FITS into Practice: Translating Research into Practice in Reducing the Use of Anti-psychotic Medication for People with Dementia Living in Care Homes

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Studies on coordination of systems development process

This thesis examines coordination of systems development process in a contemporary software producing organization. The thesis consists of a series of empirical studies in which the actions, conceptions and artifacts of practitioners are analyzed using a theory-building case study research approach. The three phases of the thesis provide empirical observations on different aspects of systemsdevelopment. In the first phase is examined the role of architecture in coordination and cost estimation in multi-site environment. The second phase involves two studies on the evolving requirement understanding process and how to measure this process. The third phase summarizes the first two phases and concentrates on the role of methods and how practitioners work with them. All the phases provide evidence that current systems development method approaches are too naïve in looking at the complexity of the real world. In practice, development is influenced by opportunity and other contingent factors. The systems development processis not coordinated using phases and tasks defined in methods providing universal mechanism for managing this process like most of the method approaches assume.Instead, the studies suggest that managing systems development process happens through coordinating development activities using methods as tools. These studies contribute to the systems development methods by emphasizing the support of communication and collaboration between systems development participants. Methods should not describe the development activities and phases in a detail level, butshould include the higher level guidance for practitioners on how to act in different systems development environments.

Young learners : teachers' questions and prompts as opportunities for children's language development

One highly regarded context for language learning is book reading, as teachers engage children in discussions around texts read. However, there is considerable variation in teachers’ patterns of talk that mediate this learning with preschool children’s oral language development dependent on the opportunities for engagement in language use provided by teachers. To explore the affordances of talk interactions within book reading a systematic analysis of teachers’ questions and children’s responses was undertaken. Results of this analysis show that the highest proportion of questions asked by this group of 18 preschool teachers were closed questions with a small proportion of open teaching questions asked. However, while open questions provided the most substantial opportunities for children’s extended talk, the range of questions asked provided opportunities for preschool teachers to extend children’s responses, support children’s understanding of the text, develop vocabulary and world knowledge, and to model more complex language structures.

Estratégias de aprendizagem e autonomia na produção oral dos alunos de licenciatura intensiva em inglês

O presente trabalho tem como objetivo averiguar de que forma os acadêmicos do curso de licenciatura em língua inglesa, em caráter intensivo do Campus de Altamira da Universidade Federal do Pará, apreendem práticas autônomas, utilizando as estratégias de aprendizagem para melhoria da prática oral. No retorno à academia, depois dos períodos sem aulas, os alunos relatam sentirem-se incapazes de participar efetivamente das aulas expondo suas ideias oralmente. Deste modo, a proposta desta pesquisa é atuar em prol de mudanças que levem a um aprimoramento das práticas de produção oral por meio da instrução das estratégias de aprendizagem. A metodologia utilizada é a pesquisa ação de abordagem qualitativa. Os dados foram coletados por meio de narrativas, questionários e entrevistas semi-estruturadas. Participaram desta pesquisa oito de 24 alunos. Eles cursavam o segundo ano da graduação. A coleta de dados foi realizada nos períodos de julho e agosto de 2011 e janeiro e fevereiro de 2012. Os resultados mostraram que a instrução das estratégias foi relevante para que os alunos se tornassem mais conscientes e mais proficientes na prática da oralidade durante e após o período sem aulas. Além disso, alguns alunos passaram a utilizar outras estratégias de maneira autônoma. Alguns deles também passaram a ensiná-las a outros aprendentes. Outros alunos continuaram utilizando as mesmas estratégias anteriores à instrução.

Micropartículas de goma gelana revestidas com filmes de amido resistente/pectina como estratégia para administração oral de insulina

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Knowledge-Production Processes in Practice Research - Outcomes and Critical Elements

The welfare sector has seen considerable changes in its operational context. Welfare services respond to an increasing number of challenges as citizens are confronted with life’s uncertainties and a variety of complex situations. At the same time the service-delivery system is facing problems of co-operation and the development of staff competence, as well as demands to improve service effectiveness and outcomes. In order to ensure optimal user outcomes in this complex, evolving environment it is necessary to enhance professional knowledge and skills, and to increase efforts to develop the services. Changes are also evident in the new emergent knowledge-production models. There has been a shift from knowledge acquisition and transmission to its construction and production. New actors have stepped in and the roles of researchers are subject to critical discussion. Research outcomes, in other words the usefulness of research with respect to practice development, is a topical agenda item. Research is needed, but if it is to be useful it needs to be not only credible but also useful in action. What do we know about different research processes in practice? What conceptions, approaches, methods and actor roles are embedded? What is the effect on practice? How does ‘here and now’ practice challenge research methods? This article is based on the research processes conducted in the institutes of practice research in social work in Finland. It analyses the different approaches applied by elucidating the theoretical standpoints and the critical elements embedded in them, and reflects on the outcomes in and for practice. It highlights the level of change and progression in practice research, arguing for diverse practice research models with a solid theoretical grounding, rigorous research processes, and a supportive infrastructure.

Correlation between dental care utilization and oral cavity cancer in a large sample of community-based United States residents

Cancer of the oral cavity and pharynx remains one of the ten leading causes of cancer death in the United States (US). Besides smoking and alcohol consumption, there are no well established risk factors. While poor dental care had been implicated, it is unknown if the lack of dental care, implying poor dental hygiene predisposes to oral cavity cancer. This study aimed to assess the relationship between dental care utilization during the past twelve months and the prevalence of oral cavity cancer. A cross-sectional design of the National Health Interview Survey of adult, non-institutionalized US residents (n=30,475) was used to assess the association between dental care utilization and self reported diagnosis of oral cavity cancer. Chi square statistic was used to examine the crude association between the predictor variable, dental care utilization and other covariates, while unconditional logistic regression was used to assess the relationship between oral cavity cancer and dental care utilization. There were statistically significant differences between those who utilized dental care during the past twelve months and those who did not with respect to education, income, age, marital status, and gender (p < 0.05), but not health insurance coverage (p = 0.53). Also, those who utilized dental care relative to those who did not were 65% less likely to present with oral cavity cancer, prevalence odds ratio (POR), 0.35, 95% Confidence Interval (CI), 0.12–0.98. Further, higher income advanced age, people of African heritage, and unmarried status were statistically significantly associated with oral cavity cancer, (p < 0.05), but health insurance coverage, alcohol use and smoking were not, p > 0.05. However, after simultaneously controlling for the relevant covariates, the association between dental care and oral cavity cancer did not attenuate nor persist. Thus, compared with those who did not use dental care, those who did wee 62% less likely to present with oral cavity cancer adjusted POR, 0.38, 95% CI, 0.13-1.10. Among US adults residing in community settings, use of dental care during the past twelve months did not significantly reduce the predisposition to oral cavity cancer. However, due to the nature of the data used in this study, which restricts temporal sequence, a large sample prospective study that may identify modifiable factors associated with oral cancer development namely poor dental care, is needed. ^

Development and evaluation of a community based, multiagency course for medical students: descriptive survey

Objective: To develop and evaluate an effective, community based, multiagency course (involving doctors, nurses, non-health statutory workers, and voluntary organisations) for all Leicester medical students, in response to the General Medical Council’s recommendation of preparing the doctors of tomorrow to handle society’s medical problems.

Obtenção de gel mucoadesivo de nistatina para o tratamento da candidíase oral. Desenvolvimento e caracterização de dispersões sólidas de nistatina

A nistatina (NYS) é o fármaco de primeira escolha no tratamento da candidíase oral, que frequentemente acomete mais os indivíduos imunocomprometidos e pacientes com outras desordens (diabetes não tratada, neoplasias, imunodeficiências). No mercado brasileiro, a NYS é encontrada na forma de suspensão oral aquosa, onde o procedimento para sua administração consiste em bochechar o medicamento. Apesar de haver a indicação de que se mantenha o contato direto entre fármaco e a mucosa oral, na qual se encontra a Candida spp., o que aumentaria expressivamente o sucesso terapêutico, a suspensão não apresenta tal propriedade. Assim, a NYS que é fármaco com ação efetiva contra a candidíase oral, é considerada pertencente à Classe IV do Sistema de Classificação Biofarmacêutica, ou seja, apresenta baixa solubilidade e baixa permeabilidade. A baixa solubilidade pode comprometer sua disponibilidade na cavidade oral, e consequentemente, sua ação farmacológica. Diante desse quadro, o objetivo do presente trabalho foi o desenvolvimento de dispersões sólidas de NYS para o tratamento da candidíase oral, e sua posterior incorporação em gel mucoadesivo oral, favorecendo a formulação no local de ação. As dispersões sólidas são sistemas farmacêuticos, onde um fármaco pouco solúvel em água encontra-se dispersado em um carreador, no estado sólido. Os carreadores normalmente são hidrofílicos, o que permite que esses sistemas sejam empregados para aumentar a solubilidade aquosa do fármaco. Assim, foram desenvolvidas as dispersões sólidas de NYS, pelo método de eliminação do solvente, empregando como carreadores, lactose, HPMC, poloxamer 407 e poloxamer 188. Essas foram submetidas à caracterização por análise térmica, usando os ensaios de calorimetria exploratória diferencial (DSC) e termogravimetria/termogravimetria derivada (TG/DTG). Dentre essas dispersões sólidas, aquelas que se mostraram com comportamento térmico sugerindo a formação de um novo \"sistema\", foram analisadas por meio de ensaio de solubilidade. Dessa forma, a formulação NYS DS G2 (49) se destacou, pois apresentou maior solubilidade em água (4,484 mg/mL); em pH 5,5 (4,249 mg/mL) e em pH 7,0 (4,293 mg/mL), ou seja, houve um aumento de 1,426 vezes em água; 4,227 vezes em pH 5,5; e 2,743 vezes em pH 7,0. Essa formulação foi, por fim avaliada por difração de raio-X e espectroscopia de infravermelho com transformada de Fourier, técnicas que corroboraram com a análise térmica quanto à indicação de formação da dispersão sólida. Por sua vez, essa dispersão sólida foi incorporada em 4 bases de géis mucoadesivos de carbopol ® 934 PNF, alterando apenas a concentração do polímero (0,5; 1,0; 1,5; 2,0 %p/p). Foi observado que a liberação de NYS DS G2 (49) foi superior, quando comparada à liberação de NYS MP a partir do gel, e através do ensaio de mucoadesão, percebeu-se que os géis desenvolvidos apresentaram propriedades mucoadesivas compatíveis com relatos na literatura, independentemente da quantidade de carbopol ® empregada. As características reológicas foram distintas, e foi observado que as formulações Gel A e Gel B, que possuem menor quantidade de polímero, tiverem um indicativo de comportamento de fluido newtoniano, diferente dos demais, o que pode não ser desejado para esse tipo de forma farmacêutica tópica e semi-sólida. Ao final desse trabalho, pode-se concluir que foi possível desenvolver um sistema farmacêutico na forma de dispersão sólida com maior solubilidade que a NYS pura, e sua incorporação em uma forma farmacêutica mucoadesiva, e que a liberação da NYS na forma DS foi muito superior que o fármaco na forma \"convencional\", o que permite que a NYS esteja mais disponível na cavidade oral, e também junto à mucosa bucal, o que levaria a efeito farmacológico mais efetivo do antifúngico.

Comparison of Reading Development Across Socioeconomic Status in the United States

It is well known that higher parental socioeconomic status (SES) predicts better child reading outcomes, but little work has been done to unpack this finding. The main overall question addressed by this project was whether cognitive models of the two main reading outcomes, single word reading (SWR) and reading comprehension (RC), performed similarly across levels of parental SES. The current study predicted a differential relation between parental SES and both predictors and outcomes because of the known large relation between parental SES and child oral language development. Three questions examined the mediating effects of cognitive predictors on the relation between parental SES and reading outcomes, the moderating effects of SES on the developmental trajectories of reading outcomes, and the strength of the relationship between SES and the two reading outcomes. Participants were part of two large and comprehensive datasets: the cross-sectional Colorado Learning Disability Research Center (CLDRC; n=1554) sample, and the International Longitudinal Twin Study (ILTS; n=463 twin pairs) sample. In terms of cognitive predictors, the relation between SES and SWR was disproportionately mediated by two language skills, vocabulary (VOC) and phonological awareness (PA). For the RC models, both SWR and oral listening comprehension (OLC) did not disproportionally mediate the relation between RC and SES; however, full mediation was not exhibited. With regard to the trajectory of reading outcomes, SES moderated the starting values of SWR and RC, and the slopes of SWR development. When performance on the control measures of early reading skills (e.g., print knowledge, vocabulary, and decoding skills) was included the models, the moderating effects of SES were completely accounted for by these measures. In terms of outcomes, SES had a stronger relation to RC than to SWR, especially at later ages. These findings have implications for interventions aimed at improving reading outcomes in children from lower SES families.

Development of task performance statements for a new office and business education learnings system (NOBELS)

Bibliography: p. 313-316.

The relevance of prepaid group practice to the effective delivery of health services.

Mode of access: Internet.

The relationship between the use of Academic Text Talk and the comprehension of scientific academic language for diverse second graders

Changing demographics impact our schools as children come from more linguistically and culturally diverse backgrounds. The various social, cultural, and economic backgrounds of the students affect their early language learning experiences which expose them to the academic language needed to succeed in school. Teachers can help students acquire academic language by introducing words that are within their Zone of Proximal Development and increasing exposure to and use of academic language. This study investigated the effects of increasing structured activities for students to orally interact with informational text on their scientific academic language development and comprehension of expository text. ^ The Academic Text Talk activities, designed to scaffold verbalization of new words and ideas, included discussion, retelling, games, and sentence walls. This study also evaluated if there were differences in scientific language proficiency and comprehension between boys and girls, and between English language learners and native English speakers. ^ A quasi-experimental design was used to determine the relationship between increasing students' oral practice with academic language and their academic language proficiency. Second graders (n = 91) from an urban public school participated in two science units over an 8 week period and were pre and post tested using the Woodcock Muñoz Language Survey-Revised and vocabulary tests from the National Energy Education Project. Analysis of covariance was performed on the pre to post scores by treatment group to determine differences in academic language proficiency for students taught using Academic Text Talk compared to students taught using a text-centered method, using the initial Florida Assessment for Instruction in Reading test as a covariate. Students taught using Academic Text Talk multimodal strategies showed significantly greater increases in their pre to posttest means on the Woodcock Muñoz Language Survey-Revised Oral Language Totals and National Energy Education Development Project Vocabulary tests than students taught using the text-centered method, ps < .05. Boys did not show significantly greater increases than girls, nor did English language learners show significantly greater increases than the native English speakers. ^ This study informs the field of reading research by evaluating the effectiveness of a multimodal combination of strategies emphasizing discourse to build academic language.^

Curso online para a parte pral do Celpe-Bras : contribuições da avaliação de proficiência para o ensino-aprendizagem de PLE

Dissertação (mestrado)—Universidade de Brasília, Departamento de Línguas Estrangeiras e Tradução, Programa de Pós-Graduação em Linguística Aplicada, 2016.