Implementation of adherence support for patients with hypertension despite antihypertensive therapy in general practice: a cluster randomized trial.

Item does not contain fulltextBACKGROUND: Uncontrolled hypertension despite treatment is highly prevalent among hypertension patients. Electronic monitoring of medication adherence has been proven to be effective in improving blood pressure. The aim of the study was to compare the effectiveness of intensive support for implementation of this tool in community pharmacies with minimal implementation support. METHODS: In a cluster randomized trial, 25 control pharmacies received a manual and 32 experimental pharmacies received intensive support to enhance implementation of electronic monitoring. Primary outcome: the number of patients included for electronic monitoring. Secondary outcomes included mean change in systolic blood pressure (SBP) and percentage of patients with adequate SBP control. RESULTS: The experimental group yielded consistently higher scores on all the steps of the implementation process than the control group, but none of these differences were significant. The mean number of patients per pharmacy included for electronic monitoring in a 3-9-months period was 1.6 in the experimental group vs. 1.0 in the control group (difference = 0.7, 95% confidence interval = -0.4; 1.7). The following patient outcomes were pooled because there were no differences between the experimental and the control group. Mean change of SBP/diastolic blood pressure (DBP) was -12 and -6 mm Hg, respectively, SBP dropped <140 mm Hg in 20.9% of all patients. In 13.6% of all patients control of SBP was achieved without treatment intensification. CONCLUSION: The intensive implementation program enhanced pharmacist performance, but appeared insufficient to overcome all problems with the implementation of electronic monitoring. The major restrictive factors concerned general practitioner (GP) involvement and the identification of eligible patients.1 september 201

[[alternative]]A study of learning outcomes of project-based learning for university students

碩士[[abstract]]本研究旨在探討淡江大學大學生專題導向學習之學習成果調查研究，包含專案管理、批判性思考、創造力、團隊合作、溝通表達、資訊素養、自我成長共七個面向，並且瞭解大學生人口變項、課程實施變項對專題導向學習之學習成果影響，以提供專題導向學習課程設計規劃及課程發展建議。本研究採自編「大學生專題導向學習之學習成果調查研究問卷」進行調查，學習成果為學生自我認同之學習獲得情形，同意程度採Likert五點量表計分，本問卷之整體信度Cronbach’s α值為.964。本研究針對淡江大學102學年度專題導向學習課程學生，共計發放問卷365份，回收有效問卷285份，有效問卷回收率91%。 本研究結果如下： 一、學生參與專題導向學習整體習成果平均得分為3.95，顯示學生學習成果的獲得與學習感受良好。學習成果依面向由高至低排序為：溝通表達、團隊合作、自我成長、創造力、資訊素養、批判性思考、專案管理。 二、在學生的人口變項方面，性別變項在專題導向學習成果表現無顯著差異，學院變項在專題導向學習成果表現有顯著差異。 三、在課程實施變項中，小組角色、定期小組會議、定期檢視進度在專題導向學習成果表現有顯著差異。 本研究提出以下建議： 一、對實施專題導向學習課程之建議 （一）在專題導向學習課程，小組角色可輪流擔任，讓小組成員都有互相學習的機會。 （二）專題導向學習課程進行過程中，需要運用專案管理的專業知識及技術，建議在大學生課程設計或專題導向學習課程的實施，加強專案管理知識。 （三）專題指導老師在專題導向學習課程扮演重要的角色，在課程的設計上老師應適切的發揮其角色功能。 二、對未來研究的建議 （一）本研究因收集樣本較少，在研究之解釋性相對較低，建議未來研究者，可擴大抽取樣本面向及樣本數。 （二）本研究僅實施調查淡江大學，後續研究者可擴大學校數，全面了解大學校院專題導向學習的成果，並比較不同實施方式的學習成果。[[abstract]]The purpose of this study is to investigate learning outcomes of project-based learning by students of Tamkamg University; seven dimensions including , project- management, critical thinking, creativity, teamwork, communicative literacy, information literacy and personal development were considered. In order, to provide advice and suggestion, this study analyzed the variable differences in learning outcomes by understanding the effect of student population change, and project-based curriculum design. The results of the study provide suggestions for the improvement of future implementation of project-based lessons and curriculum design courses for Tamkang University. The research questionnaire titled, " The study of learning outcomes by university student through project-based learning questionnaire" was developed by using Likert scales ranging from 1 to 5 points to measure the effect of project-based learning learning outcomes. The questionnaires were sent to 365 students whom were enrolled in project-based lesson courses for the academic year of 2013 and there were 285 returned with 91% of valid rate. The reliability of the questionnaire is .964 of Cronbach’s α. The conclusion of the research were summarized as follows: 1.The average degree of learning outcomes whom had participated in project-based learning courses is 3.95, which means most of the students agreed that they have learned well from project-based learning. The 7 dimensions, the rankings of learning outcomes are listed from high to low as follows: (1)communicative literacy, (2)teamwork, (3)personal development, (4)creativity (5)computer literacy, (6)critical thinking, and (7) project-management. 2.The learning outcomes varied with different variables. The variable student population, showed that gender showed no significant difference in learning outcome for project-based learning. However, student in different academic department showed significant difference in learning outcome for project-based learning courses. 3.While the variables, implementation of project-based curriculum courses, significant difference in learning outcome for project-based learning were found in students'' team role, periodic team meetings, and periodic progress reviews. The following suggestions were made for the future practice and research: 1.Suggestions for Project-based curriculum design: (1) Students can rotate and take on different roles on the team for project-based learning lessons. So to provide every member with opportunity to gain different learning experiences. (2) During on-going project-based learning lessons, large amount of professional knowledge and expertise in project management needs to be applied. Thus it is advise that when designing and implementing project-based learning curriculums, emphasis on strengthening student project management knowledge is to be enforced. (3) Professors'' instructing, play an important role in project-based learning courses, it is recommended that the role of the instructor is to be defined. 2.Suggestions for future research (1) Due to the small sample size collected in this study, relatively low explanatory research association were made. Therefore, the expansion in the number of sample size is suggested for future research. (2) To investigate and compare the learning outcomes and implementation of different project-based learning programs among different universities.[[tableofcontents]]目次 第一章　緒論 1 第一節 研究背景與動機 1 第二節 研究目的與問題 8 第三節 名詞釋義 9 第四節 研究範圍與限制 11 第二章 文獻探討 13 第一節 專題導向學習意涵 13 第二節 專題導向學習成果及其影響因素 18 第三節 國內專題導向學習學習成果研究現況 32 第三章 研究設計與實施 39 第一節 研究架構 39 第二節 研究流程 41 第三節 研究對象與抽樣方法 43 第四節 研究工具之編製 46 第五節 研究實施程序 51 第六節 資料處理 52 第四章 研究結果與討論 55 第一節 專題導向課程學生基本資料 55 第二節 大學生專題導向學習之學習成果 61 第三節 基本資料變項對專題導向學習學習成果之差異分析 72 第五章 研究結論與建議 81 第一節 研究結論 83 第二節 建議 85 參考文獻 88 中文部份 88 英文部分 90 附錄一「專題導向學習成果」問卷 92 表次 表2-2-1專題導向學習成果「七個C」技能表： 21 表2-2-2專題導向學習學習成果內涵綜整表 25 表2-3-1國內大學生專題導向學習實證研究 35 表3-3-1淡江大學102學年度專題導向學習課程修課學生人數 43 表3-3-2淡江大學102學年度各學院專題導向學習課程修課學生人數 44 表3-3-3抽樣、發放與回收數量統計表 45 表3-4-1專題導向學習成果面向及題目內容對照表 48 表4-1-1學生人口變項分佈統計表 56 表4-1-2學生課程實施方式分佈統計表 58 表4-2-1學習成果各面向與各項目平均數排序統計表 62 表4-2-2專案管理面向之項目排序 65 表4-2-3批判性思考面向之項目排序 66 表4-2-4創造力面向之項目排序 67 表4-2-5團隊合作面向之項目排序 68 表4-2-6溝通表達面向之項目排序 68 表4-2-7資訊素養面向之項目排序 69 表4-2-8自我成長面向之項目排序 70 表4-3-1性別與學習成果面向t檢定差異分析表 72 表4-3-2學院與學習成果面向單因子變異數差異分析表 73 表4-3-3小組角色與學習成果面向t檢定差異分析表 75 表4-3-4 題目設定方式與學習成果面向t檢定差異分析表 76 表4-3-5課程有無分組與學習成果面向t檢定差異分析表 76 表4-3-6小組人數與學習成果面向單因子變異數差異分析表 77 表4-3-7小組工作會議頻率與學習成果面向t檢定差異分析表 79 表4-3-8老師每週檢視進度與學習成果面向單因子變異數差異分析表 80 圖次 圖3-1-1 研究架構 40 圖3-2-1 研究流程圖 42 圖3-3-1 抽樣程序圖 45[[note]]學號: 798730239, 學年度: 10