Using Case Studies and Online Discussions to Educate Future Health Administrators

Pamela Walsh is a relatively new faculty member at Eastern Michigan University, teaching health administration. This chapter details the adjustments she made in one of her courses, Legal Issues in Health Care, the second time she taught it; the chapter also discusses adjustments Pam plans to make in the future. Pam\u27s work concentrates most heavily on the implementation of case studies and threaded discussions, and the ways in which both of these pedagogical innovations worked and the ways in which they did not live up to their promise. What Pam has done here is to provide a valuable service for people working out the kinks in a new course and trying to prefect it. She walks the reader through her thought process in exploring these teaching innovations, and also skillfully uses data to assess how well each innovation worked (from her own perspective and from the perspective of her students). It serves as a useful reminder to all of us that pedagogical innovations work best when they are frequently assessed; it also demonstrates, yet again, the potentially powerful role the student voice has in informing our teaching practices

Evaluating the Recidivism Rates for Parolees Enrolled in M-COIT, a Community Mental Health/ Substance Abuse Treatment Program

This paper focuses on an evaluation of recidivism rates of parolees with severe and persistent mental illness enrolled in a mental health/ substance abuse treatment program (M-COIT) at a community mental health center in southeastern Michigan. The two partners in the study were a community mental health center located in a city bordering the southern part of Detroit and Eastern Michigan University located in Ypsilanti, Michigan. The purpose of the study was to identify the recidivism rates and factors that affected these rates for parolees who participated in the M-COIT Program. This was a retrospective medical record review. The practical participatory evaluation was stakeholder driven; the organization’s staff initiated the evaluation and participated directly in the process from start to finish, including setting objectives and expectations, instrument development, data collection, analysis and interpretation, and reporting of outcomes. Results reported are for the parolees who participated in the program from 2004 to 2006. Implications for public health are addressed

Perspectives of Canadian Distance Educators on the Move to Online Learning

Our qualitative study explored transition in seven Canadian universities—early providers of distance education that transitioned to online learning between 2002 and 2017. We interviewed 16 individuals who were involved in the design, planning, or implementation of online learning. Participants reported their universities experienced significant impacts on organizational structure and roles. Many saw an increased focus on learning and teaching. Access, revenue generation, and technology were identified as drivers of online learning; traditional learning and teaching practices were shifting; challenges experienced included resistance to change and lack of dedicated resources; and effective, visionary leadership was seen to be critically important. We propose that the roots of today’s challenges and opportunities in online learning may be found in the experiences of distance educators who were early adopters

Provoking Curricula of Care: Weaving Stories of Rupture Towards Repair

We are five scholars of education, provoking curriculum on the topic of “care”—as practice, theory, and struggle, through our stories of living, teaching, and learning. Our inquiries surface threads of rupture, where we find that “care” indicates our efforts to address suffering. Our care-work consists of restorative, creative, and contemplative practices. We tell our stories through a literary métissage (weaving) of creative non-fiction, poetic writing, artwork, and images. We thus creatively expand the meaning of care by evoking our understandings, lived experiences, and practices of caring. In this way, we hope to create more attuned relationships, and open the way for more stories of “care” to emerge

Polypharmacy and emergency readmission to hospital after critical illness:a population-level cohort study

From PubMed via Jisc Publications RouterPolypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.126pubpub

My migraine voice survey. aA global study of disease burden among individuals with migraine for whom preventive treatments have failed

Background: Migraine is associated with many debilitating symptoms that affect daily functioning. My Migraine Voice is a large global cross-sectional study aimed at understanding the full burden and impact of migraine directly from patients suffering from ≥4 monthly migraine days (MMDs) with a history of prophylactic treatment failure. Methods: This study was conducted worldwide (31 countries across North and South Americas, Europe, the Middle East and Northern Africa, and the Asia-Pacific region) using an online survey administered to adults with migraine who reported ≥4 MMDs in the 3 months preceding survey administration, with pre-specified criteria of 90% having used preventive migraine treatment (80% with history of ≥1 treatment failure). Prophylactic treatment failure was defined as a reported change in preventive medication by individuals with migraine for any reason, at least once. Results: In total, 11,266 individuals participated in the survey. Seventy-four percent of the participants reported spending time in darkness/isolation due to migraine (average: 19 h/month). While 85% of all respondents reported negative aspects of living with migraine (feeling helpless, depressed, not understood), sleeping difficulties (83%), and fear of the next attack (55%), 57% shared ≥1 positive aspect (learning to cope, becoming a stronger person). Forty-nine percent reported feeling limited in daily activities throughout all migraine phases. Migraine impact on professional, private, or social domains was reported by 87% of respondents (51% in all domains). In the previous 12 months, 38% of respondents had visited the emergency department (average: 3.3 visits), whereas 23% stayed in hospital overnight (average: 3.2 nights) due to migraine. Conclusions: The burden of migraine is substantial among this cohort of individuals with at least 4 migraine days per month and for whom at least 1 preventive migraine treatment had failed. Interestingly, respondents reported some positive aspects in their migraine journey; the greater resilience and strength brought on by coping with migraine suggests that if future treatments could address existing unmet needs, these individuals with migraine will be able to maximize their contribution to society

Mainstreaming biodiversity in business decisions: taking stock of tools and gaps

Most businesses depend on biodiversity, either directly, indirectly as ecosystem services, or through their supply chains. In negatively impacting biodiversity, businesses risk losing essential resources and services. As a result, it is important for the private sector to demonstrate strong and improved performance on biodiversity. This paper reviews and compares tools and approaches that help businesses measure their performance on biodiversity issues. Through a literature review and interviews of tool developers, we assess how tools are constructed, how they measure biodiversity performance, how and where they are being used by different businesses and how they contribute to achieving international targets for biodiversity. We found that tools perform a range of functions and are mostly applied at product, site, and supply chain level. Further efforts are needed to align tools with global biodiversity goals. Key knowledge gaps remain to better capture dependence on biodiversity and spatial spillover effects

The TiM system: developing a novel telehealth service to improve access to specialist care in motor neurone disease using user-centered design

Objectives: Attendance at a specialist multidisciplinary motor neurone disease (MND) clinic is associated with improved survival and may also improve quality of life and reduce hospital admissions. However, patients struggle to travel to clinic and may experience difficulties between clinic visits that may not be addressed in a timely manner. We wanted to explore how we could improve access to specialist MND care. Methods: We adopted an iterative, user-centered co-design approach, collaborating with those with experience of providing and receiving MND care including patients, carers, clinicians, and technology developers. We explored the unmet needs of those living with MND, how they might be met through service redesign and through the use of digital technologies. We developed a new digital solution and performed initial testing with potential users including clinicians, patients, and carers. Results: We used these findings to develop a telehealth system (TiM) using an Android app into which patients and carers answer a series of questions about their condition on a weekly basis. The questions aim to capture all the physical, emotional, and social difficulties associated with MND. This information is immediately uploaded to the internet for review by the MND team. The data undergoes analysis in order to alert clinicians to any changes in a patient or carer’s condition. Conclusions: We describe the benefits of developing a novel digitally enabled service underpinned by participatory design. Future trials must evaluate the feasibility and acceptability of the TiM system within a clinical environment

Sex-Specific Differences in Heart Failure:Pathophysiology, Risk Factors, Management, and Outcomes

Heart failure (HF) is a leading cause of hospitalisation, morbidity, and mortality in Canada. There are sex-specific differences in the etiology, epidemiology, comorbidities, treatment response, and treatment adverse effects that have implications on outcomes in HF. Sex-specific analyses of some HF trials indicate that optimal doses of drug therapies and benefit of device therapies may differ between male and female patients, but the trials were not designed to test sex differences. The under-representation of female participants in HF randomised controlled trials (RCTs) is a major limitation in assessing the sex-specific efficacy and safety of treatments. To ensure that female patients receive safe and effective HF therapies, RCTs should include participants proportionate to the sex-specific distribution of disease. This review outlines the sex-specific differences in HF phenotype and treatment response, and highlights disparities in services and gaps in knowledge that merit further investigation