Depression among Chinese stroke survivors six months after discharge from a rehabilitation hospital

Aim and objective: The primary aim was to examine the prevalence of poststroke depression in Chinese stroke survivors six months after discharge from a rehabilitation hospital. A second aim was to determine whether six-month poststroke depression was associated with psychological, social and physical outcomes and demographic variables.---------- Background: There has been increasing recognition of the influence of depression on poststroke recovery. While some previous studies report associations between depression and social, psychological, physical and clinical outcomes, few studies had sufficient sample sizes for regression analysis thereby limiting the clinical applicability of their findings. ---------- Design: A cross-sectional design was used.---------- Method: Data were collected from 124 male and 86 female stroke survivors (mean age 71Æ7, SD 10Æ2 years). The Geriatric Depression Scale was used to measure depression, the State Self-esteem Scale to measure state self-esteem, the London Handicap Scale to measure participation restriction, the Social Support Questionnaire to measure satisfaction with social support and the Modified Barthel Index to measure functional ability. Results. Forty-two survivors (20Æ5%) reported mild and 33 (16Æ1%) reported severe depression. The presence of depression was associated with low levels of state self-esteem, social support satisfaction and functional ability. Logistic regression analysis revealed that these variables were statistically significant in predicting the probability of having depression (p < 0Æ05). ---------- Conclusions: Analyses in the present study revealed distinct patterns of correlates of depression, and the results were in agreement with prior studies that depression has a consistent positive ssociation with physical disability, living arrangements and social support and no significant association with the different types of brain lesion. Relevance to clinical practice. There is a need, routinely, to assess stroke survivors for depression and, where necessary, to intervene with the aim of enhancing psychological and social well-being.

Patient education to prevent falls among older hospital inpatients : a randomized controlled trial

Background Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent then. Methods This study was a 3-group randomized trial to evaluate the efficacy of 2 forms of multimedia patient education compared with usual care for the prevention of in-hospital falls. Older hospital patients (n = 1206) admitted to a mixture of acute (orthopedic, respiratory, and medical) and subacute (geriatric and neurorehabilitation) hospital wards at 2 Australian hospitals were recruited between January 2008 and April 2009. The interventions were a multimedia patient education program based on the health-belief model combined with trained health professional follow-up (complete program), multi-media patient education materials alone (materials only), and usual care (control). Falls data were collected by blinded research assistants by reviewing hospital incident reports, hand searching medical records, and conducting weekly patient interviews. Results Rates of falls per 1000 patient-days did not differ significantly between groups (control, 9.27; materials only, 8.61; and complete program, 7.63). However, there was a significant interaction between the intervention and presence of cognitive impairment. Falls were less frequent among cognitively intact patients in the complete program group (4.01 per 1000 patient-days) than among cognitively intact patients in the materials-only group (8.18 per 1000 patient-days) (adjusted hazard ratio, 0.51; 95% confidence interval, 0.28-0.93]) and control group (8.72 per 1000 patient-days) (adjusted hazard ratio, 0.43; 95% confidence interval, 0.24-0.78). Conclusion Multimedia patient education with trained health professional follow-up reduced falls among patients with intact cognitive function admitted to a range of hospital wards.

Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Measuring falls events in acute hospitals-A comparison of three reporting methods to identify missing data in the hospital reporting system

OBJECTIVES: To compare three different methods of falls reporting and examine the characteristics of the data missing from the hospital incident reporting system. DESIGN: Fourteen-month prospective observational study nested within a randomized controlled trial. SETTING: Rehabilitation, stroke, medical, surgical, and orthopedic wards in Perth and Brisbane, Australia. PARTICIPANTS: Fallers (n5153) who were part of a larger trial (1,206 participants, mean age 75.1 � 11.0). MEASUREMENTS: Three falls events reporting measures: participants’ self-report of fall events, fall events reported in participants’ case notes, and falls events reported through the hospital reporting systems. RESULTS: The three reporting systems identified 245 falls events in total. Participants’ case notes captured 226 (92.2%) falls events, hospital incident reporting systems captured 185 (75.5%) falls events, and participant selfreport captured 147 (60.2%) falls events. Falls events were significantly less likely to be recorded in hospital reporting systems when a participant sustained a subsequent fall, (P5.01) or when the fall occurred in the morning shift (P5.01) or afternoon shift (P5.01). CONCLUSION: Falls data missing from hospital incident report systems are not missing completely at random and therefore will introduce bias in some analyses if the factor investigated is related to whether the data ismissing.Multimodal approaches to collecting falls data are preferable to relying on a single source alone.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Virtual communities as tools to support teaching practicum

The impact of Web 2.0 and social networking tools such as virtual communities, on education has been much commented on. The challenge for teachers is to embrace these new social networking tools and apply them to new educational contexts. The increasingly digitally-abled student cohorts and the need for educational applications of Web 2.0 are challenges that overwhelm many educators. This chapter will make three important contributions. Firstly it will explore the characteristics and behaviours of digitally-abled students enrolled in higher education. An innovation of this chapter will be the appli- cation of Bourdieu’s notions of capital, particularly social, cultural and digital capital to understand these characteristics. Secondly, it will present a possible use of a commonly used virtual community, Facebook©. Finally it will offer some advice for educators who are interested in using popular social networking communities, similar to Facebook©, in their teaching and learning.

Using routinely collected hospital data for child maltreatment surveillance : issues, methods and patterns

Background: International data on child maltreatment are largely derived from child protection agencies, and predominantly report only substantiated cases of child maltreatment. This approach underestimates the incidence of maltreatment and makes inter-jurisdictional comparisons difficult. There has been a growing recognition of the importance of health professionals in identifying, documenting and reporting suspected child maltreatment. This study aimed to describe the issues around case identification using coded morbidity data, outline methods for selecting and grouping relevant codes, and illustrate patterns of maltreatment identified. Methods: A comprehensive review of the ICD-10-AM classification system was undertaken, including review of index terms, a free text search of tabular volumes, and a review of coding standards pertaining to child maltreatment coding. Identified codes were further categorised into maltreatment types including physical abuse, sexual abuse, emotional or psychological abuse, and neglect. Using these code groupings, one year of Australian hospitalisation data for children under 18 years of age was examined to quantify the proportion of patients identified and to explore the characteristics of cases assigned maltreatment-related codes. Results: Less than 0.5% of children hospitalised in Australia between 2005 and 2006 had a maltreatment code assigned, almost 4% of children with a principal diagnosis of a mental and behavioural disorder and over 1% of children with an injury or poisoning as the principal diagnosis had a maltreatment code assigned. The patterns of children assigned with definitive T74 codes varied by sex and age group. For males selected as having a maltreatment-related presentation, physical abuse was most commonly coded (62.6% of maltreatment cases) while for females selected as having a maltreatment-related presentation, sexual abuse was the most commonly assigned form of maltreatment (52.9% of maltreatment cases). Conclusion: This study has demonstrated that hospital data could provide valuable information for routine monitoring and surveillance of child maltreatment, even in the absence of population-based linked data sources. With national and international calls for a public health response to child maltreatment, better understanding of, investment in and utilisation of our core national routinely collected data sources will enhance the evidence-base needed to support an appropriate response to children at risk.

Reliability of routinely collected hospital data for child maltreatment surveillance

Background: Internationally, research on child maltreatment-related injuries has been hampered by a lack of available routinely collected health data to identify cases, examine causes, identify risk factors and explore health outcomes. Routinely collected hospital separation data coded using the International Classification of Diseases and Related Health Problems (ICD) system provide an internationally standardised data source for classifying and aggregating diseases, injuries, causes of injuries and related health conditions for statistical purposes. However, there has been limited research to examine the reliability of these data for child maltreatment surveillance purposes. This study examined the reliability of coding of child maltreatment in Queensland, Australia. Methods: A retrospective medical record review and recoding methodology was used to assess the reliability of coding of child maltreatment. A stratified sample of hospitals across Queensland was selected for this study, and a stratified random sample of cases was selected from within those hospitals. Results: In 3.6% of cases the coders disagreed on whether any maltreatment code could be assigned (definite or possible) versus no maltreatment being assigned (unintentional injury), giving a sensitivity of 0.982 and specificity of 0.948. The review of these cases where discrepancies existed revealed that all cases had some indications of risk documented in the records. 15.5% of cases originally assigned a definite or possible maltreatment code, were recoded to a more or less definite strata. In terms of the number and type of maltreatment codes assigned, the auditor assigned a greater number of maltreatment types based on the medical documentation than the original coder assigned (22% of the auditor coded cases had more than one maltreatment type assigned compared to only 6% of the original coded data). The maltreatment types which were the most ‘under-coded’ by the original coder were psychological abuse and neglect. Cases coded with a sexual abuse code showed the highest level of reliability. Conclusion: Given the increasing international attention being given to improving the uniformity of reporting of child-maltreatment related injuries and the emphasis on the better utilisation of routinely collected health data, this study provides an estimate of the reliability of maltreatment-specific ICD-10-AM codes assigned in an inpatient setting.

It really is black and white when you look at it like this : reporting on a study into Australian professors' research and teaching priorities

Despite optimistic claims about the research-teaching nexus, Australian academics still face tension between research and teaching. The teaching and research priorities, beliefs and behaviours of 70 Professorial and Associate Professorial academics in Science, Information Technology and Engineering were examined in this study. The academics from 4 faculties in 3 Australian universities, were asked to rank 16 research activities and 16 matched learning and teaching (L&T) activities from each of three perspectives: job satisfaction, leadership behaviour, and perceptions of professional importance. The findings, which were remarkably consistent across the three universities, were unequivocally in favour of Research. The only L&T activity that was ranked consistently well was “Improving student satisfaction ratings for Teaching”. The data demonstrates that Australian government and university initiatives to raise the status of L&T activity are not impacting significantly on Australia’s future leaders of university learning.

Multivariate Markov Process Models for the transmission of methicillin-resistant Staphylococcus Aureus in a hospital ward

Methicillin-resistant Staphylococcus Aureus (MRSA) is a pathogen that continues to be of major concern in hospitals. We develop models and computational schemes based on observed weekly incidence data to estimate MRSA transmission parameters. We extend the deterministic model of McBryde, Pettitt, and McElwain (2007, Journal of Theoretical Biology 245, 470–481) involving an underlying population of MRSA colonized patients and health-care workers that describes, among other processes, transmission between uncolonized patients and colonized health-care workers and vice versa. We develop new bivariate and trivariate Markov models to include incidence so that estimated transmission rates can be based directly on new colonizations rather than indirectly on prevalence. Imperfect sensitivity of pathogen detection is modeled using a hidden Markov process. The advantages of our approach include (i) a discrete valued assumption for the number of colonized health-care workers, (ii) two transmission parameters can be incorporated into the likelihood, (iii) the likelihood depends on the number of new cases to improve precision of inference, (iv) individual patient records are not required, and (v) the possibility of imperfect detection of colonization is incorporated. We compare our approach with that used by McBryde et al. (2007) based on an approximation that eliminates the health-care workers from the model, uses Markov chain Monte Carlo and individual patient data. We apply these models to MRSA colonization data collected in a small intensive care unit at the Princess Alexandra Hospital, Brisbane, Australia.

Shifting the technology context : career-change entrants’ transition into teaching

Becoming a teacher in technology-rich classrooms is a complex and challenging transition for career-change entrants. Those with generic or specialist Information and Communication Technology (ICT) expertise bring a mindset about purposeful uses of ICT that enrich student learning and school communities. The transition process from a non-education environment is both enhanced and constrained by shifting the technology context of generic or specialist ICT expertise, developed through a former career as well as general life experience. In developing an understanding of the complexity of classrooms and creating a learner centred way of working, perceptions about learners and learning evolve and shift. Shifts in thinking about how ICT expertise supports learners and enhances learning preceded shifts in perceptions about being a teacher, working with colleagues, and functioning in schools that have varying degrees of intensity and impact on evolving professional identities. Current teacher education and school induction programs are seen to be falling short of meeting the needs of career-change entrants and, as a flow on, the students they nurture. Research (see, for example, Tigchelaar, Brouwer, & Korthagen, 2008; Williams & Forgasz, 2009) highlights the value of generic and specialist expertise career-change teachers bring to the profession and draws attention to the challenges such expertise begets (Anthony & Ord, 2008; Priyadharshini & Robinson-Pant, 2003). As such, the study described in this thesis investigated perceptions of career-change entrants, who have generic (Mishra & Koehler, 2006) or specialist expertise, that is, ICT qualifications and work experience in the use of ICT. The career-change entrants‘ perceptions were sought as they shifted the technology context and transitioned into teaching in technology-rich classrooms. The research involved an interpretive analysis of qualitative data and quantitative data. The study used the explanatory case study (Yin, 1994) methodology enriched through grounded theory processes (Strauss & Corbin, 1998), to develop a theory about professional identity transition from the perceptions of the participants in the study. The study provided insights into the expertise and experiences of career change entrants, particularly in relation to how professional identities that include generic and specialist ICT knowledge and expertise were reconfigured while transitioning into the teaching profession. This thesis presents the Professional Identity Transition Theory that encapsulates perceptions about teaching in technology-rich classrooms amongst a selection of the increasing number of career-change entrants. The theory, grounded in the data, (Strauss & Corbin, 1998) proposes that career-change entrants experience transition phases of varying intensity that impact on professional identity, retention and development as a teacher. These phases are linked to a shift in perceptions rather than time as a teacher. Generic and specialist expertise in the use of ICT is a weight of the past and an asset that makes the transition process more challenging for career-change entrants. The study showed that career-change entrants used their experiences and perceptions to develop a way of working in a school community. Their way of working initially had an adaptive orientation focussed on immediate needs as their teaching practice developed. Following a shift of thinking, more generative ways of working focussed on the future emerged to enable continual enhancement and development of practice. Sustaining such learning is a personal, school and systemic challenge for the teaching profession.

Teaching sustainability : vehicle or endpoint?

In 2006, the Faculty of Built Environment and Engineering introduced the first faculty wide unit dedicated to sustainability at any Australian University. BEB200 Introducing Sustainability has semester enrolments of up to 1500 students. Instruments such as lectures, readings, field visits, group projects and structured tutorial activities are used and have evolved over the last five years in response to student and staff feedback and attempts to better engage students. More than seventy staff have taught in the unit, which is in its final offering in this form in 2010. This paper reflects on the experiences of five academics who have played key roles in the development and teaching of this unit over the last five years. They argue that sustainability is a paradigm that allows students to explore other ways of knowing as they engage with issues in a complex world, not an end in itself. From the students’ perspective, grappling with such issues enables them to move towards a context in which they can understand their own discipline and its role in the contradictory and rapidly changing professional world. Insights are offered into how sustainability units may be developed in the future.

Experiencing higher degree research supervision as teaching

This article describes research higher degree supervisors’ experiences of supervision as a teaching and learning practice. While research education is considered central to the HDR experience, comparatively little is known to date of the pedagogical lenses adopted by supervisors as they go about their supervision. We worked with 35 supervisors engaged in discipline-specific and interdisciplinary research across architectural design, science, engineering, computer science, information systems and librarianship. Several of these supervisors conducted projects which interfaced with the social sciences and humanities. The pedagogies, constructed through the discussions and phenomenographic analysis, offer a picture of supervisors’ collective awareness of supervision as a teaching and learning practice. Supervision as a teaching and learning practice was experienced as: Promoting the supervisor’s development, Imparting academic expertise, Upholding academic standards, Promoting learning to research, Drawing upon student expertise, Enabling student development, Venturing into unexplored territory, Forming productive communities, and Contributing to society.

High-challenge teaching for senior English as an Additional Language (EAL) learners in times of change

This paper will present a brief overview of the recent shifts within English and EAL/D (English as an additional language/dialect) curriculum documents and their focus on critical literacy, using the Queensland context as a case in point. The English syllabus landscape in Queensland has continued to morph in recent years. From 2002 to 2009, teachers of senior English and English as an Additional Language (EAL/D) have witnessed no less than four separate syllabus documents that impact on their daily work. The Australian Curriculum, when finally implemented, will also require teachers to navigate and grapple with its particular obligations and affordances. The combined effect of the shifts and tensions between recent policy documents has led to confusion about exactly how to cater for EAL/D learners in mainstream English. We discuss the possible effects of this on teachers as the agents of policy implementation and argue that in spite of such contradictions, EAL/D teachers can productively use syllabus frameworks to craft pedagogy to cater for their EAL/D learners’ language and literacy needs. Following this, we present aspects of the teaching practice of four teachers of senior EAL/D, who provide intellectually-engaging, critical literacy pedagogy that takes into account the language proficiency level of their learners, within the required curriculum. Such practice provides teachers with valuable pedagogic possibilities to meet EAL/D learners’ needs within continually varying policy terrain.

Integrating a sustainable academic career around scholarly learning and teaching activities

To be scholarly in learning and teaching is rigorous academic work. It demands: currency and command of both discipline subject matter and educational theory; inquiring, methodical, and reflective approaches; the collection, evaluation and documentation of evidence of learning and teaching efficacy; and, optimally, entails participation in and communication among a community of teaching professionals. This chapter examines the author’s own practice in this regard to explicate the ‘how’ and ‘why’ of scholarly and scholarship approaches, as much as the ‘what’ and ‘where’ of that endeavour. In doing so, this meta‐analysis is made ‘community property’, in the same way that Shulman (1993: 6) exhorted we ‘change the status of teaching from private to community property’ so that teaching might be more greatly valued in the academy.