Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise

Background: Traditional causal modeling of health interventions tends to be linear in nature and lacks multidisciplinarity. Consequently, strategies for exercise prescription in health maintenance are typically group based and focused on the role of a common optimal health status template toward which all individuals should aspire. ----- ----- Materials and methods: In this paper, we discuss inherent weaknesses of traditional methods and introduce an approach exercise training based on neurobiological system variability. The significance of neurobiological system variability in differential learning and training was highlighted.----- ----- Results: Our theoretical analysis revealed differential training as a method by which neurobiological system variability could be harnessed to facilitate health benefits of exercise training. It was observed that this approach emphasizes the importance of using individualized programs in rehabilitation and exercise, rather than group-based strategies to exercise prescription.----- ----- Conclusion: Research is needed on potential benefits of differential training as an approach to physical rehabilitation and exercise prescription that could counteract psychological and physical effects of disease and illness in subelite populations. For example, enhancing the complexity and variability of movement patterns in exercise prescription programs might alleviate effects of depression in nonathletic populations and physical effects of repetitive strain injuries experienced by athletes in elite and developing sport programs.

iRAP Malaysia training course : decade of action for road safety

The International Road Assessment Program (iRAP) is a not-for-profit organisation that works in partnership with governments and non-government organisations in all parts of the world to make roads safe. The iRAP Malaysia pilot study on 3700km of road identified the potential to prevent 31,800 deaths and serious injuries over the next 20 years from proven engineering improvements. To help ensure the iRAP data and results are available to planners and engineers, iRAP, together with staff from the Centre for Accident Research and Road Safety – Queensland (CARRS-Q) and the Malaysian Institute of Road Safety Research (MIROS), developed a five-day iRAP training course that covers the background, theory and practical application of iRAP protocols, with a special focus on Malaysian case studies. Funding was provided by a competitive grant from the Australia-Malaysia Institute.

How consistent are drivers in their driving? A driver training perspective

The value and effectiveness of driver training as a means of improving driver behaviour and road safety continues to fuel research and societal debates. Knowledge about what are the characteristics of safe driving that need to be learnt is extensive. Research has shown that young drivers are over represented in crash statistics. The encouraging fact is that novice drivers have shown improvement in road scanning pattern after training. This paper presents a driver behaviour study conducted on a closed circuit track. A group of experienced and novice drivers performed repeated multiple manoeuvres (i.e. turn, overtake and lane change) under identical conditions Variables related to the driver, vehicle and environment were recorded in a research vehicle equipped with multiple in-vehicle sensors such as GPS accelerometers, vision processing, eye tracker and laser scanner. Each group exhibited consistently a set of driving pattern characterising a particular group. Behaviour such as the indicator usage before lane change, following distance while performing a manoeuvre were among the consistent observed behaviour differentiating novice from experienced drivers. This paper will highlight the results of our study and emphasize the need for effective driver training programs focusing on young and novice drivers.

Selected new training documents to update user profile

Relevance Feedback (RF) has been proven very effective for improving retrieval accuracy. Adaptive information filtering (AIF) technology has benefited from the improvements achieved in all the tasks involved over the last decades. A difficult problem in AIF has been how to update the system with new feedback efficiently and effectively. In current feedback methods, the updating processes focus on updating system parameters. In this paper, we developed a new approach, the Adaptive Relevance Features Discovery (ARFD). It automatically updates the system's knowledge based on a sliding window over positive and negative feedback to solve a nonmonotonic problem efficiently. Some of the new training documents will be selected using the knowledge that the system currently obtained. Then, specific features will be extracted from selected training documents. Different methods have been used to merge and revise the weights of features in a vector space. The new model is designed for Relevance Features Discovery (RFD), a pattern mining based approach, which uses negative relevance feedback to improve the quality of extracted features from positive feedback. Learning algorithms are also proposed to implement this approach on Reuters Corpus Volume 1 and TREC topics. Experiments show that the proposed approach can work efficiently and achieves the encouragement performance.

Gender patterns for aspirations for transitional employment and training and development in local government

Purpose – The purpose of this paper is to determine the patterns of transitional employment (TE) aspirations and training and development (T&D) needs of women within local government. Design/methodology/approach – A quantitative survey methodology was used to identify aspirations in a sample of 1,068 employees from the Australian Local Government Association. Findings – Mature-aged women were very interested in continuous learning at work despite their limited formal education. Their training preferences consisted of informal delivery face-to-face or online in the areas of management or administration. Younger women were interested in undertaking university courses, while a minority were interested in blue collar occupations. Practical implications – Through the identification of patterns of TE and T&D aspirations, long term strategies to develop and retain women in local government may be developed. Findings suggest that mature-aged women would benefit from additional T&D to facilitate entry into management and senior administration positions, as well as strategies to facilitate a shift in organizational climate. Social implications – Mature-aged women were found to be a potentially untapped resource for management and senior administrative roles owing to their interest in developing skills in these fields and pursuing TE. Younger women may also benefit from T&D to maintain their capacity during breaks from employment. Encouragement of women in non-traditional areas may also address skill shortages in the local government. Originality/value – Mature-aged women were found to be a potentially untapped resource for management and senior administrative roles owing to their interest in developing skills in these fields and pursuing TE. Younger women may also benefit from T&D to maintain their capacity during breaks from employment. Encouragement of women in non-traditional areas may also address skill shortages in the local government.

Negative Mood Regulation (NMR) expectancies, mood, and affect intensity among clients in substance disorder treatment facilities

Negative mood regulation (NMR) expectancies, stress, anxiety, depression and affect intensity were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, addicts reported significantly higher levels of stress, anxiety, depression and affect intensity and lower levels of NMR compared to non-addict controls. NMR was negatively correlated with stress, anxiety, depression and affect intensity. The findings indicate that mood self-regulation is impaired in addicts. Low NMR and high affect intensity may predispose to substance abuse and addiction, or alternatively may reflect chronic drug-induced affective dysregulation.

Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities

Attachment, fear of intimacy and differentiation of self were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, clients (who were undergoing treatment for alcoholism, heroin addiction, amphetamine/cocaine addiction or cannabis abuse) reported higher levels of insecure attachment and fear of intimacy, and lower levels of secure attachment and differentiation of self, compared to controls. Insecure attachment, high fear of intimacy and low self-differentiation appear to characterize clients enrolled in addiction treatment programs. Such characteristics may reflect a predisposition to substance problems, an effect of chronic substance problems, or conceivably both.