Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study

Background. Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages. Design and methods. The mixed methods case study was undertaken in a regional general practice in Victoria, Australia, utilising patient questionnaires, waiting room observations, and clinician logbooks and interviews. The qualitative data were analysed by content analysis; the questionnaire data were analysed using descriptive statistics. Results. Patients engaged with a range of health information in the waiting room and reportedly received health messages from this information. 44% of the questionnaire respondents (33 of 74) reported watching the television health program, and half of these reported receiving a take home health message from this source. Only one of the clinicians (N=9) recalled a patient asking about the televised health program. Conclusions. The general practice waiting room remains a site where people engage with the available health information, with a televised health ‘infotainment’ program receiving most attention from patients. Our study showed that consumption of health information was primarily passive and tended not to activate patient discussions with clinicians. Future studies could investigate any link between the health infotainment program and behaviour change.N/

Using Computer Technology to Enhance Problem-Based Learning

The focus of this paper is on how computer technology can be used to enhance the effectiveness of clinical problems in a problem-based medical curriculum. Visual/audio triggers are being used in the medical course at The University of Melbourne to set the stage for clinical problems by introducing students to a virtual patient, and to some of the circumstances surrounding the hypothetical situation. Digitised photographs, Shockwave movies, digitised video segments or a combination of these media types act as entry portals into the on-line "problems of the week". In designing the triggers our aim was to create authentic images that would "suspend the disbelief" of students and allow them to approach each problem as if it were a real life clinical scenario

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals\u27 learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals\u27 learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings

The Evolution of Computer-based Tutorials Towards Web Delivery

The Biochemistry Department at Melbourne University has been committed to the use of computer aided learning (CAL) since the early 1980s. Limitations of early modules written in the department were increasingly apparent, as computer technology became more versatile and sophisticated. However, these modules represented considerable investment of time in academic content, multiple choice question formulation and graphic production, and in an environment of reducing resources and increasing demands, preservation of this investment was important. We explored the possibilities of salvaging the value of our early CAL modules and presenting the content to students in a more accessible format. This paper outlines our approach to preserving the academic content and increasing the versatility of early DOS based CAL modules by converting them to Windows based and web deliverable formats

Can technology-assisted peer learning improve performance and social connections in an undergraduate biology cohort?

Background The transition from school to University can be a challenging time for students, with changes to the expected mode of learning, pace, level of difficulty and degree of independence. Large and growing cohort sizes in foundational (first-year) subjects at many universities may exacerbate these challenges, potentially increasing student anonymity and cohort disconnection, with potentially negative consequences for learning outcomes and the student experience. However, the potential impact of enrolment numbers on learning outcomes and social connectedness remain poorly understood, and there are few evidence-based studies of potential interventions to address these problems. Aims We conducted an experimental evaluation of the effectiveness of a novel implementation of computer-assisted peer instruction (CAPI) in tutorial classes in a large (n=2,000 enrolments) first year biology subject at a research-intensive Australian university, to determine whether this intervention a) improved student performance and b) promoted social connections between students. Description of intervention Our intervention was the trial of a novel form of tutorial in which students used mobile devices to participate in firstly individual, and subsequently team-based assessments, using the team-based mode of the Learning Catalytics platform (Pearson Education). Design and methods We used a longitudinal crossover study to test the effectiveness of our intervention. During two 2-week blocks of the teaching semester (the first early in semester, and the second late in semester), one half of all weekly scheduled tutorials (n=35 tutorials of approximately 30 students each) used Learning Catalytics, while the other half were run using a traditional tutorial format on the same topic. The following week based on a new topic, the arrangement was reversed, with students who had previously attended a Learning Catalytics tutorial now attending a traditional tutorial, and vice versa,. Student participation in tutorials, engagement with biology topics and social connectedness were measured (using online analytics and written questionnaires). We compared responses across the two tutorial types, and correlated participation with student performance on relevant questions in the mid-semester test and the end-of-semester exam. Results and conclusions Our study was conducted in Semester 1, 2016, and at the time of submission of this abstract, the study had only recently concluded, so results were not yet available. These will be presented at the conference. We will discuss the outcomes of the study and highlight technical challenges associated with the implementation of this initiative at scale

Educating the next generation of bioscientists: the challenge for higher education in Australia

Traditional science boundaries continue to be challenged, thereby creating broader employment opportunities for appropriately skilled graduates. However, many factors including limited time and resources, diverse student cohorts and large student numbers, may limit good practice when it comes to developing highly skilled bioscientists. Within this context, it is timely to examine the role of undergraduate teaching in educating the next generation of bioscientists. This paper describes preliminary findings from a project supported by the Australian Learning and Teaching Council, which is examining current teaching practice in bioscience disciplines. The project is using a qualitative research framework to identify innovative approaches used by educators to enhance the scientific inquiry capabilities of their students. Twenty cases have been studied where the priority to teach scientific inquiry skills has influenced the design of the teaching approach. Cases have been identified from nine universities across five states. In general, the approaches are variations of inquiry or problem-based learning, and have been delivered through online environments, laboratory classes and lectures. Skills that educators aim to develop include: formulation of research questions and hypotheses; experimental design; critical appraisal of literature and ideas; collaboration; communication of arguments and findings. Educational technology has been used to provide solutions for distance and asynchronous communication, collaboration, incorporation of immediate learner feedback, and has been used in numerous ways to enhance the learning experience. While the extent of implementation was diverse, there were some interesting overlaps in strategies

Small molecule activators of SIRT1 replicate signaling pathways triggered by calorie restriction in vivo

<p>Abstract</p> <p>Background</p> <p>Calorie restriction (CR) produces a number of health benefits and ameliorates diseases of aging such as type 2 diabetes. The components of the pathways downstream of CR may provide intervention points for developing therapeutics for treating diseases of aging. The NAD⁺-dependent protein deacetylase SIRT1 has been implicated as one of the key downstream regulators of CR in yeast, rodents, and humans. Small molecule activators of SIRT1 have been identified that exhibit efficacy in animal models of diseases typically associated with aging including type 2 diabetes. To identify molecular processes induced in the liver of mice treated with two structurally distinct SIRT1 activators, SIRT501 (formulated resveratrol) and SRT1720, for three days, we utilized a systems biology approach and applied Causal Network Modeling (CNM) on gene expression data to elucidate downstream effects of SIRT1 activation.</p> <p>Results</p> <p>Here we demonstrate that SIRT1 activators recapitulate many of the molecular events downstream of CR <it>in vivo</it>, such as enhancing mitochondrial biogenesis, improving metabolic signaling pathways, and blunting pro-inflammatory pathways in mice fed a high fat, high calorie diet.</p> <p>Conclusion</p> <p>CNM of gene expression data from mice treated with SRT501 or SRT1720 in combination with supporting <it>in vitro </it>and <it>in vivo </it>data demonstrates that SRT501 and SRT1720 produce a signaling profile that mirrors CR, improves glucose and insulin homeostasis, and acts via SIRT1 activation <it>in vivo</it>. Taken together these results are encouraging regarding the use of small molecule activators of SIRT1 for therapeutic intervention into type 2 diabetes, a strategy which is currently being investigated in multiple clinical trials.</p

Hypertension and type 2 diabetes: What family physicians can do to improve control of blood pressure - an observational study

Background: The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice. Methods: We conducted a practice- based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient’s medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM). Results: Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure. Conclusions: When primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented strategies to improve adherence

Global Transcriptional Analysis of Spontaneous Sakacin P-Resistant Mutant Strains of Listeria monocytogenes during Growth on Different Sugars

Subclass IIa bacteriocins have strong antilisterial activity and can control the growth of Listeria monocytogenes in food. However, L. monocytogenes may develop resistance towards such bacteriocins. In this follow-up study, the transcriptomes of a high level (L502-1) and a low level (L502-6) spontaneous sakacin P-resistant mutant strain of L. monocytogenes were compared to the wild-type (L502). The growth of the resistant strains was reduced on mannose but not affected on cellobiose and the transcriptomics was performed during growth on these sugars. The mannose phosphotransferase system (PTS) encoded by the mptACD operon (mpt) is known for transporting mannose and also act as a receptor to class IIa bacteriocins. The mpt was repressed in L502-1 and this is in accordance with abolition of the bacteriocin receptor with resistance to class IIa bacteriocins. In contrast, the mpt was induced in L502-6. Despite the induction of the mpt, L502-6 showed 1,000 times more resistance phenotype and reduced growth on mannose suggesting the mannose-PTS may not be functional in L502-6. The microarray data suggests the presence of other transcriptional responses that may be linked to the sakacin P resistance phenotype particularly in L502-6. Most of commonly regulated genes encode proteins involved in transport and energy metabolism. The resistant strains displayed shift in general carbon catabolite control possibly mediated by the mpt. Our data suggest that the resistant strains may have a reduced virulence potential. Growth sugar- and mutant-specific responses were also revealed. The two resistant strains also displayed difference in stability of the sakacin P resistance phenotype, growth in the presence of both the lytic bacteriophage P100 and activated charcoal. Taken together, the present study showed that a single time exposure to the class IIa bacteriocin sakacin P may elicit contrasting phenotypic and transcriptome responses in L. monocytogenes possibly through regulation of the mpt