A failed fall prevention study in an acute care setting: lessons from the swamp

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest–post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.

Effect of a self-directed learning package on emergency nurses` knowledge of assessment of oxygenation and use of supplemental oxygen

Abstract Emergency nurses frequently and independently make decisions regarding supplemental oxygen. The importance of these decisions for patients is highlighted by the well documented association between respiratory dysfunction and adverse events. This study aimed to: (i) examine the effect of educational preparation on emergency nurses' knowledge of assessment of oxygenation, and the use of supplemental oxygen; (ii) explore the impact of existing knowledge on decisions related to the implementation of supplemental oxygen; and (iii) explore nurses' characteristics that were associated with effectiveness of the educational preparation. A pretest/post-test, controlled, quasi-experimental design was used in this study. Educational preparation was effective in increasing emergency nurses' knowledge. Baseline level of knowledge was predictive of reports of independent decisions regarding the implementation of oxygen. There was a significant positive relationship between postgraduate qualification in emergency nursing and the effect of education, and significant negative relationships between effect of education and baseline level of knowledge and daily decisions to implement supplemental oxygen.

Effect of six weeks of dura disc and mini-trampoline balance training on postural sway in athletes with functional ankle instability

Lateral ankle sprain (LAS) is one of the most common injuries incurred during sporting activities, and effective rehabilitation programs for this condition are challenging to develop. The purpose of this research was to compare the effect of 6 weeks of balance training on either a mini-trampoline or a dura disc on postural sway and to determine if the mini-trampoline or the dura disc is more effective in improving postural sway. Twenty subjects (11 men, 9 women) with a mean age of 25.4 ± 4.2 years were randomly allocated into a control group, a dura disc training (DT) group, or a mini-trampoline (MT) group. Subjects completed 6 weeks of balance training. Postural sway was measured by subjects performing a single limb stance on a force plate. The disbursement of the center of pressure was obtained from the force plate in the medial-lateral and the anterior-posterior sway path and was subsequently used for pretest and posttest analysis. After the 6-week training intervention, there was a significant (p < 0.05) difference in postural sway between pre- and posttesting for both the MT (pretest = 56.8 ± 20.5 mm, posttest = 33.3 ± 8.5 mm) and DT (pretest = 41.3 ± 2.6 mm, posttest = 27.2 ± 4.8 mm) groups. There was no significant (p > 0.05) difference detected for improvements between the MT and DT groups. These results indicate that not only is the mini-trampoline an effective tool for improving balance after LAS, but it is equally as effective as the dura disc.

Internet-based psychological and oral medical treatment compared to psychological treatment alone for ED

Introduction. Sexual function through pregnancy and the postpartum period is an important aspect of quality of life.
Despite this, prospective studies are limited, and the impact of body image on sexual function has not been explored.
Aims. The current study reports on a pilot study that evaluated the effectiveness of a combined Internet-based
psychological treatment program and oral medication compared to an Internet-based psychological program.
Methods. Twelve men with ED participated in the study.
Main Outcome Measures. Assessments were made pre and postintervention on ED, relationship satisfaction, sexual
satisfaction, self-esteem, and quality of life.
Results. Multivariate analyses of variance demonstrated that both treatment conditions showed improvements from
pretest to posttest in sexual functioning, relationships, and personal well-being.
Conclusions. This study indicates the importance of targeting psychological and relationship variables in the
treatment of ED. Further research with larger numbers of participants is necessary for a more rigorous evaluation
of treatment programs that combine psychological and medication interventions for ED.

Comparison of the pre-post and transition question assessments in a health education setting

Objective : This study examined the classical pre-intervention/post-intervention assessment (pre–post) and the single post-intervention transition question assessment (transition question) to determine how well these methods reflected qualitative interview–based participant-reported outcomes from chronic disease self-management education programs (CDSMEPs).

Study Design and Setting : A mixed-method qualitative and quantitative approach was applied in 25 interviews with participants recruited from CDSMEPs within Australia. Qualitative interviews with participants were used as a relative “gold standard” and compared with questionnaire-based pre–post and transition question assessments.

Results : Comparison of the two questionnaire-based assessments showed that most of the individual paired responses were discordant (61%). Using participant's qualitative narratives as a “true” indicator, the pre–post assessment was found on more occasions to be discordant with participant-reported outcomes than the transition question. The origin of the inconsistency was largely because of a change in respondents' perspective that had occurred after pretest, which was mediated by CDSMEPs' experiences and insights.

Conclusion : This study suggests that the pre–post assessment has poor validity for the assessment of health education program outcomes. Alternative assessments, such as the transition question, may result in a more accurate reflection of the impact of such programs on participants.

Spatial thinking processes employed by primary school students engaged in mathematical problem solving

This thesis describes changes in the spatial thinking of Year 2 and Year 4 students who participated in a six-week long spatio-mathematical program. The main investigation, which contained quantitative and qualitative components, was designed to answer questions which were identified in a comprehensive review of pertinent literatures dealing with (a) young children's development of spatial concepts and skills, (b) how students solve problems and learn in different types of classrooms, and (c) the special roles of visual imagery, equipment, and classroom discourse in spatial problem solving. The quantitative investigation into the effects of a two-dimensional spatial program used a matched-group experimental design. Parallel forms of a specially developed spatio-mathematical group test were administered on three occasions—before, immediately after, and six to eight weeks after the spatial program. The test contained items requiring spatial thinking about two-dimensional space and other items requiring transfer to thinking about three-dimensional space. The results of the experimental group were compared with those of a ‘control’ group who were involved in number problem-solving activities. The investigation took into account gender and year at school. In addition, the effects of different classroom organisations on spatial thinking were investigated~one group worked mainly individually and the other group in small cooperative groups. The study found that improvements in scores on the delayed posttest of two-dimensional spatial thinking by students who were engaged in the spatial learning experiences were statistically significantly greater than those of the control group when pretest scores were used as covariates. Gender was the only variable to show an effect on the three-dimensional delayed posttest. The study also attempted to explain how improvements in, spatial thinking occurred. The qualitative component of the study involved students in different contexts. Students were video-taped as they worked, and much observational and interview data were obtained and analysed to develop categories which were described and inter-related in a model of children's responsiveness to spatial problem-solving experiences. The model and the details of children's thinking were related to literatures on visual imagery, selective attention, representation, and concept construction.

Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

Computing in a social context : gender difference in participation

The thesis reviews the literature relating to girls and computing within a framework which is structured around three specific questions. First, are there differences between girls and boys in their participation in class computing activities and/or in non-class computing activities? Second, do these differences in participation in computing activities have broader implications which justify the growing concern about the under-representation of girls? Third, wahy are girls under-represented in these activities? Although the available literature is predominantly descriptive, the underlying implicit theoretical model is essentially a social learning model. Girl's differential participation is attributed to learned attitudes towards computing rathan to differences between girls and boys in general ability. These attitudes, which stress the masculine, mathematical, technological aspects of computing are developed through modelling, direct experience, intrinsic and extrinsic reinforcement and generalisation from pre-existing, attitudes to related curriculum areas. In the literature it is implicitly assumed that these attitudes underlie girl's decisions to self-select out of computing activities. In this thesis predictions from a social learning model are complemented by predictions derived from expectancy-value, cognitive dissonance and self-perception theories. These are tested in three separate studies. Study one provides data from a pretest-posttest study of 24 children in a year four class learning BASIC. It examines pre- and posttest differences between girls and boys in computing experience, knowledge and achievement as well as the factors relating to computing achievement. Study two uses a pretest-posttest control group design to study the gender differences in the impact of the introduction of Logo into years 1, 3, 5 and 7 in both a coeducational and single-sex setting using a sample of 222 children from three schools. Study three utilises a larger sample of 1176 students, drawn from three secondary schools and five primary schools, enabling an evaluation of gender differences in relation to a wide range of class computing experiences and in a broader range of school contexts. The overall results are consistent across the three studies, supporting the contention that social factors, rather than ability differences influence girls' participation and achievement in computing. The more global theoretical framework, drawing on social learning, expectancy-value, cognitive dissonance and self-perception theories, provides a more adequate explanation of gender differences in participation than does any one of these models.

Instructional strategies integrating cognitive style construct : a meta-knowledge processing model

The overarching goal of this dissertation was to evaluate the contextual components of instructional strategies for the acquisition of complex programming concepts. A meta-knowledge processing model is proposed, on the basis of the research findings, thereby facilitating the selection of media treatment for electronic courseware. When implemented, this model extends the work of Smith (1998), as a front-end methodology, for his glass-box interpreter called Bradman, for teaching novice programmers. Technology now provides the means to produce individualized instructional packages with relative ease. Multimedia and Web courseware development accentuate a highly graphical (or visual) approach to instructional formats. Typically, little consideration is given to the effectiveness of screen-based visual stimuli, and curiously, students are expected to be visually literate, despite the complexity of human-computer interaction. Visual literacy is much harder for some people to acquire than for others! (see Chapter Four: Conditions-of-the-Learner) An innovative research programme was devised to investigate the interactive effect of instructional strategies, enhanced with text-plus-textual metaphors or text-plus-graphical metaphors, and cognitive style, on the acquisition of a special category of abstract (process) programming concept. This type of concept was chosen to focus on the role of analogic knowledge involved in computer programming. The results are discussed within the context of the internal/external exchange process, drawing on Ritchey's (1980) concepts of within-item and between-item encoding elaborations. The methodology developed for the doctoral project integrates earlier research knowledge in a novel, interdisciplinary, conceptual framework, including: from instructional science in the USA, for the concept learning models; British cognitive psychology and human memory research, for defining the cognitive style construct; and Australian educational research, to provide the measurement tools for instructional outcomes. The experimental design consisted of a screening test to determine cognitive style, a pretest to determine prior domain knowledge in abstract programming knowledge elements, the instruction period, and a post-test to measure improved performance. This research design provides a three-level discovery process to articulate: 1) the fusion of strategic knowledge required by the novice learner for dealing with contexts within instructional strategies 2) acquisition of knowledge using measurable instructional outcome and learner characteristics 3) knowledge of the innate environmental factors which influence the instructional outcomes This research has successfully identified the interactive effect of instructional strategy, within an individual's cognitive style construct, in their acquisition of complex programming concepts. However, the significance of the three-level discovery process lies in the scope of the methodology to inform the design of a meta-knowledge processing model for instructional science. Firstly, the British cognitive style testing procedure, is a low cost, user friendly, computer application that effectively measures an individual's position on the two cognitive style continua (Riding & Cheema,1991). Secondly, the QUEST Interactive Test Analysis System (Izard,1995), allows for a probabilistic determination of an individual's knowledge level, relative to other participants, and relative to test-item difficulties. Test-items can be related to skill levels, and consequently, can be used by instructional scientists to measure knowledge acquisition. Finally, an Effect Size Analysis (Cohen,1977) allows for a direct comparison between treatment groups, giving a statistical measurement of how large an effect the independent variables have on the dependent outcomes. Combined with QUEST's hierarchical positioning of participants, this tool can assist in identifying preferred learning conditions for the evaluation of treatment groups. By combining these three assessment analysis tools into instructional research, a computerized learning shell, customised for individuals' cognitive constructs can be created (McKay & Garner,1999). While this approach has widespread application, individual researchers/trainers would nonetheless, need to validate with an extensive pilot study programme (McKay,1999a; McKay,1999b), the interactive effects within their specific learning domain. Furthermore, the instructional material does not need to be limited to a textual/graphical comparison, but could be applied to any two or more instructional treatments of any kind. For instance: a structured versus exploratory strategy. The possibilities and combinations are believed to be endless, provided the focus is maintained on linking of the front-end identification of cognitive style with an improved performance outcome. My in-depth analysis provides a better understanding of the interactive effects of the cognitive style construct and instructional format on the acquisition of abstract concepts, involving spatial relations and logical reasoning. In providing the basis for a meta-knowledge processing model, this research is expected to be of interest to educators, cognitive psychologists, communications engineers and computer scientists specialising in computer-human interactions.

An evaluation of a wellness guide for older carers living in the community

Objective: To assess the usefulness and effectiveness of a wellness guide and to identify whether its use by a group of older ‘‘new’’ carers would make them healthier and knowledgeable of community resources. Design and Sample: Pretest, posttest measures of physical and mental health and a questionnaire with associated focus groups. A purposive sample of 21 older carers who were ‘‘new’’ carers was selected for the study. Measures: Locus of control (LOC), Short Form 12, depression anxiety stress scale, and questionnaire. Results: Participants embraced the wellness guide as an excellent resource. It
changed their behavior and improved their health on LOC measures, although changes in physical and mental health were not statistically significant. Conclusions: The wellness guide assisted carers’ preparedness for their role and enhanced their sense of personal control over demanding situations.

Sweet talking to ethnic customers : a field experiment on the links between entrepreneurial business planning, cultural sensitivity and sales growth

The purpose of this study was to test whether calculated inclusion of cultural sensitivity in a selected entrepreneurial business planning (EBP) process could increase sales growth in a test market and to explore the implications of a positive answer for the theory and practice of entrepreneurial business planning. Execution of a pretest-posttest control group experimental design measured and compared the implemented effectiveness of a planned entrepreneurial initiative based on cultural sensitivity. Though small in scale and limited in focus, the initiative qualified as an example of entrepreneurial business planning (EBP) and could be used to apply, test and extend aspects of the developing theory in this field of entrepreneurship research. Since the initiative was planned to overcome a culturally-defined impediment to business growth, it also offered opportunity to explore the specific importance of cultural variables in the context of EBP.

A planned sales-promotion was offered to a control group (receiving information in English) and a treatment group (who received the information in the language of ethnic origin). The sixty subjects had been chosen at random from a population of route-trade retailers of defined ethnic origins (Greek, Lebanese and Chinese) and randomly assigned to control and treatment groups. Monthly sales averages of the promoted product were measured before and after treatment. A Chi Square test was used to evaluate the relative proportion of the control and treatment groups who accepted the promotional offer. A two sample t-test procedure and complementary non-parametric Mann-Whitney test were performed to compare the mean sales-performance change of the two groups. Analysis showed that there was a significant increase in mean sales when the planned entrepreneurial initiative was communicated in the relevant language of origin.

The experimental results have specific practical relevance to revitalising the deteriorating route-trade segment of the Australian confectionery market through increasing the sales growth of wholesalers who are prepared to act entrepreneurially and include cultural sensitivity as an element in planning and implementation. By introducing cultural sensitivity as a necessary extension of a plan’s communications role, the results also have general theoretical implications for the developing paradigm of entrepreneurial business planning.

Better access to mental health program : influence of mental health occupational therapy

Background/aim

The Better Access to Mental Health program has enabled eligible occupational therapists to provide services to people with a mental health condition. No studies have yet reported the influence of occupational therapy under this scheme. The aim of this study was to investigate whether attending an occupational therapist under this initiative influences change in psychological distress of clients as measured by the Kessler Psychological Distress Scale (K10).
Method

A quasi-experimental pretest–posttest design, using pre-existing data collected in the process of regular treatment was used. Data from a total of 31 clients (mean = 17.13 years, SD = 3.603) were accessed for this study. Pre- and post-intervention scores on the K10 were used to determine if psychological distress had changed over the course of intervention.
Results

Highly significant improvements (P < 0.001) were found between the K10 pre-intervention score (mean = 25.68, SD = 9.944) and the K10 post-intervention score (mean = 21.00, SD = 9.212). Male K10 post-intervention scores (mean = 17.64, SD = 5.3) significantly improved (P = 0.05), whereas results for females were not statistically significant. Medication use, diagnosis, age, number of sessions and prior contact with health services did not influence the results. Results from specific evidence-based interventions were not able to be considered in this study.
Conclusion

The results of this study demonstrate effectiveness of occupational therapy services for adolescents and provide support for the ongoing participation of occupational therapists in this scheme.

Induced alkalosis and caffeine supplementation : effects on 2,000-m rowing performance

Introduction: The purpose of this investigation was to determine the effect of ingested caffeine, sodium bicarbonate, and their combination on 2,000-m rowing performance, as well as on induced alkalosis (blood and urine pH and blood bicarbonate concentration [HCO3 -]), blood lactate concentration ([La-]), gastrointestinal symptoms, and rating of perceived exertion (RPE). Methods: In a double-blind, crossover study, 8 well-trained rowers performed 2 baseline tests and 4 × 2,000-m rowing-ergometer tests after ingesting 6 mg/kg caffeine, 0.3 g/kg body mass (BM) sodium bicarbonate, both supplements combined, or a placebo. Capillary blood samples were collected at preingestion, pretest, and posttest time points. Pairwise comparisons were made between protocols, and differences were interpreted in relation to the likelihood of exceeding the smallest-worthwhile- change thresholds for each variable. A likelihood of >75% was considered a substantial change. Results: Caffeine supplementation elicited a substantial improvement in 2,000-m mean power, with mean (± SD) values of 354 ± 67 W vs. placebo with 346 ± 61 W. Pretest [HCO3 -] reached 29.2 ± 2.9 mmol/L with caffeine + bicarbonate and 29.1 ± 1.9 mmol/L with bicarbonate. There were substantial increases in pretest [HCO3 -] and pH and posttest urine pH after bicarbonate and caffeine + bicarbonate supplementation compared with placebo, but unclear performance effects. Conclusions: Rowers' performance in 2,000-m efforts can improve by ~2% with 6 mg/kg BM caffeine supplementation. When caffeine is combined with sodium bicarbonate, gastrointestinal symptoms may prevent performance enhancement, so further investigation of ingestion protocols that minimize side effects is required. ABSTRACT FROM AUTHOR

Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury

AIMS AND OBJECTIVES: To test the feasibility of an evidence-based care bundle in a Thai emergency department. The specific objective of this study was to examine the impact of the implementation of the care bundle on the initial emergency nursing management of patients with severe traumatic brain injury. BACKGROUND: A care bundle approach is one strategy used to improve the consistency, quality and safety of emergency care for different patients groups, however, has not been tested in patients with severe traumatic brain injury. DESIGN: A pretest/post-test design was used. The study intervention was an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury. METHODS: Nonparticipant observations were conducted between October 2012-June 2013 at an emergency department of a 640 bed regional hospital in Southern Thailand. The initial emergency nursing care was observed in 45 patients with severe traumatic brain injury: 20 patients in the pretest period and 25 patients in the post-test period. RESULTS: There were significant improvements in clinical care of patients with severe traumatic brain injury after implementation of the care bundle: (1) use of end-tidal carbon dioxide monitoring, (2) frequency of respiratory rate assessment, (3) frequency of pulse rate and blood pressure assessment, and (4) patient positioning. CONCLUSION: This study demonstrated that implementation of an evidence-based care bundle improved specific elements of emergency nurses' clinical management of patients with severe traumatic brain injury. RELEVANCE TO CLINICAL PRACTICE: The study suggests that a care bundle approach can be used as a strategy to improve emergency nursing care of patients with severe traumatic brain injury.

On the validity of measuring change over time in routine clinical assessment: a close examination of item-level response shifts in psychosomatic inpatients

Objective: Significant life events such as severe health status changes or intensive medical treatment often trigger response shifts in individuals that may hamper the comparison of measurements over time. Drawing from the Oort model, this study aims at detecting response shift at the item level in psychosomatic inpatients and evaluating its impact on the validity of comparing repeated measurements. Study design and setting: Complete pretest and posttest data were available from 1188 patients who had filled out the ICD-10 Symptom Rating (ISR) scale at admission and discharge, on average 24 days after intake. Reconceptualization, reprioritization, and recalibration response shifts were explored applying tests of measurement invariance. In the item-level approach, all model parameters were constrained to be equal between pretest and posttest. If non-invariance was detected, these were linked to the different types of response shift. Results: When constraining across-occasion model parameters, model fit worsened as indicated by a significant Satorra–Bentler Chi-square difference test suggesting potential presence of response shifts. A close examination revealed presence of two types of response shift, i.e., (non)uniform recalibration and both higher- and lower-level reconceptualization response shifts leading to four model adjustments. Conclusions: Our analyses suggest that psychosomatic inpatients experienced some response shifts during their hospital stay. According to the hierarchy of measurement invariance, however, only one of the detected non-invariances is critical for unbiased mean comparisons over time, which did not have a substantial impact on estimating change. Hence, the use of the ISR can be recommended for outcomes assessment in clinical routine, as change score estimates do not seem hampered by response shift effects.