Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study

Objective: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. Methods: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. Results: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. Conclusion: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. Implications: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

Mielikuvat transformatiivisen oppimisen välineenä : Tutkimus mielikuvaoppimisesta luontevan esiintymistavan löytämiseksi

The research focus of this study is imagery-based learning aimed at discovering an authentic way of public speaking in the context of transformative learning. The experiences of the participants in this learning process were also a subject of study. This learning process consisted of both guided and independent imagery-based training techniques. Critical reflection plays an important role in transformative learning. Actions, and interpretations and assumptions guiding them, are recognised and subjected to critical reflection. The goal of the learning process is an authentic and wide meaning perspective. Imagery-based training benefits from the gap between the new and the old experience of public speaking, and this is utilised as an activating factor for learning. The study is qualitative, looking at the imagery learning process and its outcomes from the subjective viewpoint of the participants personal experience. The imagery training acted as an intervention in the process of learning authentic public performance. The number of participants in this study was ten, five men and five women from four different working backgrounds. There were 80 individual training sessions, each attended by one person. The author conducted the imagery-based training. For each participant the learning process took roughly nine months. The research data consisted in the answers to questions in writing, diary entries, interviews and researcher notes. The data gathered by these methods was compiled into a personal report for each participant. The learners perceived authentic public speaking performance at the end of the learning process as wider, more flexible and more genuine than at the start of the training. Authenticity was defined through an internal process of becoming aware instead of some external characteristics. The learners understood the process of imagery learning as training for public performance and as an opportunity to become familiar with one s own personal way of acting and with one s own attitudes. They also perceived it as a tool that enabled the observation of personal experiences from different points of view. The learners reflected on ways of acting related to public speaking as well as on contributing factors to performance anxiety during the imagery learning process. Towards the end of the learning process, even critical reflection took place. The learners were categorized into three groups according to differences in their learning processes: the participants, the actors and the critical reflectors. This grouping reflected the relative amount of transformation in their learning processes. The participants became aware of their actions and assumptions. They took part in guided training sessions only. Worries in private life also had some consequences to their training in imagery learning. Apart from than becoming more conscious, the learning process did not yield much difference to the public speaking experiences of the participants. The actors attended both guided imagery training sessions and did individual training on their own. They became aware of their assumptions and their ways of acting. The encounter of the new and the old way of acting stimulated their learning. The actors advanced towards their own goals or even achieved them. The critical reflectors recognised their own assumptions and ways of acting and started to reflect critically on their own attitudes, as well as external attitudes and interpretations. Their assumptions, interpretations and experiences of public performance started to change in a positive direction. The learning process of the critical reflectors was functioning as a transformative process. This learning process revealed old assumptions hindering learning and old ways of acting resulting from these assumptions, thus opening up an opportunity for critical reflection and transformation. Avainsanat Nyckelord imagery learning, imagery-based training, transformative learning, reflection, critical reflection, public speaking anxiety, authentic public performance

Auditory - Visual Matching in Learning Disabilities : Intervention Studies from Finland and Sweden

The present thesis discusses relevant issues in education: 1) learning disabilities including the role of comorbidity in LDs, and 2) the use of research-based interventions. This thesis consists of a series of four studies (three articles), which deepens the knowledge of the field of special education. Intervention studies (N=242) aimed to examine whether training using a nonverbal auditory-visual matching computer program had a remedial effect in different learning disabilities, such as developmental dyslexia, Attention Deficit Disorder (ADD) and Specific Language Impairment (SLI). These studies were conducted in both Finland and Sweden. The intervention’s non-verbal character made an international perspective possible. The results of the intervention studies confirmed, that the auditory-visual matching computer program, called Audilex had positive intervention effects. In Study I of children with developmental dyslexia there were also improvements in reading skills, specifically in reading nonsense words and reading speed. These improvements in tasks, which are thought to rely on phonological processing, suggest that such reading difficulties in dyslexia may stem in part from more basic perceptual difficulties, including those required to manage the visual and auditory components of the decoding task. In Study II the intervention had a positive effect on children with dyslexia; older students with dyslexia and surprisingly, students with ADD also benefited from this intervention. In conclusion, the role of comorbidity was apparent. An intervention effect was evident also in students’ school behavior. Study III showed that children with SLI experience difficulties very similar to those of children with dyslexia in auditory-visual matching. Children with language-based learning disabilities, such as dyslexia and SLI benefited from the auditory-visual matching intervention. Also comorbidity was evident among these children; in addition to formal diagnoses, comorbidity was explored with an assessment inventory, which was developed for this thesis. Interestingly, an overview of the data of this thesis shows positive intervention effects in all studies despite learning disability, language, gender or age. These findings have been described by a concept inter-modal transpose. Self-evidently these issues need further studies. In learning disabilities the aim in the future will also be to identify individuals at risk rather than by deficit; this aim can be achieved by using research-based interventions, intensified support in general education and inclusive special education. Keywords: learning disabilities, developmental dyslexia, attention deficit disorder, specific language impairment, language-based learning disabilities, comorbidity, auditory-visual matching, research-based interventions, inter-modal transpose

Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community

Objective: To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT). Methods: A community-based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits – guaiac (Hemoccult-ll) or immunochemical (Inform) – was assigned by general practice and mailed to participants (3,358 patients aged 50–74 years listed with the local practices). Results: Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% Cl 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% Cl 1.2-1.7), and people in their 60s were less likely to participate than those 70–74 years (OR=0.8, 95% Cl 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% Cl 28.1–48.6) for !nform and 40.0% (95% Cl 16.8–68.7) for Hemoccult-ll. Colonoscopy follow-up was 94.8% with a medical complication rate of 2–3%. Conclusions: An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false-positive rates, and both test types resulted in a high yield of neoplasia. Implications: In addition to type of FOBT, the ultimate success of a population-based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow-up.

Studio portrait of Uncle Loeb Portraits Men

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Portrait of young Hans Frankenbach seated at a desk Portraits Men

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Portrait of Surgeon Major Dr. Meyer of Dueren (Rhineland) in military uniform Portraits Men

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Portrait of Surgeon Major Dr. Bing of Nuernberg in his military uniform Portraits Men

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Alfred Falk outdoors feeding a dog Portraits Men

Handwritten on verso: fuer Hans Frankenbach

Fenja Rost with two unidentified men on a horse drawn cart working on a farm Portraits Groups

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Studio portrait of Uncle M? and Uncle Isak (seated); Cairo, Illinois Portraits Groups Men

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Kurt Hirschfeld seated in his study Portraits Men

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Kurt Hirschfeld (left) speaking with Thomas Mann Portraits Groups Men

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Paul Blum calling card with photograph Portraits Men

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