Patient deterioration education: Evaluation of face-to-face simulation and e-simulation approaches

Background: Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method: Final-year preregistration nursing students (n=97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST2ACTWeb™. Results: Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion: Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience.

Does student engagement in self-assessment calibrate their judgement over time?

One of the implicit aims of higher education is to enable students to become better judges of their own work. This paper examines whether students who voluntarily engage in self-assessment improve in their capacity to make those judgements. The study utilises data from a web-based marking system that provides students with the opportunity to assess themselves on each criterion for each assessment task throughout a programme of study. Student marks were compared with those from tutors to plot changes over time. The findings suggest that overall students’ judgements do converge with those of tutors, but that there is considerable variation across achievement levels, with weaker students showing little improvement. Whilst the study is limited by the exigencies of voluntary participation and thus consequential gaps in the data set, it shows how judgement over time can be demonstrated and points to the potential for more systematic interventions to improve students’ judgements. It also illustrates the use of the web-based marking and feedback software (ReView) that has considerable utility in aiding self-assessment research.

Creating a ‘world class’ programme: reciprocity and constraint in networked global collaboration

The article reflects on the construction of a common Master’s programme across four universities located on four continents, in order to explore the role of networks in international educational collaboration. The study draws on the documented processes of the principal members of the programme team. It is presented as a case study of the development of the programme that uses ideas drawn from actor‐network theory to draw attention to the conjunction of human and non‐human actors that shaped the resulting web‐based courses. Constraints arising from major institutional and systemic obstacles were addressed through the effects of the actor‐network. The reciprocity of action and de‐centring of individual activity made possible through the collaboration enabled the human actors to sustain a level of innovation within their own institutions that would not have been possible through them acting alone.

Confronting globalisation: learning from intercontinental collaboration

Higher education institutions are responding to globalisation in various ways. This study describes and analyses challenges encountered in a recent case of global collaboration between four universities on different continents in developing a web‐based master’s program. The key issue was how to develop programs in a way that is fair for the different countries involved. The focus of the paper is on tensions between local and national contexts, rules and resources and the creation of a common global program. ‘Agency’, ‘structure’ and ‘frame factor’ are used as analytical concepts to help understand the dynamics of the collaboration and the character of the program.

Biomechanical studies: science (f)or common sense?

 Introduction: It is our impression that many biomechanical studies invest substantial resources studying the obvious: that more and larger metal is stronger. The purpose of this study is to evaluate if a subset of biomechanical studies comparing fixation constructs just document common sense. Methods: Using a web-based survey, 274 orthopaedic surgeons and 81 medical students predicted the results of 11 biomechanical studies comparing fracture fixation constructs (selected based on the authors' sense that the answer was obvious prior to performing the study). Sensitivity, specificity, and accuracy were calculated according to standard formulas. The agreement among the observers was calculated by using a multirater kappa, described by Siegel and Castellan. Results: The accuracy of predicting outcomes was 80% or greater for 10 of 11 studies. Accuracy was not influenced by level of experience (i.e., time in practice and medical students vs. surgeons). There were substantial differences in accuracy between observers from different regions. The overall categorical rating of inter-observer reliability according to Landis and Koch was moderate (k = 0.55; standard error (SE) = 0.01). Conclusion: The results of a subset of biomechanical studies comparing fracture fixation constructs can be predicted prior to doing the study. As these studies are time and resource intensive, one criterion for proceeding with a biomechanical study should be that the answer is not simply a matter of common sense. © 2014 Elsevier Ltd. All rights reserved.

Assessing and managing breast cancer risk: Clinicians' current practice and future needs

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice.

Assessing cycling-friendly environments for children: are micro-environmental factors equally important across different street settings?

BACKGROUND: As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limis, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. METHODS: We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. RESULTS: For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. CONCLUSIONS: Improving micro-scale attributes may increase the supportiveness of a street for children's transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children.

Assessment of reliability and validity of the Gambling Related Cognitions Scale (GRCS)

This research sought to assess the reliability and validity of Raylu and Oei's (2004) widely used Gambling Related Cognitions Scale (GRCS). Two samples were used in this study. In the 'teenage sample,' 2,000 teenagers, aged 15-19, completed a web-based survey containing questions related to a host of gambling-related issues, including GRCS. The 'university sample' comprised of 764 international students and 836 domestic students sampled from three universities in Australia. Our research used the same items as those utilized by Raylu and Oei (2004). After our exploratory factor analysis of the scale items yielded two factors for both samples, we tried to fit the five-factor model of GRCS to both datasets. Despite trying various approaches to achieve model fit, our data did not provide any evidence of the five factors underlying GRCS. However, the scale exhibited excellent concurrent validity and internal reliability across both samples. This research corroborates Taylor et al.'s (2013) suggestion that external independent validation of the GRCS is needed before it can be applied for diagnosis or treatment purposes, particularly among younger people.

Doing the right thing at the right time: Assessing responses to patient deterioration in electronic simulation scenarios using course-of-action analysis

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.

Alcohol misuse interventions in the workplace: a systematic review of workplace and sports management alcohol interventions

Alcohol misuse has been linked to negative organizational outcomes, including reduced productivity and increased absenteeism. Additionally, media reports have focused on alcohol misuse within sporting organizations. Given the paucity of research evaluating alcohol misuse interventions in professional sporting organizations, two systematic literature searches were conducted. Review one examined alcohol interventions in the workplace, and Review two included sport as a search term. Resultant papers demonstrated four categories of workplace alcohol interventions; brief, web based, psychosocial, and random drug and alcohol testing. Brief interventions were prevalent, yielding largely non-significant results. Review two studies evaluated a community sporting intervention, which adopted an ecological, multi-level approach, yielding significant improvements in alcohol consumption, drink-driving, and club profitability. Brief interventions in workplaces were ineffective, and no brief interventions were found in elite sporting organizations. However, community sporting interventions showed promising results. Ongoing evaluation of alcohol interventions in professional sporting organizations are recommended.

Intradialytic hypotension prevention and management knowledge and practices: Results from a survey of Australian and New Zealand nephrology nurses

Intradialytic hypotension (IDH) remains the most frequent serious side effect of hemodialysis, increasing morbidity in patients on hemodialysis. Nephrology nurses have a critical role in the prevention and management of IDH. The aim of this study was to investigate nephrology nurse knowledge and practice habits in the prevention and management of IDH. This was an explorative cross-sectional design, web-based survey of Australian and New Zealand nephrology nurses (n = 173). IDH definitions, blood pressureinterpretation, and IDH interventions were inconsistent and not always evidencebased.Demographic characteristics had little impact on the variation in responses. A universal definition for IDH may improve early recognition of the problem. Formal guidelines in considering individualized interventional strategies for asymptomaticepisodes prior symptomatic IDH occurrence may improve outcomes for patients on hemodialysis

Does Internet reporting improve the accessibility of financial reporting in a global world? A comparative study of New Zealand and Indian companies

 The accessibility of business reporting, including financial reports on company websites is not necessarily increased by providing more information on websites. The quality of Internet-based information is affected by both the accessibility and quantity of information provided. However, the accessibility of the information is an under researched area. This paper contributes to the existing body of knowledge on webbased business reporting, by considering the dimension of accessibility in terms of website appearance and visual design from four different perspectives. The aim is to consider the differences that occur in website organisation as a way of considering the accessibility of information provided on company websites. The paper considers the differences in the accessibility of website information between New Zealand and Indian companies as a means of demonstrating the variation that can occur across countries as well as within the same reporting structure. We conclude that Internet financial reporting does provide the illusion of comparability but without a more sustained focus on the harmonisation of terminology and attributes included in Internet reporting, the potential for comparison is reduced.

The concept of physical limitations in knee osteoarthritis: as viewed by patients and health professionals

Objective: To comprehensively identify components of the physical limitation concept in knee osteoarthritis (OA) and to rate the clinical importance of these using perspectives of both patients and health professionals.Design: Concept mapping, a structured group process, was used to identify and organize data in focus groups (patients) and via a global web-based survey (professionals). Ideas were elicited through a nominal group technique and then organized using multidimensional scaling, cluster analysis, participant validation, rating of clinical importance, and thematic analyses to generate a conceptual model of physical limitations in knee OA. Results: Fifteen Danish patients and 200 international professionals contributed to generating the conceptual model. Five clusters emerged: ‘Limitations/physical deficits’; ‘Everyday hurdles’; ‘You’re not the person you used to be’; ‘Need to adjust way of living’; and ‘External limitations,’ each with sub-clusters. Patients generally found their limitations more important than the professionals did. Conclusion: Patients and professionals agreed largely on the physical limitation concept in knee OA. Some limitations of high importance to patients were lower rated by the professionals, highlighting the importance of including patients when conceptualizing patient outcomes. These data offer new knowledge to guide selection of clinically relevant outcomes and development of outcome measures in knee OA.

Corporate social responsibility programs of big food in Australia: a content analysis of industry documents

OBJECTIVE: To examine Corporate Social Responsibility (CSR) tactics by identifying the key characteristics of CSR strategies as described in the corporate documents of selected 'Big Food' companies. METHODS: A mixed methods content analysis was used to analyse the information contained on Australian Big Food company websites. Data sources included company CSR reports and web-based content that related to CSR initiatives employed in Australia. RESULTS: A total of 256 CSR activities were identified across six organisations. Of these, the majority related to the categories of environment (30.5%), responsibility to consumers (25.0%) or community (19.5%). CONCLUSIONS: Big Food companies appear to be using CSR activities to: 1) build brand image through initiatives associated with the environment and responsibility to consumers; 2) target parents and children through community activities; and 3) align themselves with respected organisations and events in an effort to transfer their positive image attributes to their own brands. IMPLICATIONS: Results highlight the type of CSR strategies Big Food companies are employing. These findings serve as a guide to mapping and monitoring CSR as a specific form of marketing.

Evaluating a standardised clinical assessment tool for pre-registration midwifery students: a cross-sectional survey of midwifery students and midwives in Australia

Abstract
Background: Assessment of clinical competence is a core component of midwifery education. Clinical assessment tools have been developed to help increase consistency and overcome subjectivity of assessment.
Aim: The study had two main aims. The first was to explore midwifery students and educators/clinical midwives’ views and experiences of a common clinical assessment tool used for all preregistration midwifery programmes in Victoria and the University of South Australia. The Second was to assess the need for changes to the tool to align with developments in clinical practice and evidence-based care.
Methods: A cross-sectional, web-based survey including Likert-type scales and open-ended questions was utilised.
Setting: Students enrolled in all four entry pathways to midwifery at seven Victorian and one South Australian University and educators/clinical midwives across both states.
Findings: One hundred and ninety-one midwifery students’ and 86 educators/clinical midwives responded.
Overall, students and educators/clinical midwives were positive about the Clinical Assessment Tool with over 90% reporting that it covered the necessary midwifery skills. Students and educators/clinical midwives reported high levels of satisfaction with the content of the learning tools. Only 4% of educators/clinical midwives and 6% of students rated the Clinical Assessment Tool as poor overall. Changes to some learning tools were necessary in order to reflect recent practice and evidence.
Key conclusions and implications for practice: A common clinical assessment tool for evaluating midwifery students’ clinical practice may facilitate the provision of consistent, reliable and objective assessment of student skills and competency.