UTB/TSC Undergraduate Catalog 1996-1997

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The New Survivors: The Longer Term Cognitive, Scholastic and Motor Outcomes of a Total Scottish Population of Surviving Very Low Birthweight Infants

The prevalence of learning problems and impairments in cognitive ability and neuromotor functioning in a total geographically based very low birthweight population (N=324) was compared at eight years of age with that in a population comprising two classroom peers, matched for gender and age (N=590). The sociodemographic characteristics of the index and comparison groups were similar. The analyses reported in this thesis do not include those children being educated in the special school sector - as appropriate controls could not be identified. The mean IQ score for the index group was significantly lower than the mean IQ score for the comparison group. A significantly greater proportion of the index group had serious cognitive impairment, that is, they were performing more than 2 SD below the mean. The index children were found to be significantly underperforming in relation to the comparison children on tests of reading and number - although after controlling for IQ (ANCOVA) the difference between the two groups was no longer significant for reading. In terms of neuromotor competence, a significantly greater proportion of the index group than the comparison group were functioning below the 10th percentile. The 10th percentile (for the comparison group) was taken as the cut off to define motor impairment and 36% of the index group were categorised as motor impaired. Furthermore, a significantly greater proportion of the index group were classified as "suspicious" or "abnormal" in terms of their neurological status. The performance of the index children was also analysed by birthweight groupings (below 1000g and 1000 to 1499g) because of increasing clinical interest in the outcomes of children born on the limits of viability. The mean IQ scores for both index groups were significantly lower than those of their respective comparison groups. In all cognitive subscales apart from that testing short term auditory sequential memory, both index groups performed less well. Both index groups performed less well in tests of reading and number - although the differences were no longer significant after controlling for IQ. Fifteen per cent of the below 1000g index children and six per cent of those with birthweights 1000 to l499g attended special schools. Index children in both groupings who attended mainstream schools performed significantly less well in tests of neuromotor function than their peers. The differential effects of being small for gestational age (SGA) and of appropriate size for gestational age (AGA) on outcome measures of cognitive ability, scholastic attainment and neuromotor functioning were investigated. No differences were found between SGA and AGA index children, probably because the mean gestational age of the AGA children was lower than that of the SGA children. The SGA comparison children performed significantly less well on some measures of cognitive ability than the AGA comparison children. Gender differences on measures of cognitive ability, scholastic attainment and neuromotor functioning were investigated for both index and comparison groups. No gender differences were found in the index group with the exception of the ball skills element of the motor skills assessment where the performance of the females was poorer. The picture was the same for the comparison group except that, additionally, females were outperforming boys on tests of scholastic attainment. The extent to which under reporting of serious cognitive impairment can result from the use of published test norms was investigated. A larger proportion of index children were classified as seriously impaired in terms of cognitive ability when their performance was measured against norms derived from the comparison group. The same was true also for performance on measures of scholastic attainment. The possibility that motor impairment might affect performance on the visual items of the cognitive assessment battery used in this study was explored. While there was some evidence of such an effect particularly for the index children of satisfactory overall cognitive ability, the results of this investigation were inconclusive. The relationship between motor competence, neurological functioning and performance on measures of scholastic attainment was investigated. This strand of the investigation demonstrated that the test of neurological functioning used in this study is a useful screening tool for identifying children at high risk of learning difficulties

An Integrative Review of the Literature on Technology Transformation in Healthcare

Healthcare transformation through technology is a core objective of health reform. It is important for decision makers to understand the likelihood that reform policies will in fact transform. This study evaluates evidence of technology transformation in healthcare through an integrative review of the healthcare and business literature, guided by the theory of punctuated equilibrium (TPE). TPE describes the process of transformation within organizations, markets, and groups. The theory explains transformation as a pattern of long periods of incremental change (equilibrium) punctuated by short periods of dramatic change (revolution). An underlying deep structure defines the environment of the organization, market, or group. Radical change in the deep structure of the environment is necessary for transformational change. This integrative review covered the period January 2004 through April 2012. The inclusion criteria required that the article or study address both the implementation of health information technology in the United States and describe one of the three components of TPE. Five hundred twenty articles focusing on transformational change were identified through structured database searches of MedLine/PubMed, Business Source Complete, Social Science Research Network, and others. The articles were reviewed, and coded using the three elements of TPE. A directed content analysis of the coded data produced 10 themes describing the three TPE elements: variations in the environment, market complexity, regulation, flawed risk and reward, theories of technology acceptance, barriers, ethical considerations, competition and sustainability, environmental elements of revolution, and internal elements of revolution. The results describe a healthcare market exhibiting strong equilibrium and substantial resistance to change from HIT. Minimal descriptions of the revolutionary element of TPE were evident. The deep structure of healthcare indicates that the historical provider and hospital-centered market prevails. Conditions that might encourage alteration of this deep structure were: empowering and engaging patients; updating care delivery models; and reducing market uncertainty. The revolutionary changes seen in other complex markets from banking to travel to manufacturing relied heavily on the power of the consumer to alter deep structure. Although the concept of patient centeredness was present in the literature there was little clarity regarding the patient as an agent of structural change. To our knowledge this is the first application of TPE to investigate technology transformation in healthcare. Others have demonstrated TPE as a viable model for explaining transformational change in other markets. The study is limited by the study timeframe and the absence of newer literature reflecting the impact of recent policy changes. Despite this limitation the findings suggest that TPE presents a potentially valuable framework to guide evaluation of the progress of policies that encourage transformation from technology. Some propose that altering the complex deep structure of healthcare may require a complete destruction of existing processes before new processes, innovations, and technologies can emerge. The Affordable Care Act (2010) and the meaningful use provisions of the HITECH Act (2009) are moving healthcare toward new patient centered models of care. Uncertainty around the future of reform policies from possible repeal or amendment likely contributes to resistance to transformational change. This may perpetuate the historical rational and incremental pattern of HIT advancement. Patients as consumers have the potential to influence change given the appropriate tools. The importance of consumers to the transformation process suggests that policies fostering technologies that integrate patients into new care delivery models are likely paramount to realizing technological transformation