The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Measuring moral judgement and the implications of cooperative education and rule-based learning

The Defining Issues Test (DIT), developed by Rest (1986), measures a person's level of moral development using hypothetical social dilemmas. Although the DIT is useful for measuring moral development in social settings, it might not adequately capture an individual's moral judgement abilities in solving work-related problems (Weber, 1990; Trevino, 1992; Welton et al., 1994). In the present study, the moral judgement levels of 97 accounting students were measured over a 1 year period using two separate test instruments, the DIT and a context-specific instrument developed by Welton et al. (1994). The test scores are significantly higher on the DIT than the Welton instrument (between the instruments and over time), suggesting that accounting students use higher levels of moral reasoning in resolving hypothetical social dilemmas and lower levels of moral reasoning in resolving context-specific dilemmas. The difference in test scores was highest during cooperative education (work placement programme), implying that the environment is a significant determinant on students' test scores.

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The utility of a workplace injury instrument in prediction of workplace injury

Workplace injuries are common and destructive to persons, organisations, and society. Various instruments presently exist that are designed to assess the factors underlying workplace injury. The study reports on the construct and predictive validity of a 46-item instrument, the safety perception survey (SPS), currently used to assess safety climate in industrial organisations throughout Australia. Initially, factor analysis was conducted on the data from a sample of 1238 employees from nine organisations, which indicated a one-factor solution, was the best fit. A structural equation model (SEM) linking injury rates to the safety climate measure for 16 sub-groups of six industrial organisations indicated that the measure contributed just 23% of the variance in injury rates. Interestingly, the results indicated that the number of employees was a better and more significant predictor of injury (R² = 0.48). It is proposed that the SPS as is would need to be modified significantly from its current form to produce improvements in validity, as in its current form the survey is no more predictive of injury than organisational size. Future research into safety climate measures should incorporate predictive validity analysis on injury rates, as for many organisations; this is a performance outcome measure.

Patient perspective : choosing or developing instruments

Previous Outcome Measures in Rheumatology (OMERACT) meetings recognized that patients view outcomes of intervention from a different perspective. This preconference position paper briefly sets out 2 patient-reported outcome (PRO) instrument approaches, the PROMISE computer adaptive testing (CAT) system and development of a rheumatoid arthritis-specific questionnaire to measure fatigue; a tentative proposal for a PRO instrument development pathway is also made.

(Electronic music) through the past (moody)

(Short 02) An eighties styled ambient piece that uses synth strings modelled on the late seventies-early eighties synths. Evoking the aural objects of that era. Instruments used in this composition are synths only.

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The rapid assessment of disability – informing the development of an instrument to measure the effectiveness of disability inclusive development through a qualitative study in Bangladesh

Purpose
The Rapid Assessment of Disability (RAD) questionnaire was developed to provide governments and development agencies with an appropriate instrument to determine the prevalence of people with disability within their target populations, and to design and evaluate the effectiveness of disability inclusive activities in addressing their priorities and needs.
Methods
The RAD questionnaire was developed using two conceptual frameworks: the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), and the International Classification of Functioning, Disability and Health (ICF). Existing instruments were reviewed to inform the structure and content of the RAD questionnaire. The RAD questionnaire that was developed for field testing in Bangladesh comprised both a household questionnaire and a questionnaire for individuals within each household, with 5 sections: 1) Demographic information, 2) Assessment of functioning, 3) Awareness of rights of people with disability, 4) Well-being and quality of life, 5) Participation in the community.
Prior to field-testing the RAD questionnaire in Bangladesh, a qualitative study was conducted to ensure the relevance of the questionnaire in the context of a developing country. In-depth interviews with 9 people with disability and a focus group of 8 parents of children with disability were conducted in Dhaka, Bangladesh.
Results
Qualitative findings highlighted factors relevant to the lives of people with disability in Bangladesh, including discrepancies between the awareness and attainment of rights for people with disability, the wellbeing of people with disability and their families, as well as numerous barriers to full participation in their community. While the findings confirmed that the design and content of the questionnaire reflected all these aspects, some changes were made to the items in the questionnaire to ensure that it reflected the views of people with disability from the context of a developing country.
Conclusions and Implications
This qualitative study was an important step in the development of the RAD questionnaire as it helped to achieve its aim - namely, to establish the prevalence of disability and to assist in the design and evaluation of disability inclusive interventions in the setting of a developing country.

Assessing outcomes for cost-utility analysis in depression : comparison of five multi-attribute utility instruments with two depression-specific outcome measures

Many mental health surveys and clinical studies do not include a multi-attribute utility instrument (MAUI) that produces quality-adjusted life-years (QALYs). There is also some question about the sensitivity of the existing utility instruments to mental health.

Keyboard control method for virtual reality micro-robotic cell injection training

The rapid development of virtual reality offers significant potential for skills training applications. Our ongoing work proposes virtual reality operator training for the micro-robotic cell injection procedure. The interface between the operator and the system can be achieved in many different ways. The computer keyboard is ubiquitous in its use for everyday computing applications and also commonly utilized in virtual reality systems. Based on the premise that most people have experience in using a computer keyboard, as opposed to more sophisticated input devices, this paper considers the feasibility of using a keyboard to control the micro-robot for cell injection. In this study, thirteen participants underwent the experimental evaluation. The participants were asked to perform three simulated trial sessions in a virtual micro-robotic cell injection environment. Each session consisted of ten cell injection trials and relevant data for each trial were recorded and analyzed. Results showed participants' performance improvement after the three sessions. It was also observed that participants intuitively controlled multiple axes of the micro-robot simultaneously despite the absence of instruction on how to do so. This continued throughout the experiments and suggests skills transfer from other keyboard based interactions. Based on the results provided, it is suggested that keyboard control is a feasible, simple and low-cost control method for the virtual micro-robot.

Validity and reliability of a physical activity recall instrument among overweight and non-overweight men and women

This study examined the validity and reliability of survey items measuring one-week recall of physical activity (PA) and examined differences by weight status. A sub-aim of the study was to objectively assess the intensity of activity that most closely matches self-report. A questionnaire was administered to adults twice, three days apart. It was again administered after subjects wore a MTI/CSA accelerometer for seven days (n = 118). Several metabolic equivalent (MET) thresholds were applied to the accelerometer data. Agreement between test and re- test estimates of sufficient physical activity for health benefits (150 min/week) was high (% agreement > 90%). Correlations (rho) between total reported PA (mins/day) and accelerometer data were 0.29 (p < 0.05) among men and 0.25 (p < 0.05) among women. Among men, self- reported duration of moderate PA (3-5.9 METS) and accelerometer data were significantly correlated (rho = 0.40, p < 0.01), with no differences by weight status. Among women, a significant relationship was found only for those who were not overweight (rho = 0.52, p < 0.001). A significant correlation between self-reported duration of vigorous PA (6+ METS) and accelerometer data was only found for overweight men (rho = 0.40, p < 0.05). When lower MET thresholds were applied to the accelerometer data, women's reported duration of moderate-intensity PA was most strongly correlated with moderate PA (accelerometer) defined as 2.0-5.9 METS (rho = 0.39, p < 0.01). The recall instrument provides a consistent measure of physical activity and validation coefficients were similar to those obtained for other physical activity recall questionnaires. However, the ability to measure PA by self-report may vary by weight status.

Enhancing students' experience in music composition through music notation software

A project was undertaken in a Hong Kong primary school to investigate the role of music notation software in leaching music composition. The project was divided into three stages. During the first stage, appropriate hardware equipment and software applications were installed in the school music room, and four teaching plans were developed on the models and strategies derived from findings in the local and international literature. During the second stage, these teaching plans were implemented in Grade One, Grade Three, Grade Five and Grade Six classes of the school. During the third stage, the effectiveness of these teaching activities was evaluated by comparing the experiences from the second stage to the corresponding findings from similar projects undertaken in other Hong Kong primary schools, as well as to findings from the international literature. The results demonstrated that tile visual and audio stimulation created by computer"based technology can motivate students to successfully engage in music composition. Moreover, computer"based technology provides an opportunity for students to compose music in an atonal idiom. However, a large number of students were unable to demonstrate the concept of structural design in their musical products, and one of the findings from this investigation was that teachers need to be more purposeful in their teaching by directing students to employ the technique of repetition of interesting musical fragments or phrases in order to achieve a sense of unity in their pieces.

Paediatric quality of life instruments: a review of the impact of the conceptual framework on outcomes

With an increasing number of paediatric quality of life (QOL) instruments being developed, it is becoming difficult for researchers and clinicians to select the most appropriate instrument. Reviews of QOL instruments tend to report only basic properties of the instruments such as domains and psychometric properties. This paper seeks to appraise critically the conceptual underpinnings of paediatric QOL instruments. A systematic review was conducted to identify QOL instruments for children aged 0 to 12 years, and to examine and compare their conceptual frameworks, definitions employed, and structure. Both generic and condition-specific measures were reviewed. Fourteen generic and 25 condition-specific QOL instruments were identified. Eleven types of definition of QOL and health-related QOL and three theories of QOL were identified. QOL was measured by a variety of domains including emotional, social and physical health, and well-being. Items commonly assessed difficulties, or intensity/frequency of feelings/symptoms, in contrast to positive aspects of life and happiness. The findings highlight the diversity that is apparent in the conceptualization of paediatric QOL and draw attention to the lack of empirical evidence for many of the fundamental assumptions. The impact of the conceptual underpinnings of the instruments on the resulting QOL scores is discussed.

Architect as composer: engaging architecture students with music in the design studio

This paper explores the engagement of architectural students with music in a second year design studio, through a Game and two design projects. A ‘Game’, in the context of this research, is a low-risk learning activity derived from the model established in the CUTSD ‘Reflective Making’ project. The Game required students to complete one of three tasks; to compose and record a piece of electronic music; to research the works of a composer within a digital presentation or to design a prototype musical instrument. This was used as a generative device to inform the design of a Music Room: a space for the contemplation and composition of music. A third stage of the project involved the actual construction of 8 Music Rooms, a high-risk, high-reward activity that requires physical resolution of an established relationship between music and architecture.

This paper will focus on the engagement of architecture students with the Game and related design projects. Student perceptions of the project are used to inform an evaluation of the project as an authentic learning experience and as a valuable component of their architectural education.