Quality of care of patients hospitalized with congestive heart failure

Background: Congestive heart failure (CHF) is an increasingly prevalent poor-prognosis condition for which effective interventions are available. It is -therefore important to determine the extent to which patients with CHF receive appropriate care in Australian hospitals and identify ways for improving suboptimal care, if it exists. Aim: To evaluate the quality of in-hospital acute care of patients with CHF using explicit quality indicators based on published guidelines. Methods: A retrospective case note review was -performed, involving 216 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between October 2000 and April 2001. Outcome measures were process-of-care quality -indicators calculated as proportions of all, or strongly -eligible (ideal), patients who received -specific interventions. Results: Assessment of underlying causes and acute precipitating factors was undertaken in 86% and 76% of patients, respectively, and objective evaluation of left ventricular function was performed in 62% of patients. Prophylaxis for deep venous thrombosis (DVT) was used in only 29% of ideal patients. Proportions of ideal patients receiving pharmacological treatments at discharge were: (i) angiotensin--converting enzyme inhibitors (ACEi) (82%), (ii) target doses of ACEi (61%), (iii) alternative vasodilators in patients ineligible for ACEi (20%), (iv) beta-blockers (40%) and (v) warfarin (46%). Conclusions: Opportunities exist for improving quality of in-hospital care of patients with CHF, -particularly for optimal prescribing of: (i) DVT prophylaxis, (ii) ACEi, (iii) second-line vasodilators, (iv) beta-blockers and (v) warfarin. More research is needed to identify methods for improving quality of in-hospital care.

Numerical study of hydrogenic effective mass theory for an impurity P donor in Si in the presence of an electric field and interfaces

In this paper we examine the effects of varying several experimental parameters in the Kane quantum computer architecture: A-gate voltage, the qubit depth below the silicon oxide barrier, and the back gate depth to explore how these variables affect the electron density of the donor electron. In particular, we calculate the resonance frequency of the donor nuclei as a function of these parameters. To do this we calculated the donor electron wave function variationally using an effective-mass Hamiltonian approach, using a basis of deformed hydrogenic orbitals. This approach was then extended to include the electric-field Hamiltonian and the silicon host geometry. We found that the phosphorous donor electron wave function was very sensitive to all the experimental variables studied in our work, and thus to optimize the operation of these devices it is necessary to control all parameters varied in this paper.

Making distance learning E.R.O.T.I.C.: Applying interpretation principles to distance learning

Distance learners are self-directed learners traditionally taught via study books, collections of readings, and exercises to test understanding of learning packages. Despite advances in e-Learning environments and computer-based teaching interfaces, distance learners still lack opportunities to participate in exercises and debates available to classroom learners, particularly through non-text based learning techniques. Effective distance teaching requires flexible learning opportunities. Using arguments developed in interpretation literature, we argue that effective distance learning must also be Entertaining, Relevant, Organised, Thematic, Involving and Creative—E.R.O.T.I.C. (after Ham, 1992). We discuss an experiment undertaken with distance learners at The University of Queensland Gatton Campus, where we initiated an E.R.O.T.I.C. external teaching package aimed at engaging distance learners but using multimedia, including but not limited to text-based learning tools. Student responses to non-text media were positive.

Evaluation of cyclooxygenase 2 inhibitor use in patients admitted to a large teaching hospital

Background: The heavy usage of coxibs in Australia far outstrips the predicted usage that was based on the treatment of patients with risk factors for upper gastro-intestinal adverse events from conventional anti--inflammatory agents. This raises questions regarding the appropriateness of prescribing. Aims: To determine: (i) the relationship between prescriptions for cyclooxygenase 2 (COX-2) inhibitors and objective evidence of inflammatory arthritis, (ii) prior experience with paracetamol and/or conventional non-steroidal anti-inflammatory drugs (NSAIDs), and (iii) contraindications to the use of NSAIDs. Methods: Drug utilization evaluation and rheumato-logical assessment was conducted on 70 consecutive patients admitted on COX-2 inhibitors to a 480-bed metropolitan hospital. The main outcome measures were: the indication for COX-2 inhibitor; objective -evidence of inflammatory arthritis; previous trial of -paracetamol or conventional NSAIDs; and patient -satisfaction. Results: Only 11 patients (16%) had symptoms or signs of an inflammatory arthropathy, and met Pharmaceut-ical Benefits Schedule criteria for prescribing a COX-2 inhibitor. Fifty-nine patients (84%) had chronic osteo-arthritis, degenerative spinal disease, injury or malignancy, without overt active inflammation. Fourteen patients (20%) had trialled regular paracetamol prior to using any NSAID treatment. Conventional NSAIDs had been previously used by 51 patients (73%). Eleven patients (16%) reported previous adverse gastrointestinal effects from conventional NSAIDs. On the basis of significant renal impairment (creatinine clearance 5/10). Conclusions: Drug utilization data indicate that COX-2 inhibitors are frequently used first line for degenerative osteoarthritis in the absence of overt inflammation, without prior adequate trial of paracetamol and with disregard for the cautions and contraindications of these agents. These findings may explain the unprecedented Pharmaceutical Benefits Schedule expenditure on COX-2 inhibitors in Australia.

Lectures and other types of teaching

A questionnaire on lectures was completed by 351 students (84% response) and 35 staff (76% response) from all five years of the veterinary course at the University of Queensland. Staff and students in all five years offered limited support for a reduction in the number of lectures in the course and the majority supported a reduction in the number of lectures in the clinical years. Students in the clinical years only and appropriate staff agreed that the number of lectures in fifth year should be reduced but were divided as to whether lectures in fifth year should be abolished. There was limited support for replacement of some lectures by computer assisted learning (CAL) programs, but strong support for replacement of some lectures by subject-based problem based learning (PBL) and strong support for more self-directed learning by students. Staff and students strongly supported the inclusion of more clinical problem solving in lectures in the clinical years and wanted these lectures to be more interactive. There was little support for lectures in the clinical years to be of the same type as in the preclinical years.

Constructing and reconstructing teaching roles: A focus on generative metaphors and dichotomies

Over the last several decades, a shift in thinking has brought to the fore the power of language as more than simply a method of expression. Indeed, language is a constituent part of social practices and social identity. For teachers, both pre-service and in-service, teaching roles are often represented through surface and generative metaphors, the latter of which are tacit. In order to study the way in which language, and in particular metaphor, influences thinking about teaching roles, the authors of this article combined their data to examine the metaphoric discourse of both pre-service and in-service teachers. Contextualizing two separate studies in their respective teacher education programs, this article highlights the obstacle of unexposed generative metaphors and the value of ongoing professional development. In addition, it emphasizes the importance of deconstructing traditional dichotomies as central to teacher education reform.

Normal values for pelvic organ descent in health nulligravid young caucasian women

Translabial ultrasound is increasingly being used for the assessment of women presenting with pelvic floor dysfunction and incontinence (1,2). However, there is little information on normal values for bladder neck descent, with the two available studies disagreeing widely (3,4). No data has so far been published on mobility of the central and posterior compartment which can now also be assessed by ultrasound (5). This study presents normal values for urethral, bladder, cervical and rectal mobility in a cohort of young, stress continent, nulliparous nonpregnant women. Methods 118 nonpregnant nulliparous Caucasian women between 18 and 23 years of age were recruited for an ongoing twin study of pelvic floor function. Translabial ultrasound assessment of pelvic organ mobility was undertaken supine and after bladder emptying (6,7). The best of at least three effective Valsalva manoeuvres was used for evaluation, with no attempts at standardization of Valsalva pressure. Parameters of anterior compartment mobility were obtained by the use of on-screen calipers; cervical and rectal descent were evaluated on printouts. All examinations were carried out under direct supervision of the first author or by personnel trained by him for at least 100 consecutive assessments. Results The median age of participants in this study was 20 (range 18- 23). Mean body mass index was 23 (range 16.9- 36.7). Of 118 women, 2 were completely unable to perform a Valsalva manoeuvre despite repeated efforts at teaching and were excluded from analysis, as were ten women who complained of urinary stress incontinence, leaving 106 datasets. Average measurements for the parameters ‘retrovesical angle at rest’ (RVA-R) and on Valsalva (RVA-S), urethral rotation, bladder neck mobility, cysto-cele descent, cervical descent and descent of the rectal ampulla are given in Table 1.

Historical and dialectical perspectives on the teaching of Aboriginal and Torres Strait Islander musics in the Australian education system

Indigenous studies (also referred to as Aboriginal and Torres Strait Islander studies) has a double identity in the Australian education system, consisting of the education of Indigenous students and education of all students about Aboriginal and Torres Strait Islander cultures and histories. Through explanations of the history of the inclusion of Aboriginal and Torres Strait Islander musics in Australian music education, this article critiques ways in which these musics have been positioned in relation to a number of agendas. These include definitions of Aboriginal and Torres Strait Islander musics as types of Australian music, as ethnomusicological objects, as examples of postcolonial discourse, and as empowerment for Indigenous students. The site of discussion is the work of the Australian Society for Music Education, as representative of trends in Australian school-based music education, and the Centre for Aboriginal Studies in Music at the University of Adelaide, as an example of a tertiary music program for Indigenous students.

Educa????o a dist??ncia: o estado da arte e o futuro necess??rio

Este artigo analisa alguns desafios que cercam a ado????o da Educa????o a Dist??ncia por institui????es de ensino, unidades de forma????o e qualifica????o profissional e de educa????o corporativa. Al??m disto, ?? sugerida uma agenda de pesquisa sobre EAD. O artigo trata do papel da EAD na educa????o continuada de adultos e na amplia????o do acesso ?? aprendizagem, em fun????o da possibilidade de intera????es ass??ncronas, mediadas por tecnologias da informa????o e comunica????o. Uma an??lise da situa????o EAD no Brasil mostra um grande crescimento da modalidade. Observa-se que ainda s??o raras as pesquisas sobre EAD no servi??o p??blico. H?? informa????es sugerindo que, em ??rg??os p??blicos com pr??ticas institucionalizadas de EAD, a modalidade representa uma valiosa e eficaz estrat??gia de inclus??o de pessoas em atividades de ensino-aprendizagem. S??o analisados alguns importantes desafios ligados ?? implementa????o e ao desenho de cursos a dist??ncia, e, al??m disto, ?? apresentada uma agenda de pesquisas para a ??rea.