Validity and reliability of instruments designed to measure factors influencing the overuse of antibiotics

Background: Antibiotic overuse is a global public health issue that is influenced by several factors. The degree and prevalence of antibiotic overuse is difficult to measure directly. A more practical approach, such as the use of a psycho-social measurement instrument, might allow for the observation and assessment of patterns of antibiotic use. Study objective: The aim of this paper is to review the nature, validity, and reliability of measurement scales designed to measure factors associated with antibiotic misuse/overuse. Design: This study is descriptive and includes a systematic integration of the measurement scales used in the literature to measure factors associated with antibiotic misuse/overuse. The review included 70 international scientific publications from 1992 to 2010. Main results: Studies have presented scales to measure antibiotic misuse. However, the workup of these instruments is often not mentioned, or the scales are used with only early-phase validation, such as content or face validity. Other studies have discussed the reliability of these scales. However, the full validation process has not been discussed in any of the reviewed measurement scales. Conclusion: A reliable, fully validated measurement scale must be developed to assess the factors associated with the overuse of antibiotics. Identifying these factors will help to minimize the misuse of antibiotics.

New evaluation methodologies for public art programs in cultural instiutions

I put my abstract in for this conference back in March, based on some evaluation work I had been doing in 2010 with my colleague Professor Greg Hearn for the 3C Regional Writing NeoGreography Project. I had been swapping notes with a colleague from the Smithsonian’s Centre for Folklife and Cultural Heritage about their evaluation work, and stuck inside during the rains of January, I decided to apply for a Qld Smithsonian fellowship based on the quandary of evaluation-particular in public histories (oral histories) and digital storytelling. In July I was awarded the fellowship, so I have tweaked my presentation to talk about what we hope to do with this collaboration, to propel the importance placed on evaluation in public arts programs in Qld and beyond.

Saying sorry in the 21st century : public apologies in a digital world

The public apology to the Forgotten Australians in late 2009 was, for many, the culmination of a long campaign for recognition and justice. The groundswell for this apology was built through a series of submissions which documented the systemic institutionalised abuse and neglect experienced by the Forgotten Australians that has resulted, for some, in life-long disadvantage and marginalisation. Interestingly it seems that rather than the official documents being the catalyst for change and prompting this public apology, it was more often the personal stories of the Forgotten Australians that resonated and over time drew out quite a torrent of support from the public leading up to, during and after the public apology, just as had been the case with the ‘Stolen Generation.’ Research suggests (cite) that the ethics of such national apologies only make sense if their personal stories are seen as a collective responsibility of society, and only carry weight if we understand and seek to Nationally address the trauma experienced by such victims. In the case of the Forgotten Australians, the National Library of Australia’s Forgotten Australians and Former Child Migrants Oral History Project and the National Museum’s Inside project demonstrate commitment to the digitisation of the Forgotten Australians’ stories in order to promote a better public understanding of their experiences, and institutionally (and therefore formally) value them with renewed social importance. Our project builds on this work not by making or collecting more stories, but by examining the role of the internet and digital technologies used in the production and dissemination of individuals’ stories that have already been created during the period of time between the tabling of the senate inquiry, Children in Institutional Care (1999 or 2003?) and a formal National apology being delivered in Federal Parliament by PM Kevin Rudd (9 Nov, 2009?). This timeframe also represents the emergent first decade of Internet use by Australians, including the rapid easily accessible digital technologies and social media tools that were at our disposal, along with the promises the technology claimed to offer — that is that more people would benefit from the social connections these technologies allegedly were giving us.

Training the public to collect oral histories of our community : the OHAA Queensland Chapter’s model

In a digital age, the skills required to undertake an oral history project have changed dramatically. For community groups, this shift can be new and exciting, but can also invoke feelings of anxiety when there is a gap in the skill set. Addressing this gap is one of Oral History Association of Australia, Queensland (OHAA Qld) main activities. This paper reports on the OHAA Qld chapter’s oral history workshop program, which was radically altered in 2011.

Data breach notification law in the EU and Australia : where to now?

Mandatory data breach notification laws have been a significant legislative reform in response to unauthorized disclosures of personal information by public and private sector organizations. These laws originated in the state-based legislatures of the United States during the last decade and have subsequently garnered worldwide legislative interest. We contend that there are conceptual and practical concerns regarding mandatory data breach notification laws which limit the scope of their applicability, particularly in relation to existing information privacy law regimes. We outline these concerns here, in the light of recent European Union and Australian legal developments in this area.

Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Background & aims: The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs, controlling for DRG. Methods: This prospective cohort study included a matched case control study. Subjective Global Assessment was used to assess the nutritional status on admission of 818 adults. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG. Results: Malnourished patients (29%) had longer hospital stays (6.9 ± 7.3 days vs. 4.6 ± 5.6 days, p < 0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95%CI 1.1–3.2, p = 0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p = 0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p < 0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95% CI 3.3-6.0, p < 0.001). Conclusions: Malnutrition was evident in up to one third of the inpatients and led to poor hospitalization outcomes and survival as well as increased costs of care, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed.

Public-private partnerships : a survey with suggestions for research

The broad aim of this paper is to examine and comment on the development of public private partnerships (ppp) in an international context, concluding with suggestions for further research. The first section offers some working definitions. Section two reflects my attempt to provide a first, broad answer to my initial research question, what is the prevalence of such partnerships, taking a historical perspective. Section three focuses on the questions of what are the expectations of government and business in regard to ppp and what is their prevalence in more recent times. The final section highlights some of the findings of this initial research survey and suggests types of research questions that could be addressed....

Using digital storytelling as a change agent for women’s participation in the Turkish public sphere

This thesis builds on the scholarship and practical know-how that have emerged from digital storytelling projects around the world with diverse groups of participants in a range of institutions. I have used the results of these projects to explore the opportunities Digital Storytelling workshop practice may hold for women’s participation in the public sphere in Turkey. Through theoretical discussion and practical experimentation, I examine the potential of Digital Storytelling workshop practice as a means to promote agency and self-expression in a feminist activist organisation, focusing in particular on whether Digital Storytelling can be used as a change agent – as a tool for challenging the idea of public sphere in ways that make it more inclusive of women’s participation. The thesis engages with feminist scholarship’s critiques of the public/private dichotomy, as well as the concept of gender, to seek connections with narrative identity in the light of the analysis of the Digital Storytelling workshops and the digital stories that were created in a feminist context. The study on which this thesis is based saw the introduction of Digital Storytelling to Turkey for the first time through workshops in Istanbul and Antakya, conducted in partnership with the feminist activist organisation Amargi Women’s Academy. Applying the principles of feminist post-structuralist discourse analysis as used by Judith Baxter (2003), I examine two sets of data collected in this project. First, I analyse the interactions during the Digital Storytelling workshops, where women from Amargi created their digital stories in a collaborative setting. This is done through participatory observation notes and in-depth interviews with the workshop participants and facilitators. Second, I seek to uncover the strategies that these women used to ‘speak back to power’ in their digital stories, reading these as texts. I conclude that women from the Amargi network used the workshops to create digital content in order to communicate their concerns about issues that can be classified as gender-specific matters. During this process, they also cooperated, established new connections, and at the end of the process even defined new ways of using, circulating and repurposing their digital stories for feminist activism in Turkey. My research thereby contributes equally to feminist discourse analysis, the study of new-media usage and uptake among non-professionals, and the study of media–public sphere interactions in a particular national setting: Turkey. My conclusion indicates that the process of production is as important as the product itself, and from that I am able to draw out some strategies for developing digitally equipped women’s activism in Turkey.

Breaking organizational barriers for greening Australian

Sustainability is an issue for everyone. For instance, the higher education sector is being asked to take an active part in creating a sustainable future, due to their moral responsibility, social obligation, and their own need to adapt to the changing higher education environment. By either signing declarations or making public statements, many universities are expressing their desire to become role models for enhancing sustainability. However, too often they have not delivered as much as they had intended. This is particularly evident in the lack of physical implementation of sustainable practices in the campus environment. Real projects such as green technologies on campus have the potential to rectify the problem in addition to improving building performance. Despite being relatively recent innovations, Green Roof and Living Wall have been widely recognized because of their substantial benefits, such as runoff water reduction, noise insulation, and the promotion of biodiversity. While they can be found in commercial and residential buildings, they only appear infrequently on campuses as universities have been very slow to implement sustainability innovations. There has been very little research examining the fundamental problems from the organizational perspective. To address this deficiency, the researchers designed and carried out 24 semi-structured interviews to investigate the general organizational environment of Australian universities with the intention to identify organizational obstacles to the delivery of Green Roof and Living Wall projects. This research revealed that the organizational environment of Australian universities still has a lot of room to be improved in order to accommodate sustainability practices. Some of the main organizational barriers to the adoption of sustainable innovations were identified including lack of awareness and knowledge, the absence of strong supportive leadership, a weak sustainability-rooted culture and several management challenges. This led to the development of a set of strategies to help optimize the organizational environment for the purpose of better decision making for Green Roof and Living Wall implementation.

Speed enforcement in Australia : a changing policy landscape shaped by public opinion

- Speeding and crash involvement in Australia - Speed management in Australia - Jurisdictional differences - National Road Safety Strategy (2011-2020) - Auditor-General reviews of speed camera programs - The role of public opinion/feedback - Implications for speed management

Toward an ethnographic imperative in public relations research

A central goal in social science research is developing descriptive and causal inferences from observable data (King, Keohane, & Verba, 1994). Following this perspective, we propose ethnography as a methodological imperative in public relations research that seeks to develop descriptive inferences about the influence of an organization’s culture on its social ecology. The ethnographic imperative in research design is derived from two interlocked, epistemological commitments in research design. First, a view that the culture of an organization is constituted as a system of shared knowledge that is socially transmitted over time among organizational members. Second, as a consequence, the cognitive setting for actorbased models of organizational social relationships and imperatives is cultural in nature. Based on these commitments, ethnography as a methodological imperative is specifically enjoined when research derived from cocreational public relations theories is explicitly set in sociocultural analysis of those organizations. The strength of this ethnographic imperative in research design is reflected by the degree of congruency between the descriptive inferences drawn from ethnographic data and the theoretical context within which such inferences are situated.

Co-management to solve homelessness : wicked solutions to wicked problems

While governments are engaged in developing social policy responses to address wicked issues such as poverty, homelessness, drug addiction and crime, long term resolution of these issues through government policy making and state-based programmatic action has remained elusive. The use of vehicles for joint action and partnership between government and the community sector such as co-management has been offered as a way of harnessing productive capability and innovative capacity of both these sectors to resolve these complex problems. However, it is suggested that while there is a well advanced agenda with the intent for collaboration and partnership, working with the models for undertaking this joint action are not well understood and have not been fully developed or evaluated. This chapter examines new approaches to resolving the wicked issue of homelessness through applying the lens of co-management to understand the complexities of this issue and its resolution. The chapter analyses an attempt to move away from traditional bureaucratic structures of welfare departments, operating through single functional ‘silos’ to a new horizontal ‘hub-based’ model of service delivery that seeks to integrate actors across many different service areas and organizations. The chapter explores case studies of co-management in the establishment, development and operation of service hubs to address homelessness. We argue that the response to homelessness needs a ‘wicked solution’ that goes beyond simply providing shelter to those in need. The case of the hub models of community sector organizations working across organizational boundaries is evaluated to determine whether this approach can be considered successful co-managing of an innovative initiative, and understanding the requirements for developing, improving and extending this model. The role of the third sector in co-managing public services is examined through the in-depth case studies and the results are presented together with an assessment of how co-management can contribute to service quality and service management in public services.

Hospital outpatient responses to potential driving impairment due to prescribed medications

Driving and using prescription medicines that have the potential to impair driving is an emerging research area. To date it is characterised by a limited (although growing) number of studies and methodological complexities that make generalisations about impairment due to medications difficult. Consistent evidence has been found for the impairing effects of hypnotics, sedative antidepressants and antihistamines, and narcotic analgesics, although it has been estimated that as many as nine medication classes have the potential to impair driving (Alvarez & del Rio, 2000; Walsh, de Gier, Christopherson, & Verstraete, 2004). There is also evidence for increased negative effects related to concomitant use of other medications and alcohol (Movig et al., 2004; Pringle, Ahern, Heller, Gold, & Brown, 2005). Statistics on the high levels of Australian prescription medication use suggest that consumer awareness of driving impairment due to medicines should be examined. One web-based study has found a low level of awareness, knowledge and risk perceptions among Australian drivers about the impairing effects of various medications on driving (Mallick, Johnston, Goren, & Kennedy, 2007). The lack of awareness and knowledge brings into question the effectiveness of the existing countermeasures. In Australia these consist of the use of ancillary warning labels administered under mandatory regulation and professional guidelines, advice to patients, and the use of Consumer Medicines Information (CMI) with medications that are known to cause impairment. The responsibility for the use of the warnings and related counsel to patients primarily lies with the pharmacist when dispensing relevant medication. A review by the Therapeutic Goods Administration (TGA) noted that in practice, advice to patients may not occur and that CMI is not always available (TGA, 2002). Researchers have also found that patients' recall of verbal counsel is very low (Houts, Bachrach, Witmer, Tringali, Bucher, & Localio, 1998). With healthcare observed as increasingly being provided in outpatient conditions (Davis et al., 2006; Vingilis & MacDonald, 2000), establishing the effectiveness of the warning labels as a countermeasure is especially important. There have been recent international developments in medication categorisation systems and associated medication warning labels. In 2005, France implemented a four-tier medication categorisation and warning system to improve patients' and health professionals' awareness and knowledge of related road safety issues (AFSSAPS, 2005). This warning system uses a pictogram and indicates the level of potential impairment in relation to driving performance through the use of colour and advice on the recommended behaviour to adopt towards driving. The comparable Australian system does not indicate the severity level of potential effects, and does not provide specific guidelines on the attitude or actions that the individual should adopt towards driving. It is reliant upon the patient to be vigilant in self-monitoring effects, to understand the potential ways in which they may be affected and how serious these effects may be, and to adopt the appropriate protective actions. This thesis investigates the responses of a sample of Australian hospital outpatients who receive appropriate labelling and counselling advice about potential driving impairment due to prescribed medicines. It aims to provide baseline data on the understanding and use of relevant medications by a Queensland public hospital outpatient sample recruited through the hospital pharmacy. It includes an exploration and comparison of the effect of the Australian and French medication warning systems on medication user knowledge, attitudes, beliefs and behaviour, and explores whether there are areas in which the Australian system may be improved by including any beneficial elements of the French system. A total of 358 outpatients were surveyed, and a follow-up telephone survey was conducted with a subgroup of consenting participants who were taking at least one medication that required an ancillary warning label about driving impairment. A complementary study of 75 French hospital outpatients was also conducted to further investigate the performance of the warnings. Not surprisingly, medication use among the Australian outpatient sample was high. The ancillary warning labels required to appear on medications that can impair driving were prevalent. A subgroup of participants was identified as being potentially at-risk of driving impaired, based on their reported recent use of medications requiring an ancillary warning label and level of driving activity. The sample reported previous behaviour and held future intentions that were consistent with warning label advice and health protective action. Participants did not express a particular need for being advised by a health professional regarding fitness to drive in relation to their medication. However, it was also apparent from the analysis that the participants would be significantly more likely to follow advice from a doctor than a pharmacist. High levels of knowledge in terms of general principles about effects of alcohol, illicit drugs and combinations of substances, and related health and crash risks were revealed. This may reflect a sample specific effect. Emphasis is placed in the professional guidelines for hospital pharmacists that make it essential that advisory labels are applied to medicines where applicable and that warning advice is given to all patients on medication which may affect driving (SHPA, 2006, p. 221). The research program applied selected theoretical constructs from Schwarzer's (1992) Health Action Process Approach, which has extended constructs from existing health theories such as the Theory of Planned Behavior (Ajzen, 1991) to better account for the intention-behaviour gap often observed when predicting behaviour. This was undertaken to explore the utility of the constructs in understanding and predicting compliance intentions and behaviour with the mandatory medication warning about driving impairment. This investigation revealed that the theoretical constructs related to intention and planning to avoid driving if an effect from the medication was noticed were useful. Not all the theoretical model constructs that had been demonstrated to be significant predictors in previous research on different health behaviours were significant in the present analyses. Positive outcome expectancies from avoiding driving were found to be important influences on forming the intention to avoid driving if an effect due to medication was noticed. In turn, intention was found to be a significant predictor of planning. Other selected theoretical constructs failed to predict compliance with the Australian warning label advice. It is possible that the limited predictive power of a number of constructs including risk perceptions is due to the small sample size obtained at follow up on which the evaluation is based. Alternately, it is possible that the theoretical constructs failed to sufficiently account for issues of particular relevance to the driving situation. The responses of the Australian hospital outpatient sample towards the Australian and French medication warning labels, which differed according to visual characteristics and warning message, were examined. In addition, a complementary study with a sample of French hospital outpatients was undertaken in order to allow general comparisons concerning the performance of the warnings. While a large amount of research exists concerning warning effectiveness, there is little research that has specifically investigated medication warnings relating to driving impairment. General established principles concerning factors that have been demonstrated to enhance warning noticeability and behavioural compliance have been extrapolated and investigated in the present study. The extent to which there is a need for education and improved health messages on this issue was a core issue of investigation in this thesis. Among the Australian sample, the size of the warning label and text, and red colour were the most visually important characteristics. The pictogram used in the French labels was also rated highly, and was salient for a large proportion of the sample. According to the study of French hospital outpatients, the pictogram was perceived to be the most important visual characteristic. Overall, the findings suggest that the Australian approach of using a combination of visual characteristics was important for the majority of the sample but that the use of a pictogram could enhance effects. A high rate of warning recall was found overall and a further important finding was that higher warning label recall was associated with increased number of medication classes taken. These results suggest that increased vigilance and care are associated with the number of medications taken and the associated repetition of the warning message. Significantly higher levels of risk perception were found for the French Level 3 (highest severity) label compared with the comparable mandatory Australian ancillary Label 1 warning. Participants' intentions related to the warning labels indicated that they would be more cautious while taking potentially impairing medication displaying the French Level 3 label compared with the Australian Label 1. These are potentially important findings for the Australian context regarding the current driving impairment warnings about displayed on medication. The findings raise other important implications for the Australian labelling context. An underlying factor may be the differences in the wording of the warning messages that appear on the Australian and French labels. The French label explicitly states "do not drive" while the Australian label states "if affected, do not drive", and the difference in responses may reflect that less severity is perceived where the situation involves the consumer's self-assessment of their impairment. The differences in the assignment of responsibility by the Australian (the consumer assesses and decides) and French (the doctor assesses and decides) approaches for the decision to drive while taking medication raises the core question of who is most able to assess driving impairment due to medication: the consumer, or the health professional? There are pros and cons related to knowledge, expertise and practicalities with either option. However, if the safety of the consumer is the primary aim, then the trend towards stronger risk perceptions and more consistent and cautious behavioural intentions in relation to the French label suggests that this approach may be more beneficial for consumer safety. The observations from the follow-up survey, although based on a small sample size and descriptive in nature, revealed that just over half of the sample recalled seeing a warning label about driving impairment on at least one of their medications. The majority of these respondents reported compliance with the warning advice. However, the results indicated variation in responses concerning alcohol intake and modifying the dose of medication or driving habits so that they could continue to drive, which suggests that the warning advice may not be having the desired impact. The findings of this research have implications for current countermeasures in this area. These have included enhancing the role that prescribing doctors have in providing warnings and advice to patients about the impact that their medication can have on driving, increasing consumer perceptions of the authority of pharmacists on this issue, and the reinforcement of the warning message. More broadly, it is suggested that there would be benefit in a wider dissemination of research-based information on increased crash risk and systematic monitoring and publicity about the representation of medications in crashes resulting in injuries and fatalities. Suggestions for future research concern the continued investigation of the effects of medications and interactions with existing medical conditions and other substances on driving skills, effects of variations in warning label design, individual behaviours and characteristics (particularly among those groups who are dependent upon prescription medication) and validation of consumer self-assessment of impairment.

Evaluation of green public road procurement in Australia : current practices and gaps to fill

Public road authorities have a key responsibility in driving initiatives for reducing greenhouse gas (GHG) emissions in the road construction project lifecycle. A coherent and efficient chain of procurement processes and methods is needed to convert green policies into tangible actions that capture the potential for GHG reduction. Yet, many infrastructure clients lack developed methodologies regarding green procurement practices. Designing more efficient solutions for green procurement requires an evaluation of the current initiatives and stages of development. A mapping of the current GHG reduction initiatives in Australian public road procurement is presented in this paper. The study includes the five largest Australian state road authorities, which cover 94% of the total 817,089 km of Australian main roads (not local) and account for 96% of the total A$13 billion annual major road construction and maintenance expenditure. The state road authorities’ green procurement processes and tools are evaluated based on interviews and a review of documents. Altogether 12 people, comprising 1-3 people of each organisation, participated in the interviews and provided documents. An evaluation matrix was developed for mapping the findings across the lifecycle of road construction project delivery. The results show how Australian state road authorities drive decisions with an impact on GHG emissions on the strategic planning phase, project development phase, and project implementation phase. The road authorities demonstrate varying levels of advancement in their green procurement methodologies. Six major gaps in the current green procurement processes are identified and, respectively, six recommendations for future research and development are suggested. The greatest gaps remain in the project development phase, which has a critical role in fixing the project (GHG reduction) goals, identifying risks and opportunities, and selecting the contractor to deliver the project. Specifically, the role of mass-haul optimisation as a part of GHG minimisation was reviewed, and mass-haul management was found to be an underutilised element with GHG reduction potential.