Assessing advanced life support (ALS) competence: Victorian practices

Advanced life support (ALS) assessments are performed to assess nurses’ abilities to recognize cardiac arrest events, and appropriately manage patients according to resuscitation guidelines. Although there is evidence for conducting assessments after initial ALS education, there is little evidence to guide educators about ongoing assessments in terms of methods, format and frequency.

The aim of this study was to determine methods used by educators to assess ALS skills and knowledge for nurses in Victorian intensive care units. This descriptive study used telephone interviews to collect data. Data were analysed using content analysis. Twenty intensive care educators participated in this study. Thirteen educators (65%) were employed in public hospitals, and 7 educators (35%) worked in private hospitals across 12 Level 3 (60%) and 8 Level 2 (40%) intensive care units.

Results showed all educators used scenarios to assess ALS skills, with 12 educators (60%) including an additional theoretical test. There was variability in ALS assessment frequency, assessment timing in relation to initial/ongoing education, person performing the assessment, and the assessor/participant ratio. Nineteen educators (95%) reported ALS skill competency assessments occurred annually; 1 educator (5%) reported assessments occurred every 2 years. Assessments were conducted during a designated month (n = 10), numerous times throughout the year (n = 8), or on nurses’ employment anniversaries (n = 2). All educators reported many nurses avoided undertaking assessments.

Variability in ongoing ALS assessment methods was evident in Victorian intensive care units with some units applying evidence-based practices. Consideration should be given to the purposes and methods of conducting annual ALS assessments to ensure resources and strategies are directed appropriately. To encourage nurses to retain ALS skills and knowledge, regular practices are recommended as an alternative to assessments. However, further research is required to support this notion.

The effect pf diary foods on CHD: a systematic review of prospective cohort studies

There is interest in the degree to which fats in dairy foods contribute to CHD. We undertook a systematic review to investigate the effect of dairy  consumption on CHD using prospective cohort studies. A systematic search of electronic databases identified studies relating dairy food intake in adulthood to episodes or death from CHD, IHD and myocardial infarction. Included studies were assessed for quality based on study methodology, validity of dietary assessment, success of follow-up, standardised  assessment of CHD, IHD or myocardial infarction end points and  appropriateness of statistical adjustment. Data from twelve cohorts involving >280 000 subjects were included. Most studies had follow-up of >80 %, adjusted statistically for three or more confounders and used standard criteria to determine end points. About half the studies used a validated FFQ, administered the FFQ more than once or had follow-up of >20 years. Fewer than half the studies involved subjects representative of the general population. Four of the twelve cohorts found no association between dairy intake and CHD. Eight studies reported varying relationships between different dairy foods and CHD or differential associations based on race, sex or over time. Although dairy foods contribute to the SFA composition of the diet, this systematic review could find no consistent evidence that dairy food consumption is associated with a higher risk of CHD. This could be due to the limited sensitivity of the dietary assessment methods to detect an effect of a single food in a mixed diet on complex clinical outcomes.

The structural and behaviourial barriers to sustainable real estate development

Sustainable real estate development appears, on literal translation of both terms, to be an oxymoron - however it is a concept that the real estate profession needs to embrace knowledgably. On one hand it can be argued that real estate development is required for continued economic growth and the adoption of sustainability measures is required to mitigate climate change and global warming. Over the last few years there has been growth in the number of sustainability tools available to designers and operators of buildings. For example, in the US the LEED scheme enables designers to assess the environmental impact of their design and to benchmark the sustainability of the design against industry recognised criteria. LEED follows a similar format to the UK’s Building Research Establishment Environmental Assessment Method (BREEAM) introduced in 1990 and the Australian ‘GreenStar’ introduced in 2004. Even though there are an increasing number of sustainability tools available to designers, it still remains that the degree of uptake of the tools has been sporadic. This paper discusses the barriers to sustainable real estate development. Firstly it identifies the barriers to uptake and secondly it establishes the structural barriers in the market which prevent the wider uptake of tools.

Overview of risk prediction models in cardiovascular disease research

Many risk prediction models have been developed for cardiovascular diseases in different countries during the past three decades. However, there has not been consistent agreement regarding how to appropriately assess a risk prediction model, especially when new markers are added to an established risk prediction model. Researchers often use the area under the receiver operating characteristic curve (ROC) to assess the discriminatory ability of a risk prediction model. However, recent studies suggest that this method has serious limitations and cannot be the sole approach to evaluate the usefulness of a new marker in clinical and epidemiological studies. To overcome the shortcomings of this traditional method, new assessment methods have been proposed. The aim of this article is to overview various risk prediction models for cardiovascular diseases, to describe the receiver operating characteristic curve method and discuss some new assessment methods proposed recently. Some of the methods were illustrated with figures from a cardiovascular disease study in Australia.

Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Community school teacher education and the construction of pedagogical discourse in Papua New Guinea

Pedagogical discourse in Papua New Guinea (PNG) community schooling is mediated by a western styles education. The daily administration and organisation of school activity, graded teaching and learning, subject selection, content boundaries, teaching and assessment methods are all patterned after western schooling. This educational settlement is part of a legacy of German, British and Australian government and non-government colonialism that officially came to an end in 1975. Given the colonial heritage of schooling in PNG, this study is interested in exploring particular aspects of the degree of mutuality between local discourses and the discourses of a western styled pedagogy in post-colonial times, for the purpose of better informing community school teacher education practices. This research takes place at and in the vicinity of Madang Teachers College, a pre-service community school teachers college on the north coast of Papua New Guinea. The research was carried out in the context of the researcher’s employment as a contract lecturer in the English language Department between 1991-1993. As an in-situ study it was influenced by the roles of different participants and the circumstances in which data was gathered and constituted, data which was compatible with participants commitments to community school teacher education and community school teaching and learning. In the exploration of specific pedagogic practices different qualitative research approaches and perspectives were brought to bear in ways best suited to the circumstances of the practice. In this way analytical foci were more dictated by circumstances rather by design. The analytical approach is both a hermeneutic one where participants’ activities are ‘read like texts’, where what is said or written is interpreted against the background of other informing contexts and texts, to better understand how understandings and meanings are produced and circulated; and also a phenomenological one where participants’ perspectives are sought to better understand how pedagogical discursive formations are assimilated with the ‘self’. The effect of shifting between these approaches throughout the study is to build up a sense of co-authorship between researcher and participants in relation to particular aspects of the research. The research explores particular sites where pedagogic discourse is produced, re-produced, distributed, articulated, consumed and contested, and in doing so seeks to better understand what counts as pedagogical discourse. These are sites that are largely unexplored in these terms, in the academic literature on teacher education and community schooling in PNG. As such, they represent gaps in what is documented and understood about the nature of post-colonial pedagogy and teacher training. The first site is a grade two community school class involved in the teaching and early learning of English as the ‘official’ language of instruction. Here local discourses of solidarity and agreement are seen to be mobilised to make meaningful, what are for the teacher and children moments in their construction as post-colonial subjects. What in instructional terms may be seen as an English language lesson becomes, in the light of the research perspectives used, an exercise in the structuring of new social identities, relations and knowings, problematising autonomous views of teaching and learning. The second site explores this issue of autonomous (decontextualised) teaching and learning through an investigation of student teachers’ epistemological contextualisations of knowledge, teaching and learning. What is examined is the way such orientations are constructed in terms of ‘traditional’ and ‘modern’ epistemological and pedagogical alignments, and, in terms of differently conceived notions of community, in a problematisation of the notion of community schooling. The third and fourth sites examine reflective accounts of student teachers’ pedagogic practices, understandings and subjectivities as they confront the moral and political economies and cultural politics of schooling in School Experiences and Practicum contexts, and show how dominant behaviourist and ‘rational/autonomous’ conceptions of what counts as teaching and learning are problematised in the way some students teachers draw upon wider social discourses to construct a dialogue with learners. The final site is a return to the community school where the discourse of school reports through which teachers, children and parents are constructed as particular subjects of schooling, are explored. Here teachers report children’s progress over a four year period and parents write back in conforming, confronting and contesting ways, in the midst of the ongoing enculturation of their children. In this milieu, schooling is shown to be a provider of differentiated social qualifications rather than a socially just and relevant education. Each of the above-mentioned studies form part of a research and pedagogic interest in understanding the ‘disciplining’ effects of schooling upon teacher education, the particular consequences of those effects, what is embraces, resisted and hidden. Each of the above sites is informed by various ‘intertexts’. The use of intertexts is designed to provide a multiplicity of views, actions and voices while enhancing the process of cross-cultural reading through contextualising the studies in ways that reveal knowledges and practices which are often excluded in more conventional accounts of teaching and learning. This research represents a journey, but not an aimless one. It is one which reads the ideological messages of coherence, impartiality and moral soundness of western pedagogical discourse against the school experiences of student-teachers, teachers, children and parents, in post-colonial Papua New Guinea, and finds them lacking.

The ecological modernisation of the Yalumba Wine Company

The thesis reports on the strategic environmental assessment of Yalumba's 'Commitment to sustainable winemaking' programme. The case study identified the benefits, as well as shortcomings, of the wine firm's commitment to sustainability in the context of plausible future scenarios under the influence of various drivers of change, prominent amongst which was climate change.

Prioritizing policy interventions to improve diets? Will it work, can it happen, will it do harm?

Policies from non-health sectors have considerable impacts on the food environment and in turn on population nutrition. Health impact assessment (HIA) methods have been developed to identify the potential health effects of non-health policies; however, they are underused both within and outside the health sector. HIA and other assessment methods and tools can be used more extensively in health promotion to assist with the identification of the best policy options to pursue to improve and protect health. A participatory process is presented in this paper which combines HIAs with feasibility and effectiveness assessments. The intention is to enable health promoters to more accurately identify which policy change options would be most likely to improve diets, considering both impact and likelihood of implementation. The process was successfully used in Fiji and Tonga and provided a more systematic way of understanding which policy interventions showed the most promise.

Assessing group work

When effective group management processes are employed, clear assessment guidelines developed and communicated and valid and fair grading processes employed, the likelihood of positive learning outcomes and student satisfaction with group activities is significantly increased. Alternatively, if students cannot see the objective of group work, are unsure of what is expected of them, or believe the assessment methods are invalid or simply unfair, the educational benefits are reduced and tensions can emerge. The conditions under which group work is conducted are crucial to its success:

Group work, under proper conditions, encourages peer learning and peer support and many studies validate the efficacy of peer learning. Under less than ideal conditions, group work can become the vehicle for acrimony, conflict and freeloading. It may also impose a host of unexpected stresses on, for example, students with overcrowded schedules living long distances from the University.
(University of Wollongong assessment policy, 2002).

The educational benefits of students working cooperatively in groups are well recognised. Among other things,
• studying collaboratively has been shown to directly enhance learning;
• employers value the teamwork and other generic skills that group work may help develop; and
• group activities may help academic staff to effectively utilise their own time.

The design of assessment is central to capturing the benefits of group work and avoiding its pitfalls. Assessment defines the character and quality of group work. In fact, the way in which students approach group work is largely determined by the way in which they are to be assessed.

To maximise student learning in group activities, this section offers advice on how academic staff can:
• establish explicit guidelines for group work to ensure that learning objectives are met and to ensure that they are transparent and equitable; and
• manage the planning, development and implementation of processes and procedures for learning through group work and group assessment.

Using constructed-response and multiple-choice questions in undergraduate examinations

This paper looks at the use of constructed-response and multiple-choice questions in first year management examinations involving 2364 students over a three semester period in 2008-9. It also compares student’s performance in research and analytical assignments with their results in Multiple-Choice tests. The results show that students who perform poorly in non-multiple-choice tests are slightly advantaged by multiple-choice tests. However, students who display high distinction scores in other pieces of assessment do not receive any advantage from multiple-choice testing. Interestingly, the research also highlighted that female students perform better in their articulation of management techniques overall, but do not gain the same comparative advantage from multiple choice testing. The analysis of the assessment methods was extremely useful in predicting the level of failures for the unit in the subsequent year. Finding the right balance of assessment tasks in first year university business courses is extremely difficult, using multiple-choice tests can be useful tool as part of the assessment mix in management units.

Analysis of twelve electrical and electronics engineering programs

This paper investigates undergraduate programs in electrical and electronics engineering offered by twelve universities in Australia, Asia, Europe, and America. The investigation focuses on the structure and content of the programs, and the contact hour and assessment of the subjects involved in the programs. The investigation is carried out in four stages: selection of universities, collection of data, analysis of data, and formulation of outcomes. A list of subjects is created based on the content of the programs. The average percentage coverage of each subject in the twelve programs is calculated. The subjects are then grouped into nine program components. The average percentage coverage of each component per university is calculated. For each component, the total number of contact hours for lecture, tutorial, and practical is calculated. Also, the average percentage of four assessment methods for each component is found. Discussions on the outcome of the investigation are presented.

Iraq's December 2005 election : reporting democratisation in the Australian and Middle Eastern print media

Throughout the coverage of Iraq since the Iran-Iraq War of the 1980s and especially since September 11, the Western mainstream Media have eschewed key historical and contextual data about Iraq, thereby serving to reduce and homogenize the complexity of the issues surrounding the region and the conflicts therein. In so doing, the media has tended towards Orientalism (Said, 1978) by trivialising Iraq and its people and thereby reinforcing the hegemony of the West over the ‘backward, barbaric’ East. Building on earlier research (Isakhan, 2005a), this paper further examines the reductive and homogenising reporting of Iraq in the Western media by using both quantitative and qualitative assessment methods to compare and contrast the discursive practices used to construct the Iraqi election of December 15, 2005 in Australia’s leading daily newspapers with newspapers from the Middle East. In essence, it finds that while the Australian media propagates Orientalism through its one-eyed coverage, the Middle Eastern papers are more contemplative, focusing on the impact that this election could have throughout the region.

Incorporating a knowledge perspective into security risk assessments

Purpose – Many methodologies exist to assess the security risks associated with unauthorized leakage, modification and interruption of information used by organisations. This paper argues that these methodologies have a traditional orientation towards the identification and assessment of technical information assets. This obscures key risks associated with the cultivation and deployment of organisational knowledge. The purpose of this paper is to explore how security risk assessment methods can more effectively identify and treat the knowledge associated with business processes.

Design/methodology/approach – The argument was developed through an illustrative case study in which a well-documented traditional methodology is applied to a complex data backup process. Follow-up interviews were conducted with the organisation’s security managers to explore the results of the assessment and the nature of knowledge “assets” within a business process.

Findings – It was discovered that the backup process depended, in subtle and often informal ways, on tacit knowledge to sustain operational complexity, handle exceptions and make frequent interventions. Although typical information security methodologies identify people as critical assets, this study suggests a new approach might draw on more detailed accounts of individual knowledge, collective knowledge and their relationship to organisational processes.

Originality/value – Drawing on the knowledge management literature, the paper suggests mechanisms to incorporate these knowledge-based considerations into the scope of information security risk methodologies. A knowledge protection model is presented as a result of this research. This model outlines ways in which organisations can effectively identify and treat risks around process knowledge critical to the business.

Assessing dietary intake in children and adolescents : considerations and recommendations for obesity research

Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifi able components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specifi c components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity.

Assessing individual clinical performance: a primer for physicians

The assessment of individual physician performance has attracted interest from several quarters, including statutory licensing agencies and credentialing bodies of healthcare institutions. Performance measures and assessment methods have been developed, although their validity, reliability and feasibility in regards to physician specialty practice are open to challenge. Despite this, professional colleges and societies will be increasingly obliged to ensure their members are demonstrating high-quality performance on the basis of assessment methods viewed as being transparent, impartial and reproducible. This article provides an overview of the current state of the art which hopefully will serve to inform future debate both within and outside professional circles.