Transformation from student to occupational therapist : using the Delphi technique to identify the threshold concepts of occupational therapy

BACKGROUND/AIM: Understanding and facilitating the transformation from occupational therapy student to practitioner is central to the development of competent and work-ready graduates. However, the pivotal concepts and capabilities that need to be taught and learnt in occupational therapy are not necessarily explicit. The threshold concepts theory of teaching and learning proposes that every discipline has a set of transformational concepts that students must acquire in order to progress. As students acquire the threshold concepts, they develop a transformed way of understanding content related to their course of study which contributes to their developing expertise. The aim of this study was to identify the threshold concepts of occupational therapy. METHOD: The Delphi technique, a data collection method that aims to demonstrate consensus in relation to important questions, was used with three groups comprising final year occupational therapy students (n = 11), occupational therapy clinicians (n = 21) and academics teaching occupational therapy (n = 10) in Victoria, Australia. RESULTS: Participants reached consensus regarding 10 threshold concepts for the occupational therapy discipline. These are: understanding and applying the models and theories of occupational therapy; occupation; evidence-based practice; clinical reasoning; discipline specific skills and knowledge; practising in context; a client-centred approach; the occupational therapist role; reflective practice and; a holistic approach. CONCLUSION: The threshold concepts identified provide valuable information for the discipline. They can potentially inform the development of competencies for occupational therapy and provide guidance for teaching and learning activities to facilitate the transformation to competent practitioner.

Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment

BACKGROUND: Little is known about predictors of recovery from bipolar depression. AIMS: We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression. METHOD: A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n = 141) or a brief psychoeducational intervention (n = 111). All analyses were by intention-to-treat. RESULTS: Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression. CONCLUSIONS: Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.

Considerations for determining the time course of post-activation potentiation

We sought to determine the efficacy of using a continuous time course trial to assess the temporal profile of post-activation potentiation and to determine the time course of potentiation of discrete jump squat kinetic and kinematic variables. Eight physically trained men performed jump squats before and 4, 8, and 12 min after a 5-repetition maximum back squat. Time intervals were assessed in 3 discontinuous trials (each time interval assessed in a separate trial) and in 1 continuous trial (all time intervals assessed in a single trial). Percentage differences between continuous and discontinuous trials at each time interval were mostly insubstantial. Discrete variables displayed a diverse time course (effect size: trivial to large); time to maximal values ranged between 5.00 ± 2.53 min (concentric peak force) and 9.50 ± 2.98 min (eccentric mean force). Eccentric variables (8.58 ± 3.56 min) took longer to peak than concentric variables (6.64 ± 2.93 min) (effect size: small). Individual subjects attained maximal values for kinetic and kinematic variables at different time intervals, yet the 4-min interval typically displayed the greatest magnitude and frequency of potentiation. We conclude that a continuous time course trial does not substantially influence performance of subsequent jumps and is appropriate for determining the temporal profile of potentiation, which is influenced by discrete jump squat kinetic and kinematic variables and individual differences.

Gatekeeping or redressing social exclusion : expectations on social work educators in relation to incarcerated students

Until recently, the author was in Scotland, where professional registration in social work extends to students and involves criminal record checks prior to acceptance into a course of study. She is now teaching at Deakin University in Australia, which places a high priority on making higher education available to persons and groups who have traditionally been excluded, both through the provision of courses through off campus (distance education) study mode and an innovative and culturally sensitive mode of provision for indigenous Australians. One result of our attempts to redress social exclusion is that, on occasion, we discover that some of our students are incarcerated. There are important logistical issues which may emerge as a consequence of accepting prisoners into a program of social work education. However, it would seem that the inclusion of prisoners is symbolic of a fundamental difference in philosophy with programmes of social work education in countries where there is a strong expectation that social work educators act as gatekeepers to the profession, especially in respect of students with criminal convictions. This in tum reflects an expectation among social work educators in Australia that it may be more appropriate for professional associations or registration bodies to determine whether or not a graduate with a criminal record is suitable for employment as a professional social worker. In some settings, a prior criminal record is not a barrier to being an effective service provider, as well as international differences in understandings of the social work role and employment
destinations of social work graduates.

Reasons stated by commencing students for studying engineering and technology

Responses were collected from commencing engineering students and an inventory of reasons stated for electing to study engineering was developed. Commencing engineering students were strongly career oriented; they believed that engineering would be an interesting and rewarding career that would offer enjoyment and career options. No difference was found in the principal reasons stated by respondents based on gender or course of study. On-campus students nominated principally career-related reasons for their choice of study (71 percent). While career-related reasons were still important for off-campus students, the most frequent type of responses were related to career upgrading (43.9 percent).

Student evaluations and the impact on curriculum, teaching and assessment

This presentation discusses some of the major pressures on universities to frame curriculum around employability skills and professional requirements. Recent evaluation of Australian university courses by graduates suggests that many institutions remain perplexed as to how to do this. The presentation suggests that the student evaluations do not necessarily indicate poor curriculum development but possibly a lack of making skill development more overt through teaching and assessment. The main objective of this presentation is to outline and describe a project on how curriculum needs to and can respond to professional needs and what this may entail for the way in which traditional professional courses are taught and assessed. The presentation seeks to involve participants in identifying and discussing options for the teaching and assessment of skills and possible options for how these skills can be progressively developed throughout a course of study.

Faster, richer, better: rapid appraisal techniques for the study of IS implementation in virtual communities

A major issue in Information Systems (IS) research is how to combine relevance and rigor (Benbasat and Zmud, 1999) and reduce the widening gap between research results and adoption (Dunn, 1994). Qualitative researchers make use of interpretivist methods to add richness and depth to their understanding of user problems. Interpretivist methods applied to IS implementations can thus result in research which communicates those findings more effectively. However standard interpretivist data-collection and analysis methods can be time-consuming and expensive. Findings based on these methods may be irrelevant to practitioners by the time they reach publication stage. A potential solution to this problem lies in Rapid Appraisal or RA, a qualitative appraisal methodology derived from rural development-related research. It offers IS researchers an additional technique for learning and acquiring relevant information in a limited period of time that  supplements current data collection and analysis techniques. RA adds value to the traditional approach for studying diffusion of innovation, supporting and extending the IS researcher’s qualitative ‘tool-kit’. In this paper we review an electronic gateway designed to facilitate the diffusion of an Australian government to business [G2B] export documentation system, EXDOC, which was first implemented with meat producers. RA techniques were used to collect and analyse data regarding the implementation of the first regional Electronic Trade Facilitation Center [ETFC] successfully established for Australian exporters in the horticulture sector. The findings from the original EXDOC implementation in the meat sector were confirmed and extended through this study. These include the importance of developing a governance structure that ensures all community members share the benefits of an implementation and the fact that virtual trading communities are attractive to users only if they add value to their business and extend standard ways of operating. Interactive interviews, part of the RA approach; also enabled us to expand our understanding of the way in which procedures developed in the course of implementing an electronic market represent value-adding opportunities for virtual trading communities. The paper has special relevance for researchers investigating adoption and diffusion issues experienced by small-scale producers with low exposure to technology in remote and rural settings.

Stability of television viewing and electronic game/computer use in a prospective cohort study of Australian children: relationship with body mass index

Background
While much cross-sectional data is available, there have been few longitudinal investigations of patterns of electronic media use in children. Further, the possibility of a bi-directional relationship between electronic media use and body mass index in children has not been considered. This study aimed to describe longitudinal patterns of television viewing and electronic game/computer use, and investigate relationships with body mass index (BMI).
Methods
This prospective cohort study was conducted in elementary schools in Victoria, Australia. 1278 children aged 5–10 years at baseline and 8–13 years at follow-up had their BMI calculated, from measured height and weight, and transformed to z-scores based on US 2000 growth data. Weight status (non-overweight, overweight and obese) was based on international BMI cut-off points. Weekly television viewing and electronic game/computer use were reported by parents, these were summed to generate total weekly screen time. Children were classified as meeting electronic media use guidelines if their total screen time was ≤14 hrs/wk.
Results
Electronic media use increased over the course of the study; 40% met guidelines at baseline but only 18% three years later. Television viewing and electronic game/computer use tracked moderately and total screen time was positively associated with adiposity cross-sectionally. While weaker relationships with adiposity were observed longitudinally, baseline z-BMI and weight status were positively associated with follow-up screen time and baseline screen time was positively associated with z-BMI and weight status at follow-up. Children who did not meet guidelines at baseline had significantly higher z-BMI and were more likely to be classified as overweight/obese at follow-up.

Conclusion
Electronic media use in Australian elementary school children is high, increases with age and tracks over time. There appears to be a bi-directional association suggesting that interventions targeting reductions in either screen time or adiposity may have a positive effect on both screen time and adiposity.

Family recovery from youth substance use related problems : a pilot study of the BEST plus program

Youth substance use related problems are increasingly common, and families experience considerable stress in attempting to cope with these problems. A pilot study of 34 Australian parents from 21 families (38% sole parent families) participating in an 8-week group program, designed to assist families recover from youth substance use related problems, provided the context to explore family change processes. Participants reported a number of significant improvements over the course of the four groups that ran from late 2003 and through 2004. Regression analyses found general support for the program logic model in identifying significant associations between program-targeted parent changes and post-program improvements in stress symptoms and cohesive family behaviors. The study's limitations are noted.

The role of the online teacher in supporting student learning: A case study

As teaching and learning environments for many tertiary courses move to online delivery, it is important to ensure effective student learning is still taking place. This paper presents a review of the current literature on the roles of the teacher and e-tutor in e-learning environments. The research presented here is a case study of a wholly online course in which the role of the etutors was examined. This was achieved through analysis of their online interactions with students from two separate offerings of the course. The study found that in this environment the main role undertaken by all e-tutors was a managerial one. Differences were also noted between the roles undertaken by casual e-tutors and faculty staff.

Variables influencing the mathematics performance of first-year tertiary students : a case study

The need to understand which factors most strongly affect performance in first-year mathematics programs at Khon Kaen University (KKU), in North Eastern Thailand, provided the main focus of the study which is described. First-year mathematics students in the 1990-1991 academic year, from four KKU faculty groups (Medicine and Nursing, Agriculture, Science and Education, and Engineering) were involved in this study. Research literatures addressing variables which were likely to influence performance in early tertiary mathematical study, and variables associated with difficulties in learning mathematics at the transition from upper secondary school to tertiary studies, were reviewed. The first major aim of the study was to identify the variables which were good predictors of first-year mathematics performance at KKU. Results from stepwise multiple regression analyses indicated that the following predictor variables were statistically significant and entered the regression equations for most Faculty groups: School Mathematics Achievement, Self-Esteem, Study Habits in Mathematics, and Faculty of Study. Other predictor variables that sometimes entered regression equations (depending on the Faculty group) were Socio-Economic-Status, Mathematics Language Competence, Mathematics Confidence, Attitude Towards Mathematics, and Gender. Depending on Faculty group, the statistically significant variables accounted for between 11% and 74% of scores on fist-year KKU mathematics examinations. The predictor variables contributed much more to the variance of scores on first-semester mathematics examinations than to the variance of scores on second-semester mathematics examinations. It was also found that scores on the Direct Entry Examination Mathematics test (administered by KKU) and the School Mathematics Achievement test (developed and administered by the author) had stronger correlations with first-year KKU mathematics performance than did scores on the National Entry Examination Mathematics tests (administered by the Thai Ministry of University Affairs). Scores on the three pre-university mathematics achievement test instruments were better predictors of first-semester mathematics performance than of second-semester mathematics performance. It was found that the mean Mathematics Confidence of male students was statistically significantly higher than that of female students, but there were no statistically significant gender differences in Mathematics Misplaced Confidence. Only about 30% of the main sample ( 30% of the male and 30% of the female sample groups) had appropriate confidence in mathematics, that is, they thought their answers were correct when they were, in fact, correct, and they thought they were wrong when they were, in fact, incorrect. So far as Faculty performance differences were concerned, Engineering students had the highest Mathematics Confidence scores, followed by the Medicine and Nursing group of students and the Science and Education group students. Agriculture students had the lowest mean Mathematics Confidence score. No statistically significant differences occurred in Mathematics Misplaced Confidence between different Faculty groups. The second main aim of the study was to investigate why many first-year students experienced difficulties in coping with their mathematics units. A small group of senior secondary mathematics teachers, university mathematics lecturers, and first-year mathematics students were interviewed during the first semester of the 1990-1991 academic year. Interviews were conducted by the author according to a questionnaire format, and were aimed at identifying factors causing difficulty in the transition from senior secondary to university mathematical study. The analysis of the quantitative data together with the interview data indicated that the major sources of difficulty were associated with: (a) students' mathematical abilities; (b) curriculum content; (c) course organisation; (d) students' study habits; (e) instructional styles; and (f) assessment procedures. The results of the investigation are discussed in the light of the relevant literature and related research. The study concludes with recommendations which are addressed to mathematics teachers and education administrators in senior secondary schools in Thailand, to the Thai Ministry of Education, and to the KKU Department of Mathematics.

Transitional issues of induction into design education for international undergraduate students : a case study analysis of architecture

The overarching aim of this paper is to present and discuss a collaborative undertaking between the School of Architecture and Building and the Academic Skills Unit at Deakin University, Australia in a programme called The Integrated Support Programme for Architecture. It does this in the following ways. It provides a justification for the setting up of an integrated programme for international architecture students. It describes the programme that was set up and outlines the reasons for collaboration between an academic School and an Academic Skills support services unit to prepare students both nationally and internationally as graduates of architecture. It then reports on a study undertaken to evaluate the programme in terms of student response and perception. Following this, it highlights directions for effective and strategic transition of past and present learning for international students. Using a case study analysis, the thrust of this paper is to advance knowledge and understanding of the pertinent issues related to international students either commencing or articulating into the professional course of architecture. It is envisaged that in this discussion matters may be raised for a strategic and effective transition of generic and internationalised learning for international students.

Engaging community pharmacists in the primary prevention of cardiovascular disease : protocol for the pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD) pilot study

Background: Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role.
Methods/Design: This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients’ overall CVD risk and individual risk factors, as well as identifying modifiable
health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation.
Discussion: This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of the most accessible health services in most developed countries.

A naturalistic study of treatment outcomes with aripiprazole in young people with first episode psychosis

Objective: Adequate treatment of a first psychotic episode in young people is a difficult challenge but may be of critical importance for changing the course of psychotic illness. Pharmacotherapy is the standard treatment of psychosis, however there is a paucity of data specific to first-episode psychosis.
Methods: In this study 12 young people who presented with a psychotic episode at a specialised early intervention service were commenced on treatment with aripiprazole. They were assessed at baseline and weeks 4, 6, 24 and 48 using a broad battery of outcome measures. Case notes were also examined.
Results: Data was available for 6 participants at week 48, and of those, one remained on treatment with Aripiprazole at endpoint. Case histories were typified by presentations that included illicit substance use and treatments characterised by several changes in medications. No single treatment choice predominated. Most participants tolerated treatment and showed symptomatic improvement with individualised therapy.
Conclusion: Most participants showed improvement during the treatment period. Aripiprazole was one of many medications used in this study and may have been useful for the treatment of some individuals with first episode psychosis.