The focus of this study is a strategy for the creation of a teaching-learning culture in higher education that facilitates assessment as learning, in line with constructivist principles and congruent with the outcomes-based approach to teaching and learning. The rationale behind the study was based on the researcher's observation that the assessment practices of learning accompanists in the health sciences tend to be traditional and behaviourist in nature, while the official and dominant approach to teaching and learning is outcomes-based. A critical ethnographic process served as research method. A primary record was compiled from the investigation into the assessment practices of the learning accompanists in health sciences by means of direct observation during academic contact sessions with students, 15 (fifteen) semi-structured individual interviews and analysis of assessment documents. The 30 (thirty) participating students' experience of the assessment practices of their learning accompanists was explored by means of 3 (three) semi-structured focus group interviews as triangulation. The data was qualitatively analysed in collaboration with an experienced qualitative researcher as co-coder; and relevant relationships between concepts were emphasised. Literature (national and international) was continuously explored, interpreted and integrated with the empirical data for enrichment of the findings. The results were reduced to 12 (twelve) condensed statements that served as a basis for a theoretical framework. A conceptual framework, which explains the relationship between the central concepts, is visually presented and discussed. A strategy for a teaching-learning culture that facilitates assessment as learning was formulated on the basis of 7 (seven) goals and a tactical plan to achieve the stated goals. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2009.

When Outcomes-Based Education (OBE) reached the Further Education and Training (FET) band in 2006, teachers were confronted for the first time with a new curriculum that challenged them to implement a learner-centred approach to teaching, learning and assessment. Since assessment is seen as the heart of effective teaching and learning, this research was aimed at establishing how effective teachers of English First Additional Language (EFAL) in the FET band were in implementing Outcomes-Based Assessment (OBA). A thorough literary survey on OBE and OBA was conducted. This survey included a study of the principles and philosophical underpinnings of OBE and the clarification of the key concepts of OBE and OBA. Various documents on the teaching, learning and assessment of English Second Language from the Departments of Education in New Zealand, Canada and Australia were studied to gain an international perspective. This was followed by an analysis of South African policy documents on the teaching, learning and assessment of EFAL. Empirical research was conducted by means of a survey in which both qualitative and quantitative methods of data collection were used. The data analysis revealed that teachers of EFAL in the FET band experience problems with the practical implementation of the curriculum and the assessment thereof. Problems were mainly experienced with setting achievable outcomes, designing lessons, teaching material and learning activities, teaching and assessing in a learner-centred way, employing the most appropriate types and methods of assessment and using feedback to enhance learning. A model for assessment has been designed to fill the gap left between the theory of OBE and OBA as expressed in the NCS for EFAL and the successful, practical implementation thereof. It is anticipated that this model will contribute to the improvement of teaching, learning and assessment of EFAL in the FET band in public schools. / Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2008.

This research investigates the application of management accounting practices (MAP) for achieving public sector outcomes-based performance management (OBPM) in Queenslandunder its Managing for Outcomes (MFO) policy. It identifies specific principles that support a performance-based environment in which outcomes-based performance is measured and for which costs are determined. This research also investigates whether there is support for the proposed MAP and examines the extent to which MAP is adopted. The research approach provides a complementary view of what should be happening with that which isactually happening in relation to MAP in the agency selected for this research.An insider research approach was undertaken for this research, drawing on a process of reflexive awareness and careful judgement to reframe, as theoretical knowledge, the tacit knowledge that has become deeply segmented in the Queensland public sector. A mixedmethod approach was used to limit the risk of the insider researcher losing objectivity and to ensure the standards of academic rigour. The approach utilised a group of criticalpractitioners, in a co-operative style of reflective inquiry, to co-create knowledge in the development of the theoretical principles. Document analyses and a case study including interviews with participants from two work units operating within one Queensland Government agency were conducted for the purposes of gaining knowledge of theQueensland Government’s MFO policy, the intended-MAP and the MAP-in-use, in particular performance measurement and cost management. An independent interviewer wasemployed wherever possible with the aim to limit possible insider researcher bias during the interview process.Findings suggest a significant gap exists between what the objectives of the MFO policy is seeking to achieve and the operational level at which this policy operates. Consultations with the critical group of practitioners and evidence from an analysis of documentation provide support for the theoretical principles. However, evidence from the case study interviews indicates a limited application of these principles. The “performance story” of theagency lacks logical links between the services it delivers and the government outcomes to which it contributes. The use of measures is not uniform throughout the agency. The agency’s ability to assess the efficiency and effectiveness to which it delivers services islimited by the fact that it reports mainly output oriented cost information. Thus, any extolments that the agency has improved their cost of delivery are largely rhetoric ratherthan anything real based on sound costing information. With an apparent compliance focus by the agency, the implication of these findings is that the costing approach adopted is one that is more likely to be based on its needs to secure sufficient resource allocations throughbudgeting processes of the Government.Opportunities exist to examine the broader social, cultural and political contexts within which Queensland government agencies operate. The findings of this study suggest that the technical merits of the proposed MAP that should be adopted by the Queensland government agencies are not sufficient to motivate agencies to adopt them. Future research that gains a fuller understanding of this aspect seems to be a logical progression.

Background: Very occasionally, when a fetus is developing in the womb, problems occur with the normal processes controlling closure of the muscles of the abdominal wall and, as a result, some of the abdominal contents develop outside of the body. This is known as an abdominal wall defect. If the pregnancy continues to term, the newborn infant will need specialised surgical care. This situation occurs so infrequently that even a dedicated surgical centre will care for very few of these women and their babies in a year. Many centres have shared their experiences of managing these babies in the published literature but the majority of reports have included only a few infants. The focus of most previous studies has been to describe what happens to these newborn infants between birth and first discharge from hospital from a purely clinical perspective. Aim: To explore methodologies to holistically understand the short and longer-term outcomes of children born with abdominal wall defects and to use the information to improve the care of future affected infants. Methods: The quality of the published literature on short-term outcomes of children born with gastroschisis was scrutinised in a systematic review. The accompanying meta-analysis used published data as a means of identifying population outcome estimates. Two national population-based cohort studies were undertaken, exploring the short-term outcomes of children born with exomphalos and the outcomes at seven to ten years of children born with gastroschisis. The latter study included an assessment of childhood outcomes from the point of view of the children themselves, along with their parents. Further parental perspectives on experiences of care were explored in a qualitative analysis of in-depth interviews with parents of children born with exomphalos. Findings: Short-term outcomes of children born with gastroschisis have been published in a large number of small studies. Pooling the published data, where possible allowed the production of population estimates but heterogeneity between studies was marked. One in fourteen children born with gastroschisis died before their first birthday when managed in developed countries. Those who developed bowel complications in utero, had an increased risk of dying before one-year. The assessment of childhood outcomes for this latter group of children, who made up 11% of the population cohort, revealed a bleak outlook for many, of with one in three either dying or requiring complex surgery to gain allow them to be able to be fed via their gut, before their ninth birthday. Due to methodological limitations, the extent of neurological and gastrointestinal morbidity among survivors in the cohort is unclear, but the findings of both the highly selected responses from the parent report and those of the clinical study provide enough concern to suggest that alternative methodologies need to be explored to identify the extent of ongoing sequelae as children grow older. The live-born population of children with exomphalos is highly varied and a large burden of comorbidity was identified, however, two-thirds of infants were able to be have their abdominal wall defect surgically closed with a low-rate of early complications. A variety of techniques are employed by UK surgeons when the defect cannot be easily closed and evidence to guide management choice will be difficult to obtain using standard techniques due to the small number of these infants born annually in the UK. Parental experiences echoed the variability in management approach and in some cases highlighted a lack of respect for parental perspectives on management choice. Conclusion: Children born with abdominal wall defects represent a spectrum from those with severe comorbidity who will need ongoing care, to those who have a straightforward course and a relatively short stay in hospital. Methods of risk-stratifying infants for the purposes of outcome assessment have been explored. This approach is crucial to contextualising the progress of an individual infant and counselling their parents about their likely prognosis.

Background: The International Classification of Function, Disability and Health (ICF) describes health using 1424 categories from 4 components: body functions (BF), body structures (BS), activities and participation (AP) and contextual factors (environmental (EF) and personal (PF)). In this study the ICF was used to describe and compare aspects of ANCA-Associated Vasculitis (AAV) measured in clinical trials and those important to clinicians and patients. Methods: Individual interviews and focus groups were used to capture the perspective of AAV patients. Clinicians’ perspective was obtained with an email-based questionnaire. Outcomes used in AAV randomized trials were extracted from results of a systematic review of literature. Identified concepts were mapped to the ICF according to previously published ICF linking rules, and the resulting lists of relevant AAV outcomes were compared descriptively. Results: Twelve individual interviews and 2 focus groups represented the patient perspective while responses from 27 clinicians yielded the clinicians’ perspective. Systematic literature review identified 67 clinical trials and 28 abstracts from which measured outcomes were extracted. All three perspectives demonstrated detailed coverage of ICF components BF and BS. In the component AP patients and clinicians identified similar ICF categories, a number of which were under-sampled by AAV trials. Contextual factors appear to be significantly more relevant to patients than clinicians and researchers. Conclusion: Patients and clinicians have different views of the relevance of various AAV outcomes, and these views differ from what is measured in clinical trials of AAV. This highlights the need for a broad and standardized approach to developing and selecting outcomes for complex medical conditions such as AAV.

Parkinson disease (PD) is the second most common neurodegenerative disease worldwide, with estimates suggesting that PD prevalence and incidence will increase with aging populations. Therapeutic options and clinical guidelines for PD have significantly changed over the past 15 years; however, pharmacoepidemiology data in PD are lacking, especially regarding adverse effects of non-ergot dopamine agonists (DAs) and outcomes associated with anticholinergic burden. The objectives of this doctoral research are threefold: 1) examine patterns of antiparkinson drug use in relation to clinical guideline publication, drug availability, and emerging safety concerns; 2) determine whether PD patients treated with non-ergot DAs are at increased risk of adverse cardiovascular or cerebrovascular outcomes; and 3) determine whether anticholinergic burden is associated with adverse outcomes in PD. Specific research questions were investigated using epidemiological methods and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records for more than 300 Cerner subscribing facilities across the United States. Findings from this work are reported in a series of manuscripts, all of which have been published. Key findings include: 1) DA use began declining in 2007, from 34% to 27% in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions; 2) heart failure was the only adverse cardiovascular or cerebrovascular outcome that demonstrated a significant association with non-ergot DA use, mainly pramipexole; and 3) anticholinergic burden in PD was associated with the diagnosis of fracture and delirium, and significantly increased the risk of emergency department visit and readmission post inpatient discharge. Reported antiparkinson prescribing trends suggest that safety and best practice information may be communicated effectively in PD. Although findings warrant replication, individuals with PD and independent risk factors for or a history of heart failure may benefit from limited use of pramipexole. Similarly, individuals with PD may benefit from substituting non-PD medications with anticholinergic effects for equally effective non-anticholinergic agents. Additional pharmacovigilance studies are needed to better understand health risks and the impact of population health interventions in PD.

Le choix des critères de jugement (principal et secondaires) est une étape essentielle de la construction d’un essai contrôlé randomisé. Notre premier travail a été de réaliser une revue systématique sur la place des critères de jugement importants pour les patients ou patient-important outcomes dans les essais contrôlés randomisés en réanimation. Nous avons défini les patient-imortant outcomes comme étant la mortalité d’une part, et l’impact fonctionnel et sur la qualité de vie des séquelles de la réanimation d’autre part. En effet, en réanimation, les deux objectifs thérapeutiques principaux sont d’une part éviter le décès des patients et d’autre part réduire l’impact des séquelles à moyen et long terme chez les survivants. Nous avons montré que les patient-imortant outcomes ne représentent qu’une proportion faible (27/112, 24%) des critères de jugement principaux des essais publiés en 2013 et que pour une grande majorité il s’agissait d’un critère de mortalité. Une analyse sur les essais publiés au premier semestre 2016 a montré qu’il n’y avait pas eu d’évolution (25% des critères de jugement principaux étaient des patient-important outcomes).Puis, en réalisant une étude ancillaire de cette revue systématique, nous avons investigué l’impact potentiel des décisions de limitation(s) ou d’arrêt(s) des thérapeutiques actives quand le critère de jugement était la mortalité, et décrit les données rapportées sur ces limitation(s) ou d’arrêt(s) des thérapeutiques actives dans les essais en réanimation. Nous avons montré que très peu d’essais contrôlés randomisés en réanimation (6/65, 9%) rapportaient le taux de décision de limitation(s)ou d’arrêt(s) des thérapeutiques actives, bien que ces décisions soient fréquentes en pratique clinique. Pour explorer l’impact qu’un déséquilibre de ces décisions entre les 2 bras d’un essai pouvait avoir en termes de biais sur la mortalité, nous avons réalisé une étude de simulation. Cette étude a montré notamment que lorsque ces décisions étaient prises de façon plus tardive dans le groupe expérimental, l’intervention pouvait apparaître protectrice alors même qu’il n’existait pas de réel effet sur la survie. Enfin, nous avons conduit un essai contrôlé randomisé en réanimation (étude AKIKI, Artificial Kidney Initiation in Kidney Injury) en utilisant la mortalité comme critère de jugement principal et en rapportant le taux et le délai des décisions de limitation(s) ou d’arrêt(s) des thérapeutiques actives dans les 2 bras / The choice of relevant primary and secondary endpoints is an essential step of the design of a randomized controlled trial. In our first work, we conducted a systematic review on patient-important outcomes in randomized controlled trials in critically ill patients. Indeed, clinical decision-making by ICU physicians now pursues the goal of improving mean and long-term outcomes in survivors in addition to increasing their chance of survival. We defined patient-important outcomes as on one hand, outcomes involving mortality at any time, and on the other, quality of life and functional outcomes assessed after ICU discharge. We found that a minority of primary outcomes (27/112,24%) used in randomized controlled trials published in 2013, were patient-important outcomes and that mortality accounted for the vast majority of them. Our analysis of most recently published trials (first half 2016) showed that patient-important outcomes were used in the samelow proportions (25% of the primary outcomes were patient-important outcomes) We then addressed the question of how well withholding and with drawal of life support therapies(W-WLST) decisions were reported in RCT in critically ill patients and how such decisions could impact mortality as outcome measure in these trials. We found that W-WLST decisions, although being a daily concern in routine practice, were scarcely reported in these trials, since they appeared in only 6 of 65 (9%) during follow-up. We further explored the impact of an imbalance in such decisions between the 2 arms of a randomized controlled trial, through a simulation study. This simulation showed that the intervention could appear as protective, if the decision of W-WLST was delayed in the interventional arm, even though the intervention had no true effecton survival. Finally, we performed a randomized controlled study (Artificial Kidney Initiation in Kidney Injury,AKIKI) using mortality as primary outcome and paid attention to report the rate of W-WLSTdecisions in the 2 arms.

The current study empirically tested four models of type II diabetic patient adherence, including wellness, screening, medication, and treatment adherence. Four mediators were proposed patient understanding, agreement, trust, and motivation were tested for each model. The current study is grounded in patient-centered communication, responding to Street’s (2013) call to model pathways between communication and patient health outcomes. Moreover, the study argues that adherence, for type II diabetic patients should be conceptualized as four distinct clusters of behavior (wellness, screening, medication, and treatment). A sample of (n=817) type II diabetes patients from the U.S. under the care of a medical provider and taking medication for their type II diabetes were surveyed. Findings from the present study indicate that the relationship between patient-centered communication and patient-health outcomes is mediated by proximal outcomes. The results contribute to our understanding or patient-centered communication, patient understanding, agreement, trust, and motivation, and adherence behaviors. Resulted indicated that while three of the four proposed hypotheses were supported, the most commonly studied type of adherence (medication), the relationship between patient-centered communication and medication adherence was not mediated. The current study ends with a discussion and implication of the findings as well as directions for future research

No description available.

Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = –2.15 mg/dL, 95%CI –3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period. © / Revisión por pares