Outcomes assessment of a pediatric practice guideline

Objective. This study examines the structure, processes, and data necessary to assess the outcome variables, length of stay and total cost, for a pediatric practice guideline. The guideline was developed by a group of physicians and ancillary staff members representing the services that most commonly provide treatment for asthma patients at Texas Children's Hospital, as a means of standardizing care. Outcomes have needed to be assessed to determine the practice guideline's effectiveness.^ Data sources and study design. Data for the study were collected retrospectively from multiple hospital data bases and from inpatient chart reviews. All patients in this quasi-experimental study had a diagnosis of Asthma (ICD-9-CM Code 493.91) at the time of admission.^ The study examined data for 100 patients admitted between September 15, 1995 and November 15, 1995, whose physician had elected to apply the asthma practice guideline at the time of the patient's admission. The study examined data for 66 inpatients admitted between September 15, 1995 and November 15, 1995, whose physician elected not to apply the asthma practice guideline. The principal outcome variables were identified as "Length of Stay" and "Cost".^ Principal findings. The mean length of stay for the group in which the practice guideline was applied was 2.3 days, and 3.1 days for the comparison group, who did not receive care directed by the practice guideline. The difference was statistically significant (p value = 0.008). There was not a demonstrable difference in risk factors, health status, or quality of care between the groups. Although not showing statistical significance in the univariate analysis, private insurance showed a significant difference in the logistic regression model presenting an elevated odds ratio (odds ratio = 2.2 for a hospital stay $\le$2 days to an odds ratio = 4.7 for a hospital stay $\le$3 days) showing that patients with private insurance experienced greater risk of a shorter hospital stay than the patients with public insurance in each of the logistic regression models. Public insurance included; Medicaid, Medicare, and charity cases. Private insurance included; private insurance policies whether group, individual, or managed care. The cost of an admission was significantly less for the group in which the practice guideline was applied, with a mean difference between the two groups of $1307 per patient.^ Conclusion. The implementation and utilization of a pediatric practice guideline for asthma inpatients at Texas Children's Hospital has a significant impact in terms of reducing the total cost of the hospital stay and length of the hospital stay for asthma patients admitted to Texas Children's Hospital. ^

Challenges of Measuring Learning Outcomes for Property Students Engaged in Work Integrated Learning

Work integrated learning (WIL) or professional practice units are recognised as providing learning experiences that help students make successful transitions to professional practice. These units require students to engage in learning in the workplace; to reflect on this learning; and to integrate it with learning at university. However, an analysis of a recent cohort of property economics students at a large urban university provides evidence that there is great variation in work based learning experiences undertaken and that this impacts on students’capacity to respond to assessment tasks which involve critiquing these experiences in the form of reflective reports. This paper highlights the need to recognise the diversity of work based experiences; the impact this has on learning outcomes; and to find more effective and equitable ways of measuring these outcomes. The paper briefly discusses assessing learning outcomes in WIL and then describes the model of WIL in the Faculty of Built Environment and Engineering at the Queensland University of Technology (QUT). The paper elaborates on the diversity of students’ experiences and backgrounds including variations in the length of work experience, placement opportunities and conditions of employment.For example, the analysis shows that students with limited work experience often have difficulty critiquing this work experience and producing high level reflective reports. On the other hand students with extensive, discipline relevant work experience can be frustrated by assessment requirements that do not take their experience into account. Added to this the Global Financial Crisis (GFC) has restricted both part time and full time placement opportunities for some students. These factors affect students’ capacity to a) secure a relevant work experience, b) reflect critically on the work experiences and c) appreciate the impact the overall experience can have on their learning outcomes and future professional opportunities. Our investigation highlights some of the challenges faced in implementing effective and equitable approaches across diverse student cohorts. We suggest that increased flexibility in assessment requirements and increased feedback from industry may help address these challenges.

Framing student evaluations of university learning and teaching : discursive strategies and textual outcomes

Evaluation in higher education is an evolving social practice, that is, it involves what people, institutions and broader systems do and say, how they do and say it, what they value, the effects of these practices and values, and how meanings are ascribed. The textual products (verbal, written, visual, gestural) that inform and are produced by, for and through evaluative practices are important as they promulgate particular kinds of meanings and values in specific contexts. This paper reports on an exploratory study that sought to investigate, using discourse analysis, the types of evaluative practices that were ascribed value, and the student responses that ensued, in different evaluative instruments. Findings indicate that when a reflective approach is taken to evaluation, students’ responses are more considered, they interrogate their own engagement in the learning context and they are more likely to demonstrate reconstructive thought. These findings have implications for reframing evaluation as reflective learning.

How should a vocational education and training course be evaluated?

The course evaluation process used by a large VET provider was evaluated using guidelines suggested by the course evaluation literature and feedback obtained from multiple stakeholders. A modified model is presented as an exemplar for course evaluation in the VET sector.

Helping undergraduate students across disciplines and cultures actively engage and collaborate as equal members of a community of scholars : peer review within an e-learning environment

At the international level, the higher education sector is currently being subjected to increased calls for public accountability and the current move by the OECD to rank universities based on the quality of their teaching and learning outcomes. At the national level, Australian universities and their teaching staff face numerous challenges including financial restrictions, increasing student numbers and the reality of an increasingly diverse student population. The Australian higher education response to these competing policy and accreditation demands focuses on precise explicit systems and procedures which are inflexible and conservative and which ignore the fact that assessment is the single biggest influence on how students approach their learning. By seriously neglecting the quality of student learning outcomes, assessment tasks are often failing to engage students or reflect the tasks students will face in the world of practice. Innovative assessment design, which includes new paradigms of student engagement and learning and pedagogically based technologies have the capacity to provide some measure of relief from these internal and external tensions by significantly enhancing the learning experience for an increasingly time-poor population of students. That is, the assessment process has the ability to deliver program objectives and active learning through a knowledge transfer process which increases student participation and engagement. This social constructivist view highlights the importance of peer review in assisting students to participate and collaborate as equal members of a community of scholars with both their peers and academic staff members. As a result of increasing the student’s desire to learn, peer review leads to more confident, independent and reflective learners who also become more skilled at making independent judgements of their own and others' work. Within this context, in Case Study One of this project, a summative, peer-assessed, weekly, assessment task was introduced in the first “serious” accounting subject offered as part of an undergraduate degree. The positive outcomes achieved included: student failure rates declined 15%; tutorial participation increased fourfold; tutorial engagement increased six-fold; and there was a 100% student-based approval rating for the retention of the assessment task. However, in stark contrast to the positive student response, staff issues related to the loss of research time associated with the administration of the peer-review process threatened its survival. This paper contributes to the core conference topics of new trends and experiences in undergraduate assessment education and in terms of innovative, on-line, learning and teaching practices, by elaborating the Case Study Two “solution” generated to this dilemma. At the heart of the resolution is an e-Learning, peer-review process conducted in conjunction with the University of Melbourne which seeks to both create a virtual sense of belonging and to efficiently and effectively meet academic learning objectives with minimum staff involvement. In outlining the significant level of success achieved, student-based qualitative and quantitative data will be highlighted along with staff views in a comparative analysis of the advantages and disadvantages to both students and staff of the staff-led, peer review process versus its on-line counterpart.

Cross cultural adaptation and validation of a Spanish version of the lower limb functional index

Background: The Lower Limb Functional Index (LLFI) is a relatively recently published regional outcome measure. The development article showed the LLFI had robust and valid clinimetric properties with sound psychometric and practical characteristics when compared to the Lower Limb Extremity Scale (LEFS) criterion standard. Objective: The purpose of this study was cross cultural adaptation and validation of the LLFI Spanish-version (LLFI-Sp) in a Spanish population. Methods: A two stage observational study was conducted. The LLFI was initially cross-culturally adapted to Spanish through double forward and single backward translation; then subsequently validated for the psychometric characteristics of validity, internal consistency, reliability, error score and factor structure. Participants (n = 136) with various lower limb conditions of >12 weeks duration completed the LLFI-Sp, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Euroqol Health Questionnaire 5 Dimensions (EQ-5D-3 L). The full sample was employed to determine internal consistency, concurrent criterion validity, construct validity and factor structure; a subgroup (n = 45) determined reliability at seven days concurrently completing a global rating of change scale. Results: The LLFI-Sp demonstrated high but not excessive internal consistency (α = 0.91) and high reliability (ICC = 0.96). The factor structure was one-dimensional which supported the construct validity. Criterion validity with the WOMAC was strong (r = 0.77) and with the EQ-5D-3 L fair and inversely correlated (r = -0.62). The study limitations included the lack of longitudinal data and the determination of responsiveness. Conclusions: The LLFI-Sp supports the findings of the original English version as being a valid lower limb regional outcome measure. It demonstrated similar psychometric properties for internal consistency, validity, reliability, error score and factor structure.

The Art of Studio Teaching

This project began in 2013, with the award of an internal QUT Teaching and Learning grant. The task we wished to undertake was to document and better understand the role of studio teaching practice in the Creative Industries Faculty. While it was well understood that the Faculty had long used studio pedagogies as a key part of its teaching approach, organizational and other changes made it productive and timely to consider how the various study areas within the Faculty were approaching studio teaching. Chief among these changes were innovations in the use of technology in teaching, and at an organizational level the merging of what were once two schools within different faculties into a newly-structured Creative Industries Faculty. The new faculty consists of two schools, Media, Entertainment and Creative Art (MECA) and Design. We hoped to discover more about how studio techniques were developing alongside an ever-increasing number of options for content delivery, assessment, and interaction with students. And naturally we wanted to understand such developments across the broad range of nineteen study areas now part of the Creative Industries Faculty. This e-book represents the first part of our project, which in the main consisted in observing the teaching practices used in eight units across the Faculty, and then interviews with the unit coordinators involved. In choosing units, we opted for a broad opening definition of ‘studio’ to include not only traditional studios but also workshops and tutorials in which we could identify a component of studio teaching as enumerated by the Australian Learning and Teaching Council’s Studio Teaching Project: • A culture, a creative community created by a group of students and studio teachers working together for periods of time • A mode of teaching and learning where students and studio teachers interact in a creative and reflective process • A program of projects and activities where content is structured to enable ‘learning in action’ • A physical space or constructed environment in which the teaching and learning can take place (Source: http://www.studioteaching.org/?page=what_is_studio) The units we chose to observe, and which we hoped would represent something of the diversity of our study areas, were: • Dance Project 1 • Furniture Studies • Wearable Architecture • Fashion Design 4 • Industrial Design 6 • Advanced Writing Practice 3 • Introduction to Creative Writing • Studio Art Practice 2 Over the course of two semesters in 2013, we attended classes, presentations, and studio time in these units, and then conducted interviews that we felt would give further insight into both individual and discipline-specific approaches to studio pedagogies. We asked the same questions in each of the interviews: • Could you describe the main focus and aims of your unit? • How do you use studio time to achieve those aims? • Can you give us an example of the kind of activities you use in your studio teaching? • What does/do these example(s) achieve in terms of learning outcomes? • What, if any, is the role of technology in your studio teaching practice? • What do you consider distinctive about your approach to studio teaching, or the approach taken in your discipline area? The unit coordinators’ responses to these questions form some of the most interesting and valuable material in this book, and point to both consistencies in approach and teaching philosophies, as well as areas of difference. We believe that both can help to raise our critical awareness of studio teaching, and provide points of comparison for the future development of studio pedagogy in the Creative Industries. In each of the following pages, the interviews are placed alongside written descriptions of the units, their aims and outcomes, assessment models, and where possible photographs and video footage, as well as additional resources that may be useful to others engaged in studio teaching.

Early childhood neurodevelopment after intrauterine growth restriction: a systematic review

BACKGROUND AND OBJECTIVE: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.

METHODS: PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines.

RESULTS: Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.

CONCLUSIONS: Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.

Methodologic rigor of clinical trials on surgical management of eyes with coexisting cataract and glaucoma.

OBJECTIVE:

To assess the methodologic quality of published studies of the surgical management of coexisting cataract and glaucoma.

DESIGN:

Literature review and analysis.

METHOD:

We performed a systematic search of the literature to identify all English language articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. Quality assessment was performed on all randomized controlled trials, nonrandomized controlled trials, and cohort studies. Overall quality scores and scores for individual methodologic domains were based on the evaluations of two experienced investigators who independently reviewed articles using an objective quality assessment form.

MAIN OUTCOME MEASURES:

Quality in each of five domains (representativeness, bias and confounding, intervention description, outcomes and follow-up, and statistical quality and interpretation) measured as the percentage of methodologic criteria met by each study.

RESULTS:

Thirty-six randomized controlled trials and 45 other studies were evaluated. The mean quality score for the randomized, controlled clinical trials was 63% (range, 11%-88%), and for the other studies the score was 45% (range, 3%-83%). The mean domain scores were 65% for description of therapy (range, 0%-100%), 62% for statistical analysis (range, 0%-100%), 58% for representativeness (range, 0%-94%), 49% for outcomes assessment (range, 0%-83%), and 30% for bias and confounding (range, 0%-83%). Twenty-five of the studies (31%) received a score of 0% in the bias and confounding domain for not randomizing patients, not masking the observers to treatment group, and not having equivalent groups at baseline.

CONCLUSIONS:

Greater methodologic rigor and more detailed reporting of study results, particularly in the area of bias and confounding, could improve the quality of published clinical studies assessing the surgical management of coexisting cataract and glaucoma.

Fish oil intakes providing dietary attainable levels of EPA and DHA reduces blood pressure in adults with systolic hypertension in a retrospective analysis

Background: Although a large number of randomized controlled trials (RCTs) have examined the impact of the n-3 (ω-3) fatty acids EPA (20:5n-3) and DHA (22:6n-3) on blood pressure and vascular function, the majority have used doses of EPA+DHA of > 3 g per d,which are unlikely to be achieved by diet manipulation. Objective: The objective was to examine, using a retrospective analysis from a multi-center RCT, the impact of recommended, dietary achievable EPA+DHA intakes on systolic and diastolic blood pressure and microvascular function in UK adults. Design: Healthy men and women (n = 312) completed a double-blind, placebo-controlled RCT consuming control oil, or fish oil providing 0.7 g or 1.8 g EPA+DHA per d in random order each for 8 wk. Fasting blood pressure and microvascular function (using Laser Doppler Iontophoresis) were assessed and plasma collected for the quantification of markers of vascular function. Participants were retrospectively genotyped for the eNOS rs1799983 variant. Results: No impact of n-3 fatty acid treatment or any treatment * eNOS genotype interactions were evident in the group as a whole for any of the clinical or biochemical outcomes. Assessment of response according to hypertension status at baseline indicated a significant (P=0.046) fish oil-induced reduction (mean 5 mmHg) in systolic blood pressure specifically in those with isolated systolic hypertension (n=31). No dose response was observed. Conclusions: These findings indicate that, in those with isolated systolic hypertension, daily doses of EPA+DHA as low as 0.7 g bring about clinically meaningful blood pressure reductions which, at a population level, would be associated with lower cardiovascular disease risk. Confirmation of findings in an RCT where participants are prospectively recruited on the basis of blood pressure status is required to draw definite conclusions. The Journal of Nutrition NUTRITION/2015/220475 Version 4

Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care

Background: Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health-care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients. Aim: To enhance assessment, communication, care and discharge planning by restructuring consistent, patient-centred multidisciplinary teams in a general medicine service. Methods: Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral-based multidisciplinary models with existing staffing levels. Results: Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6-month readmissions. in-hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients' ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed-day savings. Conclusion: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.

La carpeta de aprendizaje y la evaluación entre iguales de los estudiantes. Resultados de una innovación docente en los estudios universitarios de las artes

Students reflect more on their learning in course subjects when they participate in managing their teaching–learning environment. As a form of guided participation, peer assessment serves the following purposes: (a) it improves the student’s understanding of previously established learning objectives; (b) it is a powerful metacognitive tool; (c) it transfers to the student part of the responsibility for assessing learning, which means deciding which learning activities are important and choosing the degree of effort a course subject will require; (d) it emphasizes the collective aspect of the nature of knowledge; and (e) the educational benefits derived from peer assessment clearly justify the efforts required to implement activities. This paper reports on the relative merits of a learning portfolio compiled during fine arts-related studies in which peer assessment played an important role. The researchers analyzed the student work load and the final marks students received for compulsory art subjects. They conclude that the use of a closed learning portfolio with a well-structured, sequential and analytical design can have a positive effect on student learning and that, although implementing peer assessment may be complex and students need to become familiar with it, its use is not only feasible but recommendable.

Implementation of an integrated, technology-based, discovery mode assessment item involving an incubation period to enhance learning outcomes for engineering maths students

In this paper we discuss our current efforts to develop and implement an exploratory, discovery mode assessment item into the total learning and assessment profile for a target group of about 100 second level engineering mathematics students. The assessment item under development is composed of 2 parts, namely, a set of "pre-lab" homework problems (which focus on relevant prior mathematical knowledge, concepts and skills), and complementary computing laboratory exercises which are undertaken within a fixed (1 hour) time frame. In particular, the computing exercises exploit the algebraic manipulation and visualisation capabilities of the symbolic algebra package MAPLE, with the aim of promoting understanding of certain mathematical concepts and skills via visual and intuitive reasoning, rather than a formal or rigorous approach. The assessment task we are developing is aimed at providing students with a significant learning experience, in addition to providing feedback on their individual knowledge and skills. To this end, a noteworthy feature of the scheme is that marks awarded for the laboratory work are primarily based on the extent to which reflective, critical thinking is demonstrated, rather than the amount of CBE-style tasks completed by the student within the allowed time. With regard to student learning outcomes, a novel and potentially critical feature of our scheme is that the assessment task is designed to be intimately linked to the overall course content, in that it aims to introduce important concepts and skills (via individual student exploration) which will be revisited somewhat later in the pedagogically more restrictive formal lecture component of the course (typically a large group plenary format). Furthermore, the time delay involved, or "incubation period", is also a deliberate design feature: it is intended to allow students the opportunity to undergo potentially important internal re-adjustments in their understanding, before being exposed to lectures on related course content which are invariably delivered in a more condensed, formal and mathematically rigorous manner. In our presentation, we will discuss in more detail our motivation and rationale for trailing such a scheme for the targeted student group. Some of the advantages and disadvantages of our approach (as we perceived them at the initial stages) will also be enumerated. In a companion paper, the theoretical framework for our approach will be more fully elaborated, and measures of student learning outcomes (as obtained from eg. student provided feedback) will be discussed.