Knowledge synthesis, translation and exchange in public health and health promotion: the role of a Cochrane review group

The Cochrane Collaboration is an international non-profit organisation that aims to produce high quality systematic reviews of the effectiveness of health interventions. This work is conducted by 51 Review Groups that span a  range of topics (e.g. pregnancy and childbirth, HIV/AIDS). The role of Fields within the Collaboration has been to actively engage relevant stakeholders internationally to improve the quality and relevance of reviews. Since the inception in 1996 of the Cochrane Public Health and Health Promotion Field, the Cochrane Collaboration has begun to embrace reviews related to public health and health promotion and is adapting to the changing needs of end-users. The introduction of a Cochrane health promotion and public health review group will help ensure that reviews will be oriented towards building evidence for equity and reducing inequalities and best meet the needs of decision-makers, practitioners and consumers. Our role as a Field has led to us working with a range of partners including reviewers,  researchers, practitioners and consumers. Knowledge synthesis, translation and exchange (KST&E) has emerged as an issue in need of further  exploration for practice to influence decision-makers and for policy to  influence practitioners. 2007 will be an exciting year for evidence-informed Health Promotion and Public Health (HPPH) both within the Cochrane Collaboration and for our partners in policy, practice and research.

Interrogating the discourse of 'social literacies' in an era of uncertainty

Originally, the term 'social literacies' was used to suggest the skills, knowledge and processes for addressing multicultural teaching and learning (Kalantzis and Cope, 1983). The meaning of the phrase has since evolved to encompass widely different concepts, including for example, social 'competencies', and/or citizenship education (eg., Arthur & Davison, 2000). Clearly the discourse around 'social literacies' is shifting in response to changing educational policies, both nationally and internationally.

In this paper, we examine how constructs of 'social literacies' have been and might be deployed. Building from a review of the policy, program and theoretical literature, we pose questions concerning how 'social literacies' might be used to interrogate and rework relations, especially those of gender and culture. Questions to be considered include: will the concept of 'social literacies' enable us to better understand the processes of identity and community formations in this era of uncertainty? Which knowledges and skills are identified in the literature and positioned as critical in establishing 'productive' social relations/literacies? Additionally, we begin to theorise the degree to which such constructions of 'social literacies' might enhance and/or limit quality learning at the tertiary levels of teacher education.

Issues arising from the implementation of a comprehensive assessment approach in a large, multi-modal Bachelor of Commerce Unit

Recent literature in higher education argues university assessment has been too narrow and hasn’t adequately reflected the quality, breadth and depth of students’ learning. Research shows students often prioritise and learn what they need to know for formal, graded assessment and disregard other academic content seen as less relevant to those requirements. The predominance of essays and examinations has therefore tended to constrain learning. The case for a more comprehensive approach has been clearly articulated. So what happens when staff take up the unique challenge of designing fair and uniform assessment for a large, core, multi-modal, multi-campus unit offered nationally and internationally?
When developing an undergraduate Bachelor of Commerce unit at Deakin University, staff considered the most appropriate ways to assess a range of conceptual understandings and communication skills. This resulted in the mapping and adoption of a comprehensive approach incorporating teacher, peer, and self-assessment aspects, individual and group work, oral and written presentations, and the use of portfolios and journals. Particular practices were adopted to control workloads, ensure fairness in marking, and overcome some problems generally associated with group work. When implementing the approach, practical issues arose that demanded adjustments. This paper details the approach taken, outlines research activities, and discusses the practical implications of issues that arose.

The role of Riparian habitats in forest mosaics in promoting Avifauna at the landscape scale

The importance of riparian habitats to bird communities is well documented internationally, however the value of these habitats in largely intact landscapes is less well understood, particularly in Australia. Thirty paired riparian and adjacent non-riparian sites were selected within extensive forest mosaics of the Victorian Central Highlands and were surveyed over a two year period. Bird assemblages occurring within riparian habitats supported a significantly greater richness, abundance and diversity of species. These assemblages were also found to have species compositions significantly different from those occurring at adjacent non-riparian sites separated by a distance of approximately 750 m. Differences were attributed to a suite of distinctive species and significant contrasts in the densities of a range of species that occur in both habitat types. At the landscape level, there was a strong patterning of the avifauna centred on riparian habitats. Bird assemblages typically comprised four distinct suites of species: 1. species widespread in forests and woodlands of southeastern Australia; 2. riparian associated species (wet forest intruders); 3. riparian selective species, and; 4. riparian avoiding species. Both physiognomic and floristic differences between riparian and adjacent non-riparian habitats appear to drive responses in the structure of bird communities. There exists a distinctiveness and variability among the range of vegetation types and associated bird assemblages occurring throughout the forest matrix, including in riparian habitats. The occurrence of complimentary bird assemblages throughout the landscape mosaic highlights the importance of whole landscape planning for avifauna conservation.

Nurse practitioner standards : an Australian and New Zealand research collaboration

This paper will report the findings from research conducted in Australia and New Zealand to inform development of standards for nurse practitioner education and practice competencies. In New Zealand and Australia the nurse practitioner is a new and unique level of health-care provider. The shifting boundaries caused by health-care reform have created impetus and demand for development of new models of health-care, but have also created some uncertainty regarding nurse practitioner standards, education and models of care. The title, Nurse Practitioner, is now legislated in New Zealand and most jurisdictions in Australia but there is scant research to inform development of nurse practitioner standards. This research, sponsored by the Australian Nursing Council and the Nursing Council of New Zealand, was conducted to develop generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. The study involved collection and triangulation of data from a range of sources across Australia and New Zealand including: in-depth interviews with 15 nurse practitioners from different geographical and clinical contexts; curriculum survey of all nurse practitioner courses in the two countries and interview with convenors of these courses; collation of the authorisation/registration processes and policies from states and territories in Australia, New Zealand and internationally. These data were analysed within and across the data modalities to provide information on standards for nurse practitioner practice and education. Findings from the study included identification of the core role of the nurse practitioner as it is expressed in New Zealand and Australia and generic standards for nurse practitioner competencies, education and authorisation. These findings will standardise expectations, support mutual recognition of nurse practitioner authorisation across the two countries and make an important contribution to the current international debate on nurse practitioner standards and scope of practice.

The need for best practice standards in electronic governance of patient medical records to facilitate innovation

Background : Optimising the use of electronic data offers many opportunities to health services, particularly in rural and remote areas. These include reducing the effect of distance on access to clinical information and sharing information where there are multiple service providers for a single patient. The increasing compilation of large electronic databases of patient information and the ease with which electronic information can be transferred has raised concerns about the privacy and confidentiality of such records.
Aims & rationale/Objectives : This review aims to identify legal and ethical standards for areas of electronic governance where a lack of clarity may currently impede innovation in health service delivery.
Methods : This paper describes best practices for storage and transfer of electronic patient data based on an examination of Australian legislative requirements and a review of a number of current models. This will firstly allow us to identify basic legal requirements of electronic governance as well as areas of ambiguity not fully addressed by legislation. An examination of current models will suggest recommendations for best practice in areas lacking sufficient legal guidance.
Principal findings : We have identified the following four areas of importance, and shall discuss relevant details:
1) Patients' right of ownership to electronic patient records. 2) Custodial issues with data stored in centralised health care institutions 3) IT Security, including hierarchical level access, data encryption, data transfer standards and physical security 4) Software applications usage.
Discussion : Our examination of several models of best practice for the transfer of electronic patient data, both in Australia and internationally, identifies and clarifies many unresolved issues of electronic governance. This paper will also inform future policy in this area.
Implications : Clarification will facilitate the future development of beneficial technology-based innovations by rural health services.
Presentation type : Poster

Professional renewal through cross-generational mentoring and research

Internationally, normative discourses about literacy standards have rapidly proliferated and spaces for teachers to engage in serious intellectual inquiry seem to be shutting down. What counts, in current times, is increasingly only what can be counted. The onslaught of political and media attacks about standards has left many teachers with low morale and low energy. Many experienced teachers are doubting their own wisdom, despite years of successful practice; many novice teachers are wondering why they entered the profession.

Mastering the global market

There is an urgent need to expand the number of qualified accountants in China and, particularly, the number of local accountants whose qualifications are recognized internationally. During this period of rapid transformation, the Deakin Master of Professional Accounting program, which includes the CPA Program of CPA Australia, has been developed to assist in meeting China's needs for internationally recognized accountants. The first group of students to study a new university course incorporating the CPA Australia qualification graduated at a specially convened graduation in Beijing on August 22 this year. The increasing awareness of the need for stringent corporate governance procedures and ethical business practice in the global market, as well as the need for China to develop knowledge of modern business activities, has been a priority as the course has been taught.

Library learning space design : a good student fit

We are seeing a renewed interest nationally and internationally in the design and development of new learning environments. There is, at Deakin and more generally in the higher education sector, recognition that the students' experience of a flexible and supportive educational environment is central to excellent teaching and fosters student success. Recent Carrick Institute (now the Australian Learning and Teaching Council) grants have supported the need for a greater understanding of good practice, with workshops being held around the country.

The student experience is integral to planning the re-purposing of Library spaces at Deakin's two larger campuses, Waurn Ponds and Burwood. The physical spaces within the Library will be flexible and provide support for individual learning and study, group learning and discussion, with ubiquitous ICT access and assistance services readily accessible. The improvement to the amenities, including contemporary, wired casual spaces, will encourage students to come on to campus and stay, strengthening opportunities to build a learning community. This learning community can extend through opportunities for social networking to students studying online and off-campus.

Library services and spaces will align with the new pedagogical needs of the university, providing holistic support for students' flexible learning experiences.
"We know that space can have a significant impact on teaching and learning . . . What we know about how people learn has changed our ideas about learning space. There is value from bumping into someone and having a casual conversation. There is value from hands on, active learning as well as from discussion and reflection. There is value in being able to receive immediate support when needed and from being able to integrate multiple activities [and multiple information sources] to complete a project." (Diane Oblinger, Learning Spaces, EDUCAUSE, 2006).

Ethics guidelines for international multi-centre research involving people with intellectual disabilities

This position statement endorsed by the International Association for the Scientific Study of Intellectual Disabilities is designed to promote and facilitate research projects affecting and involving people with intellectual disabilities. The paucity of dedicated research infrastructure and expert ethical review processes to oversee research in this field, especially in developing countries, is asserted as a major issue to be addressed by both the scientific community and governments. International multicenter collaboration has been proposed as a means of addressing these problems. The statement draws on internationally recognized documents outlining the ethical considerations involved in human research activities. It interprets these documents in light of the particular needs and interests of people with intellectual disabilities and incorporates international consultation involving researchers from a variety of disciplines. It affirms the importance of ethical decision making in local communities. Specific recommendations are made concerning ethical review processes, research design considerations, consent processes and the conduct of research involving and affecting people with intellectual disabilities, their families and communities. Research proposals, especially those for international, multicenter projects, need to take into account cultural diversity among participants and differing legal requirements across jurisdictions, while at the same time maintaining the scientific rigor of the research protocol. Promoting partnerships between researchers and people with intellectual disability, together with their families, advocates and local communities are important considerations when developing research projects. Similarly, the development of strategies to both communicate findings to participants and their communities, and to promote their community's access to the benefits of these findings are all important ethical considerations.

COSMOS: COmparing standard maternity care with one-to-one midwifery support: a randomised controlled trial

Background: In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity of midwifery care have reported reduced caesareans and other interventions in labour, as well as increased maternal satisfaction, with no statistically significant differences in perinatal morbidity or mortality. RCTs conducted in the UK and in Australia have largely measured the effect of teams of care providers (commonly 6–12 midwives) with very few testing caseload (one-to-one) midwifery care. This study aims to determine whether caseload (one-to-one) midwifery care for women at low risk of medical complications decreases the proportion of women delivering by caesarean section compared with women receiving 'standard' care. This paper presents the trial protocol in detail.

Methods/design: A two-arm RCT design will be used. Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women's hospital in Melbourne, Australia. Baseline data will be collected, then women randomised to caseload midwifery or standard low risk care. Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a designated primary midwife with one or two antenatal visits conducted by a 'back-up' midwife. The midwives will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back-up midwife. For women allocated to standard care, options include midwifery-led care with varying levels of continuity, junior obstetric care and community based general medical practitioner care. Data will be collected at recruitment (self administered survey) and at 2 and 6 months postpartum by postal survey. Medical/obstetric outcomes will be abstracted from the medical record. The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14% and detect a range of other significant clinical differences. Comprehensive process and economic evaluations will be conducted.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404.

Cultural racism, language prejudice and discrimination in hospital contexts : an Australian study

This article explores the idea that racial and ethnic disparities in healthcare may be expressive of unacknowledged practices of cultural racism. In conducting this exploration, the researchers identify, describe and discuss the practice of language prejudice and discrimination by health service providers, discovered serendipitously in the context of a broader study exploring cultural safety and cultural competency in an Australian healthcare context. The original study involved individual and focus groups interviews with 145 participants recruited from over 17 different organisational and domestic home sites. Participants included health service managers, ethnic liaison officers, qualified health interpreters, cultural trainers/educators, ethnic welfare organisation staff, registered nurses, allied health professionals, and healthcare consumers. Participants self-identified as being from over 27 different ethnocultural and language backgrounds.

Analysis of the data revealed that English language proficiency, like skin colour, was used as a social marker to classify, categorise, and negatively evaluate people of non-English speaking backgrounds (NESB) in the contexts studied. Negative evaluations, in turn, were used to justify the exclusion of NESB people from healthcare relationships and resources. Further data analysis revealed that underpinning the negative attitudes and behaviours in hospital domains concerning people who spoke accented English or who did not speak English proficiently were a dislike of difference, fear of difference, intolerance of difference, fear of competition for scarce healthcare resources, repressed hostility toward difference, and ignorance.

Highlighting the implications of language prejudice for the safety and quality care of NESB people, the researchers call for further internationally comparative research and debate on the subject.

Engaging patients as safety partners : some considerations for ensuring a culturally and linguistically appropriate approach

Engaging patients as ‘safety partners’ with health service providers to help identify and rectify preventable adverse events in health care is being increasingly accepted in the USA, Australia, and elsewhere as a promising strategy to improve patient safety outcomes. The implications of this trend for patients and families of minority cultural and language backgrounds have not, however, been comprehensively considered. In this article, attention is given to briefly exploring the notion of patient participation in health care and the problematic transposition of the concept into patient safety discourse. The importance of recognising and responding to the critical relationship between culture, language and
patient safety outcomes, and the possible benefits and risks of engaging patients of minority ethnic backgrounds in safety partnership programs are explored. It is suggested that if patient safety engagement/partnership programs are to perform well in cross-cultural health care contexts, they need to be supported by research evidence and appropriately informed by the perspectives and experiences of patients and families/nominated carers from minority cultural and language backgrounds. They also need to be appropriately supported by culturally competent policies and practices across the entire health care system. The importance of robust internationally comparative research on this issue is highlighted.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Improving outcomes-based engineering education in Australia

Graduate attributes are now a ubiquitous feature of higher education in Australia and internationally, and have been part of engineering education for more than a decade. The idea of graduate attributes is an apparently simple concept, focusing on educational outcomes, rather than inputs and process. While there is evidence of some benefits in engineering education arising from the introduction of outcomes-based accreditation, there is also evidence of many short-comings of the graduate attributes approach. There would be significant value in Engineers Australia providing additional discipline-specific guidance on attribute development. There would be significant value in Engineers Australia simplifying and consolidating the current multi-document accreditation system. A genuinely outcomes-based accreditation system would be based (only) on the demonstrated individual student attainment of appropriate graduate attributes, which might be delivered/gained by a range of means, including distance education. To fully meet the letter and spirit of the law for accreditation, programs will need to adopt some method of certification of individual student attainment of graduate attributes - one such method would be the use of student portfolios.