Dissemination Of Educational Materials Research Articles

Multicentric Clinical Audit of Chemotherapy Administration for Lymphoprolipherative Diseases in Day Hospital Patient Setting

Introduction Chemotherapy (CHT) administration is a high risk process. In particular, in the Day Hospital (DH) patient setting, the potential toxicity of medications is coupled with some organizational aspects, e.g. rapid patient turnover, multiprofessional involvement, lack of continuity of medical care, which can increase the risk of adverse events. The aim of this study was to evaluate the appropriateness of CHT administration for lymphoprolipherative disease in DH setting and the quality of medical charts, by using clinical audit. Audit is a quality improvement process that allows improvement of patient care and outcome through systematic review of care against explicit criteria and the implementation of change. The following evidence-based criteria were established for reviewing CHT administration: o CHT treatment plan (including histology, stage, goals of therapy, patient's performance status, co-morbidities, CHT regimen) must be established prior to the initiation of CHT, and reported on medical record o CHT treatment summary (including number of cycles administered, extent of dose reduction and/or delay, reason for treatment delay or discontinuation, major toxicities or unexpected hospitalizations, biochemistry data) must be reported in medical records o Maintaining dose-density and dose-intensity may improve clinical outcome; the appropriate use of G-CSFs, in order to prevent neutropenia-related dose reduction or time delay, is particularly relevant when the intent of treatment is curative or to prolong survival o Inclusion of informed consent form in medical records is recommended, in order to verify the informative process and complete patient identificationPatients and methods A random sample of 15% of all CHT courses administered for Lymphoma and Chronic Lymphocitic Leukemia from July 2006 to June 2007 in five Hematological DHs was analysed. A total of 282 courses were examined: 87 ABVD, 122 CHOP(R) and 73 FC(R). We collected data about patients, chemotherapy and medical charts. Patients' clinical characteristics were similar between participating centres. Dose or time violations were considered significative if exceeding one day or 10% of scheduled timing or dosing, respectively.Results Results are reported in Table 1 and 2Tab 1: courses with dose reduction or delayCHOP(R) (%)ABVD (%)FC(R) (%)Total (%)Dose reduction30/122 (24,6)9/87 (10,3)5/73 (6,8)44/282 (15,6)Delay43/11636/84 (42,9)24/73103/273 (37,7)Tab 2: causes of dose or time violationDose reduction (%)Delay (%)Extra-hematological toxicity14/44 (31,8)6/103 (5,8)Neutropenia3/44 (6,8)27/103 (26,2)Infection-17/103(16,5)Other clinical reasons (age, PS, comorbidity)17/44 (38,7)3/103 (2,9)Organizational causes-25/103 (24,3)Not reported10/44 (22,7)25/103 (24,3)Pre-therapy biochemistry was available in 279/282 cycles (99%), while informed consent form was included in 131/282 (46.5%) medical charts. Post-therapy follow up revealed 4 unexpected hospitalizations.Conclusions Three main problems emerged:a lot of patients delayed treatment due to organizational causes (e.g. intermediate radiological restaging, holidays, lack of bed, biochemistry pending);in too many cases medical charts lacked causes of dose reduction (22,7%) or delay (24,3%);could guidelines driven use of G-CSF have prevented neutropenia-related delay? At the end of clinical audit, an action plan should be developed to improve the care process.In our study we induced and supported changes in the CHT administration process by various means: dissemination of educational material (as guidelines), interactive educational interventions, professional reminders, decision support. One year after a re-audit will be performed, in order to assess expected improvement.

Impact of information technology in academia

PurposeThe purpose of this paper is to study the provisions of information technology (IT) for development of academic resources and examines the effect of IT in academic institutions for sharing information.Design/methodology/approachThe paper examines the role of IT in sharing information in academic institutions and explores the IT effectiveness in an academic context that is used to improve efficiency and effectiveness of creation and sharing of information among people.FindingsThe paper finds that the rapid pace of change in IT is increasingly influencing the creation, publication and dissemination of educational materials and sharing information. IT facilitates connections across disciplinary, institutional, geographical, and cultural boundaries. Taken together, the computational and communication capabilities in IT offer great promise for supporting continual improvements in academia. They also underscore the need for credible research into the practical benefits and limitations of teaching and learning in settings enchanced by IT.Originality/valueThe paper provides useful suggestions for colleges and universities, which must recognize that, increasingly, the influence and demands of their respective IT ventures extend beyond physical locations that include remote or distance learners, part‐time students, collaborations with industry and consortia of other institutions. The construction of a unified IT infrastructure should be responsive to the needs of all its users in academia. IT development and implementation must demonstrate definable benefits to academia.

Sustainable engineering: a model for engineering education in the twenty-first century?

How do we design a sustainable built environment for ten billion people? What policies, economic structures and social structures will move us in this direction? These are questions that challenge contributors to and readers of this journal. They are also questions that challenge engineering educators, training the designers who will create the built environment of the twenty-first century. Engineering educators often describe their curricula with the metaphor of a toolbox. Engineering principles of mass conservation, energy conservation, and thermodynamics, to name just a few, can be viewed as powerful tools for solving problems and designing processes and products. An engineering education makes students proficient users of these tools. Yet if the toolbox is too limited, the designs created using those tools can be ineffective. To repeat an overused cliche, if the only tool you have is a hammer, everything looks like a nail. An engineering education also teaches our future designers to focus. From the earliest stages of an engineering education, students are taught to draw a ‘‘box’’ around the system to be analyzed, and to limit their attention to that boxed system. This is a necessary and powerful concept in engineering education, yet there is an increasing need to teach students to consider factors that are ‘‘out of the box’’. Engineering education needs new approaches that enlarge the box, and that give students the tools to effectively treat more complex problems, like the design of sustainable systems. How can engineering educators, practicing engineers and designers of all sorts, enlarge the box and create new tools? There are no simple answers, but offered here are some basic thoughts, using tools needed for the design of sustainable technologies as an example. As a case study of the process of enlarging the box and creating new tools for engineering design, consider the decisions surrounding how to provide personal mobility. In most of North America, personal mobility is achieved through the automobile. The choice of the automobile as the provider of personal mobility necessitates other decisions involving land use, fuel infrastructures, industrial supply chains, and societal investments in roadways. These levels of impact, associated with mobility decisions, are shown conceptually in Fig. 1. A first set of design questions (represented by the innermost layer of Fig. 1) are the choices faced by a parts engineer. In selecting the materials for a bumper/ front end, for example, the engineer could select galvanized steel or a composite, glass-reinforced plastic. Which bumper is better? Like many engineering decisions, this decision can be viewed from environmental, economic and social perspectives. The galvanized steel can be far more effectively recycled, yet the plastic composite will lead to greater fuel efficiency over the life of the vehicle. The steel bumper may be less costly to repair, resulting in different costs of ownership than the glass composite bumper. And, there may be different levels of passenger safety offered by the two materials. New analysis tools, such as environmental life cycle assessments (Curran 1996), have emerged to allow designers to address some of the multifaceted attributes of their designs. These types of analysis methods should become part of the engineer’s toolbox. The next level of questions and tools, represented by the second layer from the center in Fig. 1, considers supply chain impacts. For automobiles, how are parts manufacturers, automotive repair shops, coal producers, The authors have jointly formed the Center for Sustainable Engineering (http://www.csengin.org), which is dedicated to the development and dissemination of educational materials for incorporating concepts of sustainability into engineering curricula.

Barriers to HIV/AIDS knowledge and prevention among deaf and hard of hearing people

This study investigated knowledge about HIV/AIDS and barriers to HIV/AIDS education and prevention among deaf and hard of hearing people. Focus groups and individual interviews were used to elicit information from various groups of people with a hearing loss in different regions of New York State. Themes elicited in the interviews suggested that deaf sign language users are less knowledgeable about HIV/AIDS than oral deaf and hard of hearing participants, and that deaf adolescents have more knowledge than deaf adults. These findings likely reflect differences in levels of education and English proficiency. In addition, participants living in urban areas and in sizeable deaf communities are more exposed to information about HIV/AIDS than other participants. All participants reported difficulties in communication with medical providers, limiting their access to health information and proper medical care. Recommendations for the design and dissemination of educational materials and greater access to services for deaf and hard of hearing people are provided.

Effectiveness and efficiency of guideline dissemination and implementation strategies.

To undertake a systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies. To estimate the resource implications of these strategies. To develop a framework for deciding when it is efficient to develop and introduce clinical guidelines. MEDLINE, Healthstar, Cochrane Controlled Trial Register, EMBASE, SIGLE and the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group. Single estimates of dichotomous process variables were derived for each study comparison based upon the primary end-point or the median measure across several reported end-points. Separate analyses were undertaken for comparisons of different types of intervention. The study also explored whether the effects of multifaceted interventions increased with the number of intervention components. Studies reporting economic data were also critically appraised. A survey to estimate the feasibility and likely resource requirements of guideline dissemination and implementation strategies in UK settings was carried out with key informants from primary and secondary care. In total, 235 studies reporting 309 comparisons met the inclusion criteria; of these 73% of comparisons evaluated multifaceted interventions, although the maximum number of replications of a specific multifaceted intervention was 11 comparisons. Overall, the majority of comparisons reporting dichotomous process data observed improvements in care; however, there was considerable variation in the observed effects both within and across interventions. Commonly evaluated single interventions were reminders, dissemination of educational materials, and audit and feedback. There were 23 comparisons of multifaceted interventions involving educational outreach. The majority of interventions observed modest to moderate improvements in care. No relationship was found between the number of component interventions and the effects of multifaceted interventions. Only 29.4% of comparisons reported any economic data. The majority of studies only reported costs of treatment; only 25 studies reported data on the costs of guideline development or guideline dissemination and implementation. The majority of studies used process measures for their primary end-point, despite the fact that only three guidelines were explicitly evidence based (and may not have been efficient). Respondents to the key informant survey rarely identified existing budgets to support guideline dissemination and implementation strategies. In general, the respondents thought that only dissemination of educational materials and short (lunchtime) educational meetings were generally feasible within current resources. There is an imperfect evidence base to support decisions about which guideline dissemination and implementation strategies are likely to be efficient under different circumstances. Decision makers need to use considerable judgement about how best to use the limited resources they have for clinical governance and related activities to maximise population benefits. They need to consider the potential clinical areas for clinical effectiveness activities, the likely benefits and costs required to introduce guidelines and the likely benefits and costs as a result of any changes in provider behaviour. Further research is required to: develop and validate a coherent theoretical framework of health professional and organisational behaviour and behaviour change to inform better the choice of interventions in research and service settings, and to estimate the efficiency of dissemination and implementation strategies in the presence of different barriers and effect modifiers.

Implementing clinical guidelines: Current evidence and future implications

One of the most common findings from health services research is a failure to routinely translate research findings into daily practice. Previous systematic reviews of strategies to promote the uptake of research findings suffered from a range of methodologic problems that have been addressed in a more recent systematic review of guideline dissemination and implementation strategies. Changes in practitioner behavior; in the desired direction, were reported in 86% of the comparisons made. The median effect size overall was approximately 10% improvement in absolute terms. The review suggests that interventions that were previously thought to be ineffective (e.g., dissemination of educational materials) may have modest but worthwhile benefits. Also, multifaceted interventions, previously thought to be more effective than single interventions, were found to be no more effective than single interventions. Overall, there is an imperfect evidence base for decision makers to work from. Many studies had methodologic weaknesses, and reporting of this kind of research is generally poor, making the generalizability of study findings frequently uncertain. A better theoretical underpinning of studies would make this body of research more useful.

A Review of Integrated Coastal Management Educational Materials in the Philippines and Indonesia: Matching Materials with Needs

This article explores existing educational materials available to support integrated coastal management (ICM) in the Philippines and Indonesia. Emphasis is placed on materials gathered from informal education institutions (i.e., nongovernmental organizations, donor-sponsored projects, national initiatives, etc.). Over 100 sets of educational materials were collected and evaluated based upon criteria such as interactive qualities, availability, target audience, geographical focus, etc. Several deficiencies and gaps in the content and coverage of ICM materials were observed. Most significantly, it appears that improved coordination of education programs and dissemination of educational materials is needed. Accessibility and the choice of delivery mechanism (i.e., books, Internet, videos, etc.) also emerged as important considerations when designing educational materials. Surveys conducted with ICM practitioners in the Philippines and Indonesia further illustrate the challenges and opportunities in ICM education. Findings from the assessment of educational materials and surveys facilitated the development of several recommendations for future ICM educational materials, including improved local-level ICM education and focusing on ICM and ICM process sustainability.

Public education projects in skin cancer. Experience of the Canadian Dermatology Association.

The mandate of the Canadian Dermatology Association's Sun Awareness Program is to increase awareness of the dangers of the sun's ultraviolet (UV) rays and to provide information on prevention and early detection of skin cancer. Major projects include an annual national press campaign, which reaches an increasing number of Canadians each year, and the production and distribution of educational materials. Each year during Sun Awareness Week, screening stations have been established across the country, staffed by volunteer dermatologists and members of the Canadian Cancer Society. In Vancouver between 1991 and 1993, 1767 people were screened for skin cancer. Results indicate that these events can attract people at risk for skin cancer, even though people older than age 65 are probably underrepresented as a group. Although popular with the public, these screenings are difficult to organize and are limited by human resources. These events continue in limited numbers, because they provide an excellent venue for the dissemination of educational material. Cooperation with federal agencies has been a major focus of the program. For the past 2 years, educational material on protecting newborns and children from the sun has been made available free to every new mother in Canada, while Environment Canada's Ultraviolet index program provides daily information on UV intensity along with public health messages. With the realization that health promotion requires a sustained change in behavior of an individual, we are now embarking on a national program to evaluate the knowledge, attitudes, and behavior of Canadians concerning UV radiation. With this information, we hope to adapt our educational materials so that people will adopt and maintain healthy behavior choices while out in the sun.

The role of UoSAT spacecraft in space education

Traditionally, the role of satellites within education has been seen as that of a common-carrier for the dissemination of educational materials, particularly into areas poorly served by conventional communications networks.Whilst UoSAT-2 can play this role admirably using its Digital Communication Experiment payload and Bulletin Service, both the UoSAT spacecraft have gone further by providing the first dedicated school's experiments, which stimulate a growing interest in space technology, both in the UK and abroad, via direct and active participation by school groups.The UoSAT Programme offers schools, colleges and universities a unique opportunity to take a direct part in space research, with the minimum of cost and complexity. The data provided by the two UoSAT satellites are of such a quality and quantity that they are having a significant impact on science teaching in the UK, and fit in very well with the new criteria laid down for the GCSE examinations. Further, a postgraduate Masters Degree Course in Satellite Communications Engineering has been established at the University of Surrey to help prepare student engineers for the space industry.The provision of educational satellites and the establishment of a support network based around the National Resource Centre for Satellites in Education (within the U0SAT Unit) has provided the UK with a valuable resource for the improvement of technical education nationally, whilst also stimulating young people to consider engineering (particularly space engineering) as a career.

Comparison of Media for Substance Abuse Education in Rural Communities

A study was done in Orangeburg County, South Carolina, to compare the effectiveness of the various mass media, television, radio, and newspaper, for the dissemination of educational material about substance abuse. Effectiveness of the media in reaching certain subpopulations defined by race, sex, income, age, and population density was also examined. It was found that the radio medium was generally less effective than the others. Furthermore, it was found that Blacks and Whites differed in the extent to which they were reached by radio and television.

A panel session on “digital system education”

This panel is composed of the chairmen of the task forces of the DISE (Digital Systems Education Committee). DISE is a project sponsored by the NSF and managed by University of Pittsburgh for the purpose of generation and dissemination of educational material on all aspects of digital system education. The panel members will discuss the current activities of these task forces and then seek the audience's participation in learning more about the status and need of current digital system education.

Food Waste in Distribution and Use

NTIL recently, increasing the Nation's food supply to meet war needs has been regarded almost entirely as a production problem. The focal point for securing increased food production has been the farm. Truly, the farmer who plants and harvests a bushel of potatoes or wheat is the cornerstone of the physical process of production. Yet the size of our food supply is not entirely dependent on production. After the farmer produces food, the amount that reaches the consumer depends on the care taken in marketing and using it. Thus, maintaining a bushel of potatoes in sound condition after production may be considered equally as productive as the production of the potatoes. Every bushel of potatoes conserved that otherwise might be spoiled adds to the food supply of the Nation. The 1943 food program anticipated a production increase of about three percent over 1942 production. This anticipated increase may be contrasted with the amount of food waste that ordinarily occurs after production. Such waste has been variously estimated at from 5 to 40 percent of production,1 depending on the commodity in question. The Nutrition and Food Conservation Branch, Food Distribution Administration, estimates the over-all food wastage at 20-30 percent of all food production.2 If any part of this waste is saved, an addition to the Nation's food supply has been made. The Food Distribution Administration is conducting campaigns to encourage consumers and handlers of food to reduce food waste to a minimum. Its program includes, among other activities, the dissemination of educational material on food conservation by way of