Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.

Policing services with mentally ill people : developing greater understanding and best practice

Although it is now well known that there is a disproportionate number of people with mental illnesses in the criminal justice system, surprising little attention has been paid to the challenges faced by policing people with mental illnesses in the community. This article provides an overview of some of the key findings from a programme of research undertaken in Victoria to further understand and develop a best practice model at this interface. The areas covered will include the prevalence of psychiatric symptoms and mental illnesses among police cell detainees; the existing knowledge base and attitudes of police towards mentally ill people; the relationship between mental illness and offending; the frequency and nature of police apprehensions of mentally ill people under the Mental Health Act; the association among mental disorder, police shootings, and other injuries to people as a result of these encounters; and police interactions with victims of crime. The work highlights the need for ongoing improvements in policing people with mental illnesses, and particularly the need for improved inter-agency practices for dealing with them.

Principal led school improvement and teacher capacity building in the Barwon South Network : final report, May 2013

The period of interest for this report is the beginning of 2011 to the end of 2012. The period commenced when the Regional Network Leader of the Barwon South Network of schools in the Barwon South Region of the Department of Education and Early Childhood contacted the School of Education at Deakin University, Waurn Ponds Campus Geelong. The Regional Network Leader outlined a desire to engage with Deakin University to research a short-term-cycle model of school improvement to be implemented in the region. While the model was expected to be taken on by all schools in the region the research was limited to the 23 schools in the Barwon South Network with four schools to be investigated more closely for each of two years (2001 & 2012) – eight focus schools in total.

Many positive outcomes flowed from the implementation of short-term-cycle school improvement plans and their associated practices but there was wide variation in the nature and degrees of success and of the perception of the process. The research team asked the following questions of the data:

1. What aspects of the School Improvement Plan (SIP) approach were important for initiating and supporting worthwhile change?
2. What might we take from this, to provide guidance on how best to support change in teaching and learning processes in schools?

The School Improvement Plan (SIP) worked in a range of ways. At one level it was strongly focused on school leadership, and a need to improve principals’ capacity to initiate worthwhile teaching and learning processes in their schools. Underlying this intent, one might think an assumption is operation is that the leadership process involves top down decision-making and a willingness to hold staff accountable for the quality of their practice.

The second strong focus was on the translation into practice and the consequent effect on student learning, involving an emphasis on data and evidence led practice. Hence, along with the leadership focus there was a demand for the process of school improvement to reach down into students and classrooms. Thus, the SIP process inevitably involved a chain of decision-making by which student learning quality drove the intervention, and teachers responsible for this had a common view. The model therefore should not be seen as an intervention only on the principal, but rather on the school decision-making system and focus. Even though it was the principal receiving the SIP planning template, and reporting to the network, the reporting was required to include description of the operation of the school processes, of classroom processes, and of student learning. This of course placed significant constraints on principals, which may help explain the variation in responses and outcomes described above.

The findings from this study are based on multiple data sources: analysis of both open and closed survey questions which all teachers in the 23 schools in the network were invited to complete; interviews with principals, teachers and leaders in the eight case study schools; some interviews with students in the case study schools; and interviews with leaders who worked in the regional network office; and field notes from network meetings including the celebrations days. Celebrations days occurred each school term when groups of principals came together to share and celebrate the improvements and processes happening in their schools. Many of the themes emerging from the analysis of the different data sources were similar or overlapping, providing some confidence in the evidence-base for the findings.

The study, conducted over two years of data collection and analysis, has demonstrated a range of positive outcomes in at the case study schools relating to school communication and collaboration processes, professional learning of principals, leadership teams and classroom teachers. There was evidence in the survey responses and field notes from ‘celebration days’ that these outcomes were also represented in other schools in the network. The key points of change concerned the leadership processes of planning for improvement, and the rigorous attention to student data in framing teaching and learning processes. This latter point of change had the effect of basing SIP processes on a platform of evidence-based change. The research uncovered considerable anecdotal and observational evidence of improvements in student learning, in teacher accounts in interview, and presentations of student work. Interviews with students, although not as representative as the team would have liked, showed evidence of student awareness of learning goals, a key driver in the SIP improvement model. It was, however, not possible over this timescale to collect objective comparative evidence of enhanced learning outcomes.

A number of features of the short-term-cycle SIP were identified that supported positive change across the network. These were: 1) the support structures represented by the network leader and support personnel within schools, 2) the nature of the SIP model – focusing strongly on change leadership but within a collaborative structure that combined top-down and bottom-up elements, 3) the focus on data-led planning and implementation that helped drill down to explicit elements of classroom practice, and 4) the accountability regimes represented by network leader presence, and the celebration days in which principals became effectively accountable to their peers. We found that in the second year of the project, momentum was lost in the case study schools, as the network was dismantled. This raised issues also for the conduct of research in situations of systemic change.

Alongside the finding of evidence of positive outcomes in the case study schools overall, was the finding that the SIP processes and outcomes varied considerably across schools. A number of contextual factors were identified that led to this variation, including school histories of reform, principal management style, and school size and structure that made the short-term-cycle model unmanageable. In some cases there was overt resistance to the SIP model, at least in some part, and this led to an element of performativity in which the language of the SIP was conscripted to other purposes. The study found that even with functioning schools the SIP was understood differently and the processes performed differently, raising the question of whether in the study we are dealing with one SIP or many. The final take home message from the research is that schools are complex institutions, and models of school improvement need to involve both strong principled features, and flexibility in local application, if all schools’ interests in improving teaching and learning processes and outcomes are to be served.

International ‘benchmarking’ studies and the identification of ‘education best practice’: a focus on classroom teachers and their practices

 Abstract:The disproportionate focus on classroom teachers and their instruction&mdash;teacher effectiveness&mdash;in order to confront and address under-achievement and disadvantage appears as a contemporary education policy theme in Australia. Phrases such as &lsquo;high performing schooling systems&rsquo;, &lsquo;the best teachers&rsquo;, &lsquo;high performing countries&rsquo;, &lsquo;quality teaching&rsquo;, &lsquo;under-performing schools&rsquo;, &lsquo;the right change&rsquo;, &lsquo;operationally feasible&rsquo;, &lsquo;targeting of reforms&rsquo;, &lsquo;degrees of under-performance&rsquo;, &lsquo;educational drivers&rsquo;, &lsquo;teacher quality and improved teaching&rsquo; and &lsquo;external standards and governance&rsquo; are constantly mentioned and given continual attention and prominence by policy-makers. The paper questions and critiques a policy-making direction that uses teacher effectiveness research to force and steer reform in education. The distinctive and narrow concern with teacher effectiveness works to the specific exclusion of breadth and scope concerning debate about broader education related issues and questions, for example, matters of student achievement, exclusion and disadvantage. This article uses a qualitative research approach informed by critical theory to examine three influential private sector reports on education and schooling: The McKinsey Report ( 2007 )&mdash;How the world&rsquo;s best-performing school systems come out on top, The Nous Group ( 2011 )&mdash;Schooling Challenges and Opportunities and The Grattan Institute ( 2012 )&mdash;Catching up: Learning from the best school systems in East Asia. The article subjects the reports to close critical scrutiny and examination and finds that classroom teachers are positioned so that their specific and explicit instruction becomes the differentiating &lsquo;variable&rsquo; in matters of student achievement and success.

Elements underpinning successful implementation of a national best-practice child investigative interviewing framework

The complexity and effort required to achieve the widespread implementation of best-practice child interview guidelines justifies the establishment of structures to enhance cross-jurisdictional sharing of expertise, resources and training delivery support. Australia has made great strides toward such a system via work currently being undertaken by police jurisdictions to facilitate greater consistency in education and training for practitioners in the area of investigative interviewing, strengthening collaboration between police and tertiary education institutions, and growing commitment to evidence-based policy and practice among police executives. To maximise progress, however, organisations need to consider the development of a coordinated continual quality improvement approach. This will be impeded by three structural elements: access to field interviews for practitioner feedback and organisational evaluation, interviewer tenure and case tracking. This article discusses each element, their roles within a national best-practice interview framework, and attempts by some jurisdictions to address them. It also provides recommendations to guide further reform.

Optimal second best taxation of addictive goods in dynamic general equilibrium: a revenue raising perspective

In this paper we derive conditions under which optimal tax rates for addictive goods exceed tax rates for non-addictive consumption goods within a rational addiction framework where exogenous government spending cannot be financed with lump sum taxes. We reexamine classic results on optimal commodity taxation and find a rich set of new findings. Two dynamic effects exist. First, households anticipating higher future addictive tax rates reduce current addictive consumption, so they will be less addicted when the tax rate increases. Therefore, addictive tax revenue falls prior to the tax increase. Surprisingly, the optimal tax rate on addictive goods is generally decreasing in the strength of tolerance, since strong tolerance strengthens this tax anticipation effect. Second, high current tax rates on addictive goods make households less addicted in the future, affecting all future tax revenues in a way which depends on how elasticities are changing over time. Classic results on uniform commodity taxation emerge as special cases when elasticities are constant and the addiction function is homogeneous of degree one. Finally, we also study features of addictive goods such as complementarity to leisure that, while not directly related to the definition of addiction, are nonetheless properties many addictive goods display.

Friedrich Hayek and Michael Polanyi in correspondence

Friedrich Hayek and Michael Polanyi corresponded with each other for the best part ofthirty years. They had shared interests that included science, social science, economics,epistemology, history of ideas and political philosophy. Studying their  correspondenceand related writings, this article shows that Hayek and Polanyi were committedLiberals but with different understandings of liberty, the forces that endanger liberty,and the policies required to rescue it.

Are vitamins A and D important in the development of food allergy and how are they best measured?

Food allergy has a dramatic impact on a child's (and their family's) quality of life and places a major financial burden on the community. It has been hypothesized that the increase in food allergy may relate to the concordant rise in prevalence of vitamin D insufficiency. More recently a second hypothesis has implicated vitamin A sufficiency in the development of immune tolerance. Together, these hypotheses have prompted investigation into the circulating levels of vitamins A and D in relation to food allergy prevalence. This review aims to examine the relationship between vitamins A and D and food allergy. The first part of this review presents the available epidemiological data which proposes a dramatic increase of food allergy and related anaphylaxis during the last two decades. There is some indirect evidence that variation in food allergy prevalence within countries might be linked with ambient ultra violet radiation exposure and thus potentially with vitamin D levels. Only a few studies to date have directly examined the relationship between measured serum vitamin D levels and either food sensitization or allergy. The significance of vitamin A in food allergy prevalence is only provided through a hypothetical association due to its role in the immune system. The second part of this review discusses the relevant aspects of the analytical methods to assess vitamin A and D levels in children. The primary methods utilized relate to measuring the main circulating forms of vitamins A and D in blood i.e. retinol and 25-hydroxy-vitamin-D3 respectively. Chromatographic separation coupled with mass spectrometric detection is considered the gold standard method for both vitamins. These analytical methods should be fully validated for the use in pediatric populations to ensure they are fit for their clinical purpose.