Q-RARA : a rapid and rigorous method for researching small, primary health care organisations

Understanding the organisational processes driving quality primary care is crucial to the maintaining and improving practice. Qualitative methods are increasingly popular in health services research, but this area is dominated by interview studies. Multiple qualitative methods are rarely used in a systematically integrated fashion. We developed a method to study small primary health care organizations using rapid appraisal and qualitative mixed methods: Q-RARA – Qualitative Rapid Appraisal, Rigorous Analysis

A comparison of treatment options for management of end stage kidney disease in elderly patients : a systematic review

Background Chronic kidney disease is a global public health problem of increasing prevalence. There are five stages of kidney disease, with Stage 5 indicating end stage kidney disease (ESKD) requiring dialysis or death will eventually occur. Over the last two decades there have been increasing numbers of people commencing dialysis. A majority of this increase has occurred in the population of people who are 65 years and over. With the older population it is difficult to determine at times whether dialysis will provide any benefit over non-dialysis management. The poor prognosis for the population over 65 years raises issues around management of ESKD in this population. It is therefore important to review any research that has been undertaken in this area which compares outcomes of the older ESKD population who have commenced dialysis with those who have received non-dialysis management. Objective The primary objective was to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with ESKD. Inclusion criteria Types of participants This review considered studies that included participants who were 65 years and older. These participants needed to have been diagnosed with ESKD for greater than three months and also be either receiving renal replacement therapy (RRT) (hemodialysis [HD] or peritoneal dialysis [PD]) or non-dialysis management. The settings for the studies included the home, self-care centre, satellite centre, hospital, hospice or nursing home. Types of intervention(s)/phenomena of interest This review considered studies where the intervention was RRT (HD or PD) for the participants with ESKD. There was no restriction on frequency of RRT or length of time the participant received RRT. The comparator was participants who were not undergoing RRT. Types of studies This review considered both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies. This review also considered descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion. This review included any of the following primary and secondary outcome measures: •Primary outcome – survival measures •Secondary outcomes – functional performance score (e.g. Karnofsky Performance score) •Symptoms and severity of end stage kidney disease •Hospital admissions •Health related quality of life (e.g. KDQOL, SF36 and HRQOL) •Comorbidities (e.g. Charlson Comorbidity index).

Consumer’s persistence in solving their own problem with self‐service technology

An increasing range of technology services are now offered on a self-service basis. However, problems with self-service technologies (SSTs) occur at times due to the technical error, staff error, or consumers’ own mistakes. Considering the role of consumers as co-producers in the SST context, we aim to study consumer’s behaviours, strategies, and decision making in solving their problem with SST and identify the factors contributing to their persistence in solving the problem. This study contributes to the information systems research, as it is the first study that aims to identify such a process and the factors affecting consumers’ persistence in solving their problem with SST. A focus group with user support staff has been conducted, yielding some initial results that helped to conduct the next phases of the study. Next, using Critical Incident Technique, data will be gathered through focus groups with users, diary method, and think-aloud method.

Learning through modelling in the primary years

Many nations are highlighting the need for a renaissance in the mathematical sciences as essential to the well-being of all citizens (e.g., Australian Academy of Science, 2006; 2010; The National Academies, 2009). Indeed, the first recommendation of The National Academies’ Rising Above the Storm (2007) was to vastly improve K–12 science and mathematics education. The subsequent report, Rising Above the Gathering Storm Two Years Later (2009), highlighted again the need to target mathematics and science from the earliest years of schooling: “It takes years or decades to build the capability to have a society that depends on science and technology . . . You need to generate the scientists and engineers, starting in elementary and middle school” (p. 9). Such pleas reflect the rapidly changing nature of problem solving and reasoning needed in today’s world, beyond the classroom. As The National Academies (2009) reported, “Today the problems are more complex than they were in the 1950s, and more global. They’ll require a new educated workforce, one that is more open, collaborative, and cross-disciplinary” (p. 19). The implications for the problem solving experiences we implement in schools are far-reaching. In this chapter, I consider problem solving and modelling in the primary school, beginning with the need to rethink the experiences we provide in the early years. I argue for a greater awareness of the learning potential of young children and the need to provide stimulating learning environments. I then focus on data modelling as a powerful means of advancing children’s statistical reasoning abilities, which they increasingly need as they navigate their data-drenched world.

Exploring links between pedagogical knowledge practices and student outcomes in STEM education for primary schools

Science, technology, engineering, and mathematics (STEM) education is an emerging initiative in Australia, particularly in primary schools. This qualitative research aimed to understand Year 4 students' involvement in an integrated STEM education unit that focused on science concepts (e.g., states of matter, testing properties of materials) and mathematics concepts (e.g., 3D shapes and metric measurements) for designing, making and testing a strong and safe medical kit to insulate medicines (ice cubes) at desirable temperatures. Data collection tools included student work samples, photographs, written responses from students and the teacher, and researcher notes. In a post-hoc analysis, a pedagogical knowledge practice framework (i.e., planning, timetabling, preparation, teaching strategies, content knowledge, problem solving, classroom management, questioning, implementation, assessment, and viewpoints) was used to explain links to student outcomes in STEM education. The study showed how pedagogical knowledge practices may be linked to student outcomes (knowledge, understanding, skill development, and values and attitudes) for a STEM education activity.

The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke

Background Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Conclusions Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used.

Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Palliative care problem severity score: Reliability and acceptability in a national study

Background The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe). Aim To test the reliability and acceptability of the Palliative Care Problem Severity Score. Design: Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool. Setting/participants Clinicians from 10 Australian palliative care services: 9 inpatient units and 1 mixed inpatient/community-based service. Results A total of 102 clinicians participated, with almost 600 paired assessments completed for each domain, involving 420 patients. A total of 91% of paired assessments were undertaken within 2 h. Strength of agreement for three of the four domains was moderate: pain (Kappa = 0.42, 95% confidence interval = 0.36 to 0.49); psychological/spiritual (Kappa = 0.48, 95% confidence interval = 0.42 to 0.54); family/carer (Kappa = 0.45, 95% confidence interval = 0.40 to 0.52). Strength of agreement for the remaining domain (other symptoms) was fair (Kappa = 0.38, 95% confidence interval = 0.32 to 0.45). Conclusion The Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.

Experience of problem-based learning (PBL) in virtual space : a phenomenographical study

This thesis reports the outcomes of an investigation into students’ experience of Problem-based learning (PBL) in virtual space. PBL is increasingly being used in many fields including engineering education. At the same time many engineering education providers are turning to online distance education. Unfortunately there is a dearth of research into what constitutes an effective learning experience for adult learners who undertake PBL instruction through online distance education. Research was therefore focussed on discovering the qualitatively different ways that students experience PBL in virtual space. Data was collected in an electronic environment from a course, which adopted the PBL strategy and was delivered entirely in virtual space. Students in this course were asked to respond to open-ended questions designed to elicit their learning experience in the course. Data was analysed using the phenomenographical approach. This interpretative research method concentrated on mapping the qualitative differences in students’ interpretations of their experience in the course. Five qualitatively different ways of experiencing were discovered: Conception 1: ‘A necessary evil for program progression’; Conception 2: ‘Developing skills to understand, evaluate, and solve technical Engineering and Surveying problems’; Conception 3: ‘Developing skills to work effectively in teams in virtual space’; Conception 4: ‘A unique approach to learning how to learn’; Conception 5: ‘Enhancing personal growth’. Each conception reveals variation in how students attend to learning by PBL in virtual space. Results indicate that the design of students’ online learning experience was responsible for making students aware of deeper ways of experiencing PBL in virtual space. Results also suggest that the quality and quantity of interaction with the team facilitator may have a significant impact on the student experience in virtual PBL courses. The outcomes imply pedagogical strategies can be devised for shifting students’ focus as they engage in the virtual PBL experience to effectively manage the student learning experience and thereby ensure that they gain maximum benefit. The results from this research hold important ramifications for graduates with respect to their ease of transition into professional work as well as their later professional competence in terms of problem solving, ability to transfer basic knowledge to real-life engineering scenarios, ability to adapt to changes and apply knowledge in unusual situations, ability to think critically and creatively, and a commitment to continuous life-long learning and self-improvement.

A soft approach to solving hard problems in construction project management

Construction projects are faced with a challenge that must not be underestimated. These projects are increasingly becoming highly competitive, more complex, and difficult to manage. They become ‘wicked problems’, which are difficult to solve using traditional approaches. Soft Systems Methodology (SSM) is a systems approach that is used for analysis and problem solving in such complex and messy situations. SSM uses “systems thinking” in a cycle of action research, learning and reflection to help understand the various perceptions that exist in the minds of the different people involved in the situation. This paper examines the benefits of applying SSM to wicked problems in construction project management, especially those situations that are challenging to understand and difficult to act upon. It includes relevant examples of its use in dealing with the confusing situations that incorporate human, organizational and technical aspects.

Promoting interdisciplinarity through mathematical modelling

This article presents one approach to addressing the important issue of interdisciplinarity in the primary school mathematics curriculum, namely, through realistic mathematical modelling problems. Such problems draw upon other disciplines for their contexts and data. The article initially considers the nature of modelling with complex systems and discusses how such experiences differ from existing problem-solving activities in the primary mathematics curriculum. Principles for designing interdisciplinary modelling problems are then addressed, with reference to two mathematical modelling problems— one based in the scientific domain and the other in the literary domain. Examples of the models children have created in solving these problems follow. A reflection on the differences in the diversity and sophistication of these models raises issues regarding the design of interdisciplinary modelling problems. The article concludes with suggested opportunities for generating multidisciplinary projects within the regular mathematics curriculum.

Visuacy, imagination, and engagement

Australia’s National Review of Visual Education (DEEWR, 2009) asserts the primacy of visual language ability, or ‘visuacy” in problem-solving. This paper reports on a recent university/schools research project with ‘at risk’ middle school students in which visuacy was promoted as a primary medium for obtaining data relating to issues of immediate concern to the students. Using a students-as-researchers approach, the project investigated middle school students’ perspectives on school engagement and disengagement. In this project, novice researchers used a variety of data gathering methods including photography, video interviews and drawn images as well as more traditional verbal methods, such as interviews, and quantitative methods, such as questionnaires. Engaging student imagination was a key focus of the approach taken by the project, acknowledging that student participants may be reluctant to enter dialogue with teachers and researchers on matters to which they have previously had little input. Students who have previously been marginalized and prevented from contributing their voices to educational forums often have difficulty in adjusting to the novelty of collaborative research with adults (Rudduck, 2003) and may be uncertain of their own place in the relationship that defines teacher/student interactions. It is argued that the project’s promotion of visuacy, alongside more traditional literacies and numeracy in education research, helped to overcome these concerns, engaged the imaginations of the student researchers, and provided a medium for the expression of the voices of marginalised young people.

The role of fluency in a mathematics item with an embedded graphic: Interpreting a pie chart.

The purpose of this study was to identify the pedagogical knowledge relevant to the successful completion of a pie chart item. This purpose was achieved through the identification of the essential fluencies that 12–13-year-olds required for the successful solution of a pie chart item. Fluency relates to ease of solution and is particularly important in mathematics because it impacts on performance. Although the majority of students were successful on this multiple choice item, there was considerable divergence in the strategies they employed. Approximately two-thirds of the students employed efficient multiplicative strategies, which recognised and capitalised on the pie chart as a proportional representation. In contrast, the remaining one-third of students used a less efficient additive strategy that failed to capitalise on the representation of the pie chart. The results of our investigation of students’ performance on the pie chart item during individual interviews revealed that five distinct fluencies were involved in the solution process: conceptual (understanding the question), linguistic (keywords), retrieval (strategy selection), perceptual (orientation of a segment of the pie chart) and graphical (recognising the pie chart as a proportional representation). In addition, some students exhibited mild disfluencies corresponding to the five fluencies identified above. Three major outcomes emerged from the study. First, a model of knowledge of content and students for pie charts was developed. This model can be used to inform instruction about the pie chart and guide strategic support for students. Second, perceptual and graphical fluency were identified as two aspects of the curriculum, which should receive a greater emphasis in the primary years, due to their importance in interpreting pie charts. Finally, a working definition of fluency in mathematics was derived from students’ responses to the pie chart item.

Mood, persistence, and success

Tested the hypothesis that level of performance and persistence in completing tasks is affected by mood. 44 female and 41 male college students received tape-recorded instructions to recall vividly happy or sad experiences or to imagine a neutral situation. Results for the primary dependent variables on which a mood difference was predicted were analyzed with a multivariate analysis of variance (MANOVA). After the induction happy Ss persisted longer at an anagrams task and solved more anagrams than sad Ss. Women were also faster at reaching solutions when happy than sad. Results support the hypothesis that positive moods promote persistence and ultimate success, but they raise questions about the role of self-efficacy and the sources of gender differences.

Blogs, wikis and podcasts : collaborative knowledge building tools in a design and technology course

Design and Technology has become an important part of the school curriculum. In Queensland, Australia, Technology (which encompasses Design) is one of the Key Learning Areas (KLAs) for students in the first ten years of schooling. This KLA adopts a student-centred, hands-on constructivist approach to teaching and learning. The ability to conceptualise and implement appropriate learning experiences, however, has been a challenge for some early career teachers. This paper describes how Design and Technology is being taught to pre-service primary teachers at an Australian University through their involvement in a range of authentic problem-solving activities supported by social learning tools such as wikis and blogs. An interview with a sample from this group (N=5) provides an insight into how these social software tools enhanced their knowledge and learning. This paper will describe how these social learning tools impact on the agency of learning.