Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

Can less be more? Comparison of an 8-item placement quality measure with the 50-item Dundee Ready Educational Environment Measure (DREEM)

Clinical clerks learn more than they are taught and not all they learn can be measured. As a result, curriculum leaders evaluate clinical educational environments. The quantitative Dundee Ready Environment Measure (DREEM) is a de facto standard for that purpose. Its 50 items and 5 subscales were developed by consensus. Reasoning that an instrument would perform best if it were underpinned by a clearly conceptualized link between environment and learning as well as psychometric evidence, we developed the mixed methods Manchester Clinical Placement Index (MCPI), eliminated redundant items, and published validity evidence for its 8 item and 2 subscale structure. Here, we set out to compare MCPI with DREEM. 104 students on full-time clinical placements completed both measures three times during a single academic year. There was good agreement and at least as good discrimination between placements with the smaller MCPI. Total MCPI scores and the mean score of its 5-item learning environment subscale allowed ten raters to distinguish between the quality of educational environments. Twenty raters were needed for the 3-item MCPI training subscale and the DREEM scale and its subscales. MCPI compares favourably with DREEM in that one-sixth the number of items perform at least as well psychometrically, it provides formative free text data, and it is founded on the widely shared assumption that communities of practice make good learning environments.

Paving the way for the use of the SDQ in economic evaluations of school-based population health interventions: an empirical analysis of the external validity of SDQ mapping algorithms to the CHU9D in an educational setting

Purpose
The Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening tool for children. The SDQ is increasingly used as the primary outcome measure in population health interventions involving children, but it is not preference based; therefore, its role in allocative economic evaluation is limited. The Child Health Utility 9D (CHU9D) is a generic preference-based health-related quality of-life measure. This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms. The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions.
Methods
Data were available from children participating in a cluster randomised controlled trial of the school-based roots of empathy programme in Northern Ireland. Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms. t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms.
Results
Mean (standard deviation) SDQ total difficulties and prosocial scores were 12 (3.2) and 8.3 (2.1). Utility values obtained from the original tariff, alternative tariff, and mapping algorithms using five and three SDQ subscales were 0.84 (0.11), 0.80 (0.13), 0.84 (0.05), and 0.83 (0.04), respectively. Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm.
Conclusion
Initial evidence suggests the SDQ and CHU9D are related in some of their measurement properties. The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility. Future research valuing changes in the SDQ scores would contribute to this research.

The impact of an educational DVD on pregnant women with gestational diabetes mellitus: a randomised controlled trial

Background The diagnosis of gestational diabetes (GDM) during pregnancy can lead to anxiety. Little research has focused on the education these women receive and how this is best delivered in a busy clinic. Aim This study evaluated the impact of an innovative patient-centred educational DVD on anxiety and glycaemic control and in newly diagnosed women with GDM. Method 150 multi-ethnic women, aged 19-44 years, from three UK hospitals were randomised to either standard care plus DVD (DVD group, n=77) or standard care alone (control group, n=73) at GDM diagnosis. Women were followed up at their next clinic visit at a mean ± SD of 2.5 ± 1.6 weeks later. Primary outcomes were anxiety (State-Trait Anxiety Inventory) and mean 1-hour postprandial capillary self-monitored blood glucose for all meals, on day prior to follow-up. Secondary outcomes included pregnancy specific stress (Pregnancy Distress Questionnaire), emotional adjustment to diabetes (Appraisal of Diabetes Scale), self-efficacy (Diabetes Empowerment Scale) and GDM knowledge (non-validated questionnaire). Other outcomes included mean fasting and 1-hour postprandial blood glucose at each meal, on day prior to follow-up. Women in the DVD group completed a feedback questionnaire on the resource. Results No significant difference between the DVD and control group were reported, for anxiety (37.7 ± 11.7 vs 36.2 ± 10.9; mean difference after adjustment for covariates (95%CI) 2.5 (-0.8, 5.9) or for mean 1-hour postprandial glucose (6.9 ± 0.9 vs 7.0 ± 1.2 mmol/L; -0.2 (-0.5, 0.2). Similarly, no significant differences in the other psychosocial variables were identified between the groups. However, the DVD group had significantly lower postprandial breakfast glucose compared to the control group (6.8 ± 1.2 vs 7.4 ± 1.9 mmol/L; -0.5 (-1.1, -<0.1; p=0.04). Using a scale of 0-10, 84% rated the DVD 7 or above for usefulness (10 being very useful), and 88% rated it 7 or above when asked if they would recommend to a friend (10 being very strongly recommend). Women described the DVD as ‘reassuring’, ‘a fantastic tool’, that ‘provided a lot of information in a quick and easy way’ and ‘helped reinforce all the information from clinic’. Discussion While no significant change was observed in anxiety or mean postprandial glucose, the DVD was rated highly by women with GDM and may be a useful resource to assist with educating newly diagnosed women. This project is supported by BRIDGES, an IDF programme supported by an educational grant from Lilly Diabetes.

Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial

Objective: To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia. Design: Cluster randomized, investigator masked, controlled trial.Setting 252 primary schools in two prefectures in western China, 2012-13. Participants: 3177 of 19 934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.Interventions Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class. Main outcome measures: Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations. Results: Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, −0.04 to 0.09) or family wealth (0.01, −0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect. Conclusions: The provision of free glasses to Chinese children with myopia improves children’s performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting. Trial Registration: Current Controlled Trials ISRCTN03252665.

Ophthalmology. 2011 Dec;118(12):2343-50. doi: 10.1016/j.ophtha.2011.06.016. Epub 2011 Sep 1. Randomized, controlled trial of an educational intervention to promote spectacle use in rural China: the see well to learn well study.

OBJECTIVE: To test an educational intervention promoting the purchase of spectacles among Chinese children. DESIGN: Randomized, controlled trial. PARTICIPANTS: Children in years 1 and 2 of all 20 junior and senior high schools (ages 12-17 years) in 3 rural townships in Guangdong, China. METHODS: Children underwent visual acuity (VA) testing, and parents of participants with presenting VA worse than 6/12 in either eye improving by more than 2 lines with cycloplegic refraction were recommended to purchase glasses. Children at 10 randomly selected schools received a lecture, video, and classroom demonstration promoting spectacle purchase. MAIN OUTCOME MEASURES: Self-reported purchase of spectacles (primary outcome) and observed wear or possession of newly purchased glasses (secondary outcome) at follow-up examinations (mean, 219 ± 87 days after the baseline visit). RESULTS: Among 15 404 eligible children, examinations were completed for 6379 (74.6%) at intervention schools and 5044 (73.6%) at control schools. Spectacles were recommended for 2236 (35.1%) children at intervention schools and for 2212 (43.9%) at control schools. Of these, 417 (25.7%) intervention schools children and 537 (34.0%, P = 0.45) control schools children reported buying glasses. Predictors of purchase in regression models included female gender (P = 0.02), worse uncorrected VA (P < 0.001), and higher absolute value of refractive error (P = 0.001). Neither the rate of self-reported purchase of glasses or observed wear or possession of newly purchased glasses differed between control schools and intervention schools in mixed-effect logistic regression models. Among children not purchasing glasses, 21.7% had better-eye VA of worse than 6/18. CONCLUSIONS: An intervention based on extensive pilot testing and focus groups in the area failed to promote spectacle purchase or wear. The high burden of remaining uncorrected poor vision underscores the need to develop better interventions. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Allocating Participants to Groups In Educational Trials: What Does Random Mean?

What is meant by the term random? Do we understand how to identify which type of randomisation to use in our future research projects? We, as researchers, often explain randomisation to potential research participants as being a 50/50 chance of selection to either an intervention or control group, akin to drawing numbers out of a hat. Is this an accurate explanation? And are all methods of randomisation equal? This paper aims to guide the researcher through the different techniques used to randomise participants with examples of how they can be used in educational research.

School's out forever: Postsecondary educational trajectories of students with autism

Objective:Postsecondary educational attainment is the key for successful transition to adulthood, economic self-sufficiency, and good mental and physical health.Method:Secondary analyses of school leavers’ data were carried out to establish postsecondary educational trajectories of students on the autism spectrum in the United Kingdom.Results:Findings show that students with autism who had attended mainstream secondary schools enter Further Education (post-16 vocational training) and Higher Education (University) institutions at a similar rate to other students to study the full range ofsubjects on offer. However, they are more likely to be younger, study at a lower academic level, and remain living at home.Conclusion:While course completion data were not yet available, attainment data showed that prospects were improving, although more needs to be done to enable these young adults to a achieving their post secondary educational potential.

Implications of divergences in Adult Protection legislation

Purpose – The purpose of this paper is to explore the similarities and differences of legal responses to older adults who may be at risk of harm or abuse in the UK, Ireland, Australia and the USA.
Design/methodology/approach – The authors draw upon a review of elder abuse and adult protection undertaken on behalf of the commissioner for older people in Northern Ireland. This paper focusses on the desk top mapping of the different legal approaches and draws upon wider literature to frame the discussion of the relative strengths and weaknesses of the different legal responses.
Findings – Arguments exist both for and against each legal approach. Differences in defining the scope and powers of adult protection legislation in the UK and internationally are highlighted.
Research limitations/implications – This review was undertaken in late 2013; while the authors have updated the mapping to take account of subsequent changes, some statutory guidance is not yet available. While the expertise of a group of experienced professionals in the field of adult safeguarding was utilized,
it was not feasible to employ a formal survey or consensus model.
Practical implications – Some countries have already introduced APL and others are considering doing so. The potential advantages and challenges of introducing APL are highlighted.
Social implications – The introduction of legislation may give professionals increased powers to prevent and reduce abuse of adults, but this would also change the dynamic of relationships within families and between families and professionals.
Originality/value – This paper provides an accessible discussion of APL across the UK and internationally
which to date has been lacking from the literature.

Respostas curriculares e educativas disponibilizadas entre 1997 e 2007 às crianças com síndrome de X Frágil, no Concelho de Alandroal

Com a realização deste trabalho pretendemos apurar as Respostas Curriculares e Educativas disponibilizadas entre 1997 e 2007 às crianças com síndrome X Frágil, no concelho de Alandroal. Foi privilegiada uma abordagem metodológica qualitativa, que recorre à análise de conteúdos de documentos presentes nos processos dos cinco alunos sinalizados e também a actas dos conselhos de docentes e de turma. Depois de analisados os resultados, constatou-se que o tipo de respostas curriculares e/ou educativas mais utilizadas para esta população, assentou numa dimensão predominantemente pedagógica, mas também se salientam as dimensões terapêutica e curricular. Para tal, registou-se o recurso a espaços físicos, à legislação, a recursos didácticos e humanos, bem como a parcerias que se estabeleceram dentro e fora do concelho do Alandroal. As estratégias mais utilizadas para cada aluno em particular mereceram também a nossa atenção; ABSTRACT: The aim of this study was to find out the "curricular/educational" responses that were in-place to meet the needs of the students with Fragile X syndrome, in the Alandroal’s county, between 1997/2007. A qualitative methodological approach has been preferred, consisting on the analysis of the documents present in the student’s individual processes (which have been referred for special education) and also in some minutes of the teacher’s council meetings and class council. Results have shown that the most used response within this population was mainly connected to the pedagogic dimension, but also it was also based on the therapeutic and curricular dimensions. So, it has been used resources related to physical spaces, legislation, human and didactic, as well as to partnerships inside and outside Alandroal’s county. Specific strategies used on particular students did also have our special attention.

A biblioteca escolar/centro de recursos educativos e o currículo - que (inter)ligação?: o caso de Vendas Novas

Este trabalho de investigação centra-se na importância do conhecimento da inter (ligação) entre a Biblioteca Escolar/Centro de Recursos Educativos e o currículo. A problemática da investigação é lançada pela questão que constitui o ponto de partida deste trabalho: “ De que forma é que a Biblioteca Escolar/Centro de Recursos Educativos interage com o Currículo como um recurso do processo de ensino-aprendizagem? “ Tendo como base esta problemática, o corpo da dissertação é constituída por duas panes. A primeira respeitante ao quadro teórico e a segunda referente ao estudo empírico. No quadro teórico procedemos a uma aproximação conceptual à problemática em estudo. Tecemos considerações acerca da evolução da biblioteca escolar, conhecendo igualmente os princípios e as formas de atuar do Programa Rede de Bibliotecas Escolares e a principal legislação sobre este assunto. Refletimos acerca do currículo do ensino pré-escolar e do 1° ciclo do ensino básico, níveis com os quais realizámos a componente empírica do trabalho, identificando a Biblioteca Escolar/Centro de Recursos Educativos como constituindo um recurso fundamental no processo de ensino aprendizagem, no contexto da diferenciação curricular, chamando igualmente a atenção para a importância das parcerias no âmbito da articulação entre o ambiente educacional e o território. A dimensão empírica da pesquisa envolveu a conceção e a testagem de instrumentos de recolha de dados, nomeadamente a análise documental, a observação direta em contexto de Biblioteca Escolar, a realização de entrevistas semi-directivas e a aplicação de um inquérito por questionário aos alunos do 1° ciclo do ensino básico. O conhecimento produzido permitiu-nos responder à problemática objetivada no início da investigação, evidenciando que a Biblioteca Escolar/Centro de Recursos Educativos interage com o Currículo como um recurso do processo de ensino aprendizagem, constituindo-se como um centro de motivação da comunidade educativa que potencia um conjunto de aprendizagens das quais se destacam a leitura e a escrita e as atividades de pesquisa, através da metodologia de projeto. A BE/CRE complementa e enriquece o trabalho da sala de aula, quer ao nível das áreas curriculares disciplinares, quer ao nível das áreas curriculares não disciplinares. Com base nas conclusões resultantes da investigação empírica, terminámos com a formulação de algumas sugestões e recomendações que a evolução do estudo nos foi aconselhando. /ABSTRACT - This research work focuses the importance of the school library/educational resource centre and its connection with the school curriculum. The research was focussed on the following question: “How can the school library/educational resource Centre interact with the curriculum as a teaching resource?” Based on this question, the dissertation includes two distinctive parts. The former concerns the theoretical framework and the latter the empirical study case. As far as the theoretical framework is concerned, we have studied the conceptual facts and drew some major conclusions about the evolution of the school library, taking into account the rules and proceedings of the School Library Network Programme and the legislation on the issue. We went through the curriculum of the kindergarten and the primary school on which we developed our study case. The school library/educational resource centre was, therefore, identified as a fundamental resource in the learning/teaching process for the curricula differentiation. We also emphasized the importance of partnerships to enhance the articulation between the educational environment and school territory. The empirical research included both the conception and the testing of some important data collecting techniques, namely the documentary analysis, direct observation in a School Library, half-directed interviews and a questionnaire which was answered by primary school students. The knowledge acquired allowed us to find possible answers for the question we have asked at the beginning of our research. We can conclude that the School Library/Educational Resource Centre does interact with the curriculum as motivation to improve the process of learning, such as reading and writing, of the educational community. The project work also gains a new perspective as the school library/educational resource centre enriches and complements the classroom work both on the curriculum subjects and non- subject curricular areas. Based on the conclusions we drew from our study case, we make suggestions and recommendations for further research.

A cartografia educacional de um território como factor enriquecedor da oferta educativa: O caso do agrupamento de escolas nº 4 de Évora

A presente dissertação teve como linha de rumo a questão de partida: De que forma é que a existência de ambientes de aprendizagem não formal e informal no território/comunidade pode enquadrar e reforçar as aprendizagens formais e a relação com a escola? Através duma abordagem teórica que inclui uma revisão bibliográfica e a análise de normativos legais que abordam e regulamentam a área em que decorre o nosso estudo, procurámos dar resposta aos seguintes objectivos: a) efectuar a cartografia institucional do território educativo do Agrupamento de Escolas nº4 de Évora; b) conhecer o potencial educativo existente nas associações e instituições localizadas no território; c) identificar instituições que possibilitem novas ofertas educativas e possam promover e potenciar o sucesso educativo, d) avaliar a oferta local de ambientes de aprendizagem e a sua disponibilidade para a promoção de parcerias educativas. Ao nível do estudo empírico e como forma de dar resposta às questões da investigação, optámos por uma metodologia mista (quantitativa/qualitativa), numa aproximação conceptual ao estudo de caso, tendo recorrido ao inquérito por questionário, aplicado como técnica de recolha de dados. Após a apresentação dos dados disponíveis, sua análise e interpretação, apurámos as seguintes conclusões: a) as instituições objecto do nosso estudo constituem um recurso do qual este Agrupamento não pode prescindir para a prossecução da sua acção educativa; b) estas instituições desenvolvem no seu seio uma considerável quantidade de actividades que envolvem aprendizagens; c) estas instituições estão receptivas à promoção de parcerias com o Agrupamento; d) estas instituições, pela área de actividade desenvolvida e pelo desenvolvimento de actividades com aprendizagem, podem potenciar novas ofertas educativas; e) estão reunidas as condições, nesta comunidade educativa, para a construção duma Carta Educativa de Agrupamento envolvendo todos os ambientes de aprendizagem disponíveis. No final da nossa dissertação expressámos as recomendações e sugestões que possam potenciar futuras investigações ABSTRACT; The following dissertation had, has a basis, the starting question (How can the existence of formal and informal environments in the territory/community regulate and reinforce the formal apprenticeships and the relationship with the school?). Through a theoretical approach and bibliographical and an analysis of legislation concerning to the area of our study we have tried to answer to the following objectives: a) create an institutional map of the educative territory of 4th Group of Schools of Évora) understand the educational potential of the institutions and associations in the territory; c) identify the institutions that may offer new educational offers that promote and may increase the educational success and d) evaluate the local offer of apprenticeship environments and their willingness to promote educational partnerships. ln terms of empirical study and as a way to answer the questions of our investigation we have opted to use a mixed quantitative/qualitative methodology in a conceptual approach to the case study having used a survey by questionnaire which was used as a technique for data collection. After the presentation of the available data, we have analyzed and interpreted it and got to the following conclusions: a) the institutions that we have studied are a resource that our Group of Schools must use to fulfill its educational action; b) these institutions create inside themselves a considerable amount of activities that involve apprenticeships; c) these institutions are receptive to the creation of partnerships with the group; d) these institutions may create new educational offers because of their activity area and their development of apprenticeship activities; e) there are conditions, in this educational community for the creation of a real Educational Chart for the 4th Group of Schools concerning all the learning environments. At the end of our dissertation we express our recommendations and suggestions that may help in future investigations