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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.
Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).
Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]).
Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.
State Health Research Advisory Council, Department of Health, Government of Western Australia.
Journal Article
Conducting educational research
\"Conducting Educational Research is geared to help students understand and apply the most important principles of scholarly investigation. Now in its 6th edition, this research textbook includes updates such as a completely rewritten Chapter 12, a chapter devoted to statistical research without having to use the expensive program SPSS. The text has been revised throughout to include recent technological advances, simpler exercises, and visual elements to help the student understand the research process\"-- Provided by publisher.
Book
Fabricating Quality in Education
How is European Education Governed?
Data is now the lifeblood of education governance. At the international level, organisations like the OECD steer education systems through their programmes of assessment and the European Commission's project of creating the most successful knowledge economy in the world is driven by data collection, analysis and comparison. At the national level, policy-makers increasingly depend on data to show them where they are positioned, in relation to their competitors, and draw on data to justify policy directions. Within systems, schools and teachers have become proficient in data use, and interpret their priorities with reference to data.
This book draws on a three-year comparative study of the influence of data on education systems in Europe, looking at the contrasting policy contexts of Denmark, England, Finland, Scotland and Sweden, and examining the use of data in these systems, in relation to steering by Europe, as well as policy mediation and 'translation' of data within systems. The authors draw on interviews with key policy actors in the European Commission and with national policy makers in all five systems, as well as on local case studies and a major comparative survey of the effects of data production and use on the work of teachers and headteachers. The research brought together international researchers from a variety of disciplinary backgrounds, including educationalists, political scientists and specialists in research and evaluation.
The book offers new arguments relating to the use of Quality Assurance and Evaluation as a means of standardising and harmonising education policy and practice, while also drawing attention to significant variation in policy and practice across these systems. It should be of interest to researchers, post-graduate students and advanced undergraduate students in policy studies in education and more generally.
eBook
Effect of Diabetes Education Through Pattern Management on Self-Care and Self-Efficacy in Patients with Type 2 Diabetes
This study investigated the effect of applying a customized diabetes education program through pattern management (PM), using continuous glucose monitoring system (CGMS) results, on individual self-care behaviors and self-efficacy in patients with type 2 diabetes mellitus. Patients with type 2 diabetes who had never received diabetes education, enrolled from March to September 2017, were sequentially assigned to either PM education or control groups. In the PM education group, the CGMS test was first conducted one week before diabetes education and repeated three times by PM in order to obtain data on self-care behaviors and self-efficacy. These results were then compared before and after education at three and six months. The control group received the traditional diabetes education. Self-efficacy showed statistically significant interactions between the two groups over time, indicating a significant difference in the degree of self-efficacy between the PM education and control groups. Diabetes education by PM using CGMS result analysis improved life habits with a positive influence on self-care behaviors and self-efficacy for diabetes management. Further studies are needed to further develop and apply individual diabetes education programs in order to sustain the effects of self-care behaviors and self-efficacy in patients with diabetes who experience a decrease in self-efficacy after three months of education.
Journal Article
Statistical power analysis for the social and behavioral sciences : basic and advanced techniques
\"This will be the first book to demonstrate the application of power analysis to the newer more advanced techniques such as hierarchical linear modeling, meta-analysis, and structural equation modelling that are increasingly popular in behavioral and social science research\"-- Provided by publisher.
Book
Anatomy education of medical and dental students during COVID-19 pandemic: a reality check
PurposeDuring this forced down-time of COVID-19 pandemic, shift to virtual anatomy education is the solitary solution to support the learning of students. The purpose of this study was to understand the visible and invisible potential challenges being faced by the 1st year medical and dental students while attending digital anatomy classes.MethodsThe present study was conducted on 81st year medical and dental students who were admitted to their respective college in August 2019 and were willing to participate in the study. A multiple choice close-ended questionnaire regarding their opinion on virtual classes was designed and feedback was taken from the students.ResultsMajority (65%) of the students agreed that they missed their traditional anatomy learning i.e., dissection courses, face to face lectures and interaction with mentors. The students strongly felt the lack of confidence and difficulty in the topics completed without dissections, models, microscopic slides and other modalities. 83% felt lack of proper gadgets, high-band width and strong internet connections, a potential barrier in their digital learning. Lack of self-motivation was felt by 69% students.ConclusionsThe current situation of anatomy education is not intentional, and is not the long term silver bullet solution for a visual subject like anatomy. Though learners face a lot of challenges, however, a shift to online must be supported at this time of health crisis. As the digital learning may go for indefinite period, the feedback of students may be helpful for relevant and timely modifications in digital anatomy education.
Journal Article
Video feedback and e-Learning enhances laboratory skills and engagement in medical laboratory science students
Background
Traditionally, the training of medical laboratory science students has taken place in the laboratory and has been led by academic and pathology experts in a face-to-face context. In recent years, budgetary pressures, increasing student enrolments and limited access to laboratory equipment have resulted in reduced staff-student contact hours in medical laboratory science education. While this restructure in resources has been challenging, it has encouraged innovation in online blended learning.
Methods
Blended learning histology lessons were implemented in a face-to-face and e-Learning format in a medical laboratory science program to teach tissue morphology and technical procedures outside of the traditional laboratory classroom. Participating students were randomly allocated to either the ‘video’ group (
n
= 14) or the ‘control’ group (
n
= 14). After all students attempted the e-Learning lessons and viewed expert-led video recordings online, students demonstrated their hands-on practical skills in the laboratory. Technical skills, demonstration of safety awareness, and use of histology equipment was captured by video through first person ‘point of view’ recordings for the ‘video’ group only. The ‘control’ group performed the same activities but were not recorded. Prior to summative assessment, the ‘video’ group students had a digital resource portfolio that enabled them to review their skills, receive captured feedback and retain a visual copy of their recorded procedure.
Results
Results showed that students who participated in the online video format had statistically better practical examination scores and final grades compared to the control group.
Conclusion
Findings from this study suggest that students are engaged and motivated when being taught in a blended learning format and respond positively to the use of video recordings with expert feedback for the initial learning of hands-on techniques. For the academic, developing a blended learning medical laboratory science program, which includes annotated virtual microscopy, video demonstrations, and online interactive e-Learning activities, provides an effective and economic approach to learning and teaching.
Journal Article