Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Seeking a life in the literary position : the writing of Charmian Clift

An examination of the published and unpublished writing of Charmian Clift.

Advertising & Promotion : An Integrated Marketing Communications Approach, 2nd Edition [Book Review]

Advertising & Promotion’s second edition maintains a sharp and updated focus on the advertising industry, providing interesting ideas for both students and advertising professionals. Not only does the author demonstrate how agencies, businesses and organisations research, create and monitor particular campaigns, but also the extent to which advertising texts are themselves embedded in everyday contemporary culture. For me one of the strengths of the book is how the research brings together the managerial side of the industry, its sociology and political dynamics, with the cultural and ethical implications of advertising consumption.

Change is life process

A paper presented at the Rockhampton Women's Business Network Breakfast on 6 October 2000. Breakfast presentations were to be sharing, reflective and a light start to the day.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Working together for Toby : early childhood student teachers engaging in collaborative problem-based learning around child abuse and neglect

Early childhood teacher education programs have a responsibility, amongst many, to prepare teachers for decision-making on real world issues, such as child abuse and neglect. Their repertoire of skills can be enhanced by engaging with others, either face-to-face or online, in authentic problem-based learning. This paper draws on a study of early childhood student teachers who engaged in an authentic learning experience, which was to consider and to suggest how they would act upon a real-life case of child abuse encountered in an early childhood classroom in Queensland. This was the case of Toby (a pseudonym), who was suspected of being physically abused at home. Students drew upon relevant legislation, policy and resource materials to tackle Toby’s case. The paper provides evidence of students grappling with the complexity of a child abuse case and establishing, through collaboration with others, a proactive course of action. The paper has a dual focus. First, it discusses the pedagogical context in which early childhood student teachers deal with issues of child abuse and neglect in the course of their teacher education program. Second, it examines evidence of students engaging in collaborative problem-solving around issues of child abuse and neglect and teachers’ responsibilities, both legal and professional, to the children and families they work with. Early childhood policy-makers, practitioners and teacher educators are challenged to consider how early childhood teachers are best equipped to deal with child protection and early intervention.

A virtual test assessment tool for second year signal processing students

The development and use of a virtual assessment tool for a signal processing unit is described. It allows students to take a test from anywhere using a web browser to connect to the university server that hosts the test. While student responses are of the multiple choice type, they have to work out problems to arrive at the answer to be entered. CGI programming is used to verify student identification information and record their scores as well as provide immediate feedback after the test is complete. The tool has been used at QUT for the past 3 years and student feedback is discussed. The virtual assessment tool is an efficient alternative to marking written assignment reports that can often take more hours than actual lecture hall contact from a lecturer or tutor. It is especially attractive for very large classes that are now the norm at many universities in the first two years.

Adaptive modelling of sustainable architecture design in entropy evolutionary

This paper argues a model of adaptive design for sustainable architecture within a framework of entropy evolution. The spectrum of sustainable architecture consists of efficient use of energy and material resource in the life-cycle of buildings, active involvement of the occupants into micro-climate control within the building, and the natural environment as the physical context. The interactions amongst all the parameters compose a complex system of sustainable architecture design, of which the conventional linear and fragmented design technologies are insufficient to indicate holistic and ongoing environmental performance. The latest interpretation of the Second Law of Thermodynamics states a microscopic formulation of an entropy evolution of complex open systems. It provides a design framework for an adaptive system evolves for the optimization in open systems, this adaptive system evolves for the optimization of building environmental performance. The paper concludes that adaptive modelling in entropy evolution is a design alternative for sustainable architecture.

Good practice for enhancing the engagement and success of commencing students

There is widespread recognition that higher education institutions (HEIs) must actively support commencing students to ensure equity in access to the opportunities afforded by higher education. This role is particularly critical for students who because of educational, cultural or financial disadvantage or because they are members of social groups currently under-represented in higher education, may require additional transitional support to “level the playing field.” The challenge faced by HEIs is to provide this “support” in a way that is integrated into regular teaching and learning practices and reaches all commencing students. The Student Success Program (SSP) is an intervention in operation at the Queensland University of Technology (QUT) designed to identify and support those students deemed to be at risk of disengaging from their learning and their institution. Two sets of evidence of the impact of the SSP are presented: First, its expansion (a) from a one-faculty pilot project (Nelson, Duncan & Clarke, 2009) to all faculties and (b) into a variety of applications mirroring the student life cycle; and second, an evaluation of the impact of the SSP on students exposed to it. The outcomes suggest that: the SSP is an example of good practice that can be successfully applied to a variety of learning contexts and student enrolment situations; and the impact of the intervention on student persistence is sustained for at least 12 months and positively influences student retention. It is claimed that the good practice evidenced by the SSP is dependent on its integration into the broader First Year Experience Program at QUT as an example of transition pedagogy in action.

Distinguishing forced versus discretionary replacements in new product diffusion models

In many product categories of durable goods such as TV, PC, and DVD player, the largest component of sales is generated by consumers replacing existing units. Aggregate sales models proposed by diffusion of innovation researchers for the replacement component of sales have incorporated several different replacement distributions such as Rayleigh, Weibull, Truncated Normal and Gamma. Although these alternative replacement distributions have been tested using both time series sales data and individual-level actuarial “life-tables” of replacement ages, there is no census on which distributions are more appropriate to model replacement behaviour. In the current study we are motivated to develop a new “modified gamma” distribution by two reasons. First we recognise that replacements have two fundamentally different drivers – those forced by failure and early, discretionary replacements. The replacement distribution for each of these drivers is expected to be quite different. Second, we observed a poor fit of other distributions to out empirical data. We conducted a survey of 8,077 households to empirically examine models of replacement sales for six electronic consumer durables – TVs, VCRs, DVD players, digital cameras, personal and notebook computers. This data allows us to construct individual-level “life-tables” for replacement ages. We demonstrate the new modified gamma model fits the empirical data better than existing models for all six products using both a primary and a hold-out sample.

On location : the imagined private interior in public life

This paper reveals the interior landscapes of selected contemporary Australian films, such as The Caterpillar Wish and Bad Boy Bubby, to develop a number of thematic influences on the manner in which domestic and private lives are constructed through filmic imagination. The research uncovers the conditions that contribute to particular scenographic representations of the humble interiors that act as both backdrop and performer to subtle and often troubled narratives. Such readings are informed by the theoretical works of writer Gertrude Stein, among others, who explore the relationships between the scenographic third dimension and the fourth dimensional performance in the representation of narrative space. A further theoretical thread lies in Giuliana Bruno’s work on the tension between private and public filmic space, which is explored through the public outing of intensely private spaces generated through narratives framed by the specificities of found interiors. Beyond the interrogation of qualities of imagined filmic space is the condition whereby locations, once transformed by the event of movie making are consequently forever revised. These altered conditions subsequently reinvest the lives of those who return to the location with layered narratives of occupation. Situationally, the now reconverted interior performs as contributor to subsequent private inhabitation, even if only as imagined space. The possibility here is that the qualities of the original may be superimposed and recontextualised to invest post-produced interiors with the qualities of the other space as imagined. This reading of film space explores new theoretical design scenarios for imagined and everyday interior landscapes.

Listening in to others : in between noise and silence

Since the launch of the ‘Clean Delhi, Green Delhi’ campaign in 2003, slums have become a significant social and political issue in India’s capital city. Through this campaign, the state, in collaboration with Delhi’s middle class through the ‘Bhagidari system’ (literally translated as ‘participatory system’), aims to transform Delhi into a ‘world-class city’ that offers a sanitised, aesthetically appealing urban experience to its citizens and Western visitors. In 2007, Delhi won the bid to host the 2010 Commonwealth Games; since then, this agenda has acquired an urgent, almost violent, impetus to transform Delhi into an environmentally friendly, aesthetically appealing and ‘truly international city’. Slums and slum-dwellers, with their ‘filth, dirt, and noise’, have no place in this imagined city. The violence inflicted upon slum-dwellers, including the denial of their judicial rights, is justified on these accounts. In addition, the juridical discourse since 2000 has ‘re-problematised slums as ‘nuisance’. The rising antagonism of the middle-classes against the poor, supported by the state’s ambition to have a ‘world-class city’, has allowed a new rhetoric to situate the slums in the city. These representations articulate slums as homogenised spaces of experience and identity. The ‘illegal’ status of slum-dwellers, as encroachers upon public space, is stretched to involve ‘social, cultural, and moral’ decadence and depravity. This thesis is an ethnographic exploration of everyday life in a prominent slum settlement in Delhi. It sensually examines the social, cultural and political materiality of slums, and the relationship of slums with the middle class. In doing so, it highlights the politics of sensorial ordering of slums as ‘filthy, dirty, and noisy’ by the middle classes to calcify their position as ‘others’ in order to further segregate, exclude and discriminate the slums. The ethnographic experience in the slums, however, highlights a complex sensorial ordering and politics of its own. Not only are the interactions between diverse communities in slums highly restricted and sensually ordained, but the middle class is identified as a sensual ‘other’, and its sensual practices prohibited. This is significant in two ways. First, it highlights the multiplicity of social, cultural experience and engagement in the slums, thereby challenging its homogenised representation. Second, the ethnographic exploration allowed me to frame a distinct sense of self amongst the slums, which is denied in mainstream discourses, and allowed me to identify the slums’ own ’others’, middle class being one of them. This thesis highlights sound – its production, performances and articulations – as an act with social, cultural, and political implications and manifestations. ‘Noise’ can be understood as a political construct to identify ‘others’ – and both slum-dwellers and the middle classes identify different sonic practices as noise to situate the ‘other’ sonically. It is within this context that this thesis frames the position of Listener and Hearer, which corresponds to their social-political positions. These positions can be, and are, resisted and circumvented through sonic practices. For instance, amplification tactics in the Karimnagar slums, which are understood as ‘uncultured, callous activities to just create more noise’ by the slums’ middle-class neighbours, also serve definite purposes in shaping and navigating the space through the slums’ soundscapes, asserting a presence that is otherwise denied. Such tactics allow the residents to define their sonic territories and scope of sonic performances; they are significant in terms of exerting one’s position, territory and identity, and they are very important in subverting hierarchies. The residents of the Karimnagar slums have to negotiate many social, cultural, moral and political prejudices in their everyday lives. Their identity is constantly under scrutiny and threat. However, the sonic cultures and practices in the Karimnagar slums allow their residents to exert a definite sonic presence – which the middle class has to hear. The articulation of noise and silence is an act manifesting, referencing and resisting social, cultural, and political power and hierarchies.

Bushfire sustainability : Strategies for reconciling bushfire and biodiversity with daily life

This exhibition and catalogue provides a visual record of student work exhibited at the Australian Institute of Architects offices in Brisbane from November 15 to 29, 2010. The exhibition features the final design outcomes of the inaugural Bushfire Sustainability unit conducted at QUT in semester two, 2010. The core objective of this unit was to develop our students’ skills in collaborative practice in design, research and presentation. The theme of ‘bushfire sustainability’ was chosen because living sustainably in bushfire prone landscapes presents a number of problems, the nature of which might only be resolved via multidisciplinary collaboration among the design disciplines. The students involved represent the disciplines of Interior Design, Landscape Architecture, Industrial Design, Architecture and Sustainability – all from within the School of Design at QUT. 55 students, mostly in their third year of study, worked in teams of five (one from each discipline) to design one of a number of homes in highly bushfire prone sites in either Western Australia or SE Queensland. This year level and the interdisciplinary mix are perhaps the best placed to resolve these problems: being unrestrained from the burdens of professional practice and technical overload they retain the potential for innovative, lateral thinking across the range of spatial scales and philosophical perspectives associated with inhabitation of bushfire prone landscapes. It is envisaged that, through the ‘vehicle’ of this design research, that the students’ work will contribute to understandings of how creative design disciplines might respond to this significant national problem, which hitherto has been attended to primarily by engineering and the sciences.