Decision support and the effectiveness of web-based delivery and information tailoring for bowel cancer screening : an exploratory study

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study.
Objective: To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials.
Methods: Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool.
Results: Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.”
Conclusions: This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.

Identifying the determinants of e-learning service delivery quality

In recent years, many universities and educational institutions have made considerable investments in e-learning systems. These are systems that deliver educational services via electronic channels. Service quality has been studied in previous research as a critical factor for measuring systems success. Modest attention has been paid to factors affecting the service delivery quality in the e-learning arena. The objective of this study is to identify the factors considered to impact the e-learning systems service delivery quality through a survey of stakeholders. The sample was 720 students enrolled in online courses at the University of Southern Queensland (USQ).The main finding of this study is that IT infrastructure, system quality, and information quality significantly affect service delivery quality in the e-learning systems field. IT infrastructure services were found to play a critical role in improving system quality and information quality, and this construct can be considered as a foundation of delivering high quality educational services.

ICT alternative for primary care delivery in Indonesia : a proposal

This paper proposes a new research program and presents a current analysis of the potential of health information systems (HIS) to improve primary care delivery in rural Indonesia. A new HIS will be implemented to facilitate patient centred primary care and to support the interactions and collaborations between three types of participants including the patient, their doctors and pharmacist in Malang, Indonesia. A tetradic relationship between the new HIS and three participants (patient, doctors, and pharmacist) is examined through the lens of the actor network theory (ANT) with a view to form a new healthcare service delivery model for primary care providers in Indonesia. Based on this model, a network of primary care providers would share the patient medical records (PMR) and provide collaborative care programs to promote healthy life styles, prevent diseases, and to manage chronic disease care more effectively and efficiently.

Primary science specialist learning program – report of delivery

The Primary Science Specialist (PrimSS) Professional Learning Program consisted of a fifteen day program, of which Deakin delivered 5 days of pedagogy and content in science education, followed by 3 days of leading change in schools and developing other teachers' capacities. Delivered in several phases, it was possible to provide teachers with ideas and models for them to trial within their schools and to report back to the group, during the program.

Dedicated emergency theatres improve service delivery and surgeons' job satisfaction

Background
There are well-described benefits to separating emergency and elective surgery. Geelong Hospital lacked the resources to implement a separate acute surgical unit, but instituted daily dedicated emergency general surgery operating sessions, managed by an on-site consultant. This study aims to assess the impact of this on service delivery and surgeons' job satisfaction.
Methods
From 1 February 2011, daily half-day operating lists were allocated for general surgical emergencies. Patients treated on these lists were studied prospectively until 31 December 2011. Theatre waiting times and hospital stay were compared with the previous year. A quality-of-life questionnaire was administered to participating surgeons before the project commenced and after 6 months.
Results
A total of 966 patients underwent surgery during an emergency general surgery admission in the control period, and 984 underwent surgery during the study period. The median time from arrival in the emergency department (ED) to surgery was reduced from 19 (18–21) h in the control group to 18 (17–19) h in the study group (P = 0.033). The time from booking surgery to operation was reduced from 4.8 (4.3–5.4) h to 3.9 (3.5–4.3) h (P < 0.0001). For patients undergoing emergency laparotomy, the time from booking to surgery was reduced from 3.1 (2.2–4.1) to 2.4 (1.8–2.9) h, and hospital stay was reduced from 13 (11–15) to 10 (9–12) days (P = 0.0089). The surgeons' responses to the questionnaires showed improvement in job satisfaction (P < 0.0001).
Conclusion
This intervention has improved service delivery for emergency surgery patients, and improved the participating surgeons' job satisfaction.

Evaluation of delivery of the switched on secondary science professional learning (SOSSPL) program

The Switched On Secondary Science Professional Learning (SOSSPL) program consisted of three days professional learning. Days 1 and 2 were undertaken consecutively, with Day 3 following a break of several weeks. The break allowed sufficient time for teachers to undertake a small classroom-based project within one of the topics teachers will be teaching at the time. The program was designed to build teacher capacity to improve learning outcomes in secondary science.

Evaluation of delivery of the switched on secondary science professional learning (SOSSPL) program (2011-12)

The Switched On Secondary Science Professional Learning (SOSSPL) program consisted of three days professional learning for Victorian DEECD secondary science teachers. Days 1 and 2 were undertaken consecutively, with Day 3 following a break of several weeks. The break allowed sufficient time for teachers to undertake a small classroom-based project within one of the topics they were teaching at the time. The program was designed to build teacher capacity to improve student learning outcomes in secondary science.

The program supported teachers to plan and implement classroom sequences that focused on student construction and interpretation of different representations of the science concepts and processes that are described by the Victorian Essential Learning Standards (VELS): Science and the Science Continuum P-10. The Deakin University team in collaboration with the Department of Education and Early Childhood Development (DEECD) produced curriculum resources for the program that encapsulated a representational focus to the teaching and learning of science. The program explored and linked to core DEECD resources such as the e5 Instructional Model and the Science Continuum P-10.
The SOSSPL program was delivered in all Victorian DEECD regions in 2010-11 and was evaluated (Hubber et al, 2011). The program was delivered again in all Victorian DEECD regions in 2011-12. The evaluation of the 2011-12 program is reported here with some comparisons made to the findings from the previously delivered program.
This evaluation of the SOSSPL program involved an online survey, daily workshop evaluations, focus group and presentations data of the participating teachers’ classroom-based projects. The aim of the evaluation was to make a judgement about the effectiveness of the SOSSPL program in terms of building teacher capacity to improve student learning outcomes in secondary science.

Target-specific delivery of doxorubicin to retinoblastoma using epithelial cell adhesion molecule aptamer

PURPOSE: To study target-specific delivery of doxorubicin (Dox) using an RNA aptamer against epithelial cell adhesion molecule (EpCAM) in retinoblastoma (RB) cells. METHODS: The binding affinity of the EpCAM aptamer to RB primary tumor cells, Y79 and WERI-Rb1 cells, and Müller glial cell lines were evaluated with flow cytometry. Formation of physical conjugates of aptamer and Dox was monitored with spectrofluorimetry. Cellular uptake of aptamer-Dox conjugates was monitored through fluorescent microscopy. Drug efficacy was monitored with cell proliferation assay. RESULTS: The EpCAM aptamer (EpDT3) but not the scrambled aptamer (Scr-EpDT3) bound to RB tumor cells, the Y79 and WERI-Rb1 cells. However, the EpCAM aptamer and the scrambled aptamer did not bind to the noncancerous Müller glial cells. The chimeric EpCAM aptamer Dox conjugate (EpDT3-Dox) and the scrambled aptamer Dox conjugate (Scr-EpDT3-Dox) were synthesized and tested on the Y79, WERI-Rb1, and Müller glial cells. The targeted uptake of the EpDT3-Dox aptamer caused cytotoxicity in the Y79 and WERI-Rb1 cells but not in the Müller glial cells. There was no significant binding or consequent cytotoxicity by the Scr-EpDT3-Dox in either cell line. The EpCAM aptamer alone did not cause cytotoxicity in either cell line. CONCLUSIONS: The results show that the EpCAM aptamer-Dox conjugate can selectively deliver the drug to the RB cells there by inhibiting cellular proliferation and not to the noncancerous Müller glial cells. As EpCAM is a cancer stem cell marker, this aptamer-based targeted drug delivery will prevent the undesired effects of non-specific drug activity and will kill cancer stem cells precisely in RB.

Transdermal estrogen patches for aggressive behavior in male patients with dementia : a randomized, controlled trial

Objectives: To investigate the efficacy and tolerability of transdermal estrogen patches for the adjunctive treatment of aggressive behavior in male patients with advanced dementia. Methods: The study was designed as an 8-week, randomized, controlled trial in acute aged psychiatry inpatient units and specialized nursing homes in Melbourne, Australia, between 1998 and 1999. The participants were 27 men with established dementia, identified as displaying aggressive behavior not responding to treatment for at least 2 weeks prior to referral. The instruments used to measure aggressive behavior were the Rating Scale for Aggressive Behavior in the Elderly (RAGE), the Cornell Scale for Depression in Dementia (CSDD) and the Mini-mental State Examination (MMSE). Physical examination was performed and biochemistry and serum hormone concentrations were measured at baseline and at 8 weeks. Concomitant psychotropic medication use was recorded and analyzed. Results: There was no significant difference in aggressive behavior at 8 weeks, but significant “rebound” in aggressive behavior (change in scores between week 8 and week 10, p<0.009) and benzodiazepine use in the estrogen group (p<0.03), following removal of the patches. Only behavioral items of the CSDD improved in the experimental group (p=0.031). The use of patches was associated with a significant rise in serum estrogen (p<0.001) but not with a significant decrease in serum testosterone (p=0.077). There were no adverse effects associated with their use. Conclusions: The use of transdermal estrogen yielding up to 100μg per day was not associated with discernable improvement in aggressive behavior in men with advanced dementia. Small subject numbers, multiple variables and a lack of statistical power impair interpretation of these results. However, the tolerability and apparent rebound effect on removal of patches indicate the need for larger studies in this area.