Provider documentation of patient education: a lean investigation

Purpose

The study evaluates how providers give patient education materials and identifies improvements to comply with Meaningful Use (MU) requirements.

Methods

Thirty-eight patient-provider interactions in two health care outpatient clinics were observed.

Results

Providers do not uniformly know MU patient education requirements. Providers have individual preferences and find gaps in what is available. Accessing and documenting patient education varies among providers. Embedded electronic health record (EHR) materials, while available, have technical access barriers.

Conclusions

Providers'' EHR skills and knowledge levels contribute to non-standardized patient education delivery.     

Maltreatment of children in The Netherlands: an update after ten years

Governmental consultation and advice on child abuse and neglect in the Netherlands started in 1972 as a two-year experiment with four offices for "confidential doctors" in four major cities of the country. After these two experimental years, a governmental institute for prevention of child abuse and neglect was organized. Over the ensuing decade the number of offices increased to ten, covering the whole country. The State Department of Welfare, Public Health, and Environment collected data from the confidential doctors and their coworkers every year. This study compares the data of the first year 1974 with those of 1983 in order to detect changing patterns over a 10-year period. The major changes are as follows: a threefold increase in cases, an extraordinary increase in cases of emotional maltreatment, an increase in detection of child fatalities but decrease in severity of physical abuse. Sexual abuse was hardly recognized in 1974 but gradually was recognized more frequently during the study decade and accounted for an alarming 7.2% of detected cases of maltreatment in 1983. No change was found in the social conditions of the family and the identity of the perpetrators--primarily fathers and/or mothers. A decrease was noted in the percentage of married parents. The increased percentage of single parents was primarily represented by mothers alone. An increase in the numbers of victims residing at home and a decrease in the need for children's homes as a temporary or permanent residence is attributed to aftercare. The discrepancy between the results of this voluntary notification system in the Netherlands and the results of a mandatory reporting system as used in the U.S.A. is still very high. The hope is that the government will decide to make reporting of maltreatment mandatory for everyone.     

Effects of writing instruction and assessment on functional composition performance

In this study the relationships between writing instruction and functional composition performance were analyzed. The data were obtained in a national assessment on the language proficiency of students in the third year of Dutch secondary education (age ±15). Multivariate multilevel analysis showed that 10 out of 36 instructional characteristics were related to functional composition performance. The effective instructional characteristics included: instruction and exercises in writing functional texts, writing for a specific purpose, tailoring to a particular audience, global rating of writing products by the teacher, and frequent evaluation of Dutch language proficiency through teacher-made tests and written assignments. No effects were found for the rather popular subskill exercises on idiom, syntax, spelling and punctuation, and for pre-writing activities, text revisions and peer-review. Furthermore, the effect of instructional characteristics was often different on one task than on another. Finally, there was little differential effectiveness for different groups of students. If one instructional characteristic was more effective than the other, this was generally true, to an equal degree, for boys and girls and for promoted and non-promoted students.     

Picking the winners by consensus: Grant-giving practice in the Netherlands

The Netherlands form a consensus democracy. In such a society the legitimacy of decisions is of great concern to all. An elaborate system of checks and balances tends to exist and the pressure to join an emerging consensus at meetings is both subtle and tremendously powerful. In the Dutch system of higher education and research the manifestations of the consensus ideal are numerous. This paper highlights them where appropriate. It reviews the Dutch research effort in an international perspective and concludes that R&D expenditure in the Netherlands, measured as a proportion of GDP, is declining. Fairly radical changes in science policy orientation since the 1960s are reviewed and the current frameworks for policy formulation, academic foresight and the organisation of support are sketched. After discussing NWO's different funding instruments, the practices of picking the winners are described in some detail. Three different peer review models are then discussed with special attention to their strengths and weaknesses. The paper's final section is focussed on the evaluation practices in force.     

EQUAL OPPORTUNITY OR INTEGRATION FOR WOMEN IN THE DUTCH ACADEMIC WORLD

In 1981, the career structure in Dutch higher education was modified in such a way that performance criteria, particularly possession of a doctorate and research and publication activity, were required for promotion. In particular, the hierarchy of university posts below that of full professor was modified in such a way that persons holding so‐called WHM(senior scientific staff level) positions were required to reapply for the new UHD(associate professor) positions on a competitive basis which stressed the publication record of candidates. Using a sampling of academic women drawn from the natural sciences, the authors offer an explanation as to why women academics did less well than men in the competitions for these new posts. Although the process did not discriminate against women as such, it did not favour academics on the periphery of the profession, where many women at the time found themselves. The situation identified was the result of social factors more than of institutional discrimination. Presently, younger women ‐graduate students ‐ are rapidly moving from the periphery of the profession to the centre. Active involvement in professional networks will aid academic women in their careers; however, over‐involvement in family matters (the care network) may be harmful to the career progress of academic women.     

Interpersonal and relational orientation among pre-service educators: differential effects on attitudes toward inclusion of students with disabilities

The purpose of this investigation was to determine the extent to which pre-service educators’ interpersonal characteristics affected their attitudes toward teaching students with disabilities (inclusion), as measured by the FIRO-B and ATIES pre- and post-course. The FIRO-B was administered to assess expressed and wanted aspects of three interpersonal needs: personal inclusion, affection and control. The ATIES was administered to measure attitudes toward classroom inclusion of students with physical, academic, behavioral and social disabilities. Repeated measures ANOVAs revealed a main effect for wanted inclusion and an interaction effect for expressed inclusion and expressed affection on attitudes toward classroom inclusion. Ultimately, these findings reveal how unique relational characteristics may influence preparation initiatives and may encourage consideration of how individual factors may mediate teacher training and preparation.     

What's wrong? Understanding beginners' problems with Prolog

This paper reviews psychological research on programming and applies it to the problems of learning and teaching Prolog. We present a psychological model that explains how a certain class of errors in programs comes about. The model fits quite well with the results of a small sample of students and problems. The problems that underlie these and other errors seem to be (a) the complexity of the Prolog primitives (unification and backtracking) and (b) the misfit between students' naive solutions to a problem and the constructs that are available in Prolog (e.g. iterative solutions do not map easily to recursive programs). This suggests that learning Prolog could be helped by (1) coherent and detailed instruction about how Prolog works, (2) emphasis on finding recursive solutions that do not rely on primitives such as assignment and (3) instruction in programming techniques that allow students to implement procedural solutions.