The Use of Case Based Multiple Choice Questions for Assessing Large Group Teaching: Implications on Student's Learning

The practice of assessments in third level education is extremely important and a rarely disputed part of the university curriculum as a method to demonstrate a student’s learning. However, assessments to test a student’s knowledge and level of understanding are challenging to apply given recent trends which are showing that student numbers are increasing, student demographics are wide ranging and resources are being stretched. As a result of these emerging challenges, lecturers are required to develop a comprehensive assessment to effectively demonstrate student learning, whilst efficiently managing large class sizes. One form of assessment which has been used for efficient assessment is multiple choice questions (MCQs); however this method has been criticised for encouraging surface learning, in comparison to other methods such as essays or case studies. This research explores the impact of blended assessment methods on student learning. This study adopts a rigorous three-staged qualitative methodology to capture third level lecturers’ and students’ perception to (1) the level of learning when using MCQs; (2) the level of learning when blended assessment in the form of case based MCQs are used. The findings illuminate the positive impact of cased based MCQs as students and lecturers suggest that it leads to a higher level of learning and deeper information processing over that of MCQs without case studies. The implications of this research is that this type of assessment contributes to the current thinking within literature on the use of assessments methods, as well as the blending of assessment methods to reach a higher level of learning. It further serves to reinforce the belief that assessments are the greatest influence on students’ learning, and the requirement for both universities and lecturers to reflect on the best form of assessment to test students’ level of understanding, whilst also balancing the real challenges of large class size teaching

The validity of the MacNew Quality of Life in heart disease questionnaire

BACKGROUND: A previous review suggested that the MacNew Quality of Life Questionnaire was the most appropriate disease-specific measure of health-related quality of life among people with ischaemic heart disease. However, there is ambiguity about the allocation of items to the three factors underlying the MacNew and the factor structure has not been confirmed previously among the people in the UK. METHODS: The MacNew Questionnaire and the SF-36 were administered to 117 newly admitted patients to a tertiary referral centre in Northern Ireland. All patients had been diagnosed with ischaemic heart disease. RESULTS: A confirmatory factor analysis was conducted on the factor structure of the MacNew and the model was found to be an inadequate fit of the data. A quantitative and qualitative analysis of the items suggested that a five factor solution was more appropriate and this was validated by confirmatory factor analysis. This new structure also displayed strong evidence of concurrent validity when compared to the SF-36. CONCLUSION: We recommend that researchers should submit scores obtained from items on the MacNew to secondary analyses after being grouped according to the factor structure proposed in this paper, in order to explore further the most appropriate grouping of items

The Role of Action Research in the Study of Small Business Marketing and Retailer Loyalty Card Data

The small business is challenged on a daily basis to compete in an ever demanding and ever expanding marketplace. As a result of new technologies such as market intelligence databases, small business owner-managers are playing catch–up with larger and more resource based firms in maintaining current insight into the market. Larger firms have typically been better positioned to afford and analyse the latest market intelligence data for internal marketing purposes. This study provides insight into three action research case studies through a participatory action research, investigating the ways in which traditionally informal small business owner-managers addressed marketing challenges through the utilisation of free access of formalised retailer loyalty card data for the first time in their daily business marketing activities

Marketing planning and digital customer loyalty data in small business

Purpose – Retailer loyalty card marketing intelligence presents actual customer purchasing preferences, competitor activities and performance. Typically, extant literature implies that larger firms with formal marketing planning approaches will be more able to leverage it, structured as it is within a formalized statistical format. Small business literature on the other hand emphasizes their more informal approach to marketing planning. The purpose of this paper is to consider, for the first time, the potential relationship between retailer loyalty card marketing intelligence and small business market orientation. Design/methodology/approach – A conceptual model is developed which diagrammatically interprets how retailer loyalty card marketing intelligence can relate to small business market orientation. Propositions provide a basis for further discussion with applied and research implications. Findings – A pertinent aspect of the conceptualization is the role of small business owner-manager insight and intuition within an experiential learning context. A complementary relationship is posited in the leveraging of retailer loyalty card marketing intelligence to enhance small business market orientation, which with higher levels of entrepreneurship orientation can lead to positive organizational outcomes, such as facilitating more successful and informed engagement with larger suppliers. Originality/value – The paper addresses the increasing pressure small businesses face in dealing with retailer loyalty card marketing intelligence. Generally, literature has yet to adequately address marketing planning implications for firms. The informal/formal tension when considering small businesses presents a particularly interesting area of conceptual development, integrating market orientation literature and also recent developments which point to interaction between market and entrepreneurship orientations. This paper therefore provides a basis for a new small business research agenda in an area which is highly topical and important, with a synthesis of the extant literature in developing a conceptualization and propositions. The conceptualization and propositions can facilitate the development of new research and thinking in this potentially fruitful area of future enquiry

The Complete Ethical Framework for End-of-Life Care

The Ethical Framework for End-of-life Care is part of a national programme, the Hospice Friendly Hospitals Programme (HfH) of the Irish Hospice Foundation, which is intended to improve the culture of care and organization regarding dying, death and bereavement in Irish hospitals. The Framework is an educational resource that consists of eight Modules of Learning for health professionals, patients, families and the general public. The Framework is the outcome of a unique collaboration between University College Cork, the Royal College of Surgeons in Ireland and the Irish Hospice Foundation, with contributions from ethicists, legal experts, theologians, sociologists and clinicians. It draws on a range of values and principles that have been identified as important considerations in end-oflife decision making by international experts in bioethics and by professional codes of conduct, policy documents and laws. It is also informed by extensive international research on patients’ and families’ experiences of death and dying and the contribution of health professionals and organizations to quality end-of-life care. In order to ensure that the Framework addresses the concerns of the Irish public and that it is relevant and useful to the work of health professionals involved in end-of-life care in Irish hospitals, the Framework is informed by reviews and studies involving hospice, palliative and acute care services especially commissioned by the Irish Hospice Foundation in the last decade. It also draws on a significant body of research, undertaken in 2007/2008, which specifically addresses ethical issues in relation to end-of-life care in Irish hospitals

Survey in expert clinicians on the validity of automated calculation of optimal cerebral perfusion pressure

BACKGROUND: Optimal cerebral perfusion pressure (CPPopt) targeting in traumatic brain injury (TBI) patients constitutes an active and controversial area of research. It has been suggested that an autoregulation guided CPP therapy may improve TBI outcome. Prerequisites of a CPPopt intervention study would be objective criteria for the CPPopt detection. This study compared the agreement between automated and visual CPPopt detection. METHODS: Twenty-five clinicians from 18 centers worldwide, familiar with brain monitoring and using dedicated software, reviewed ten 4-hour CPPopt screenshots at 48 hours after ictus in selected TBI patients. Each screenshot displayed the trends of cerebral perfusion pressure (CPP), intracranial pressure (ICP), cerebrovascular pressure reactivity (PRx) as well as the "CPP-optimal" curve and its associated value (automated CPPopt). The main objective was to evaluate the agreement between expert clinicians as well as the agreement between the clinicians and automated CPPopt. RESULTS : Twenty-two clinicians responded to our call (88%). Three screenshots were judged as "CPPopt not determinable" by > 45% of the clinicians. For the whole group, the consensus between automated CPPopt and clinicians' visual CPPopt was high. Three clinicians were identified as outliers. All clinicians recommended to modify CPP when patients differed >+/- 5 mmHg from their CPPopt. The inter-observer consensus was highest in cases with current CPP below the optimal value. CONCLUSIONS: The overall agreement between automated CPPopt and visual CPPopt identified by autoregulation experts was high, except for those cases when the curve was deemed by the clinicians not reliable enough to yield a trustworthy CPPopt

Baroreflex Impairment After Subarachnoid Hemorrhage Is Associated With Unfavorable Outcome.

BACKGROUND AND PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is characterized by important changes in the autonomic nervous system with potentially adverse consequences. The baroreflex has a key role in regulating the autonomic nervous system. Its role in SAH outcome is not known. The purpose of this study was to evaluate the association between the baroreflex and the functional 3-month outcome in SAH. METHODS: The study used a prospective database of 101 patients hospitalized for SAH. We excluded patients receiving β-blockers or noradrenaline. Baroreflex sensitivity (BRS) was measured using the cross-correlation method. A good outcome was defined by a Glasgow Outcome Scale score at 4 or 5 at 3 months. RESULTS: Forty-eight patients were included. Median age was 58 years old (36-76 years); women/men: 34/14. The World Federation of Neurosurgery clinical severity score on admission was 1 or 2 for 73% of patients. In the univariate analysis, BRS (P=0.007), sedation (P=0.001), World Federation of Neurosurgery score (P=0.001), Glasgow score (P=0.002), Fisher score (P=0.022), and heart rate (P=0.037) were associated with outcome. The area under the receiver operating characteristic curve for the model with BRS as a single predictor was estimated at 0.835. For each unit increase in BRS, the odds for a good outcome were predicted to increase by 31%. Area under the receiver operating characteristic curve for heart rate alone was 0.670. In the multivariate analysis, BRS (odds ratio, 1.312; 95% confidence interval, 1.048-1.818; P=0.018) and World Federation of Neurosurgery (odds ratio, 0.382; 95% confidence interval, 0.171-0.706; P=0.001) were significantly associated with outcome. Area under the receiver operating characteristic curve was estimated at 0.900. CONCLUSIONS: In SAH, early BRS was associated with 3-month outcome. This conclusion requires confirmation on a larger number of patients in a multicentre study

REACT-1 round 13 interim report: acceleration of SARS-CoV-2 Delta epidemic in the community in England during late June and early July 2021

Background Despite high levels of vaccination in the adult population, cases of COVID-19 have risen exponentially in England since the start of May 2021 driven by the Delta variant. However, with far fewer hospitalisations and deaths per case during the recent growth in cases compared with 2020, it is intended that all remaining social distancing legislation in England will be removed from 19 July 2021. Methods We report interim results from round 13 of the REal-time Assessment of Community Transmission-1 (REACT-1) study in which a cross-sectional sample of the population of England was asked to provide a throat and nose swab for RT-PCR and to answer a questionnaire. Data collection for this report (round 13 interim) was from 24 June to 5 July 2021. Results In round 13 interim, we found 237 positives from 47,729 swabs giving a weighted prevalence of 0.59% (0.51%, 0.68%) which was approximately four-fold higher compared with round 12 at 0.15% (0.12%, 0.18%). This resulted from continued exponential growth in prevalence with an average doubling time of 15 (13, 17) days between round 12 and round 13. However, during the recent period of round 13 interim only, we observed a shorter doubling time of 6.1 (4.0, 12) days with a corresponding R number of 1.87 (1.40, 2.45). There were substantial increases in all age groups under the age of 75 years, and especially at younger ages, with the highest prevalence in 13 to 17 year olds at 1.33% (0.97%, 1.82%) and in 18 to 24 years olds at 1.40% (0.89%, 2.18%). Infections have increased in all regions with the largest increase in London where prevalence increased more than eight-fold from 0.13% (0.08%, 0.20%) in round 12 to 1.08% (0.79%, 1.47%) in round 13 interim. Overall, prevalence was over 3 times higher in the unvaccinated compared with those reporting two doses of vaccine in both round 12 and round 13 interim, although there was a similar proportional increase in prevalence in vaccinated and unvaccinated individuals between the two rounds. Discussion We are entering a critical period with a number of important competing processes: continued vaccination rollout to the whole adult population in England, increased natural immunity through infection, reduced social mixing of children during school holidays, increased proportion of mixing occurring outdoors during summer, the intended full opening of hospitality and entertainment and cessation of mandated social distancing and mask wearing. Surveillance programmes are essential during this next phase of the epidemic to provide clear evidence to the government and the public on the levels and trends in prevalence of infections and their relationship to vaccine coverage, hospitalisations, deaths and Long COVID

Understanding the epidemiology of avoidable significant harm in primary care:Protocol for a retrospective cross-sectional study

Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and Analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to sixteen general practices from three areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100,000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100,000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included we will follow these instructions. We will produce a report for the Department of Health’s Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182)

Incidence, nature and causes of avoidable significant harm in primary care in England:retrospective case note review

Objective To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. Design Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded. Setting Primary care. Participants Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients). Main outcome measures The incidence of significant harm considered at least ‘probably avoidable’ and the nature of the safety incidents. Results The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines. Conclusion There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care