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This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664109910306749. When citing the article, please cite: Paul Hattam, Alison Smeatham, (1999), “Evaluation of an orthopaedic screening service in primary care”, British Journal of Clinical Governance, Vol. 4 Iss: 2, pp. 45 - 49.
Improving the management of the orthopaedic patient has long been a top priority in healthcare provision in the UK. For the past two decades, successive governments have…
Improving the management of the orthopaedic patient has long been a top priority in healthcare provision in the UK. For the past two decades, successive governments have funded a plethora of “waiting list initiatives” in order to reduce waiting times for both in and outpatients. In recent years, extended scope physiotherapists (ESPs) have become increasingly involved in making clinical management decisions for all orthopaedic patients – a process known as “triaging”. Their effectiveness in this triaging role remains largely untested despite having far reaching implications in terms of service delivery, professional recognition and patient satisfaction. The study is cross‐sectional in design using a survey to retrieve archival outcome data from hospital case notes of patients referred by ESPs for consultant management. The time‐framed sample yielded 170 subjects with a wide range of disorders distributed across all anatomical regions. The data was categorised so that effectiveness could be measured by judging the specificity and appropriateness of referral. Results and the possibility of developing the ESP role to include access to additional investigations and surgical listing are discussed.
Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new…
Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new initiatives to reduce waiting times. One such initiative has been the introduction of orthopaedic assistants, usually physiotherapists, working with an extended scope of practice who see patients after referral to secondary care and determine the patients on‐going management. Studies to date have examined the effect of an orthopaedic assistant working alongside a consultant in the hospital environment. This study describes the impact on the management of the orthopaedic caseload in one general practice resulting from “screening” prior to referral to secondary care by a physiotherapist with an extended scope of practice. It demonstrates the successful management of the majority of patients within primary care.
Since 2007, it has been mandatory for all vocational schools in Denmark to assess the prior qualifications of all students when they begin at the school and to use this…
Since 2007, it has been mandatory for all vocational schools in Denmark to assess the prior qualifications of all students when they begin at the school and to use this assessment to divide students into different ability-based courses (streaming) with the aim of increasing the retention of students. The purpose of this paper is to explore students’ experiences of being placed on a low-ability course by using case studies of two classes from separate vocational schools in Denmark with different practices regarding the streaming of students.
The study draws on theories of student drop-out and engagement (Rumberger, 1993; Finn, 1989) and on the differentiation-polarization theory (Gamoran, 2010) concerning the effects of streaming students into ability-based classes. Two cases are described, representing on the one hand predominately positive experiences of streaming (better relations to teachers and peers) and on the other hand predominately negative experiences of streaming (low teacher expectations and negative peer-learning).
The study shows that the two schools have organized streaming differently and that the students have very diverse experiences of being placed in a low-ability class depending on the way the schools organize streaming.
The paper discusses the basic dilemma that schools face when they have to teach students with very diverse backgrounds and levels of engagement. The study shows that the division of students into separate streams involves a risk of reducing the level of engagement among students in the low-ability courses, but it also suggests how streaming can be organized to increase the engagement of students and possibly reduce their risk of dropping out of vocational education.
Understanding the supply network of construction materials used to construct shelters in refugee camps, or during the reconstruction of communities, is important as it can…
Understanding the supply network of construction materials used to construct shelters in refugee camps, or during the reconstruction of communities, is important as it can reveal the intricate links between different stakeholders and the volumes and speeds of material flows to the end-user. Using social network analysis (SNA) enables another dimension to be analysed – the role of commonalities. This is likely to be particularly important when attempting to replace vernacular materials with higher-performing alternatives or when encouraging the use of non-vernacular methods. This paper aims to analyse the supply networks of four different disaster-relief situations.
Data were collected from interviews with 272 displaced (or formally displaced) families in Afghanistan, Bangladesh, Nepal and Turkey, often in difficult conditions.
The results show that the form of the supply networks was highly influenced by the nature/cause of the initial displacement, the geographical location, the local availability of materials and the degree of support/advice given by aid agencies and or governments. In addition, it was found that SNA could be used to indicate which strategies might work in a particular context and which might not, thereby potentially speeding up the delivery of novel solutions.
This study represents the first attempt in theorising and empirically investigating supply networks using SNA in a post-disaster reconstruction context. It is suggested that future studies might map the up-stream supply chain to include manufacturers and higher-order, out of country, suppliers. This would provide a complete picture of the origins of all materials and components in the supply network.
This is original research, and it aims to produce new knowledge.
The state of citizenship education in Australia continues to attract media attention as evidenced by two recent newspaper headlines, Students take apathetic view of…
The state of citizenship education in Australia continues to attract media attention as evidenced by two recent newspaper headlines, Students take apathetic view of democracy and Teach young about democracy. These headlines were reporting on the latest findings of the Australian Council for Educational Research (ACER) on school students understanding of democracy. As a part of a 28‐nation civics survey, the ACER found half of Australian students had no grasp of democracy (ranking them behind countries like Poland, Cyprus and the Slovak Republic); lacked clarity about the Constitution, elections, voting systems or the role of groups like trade unions; were unwilling to engage in politics; and believed politics was relatively unimportant
Interest in developing institutional explanations of political and economic behavior has blossomed among social scientists since the early 1980s. Three intellectual perspectives are now prevalent: rational choice theory, historical institutionalism and a new school of organizational analysis. This paper summarizes, compares and contrasts these views and suggests ways in which cross‐fertilization may be achieved. Particular attention is paid to how the insights of organizational analysis and historical institutionalism can be blended to provide fruitful avenues of research and theorizing, especially with regard to the production, adoption, and mobilization of ideas by decision makers.
Pink ring is a ubiquitous problem arising during the manufacture of multilayer PCBs, being the manifestation of local delamination at the inner‐layer oxide interfaces…
Pink ring is a ubiquitous problem arising during the manufacture of multilayer PCBs, being the manifestation of local delamination at the inner‐layer oxide interfaces around drilled holes and subsequent dissolution of the oxide during plating processes. Except in extreme cases, there is no evidence that the occurrence of pink ring identifies any in‐service reliability problem, but it is nevertheless a clear process indicator and is strictly monitored in statistical process control. The UK Printed Circuit Industry has carried out a collaborative research programme aimed at providing an understanding and a quantitative analysis of the pink ring condition. The research has advanced on two fronts: (i) an investigation into the micro‐mechanisms of the delamination and stress relief around drilled holes and subsequent rôles of the desmear and plating chemicals, and (ii) a statistical analysis of boards manufactured in a variety of ways, analysing the quantitative measurements of pink ring in terms of, for example, panel source, drill supplier, drill quality, drilling backing material, drilling chip rate, stack position, and panel entry/exit side.
The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope…
The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope physiotherapists (ESPs). This paper aims to highlight the extent and appropriateness of surgical and radiological referrals by ESPs working in an adult orthopaedic service.
The patient pathway following ESP assessment was audited over 31 months. Parameters explored included ESP referral rates to orthopaedic consultants; the percentage of patients where the entire episode of care was managed by the ESP; whether orthopaedic referrals were appropriate in terms of surgical interventions; and numbers of radiology referrals specifically for knee or lumbar complaints.
Of the patients, 79 per cent had their entire episode of care managed by ESPs. Of the patients, 9 per cent were referred on for a surgical opinion (of which 42 per cent knees, 20 per cent lumbar). 13 per cent were referred for x‐rays, 10 per cent for magnetic resonance imaging. Of the patients referred on for surgical opinion surgical intervention was appropriate in 89 per cent of cases.
Data from an ESP service with broad guiding protocols in a specific hospital are not readily extrapolated to ESPs elsewhere. Appropriateness of onwards referrals was based on the opinions of consultants to whom patients were referred. The potential benefit of a second opinion even if surgery is not offered is not taken into account by this model.
These audits reinforce the impact ESPs have on efficiency within orthopaedics. They document referral rates for x‐rays and magnetic resonance imaging by ESPs for lumbar and knee complaints that may benefit units proposing new ESP services.
This paper reinforces published data on ESP management of the entire episode of care of the majority of referrals to orthopaedics, and on the highly appropriate nature of onwards referrals. Documented for possibly the first time, data regarding investigations for lumbar and knee disorders highlight low referral rates.
Purpose – We make a case for bridging two types of logics – analytic and dialectic – for explaining processes of social-historical change, and maintain that a successful…
Purpose – We make a case for bridging two types of logics – analytic and dialectic – for explaining processes of social-historical change, and maintain that a successful bridge between these two logics depends on a variety of conditions and most especially the type of analytic logic or model one employs for capturing dynamic processes.
Methodology/approach – Conventional models of social change processes typically presuppose ergodic social worlds and are problematic as analytic approaches generally and most certainly are not fertile grounds for feeding dialectic theorization. Instead, we propose modeling dynamic processes that begin by assuming a nonergodic social world – one in flux, one that is nonrepeating, one within which model process and parameter structures are historically contingent and change with time, one that is autocatalytic, creating and changing its own possibilities.
Findings – We develop the line of thinking adumbrated above and illustrate these modeling strategies with empirical examples from US labor movement history. Results from these examples lend much weight to our proposals. Thus, this chapter demonstrates that concerns about the use of ergodic assumptions and about greater use of dialectical reasoning when studying social processes are not idle speculations within theoretical commentaries but have practical consequences in the conduct of research and the building of better theory.
Research limitations/implications – To approximate such an approach, social scientists should avoid cross-sectionalist and longitudinal modeling strategies that presuppose stability and homogeneity in parameter and process structures. Homogeneity and stability in parameter and process structures should be demonstrated, not assumed.
Originality/value – Rather than accepting the alienated spheres of social science analytics and dialectic theory, our proposal presupposes nonergodic social worlds and takes pragmatic steps for estimating analytic models that are more amenable to dialectic reasoning. Models that take nonergodicity seriously not only have the potential to produce better, historically grounded analytics but are also best suited to bridge with dialectic logic, thus taking advantage of the strengths of both forms of logic.