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Purpose: Unless higher education institutions ensure that first-rate academic programme offerings are supported with the provision of high-quality services, student satisfaction, retention, enrolment and ultimately, viability of the institutions will be adversely affected (Canic and McCarthy, 2000). The purpose of this paper is to evaluate the quality of selected administrative and academic support services by a community college in Trinidad and Tobago using a performance-only model of service quality (SERVPERF). This also informed the development of a service quality construct unique to the particular educational setting. Design/methodology/approach: A multi-method approach was adopted where qualitative data from focus groups and two routine institutional surveys were triangulated with quantitative data from a slightly modified SERVPERF survey administered to separate random samples of students. Principal component analysis was also used to examine the unique service quality dimensions in this setting. Findings: Results indicated that students had major issues with the timeliness of responses and staff not taking time to understand their needs. They also placed a high value on knowledge and courtesy of staff. Three separable dimensions of service quality (effectiveness and efficiency; professional and personal touch; and tangibles) emerged from the analysis. Originality/value: This research demonstrated an appropriate approach which could be used to evaluate overall service quality as well as develop an instrument to routinely monitor, assess and inform improvements to service quality at similar types of tertiary-level educational institutions.

This article addresses the importance of differentiated instruction in the college classroom. Additionally, it focuses on the results of the students' perceptions of differentiated instruction in the college classroom. Students in the college classroom were given choice boards to display their understanding on phonemic awareness, phonics, and morphology. The article discusses ideas for future direction based on the results from the action research project.

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.

La récupération améliorée après la chirurgie se veut une approche fondée sur des données probantes pour les soins chirurgicaux visant à minimiser le stress causé par une chirurgie et à soutenir les patients pour qu'ils se rétablissent rapidement. Ses cheminements en soins périopératoires visent à promouvoir la mobilisation du patient, à réduire les complications après la chirurgie, à favoriser des séjours plus courts à l'hôpital, à minimiser les réadmissions à l'hôpital et à réduire les coûts. Le programme suit les patients à travers toutes les étapes du processus, de la visite préopératoire à celle après l'intervention, et il a été démontré qu'il améliorait les résultats pour la sécurité. En 2017, Récupération optimisée Canada a été créé pour soutenir la mise en oeuvre de pratiques exemplaires en matière de chirurgie pour tous les Canadiens. Des outils de cheminement chirurgical et des ressources pour les patients sont maintenant offerts pour appuyer les chirurgies les plus courantes qui ont lieu dans toutes les salles d'opération à travers le pays, incluant les chirurgies colorectales, gynécologiques et les chirurgies orthopédiques de remplacements de la hanche et du genou pour les patients hospitalisés et ceux en chirurgie d'un jour. Mots-clés : Récupération optimisée Canada, ROC, Récupération améliorée après la chirurgie, RAAC. Enhanced Recovery After Surgery is an evidence-based approach to surgical care aimed at minimizing the stress of surgery and supporting patients to recover quickly. Its perioperative care pathways aim to promote patient mobilization, reduce complications after surgery, support shorter hospital stays, minimize hospital readmissions, and reduce costs. The program follows patients through all stages of the process, from pre-op to post-op, and has been shown to improve safety outcomes. In 2017, Enhanced Recovery Canada was formed to support the implementation of surgical best practices for all Canadians. Surgical pathway tools and patient resources are now available to support the most frequent surgeries that touch every operating room across the country, including colorectal surgeries, gynecologic surgeries, and inpatient/outpatient orthopaedic hip and knee replacements. Keywords: Enhanced Recovery Canada, ERC, Enhanced Recovery After Surgery, ERAS., INTRODUCTION La récupération améliorée après la chirurgie (RAAC) représente un changement de paradigme dans la façon dont les soins aux patients sont planifiés, dispensés et suivis. Elle se veut une [...]

Pressure to reduce health care costs, limited hospital bed availability as well as improvements in surgical techniques and perioperative care motivated many health care centres to implement short-stay protocols for patients undergoing hip or knee arthroplasty. To improve patient outcomes and maintain care safety, we strongly believe the best way to implement a successful outpatient program would be to embrace the principles of Enhanced Recovery After Surgery (ERAS), and to improve patient recovery to a level such that the patient could leave the hospital sooner. Enhanced Recovery Canada and the Canadian Patient Safety Institute support the development of ERAS pathways for orthopedic procedures. The goal is to provide patients, health care providers and leaders with helpful tools and resources to effectively implement and sustain ERAS protocols. Reducing the rate of adverse events while reducing the length of hospital stays to less than 24 hours is a winning situation for everyone., In recent years, there has been a shift toward outpatient and short-stay protocols for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This is due, in part, [...]

ObjectivesTo examine the associations between depressive symptoms, antidepressant use, and duration of use with incident frailty 3 years later in nonfrail women aged 65 and older.DesignSecondary analysis of the Women's Health Initiative Observational Study (WHI-OS), a prospective cohort study.SettingWHI-OS was conducted in 40 U.S. clinical centers.ParticipantsWomen aged 65 to 79, not frail at baseline.MeasurementsAntidepressant use was assessed through medication container inspection at baseline. Four groups were created according to baseline use and Burnam depression screen (range 0-1, 0.06 cutoff): antidepressant nonusers without depressive symptoms (reference group), antidepressant nonusers with depressive symptoms, antidepressant users without depressive symptoms, and antidepressant users with depressive symptoms. Frailty components included slowness or weakness, exhaustion, low physical activity, and unintended weight loss, ascertained through self-report and physical measurements at baseline and Year 3.ResultsOf 27,652 women at baseline, 1,350 (4.9%) were antidepressant users and 1,794 (6.5%) were categorized as depressed. At Year 3, 4,125 (14.9%) were frail. All groups had a greater risk of incident frailty than the reference group. Odds ratios (ORs) ranged from 1.73 (95% confidence interval (CI) = 1.41-2.12) in antidepressant users who were not depressed to 3.63 in antidepressant users who were depressed (95% CI = 2.37-5.55). All durations of use were associated with incident frailty (3 years OR = 1.60, 95% CI = 1.20-2.14).ConclusionIn older adult women, depressive symptoms and antidepressant use were associated with frailty after 3 years of follow-up.

Background: Inherited deficiencies in the FBN1 gene, which encodes fibrillin-1, result in Marfan syndrome, an autosomal dominant connective tissue disorder that is associated with aortic root dilatation and predisposes to aortic dissection. This report is of a 37-year-old woman presenting at 39 weeks of pregnancy with acute thoracic aortic dissection due to previously undiagnosed FBN1-related Marfan syndrome. This case report aims to illustrate the challenges in the diagnosis and in the peri-operative management of acute aortic dissection during pregnancy. Case Report: A healthy 37-year-old woman at 39 weeks of gestation presented to our hospital with dyspnea and chest pain. Initial evaluation for pulmonary embolism with chest computed tomography was unrevealing. The patient was admitted to the intensive care unit for further management. Overnight, her clinical conditions deteriorated, and a transthoracic echocardiography was obtained, demonstrating an acute ascending aortic dissection. She emergently underwent a successful combined cesarean section and ascending aortic dissection repair, with no immediate complications. On postoperative day 4 she developed cardiac tamponade, for which she underwent emergent mediastinal exploration. She was discharged home on postoperative day 10. A month later she completed genetic testing, which revealed a pathogenic mutation in the FBN1 gene, consistent with a molecular diagnosis of Marfan syndrome. Conclusions: This report has shown that FBN1-related Marfan’s syndrome has a variable clinical presentation that can include life-threatening aortic dissection during pregnancy. Successful diagnosis and management of these patients is challenging and requires multidisciplinary expertise, including confirmation of the diagnosis by a clinical geneticist. [ABSTRACT FROM AUTHOR]

Objective: The authors measured the prevalence of depressive symptoms among dental students at a historically black college in the United States to determine how depressive symptoms, stress, and social support influence each other within this student population. Participants: Dental students (n = 143) completed a self-administered survey to assess depressive symptoms, stress, and social support, using validated and reliable instruments. Participants also reported demographic variables. Methods: The authors used multivariable linear regression controlling for potential confounding. Results: The prevalence of depressive symptoms was 16.7%. There were significantly higher levels of stress for students with depressive symptoms compared with those without such symptoms (p less than 0.01), and students with depressive symptoms had significantly lower levels of social support (p less than 0.01). Results show higher levels of depressive symptomatology to be related to decreased social support at both high and low stress levels (p less than 0.01). Conclusions: Stress and social support are associated with depressive symptoms among dental students. (Contains 2 tables.)

Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute's Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians., Colorectal surgery may be associated with undesirable outcomes, including long length of stay in hospital, high rates of surgical site infection, perioperative nausea and vomiting, high readmission rates, and increased [...]