Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking

PURPOSE Every health care sector including hospice/palliative care needs to systematically improve services using patient-defined outcomes. Data from the national Australian Palliative Care Outcomes Collaboration aims to define whether hospice/palliative care patients' outcomes and the consistency of these outcomes have improved in the last 3 years. METHODS Data were analysed by clinical phase (stable, unstable, deteriorating, terminal). Patient-level data included the Symptom Assessment Scale and the Palliative Care Problem Severity Score. Nationally collected point-of-care data were anchored for the period July-December 2008 and subsequently compared to this baseline in six 6-month reporting cycles for all services that submitted data in every time period (n = 30) using individual longitudinal multi-level random coefficient models. RESULTS Data were analysed for 19,747 patients (46 % female; 85 % cancer; 27,928 episodes of care; 65,463 phases). There were significant improvements across all domains (symptom control, family care, psychological and spiritual care) except pain. Simultaneously, the interquartile ranges decreased, jointly indicating that better and more consistent patient outcomes were being achieved. CONCLUSION These are the first national hospice/palliative care symptom control performance data to demonstrate improvements in clinical outcomes at a service level as a result of routine data collection and systematic feedback.

Optimal HMM filtering and decision feedback equalisation for differential encoded transmission systems

In this paper conditional hidden Markov model (HMM) filters and conditional Kalman filters (KF) are coupled together to improve demodulation of differential encoded signals in noisy fading channels. We present an indicator matrix representation for differential encoded signals and the optimal HMM filter for demodulation. The filter requires O(N3) calculations per time iteration, where N is the number of message symbols. Decision feedback equalisation is investigated via coupling the optimal HMM filter for estimating the message, conditioned on estimates of the channel parameters, and a KF for estimating the channel states, conditioned on soft information message estimates. The particular differential encoding scheme examined in this paper is differential phase shift keying. However, the techniques developed can be extended to other forms of differential modulation. The channel model we use allows for multiplicative channel distortions and additive white Gaussian noise. Simulation studies are also presented.

Improving criteria and feedback in student assessment in law

Spurred on by both the 1987 Pearce Report1 and the general changes to higher education spawned by the “Dawkins revolution” from 1988, there has been much critical self-evaluation leading to profound improvements to the quality of teaching in Australian law schools.2 Despite the changes there are still areas of general law teaching practice which have lagged behind recent developments in our understanding of what constitutes high quality teaching. One such area is assessment criteria and feedback. The project Improving Feedback in Student Assessment in Law is an attempt to remedy this. It aims to produce a manual containing key principles for the design of assessment and the provision of feedback, with practical yet flexible ideas and illustrations which law teachers may adopt or modify. Most of the examples have been developed by teachers at the University of Melbourne Law School. The project was supported in 1996 by a Committee for the Advancement of University Teaching grant and the manual will be published late in 1997.3 This note summarises the core principles which are elaborated further in the manual.

Stochastic output feedback model predictive control

This paper addresses the issue of output feedback model predictive control for linear systems with input constraints and stochastic disturbances. We show that the optimal policy uses the Kalman filter for state estimation, but the resultant state estimates are not utilized in a certainty equivalence control law

Learning-based Relevance Feedback for Web-based Relation Completion

In a pilot application based on web search engine calledWeb-based Relation Completion (WebRC), we propose to join two columns of entities linked by a predefined relation by mining knowledge from the web through a web search engine. To achieve this, a novel retrieval task Relation Query Expansion (RelQE) is modelled: given an entity (query), the task is to retrieve documents containing entities in predefined relation to the given one. Solving this problem entails expanding the query before submitting it to a web search engine to ensure that mostly documents containing the linked entity are returned in the top K search results. In this paper, we propose a novel Learning-based Relevance Feedback (LRF) approach to solve this retrieval task. Expansion terms are learned from training pairs of entities linked by the predefined relation and applied to new entity-queries to find entities linked by the same relation. After describing the approach, we present experimental results on real-world web data collections, which show that the LRF approach always improves the precision of top-ranked search results to up to 8.6 times the baseline. Using LRF, WebRC also shows performances way above the baseline.

Setting measureable goals with young people : qualitative feedback from the Goal Attainment Scale in youth mental health

Introduction Measuring occupational performance is an essential part of clinical practice; however, there is little research on service user perceptions of measures. The aim of this investigation was to explore the acceptability and utility of one occupational performance outcome measure, Goal Attainment Scaling, with young people (12–25 years old) seeking psychological help. Method Semi-structured interviews were conducted with ten young people seeking help from a youth mental health clinic. Interviews were audio taped and a field diary kept. Interviews were transcribed verbatim and analysed using content analysis. Results were verified by member checking. Results All participants were able to engage in using Goal Attainment Scaling to set goals for therapy, and reported the process to be useful. The participants identified the physical location and ownership of the scale was important to help motivate them to work on their goals. Conclusion Young help-seekers see Goal Attainment Scaling as an acceptable tool to facilitate the establishment of functional goals. Young service users were particularly keen to maintain control over the physical location of completed forms.

A methodological exploration to determine transportation disadvantage variables: the partial least square approach

Determining the key variables of transportation disadvantage remains a great challenge as the variables are commonly selected using ad-hoc techniques. In order to identify the variables, this research develops a transportation disadvantage framework by manipulating the capability approach. Developed framework is statistically analysed using partial least square-based software to determine the framework fitness. The statistical analysis identifies mobility and socioeconomic variables that significantly influence transportation disadvantage. The research reveals the key socioeconomic variables for transportation disadvantage in the case of Brisbane, Australia as household structure, presence of dependent family member, vehicle ownership, and driving licence possession.

The perspectives of older drivers on the impact of feedback on their driving behaviours : a qualitative study

Self-regulation is a coping strategy that allows older drivers to drive safely for longer. Self-regulation depends largely on the ability of drivers to evaluate their own driving. Therefore the success of self-regulation, in terms of driving safety, is influenced by the ability of older drivers to have insight into their declining driving performance. In addition, previous studies suggest that providing feedback to older adults regarding their driving skills may lead them to change their driving behaviour. However, little is currently known about the impact of feedback on older drivers’ self-awareness and their subsequent driving regulatory behaviour. This study explored the process of self-regulation and driving cessation among older drivers using the PAPM as a framework. It also investigated older adults’ perceptions and opinions about receiving feedback in regards to their driving abilities. Qualitative focus groups with 27 participants aged 70 years or more were conducted. Thematic analysis resulted in the development of five main themes; the meaning of driving, changes in driving pattern, feedback, the planning process, and solutions. The analysis also resulted in an initial model of driving self-regulation among older drivers that is informed by the current research and the Precaution Adoption Process Model as the theoretical framework. It identifies a number of social, personal, and environmental factors that can either facilitate or hinder people’s transition between stages of change. The findings from this study suggest that further elaboration of the PAPM is needed to take into account the role of insight and feedback on the process of self-regulation among older drivers.

Effect of partial H2O-D2O replacement on the anisotropy of transverse proton spin relaxation in bovine articular cartilage

Anisotropy of transverse proton spin relaxation in collagen-rich tissues like cartilage and tendon is a well-known phenomenon that manifests itself as the "magic-angle" effect in magnetic resonance images of these tissues. It is usually attributed to the non-zero averaging of intra-molecular dipolar interactions in water molecules bound to oriented collagen fibers. One way to manipulate the contributions of these interactions to spin relaxation is by partially replacing the water in the cartilage sample with deuterium oxide. It is known that dipolar interactions in deuterated solutions are weaker, resulting in a decrease in proton relaxation rates. In this work, we investigate the effects of deuteration on the longitudinal and the isotropic and anisotropic contributions to transverse relaxation of water protons in bovine articular cartilage. We demonstrate that the anisotropy of transverse proton spin relaxation in articular cartilage is independent of the degree of deuteration, bringing into question some of the assumptions currently held over the origins of relaxation anisotropy in oriented tissues.

Mentor feedback : models, viewpoints and strategies

A mentor’s feedback can present professional insights to allow a mentee to reflect and develop practice. This paper positions two models for feedback that have emanated from empirical studies. It also demonstrates the diverse viewpoints of mentors and suggests strategies for providing quality feedback. In one qualitative study, 24 mentors observed a final-year preservice teacher through a professionally video-recorded lesson and wrote their observations towards giving feedback to the potential mentee. Tables illustrated in the paper, show that mentors’ positive feedback and constructive criticisms vary considerably on the same observed events. Data from this study were synthesised to posit a theoretical model for analysing mentor feedback in an interconnected, three-way Venn diagram, namely: visual, auditory and conceptual frames. Another study (n=28), which is a collection of mentor teachers’ work samples during the Mentoring for Effective Teaching (MET) program, provides strategies within six feedback practices, that is: (1) negotiated mentor-mentee expectations for providing feedback on practices, (2) reviewing teaching plans, (3) arranging for observations of practices, (4) providing oral feedback, (5) providing written feedback, and; (6) presenting opportunities for the mentee to evaluate teaching practices with consideration of the mentor’s feedback. For example, on the last mentioned practice (6) there were strategies such as “Plan a time for evaluation of practices (guided reflection)”, “Read the mentee’s reflection on practice and discuss how it aligns with your observations of their practices”, and “Highlight verbally and/or in writing where the mentee is perceptive about the reflection and how the reflection could be enhanced for future evaluations”. Developing a range of strategies that may assist the mentee in professional growth, include enlisting a community of mentors, ensuring mentors have a repertoire of strategies for articulating feedback, and using mentor feedback tools and models. This study has implications for the development of feedback models and strategies.

Use of partial coherence interferometry in measuring retinal shape

This study concerned development and validation of a simple and inexpensive method involving partial coherence interferometry for measuring retinal shape, and its use in exploring association between retinal shape and myopia. Retinal shapes estimates using partial coherence interferometry were validated against estimates obtained from magnetic resonance imaging. Steeper retinas were found along the horizontal than along the vertical meridian, in myopes than in emmetropes, and in East Asian myopes than in Caucasian myopes. The racial differences, combined with the high prevalence of myopia in East Asia, suggest that retinal shape may play a role in myopia development.

When an eco-feedback system joins the family

The dynamic, chaotic, intimate and social nature of family life presents many challenges when designing interactive systems in the household space. This paper presents findings from a whole-of-family approach to studying the use of an energy awareness and management system called “Ecosphere”. Using a novel methodology of inviting 12 families to create their own self-authored videos documenting their energy use, we report on the family dynamics and nuances of family life that shape and affect this use. Our findings suggest that the momentum of existing family dynamics in many cases obstructs behaviour change and renders some family members unaware of energy consumption despite the presence of an energy monitor display in the house. The implication for eco-feedback design is that it needs to recognise and respond to the kinds of family relations into which the system is embedded. In response, we suggest alternative ways of sharing energy-related information among families and incentivising engagement among teenagers.