Faculty Perspectives on E-Learning Policy in a Canadian University

This qualitative multi-method study investigated faculty member perspectives on e-learning policy, and its influence on their use of e-learning. The research was conducted at one medium sized comprehensive university in Ontario, Canada. Data were collected from interviews with 12 full-time faculty members, eight of whom had taught at least one online undergraduate university course. Data were also collected from institutional and government documents. Respondents noted e-learning increased flexibility and/or convenience with respect to both their engagement with students, and student engagement with course material. E-learning was identified positively for its ability to save time by some respondents, and negatively as being time intensive by others. Increased student and government demand for on-line courses, as well as the opportunity to use technology for instructional purposes, increased respondents’ use of e-learning. Additionally, the university’s pedagogical centre, which provided direct support to respondents, was considered key in supporting their transition to e-learning. Respondents were generally unable to identify specific university policy related to e-learning, and some noted the lack of specific policy had hampered e-learning course development in their departments. The documents reviewed tended to view e-learning in favourable terms, highlighting it as a response to changing political, economic, and societal conditions, and promoting it for its ability to reduce costs to the university, increase student enrolment, and provide more equitable access to university programs, particularly for under-represented groups such as new Canadians, Indigenous peoples, and first-generations students. Whereas government documents tended to focus on mandates (e.g. the intent to change the university system based on each university’s strengths), institutional documents focused on teaching, learning, and e-learning, both in response to government mandates, and in alignment with the University’s strategic direction. Collectively, the documents shared the respondents’ perceptions regarding flexibility, time, and demand. However, while government documents focused on issues of cost, changing conditions, enrolment and equitable access, institutional documents explained e-learning, the differences with face-to-face teaching and learning, and how best to integrate e-learning into practice

Increasing participation in continuing education the relationship of specific obstacles and supports to likelihood of participation

The study investigated the relationship between reported likelihood of participation in a continuing education course and the importance of obstacles and supports to participation as perceived by 238 adults. The research instrument, a questionnaire developed by the author, was mailed to 1,000 residences in the county of Waterloo, Ontario. Previous research and theoretical positions on obstacles to participation in continuing education were examined. It was hypothesized that obstacles and supports related to concern with academic ability would be significantly correlated with Likelihood of participation. The Pearson Product-Moment statistic was utilized to test the hypothesis. No significant correlations between the dependent variable, likelihood of participation, and the obstacles and supports related to concern with academic ability were found. A regression and analysis which included all of the obstacle, support and socio-demographic variables yielded a model with little predictive value. A post-hoc analysis was performed utilizing level of education as a moderating variable. The analysis revealed a significant correlation between one hypothesized obstacle, “Having been away from school too long”, and the dependent variable among respondents with less than a grade twelve education. The “theory of reasoned action” (Ajzen & Fishbein, 1980) was considered as a possible explanation for the lack of significant findings. The exact nature of the interaction between the decision to participate in continuing education and obstacles and supports to participation remains unclear. However, the research did provide some data which may be of value to continuing education providers seeking ways to increase participation in continuing education

Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial

Background: Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best practice model that applies major elements of case management, including patient education, can improve antithrombotic management in primary health care in terms of reducing major thromboembolic and bleeding events. Methods: This 24-month cluster-randomized trial will be performed in 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, health care assistants and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, health care assistants will be trained in case management and will use the Coagulation-Monitoring-List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment-as-usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization, and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients' assessment of chronic illness care, self-reported adherence to medication, general practitioners' and health care assistants' knowledge, patients' knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline (T0), follow-up after 12 (T1) and after 24 months (T2). Discussion: The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients and the methodological tool, case-management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment

Dyslipidemia in Newfoundland: findings from Canadian primary care sentinel surveillance network in Newfoundland and Labrador

Newfoundland and Labrador (NL) has a higher level of cardiovascular disease (CVD) mortality than any other Canadian province. One factor which may explain this trend is the lipid profile pattern in this province. Given the limited lipid profile data which has been reported from NL, we organized three studies in this thesis to describe the lipid profile of Newfoundlanders. The first study was a secondary analysis of Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data to document single and mixed dyslipidemia in NL. The second study compared lipid profiles and the prevalence of dyslipidemia between NL CPCSSN data and the Canadian Health Measures Survey (CHMS). The third study used electronic medical record (EMR) data in assessing the validity of ICD codes for identifying patients with dyslipidemia. This was a secondary analysis of EMR data in NL. Most recent lipid profile scores, co-morbidities, and demographic information were extracted from the CPCSSN database. We demonstrated that single and mixed dyslipidemia are quite prevalent in the NL population. Unhealthy levels of HDL were also more prevalent in NL men, compared to the Canadian sample. Of importance, the use of the ICD coding, either alone or in combination with laboratory data or lipid-lowering medication records, was an inaccurate indicator in identifying dyslipidemia

Precepting in the age of electronic medical records: A primer for clinical teachers

Background The use of Electronic Medical Records (EMR) is increasingly common. Little is known about the influence of EMR on resident learning, and little guidance is available for clinical teachers in the EMR setting. Objectives This study aims to examine the impact of EMR on Memorial University of Newfoundland (MUN) Family Medicine resident learning and to develop a teaching primer for clinical teachers. Methods Impact of EMR on resident learning was evaluated using a web survey and focus group discussions. Introductory letters with consent form and link to web survey were emailed to all MUN Family Medicine residents and Academic Family Medicine faculty preceptors. To achieve desirable response rate the web survey was sent three times over the 20-week survey period. Response frequencies were descriptively analyzed. Concordance and discordance between faculty and residents were evaluated. Six residents and four faculty preceptors participated in the focus group discussions. FGDs were analyzed using thematic analysis. Recurrent themes arising from the web survey and focus groups were compiled with results from the literature review to form a primer for clinical teaching. Results 34 of the 43 eligible residents (79%) and 16 of the 17 eligible faculty (95%) completed the survey. Approximately 70% of residents and 69% of faculty agreed that EMR generally improves resident learning. Impairment of resident communication with patients was rated as the most frequent deficit (50% and 36% respectively. rho= -0.25). The FGDs affirmed the web survey results that EMR generally improves resident learning and preceptor feedback, but noted that improvements can be made using targeted communication training, avoiding EMR distraction when giving feedback, and avoidance of resident over-reliance on EMR templates and prescribing functions. Data is collated with a review of the literature in the form of a clinical primer to guide clinical teachers. Conclusions The rise of EMR has subtly changed the clinical supervision and instruction of medical learners. The results of this study contribute to the development of teaching strategies for enhancement of resident learning in the EMR setting. Targeted training for clinical teachers in the EMR setting may be of benefit to teachers and learners

The Satanic Cult Conspiracy: How online conspiracy theory discourses construct moral panic

The Satanic cult conspiracy theory alleges the existence of evil, secret, Satan-worshipping cults that seek to morally subvert society. From the Middle Ages to the late 20th century, its accusations have ebbed and flowed – peaking in the form of periodic ‘moral panics’ whereby Satanism becomes depicted as an urgent moral threat to society. These panics have consistently led to the identification and persecutions, including murders, of innocent individuals accused of Satanic cult activity. The last decade has seen a concerning resurgence of Satanic cult conspiracy theories online, however currently there is no research that analyses the overall breadth of themes found within this discourse today. This thesis evidences and presents a detailed and comprehensive analysis of the content of contemporary Satanic cult conspiracy theory discourse across Twitter/X, Instagram, and TikTok, with the aim of determining whether it indicates a new wave of Satanic moral panic. Highlighting the differences between interest-group and grassroots moral panics, it also pays attention to exploring how this notion of a ‘Satanic moral panic’ can even be identified, and why accurately identifying it matters in the first place. Research is currently limited in its understanding of the exact relationship between conspiracy theories and moral panics. To address this, I then also develop and present in this thesis a new research framework for identifying when conspiracy theory discourses are indicative of moral panics, and when they are not

Relationship between bacterial strain type, host biomarkers, and mortality in clostridium difficile infection

Background: Despite substantial interest in biomarkers, their impact on clinical outcomes and variation with bacterial strain has rarely been explored using integrated databases. Methods: From September 2006 to May 2011, strains isolated from Clostridium difficile toxin enzyme immunoassay (EIA)-positive fecal samples from Oxfordshire, United Kingdom (approximately 600 000 people) underwent multilocus sequence typing. Fourteen-day mortality and levels of 15 baseline biomarkers were compared between consecutive C. difficile infections (CDIs) from different clades/sequence types (STs) and EIA-negative controls using Cox and normal regression adjusted for demographic/clinical factors. Results: Fourteen-day mortality was 13% in 2222 adults with 2745 EIA-positive samples (median, 78 years) vs 5% in 20 722 adults with 27 550 EIA-negative samples (median, 74 years) (absolute attributable mortality, 7.7%; 95% CI, 6.4%-9.0%). Mortality was highest in clade 5 CDIs (25% [16 of 63]; polymerase chain reaction (PCR) ribotype 078/ST 11), then clade 2 (20% [111 of 560]; 99% PCR ribotype 027/ST 1) versus clade 1 (12% [137 of 1168]; adjusted P <. 0001). Within clade 1, 14-day mortality was only 4% (3 of 84) in ST 44 (PCR ribotype 015) (adjusted P =. 05 vs other clade 1). Mean baseline neutrophil counts also varied significantly by genotype: 12.4, 11.6, and 9.5 × 109 neutrophils/L for clades 5, 2 and 1, respectively, vs 7.0 × 109 neutrophils/L in EIA-negative controls (P <. 0001) and 7.9 × 109 neutrophils/L in ST 44 (P =. 08). There were strong associations between C. difficile-type-specific effects on mortality and neutrophil/white cell counts (rho = 0.48), C-reactive-protein (rho = 0.43), eosinophil counts (rho =-0.45), and serum albumin (rho =-0.47). Biomarkers predicted 30%-40% of clade-specific mortality differences. Conclusions: C. difficile genotype predicts mortality, and excess mortality correlates with genotype-specific changes in biomarkers, strongly implicating inflammatory pathways as a major influence on poor outcome after CDI. PCR ribotype 078/ST 11 (clade 5) leads to severe CDI; thus ongoing surveillance remains essential

Patient needs in advanced Renal Cell Carcinoma: What are patients’ priorities and how well are we meeting them?

Treatment options and duration of therapy for patients with metastatic renal cell carcinoma (mRCC) have increased. Many patients now spend in excess of 2 years on active therapy. These patients’ needs, and the ability of health services to respond to them, are poorly understood. Ten patients living with mRCC for more than 2 years and treated with at least one targeted agent were selected at random from three hospitals in the United Kingdom (UK). One interviewer who was not involved in their care conducted in-depth interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify issues of greatest importance to patients, and to understand how well patients felt their needs were being addressed. Perceived delay in initial diagnosis was a major theme. Being told the truth about treatment side effects upfront was important, but was often at odds with perceived delivery. ‘Dealing with side effects’, understanding dose and its effects and not letting ‘negative thoughts get in’ were highlighted as important, but were highly personal to patients and areas where patients struggled. Concordance was observed with delivery of ‘a clear next step’ for treatment, timely access to drugs and guidance on a drug ‘holiday’. Patient experience of mRCC and its treatment requires a tailored approach. This research suggests there are key opportunities for service improvement and improved communication throughout the pathway to better meet the needs of patients, including non-clinical support to build personal resilience

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Background: Health services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs). Aim: To develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk. Methods Development: We synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs. Implementation: The Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence. Evaluation: The Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment. Trial results Depression trial: In total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5; p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence. CVD risk trial: In total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9; p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management. The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement. Conclusion: The Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs