Initial design principles for establishing a learning community for public health professionals through authentic e-learning

The storage, transportation and distribution of time and temperature sensitive pharmaceutical products (TTSPPs) such as vaccines within the appropriate temperature conditions are important public health concerns. The personnel who handle pharmaceutical products must have high levels of expertise so they can take actions to ensure that the TTSPPs are not negatively affected by sub-standard practices. This paper describes the first phase of a multi-year educational design research project designed to enhance expertise in the field of pharmaceutical cold chain management. The paper describes the process of developing design principles to guide the conceptualisation and prototyping of authentic e-learning capable of enabling public health personnel to develop the skills required for effective pharmaceutical cold chain management and to establish a learning community extending beyond the course. Five design principles are shared along with examples of how they were instantiated in the prototype e-learning

Acute Treatment Effects on GFR in Randomized Clinical Trials of Kidney Disease Progression

Background: Acute changes in GFR can occur after initiation of interventions targeting progression of CKD. These acute changes complicate the interpretation of long-term treatment effects. Methods: To assess the magnitude and consistency of acute effects in randomized clinical trials and explore factors that might affect them, we performed a meta-analysis of 53 randomized clinical trials for CKD progression, enrolling 56,413 participants with at least one estimated GFR measurement by 6 months after randomization. We defined acute treatment effects as the mean difference in GFR slope from baseline to 3 months between randomized groups. We performed univariable and multivariable metaregression to assess the effect of intervention type, disease state, baseline GFR, and albuminuria on the magnitude of acute effects. Results: The mean acute effect across all studies was 20.21 ml/min per 1.73 m2 (95% confidence interval, 20.63 to 0.22) over 3 months, with substantial heterogeneity across interventions (95% coverage interval across studies, 22.50 to 12.08 ml/min per 1.73 m2). We observed negative average acute effects in renin angiotensin system blockade, BP lowering, and sodium-glucose cotransporter 2 inhibitor trials, and positive acute effects in trials of immunosuppressive agents. Larger negative acute effects were observed in trials with a higher mean baseline GFR. Conclusion: The magnitude and consistency of acute GFR effects vary across different interventions, and are larger at higher baseline GFR. Understanding the nature and magnitude of acute effects can help inform the optimal design of randomized clinical trials evaluating disease progression in CKD

Using preliminary risk assessment in a formative evaluation

Risk assessment is used to identify potential hazards and prioritize those that may be most likely to have a significant impact. While widely used in the aviation, pharmaceutical, and chemical industries, formalized risk assessments are not often used for instructional interventions such as e-learning. As part of a formative evaluation for a new e-learning course, facilitators and design team members performed a risk assessment on topics related to the technology used in the course, the communication of mentors and participants, sustainability, and evaluation. With this information, the design team and mentors prepared a risk management plan, identifying ways to prevent unwanted events as well as to plan for contingencies in the case of their occurrence. The framework of the plan is described, together with details of its implementation in a formative evaluation of the course

Incorporating risk assessment into the formative evaluation of an authentic e-learning program

This paper describes the use of two different risk assessment strategies during the design and development of a complex authentic task-based e-learning program developed by the World Health Organization (WHO). The first strategy involved the use of expert reviewers and the second strategy employed the engagement of a risk assessment expert facilitator. This approach enabled the WHO design team to identify risks in advance and employ control and mitigation strategies to eliminate or reduce the risks that were revealed by the two risk assessments