Rightsizing healthcare: what works, what doesn't, and why

Recently a nationwide study of the methods and consequences of restructuring in healthcare was completed by E.C. Murphy, Ltd., in cooperation with the American Society for Work Redesign. The results have important implications for hospitals and systems involved in or considering restructuring. The following are excerpts of an interview with Emmett C. Murphy, PhD, president of the firm.     

A review of CHIN initiatives: what works and why

A Community Health Information Network (CHIN) can generate revenue through multiple avenues and maximize efficiency for participants, including multiple payers, physicians, hospitals, labs, pharmacies, and ancillary providers. This article reviews representative CHIN initiatives over the past decade and identifies key success factors, such as provider adoption and participation in planning, multiple-payer participation, providing key transactions, and incremental implementation.     

Evaluation of a community bicycle helmet promotion campaign: what works and why

PURPOSE. This study identifies effective components of a bicycle helmet promotion campaign, and mechanisms by which these components affect child helmet ownership. DESIGN. A random telephone survey identified parents whose children did not own helmets prior to an educational campaign. A follow-up survey was conducted six months later. Regression analysis estimated the effects of four campaign components on child helmet ownership and tested for mediation by cognitive variables. SETTING. Study participants were residents of a suburban community which undertook a citywide educational campaign to increase child helmet ownership. SUBJECTS. Subjects were 210 parents with at least one school-aged child, none of whom owned helmets. INTERVENTION. A multicomponent campaign was implemented by a community coalition. In addition, random subsamples of the study participants received direct mail or direct telephone communications. RESULTS. Of the eligible respondents identified in the baseline sample, 39% completed the follow-up survey. Regression analysis showed that children whose parents received either helmet advice from a physician or direct telephone communications were 2.6 and 2.2 times more likely, respectively, to own helmets as children whose parents did not experience similar communication. Parental worry mediated the association, but parental beliefs about the effectiveness of helmets did not. CONCLUSION. Future helmet campaigns should use interpersonal strategies to increase parental worry about their children being involved in a bicycle accident. Generalization of these findings is limited by the high socioeconomic status of the study participants, and by the outcome measure, which is helmet ownership, not helmet use.     

Tutoring in problem-based learning: a teacher development process

Summary: Summary . Undergraduate medical curricula have become increasingly innovative in order to better prepare their graduates to enter practice, with the most notable innovation being the introduction of problem-based learning (PBL). This paper describes Dalhousie University's transition to PBL, from a teacher development perspective.
The paper reinforces the need for a well-designed teacher development process that is carefully implemented and evaluated in order to ensure a successful curriculum change. A seven-stage process for teacher development of tutors at Dalhousie is described, and programme evaluation data are reported from both students' and teachers' points of view. The results from the evaluation are very positive and suggest ways of improving the teacher development process. These improvements are described, as well as future plans in this area.     

Feasibility of problem-based learning in Jiujiang Medical College: why not try it?

Against a background of problems in delivering rural health care in the Jiujiang district of China, this paper outlines the development of a relevant 3-year SSO (Strengthening the training of clinical skills, Strengthening preventive medicine education, and Optimizing curricular structure) programme at Jiujiang Medical College (JMC). Some comparisons between JMC and the Southern Illinois University School of Medicine (SIUSM) are made, and the possibility of applying problem-based learning to JMC is discussed.     

CA-MRSA lesions: what works, what doesn't

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) abscesses are best managed surgically; postprocedure antibiotics do not substantially improve outcomes. Cure rates with incision and drainage alone are at least 90%. If incision and drainage fail to promote healing within 7 days, the oral antibiotics of choice are trimethoprim-sulfamethoxazole and tetracycline.     

Reaching the poor with health,nutrition and population services: What works,what doesn't and why

Abstract

In sub-Saharan Africa, HIV/AIDS has resulted in a rapidly growing population of orphans and vulnerable children (OVC). These OVC have strained the traditional safety net provided by extended families to its breaking point. Increasingly, community-based initiatives are emerging to fill the gap. However, relatively little is known about these efforts and their effectiveness. This article looks at one such initiative in rural Tanzania, and explores the relationship between local communities that seek to empower themselves to address the needs of their OVC and external organisations that have the resources and power to help them. This case study describes the successful effort of a community to build a Centre housing its orphans, and the subsequent closure of that Centre despite its evident success, because of a conflict between internal and external interests. This case study is used as the basis of a broader discussion on how those with power, and communities seeking empowerment, are complexly intertwined.     

Effects of tutor-related behaviours on the process of problem-based learning

Tutors in a Problem-Based Learning (PBL) curriculum are thought to play active roles in guiding students to develop frameworks for use in the construction of knowledge. This implies that both subject-matter expertise and the ability of tutors to facilitate the learning process must be important in helping students learn. This study examines the behavioural effects of tutors in terms of subject-matter expertise, social congruence and cognitive congruence on students’ learning process and on their final achievement. The extent of students’ learning at each PBL phase was estimated by tracking the number of relevant concepts recalled at the end of each learning phase, while student achievement was based on students’ ability to describe and elaborate upon the relationship between relevant concepts learned. By using Analysis of Covariance, social congruence of the tutor was found to have a significant influence on learning in each PBL phase while all of the tutor-related behaviours had a significant impact on student achievement. The results suggest that the ability of tutors to communicate informally with students and hence create a less threatening learning environment that promotes a free flow exchange of ideas, has a greater impact on learning at each of the PBL phases as compared to tutors’ subject-matter expertise and their ability to explain concepts in a way that is easily understood by students. The data presented indicates that these tutor-related behaviours are determinants of learning in a PBL curriculum, with social congruence having a greater influence on learning in the different PBL phases.