A multidisciplinary reference framework to support innovative design, implementation and assessment of chronic care models

Hoy en día, por primera vez en la historia, la mayor parte de la población podrá vivir hasta los sesenta años y más (United Nations, 2015). Sin embargo, todavía existe poca evidencia que demuestre que las personas mayores, estén viviendo con mejor salud que sus padres, a la misma edad, ya que la mayoría de los problemas de salud en edades avanzadas están asociados a las enfermedades crónicas (WHO, 2015). Los sistemas sanitarios de los países desarrollados funcionan adecuadamente cuando se trata del cuidado de enfermedades agudas, pero no son lo suficientemente eficaces en la gestión de las enfermedades crónicas. Durante la última década, se han realizado esfuerzos para mejorar esta gestión, por medio de la utilización de estrategias de prevención y de reenfoque de la provisión de los servicios de atención para la salud (Kane et al. 2005). Según una revisión sistemática de modelos de cuidado de salud, comisionada por el sistema nacional de salud Británico, pocos modelos han conceptualizado cuáles son los componentes que hay que utilizar para proporcionar un cuidado crónico efectivo, y estos componentes no han sido suficientemente estructurados y articulados. Por lo tanto, no hay suficiente evidencia sobre el impacto real de cualquier modelo existente en la actualidad (Ham, 2006). Las innovaciones podrían ayudar a conseguir mejores diagnósticos, tratamientos y gestión de pacientes crónicos, así como a dar soporte a los profesionales y a los pacientes en el cuidado. Sin embargo, la forma en las que estas innovaciones se proporcionan no es lo suficientemente eficiente, efectiva y amigable para el usuario. Para mejorar esto, hace falta crear equipos de trabajo y estrategias multidisciplinares. En conclusión, hacen falta actividades que permitan conseguir que las innovaciones sean utilizadas en los sistemas de salud que quieren mejorar la gestión del cuidado crónico, para que sea posible: 1) traducir la “atención sanitaria basada en la evidencia” en “conocimiento factible”; 2) hacer frente a la complejidad de la atención sanitaria a través de una investigación multidisciplinaria; 3) identificar una aproximación sistemática para que se establezcan intervenciones innovadoras en el cuidado de salud. El marco de referencia desarrollado en este trabajo de investigación es un intento de aportar estas mejoras. Las siguientes hipótesis han sido propuestas: Hipótesis 1: es posible definir un proceso de traducción que convierta un modelo de cuidado crónico en una descripción estructurada de objetivos, requisitos e indicadores clave de rendimiento. Hipótesis 2: el proceso de traducción, si se ejecuta a través de elementos basados en la evidencia, multidisciplinares y de orientación económica, puede convertir un modelo de cuidado crónico en un marco descriptivo, que define el ciclo de vida de soluciones innovadoras para el cuidado de enfermedades crónicas. Hipótesis 3: es posible definir un método para evaluar procesos, resultados y capacidad de desarrollar habilidades, y asistir equipos multidisciplinares en la creación de soluciones innovadoras para el cuidado crónico. Hipótesis 4: es posible dar soporte al desarrollo de soluciones innovadoras para el cuidado crónico a través de un marco de referencia y conseguir efectos positivos, medidos en indicadores clave de rendimiento. Para verificar las hipótesis, se ha definido una aproximación metodológica compuesta de cuatro Fases, cada una asociada a una hipótesis. Antes de esto, se ha llevado a cabo una “Fase 0”, donde se han analizado los antecedentes sobre el problema (i.e. adopción sistemática de la innovación en el cuidado crónico) desde una perspectiva multi-dominio y multi-disciplinar. Durante la fase 1, se ha desarrollado un Proceso de Traducción del Conocimiento, elaborado a partir del JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare (Pearson, 2005), y sobre el cual se han definido cuatro Bloques de Innovación. Estos bloques consisten en una descripción de elementos innovadores, definidos en la fase 0, que han sido añadidos a los cuatros elementos que componen el modelo JBI. El trabajo llevado a cabo en esta fase ha servido también para definir los materiales que el proceso de traducción tiene que ejecutar. La traducción que se ha llevado a cabo en la fase 2, y que traduce la mejor evidencia disponible de cuidado crónico en acción: resultado de este proceso de traducción es la parte descriptiva del marco de referencia, que consiste en una descripción de un modelo de cuidado crónico (se ha elegido el Chronic Care Model, Wagner, 1996) en términos de objetivos, especificaciones e indicadores clave de rendimiento y organizada en tres ciclos de innovación (diseño, implementación y evaluación). Este resultado ha permitido verificar la segunda hipótesis. Durante la fase 3, para demostrar la tercera hipótesis, se ha desarrollado un método-mixto de evaluación de equipos multidisciplinares que trabajan en innovaciones para el cuidado crónico. Este método se ha creado a partir del método mixto usado para la evaluación de equipo multidisciplinares translacionales (Wooden, 2013). El método creado añade una dimensión procedural al marco. El resultado de esta fase consiste, por lo tanto, en una primera versión del marco de referencia, lista para ser experimentada. En la fase 4, se ha validado el marco a través de un caso de estudio multinivel y con técnicas de observación-participante como método de recolección de datos. Como caso de estudio se han elegido las actividades de investigación que el grupo de investigación LifeStech ha desarrollado desde el 2008 para mejorar la gestión de la diabetes, actividades realizadas en un contexto internacional. Los resultados demuestran que el marco ha permitido mejorar las actividades de trabajo en distintos niveles: 1) la calidad y cantidad de las publicaciones; 2) se han conseguido dos contratos de investigación sobre diabetes: el primero es un proyecto de investigación aplicada, el segundo es un proyecto financiado para acelerar las innovaciones en el mercado; 3) a través de los indicadores claves de rendimiento propuestos en el marco, una prueba de concepto de un prototipo desarrollado en un proyecto de investigación ha sido transformada en una evaluación temprana de una intervención eHealth para el manejo de la diabetes, que ha sido recientemente incluida en Repositorio de prácticas innovadoras del Partenariado de Innovación Europeo en Envejecimiento saludable y activo. La verificación de las 4 hipótesis ha permitido demonstrar la hipótesis principal de este trabajo de investigación: es posible contribuir a crear un puente entre la atención sanitaria y la innovación y, por lo tanto, mejorar la manera en que el cuidado crónico sea procurado en los sistemas sanitarios. ABSTRACT Nowadays, for the first time in history, most people can expect to live into their sixties and beyond (United Nations, 2015). However, little evidence suggests that older people are experiencing better health than their parents, and most of the health problems of older age are linked to Chronic Diseases (WHO, 2015). The established health care systems in developed countries are well suited to the treatment of acute diseases but are mostly inadequate for dealing with CDs. Healthcare systems are challenging the burden of chronic diseases by putting more emphasis on the prevention of disease and by looking for new ways to reorient the provision of care (Kane et al., 2005). According to an evidence-based review commissioned by the British NHS Institute, few models have conceptualized effective components of care for CDs and these components have been not structured and articulated. “Consequently, there is limited evidence about the real impact of any of the existing models” (Ham, 2006). Innovations could support to achieve better diagnosis, treatment and management for patients across the continuum of care, by supporting health professionals and empowering patients to take responsibility. However, the way they are delivered is not sufficiently efficient, effective and consumer friendly. The improvement of innovation delivery, involves the creation of multidisciplinary research teams and taskforces, rather than just working teams. There are several actions to improve the adoption of innovations from healthcare systems that are tackling the epidemics of CDs: 1) Translate Evidence-Based Healthcare (EBH) into actionable knowledge; 2) Face the complexity of healthcare through multidisciplinary research; 3) Identify a systematic approach to support effective implementation of healthcare interventions through innovation. The framework proposed in this research work is an attempt to provide these improvements. The following hypotheses have been drafted: Hypothesis 1: it is possible to define a translation process to convert a model of chronic care into a structured description of goals, requirements and key performance indicators. Hypothesis 2: a translation process, if executed through evidence-based, multidisciplinary, holistic and business-oriented elements, can convert a model of chronic care in a descriptive framework, which defines the whole development cycle of innovative solutions for chronic disease management. Hypothesis 3: it is possible to design a method to evaluate processes, outcomes and skill acquisition capacities, and assist multidisciplinary research teams in the creation of innovative solutions for chronic disease management. Hypothesis 4: it is possible to assist the development of innovative solutions for chronic disease management through a reference framework and produce positive effects, measured through key performance indicators. In order to verify the hypotheses, a methodological approach, composed of four Phases that correspond to each one of the stated hypothesis, was defined. Prior to this, a “Phase 0”, consisting in a multi-domain and multi-disciplinary background analysis of the problem (i.e.: systematic adoption of innovation to chronic care), was carried out. During phase 1, in order to verify the first hypothesis, a Knowledge Translation Process (KTP) was developed, starting from the JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare was used (Pearson, 2005) and adding Four Innovation Blocks. These blocks represent an enriched description, added to the JBI model, to accelerate the transformation of evidence-healthcare through innovation; the innovation blocks are built on top of the conclusions drawn after Phase 0. The background analysis gave also indication on the materials and methods to be used for the execution of the KTP, carried out during phase 2, that translates the actual best available evidence for chronic care into action: this resulted in a descriptive Framework, which is a description of a model of chronic care (the Chronic Care Model was chosen, Wagner, 1996) in terms of goals, specified requirements and Key Performance Indicators, and articulated in the three development cycles of innovation (i.e. design, implementation and evaluation). Thanks to this result the second hypothesis was verified. During phase 3, in order to verify the third hypothesis, a mixed-method to evaluate multidisciplinary teams working on innovations for chronic care, was created, based on a mixed-method used for the evaluation of Multidisciplinary Translational Teams (Wooden, 2013). This method adds a procedural dimension to the descriptive component of the Framework, The result of this phase consisted in a draft version of the framework, ready to be tested in a real scenario. During phase 4, a single and multilevel case study, with participant-observation data collection, was carried out, in order to have a complete but at the same time multi-sectorial evaluation of the framework. The activities that the LifeStech research group carried out since 2008 to improve the management of diabetes have been selected as case study. The results achieved showed that the framework allowed to improve the research activities in different directions: the quality and quantity of the research publications that LifeStech has issued, have increased substantially; 2 project grants to improve the management of diabetes, have been assigned: the first is a grant funding applied research while the second is about accelerating innovations into the market; by using the assessment KPIs of the framework, the proof of concept validation of a prototype developed in a research project was transformed into an early stage assessment of innovative eHealth intervention for Diabetes Management, which has been recently included in the repository of innovative practice of the European Innovation Partnership on Active and Health Ageing initiative. The verification of the 4 hypotheses lead to verify the main hypothesis of this research work: it is possible to contribute to bridge the gap between healthcare and innovation and, in turn, improve the way chronic care is delivered by healthcare systems.

Assessment of species diversity and state of "Stipa tenacissima" steppes

North African steppes are subjected to extreme degradation resulting in the reduction of their surface, genetic erosion of resources, and decrease in biodiversity. "Stipa tenacissima" steppes, which constitute one of the most representative vegetation types in the driest areas of the Mediterranean basin, are continuously degrading. With the aim of contributing to a better knowledge of the floristic composition and diagnosing the state of degradation of these steppes, we conducted a phytoecological analysis of 10 "S. tenacissima" sites in Tunisia. Floristic inventory compiled a systematic list of 46 vascular plant species belonging to 43 genera and 26 families. Species richness ranged from 4 to 18 species per 900 m2. Total vegetation cover was moderate and fluctuated between 22.8% and 49.9%. Our results revealed also a decreasing trend in species richness with increasing elevation (ρ = –0.585). Indeed, species richness was negatively correlated with slope (ρ = –0.19) and positively correlated with sand content (ρ = 0.262). Biological types were dominated by chamaephytes; this chamaephytization is due to the phenomenon of aridization and overgrazing. Moreover, the low species cover and the appearance of nonpalatable species highlighted the vulnerability of these steppes to degradation.

Design of a generalized tool for the performance assessment under sail based on analytical, numerical and empirical results : a global sailing yacht meta-model

La evaluación de las prestaciones de las embarcaciones a vela ha constituido un objetivo para ingenieros navales y marinos desde los principios de la historia de la navegación. El conocimiento acerca de estas prestaciones, ha crecido desde la identificación de los factores clave relacionados con ellas(eslora, estabilidad, desplazamiento y superficie vélica), a una comprensión más completa de las complejas fuerzas y acoplamientos involucrados en el equilibrio. Junto con este conocimiento, la aparición de los ordenadores ha hecho posible llevar a cabo estas tareas de una forma sistemática. Esto incluye el cálculo detallado de fuerzas, pero también, el uso de estas fuerzas junto con la descripción de una embarcación a vela para la predicción de su comportamiento y, finalmente, sus prestaciones. Esta investigación tiene como objetivo proporcionar una definición global y abierta de un conjunto de modelos y reglas para describir y analizar este comportamiento. Esto se lleva a cabo sin aplicar restricciones en cuanto al tipo de barco o cálculo, sino de una forma generalizada, de modo que sea posible resolver cualquier situación, tanto estacionaria como en el dominio del tiempo. Para ello se comienza con una definición básica de los factores que condicionan el comportamiento de una embarcación a vela. A continuación se proporciona una metodología para gestionar el uso de datos de diferentes orígenes para el cálculo de fuerzas, siempre con el la solución del problema como objetivo. Esta última parte se plasma en un programa de ordenador, PASim, cuyo propósito es evaluar las prestaciones de diferentes ti pos de embarcaciones a vela en un amplio rango de condiciones. Varios ejemplos presentan diferentes usos de PASim con el objetivo de ilustrar algunos de los aspectos discutidos a lo largo de la definición del problema y su solución . Finalmente, se presenta una estructura global de cara a proporcionar una representación virtual de la embarcación real, en la cual, no solo e l comportamiento sino también su manejo, son cercanos a la experiencia de los navegantes en el mundo real. Esta estructura global se propone como el núcleo (un motor de software) de un simulador físico para el que se proporciona una especificación básica. ABSTRACT The assessment of the performance of sailing yachts, and ships in general, has been an objective for naval architects and sailors since the beginning of the history of navigation. The knowledge has grown from identifying the key factors that influence performance(length, stability, displacement and sail area), to a much more complete understanding of the complex forces and couplings involved in the equilibrium. Along with this knowledge, the advent of computers has made it possible to perform the associated tasks in a systematic way. This includes the detailed calculation of forces, but also the use of those forces, along with the description of a sailing yacht, to predict its behavior, and ultimately, its performance. The aim of this investigation is to provide a global and open definition of a set of models and rules to describe and analyze the behavior of a sailing yacht. This is done without applying any restriction to the type of yacht or calculation, but rather in a generalized way, capable of solving any possible situation, whether it is in a steady state or in the time domain. First, the basic definition of the factors that condition the behavior of a sailing yacht is given. Then, a methodology is provided to assist with the use of data from different origins for the calculation of forces, always aiming towards the solution of the problem. This last part is implemented as a computational tool, PASim, intended to assess the performance of different types of sailing yachts in a wide range of conditions. Several examples then present different uses of PASim, as a way to illustrate some of the aspects discussed throughout the definition of the problem and its solution. Finally, a global structure is presented to provide a general virtual representation of the real yacht, in which not only the behavior, but also its handling is close to the experience of the sailors in the real world. This global structure is proposed as the core (a software engine) of a physical yacht simulator, for which a basic specification is provided.

Digital Innovation Through Partnership Between Nature Conservation Organisations and Academia : A Qualitative Impact Assessment

We would like to thank all interviewees for sharing their experiences of working with academics, and the guest editor and three anonymous reviewers for valuable comments on earlier versions of the work. The research in this paper is supported by the RCUK dot.rural Digital economy Research Hub, University of Aberdeen (Grant reference: EP/G066051/1).

Digital Innovation Through Partnership Between Nature Conservation Organisations and Academia : A Qualitative Impact Assessment

We would like to thank all interviewees for sharing their experiences of working with academics, and the guest editor and three anonymous reviewers for valuable comments on earlier versions of the work. The research in this paper is supported by the RCUK dot.rural Digital economy Research Hub, University of Aberdeen (Grant reference: EP/G066051/1).

A quantitative assessment of students’ experiences of studying music: a Spanish perspective on the European credit transfer system (ECTS)

The purpose of this investigation is to evaluate whether or not the allocation of time proposed in the Music Study Guide, adapted from the European Higher Education Area (EHEA) guidelines, is consistent and adequate for students with minimal musical knowledge. The report takes into account the importance of students’ previous knowledge and the relation this has to the time and effort expended by students in acquiring appropriate knowledge and skills. This is related also to the adequacy of the course specification to meet the demands of university study and the labour market. Results show that those students who enrolled at university without any previous musical knowledge are likely to experience significant difficulty in the acquisition of certain musical and professional competences. This highlights a need to reinforce the music curriculum, or establish zero-level courses, in order to enable such students to succeed in the subject.

Assessment of University External Internships. Towards a Mixed Model for Measuring the Acquisition of Skills and the Satisfaction of Parties Involved

The continuous improvement of management and assessment processes for curricular external internships has led a group of university teachers specialised in this area to develop a mixed model of measurement that combines the verification of skill acquisition by those students choosing external internships with the satisfaction of the parties involved in that process. They included academics, educational tutors of companies and organisations and administration and services personnel in the latter category. The experience, developed within University of Alicante, has been carried out in the degrees of Business Administration and Management, Business Studies, Economics, Advertising and Public Relations, Sociology and Social Work, all part of the Faculty of Economics and Business. By designing and managing closed standardised interviews and other research tools, validated outside the centre, a system of continuous improvement and quality assurance has been created, clearly contributing to the gradual increase in the number of students with internships in this Faculty, as well as to the improvement in satisfaction, efficiency and efficacy indicators at a global level. As this experience of educational innovation has shown, the acquisition of curricular knowledge, skills, abilities and competences by the students is directly correlated with the satisfaction of those parties involved in a process that takes the student beyond the physical borders of a university campus. Ensuring the latter is a task made easier by the implementation of a mixed assessment method, combining continuous and final assessment, and characterised by its rigorousness and simple management. This report presents that model, subject in turn to a persistent and continuous control, a model all parties involved in the external internships are taking part of. Its short-term results imply an increase, estimated at 15% for the last course, in the number of students choosing curricular internships and, for the medium and long-term, a major interweaving between the academic world and its social and productive environment, both in the business and institutional areas. The potentiality of this assessment model does not lie only in the quality of its measurement tools, but also in the effects from its use in the various groups and in the actions that are carried out as a result of its implementation and which, without any doubt and as it is shown below, are the real guarantee of a continuous improvement.

The Importance of Foreign Language Skills in the Labour Markets of Central and Eastern Europe: An assessment based on data from online job portals. CEPS Special Report No. 129/January 2016

In a globalised world, knowledge of foreign languages is an important skill. Especially in Europe, with its 24 official languages and its countless regional and minority languages, foreign language skills are a key asset in the labour market. Earlier research shows that over half of the EU27 population is able to speak at least one foreign language, but there is substantial national variation. This study is devoted to a group of countries known as the Visegrad Four, which comprises the Czech Republic, Hungary, Poland and Slovakia. Although the supply of foreign language skills in these countries appears to be well-documented, less is known about the demand side. In this study, we therefore examine the demand for foreign language skills on the Visegrad labour markets, using information extracted from online job portals. We find that English is the most requested foreign language in the region, and the demand for English language skills appears to go up as occupations become increasingly complex. Despite the cultural, historical and economic ties with their German-speaking neighbours, German is the second-most-in-demand foreign language in the region. Interestingly, in this case there is no clear link with the complexity of an occupation. Other languages, such as French, Spanish and Russian, are hardly requested. These findings have important policy implications with regards to the education and training offered in schools, universities and job centres.

Assessment of fight outcome is needed to activate socially driven transcriptional changes in the zebrafish brain

Group living animals must be able to express different behavior profiles depending on their social status. Therefore, the same genotype may translate into different behavioral phenotypes through socially driven differential gene expression. However, how social information is translated into a neurogenomic response and what are the specific cues in a social interaction that signal a change in social status are questions that have remained unanswered. Here, we show for the first time, to our knowledge, that the switch between status-specific neurogenomic states relies on the assessment of fight outcome rather than just on self- or opponent-only assessment of fighting ability. For this purpose, we manipulated the perception of fight outcome in male zebrafish and measured its impact on the brain transcriptome using a zebrafish whole genome gene chip. Males fought either a real opponent, and a winner and a loser were identified, or their own image on a mirror, in which case, despite expressing aggressive behavior, males did not experience either a victory or a defeat. Massive changes in the brain transcriptome were observed in real opponent fighters, with losers displaying both a higher number of differentially expressed genes and of coexpressed gene modules than winners. In contrast, mirror fighters expressed a neurogenomic state similar to that of noninteracting fish. The genes that responded to fight outcome included immediate early genes and genes involved in neuroplasticity and epigenetic modifications. These results indicate that, even in cognitively simple organisms such as zebrafish, neurogenomic responses underlying changes in social status rely on mutual assessment of fighting ability.

The Effects of Civic Education on Political Knowledge

Traditionally political knowledge was regarded as an important potential outcome for civic education efforts. Most of the currently available research, however, tends to focus on non-cognitive goals, despite the fact that studies repeatedly have shown that political knowledge is an important resource for enlightened and engaged citizenship. In this article, we investigate whether civic education contributes to political knowledge levels. The analysis is based on the Belgian Political Panel Survey, a two year panel study among 2,988 Belgian late adolescents. The analysis shows that experiences with group projects at school contribute significantly to political knowledge levels two years later on. Furthermore, we can observe an interaction effect as those who are already most knowledgeable about politics, gain most from these group projects. Classes about politics, on the other hand, did not have an effect on knowledge levels. In the discussion, it is argued that civic education can have strong cognitive effects, but that these effects are not always related to classical civic education efforts.

An Integrated Assessment of the Red Sea Urchin (Strongylocentrotus franciscanus) Fisheries in Southern California and Washington State: Addressing Sustainability and Vulnerability in the face of Climate Change

Thesis (Master's)--University of Washington, 2016-06

Going global with assessment: what to do when the dominant culture's literacy drives assessment

This article explores how the dominant cultural literacy in a western context relies on a western template of knowledge that can inhibit internationalisation of the curricula unless it is identified, transformed, and broadened to become interculturally responsive. As Brian Street has said "literacies may be sites of negotiation and transform ation" (1994, p. 99). Drawing on the findings of an innovative website, Worldmarks , developed at Queensland University of Technology, as well as qualitative interviews with international students and staff, this article addresses the serious implications of assessment driven by the dominant culture's literacy. We identify how and why assessment driven by responsive cultural literacy enables all students to develop comprehensive intercultural communication skills and understandings as part of their lifelong learning in Australian universities.

Capturing expert knowledge for threatened species assessments: a case study using NatureServe conservation status ranks

Assessments for assigning the conservation status of threatened species that are based purely on subjective judgements become problematic because assessments can be influenced by hidden assumptions, personal biases and perceptions of risks, making the assessment process difficult to repeat. This can result in inconsistent assessments and misclassifications, which can lead to a lack of confidence in species assessments. It is almost impossible to Understand an expert's logic or visualise the underlying reasoning behind the many hidden assumptions used throughout the assessment process. In this paper, we formalise the decision making process of experts, by capturing their logical ordering of information, their assumptions and reasoning, and transferring them into a set of decisions rules. We illustrate this through the process used to evaluate the conservation status of species under the NatureServe system (Master, 1991). NatureServe status assessments have been used for over two decades to set conservation priorities for threatened species throughout North America. We develop a conditional point-scoring method, to reflect the current subjective process. In two test comparisons, 77% of species' assessments using the explicit NatureServe method matched the qualitative assessments done subjectively by NatureServe staff. Of those that differed, no rank varied by more than one rank level under the two methods. In general, the explicit NatureServe method tended to be more precautionary than the subjective assessments. The rank differences that emerged from the comparisons may be due, at least in part, to the flexibility of the qualitative system, which allows different factors to be weighted on a species-by-species basis according to expert judgement. The method outlined in this study is the first documented attempt to explicitly define a transparent process for weighting and combining factors under the NatureServe system. The process of eliciting expert knowledge identifies how information is combined and highlights any inconsistent logic that may not be obvious in Subjective decisions. The method provides a repeatable, transparent, and explicit benchmark for feedback, further development, and improvement. (C) 2004 Elsevier SAS. All rights reserved.

Assessment of volume depletion in children with malaria

Background The degree of volume depletion in severe malaria is currently unknown, although knowledge of fluid compartment volumes can guide therapy. To assist management of severely ill children, and to test the hypothesis that volume changes in fluid compartments reflect disease severity, we measured body compartment volumes in Gabonese children with malaria. Methods and Findings Total body water volume (TBW) and extracellular water volume (ECW) were estimated in children with severe or moderate malaria and in convalescence by tracer dilution with heavy water and bromide, respectively. Intracellular water volume (ICW) was derived from these parameters. Bioelectrical impedance analysis estimates of TBW and ECW were calibrated and bioelectrical impedance analysis measurements were taken daily against dilution methods, until discharge. Sixteen children had severe and 19 moderate malaria. Severe childhood malaria was associated with depletion of TBW (mean [SD] of 37 [33] ml/kg, or 6.7% [6.0%]) relative to measurement at discharge. This is defined as mild dehydration in other conditions. ECW measurements were normal on admission in children with severe malaria and did not rise in the first few days of admission. Volumes in different compartments (TBW, ECW, and ICW) were not related to hyperlactataemia or other clinical and laboratory markers of disease severity. Moderate malaria was not associated with a depletion of TBW. Conclusions Significant hypovolaemia does not exacerbate complications of severe or moderate malaria. As rapid rehydration of children with malaria may have risks, we suggest that fluid replacement regimens should aim to correct fluid losses over 12-24 h.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.