The impact of health information technology on the quality of medical and health care : a systematic review

Objective: To systematically review the published evidence of the impact of health information technology (HIT) on the quality of medical and health care specifically clinicians’ adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. In order to be as inclusive as possible the research examined literature discussing the use of health information technologies and systems in both medical care such as clinical and surgical, and other health care such as allied health and preventive services.----- Design: Systematic review----- Data Sources: Relevant literature was systematically searched on English language studies indexed in MEDLINE and CINAHL(1998 to 2008), Cochrane Library, PubMed, Database of Abstracts of Review of Effectiveness (DARE), Google scholar and other relevant electronic databases. A search for eligible studies (matching the inclusion criteria) was also performed by searching relevant conference proceedings available through internet and electronic databases, as well as using reference lists identified from cited papers.----- Selection criteria: Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measures could be either changes in clinical processes resulting from a change of the providers’ behaviour or specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. ----- Methods: Studies were reviewed and summarised in tabular and text form. Due to heterogeneity between studies, meta-analysis was not performed.----- Results: Out of 17 studies that assessed the impact of health information technology on health care practitioners’ performance, 14 studies revealed a positive improvement in relation to their compliance with evidence-based guidelines. The primary domain of improvement was evident from preventive care and drug ordering studies. Results from the studies that included an assessment for patient outcomes however, were insufficient to detect either clinically or statistically important improvements as only a small proportion of these studies found benefits. For instance, only 3 studies had shown positive improvement, while 5 studies revealed either no change or adverse outcomes.----- Conclusion: Although the number of included studies was relatively small for reaching a conclusive statement about the effectiveness of health information technologies and systems on clinical care, the results demonstrated consistency with other systematic reviews previously undertaken. Widescale use of HIT has been shown to increase clinician’s adherence to guidelines in this review. Therefore, it presents ongoing opportunities to maximise the uptake of research evidence into practice for health care organisations, policy makers and stakeholders.

Homegardening as a panacea : a case study of South Tarawa

The Republic of Kiribati is a small, highly infertile Pacific Island nation and is one of the most challenging locations to attempt to support dense urban populations. Kiribati, like other nations in the Pacific, faces an urban future where food insecurity, unemployment, waste management and malnutrition will become increasing issues. Homegardening is suggested as one way to address many of these problems. However, the most recent study on agriculture production in urban centres in Kiribati shows that, in general, intensive cultivation of homegardens is not a common practice. This disparity between theory and practice creates an opportunity to re-examine homegardening in Kiribati and, more broadly, in the Pacific. This paper examines the practice of homegardening in urban centres in Kiribati and explores reasons why change has or has not occurred through interviews with homegardeners and government/donor representives. Results show that homegardening has increased significantly in the past five years, largely because of the promotion of homegardens and organic composting systems by donor organisations. While findings further endorse homegardening as an excellent theoretical solution to many of the problems that confront urban settlements in Kiribati and the Pacific, it raises additional questions regarding the continuation of homegarden schemes beyond donor support programmes.

Generating Flash files of Your Lectures: Good Practice Strategies Helping Students Engage with Their Learning

Our students come from diverse backgrounds. They need flexibility in their learning. First year students tend to worry when they miss lectures or part of lectures. Having the lecture as an on line resource allows students to miss a lecture without stressing about it and to be more relaxed in the lecture, knowing that anything they may miss will be available later. The resource: The Windows based program from Blueberry Software (not Blackberry!) - BB Flashback - allows the simultaneous recording of the computer screen together with the audio, as well as Webcam recording. Editing capabilities include adding pause buttons, graphics and text to the file before exporting it in a flash file. Any diagrams drawn on the board or shown via visualiser can be photographed and easily incorporated. The audio from the file can be extracted if required to be posted as podcast. Exporting modes other than Flash are also available, allowing vodcasting if you wish. What you will need: - the recording software: it can be installed on the lecture hall computer just prior to lecture if needed - a computer: either the ones in lecture halls, especially if fitted with audio recording, or a laptop (I have used audio recording via Bluetooth for mobility). Feedback from students has been positive and will be presented on the poster.

Creating cultural change in education : A proposal for a continuum for evaluating the effectiveness of sustainable schools implementation strategies in Australia

Networks are increasingly recognised as advantageous when creating and embedding cultural change within organisations. This paper explores andproblematises ideas around networks for education for sustainability (EfS), Australian Sustainable Schools Initiative (AuSSI), a national, whole-school approach to EfS. In three Australian states - New South Wales, Victoria and Queensland – AuSSI has been implemented in different ways. In examining the use of products, facilitators and networks to embed initiatives such as AuSSI in Australian schools, we propose a “continuum of cultural change strategies” as a framework for thinking about each of these approaches to creating organisational and cultural change for sustainability. We anticipate that such a framework may assist where choices need to be made in relation to the kinds of capacity building processes that might best achieve “deep and wide” change within schools hoping to engender significant cultural change.

HABITAT : a longitudinal multilevel study of physical acitvity change in mid-aged adults

Purpose. To explore the role of the neighborhood environment in supporting walking Design. Cross sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate). Setting. The Brisbane City Local Government Area, Australia, 2007. Subjects. Brisbane residents aged 40 to 65 years. Measures. Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and street lights within a one kilometer circular buffer from each resident’s home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes in the previous week categorized as < 30 minutes, ≥ 30 < 90 minutes, ≥ 90 < 150 minutes, ≥ 150 < 300 minutes, and ≥ 300 minutes. Analysis. The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression and the model parameters were estimated using Markov chain Monte Carlo simulation. Results. After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (OR=1.93, 99% CI 1.32-2.80), the greatest residential density (OR=1.47, 99% CI 1.02-2.12), the least tree coverage (OR=1.69, 99% CI 1.13-2.51), the most bikeways (OR=1.60, 99% CI 1.16-2.21), and the most street lights (OR=1.50, 99% CI 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR=2.06, 99% CI 1.41-3.02). Conclusion. The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more street lights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease.

New insights into appetite, inflammation and the use of fish oil in hemodialysis patients

Protein-energy wasting (PEW) is commonly seen in patients with chronic kidney disease (CKD). The condition is characterised by chronic, systemic low-grade inflammation which affects nutritional status by a variety of mechanisms including reducing appetite and food intake and increasing muscle catabolism. PEW is linked with co-morbidities such as cardiovascular disease, and is associated with lower quality of life, increased hospitalisations and a 6-fold increase in risk of death1. Significant gender differences have been found in the severity and effects of several markers of PEW. There have been limited studies testing the ability of anti-inflammatory agents or nutritional interventions to reduce the effects of PEW in dialysis patients. This thesis makes a significant contribution to the understanding of PEW in dialysis patients. It advances understanding of measurement techniques for two of the key components, appetite and inflammation, and explores the effect of fish oil, an anti-inflammatory agent, on markers of PEW in dialysis patients. The first part of the thesis consists of two methodological studies conducted using baseline data. The first study aims to validate retrospective ratings of hunger, desire to eat and fullness on visual analog scales (VAS) (paper and pen and electronic) as a new method of measuring appetite in dialysis patients. The second methodological study aims to assess the ability of a variety of methods available in routine practice to detect the presence of inflammation. The second part of the thesis aims to explore the effect of 12 weeks supplementation with 2g per day of Eicosapentaenoic Acid (EPA), a longchain fatty acid found in fish oil, on markers of PEW. A combination of biomarkers and psychomarkers of appetite and inflammation are the main outcomes being explored, with nutritional status, dietary intake and quality of life included as secondary outcomes. A lead in phase of 3 months prior to baseline was used so that each person acts as their own historical control. The study also examines whether there are gender differences in response to the treatment. Being an exploratory study, an important part of the work is to test the feasibility of the intervention, thus the level of adherence and factors associated with adherence are also presented. The studies were conducted at the hemodialysis unit of the Wesley Hospital. Participants met the following criteria: adult, stage 5 CKD on hemodialysis for at least 3 months, not expected to receive a transplant or switch to another dialysis modality during the study, absence of intellectual impairment or mental illness impairing ability to follow instructions or complete the intervention. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and 12 weeks. Inflammation was measured using five biomarkers: c-reactive protein (CRP), interleukin-6 (IL6), intercellular adhesion molecule (sICAM-1), vascular cell adhesion molecule (sVCAM-1) and white cell count (WCC). Subjective appetite was measured using the first question from the Appetite and Dietary Assessment (ADAT) tool and VAS for measurements of hunger, desire to eat and fullness. A novel feature of the study was the assessment of the appetite peptides leptin, ghrelin and peptide YY as biomarkers of appetite. Nutritional status/inflammation was assessed using the Malnutrition-Inflammation Score (MIS) and the Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day records. Quality of life was measured using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF™ v1.3 © RAND University), which combines the Short-Form 36 (SF36) with a kidney-disease specific module2. A smaller range of these variables was available for analysis during the control phase (CRP, ADAT, dietary intake and nutritional status). Statistical analysis was carried out using SPSS version 14 (SPSS Inc, Chicago IL, USA). Analysis of the first part of the thesis involved descriptive and bivariate statistics, as well as Bland-Altman plots to assess agreement between methods, and sensitivity analysis/ROC curves to test the ability of methods to predict the presence of inflammation. The unadjusted (paired ttests) and adjusted (linear mixed model) change over time is presented for the main outcome variables of inflammation and appetite. Results are shown for the whole group followed by analyses according to gender and adherence to treatment. Due to the exploratory nature of the study, trends and clinical significance were considered as important as statistical significance. Twenty-eight patients (mean age 61±17y, 50% male, dialysis vintage 19.5 (4- 101) months) underwent baseline assessment. Seven out of 28 patients (25%) reported sub-optimal appetite (self-reported as fair, poor or very poor) despite all being well nourished (100% SGA A). Using the VAS, ratings of hunger, but not desire to eat or fullness, were significantly (p<0.05) associated with a range of relevant clinical variables including age (r=-0.376), comorbidities (r=-0.380) nutritional status (PG-SGA score, r=-0.451), inflammatory markers (CRP r=-0.383; sICAM-1 r=-0.387) and seven domains of quality of life. Patients expressed a preference for the paper and pen method of administering VAS. None of the tools (appetite, MIS, PG-SGA, albumin or iron) showed an acceptable ability to detect patients who are inflamed. It is recommended that CRP should be tested more frequently as a matter of course rather than seeking alternative methods of measuring inflammation. 27 patients completed the 12 week intervention. 20 patients were considered adherent based on changes in % plasma EPA, which rose from 1.3 (0.94)% to 5.2 (1.1)%, p<0.001, in this group. The major barriers to adherence were forgetting to take the tablets as well as their size. At 12 weeks, inflammatory markers remained steady apart from the white cell count which decreased (7.6(2.5) vs 7.0(2.2) x109/L, p=0.058) and sVCAM-1 which increased (1685(654) vs 2249(925) ng/mL, p=0.001). Subjective appetite using VAS increased (51mm to 57mm, +12%) and there was a trend towards reduction in peptide YY (660(31) vs 600(30) pg/mL, p=0.078). There were some gender differences apparent, with the following adjusted change between baseline and week 12: CRP (males -3% vs females +17%, p=0.19), IL6 (males +17% vs females +48%, p=0.77), sICAM-1 (males -5% vs females +11%, p=0.07), sVCAM-1 (males +54% vs females +19%, p=0.08) and hunger ratings (males 20% vs females -5%, p=0.18). On balance, males experienced a maintainence or reduction in three inflammatory markers and an improvement in hunger ratings, and therefore appeared to have responded better to the intervention. Compared to those who didn’t adhere, adherent patients maintained weight (mean(SE) change: +0.5(1.6) vs - 0.8(1.2) kg, p=0.052) and fat-free mass (-0.1 (1.6) vs -1.8 (1.8) kg, p=0.045). There was no difference in change between the intervention and control phase for CRP, appetite, nutritional status or dietary intake. The thesis makes a significant contribution to the evidence base for understanding of PEW in dialysis patients. It has advanced knowledge of methods of assessing inflammation and appetite. Retrospective ratings of hunger on a VAS appear to be a valid method of assessing appetite although samples which include patients with very poor appetite are required to confirm this. Supplementation with fish oil appeared to improve subjective appetite and dampen the inflammatory response. The effectiveness of the intervention is influenced by gender and adherence. Males appear to be more responsive to the primary outcome variables than females, and the quality of response is improved with better adherence. These results provide evidence to support future interventions aimed at reducing the effects of PEW in dialysis patients.

Embedded engagements : the challenge of creative practice research to the humanities

This article explores the opportunities and challenges surrounding a viable cross-disciplinary engagement between the Humanities disciplines and the Creative Practice disciplines within the innovative context of the Creative Industries Faculty at the Queensland University of Technology. This will involve a charting of the intersection of the emerging field of creative practice-led research with various disciplines in the Humanities such as cultural studies. The potential for a reciprocal, transformative process in these creative fields will be addressed. Several examples of postgraduate students’ research will be foregrounded as case studies of the issues involved in fostering a genuine cultural critique both within and through creative practice. Some observers may argue that the research higher degree creative practitioner in effect looks outward from the symbolic material forms being created, in search of an interpretative paradigm, thereby trawling the Humanities for a theory. Several current debates within the postgraduate research arena regarding the balance between the theoretical exegesis and the creative work (e.g. performance, drama, dance, visual art, creative writing, film and screen production, music, interactive media etc) will also be critically examined.

Transforming Queensland VET : Challenges and Opportunities (Volume 1)

The volume is a collection of papers that address issues associated with change in the delivery of VET programs in Queensland, foreshadowed by the release of The Queensland Skill Plan in 2006. Issues that relate to the implementation of the Actions identified in the Queensland Skills Plan are the focus of the collection. In particular, the incorporation of Information Communication Technologies (ICTs) and e-learning approaches in the delivery of training packages is a key topic, how such change can be managed in the delivery of training programs, as well as broader professional development issues for VET practitioners. Change at an organisational level is the focus of two papers. Lyn Ambrose uses ideas from Diffusion of Innovations Theory to consider how the adoption eLearning in a TAFE community can be addressed. The paper by Susan Todhunter also discusses the organisational challenges in change initiatives in TAFE Institutes. Specific issues related to in the professional development of VET teachers are the focus of the papers by Mary Campbell, Sharon Altena, and Judy Gronold. Mary Campbell discusses the importance of building staff capabilities within the TAFE system and how this might be managed. Sharon Altena considers how professional development programs are currently delivered and how new approaches to professional development for TAFE teachers are needed to ensure changes can be sustained in teaching practice. The paper by Judy Gronold takes up a specific challenge for VET practitioners in the Queensland Skills Plan. She addresses issues related to embedding employability skills into training delivery in order to address industries’ need for flexible, multi-skilled productive workers. Mark Driver discusses the issues resulting from increased number of mature-aged learners in VET programs and how this change in the demographic profile of students presents challenges to the VET system. In the paper by David McKee, implications in the incorporation of ICTs into trade training are discussed and the need for effective change management strategies to ensure a smooth transition to new ways of delivering trade training. Finally, in the paper by David Roberts, the potential of Problem-Based Learning (PBL) approaches in VET training and the role of ICTs within such approaches are discussed. David uses horticulture training as an example to discuss the issues in implementing PBL effectively in VET programs. These papers were completed by the authors as a part of their postgraduate studies at QUT. The views reported are those of the authors and should not be attributed to the Queensland Department of Education, Training and the Arts.

Transforming Queensland VET : Challenges and Opportunities (Volume 3)

The volume is the third in a series that addresses change and development in the delivery of VET programs in Queensland. The chapters address a breadth of issues that relate to the changing landscape for teaching and learning in VET programs through e-learning. Organisational change is a key focus of this volume. James Waterson examines business and pedagogical perspectives for SkillsTech Australia to create teaching and learning environments that will enrich the learning experience for staff and students. Kerry Emerson explores the ways in which printing teachers might change current practices in order to deliver their training to apprentices and trainees – off-the-job, onthe- job and online, through e-learning. The chapter by Erik Dodwell takes up issues of user-friendly RPL interviews and the challenges to develop a model that may be applied consistently across all industry areas using conversational interviews. The chapters by Linda Roberston, Nina Woodrow, and Anushka Weerackody discuss teaching and learning for specific groups of students. Linda Roberston proposes a vision for learning support teachers in which the learner is encouraged to be a self-directed and autonomous learner who is capable of utilising e-learning resources and is information literate. Nina Woodrow presents a case for the diminished sense of occupational identity by adult literacy teachers and the implications of this loss of expertise across the VET sector. Constructive strategies for change are outlined. The chapter by Anushka Weerackody explores ideas to enhance the practices of ESL teachers in TAFE Queensland through an online community of practice. The issues of on-the-job training through e-learning for various trades is considered by Anne-Louise Johnston and the benefits and challenges for SkillsTech Australia in developing training partnerships with industry to deliver these changes. These papers were completed by the authors as a part of their postgraduate studies at QUT. The views reported are those of the authors and should not be attributed to the Queensland Department of Education and Training. Donna Berthelsen and Lauren Vogel Faculty of Education Queensland University of Technology December 2009

Bend and stretch : pedagogical callisthenics in creative practice honours

The supervision of research higher degree (RHD) candidates in creative practice-led programs poses challenges for both candidates and supervisors. Changes in international postgraduate training agendas have complicated this ever-shifting terrain. This paper investigates the honours research training year. This fourth year is made up of a project and coursework and is a traditional entry point for doctoral study. At Creative Industries, honours acts as a precursor and model for supervisory practice in postgraduate creative arts in an interdisciplinary faculty. The findings indicate that best practice may involve ‘bending and stretching’ existing pedagogical approaches for an increasingly interdisciplinary and mobile research environment. This discussion considers the supervision of candidates enrolled in Queensland University of Technology Faculty of Creative Industries honours courses that encompass a range of disciplines including creative writing, fashion, animation and performance studies. We present results of an analysis of the work of honours students who are creative practitioners (many of whom will, or have, moved into the RHD environment). This examination was undertaken in order to develop an understanding of the dynamics of creative practice at this level, particularly in light of the growing emphasis on early research training in Australian universities. Specific pedagogical strategies mooted include establishing a common research vocabulary, an increasing focus on research design, and a linking of theory and practice.

Recruiting local public relations professionals for global relations practice : a comparative analysis between Australian and Indian public relations recruitment advertisements

The aim of this exploratory study was to gain an insight into Asian and Western public relations practices by investigating them through job advertisements and thus reflecting on what organisations expect from the public relations professionals. Grunig's (1984) four models of public relations and the concept of relationships management were used as the foundation for this study. Australia was used to represent the Western region and India was used to represent the Asian region. Sample sets of public relations recruitment advertisements from both countries were examined against Grunig's one-way communication, two-way communication and relationship management attributes.

A model of teacher professional development based on the principles of lesson study

The researcher’s professional role as an Education Officer was the impetus for this study. Designing and implementing professional development activities is a significant component of the researcher’s position description and as a result of reflection and feedback from participants and colleagues, the creation of a more effective model of professional development became the focus for this study. Few studies have examined all three links between the purposes of professional development that is, increasing teacher knowledge, improving teacher practice, and improving student outcomes. This study is significant in that it investigates the nature of the growth of teachers who participated in a model of professional development which was based upon the principles of Lesson Study. The research provides qualitative and empirical data to establish some links between teacher knowledge, teacher practice, and student learning outcomes. Teacher knowledge in this study refers to mathematics content knowledge as well as pedagogical-content knowledge. The outcomes for students include achievement outcomes, attitudinal outcomes, and behavioural outcomes. As the study was conducted at one school-site, existence proof research was the focus of the methodology and data collection. Developing over the 2007 school year, with five teacher-participants and approximately 160 students from Year Levels 6 to 9, the Lesson Study-principled model of professional development provided the teacher-participants with on-site, on-going, and reflective learning based on their classroom environment. The focus area for the professional development was strategising the engagement with and solution of worded mathematics problems. A design experiment was used to develop the professional development as an intervention of prevailing teacher practice for which data were collected prior to and after the period of intervention. A model of teacher change was developed as an underpinning framework for the development of the study, and was useful in making decisions about data collection and analyses. Data sources consisted of questionnaires, pre-tests and post-tests, interviews, and researcher observations and field notes. The data clearly showed that: content knowledge and pedagogical-content knowledge were increased among the teacher-participants; teacher practice changed in a positive manner; and that a majority of students demonstrated improved learning outcomes. The positive changes to teacher practice are described in this study as the demonstrated use of mixed pedagogical practices rather than a polarisation to either traditional pedagogical practices or contemporary pedagogical practices. The improvement in student learning outcomes was most significant as improved achievement outcomes as indicated by the comparison of pre-test and post-test scores. The effectiveness of the Lesson Study-principled model of professional development used in this study was evaluated using Guskey’s (2005) Five Levels of Professional Development Evaluation.

Change in colour appearance of small defocused lights

Small long wavelength lights (≤ 1’ arc) change colour appearance with positive defocus, appearing yellow or white. I investigated influences of longitudinal chromatic aberration and monochromatic aberrations on colour appearance of small narrow band lights. Seven cyclopleged participants viewed a small light (1’ arc diameter, λmax range 510 - 628 nm) centred within a 4.6’ black annulus and surrounded by a uniform white field under photopic light levels. An optical trombone varied focus. Participants were required to vary the focus by moving the optical trombone in either positive or negative direction and report when they noticed a change in appearance of the defocused narrow band light. Longitudinal chromatic aberration was controlled using a Powell achromatizing lens and its doublet and triplet components that neutralized, doubled and reversed the eye’s chromatic aberration, respectively. Changes in colour appearance for a 628 nm light occurred without any lens at +0.5 ± 0.2D defocus and with the doublet at +0.6 ± 0.2 D. The achromatizing lens did not affect appearance and the phenomenon was evident with the triplet for negative defocus (-0.5 ± 0.3 D). Adaptive optics correction of astigmatism and higher order monochromatic aberration did not affect magnitude significantly. Colour changes occurred despite a range of participant L/M cone ratios. Direction of change in colour appearance was reversed for short compared to long wavelengths. We conclude that longitudinal chromatic aberrations, but not monochromatic aberrations, are involved in changing appearance of small lights with defocus. Additional neuronal mechanisms that may contribute to the colour changes are considered.