Using a clinical pathway and education to reduce inappropriate prescribing of enoxaparin in patients with acute coronary syndromes: a controlled study

Aims: To evaluate efficacy of a pathway-based quality improvement intervention on appropriate prescribing of the low molecular weight heparin, enoxaparin, in patients with varying risk categories of acute coronary syndrome (ACS). Methods: Rates of enoxaparin use retrospectively evaluated before and after pathway implementation at an intervention hospital were compared to concurrent control patients at a control hospital; both were community hospitals in south-east Queensland. The study population was a group of randomly selected patients (n = 439) admitted to study hospitals with a discharge diagnosis of chest pain, angina, or myocardial infarction, and stratified into high, intermediate, low-risk ACS or non-cardiac chest pain: 146 intervention patients (September-November 2003), 147 historical controls (August-December 2001) at the intervention hospital; 146 concurrent controls (September-November 2003) at the control hospital. Interventions were active implementation of a user-modified clinical pathway coupled with an iterative education programme to medical staff versus passive distribution of a similar pathway without user modification or targeted education. Outcome measures were rates of appropriate enoxaparin use in high-risk ACS patients and rates of inappropriate use in intermediate and low-risk patients. Results: Appropriate use of enoxaparin in high-risk ACS patients was above 90% in all patient groups. Inappropriate use of enoxaparin was significantly reduced as a result of pathway use in intermediate risk (9% intervention patients vs 75% historical controls vs 45% concurrent controls) and low-risk patients (9% vs 62% vs 41%; P < 0.001 for all comparisons). Pathway use was associated with a 3.5-fold (95% CI: 1.3-9.1; P = 0.012) increase in appropriate use of enoxaparin across all patient groups. Conclusion: Active implementation of an acute chest pain pathway combined with continuous education reduced inappropriate use of enoxaparin in patients presenting with intermediate or low-risk ACS.

Measurement of community beliefs about colorectal cancer

Few educational campaigns have focused on bowel cancer, though studies have indicated that members of the community need and want current information about relevant issues. In order to facilitate research in this area, reliable and valid measures of community attitudes are needed. Content validity of a survey instrument was obtained through use of a Delphi process with Directors of Education from the Australia Cancer Council and focus group discussions with informed members of the public. The subsequent survey of community perceptions about colorectal cancer included a broad range of content areas related to the risk of bowel cancer, preventing and coping with bowel cancer and beliefs about susceptibility and severity. The construct validity of these content areas was investigated by use of a factor analysis and confirmation of an association with related predictor variables. Two measures related to personal influence and anticipated coping responses showed favourable psychometric properties, including moderate to high levels of internal consistency and test-retest reliability. A test of the concurrent validity of these measures requires further development of instruments related to colorectal cancer or adaptation of measures from other areas of health research. (C) 2000 Elsevier Science Ltd. All rights reserved.

Online conference case study: Creating a comfort zone within an emerging community of practice

This paper outlines the context and theoretical basis for the design, implementation and evaluation of an online conference conducted in 2003. The purpose of the conference was to provide postgraduate distance learners with an opportunity to interact with human factors and healthcare professionals, thereby providing them with exposure to this emerging community of practice. The conference was delivered through a WebCT site and stimulated various modes of interaction. The paper discusses the design and format of the conference and details an analysis of the online transcript that shows development of learning communities as “comfort zones” within which the participants could communicate in a common language and atmosphere of understanding over the 2 days that the conference ran.

Sustainable design practitioners: Why they must be at the centre of discussions on sustainable design education

Sustainable design education is vital for engineering students. This is to allow them to meet the challenges both engineering and the wider community will face in the future. This need has not only been mandated by Engineers Australia’s graduate attributes from an Australian perspective, but more widely the issue of sustainability is one of the greatest challenges humanity has ever faced. Engineers need to be at the forefront of this challenge, because we can not only do the greatest good, but have the potential to cause the greatest harm. The biggest question with respect to the education of engineers about sustainable design is what do engineers need to know, and how best to enable this learning. This paper argues that since the entire phenomenon of sustainable design is constantly growing and changing, it is only by looking at practitioners currently trying design sustainably, and their ways of experiencing sustainable design, can we hope to articulate what it is, and therefore what and how we need to teach engineering students. It also argues that to accommodate sustainable design within engineering, we need to go further and transform the engineering profession to enable it to meet the challenges that sustainability presents. © 2005, Australasian Association for Engineering Education