Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Strategies to engage engineering students in group project work

Project focused group work is significant in developing social and personal skills as well as extending the ability to identify, formulate and solve engineering problems. As a result of increasing undergraduate class sizes, along with the requirement for many students to work part-time, group projects, peer and collaborative learning are seen as a fundamental part of engineering education. Group formation, connection to learning objectives and fairness of assessment has been widely reported as major issues that leave students dissatisfied with group project based units. Several strategies were trialled including a study of formation of groups by different methods across two engineering disciplines over the past 2 years. Other strategies involved a more structured approach to assessment practices of civil and electrical engineering disciplines design units. A confidential online teamwork management tool was used to collect and collate student self and peer assessment ratings and used for both formative feedback as well as assessment purposes. Student satisfaction and overall academic results in these subjects have improved since the introduction of these interventions. Both student and staff feedback highlight this approach as enhancing student engagement and satisfaction, improved student understanding of group roles, reducing number of dysfunctional groups whilst requiring less commitment of academic resources.

Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

Interest from Tertiary Educated Persons in Fostering Children with Higher Care needs under a Professional (Paid) Model Compared with General Foster Care

The number of Australian children requiring foster care due to abuse and neglect is increasing at a faster rate than suitable carers can be recruited. Currently increased numbers of foster children are presenting with higher care needs. Evidence suggests carers with a higher education could contribute to placement stability and ultimately provide more positive outcomes for this group of children. This paper explores the level of interest by tertiary educated persons toward a model of fostering for children with higher needs. Using a descriptive survey methodology, a convenience sample of 644 university undergraduate and postgraduate students within faculties of health sciences, and education, arts and social sciences was employed. Psychology students in the 17-26 year old age group showed greatest interest in a professional foster care model and this was statistically significant (p=0.002 955 CI .000-.010) when compared to other health professionals and other age groups. Education students held the highest interest in general fostering although not statistically significant. When these survey results were extrapolated to the total number of health professionals in Australia there could be 8,385 potential recruits for a model professional foster care. Focused campaigns are required to source professional as recruits to fostering with the benefit of servicing the placement needs of higher care needs children and contributing to general foster care resources.

Developing reflective practitioners online: The business of blogs in work integrated learning

Reflective practice is widely considered across discussions around educational psychology, professional identity, employability of graduates, and generic or graduate capabilities. Critical reflection is essential for providing a bridge between the university and the workplace, and for ultimately preparing work ready graduates (Patrick et al, 2008). Work integrated learning, particularly through internships and work placements for students, is viewed as a valuable approach for students developing skills in reflective practice. Reflective journals are one of the tools often used to encourage and develop student reflection. Shifting the reflective journal to an online interface as a reflective blog presents opportunities for more meaningful, frequent and richer interaction between the key players in a work integrated learning experience. This paper examines the adoption, implementation and refinement of the use of reflective blogs in a work integrated learning unit for business students majoring in advertising, marketing and public relations disciplines. The reflective blog is discussed as a learning and assessment tool, including the approaches taken to integrate and scaffold the blog as part of the work integrated learning experience. Graduate capabilities were used as cornerstones for students to frame students’ thinking, experiences and reflection. These capabilities emphasise the value of coherent theoretical and practical knowledge, coupled with critical, creative and analytical thinking, problem solving skills, self reliance and resilience. Underlying these graduate capabilities is a focus on assessment for learning matched with assessment of learning. Using specific triggers and prompts as part of the reflective process, and incorporating ongoing feedback from academic supervisors, students moved from descriptive levels of reflection, to more meaningful and critical reflection. Students’ blogs are analysed to identify key themes, challenges and achievements in the work integrated learning experience. Suggestions for further development and improvement, together with a model of best practice, are proposed.

Overcoming challenges to collaboration: Nurse educators’ experiences in curriculum change

This article describes challenges to effective collaboration encountered by nurse educators as they transformed a unit within a school of nursing in Taiwan. This study introduced collaborative action research as a vehicle for curriculum change. Although the team achieved positive outcomes in transforming a unit, the collaborative process was complex with four major challenges: meaning, time, work culture, and conflicting views. This article provides an overview of the study, and the major challenges posed by working together are expounded and illustrated with excerpts drawn from the study data. Possible reasons for the challenges, how these challenges were overcome, and facilitation of the collaborative process are discussed.

Measurement of affect during simulation-based training

Training designed to support and strengthen higher-order mental abilities now often involves immersion in Virtual Reality where dangerous real world scenarios can be safely replicated. However despite the growing popularity of advanced training simulations, methods for evaluating their use rely heavily on subjective measures or analysis of final outcomes. Without dynamic, objective performance measures the outcome of training in terms of impact on cognitive skills and ability to transfer newly acquired skills to the real world is unknown. The relationship between affective intensity and cognitive learning provides a potential new approach to ensure the processing of cognitions which occur prior to final outcomes, such as problem-solving and decision-making, are adequately evaluated. This paper describes the technical aspects of pilot work recently undertaken to develop a new measurement tool designed to objectively track individual affect levels during simulation-based training.

Conceptual models of satisfaction level in construction

It is recognized that, in general, the performance of construction projects does not meet optimal expectations. One aspect of this is the performance of each participant, which is interdependent and makes a significance impact on overall project outcomes. Of these, the client is traditionally the owner of the project, the architect or engineer is engaged as the lead designer and a contractor is selected to construct the facilities. Generally, the performance of the participants is gauged by considering three main factors, namely time, cost and quality. As the level of satisfaction is a subjective measurement, it is rarely used in the performance evaluation of construction work. Recently, various approaches to the measurement of satisfaction have been made in attempting to determine the performance of construction project outcomes – for instance client satisfaction, consultant satisfaction, contractor satisfaction, customer satisfaction and home buyer satisfaction. These not only identify the performance of the construction project, but are also used to improve and maintain relationships. In addition, these assessments are necessary for continuous improvement and enhanced cooperation between participants. The measurement of satisfaction levels primarily involves expectations and perceptions. An expectation can be regarded as a comparison standard of different needs, motives and beliefs, while a perception is a subjective interpretation that is influenced by moods, experiences and values. This suggests that the disparity between perceptions and expectations may be used to represent different levels of satisfaction. However, this concept is rather new and in need of further investigation. This paper examines the current methods commonly practiced in measuring satisfaction level and the advantages of promoting these methods. The results provided are a preliminary review of the advantages of satisfaction measurement in the construction industry and recommendations are made concerning the most appropriate methods for use in identifying the performance of project outcomes.

Assessing the leanness in product design : a model for planned design reuse

Shrinking product lifecycles, tough international competition, swiftly changing technologies, ever increasing customer quality expectation and demanding high variety options are some of the forces that drive next generation of development processes. To overcome these challenges, design cost and development time of product has to be reduced as well as quality to be improved. Design reuse is considered one of the lean strategies to win the race in this competitive environment. design reuse can reduce the product development time, product development cost as well as number of defects which will ultimately influence the product performance in cost, time and quality. However, it has been found that no or little work has been carried out for quantifying the effectiveness of design reuse in product development performance such as design cost, development time and quality. Therefore, in this study we propose a systematic design reuse based product design framework and developed a design leanness index (DLI) as a measure of effectiveness of design reuse. The DLI is a representative measure of reuse effectiveness in cost, development time and quality. Through this index, a clear relationship between reuse measure and product development performance metrics has been established. Finally, a cost based model has been developed to maximise the design leanness index for a product within the given set of constraints achieving leanness in design process.

The social work & human services workforce : report from a national study of education, training and workforce needs

This report analyses the national curriculum and workforce needs of the social work and human services workforce. Australia’s community and health services are among the fastest growing sectors of employment in the nation but the sustainability of an appropriately qualified workforce is threatened. Yet there is little integration of education and workforce planning for the community services sector. This contrasts markedly with the health services sector, where key stakeholders are collaboratively addressing workforce challenges. Our research confirmed rapid growth in the social work and human services workforce and it also identified: • an undersupply of professionally qualified social work and human service practitioners to meet workforce demand; • the rapid ageing of the workforce with many workers approaching retirement; • limited career and salary structures creating disincentives to retention; • a highly diverse qualification base across the workforce. This diversity is inconsistent with the specialist knowledge and skills required of practitioners in many domains of community service provision. Our study revealed a lack of co-ordination across VET and higher education to meet the educational needs of the social work and human services workforce. Our analysis identified: • strong representation of equity groups in social work and related human service programs, although further participation of these groups is still needed; • the absence of clear articulation pathways between VET and higher education programs due the absence of co-ordination and planning between these sectors; • substantial variation in the content of the diverse range of social work and human service programs, with accredited programs conforming to national standards and some others in social and behavioural sciences lacking any external validation; • financial obstacles and disincentives to social work and human service practitioners in achieving postgraduate level qualifications. We recommend that: • DEEWR identify accredited social work and human services courses as a national education priority (similar to education and nursing). This will help ensure the supply of professional workers to this sector; • VET and higher education providers are encouraged to collaboratively develop clear and accessible educational pathways across the educational sectors; • DEEWR undertake a national workforce analysis and planning processes in collaboration with CSDMAC, and all social and community services stakeholders, to ensure workforce sustainability; and • COAG develop a national regulation framework for the social and community services workforce. This would provide sound accountability systems, and rigorous practice and educational standards necessary for quality service provision. It will also ensure much needed public confidence in this workforce.

Assessment of the influence of cultural barriers to HDR supervision of non-English speaking background (NESD) students in engineering and information technology (IT) disciplines

The paper details the results of the first phase of an on-going research into the sociocultural factors that influence the supervision of higher degrees research (HDR) engineering students in the Faculty of Built Environment and Engineering (BEE) and Faculty of Science and Technology (FaST) at Queensland University of Technology. A quantitative analysis was performed on the results from an online survey that was administered to 179 engineering students. The study reveals that cultural barriers impact their progression and developing confidence in their research programs. We argue that in order to assist international and non-English speaking background (NESB) research students to triumph over such culturally embedded challenges in engineering research, it is important for supervisors to understand this cohort's unique pedagogical needs and develop intercultural sensitivity in their pedagogical practice in postgraduate research supervision. To facilitate this, the governing body (Office of Research) can play a vital role in not only creating the required support structures but also their uniform implementation across the board.

An intelligent data mining technique for product quality improvement

Advances in data mining have provided techniques for automatically discovering underlying knowledge and extracting useful information from large volumes of data. Data mining offers tools for quick discovery of relationships, patterns and knowledge in large complex databases. Application of data mining to manufacturing is relatively limited mainly because of complexity of manufacturing data. Growing self organizing map (GSOM) algorithm has been proven to be an efficient algorithm to analyze unsupervised DNA data. However, it produced unsatisfactory clustering when used on some large manufacturing data. In this paper a data mining methodology has been proposed using a GSOM tool which was developed using a modified GSOM algorithm. The proposed method is used to generate clusters for good and faulty products from a manufacturing dataset. The clustering quality (CQ) measure proposed in the paper is used to evaluate the performance of the cluster maps. The paper also proposed an automatic identification of variables to find the most probable causative factor(s) that discriminate between good and faulty product by quickly examining the historical manufacturing data. The proposed method offers the manufacturers to smoothen the production flow and improve the quality of the products. Simulation results on small and large manufacturing data show the effectiveness of the proposed method.

Finding the remote: Immersive learning in an outback community

Real-world design education projects present particular challenges when in a place remote from and distinctively different to students’ familiar territory. The teaching challenge is to assist students to translate the skills they learn at university into an entirely new context, facilitating a project they will learn from, and the community will value. In 2008 QUT design and engineering students undertook a project called Linking Karumba for this remote Queensland town. They engaged with a landscape, climate and community dramatically different from their base in urban Brisbane, and in a fortnight produced locally responsive strategic planning options. The theoretical approach to this was twofold: they needed to make a rapid shift along a continuum from being “outsiders” towards becoming “insiders” (Relph 1976), and to create designs responsive to local distinctiveness (Cumberlidge and Musgrave 2007). This paper outlines Linking Karumba’s teaching strategy via an analogy with the “immersion” method in bilingual education. Three teaching methods were adopted. Firstly, the overall framework drew on Brockbank and McGill (1998), and Thomas’ (2006a) approaches to student reflective practice. Within this, Girot’s “Four Trace Concepts” (1999) inspired exercises for finding Karumba and moving toward insideness; and a program of community engagement sought immersion in local distinctiveness, and “conversation” between the differing forms of knowledge and capacities embedded within the community and students (Armstrong 1999, Thomas 2006). The responsiveness of the student work to the character of Karumba’s culture and environment indicated remarkable levels of immersion, and the community highly valued the project outcomes: four strategic planning options which attracted $830 000 in state government funding for implementation.

Reference bias : presentation of extreme health states prior to EQ-VAS improves health-related quality of life scores. A randomised crossover trial.

Background: Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as healthrelated quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS) and whether consideration of good and poor health state descriptors immediately changes their selfreport. Methods: A randomised crossover trial was implemented amongst hospitalised older adults (n = 151). Patients were asked to consider descriptions of extremely good (Description-A) and poor (Description-B) health states. The EQ-VAS was administered as a self-report at baseline, after the first descriptors (A or B), then again after the remaining descriptors (B or A respectively). At baseline patients were also asked if they had considered either EQVAS anchors. Results: Overall 106/151 (70%) participants changed their self-evaluation by ≥5 points on the 100 point VAS, with a mean (SD) change of +4.5 (12) points (p < 0.001). A total of 74/151 (49%) participants did not consider the best health VAS anchor, of the 77 who did 59 (77%) thought the good health descriptors were more extreme (better) then they had previously considered. Similarly 85/151 (66%) participants did not consider the worst health anchor of the 66 who did 63 (95%) thought the poor health descriptors were more extreme (worse) then they had previously considered. Conclusions: Health state self-reports may not be well considered. An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring. Caution should be exercised in research and clinical settings when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning. Trial Registration: Australian and New Zealand Clinical Trials Registry (#ACTRN12607000606482) http://www.anzctr. org.au

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.