Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus.

BACKGROUND: Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature. METHODS: The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations. RESULTS: In the German S3 and other Western guidelines, adenocarcinomas of the esophagogastric junction (AEG) are classified according to formerly defined AEG I-III subgroups due to the high surgical impact. To stage local disease, computed tomography of the chest and abdomen and endosonography are reinforced. In contrast, laparoscopy is optional for staging. Mucosal cancers (T1a) should be endoscopically resected "en-bloc" to allow complete histological evaluation of lateral and basal margins. For locally advanced cancers of the stomach or esophagogastric junction (≥T3N+), preferred treatment is preoperative and postoperative chemotherapy. Preoperative radiochemotherapy is an evidence-based alternative for large AEG type I-II tumors (≥T3N+). Additionally, some experts recommend treating T2 tumors with a similar approach, mainly because pretherapeutic staging is often considered to be unreliable. CONCLUSIONS: The German S3 guideline represents an up-to-date European position with regard to diagnosis, staging, and treatment recommendations for patients with locally advanced esophagogastric cancer. Effects of perioperative chemotherapy versus chemoradiotherapy are still to be investigated for adenocarcinoma of the cardia and the lower esophagus.

On-line teaching and Copyright : Any Hopes for an EU Harmonized Playground?

Education never fails to be mentioned ¿ and, often, mentioned first ¿ as a public interest that justifies an exception to copyright. Educational purposes were already present in the first version of the Berne Convention of 18862 and have remained there (although in revised language) ever since. The WIPO Copyright Treaty of 19963 expressly referred to education in its Preamble, when ¿Recognizing the need to maintain a balance between the rights of authors andthe larger public interest, particularly education, research and access to information, as reflected in the Berne Convention¿ (emphasis added). And morerecently, the EU Directive on Copyright in the Information Society4 stressed its goal ¿to promote learning and culture by protecting works and other subjectmatter while permitting exceptions or limitations in the public interest for the purpose of education and teaching¿ (Recital 14, emphasis added).

Expectations and Experiences of International Students in Information Technology Department

Education in Finland plays a significant role. International students are becoming an essential part of Finnish Educational system. The study was meant to examine their expectations and experiences in a Finnish University. As a case, Lappeenranta University of Technology (LUT) was chosen and, in particular, Information Technology (IT) Department. The main objectives of the study were to examine students’ satisfaction of their study experiences, their evaluation of the teaching quality of courses and last but not least the cultural impact on those. Data for the study were mainly collected with the help of three Internet surveys from a sample of 50 students – currently studying at LUT or already graduated. Response rate from questionnaire to questionnaire varied, however, still close to average and was considered as good and relevant enough. The study was initially meant as qualitative, however, a number of quantitative data analysis methods were used as well. Most of students’ expectations appear to become true, majority of students are satisfied with their experiences. Results show that teaching quality in LUT is evaluated as ‘good’. Nevertheless, students prefer particular courses to the other ones. In conclusion, it can be said that culture does affect students’ expectations, experiences, perception of the world, however, cultural differences do not cause any serious problems.

Quality enhancement in teacher education : Tanzanian teacher educators’ conceptions and experiences

The overall aim of this study was to investigate and examine teacher educators’ conceptions and experiences of quality of teacher education. The research interest therefore was two-fold: a) to deepen understanding of the concept quality and b) scrutinize experiences of teacher educators of quality enhancement. To achieve this ambition the study was conducted in the context of a newly established university college-based teacher education in Tanzania. Two research questions guided the study. The first focused on investigating how teacher educators conceived quality in the domain of teacher education and the second intended to explore teacher educators’ experiences of quality enhancement. The theoretical framework of the study centered on the concepts of teacher education, quality, and criteria for quality enhancement. Phenomenographic and phenomenological approaches under the main umbrella of qualitative research design were selected. Twenty five teacher educators participated in the study. Interviews were used for the collection of the data. The results of the first research question, in brief, indicate that teacher educators’ conceptions of quality are expressed in two main categories, namely, outstanding academic scholarship and adequate professional scholarship. Quality as outstanding academic scholarship was illustrated by two subcategories: excellence and positive transformation. While the former was composed of two aspects, the latter was demonstrated by three aspects. Quality as adequate professional scholarship was described in three sub-categories. The first was improved teaching competency, consisting of two aspects. The second was conscious research orientation, which is displayed by three aspects, and the last was enhancing the ability to reflect, represented by two aspects. The results of the second research question, which focused on exploring teacher educators’ experience of quality enhancement, were classified into two main categories of description: insufficient programs of teacher education and unsatisfactory professional development of teacher educators. From the two categories, the strengths, weaknesses, opportunities and challenges related to programs of educating teachers, particularly curriculum development and implementation, and the professional development of educators, were exposed. Since the ambition of conducting the study was to deepen the understanding by producing insight that would act as a platform for appraising and enhancing the quality of teacher education, the results hopefully can be used for the development of the quality of teacher education in Tanzania.

TA tales : [re]storying the teaching and learning experiences of university teaching assistants

This inquiry examines reported critical incidents that shaped the lived experience of 5 university TAs as they negotiated multiple roles and relationships within the teaching and learning context. Questions and ensuing conversations explore the ways in which these critical incidents in teaching contributed to the TAs' understanding of themselves as teachers, of teaching and learning tensions in higher education, and of the institutional contexts in which they work. The inquiry also explores the ways in which narrative, particularly creative fiction, can represent the stories TAs tell of their experiences.

Ontological beliefs and their impact on teaching elementary geometry. 'Creencias ontológicas y su impacto en la enseñanza de la geometría elemental'.

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Modelling the likely impact of healthy eating guidelines on agricultural production and land use in England and Wales

Quadratic programming techniques were applied to household food consumption data in England and Wales to estimate likely changes in diet under healthy eating guidelines, and the consequences this would have on agriculture and land use in England and Wales. The first step entailed imposing nutrient restrictions on food consumption following dietary recommendations suggested by the UK Department of Health. The resulting diet was used, in a second step as a proxy for demand in agricultural commodities, to test the impact of such a scenario on food production and land use in England and Wales and the impacts of this on agricultural landscapes. Results of the diet optimisation indicated a large drop in consumption of foods rich in saturated fats and sugar, essentially cheese and sugar-based products, along with lesser cuts of fat and meat products. Conversely, consumption of fruit and vegetables, cereals, and flour would increase to meet dietary fibre recommendations. Such a shift in demand would dramatically affect production patterns: the financial net margin of England and Wales agriculture would rise, due to increased production of high market value and high economic margin crops. Some regions would, however, be negatively affected, mostly those dependent on beef cattle and sheep production that could not benefit from an increased demand for cereals and horticultural crops. The effects of these changes would also be felt in upstream industries, such as animal feed suppliers. While arable dominated landscapes would be little affected, pastoral landscapes would suffer through loss of grazing management and, possibly, land abandonment, especially in upland areas.

The status of literature: English teaching and the condition of literature teaching in schools

Although the curriculum subject of English is continually reviewed and revised in all English speaking countries, the status of literature is rarely questioned i.e. that it is of high cultural value and all students should be taught about it. The concerns of any review, in any country, are typically about what counts as literature, especially in terms of national heritage and then how much of the curriculum should it occupy. This article reports on three inter-related pieces of research that examine the views of in-service, and pre-service, English teachers about their experiences of teaching literature and their perceptions of its ‘status’ and significance at official level and in the actual classroom; it draws attention to how England compares to some other English speaking countries and draws attention to the need to learn from the negative outcomes of political policy in England. The findings suggest that the nature of engagement with literature for teachers and their students has been distorted by official rhetorics and assessment regimes and that English teachers are deeply concerned to reverse this pattern.

Boundaries and Bridges: the influence of James Cooksey Culwick on the development of the teaching and learning of music in nineteenth century Ireland

James Cooksey Culwick (1845-1907) was born in England. Trained as chorister and organist in Lichfield Cathedral, he moved to Ireland at twenty- one and remained until his death in 1907. Although his reputation as scholar, musician and teacher was acknowledged widely during his lifetime - he received an honorary doctorate from University of Dublin (1893) - little is known about the contribution he made to music education. This paper addresses this gap in the literature and argues that it was Culwick's singular achievement to pay attention to music pedagogy at secondary level, by recognizing that music could be seen as a serious career option for girls, and by providing resources for teachers which emphasised the development of an 'art-feeling' in pupils of all abilities. In addition, he considered Irish music as an art which had significance as music first, and Irish music second, and advocated a 'laudable tolerance' for opposing views on matters of cultural identity to Ireland at the end of the nineteenth century.

It is always on your mind: experiences and perceptions of falling of older people and their carers and the potential of a mobile falls detection device

Background. Falls and fear of falling present a major risk to older people as both can affect their quality of life and independence. Mobile assistive technologies (AT) fall detection devices may maximise the potential for older people to live independently for as long as possible within their own homes by facilitating early detection of falls. Aims. To explore the experiences and perceptions of older people and their carers as to the potential of a mobile falls detection AT device. Methods. Nine focus groups with 47 participants including both older people with a range of health conditions and their carers. Interviews were audio recorded, transcribed verbatim, and thematically analysed. Results. Four key themes were identified relating to participants’ experiences and perceptions of falling and the potential impact of a mobile falls detector: cause of falling, falling as everyday vulnerability, the environmental context of falling, and regaining confidence and independence by having a mobile falls detector. Conclusion. The perceived benefits of a mobile falls detector may differ between older people and their carers. The experience of falling has to be taken into account when designing mobile assistive technology devices as these may influence perceptions of such devices and how older people utilise them.