Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review

Background Post-stroke recovery is demanding. Increasing studies have examined the effectiveness of self-management programs for stroke survivors. However no systematic review has been conducted to summarize the effectiveness of theory-based stroke self-management programs. Objectives The aim is to present the best available research evidence about effectiveness of theory-based self-management programs on community-dwelling stroke survivors’ recovery. Inclusion criteria Types of participants All community-residing adults aged 18 years or above, and had a clinical diagnosis of stroke. Types of interventions Studies which examined effectiveness of a self-management program underpinned by a theoretical or conceptual framework for community-dwelling stroke survivors. Types of studies Randomized controlled trials. Types of outcomes Primary outcomes included health-related quality of life and self-management behaviors. Secondary outcomes included physical (activities of daily living), psychological (self-efficacy, depressive symptoms), and social outcomes (community reintegration, perceived social support). Search Strategy A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese. Methodological quality The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies. Data Collection A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results. Data Synthesis There were incomplete details about the number of participants and the results in two studies, which makes it impossible to perform meta-analysis. A narrative summary of the effectiveness of stroke self-management programs is presented. Results Three studies were included. The key issues of concern in methodological quality included insufficient information about random assignment, allocation concealment, reliability and validity of the measuring instruments, absence of intention-to-treat analysis, and small sample sizes. The three programs were designed based on the Stanford Chronic Disease Self-management program and were underpinned by the principles of self-efficacy. One study showed improvement in the intervention group in family and social roles three months after program completion, and work productivity at six months as measured by the Stroke Specific Quality of Life Scale (SSQOL). The intervention group also had an increased mean self-efficacy score in communicating with physicians six months after program completion. The mean changes from baseline in these variables were significantly different from the control group. No significant difference was found in time spent in aerobic exercise between the intervention and control groups at three and six months after program completion. Another study, using SSQOL, showed a significant interaction effect by treatment and time on family roles, fine motor tasks, self-care, and work productivity. However there was no significant interaction by treatment and time on self-efficacy. The third study showed improvement in quality of life, community participation, and depressive symptoms among the participants receiving the stroke self-management program, Stanford Chronic Disease Self-management program, or usual care six months after program completion. However, there was no significant difference between the groups. Conclusions There is inconclusive evidence about the effectiveness of theory-based stroke self-management programs on community-dwelling stroke survivors’ recovery. However the preliminary evidence suggests potential benefits in improving stroke survivors’ quality of life and self-efficacy.

The importance of understanding student learning styles in accounting degree programs

Accounting education is critical and any improvements in tertiary education of accounting students should result in better prepared graduates entering the profession. This study evaluates accounting students’ learning styles and the interaction of learning styles and teaching methodologies during degree programmes. Nine classes of accounting students (648 students) spread across four years and two degree programmes were evaluated. Students self-evaluated their learning style, pre-instruction. They were then subject to two separate teaching techniques (one active and one passive) in each course. Learning styles were then re-assessed and teaching techniques evaluated. Accounting students displayed a preference for passive learning, even those far advanced in their degrees. Furthermore, when learning styles matched teaching methods used, usefulness was assessed as high but when learning styles and teaching methods differed, usefulness deteriorated. Overall, the teaching methods were deemed more effective by active rather than passive learners. The implications are significant. To maximise educational benefit for the accounting profession, student learning styles should be assessed before designing appropriate teaching methodologies. This has resource implications which would have to be considered.

Equally engaged : demystifying tertiary study in the creative arts to equity communities

The participation rate of students from low socio-economic (SES) backgrounds into Australian universities remains low. A nationwide initiative to raise participation rates aims to stimulate interest, highlight career possibilities and enhance understanding of university. The program also aims to improve retention and completion rates of those students. This paper provides a case study and preliminary evaluation of QUT’s Creative Industries Faculty’s (CIF) outreach programs to low SES school students, operating since 2012. Programs are conducted across the disciplines of Dance, Drama, Media, Digitalstorytelling, Music and Entertainment. Presenting the arts and creative industries as a viable study / career pathway is particularly challenging to low SES groups. However, the focus on the creative industries aims to broaden understanding of arts and creativity, emphasising the significance of digital technology in the transformation of the workforce, providing new career opportunities in the creative and non-creative sectors. CIF’s outreach programs have been delivered to hundreds of students and this paper presents a case study and evaluation of several programs.

The impact of work-family programs on the relationship between gender diversity and performance

Work–family programs signal an employer's perspective on gender diversity to employees, and can influence whether the effects of diversity on performance are positive or negative. This article tests the interactive effects of nonmanagement gender diversity and work–family programs on productivity, and management gender diversity and work–family programs on financial performance. The predictions were tested in 198 Australian publicly listed organizations using primary (survey) and secondary (publicly available) data based on a two-year time lag between diversity and performance. The findings indicate that nonmanagement gender diversity leads to higher productivity in organizations with many work–family programs, and management gender diversity leads to lower financial performance in organizations with few work–family programs. The results suggest different business cases at nonmanagement and management levels for the adoption of work–family programs in gender-diverse organizations.

Educating the creative citizen : design education programs in the knowledge economy

The shift in the last twenty years from an industrialised economy to a knowledge economy demands new modes of education in which individuals can effectively acquire 21st century competencies. This article builds on the findings and recommendations of a Knowledge Economy Market Development Mapping Study (KEMDMS), conducted in Queensland, Australia. The study was conducted to identify the value of design education programs from primary school through to the professional development level. This article considers the ability of design education as a framework to deliver on the 21st century competences required for the three defining features of the creative knowledge economy – Innovation, Transdisciplinarity and Networks. This is achieved by contextualising key findings from the KEMDMS, including current design education initiatives, and outlining the current and future challenges faced. From this, this article focuses on the role of the tertiary education sector as the central actor in the creative economy in the development of generic design/design education capabilities. Through the unpacking of the study's three key observation themes for change, a holistic design education framework is proposed, and further research directions are discussed.

IHRM and expatriation in Japanese MNCs: HRM practices and their impact on adjustment and job performance

Studies of international human resource management (IHRM) have pointed out that Japanese multinational companies (MNCs) tend to use more parent-country nationals (PCNs) than do western MNCs. The ethnocentric staffing policies imply that the management of expatriation has a greater influence on the success of Japanese MNCs. We use survey data from 149 Japanese repatriates to examine the relationship between IHRM practices – selection, preparation and corporate support – and expatriate adjustment and job performance, as well as identify differences by the location of assignment. We find that selection criteria, language ability and familiarity with local cultures are positively related to work adjustment, and that leadership and relational abilities are slightly associated with job performance though there were no significant relationships between considerations for family situations and adjustment or job performance. The results also reveal that HRM practices while abroad, in particular the interactive exchange of information between expatriates and the headquarters, have a significant influence. Pre-departure preparation programs are not related to the dependent variables. The data also suggests that living and working in China is a particular problem for Japanese expatriates.

Managing change without sacrificing quality: music teaching and learning at South African tertiary institutions

After the jubilation of the first democratic election in 1994, South African educational settings were faced with the challenge to rethink curriculum, content and delivery as part of its nation building process. Education continues to be a major player in stimulating wider change in society and is one arena where change may be readily facilitated. Changing the style and practice of teacher education programs remains a key feature in the transformation process. Twelve years on, curriculum, has undergone reform in terms of Outcomes Based Education (OBE)? Revised National Curriculum Statement (RNCS) of 2002, accordingly, universities continue to prepare teachers for multicultural classrooms. Universities are now challenged to manage increased student intake (quantity) for teacher education programs without having to sacrifice quality for teacher education. This article focuses only on The University of Pretoria, a city university previously known as a traditional Afrikaans university situated in the greater Johannesburg area in South Africa. Through interview data with two music educators at this university, I present some of the current trends and challenges that tertiary music educators face in preparing music teachers in South Africa. This article also outlines a paradigm shift in the curriculum and argues for a holistic music education, one that endorses most of the major cultures and musics in South Africa. The question I pose is how then do we effectively manage change at tertiary level without sacrificing quality when preparing future music teachers to meet the needs and challenges of the curriculum and society.

Variables influencing the mathematics performance of first-year tertiary students : a case study

The need to understand which factors most strongly affect performance in first-year mathematics programs at Khon Kaen University (KKU), in North Eastern Thailand, provided the main focus of the study which is described. First-year mathematics students in the 1990-1991 academic year, from four KKU faculty groups (Medicine and Nursing, Agriculture, Science and Education, and Engineering) were involved in this study. Research literatures addressing variables which were likely to influence performance in early tertiary mathematical study, and variables associated with difficulties in learning mathematics at the transition from upper secondary school to tertiary studies, were reviewed. The first major aim of the study was to identify the variables which were good predictors of first-year mathematics performance at KKU. Results from stepwise multiple regression analyses indicated that the following predictor variables were statistically significant and entered the regression equations for most Faculty groups: School Mathematics Achievement, Self-Esteem, Study Habits in Mathematics, and Faculty of Study. Other predictor variables that sometimes entered regression equations (depending on the Faculty group) were Socio-Economic-Status, Mathematics Language Competence, Mathematics Confidence, Attitude Towards Mathematics, and Gender. Depending on Faculty group, the statistically significant variables accounted for between 11% and 74% of scores on fist-year KKU mathematics examinations. The predictor variables contributed much more to the variance of scores on first-semester mathematics examinations than to the variance of scores on second-semester mathematics examinations. It was also found that scores on the Direct Entry Examination Mathematics test (administered by KKU) and the School Mathematics Achievement test (developed and administered by the author) had stronger correlations with first-year KKU mathematics performance than did scores on the National Entry Examination Mathematics tests (administered by the Thai Ministry of University Affairs). Scores on the three pre-university mathematics achievement test instruments were better predictors of first-semester mathematics performance than of second-semester mathematics performance. It was found that the mean Mathematics Confidence of male students was statistically significantly higher than that of female students, but there were no statistically significant gender differences in Mathematics Misplaced Confidence. Only about 30% of the main sample ( 30% of the male and 30% of the female sample groups) had appropriate confidence in mathematics, that is, they thought their answers were correct when they were, in fact, correct, and they thought they were wrong when they were, in fact, incorrect. So far as Faculty performance differences were concerned, Engineering students had the highest Mathematics Confidence scores, followed by the Medicine and Nursing group of students and the Science and Education group students. Agriculture students had the lowest mean Mathematics Confidence score. No statistically significant differences occurred in Mathematics Misplaced Confidence between different Faculty groups. The second main aim of the study was to investigate why many first-year students experienced difficulties in coping with their mathematics units. A small group of senior secondary mathematics teachers, university mathematics lecturers, and first-year mathematics students were interviewed during the first semester of the 1990-1991 academic year. Interviews were conducted by the author according to a questionnaire format, and were aimed at identifying factors causing difficulty in the transition from senior secondary to university mathematical study. The analysis of the quantitative data together with the interview data indicated that the major sources of difficulty were associated with: (a) students' mathematical abilities; (b) curriculum content; (c) course organisation; (d) students' study habits; (e) instructional styles; and (f) assessment procedures. The results of the investigation are discussed in the light of the relevant literature and related research. The study concludes with recommendations which are addressed to mathematics teachers and education administrators in senior secondary schools in Thailand, to the Thai Ministry of Education, and to the KKU Department of Mathematics.

Paving pathways : shaping the public health workforce through tertiary education

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector. Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009). The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the “obesity epidemic”, climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both? This paper presents some of the key discussion points from 2008 - 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future

Reading, writing, crafting – Innovations in first year tertiary writing pedagogy

This paper will outline some of the rationale behind, and strategies contributing to, curriculum revision in first-year creative writing at Deakin University in 2012 – delivered in that year and currently running in 2013. The process aimed to produce two consecutive offerings, with distinct but strategically scaffolded preoccupations. This paper deals with the first of these. The design process for this offering, named ‘Writing Craft’, involved addressing two central concerns: (a) the need to unhook the initial encounter with tertiary creative writing pedagogy from a preoccupation with ‘genres’ or the ‘forms’ of creative writing (such as prose fiction, creative nonfiction, script, poetry, and so on) and instead to reorient efforts towards establishing an engagement with craft per se; (b) to address a perceived impoverishment in the range of texts to which students had been exposed prior to commencing study – in other words, to emphasise the practice of reading to facilitate the practice of writing. The curriculum design also involved reimagining assessment, noting the ‘messages about making’ sent to students via the framing of tasks and rubrics. Aiming instead to deemphasise the role of inspiration and ‘work arriving fully formed’, it sought to offer assessment that provided clear – and bounded – prompts for incidents of making and the practice of craft, as well as to provoke conversation with a broad range of texts as a way of courting intertextual inspiration and aesthetic formation.

Designing blended spaces to maximise student learning in work integrated learning programs

This paper describes a case study at a large metropolitan university in Australia where a range of technology-enabled blended spaces are used for interaction, communication and reflection between the work and university environments to enrich students' learning experiences during their work placement year. Blended space design requirements to maximise the learning experience of students undertaking work integrated learning are identified

Enriching interdisciplinary connections : student engagement in theory and practice in higher education programs in Australia and the UK

This paper provides insight into how postgraduate students in two pre-service disciplines, namely medicine and education, identify and make meaning of their circumstances in the globalised era of tertiary education.
Drawing on elements of Giddens’ theory of structuration, we discuss some of the tensions students have reported encountering in an era which is characterised by greater internationalisation of the student body and more globalised curricula.

Cohort Study on the Association Between Helmet Use and Traumatic Brain Injury in Snowboarders From a Swiss Tertiary Trauma Center.

BACKGROUND Since the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI). METHODS This cohort study included 117 adult (≥ 16 years) snowboarders with TBI admitted to a level I alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI during the past decade in relation to increased helmet use. RESULTS Of 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were men (median age, 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate, and 7% severe TBI according to the Glasgow coma scale. Pathologic computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate during the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the 5 patients requiring surgery only 1 was wearing a helmet. Off-piste compared with on-slope snowboarders showed an odds ratio of 26.5 (P = 0.003) for sustaining a moderate-to-severe TBI. CONCLUSIONS Despite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.

Exploring the use of pharmaceutical patient assistance programs as an option to improve access to and affordability of prescription drugs

Background. Pharmaceutical-sponsored patient assistance programs (PAPs) are charity programs that provide free or reduced-priced medications to eligible patients. PAPs have the potential to improve prescription drug accessibility for patients but currently there is limited information about their use and effectiveness. ^ Objectives and methods. This dissertation described the use of PAPs in the U.S. through the conduct of two studies: (1) a systematic review of primary studies of PAPs from commercially-published and “grey” literature sources; and (2) a retrospective, cross-sectional study of cancer patients' use of PAPs at a tertiary care cancer outpatient center. ^ Results. (1) The systematic review identified 33 studies: 15 evaluated the impact of PAP enrollment assistance programs on patient healthcare outcomes; 7 assessed institutional costs of providing enrollment assistance; 7 surveyed stakeholders; 4 examined other aspects. Standardized mean differences calculated for disease indicator outcomes (most of which were single group, pre-posttest designs) showed significant decreases in glycemic and lipid control, and inconsistent results for blood pressure. Grey literature abstracts reported insufficient statistics for calculations. Study heterogeneity made weighted summary estimates inappropriate. Economic analyses indicated positive financial benefits to institutions providing enrollment assistance (cost) compared to the wholesale value of the medications provided (benefit); analyses did not value health outcomes. Mean quality of reporting scores were higher for observational studies in commercially-published articles versus full text, grey literature reports. (2) The cross-sectional study found that PAP outpatients were significantly more likely to be uninsured, indigent, and < 65 years old than non-PAP patients. Nearly all non-PAP and PAP prescriptions were for non-cancer conditions, either for co-morbidities (e.g., hypertension) or the management of treatment side effects (e.g., pain). Oral chemotherapies from PAPs were significantly more likely to be for breast versus other cancers, and be a newer, targeted versus traditional chemotherapy.^ Conclusions. In outpatient settings, PAP enrollment assistance plus additional medication services (e.g., counseling, reminders, and free samples) is associated with improved disease indicators for patients. Healthcare institutions, including cancer centers, can offset financial losses from uncompensated drug costs and recoup costs invested in enrollment assistance programs by procuring free PAP medications. Cancer patients who are indigent and uninsured may be able to access more outpatient medications for their supportive care needs through PAPs, than for cancer treatment options like oral chemotherapies. Because of the selective availability of drugs through PAPs, there may be more options for newer, oral, targeted chemotherapies for the treatment breast cancer versus other for other cancers.^