management of ES-related knowledge has been suggested as a critical success factor for these ES projects in ES implementations. This paper suggests theoretical views purporting the importance of understanding on knowledge management for ES success. To explain the complex, dynamic and multifaceted of knowledge management, we adopt the concepts in Learning Network Theory. We then conceptualized the impact of knowledge management on ES by analyzing five case studies in several industries in India, based on the Knowledge-based Theory of the Firm that captures the performance of the system.

An empirical study of applying ISO 9001 elements in large size Indonesian contractors

The effective implementation of such an ISO 9001 Quality Management System (QMS) in construction companies requires a proper and full implementation of the system to allow companies to improve the way they operate, by this means increasing profitability and market share, producing innovative and sustainable construction products, or improving employee and customer satisfaction. In light of this, this paper discusses the current status of QMS implementation, particularly related to the twenty elements of ISO 9001 within the grade 7 (G-7) category of Indonesian construction companies. A survey was conducted involving 403 respondents from 77 companies, to solicit an evaluation of the current implementation levels of the ISO 9001 elements. The survey findings indicated that for a large percentage of the sector surveyed they had ���not so fully implemented��� the elements. Scrutiny of the data had also indicated elements that are ���minimally implemented���, whilst none of the elements fell in the category of ���fully implemented���. Based on these findings, it is suggested that the G-7 contractors may need to fully commit to practicing control of customer-supplied product and statistical techniques in order to enhance an effective implementation of ISO 9001 elements for ensuring better quality performance. These two elements are recognized as the least implemented of the quality elements.

Successes and stresses : A case study on relations between international higher degree students in Australia and their universities.

The paper examines the situation of postgraduate international students studying in Australia, mostly at doctoral level; a group widely seen as sought-after by Australian universities and employers, though also exposed to difficulties in aspects like learning culture, language and temporary employment. The investigation follows a novel path, as an exercise in practice-led research on issues involved in Higher Degree supervision. It is in fact an exercise within an advanced program of professional development for HD research supervisors. It begins by deploying a journalistic method, to obtain and present information. This has entailed the publishing of two feature articles about the lives of scholars for Subtropic, a campus based online magazine in Brisbane, www.subtropic.com.au. The next step is a review of a set of supervisions, citing issues raised in individual cases. Parallels can be seen between the two information-getting and analytical processes, with scope for contradictions. An exegetical statement deals with supervisory issues that have been exposed, and implications for learning, with recommendations for developing the quality of the experience of these students.

Assessment policy change in relation to English language teaching and learning in China : a study of perspectives from two universities

In response to concerns about the quality of English Language Learning (ELL) education at tertiary level, the Chinese Ministry of Education (CMoE) launched the College English Reform Program (CERP) in 2004. By means of a press release (CMoE, 2005) and a guideline document titled College English Curriculum Requirements (CECR) (CMoE, 2007), the CERP proposed two major changes to the College English assessment policy, which were: (1) the shift to optional status for the compulsory external test, the College English Test Band 4 (CET4); and (2) the incorporation of formative assessment into the existing summative assessment framework. This study investigated the interactions between the College English assessment policy change, the theoretical underpinnings, and the assessment practices within two Chinese universities (one Key University and one Non-Key University). It adopted a sociocultural theoretical perspective to examine the implementation process as experienced by local actors of institutional and classroom levels. Systematic data analysis using a constant comparative method (Merriam, 1998) revealed that contextual factors and implementation issues did not lead to significant differences in the two cases. Lack of training in assessment and the sociocultural factors such as the traditional emphasis on the product of learning and hierarchical teacher/students relationship are decisive and responsible for the limited effect of the reform.

Inquiry teaching in primary science : a phenomenographic study

In spite of having a long history in education, inquiry teaching (the teaching in ways that foster inquiry based learning in students) in science education is still a highly problematic issue. However, before teacher educators can hope to effectively influence teacher implementation of inquiry teaching in the science classroom, educators need to understand teachers��� current conceptions of inquiry teaching. This study describes the qualitatively different ways in which 20 primary school teachers experienced inquiry teaching in science education. A phenomenographic approach was adopted and data sourced from interviews of these teachers. The three categories of experiences that emerged from this study were; Student Centred Experiences (Category 1), Teacher Generated Problems (Category 2), and Student Generated Questions (Category 3). In Category 1 teachers structure their teaching around students sensory experiences, expecting that students will see, hear, feel and do interesting things that will focus their attention, have them asking science questions, and improve their engagement in learning. In Category 2 teachers structure their teaching around a given problem they have designed and that the students are required to solve. In Category 3 teachers structure their teaching around helping students to ask and answer their own questions about phenomena. These categories describe a hierarchy with the Student Generated Questions Category as the most inclusive. These categories were contrasted with contemporary educational theory, and it was found that when given the chance to voice their own conceptions without such comparison teachers speak of inquiry teaching in only one of the three categories mentioned. These results also help inform our theoretical understanding of teacher conceptions of inquiry teaching. Knowing what teachers actually experience as inquiry teaching, as opposed to understand theoretically, is a valuable contribution to the literature. This knowledge provides a valuable contribution to educational theory, which helps policy, curriculum development, and the practicing primary school teachers to more fully understand and implement the best educative practices in their daily work. Having teachers experience the qualitatively different ways of experiencing inquiry teaching uncovered in this study is expected to help teachers to move towards a more student-centred, authentic inquiry outcome for their students and themselves. Going beyond this to challenge teacher epistemological beliefs regarding the source of knowledge may also assist them in developing more informed notions of the nature of science and of scientific inquiry during professional development opportunities. The development of scientific literacy in students, a high priority for governments worldwide, will only to benefit from these initiatives.