Urinary symptoms are common for people with neurogenic lower urinary tract dysfunction (NLUTD). No nonprescription approach has been proven safe and effective for self-management of urinary symptoms. Our objective was to describe the safety and tolerability of Lactobacillus rhamnosus GG (LGG®) instilled intravesically for self-management of inflammatory urinary symptoms in adults and children with NLUTD due to spinal cord injury or disease (SCI/D) and who use intermittent catheterization (IC). A total of 103 individuals with SCI/D enrolled in an 18-month study consisting of three 6-month stages: baseline (weekly observation of urinary symptoms); intervention (self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine); and washout (weekly observation of urinary symptoms). Urinary symptoms were assessed using the Urinary Symptom Questionnaire for people with neurogenic bladder using intermittent catheters (USQNB-IC). Safety was based on serious adverse events and adverse events (S/AEs) and trends in symptoms. Tolerability was defined as the independence of AE experience and willingness to use/pay for this intervention. A total of 74 (77%) adults and 6 (86%) of children completed the study, of whom 64 instilled LGG® for a total of 357 instillations (range 1–41 per person). There were 59 S/AEs, 44% (26/59) of which were categorized as infectious genitourinary. There was no statistical relationship between S/AEs and use or dose of the intervention. One or two doses of self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine was safe and well tolerated among this sample of adults and children with SCI/D who have NLUTD and use IC.

The objectives of this study were to describe and demonstrate a new model of developing patient reported outcomes (PROs) that are patient-centered, and to test the hypothesis that following this model would result in a qualitatively different PRO than if the typical PRO development model were followed. The typical process of developing PROs begins with an initial list of signs or symptoms originating from clinicians or PRO developers; patient validation of this list ensures that the list (i.e., the new PRO) is interpretable by patients, but not that patient perspectives are central or even represented. The new model begins with elicitation from clinicians and patients independently and separately. These perspectives are formally analyzed qualitatively, and the results are iteratively integrated by researchers, supporting clinical relevance and patient centeredness. We describe the application of this new model to the development of a PRO for urinary signs and symptoms in individuals with neuropathic bladder, and test the hypothesis that the two processes generate qualitatively different instruments using a national validation sample of 300 respondents. Of its 29 items, the new instrument included 13 signs/symptoms derived from existing clinical practice guidelines, with 16 others derived from the patient/focus groups. The three most-endorsed items came from the patients, and the three least-endorsed items came from clinical guidelines. Thematic qualitative analysis of the elicitation process, as well as the results from our national sample, support the conclusion that the new model yields an instrument that is clinically interpretable, but more patient-centered, than the typical model would have done in this context.

It is common to create courses for the higher education context that accomplish content-driven teaching goals and then develop assessments (quizzes and exams) based on the target content. However, content-driven assessment can tend to support teaching- or teacher-centered instruction. Adult learning and educational psychology theories suggest that instead, assessment should be aligned with learning, not teaching, objectives. To support the alignment of assessments with instruction in higher education, the Assessment Evaluation Rubric (AER) was developed. The AER can be utilized to guide the development and evaluation/revision of assessments that are already used. The AER describes, or permits the evaluation of, four features of an assessment: its general alignment with learning goal(s), whether the assessment is intended to/effective as formative or summative, whether some systematic approach to cognitive complexity is reflected, and whether the assessment (instructions as well as results) itself is clearly interpretable. Each dimension (alignment, utility, complexity, and clarity) has four questions that can be rated as present/absent. Other rating methods can also be conceptualized for the AER’s 16 questions, depending on the user’s intent. Any instructor can use the AER to evaluate their own assessments and ensure that they—or new assessments in development—will promote learning and learner-centered teaching. As instructors shift from face-to-face toward virtual or hybrid teaching models, or as they shift online instruction (back) to face-to-face teaching, it creates an ideal opportunity to ensure that assessment is optimizing learning and is valid for instructional decision-making.

We developed a Urinary Symptom Questionnaire for individuals with neurogenic bladder due to spinal cord injury (SCI) and spina bifida (SB) who manage their bladders with intermittent catheterization, the USQNB-IC. This project followed an approach to patient-centered patient reported outcomes development that we created and published in 2017, specifically to ensure the primacy of the patient’s perspective and experience. Two sets of responses were collected from individuals with neurogenic bladder due to either SCI (n = 336) and SB (patients, n = 179; and caregivers of patients with NB, n = 66), and three sets of “controls”, individuals with neurogenic bladder who do not have a history of UTIs (n = 49) individuals with chronic mobility impairments (neither SCI nor SB) and without neurogenic bladder (n = 46), and those with no mobility impairment, no neurogenic bladder, and no history of UTIs (n = 64). Data were collected from all respondents to estimate these psychometric or measurement domains characterizing a health related PRO: Reliability (minimization of measurement error; internal consistency or interrelatedness of the items; and maximization of variability that is due to “true” difference between levels of the symptoms across patients), and validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured; and criterion, association with a gold standard). Evidence from these five groups of respondents suggest the instrument has face, content, criterion, convergent, and divergent validity, as well as reliability. The items were all more descriptive of our patient (focus) groups and were only weakly endorsed by the control groups. The instrument is unique in its emphasis on, and origination from, the lived experiences of patients with neurogenic bladder who use intermittent catheterization; this preliminary psychometric evidence suggests the instrument could be useful for research and in the clinic. These results justify further development of the instrument, including formal exploration of the scoring and estimation of responsivity of these items to clinical interventions as well as patient-directed self care.

Interest in sustainable learning has been growing over the past 20 years but it has never been determined whether students—whose learning we are trying to sustain—can perceive either the sustainability of their learning or any of the features of this construct. A four-item survey was developed based on a published definition of “sustainable learning”, and was sent to the 12 graduate students who have completed a new seminar in ethical reasoning. A thematic analysis of the narrative responses was submitted to a degrees-of-freedom analysis to determine the level and type of evidence for student perception of sustainability. Respondents (n = 9) endorsed each of the four dimensions of sustainable learning—and each gave examples for each dimension outside of, and after the end of, the course. One respondent endorsed all dimensions of sustainable learning, but was uncertain whether the course itself led to one particular sustainability dimension. While these results must be considered preliminary because our sample is small and the survey is the first of its kind, they suggest that graduate students can and do perceive each of the four features of sustainability. The survey needs refinement for future/wider use; but this four-dimensional definition could be useful to develop and promote (and assess) sustainable learning in higher education.