Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed preintervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.

Enhanced recovery after surgery program for elective adbominal surgery at three Victorian hospitals

The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The man outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range of 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.

Enhanced Recovery After Surgery program for elective abdominal surgery at three Victorian hospitals

The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.

Evaluation of delivery of the switched on secondary science professional learning (SOSSPL) program

The Switched On Secondary Science Professional Learning (SOSSPL) program consisted of three days professional learning. Days 1 and 2 were undertaken consecutively, with Day 3 following a break of several weeks. The break allowed sufficient time for teachers to undertake a small classroom-based project within one of the topics teachers will be teaching at the time. The program was designed to build teacher capacity to improve learning outcomes in secondary science.

Evaluation of delivery of the switched on secondary science professional learning (SOSSPL) program (2011-12)

The Switched On Secondary Science Professional Learning (SOSSPL) program consisted of three days professional learning for Victorian DEECD secondary science teachers. Days 1 and 2 were undertaken consecutively, with Day 3 following a break of several weeks. The break allowed sufficient time for teachers to undertake a small classroom-based project within one of the topics they were teaching at the time. The program was designed to build teacher capacity to improve student learning outcomes in secondary science.

The program supported teachers to plan and implement classroom sequences that focused on student construction and interpretation of different representations of the science concepts and processes that are described by the Victorian Essential Learning Standards (VELS): Science and the Science Continuum P-10. The Deakin University team in collaboration with the Department of Education and Early Childhood Development (DEECD) produced curriculum resources for the program that encapsulated a representational focus to the teaching and learning of science. The program explored and linked to core DEECD resources such as the e5 Instructional Model and the Science Continuum P-10.
The SOSSPL program was delivered in all Victorian DEECD regions in 2010-11 and was evaluated (Hubber et al, 2011). The program was delivered again in all Victorian DEECD regions in 2011-12. The evaluation of the 2011-12 program is reported here with some comparisons made to the findings from the previously delivered program.
This evaluation of the SOSSPL program involved an online survey, daily workshop evaluations, focus group and presentations data of the participating teachers’ classroom-based projects. The aim of the evaluation was to make a judgement about the effectiveness of the SOSSPL program in terms of building teacher capacity to improve student learning outcomes in secondary science.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Tracking of dietary intakes in early childhood : the Melbourne InFANT program

Background/Objectives: The objectives of the present study were to describe food and nutrient intakes in children aged 9 and 18 months, and to assess tracking of intakes between these two ages.

Subjects/Methods: Participants were 177 children of first-time mothers from the control arm of the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. Dietary intake was collected at 9 and 18 months using three 24 h diet recalls. Tracking was assessed for food and nutrient intakes using logistic regression analysis and estimating partial correlation coefficients, respectively.

Results: Although overall nutrient intakes estimated in this study did not indicate a particular risk of nutrient deficiency, our findings suggest that consumption of energy-dense, nutrient-poor foods occurred as early as 9 months of age, with some of these foods tracking highly over the weaning period. Intakes of healthier foods such as fruits, vegetables, dairy products, eggs, fish and water were also relatively stable over this transition from infancy to toddlerhood, along with moderate tracking for riboflavin, iodine, fibre, calcium and iron. Tracking was low but close to ρ=0.3 for zinc, magnesium and potassium intakes.

Conclusions: The tracking of energy-dense, nutrient-poor foods has important implications for public health, given the development of early eating behaviours is likely to be modifiable. At this stage of life, dietary intakes are largely influenced by the foods parents provide, parental feeding practices and modelling. This study supports the importance of promoting healthy dietary trajectories from infancy.

A combined impact-process evaluation of a program promoting active transport to school: understanding the factors that shaped program effectiveness

This mixed methods study was a comprehensive impact-process evaluation of the Ride2School program in metropolitan and regional areas in Victoria, Australia. The program aimed to promote transport to school for primary school children. Qualitative and quantitative data were collected at baseline and followup from two primary schools involved in the pilot phase of the program and two matched comparison schools, and a further 13 primary schools that participated in the implementation phase of the program. Classroom surveys, structured and unstructured observations, and interviews with Ride2School program staff were used to evaluate the pilot program. For the 13 schools in the second phase of the program, parents and students completed questionnaires at baseline (N = 889) and followup (N = 761). Based on the quantitative data, there was little evidence of an overall increase in active transport to school across participating schools, although impacts varied among individual schools. Qualitative data in the form of observations, interviews, and focus group discussions with students, school staff, and program staff provided insight into the reasons for variable program impacts. This paper highlights the benefits of undertaking a mixed methods approach to evaluating active transport to school programs that enables both measurement and understanding of program impacts.

Optimal metric selection for improved multi-pose face recognition with group information

We address the limitation of sparse representation based classification with group information for multi-pose face recognition. First, we observe that the key issue of such classification problem lies in the choice of the metric norm of the residual vectors, which represent the fitness of each class. Then we point out that limitation of the current sparse representation classification algorithms is the wrong choice of the ℓ2 norm, which does not match with data statistics as these residual values may be considerably non-Gaussian. We propose an explicit but effective solution using ℓp norm and explain theoretically and numerically why such metric norm would be able to suppress outliers and thus can significantly improve classification performance comparable to the state-of-arts algorithms on some challenging datasets

Mothers after gestational diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial

Background:
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals.

Methods/Design:
The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups.

Discussion:
This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population.

The effect of physical activity on psychological distress, cortisol and obesity: results of the farming fit intervention program

Background:
Rural and regional Australians have a higher likelihood of mental illness throughout their lifetime than people living in major cities, although the underlying reasons are not yet well defined. Additionally, rural populations experience more lifestyle associated co-morbidities including obesity, diabetes and cardiovascular disease. Research conducted by the National Centre for Farmer Health between 2004 and 2009 revealed a positive correlation between obesity and psychological distress among the farming community. Chronic stress is known to overstimulate the regulation of the hypothalamic-pituitary-adrenal (HPA) axis and cortisol secretion which are associated with abdominal adiposity. Increasing physical activity may normalise cortisol secretion and thereby positively impact both physical and mental health. This paper assesses the effects of increasing physical activity on obesity, health behaviors and mental health in Victorian farming men and women.

Methods:
Farming Fit was a six month quasi-experimental (convenience sample) longitudinal design control-intervention study. Overweight or obese (BMI ?25?kg/m2) farm men (n?=?43) and women (n?=?29) were recruited with demographic, health behaviors, anthropometric, blood pressure and biochemistry data collected at baseline and at a six months. Salivary cortisol and depression anxiety stress scale results were collected at baseline, three and six months. The intervention group (n?=?37) received a personalized exercise program and regular phone coaching to promote physical activity.

Results:
The intervention group showed significant reductions in body weight and waist circumference. Results indicated that following the six month exercise program, the intervention group were 2.64???0.65?kg lighter (p?<?0.001), had reduced waist circumference by 2.01???0.86?cm (p?=?0.02) and BMI by 0.97???0.22?kg/m2 (p?<?0.001) relative to the control group.

Conclusion:
Increasing physical activity altered measures of obesity in farm men and women but did not affect mental health measures or cortisol secretion levels.

Salivary immunoglobulin A (sIgA) as a biomarker of immune suppression following the combat fitness assessment

SIgA is a potential biomarker for stress. The usual day-to-day and within day variation in sIgA amongst a group of healthy Army reservists was estimated and the acute response of sIgA to moderate intensity exercise (Combat Fitness Assessment) undertaken in both cool-dry and hot-humid conditions was determined. The results indicate that thermal and cardiovascular strain resulting from moderate intensity exercise in hot-humid conditions suppresses sIgA for at least 24 hours post-exercise. Salivary sIgA exhibits a wide biological variation which casts some doubt on its usefulness as a biomarker, however because sIgA has been shown to be sensitive to dietary restriction, alcohol consumption, loss of body mass, fatigue and negative emotions in previous studies and now heat-induced cardiovascular strain, further work is warranted to develop this biomarker.

Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial

Background
Previous research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care.

Methods
This concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations. Practices were randomly allocated to intervention (n = 16) and control (n = 14) groups. In each practice up to 160 eligible patients aged between 40 and 64 years old, were invited to participate. Intervention practice staff were trained in lifestyle assessment and counseling and referred high risk patients to a lifestyle modification program (LMP) consisting of two individual and six group sessions over a nine month period. Data included a patient survey, clinical audit, practice survey on capacity for preventive care, referral and attendance records at the LMP and qualitative interviews with Intervention Officers facilitating the LMP. Multi-level logistic regression modelling was used to examine independent predictors of attendance at the LMP, supplemented with qualitative data from interviews with Intervention Officers facilitating the program.

Results
A total of 197 individuals were referred to the LMP (63% of those eligible). Over a third of patients (36.5%) referred to the LMP did not attend any sessions, with 59.4% attending at least half of the planned sessions. The only independent predictors of attendance at the program were employment status - not working (OR: 2.39 95% CI 1.15-4.94) and having high psychological distress (OR: 2.17 95% CI: 1.10-4.30). Qualitative data revealed that physical access to the program was a barrier, while GP/practice endorsement of the program and flexibility in program delivery facilitated attendance.

Conclusion
Barriers to attendance at a LMP for CVD prevention related mainly to external factors including work commitments and poor physical access to the programs rather than an individuals’ health risk profile or readiness to change. Improving physical access and offering flexibility in program delivery may enhance future attendance. Finally, associations between psychological distress and attendance rates warrant further investigation.

Using appreciative inquiry to frame the appraisal of an Australian initial teacher education program

This paper reports on a study that investigated the process and outcomes of using Appreciative Inquiry (AI) in an Australian initial teacher education (ITE) program review. The aim of the study, which drew on a sample of teaching staff involved in this Master of Teaching program, was to gain an understanding of the extent to which the application of the AI framework can be used effectively in the review of ITE programs. AI promotes collegial reflective practice and the generation of positive resolutions and thus aligned with the purposes of the review that were to foster collaboration, strengthen staff morale and, subsequently, build a stronger program for students. This paper provides a perceptual account of the AI review process as reported by the facilitators and a sample of review participants, and contributes to international literature in the areas of ITE program appraisal, organisational reform and Appreciative Inquiry.

Improving access to the justice system for people with communication difficulties : a training program for people working in the justice system

This training package is provided as a guide and resource to promote awareness and understanding of people who have complex communication needs and give people who work in law and justice system strategies to facilitate successful communication interactions. Complex communication needs are defined as communication problems associated with a wide range of physical, sensory and environmental causes which restrict/limit an individual's ability to participate independently in society. They and their communication partners may benefit from using Alternative and Augmentative Communication (AAC) methods. Alternative and Augmentative Communication (AAC) is an approach or communication system that makes it possible for a person without speech to communicate. AAC includes gestures and sign language, picture and alphabet boards and high technology electronic communication devices that produce computerised speech. Many people with complex communication needs use a combination of AAC communication to express themselves. It is hoped that this package will facilitate access to the justice system for a group of people who may experience social disadvantage as a result of their complex communication needs. The information included in the package is not exhaustive. It is designed to : provide the trainer and staff with a general understanding of complex communication needs; challenge misconceptions about people who have little or no functional speech; provide practical strategies and guidelines to assist staff to more successfully communicate with people with complex communication needs.