Is simulation training effective in increasing podiatrists' confidence in foot ulcer management?

Background: Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or “part task” (for example, practicing ingrown toenail procedures on models). This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants’ clinical confidence in the management of foot ulcers. Methods: Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST) course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer), and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor) with a model foot ulcer). The primary outcome measure of the course was participants’ pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient). Participants’ knowledge, satisfaction and their perception of the relevance and fidelity (realism) of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson’s r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p < 0.05 was used. Results: An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p < 0.05). The lack of an overall significant change in knowledge scores reflected the participant populations’ high baseline knowledge and pre-requisite completion of web-based modules. Satisfaction, relevance and fidelity of all course elements were rated highly. Conclusions: This pilot study suggests simulation training programs can improve participants’ clinical confidence in the management of foot ulcers. The approach has the potential to enhance clinical training in diabetes-related foot complications and chronic wounds in general.

PMI Research and Education Conference 2010

The PMI Research and Education Conference 2010 ended one week ago at the time of this writing. Aside from 3 enlightening keynote speeches, 78 proffered papers were presented. On the basis of the reviewers' assessments, the 10 best papers have been selected to form this special issue...

Making sense of mass education

Making Sense of Mass Education provides a comprehensive analysis of the field of mass education. The book presents new assessment of traditional issues associated with education – class, race, gender, discrimination and equity –to dispel myths and assumptions about the classroom. It examines the complex relationship between the media, popular culture and schooling, and places the expectations surrounding the modern teacher within ethical, legal and historical contexts. The book blurs some of the disciplinary boundaries within the field of education, drawing upon sociology, cultural studies, history, philosophy, ethics and jurisprudence to provide stronger analyses. The book reframes the sociology of education as a complex mosaic of cultural practices, forces and innovations. Engaging and contemporary, it is an invaluable resource for teacher education students, and anyone interested in a better understanding of mass education.

Transport injury risks in Queensland adolescents of Pacific Islander descent

Ethnicity is rarely considered in the development of injury prevention programs, despite its known impact on participation in risk behaviour. This study sought to understand engagement in transport related risk behaviours, patterns of injury and perceptions of risk among early adolescents who self-identify as being from a Pacific Islander background. In total 5 high schools throughout Queensland, Australia were recruited, of which 498 Year 9 students (13-14 years) completed questionnaires relating to their perceptions of risk and recent injury experience (specifically those transport behaviours that were medically treated and those that were not medically treated). The transport related risk behaviours captured in the survey were bicycle use, motorcycle use and passenger safety (riding with a drink driver and riding with a dangerous driver). The results are explored in terms of the prevalence of engagement in risky transport related behaviour among adolescents’ of Pacific Islander background compared to others of the same age. The results of this study provide an initial insight into the target participants’ perspective of risk in a road safety context as well as their experience of such behaviour and related injuries. This information may benefit future intervention programs specific to adolescents’ of Pacific Islander background.

Finding your research voice : the application of bibliometrics as an analytic literature tool on the pedagogic field of higher education

This paper documents the use of bibliometrics as a methodology to bring forth a structured, systematic and rigorous way to analyse and evaluate a range of literature. When starting out and reading broadly for my doctoral studies, one article by Trigwell and Prosser (1996b) led me to reflect about my level of comprehension as the content, concepts and methodology did not resonate with my epistemology. A disconnection between our paradigms emerged. Further reading unveiled the work by Doyle (1987) who categorised research in teaching and teacher education by three main areas: teacher characteristics, methods research and teacher behaviour. My growing concerns that there were gaps in the knowledge also exposed the difficulties in documenting said gaps. As an early researcher who required support to locate myself in the field and to find my research voice, I identified bibliometrics (Budd, 1988; Yeoh & Kaur, 2007) as an appropriate methodology to add value and rigour in three ways. Firstly, the application of bibliometrics to analyse articles is systematic, builds a picture from the characteristics of the literature, and offers a way to elicit themes within the categories. Secondly, by systematic analysis there is occasion to identify gaps within the body of work, limitations in methodology or areas in need of further research. Finally, extension and adaptation of the bibliometrics methodology, beyond citation or content analysis, to investigate the merit of methodology, participants and instruments as a determinant for research worth allowed the researcher to build confidence and contribute new knowledge to the field. Therefore, this paper frames research in the pedagogic field of Higher Education through teacher characteristics, methods research and teacher behaviour, visually represents the literature analysis and locates my research self within methods research. Through my research voice I will present the bibliometrics methodology, the outcomes and document the landscape of pedagogy in the field of Higher Education.

Evaluation of the quality of diverse teaching practice in higher education research methods

The purpose of this paper is to report on a methods research project investigating the evaluation of diverse teaching practice in Higher Education. The research method is a single site case study of an Australian university with data collected through published documents, surveys, interviews and focus groups. This project provides evidence of the wide variety of evaluation practice and diverse teaching practice across the university. This breadth identifies the need for greater flexibility of evaluation processes, tools and support to assist teaching staff to evaluate their diverse teaching practice. The employment opportunities for academics benchmark the university nationally and position the case study in the field. Finally this reaffirms the institutional responsibility for services to support teaching staff in an ongoing manner.

The pedagogical balancing act : teaching reflection in higher education

Despite the common use of the term reflection in higher education assessment tasks, learners are not often taught how to communicate their disciplinary knowledge through reflection. This paper argues that students can and should be taught how to reflect in deep and transformative ways. It highlights the reflexive pedagogical balancing act of attending to different levels of reflection as a way to stimulate focused, thoughtful and reasoned reflections that show evidence of new ways of thinking and doing. The paper uses data from a current project to illustrate the effects of focusing on particular levels of reflection in the pedagogical strategies used, and argues that while the goal of academic or professional reflection is generally to move students to the highest level of reflection to transform their learning/practice, unless higher education teachers attend to every level of reflection, there are specific, observable gaps in the reflections that students produce.

Behavioural beliefs concerning gender and high-risk sexual behaviours in the context of HIV/AIDS in PNG : views from within teacher education

Education is often viewed as a key approach to address sexual-health issues; the current concern is the burgeoning HIV/AIDS epidemic. This ethnographic study investigates the gender practices associated with high-risk sexual behaviour in Papua New Guinea as viewed by educators there. A number of practices, including gender inequality and associated sexual behaviours have been highlighted by male and female participants as escalating PNG’s HIV/AIDS epidemic. The study finds that although participants were well-informed concerning HIV/AIDS, they had varying beliefs concerning the prevailing gender/sexual issues involved in escalating highrisk behaviour and how to address the problem. The study further examines the behavioural beliefs and intentions of the educators themselves. Subsequently, within the data a number of underpinning factors, pertaining to gender, education and life experience, were found to be related to the behaviour beliefs and intentions of participants towards embracing change with regard to behaviours associated with gender equality in PNG. These factors appeared to encourage participants to adopt healthier gender and sexual behavioural intentions and, arguably, could provide the basis for ways to help address the gender inequality and high-risk behaviours associated with HIV/AIDS in PNG.

Factors affecting the motivation of TEFL academics in higher education in China

This study investigates the motivation of English language lecturers in a Chinese university. Recent studies have shown that low morale and job dissatisfaction are significant problems identified in lecturers who teach English in universities in China. Given the importance of teaching English as a second language in China, this problem has potentially significant ramifications for the nation’s future. Low staff morale is likely to be associated with less effective teaching and poor student learning outcomes. Although the problem is acknowledged, there has been limited research to understand the underlying contributing factors. To address this, a sequential explanatory mixed methods approach was adopted and implemented in two phases at a large regional university in Northern China. The participants in the main study were 100 lecturers from two colleges at this university. All of the lecturers were responsible for teaching English as a foreign language (TEFL); 50 were teaching English majors and 50 were teaching university students whose majors were not English. The research was informed by a synthesis of self determination theory and theories of organisational culture. The study found: 1) in contrast to previously reported studies, lecturers in this institution were in general autonomously motivated in teaching. 2) However, their level of motivation was influenced by their personal experiences and varied sense of competence, relatedness and autonomy. 3) In particular, personal experiences and contextual factors such as the influence of Chinese culture, societal context, and organisational climate were significant in regulating lecturers’ motivation to teach. The findings are significant for leaders in higher education who need to implement policies that foster effective work environments. The study has also provided insights into the capacity of self determination theory to explain motivation in a Chinese culture.

Ecological footprinting : its potential as a tool for change in preservice teacher education

Environmental and sustainability issues pose challenges for society. Although education is seen as being a contributor to addressing sustainability, teacher education has been slow to act in preparing future teachers to teach sustainability. Recent Australian curriculum documents nominate sustainability as one of three cross-curriculum priorities. In one Australian university course, an Ecological Footprint Calculator tool has been employed to challenge preservice early childhood teachers to consider the sustainability of their lifestyles as a means for engaging them in learning and teaching for sustainability. Students enrolled in an integrated arts and humanities subject voluntarily engaged with the online calculator and shared their findings on an electronic discussion forum. These postings then became the basis of qualitative analysis and discussion. Data categories included reactions and reflections on reasons for the ‘heaviness’ of their footprints , student reactions leading to actions to reduce their footprints, reflections on the implications of the footprint results for future teaching, reactions that considered the need for societal change, and reflections on the integration of sustainability with the visual arts. The power of the tool’s application to stimulate interest in sustainability and education for sustainability more broadly in teacher education is explored.

Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer : results from a randomised controlled trial

AIM: To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. METHODS: Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6 weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. RESULTS: The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107 min, and median length of hospital stay was 2 and 5 days in the TLH and TAH group, respectively (p<0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006). CONCLUSIONS: Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.

Knee extensor strength differences in obese and healthy-weight 10-13 year olds

The purpose of this study was to investigate if obese children have reduced knee extensor (KE) strength and to explore the relationship between adiposity and KE strength. An observational case-control study was conducted in three Australian states, recruiting obese [n=107 (51 female, 56 male)] and healthy-weight [n=132 (56 female, 76 male)] 10–13 year old children. Body mass index, body composition (dual energy X-ray absorptiometry), isokinetic/isometric peak KE torques (dynamometry) and physical activity (accelerometry) were assessed. Results revealed that compared with their healthy-weight peers, obese children had higher absolute KE torques (P≤0.005), equivocal KE torques when allometrically normalized for fat-free mass (FFM) (P≥0.448) but lower relative KE torques when allometrically normalized for body mass (P≤0.008). Adjustments for maternal education, income and accelerometry had little impact on group differences, except for isometric KE torques relative to body mass which were no longer significantly lower in obese children (P≥0.013, not significant after controlling for multiple comparisons). Percent body fat was inversely related to KE torques relative to body mass (r= -0.22 to -0.35, P≤0.002), irrespective of maternal education, income or accelerometry. In conclusion, while obese children have higher absolute KE strength and FFM, they have less functional KE strength (relative to mass) available for weight-bearing activities than healthy-weight children. The finding that FFM-normalized KE torques did not differ suggests that the intrinsic contractile properties of the KE muscles are unaffected by obesity. Future research is needed to see if deficits in KE strength relative to mass translate into functional limitations in weight-bearing activities.

Encouraging, assisting and time to EAT : improved nutritional intake for older medical patients receiving Protected Mealtimes and/or additional nursing feeding assistance

Background & Aims: Inadequate feeding assistance and mealtime interruptions during hospitalisation may contribute to malnutrition and poor nutritional intake in older people. This study aimed to implement and compare three interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. Methods: Pre-post study compared three mealtime assistance interventions: PM: Protected Mealtimes with multidisciplinary education; AIN: additional assistant-in-nursing (AIN) with dedicated meal role; PM+AIN: combined intervention. Dietary intake of 254 patients (pre: n=115, post: n=141; mean age 80±8) was visually estimated on a single day in the first week of hospitalisation and compared with estimated energy requirements. Assistance activities were observed and recorded. Results: Mealtime assistance levels significantly increased in all interventions (p<0.01). Post-intervention participants were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. Conclusions: Protected Mealtimes and additional AIN assistance (implemented alone or in combination) may produce modest improvements in nutritional intake. Targeted feeding assistance for certain patient groups holds promise; however, alternative strategies are required to address the complex problem of malnutrition in this population.

A prospective study of pregnancy weight gain in Australian women

Background: While weight gain during pregnancy is regarded as important, there has not been a prospective study of measured weight gain in pregnancy in Australia. This study aimed to prospectively evaluate pregnancy-related weight gain against the Institute of Medicine (IOM) recommendations in women receiving antenatal care in a setting where ongoing weight monitoring is not part of routine clinical practice, to describe women's knowledge of weight gain recommendations and to describe the health professional advice received relating to gestational weight gain (GWG). Methods: Pregnant women were recruited ≤20 weeks of gestation (n = 664) from a tertiary obstetric hospital between August 2010 to July 2011 for this prospective observational study. Outcome measures were weight gain from pre-pregnancy to 36 weeks of gestation, weight gain knowledge and health professional advice received. Results: Thirty-six percent of women gained weight according to guidelines. Twenty-six percent gained inadequate weight, and 38% gained excess weight. Fifty-six percent of overweight women gained weight in excess of the IOM guidelines compared with 30% of those who started with a healthy weight (P < 0.001). At 16 weeks, 47% of participants were unsure of the weight gain recommendations for them. Sixty-two percent of women reported that the health professionals caring for them during this pregnancy ‘never’ or ‘rarely’ offered advice about how much weight to gain. Conclusions: The prevalence of inappropriate gestational weight gain in this study was high. The majority of women do not know their recommended weight gain. The advice women received from health professionals relating to healthy weight gain in pregnancy could be improved.