Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Is there a Kuznets' process in Southeast Asia?

Relatively little is known about the determinants of inequality in Southeast Asia. This paper fills this void by comprehensively testing Kuznets’ hypothesis for Southeast Asia. We estimate both unconditional and conditional Kuznets’ curves using panel data for 8 countries. The analysis suggests the existence of a Kuznets’ curve with respect to per capita income; the path of inequality is nonlinear with respect to economic development. There is no evidence of a Kuznets curve with respect to non-agricultural employment. There is some evidence in terms of urbanization, though this is not robust. There is robust evidence on the role of national governments and education in shaping the path of inequality in the region. Government involvement reduces inequality. Education appears to have a non-linear effect on inequality.

The double sensor-a non-invasive device to continuously monitor core temperature in humans on earth and in space

The objective of our study was to establish whether rectal temperature recordings in humans could be replaced by a non-invasive skin temperature sensor combined with a heat flux sensor (Double Sensor) located at the forehead to monitor core body temperature changes due to circadian rhythms. Rectal and Double Sensor data were collected continuously for 24h in seven men undertaking strict head-down tilt bed-rest. Individual differences between the two techniques varied between -0.72 and +0.55 degrees C. Nonetheless, when temperature data were approximated by cosinor analysis in order to compare circadian rhythm profiles between methods, it was observed that there were no significant differences between mesor, amplitude, and acrophase (P>0.310). It was therefore concluded that the Double Sensor technology is presently not accurate enough for performing single individual core body temperature measurements under resting conditions at normal ambient room temperature. Yet, it seems to be a valid, non-invasive alternative for monitoring circadian rhythm profiles.

Indelible shame? News reporting of non-convictions in digital space

This paper examines the role of media in publicising the names of people who receive a non-conviction for a minor crime. It positions the news media’s ability to “name and shame” people who appear before the courts as a powerful cultural practice, rather than adopt a widely celebrated Fourth Estate view of the press as a watchdog on the judicial process. The research draws on interviews conducted in two regional centres of Victoria, Australia, with those involved in news coverage of very minor crimes where non-convictions were imposed. Their spoken words reveal a range of tensions linked to reporting non-convictions in the digital age. In the eyes of the law, a non-conviction means that an offender has an opportunity to rehabilitate away from the public gaze. However, the news media ‘s ability to name such offenders online has the potential to impose a lasting “mark of shame” in digital space that can prevent them gaining employment or housing, and damage their social standing and relationships. We live in a media-saturated culture in which the vast majority of people rely on news media for information about judicial proceedings and in turn, the news media constructs public understanding of the law through the way it represents crime and court processes. This paper argues that traditional understanding of the nexus between the judicial system and the Fourth Estate fails to acknowledge the news media’s considerable power outside the officially recognised operation of the open justice relationship, and that this deserves attention in the digital age

A new process capability index for multiple quality characteristics based on principal components

This paper presents a new multivariate process capability index (MPCI) which is based on the principal component analysis (PCA) and is dependent on a parameter (Formula presented.) which can take on any real number. This MPCI generalises some existing multivariate indices based on PCA proposed by several authors when (Formula presented.) or (Formula presented.). One of the key contributions of this paper is to show that there is a direct correspondence between this MPCI and process yield for a unique value of (Formula presented.). This result is used to establish a relationship between the capability status of the process and to show that under some mild conditions, the estimators of this MPCI is consistent and converge to a normal distribution. This is then applied to perform tests of statistical hypotheses and in determining sample sizes. Several numerical examples are presented with the objective of illustrating the procedures and demonstrating how they can be applied to determine the viability and capacity of different manufacturing processes.

Screening for diabetic retinopathy using a non-mydriatic retinal camera in rural Victoria

PURPOSE: To develop a screening programme for the early detection of diabetic retinopathy using non-mydriatic retinal photography. METHODS: A community based screening service was offered to all people with known diabetes mellitus in selected townships in the LaTrobe and Goulburn Valleys in Victoria. At the local examination centre, basic sociodemographic information was collected as well as details of previous use of eye care services for the early detection of diabetic retinopathy. The examination included visual acuity (VA), glycosylated haemoglobin level and Polaroid photographs of each fundus using a Canon CR5-45NM non-mydriatic retinal camera (Canon, Tochigiken, Japan). Dilating drops were not used. Photographs were subsequently reviewed and letters were sent to all participants (with copies to their general practitioners) with recommendations for appropriate follow up. RESULTS: A total of 1177 people with diabetes attended the screening service, which is estimated to be 40% of the total population with known diabetes in the study area. The mean age was 65 years (range 20-94 years); 559 (48%) people reported not having a dilated fundus examination within the past 2 years; 345 (29%) people had never had a dilated fundus examination. Of the 2354 eyes, 2126 (90%) of the photographs were gradable. A total of 704 people (60%) had normal VA and no evidence of diabetic retinopathy, 209 people (18%) had diabetic retinopathy, 101 people (9%) had evidence of other fundus pathology, 42 people (3%) had reduced acuity (< 6/18) in one or both eyes (with no fundus pathology evident) and 121 people (10%) had ungradable photographs in one or both eyes. CONCLUSIONS: The present study demonstrates the usefulness of a screening programme with non-mydriatic retinal photography as an adjunct to current eye care services for the early detection of diabetic retinopathy.

Evaluation of a knowledge translation and exchange platform to advance non-communicable disease prevention

Coordinated systems are required to ensure evidence-informed practice and evaluation of community-based interventions (CBIs). Knowledge translation and exchange (KTE) strategies show promise, but these require evaluation. This paper describes implementation and evaluation of COOPS, a national KTE platform to support best practice in obesity prevention CBIs. A logic model guides KTE activities including knowledge brokering, networking, tailored communications, training, and needs assessments. A mixed-methods evaluation includes communications data, knowledge brokering database, annual survey of CBIs, pre- and post-event questionnaires, interviews, social network analysis, and case studies. This evaluation will contribute to understanding the process of implementing a KTE platform with CBIs and its reach, quality and effectiveness.