BackgroundThe British Army Initial Recruit Medical includes a history and physical examination. The study objective was to compare the incremental value of adding an electrocardiogram (ECG) and echocardiogram to this medical, in order to detect cardiac disease.MethodsA physical examination, ECG and echocardiogram were prospectively performed in volunteers when there was no history suggestive of cardiac disease. Electrocardiograms and echocardiograms were analysed according to published criteria. Further investigations were determined by clinical need. A pragmatic ‘Gold standard’ of ECG, echocardiogram and other investigations elsewhere, when clinically indicated, was used. Enlistment eligibility was decided using military guidelines.Results812 candidates volunteered. A murmur was detected in 73 (8.9%) candidates, 98 (12.1%) had an ECG abnormality and 161 (19.8%) had either a murmur or ECG abnormality. Sixteen candidates were diagnosed with disease on the day. Seventeen candidates (2.1%) required further cardiac investigations with disease ultimately excluded in sixteen (2.0%). Cardiac disease was detected in seventeen (2.1%) candidates with six conditions associated with sudden death in asymptomatic individuals. Thirteen (1.6%) candidates were prevented from enlisting.Diagnostic test evaluationPhysical examination only: Sensitivity: 52.94%, Specificity: 91.95%, Positive Predictive Value: 12.33%, Negative Predictive Value: 98.92%.Additional electrocardiogram: Sensitivity: 88.24%, Specificity: 81.53%, Positive Predictive Value: 9.26%, Negative Predicted Value: 99.69%.ConclusionsAdding an ECG to the Initial Recruit Medical is more sensitive in identifying disease than physical examination alone, but has a higher false-positive rate. When physical examination or ECG abnormalities are discovered additional echocardiography reduces the failure rate on the day to 4.1% and of these approximately half ultimately have a disease diagnosis.
There is a long policy and tradition of service users being involved in the education of social work students and post-qualifying candidates, and they are recognised as educators in their own right, however there appears to have been limited measurement of the impact of service user educator involvement in post-qualifying education on practice, and ultimately on outcomes for end service users. A collaborative partnership between service user educators, practitioners and academics carried out research in this area in four local authorities in the English East Midlands (Equally Experienced Research Group, 2011); whilst it was found that direct service user educator input had a positive impact on candidates’ practice, some unexpected and somewhat surprising responses arose. Interviews with candidates’ line managers identified that there appeared to be significantly less active evaluation of outcomes for service users than we had assumed would be the case.This paper initially sets the context for considering these responses by outlining the research undertaken, and considering how post-qualifying education as a whole might be evaluated as making a difference to practice. The second part of the paper looks at wider issues of evaluating practice and organisational service delivery. Methods used for measuring service user outcomes will be considered, alongside consideration of the active participation of service users in developing individual practice and agency service provision.
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