Alternative approaches to tuberculosis treatment evaluation: the role of pragmatic trials

Clinical trials are sometimes classified as being explanatory or pragmatic, although they are rarely reported in that way. Explanatory trials may seek to investigate the efficacy of new treatments by imposing strict limitations on many aspects of trial design, including, for example, recruiting only those patients who are most likely to respond. In contrast, the objective of pragmatic trials is to assess whether treatments work in conditions more appropriate to routine practice. This dichotomy is, however, over-simplistic; there is usually a continuum, which is a consequence of there being many areas of trial design that can vary between the extremities of the explanatory and pragmatic approaches. The PRECIS (pragmatic-explanatory continuum indicator summary) wheel based on 10 domains, which include inclusion criteria, flexibility of delivery of the intervention and intensity of follow-up, has been proposed as a way of enabling researchers to assess the extent to which the trials they are designing could be considered explanatory or pragmatic. In this article, we consider how the PRECIS tool can be applied to trials of tuberculosis treatment. In view of the well-recognised delay in getting results from well-conducted clinical trials into practice, we would suggest that if more pragmatic trials were to be conducted, physicians would better understand the implications of the results for their own practice and be more ready to adopt new treatments

Employee Voice: The Missing Factor in Sustainable HRM?

Sustainable Human Resource Management (HRM), has the potential to facilitate organisations development of principles, policies and practices for the challenges of the 21st century. However, to do this we argue a fundamental element in this process has yet to be fully addressed and incorporated into the theory and practice of sustainable HRM; this is employee voice. Additionally, the actual and potential role of trade unions in facilitating employee voice is yet to be conceptualised within sustainable HRM literature. We argue that the development of effective employee voice mechanisms is vital in the implementation and maintenance of sustainable HRM. In this conceptual paper, we outline the nature of the voice architecture, the impact of the employment relationship on voice mechanisms, how it can be effectively measured, and propose a framework for further exploring these concepts. These key factors we identify as critical in implementing and assessing the effectiveness of the relationship between employee voice and sustainable HRM, to potentially serve as a basis of future research into sustainable HRM

The value of the pragmatic-explanatory continuum indicator summary wheel in an ongoing study: the bullous pemphigoid steroids and tetracyclines study

BACKGROUND: The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool is intended to be used in the design phase of trials to help investigative teams design trials in-line with their purpose. Our team applied this tool to an ongoing trial (BLISTER) to determine whether the initial suggestion among some team members that the trial could be described as largely pragmatic was the consensus. METHODS: Each of the six members of the BLISTER trial team was sent a blank PRECIS wheel to independently complete. The results obtained were averaged and plotted on a single PRECIS wheel to illustrate the degree of pragmatism of the trial. RESULTS: The trial team found that the design of the trial was closest to the pragmatic end of the pragmatic-explanatory continuum. The strongest consensus was found on the 'flexibility of the comparison intervention' and 'practitioner adherence' domains (SD = 13). The trial team appeared to disagree most on the 'eligibility criteria' (SD = 35) and 'participant compliance' (SD = 31) domains, although the large standard deviations were a result of a single outlier in the two domains. CONCLUSION: The PRECIS tool can be used to retrospectively determine the pragmatism of a trial provided enough expertise and information on the trial is available. Illustrating the design of a trial on the PRECIS wheel can help research users more easily identify studies of interest. We hope our recommendations for applying this useful tool will encourage others to consider using it when designing, conducting and reporting studies. TRIAL REGISTRATION: Current Controlled Trials http://www.controlled-trials.com/ISRCTN13704604

The emotional labour of teleworkers conducting online counselling during Covid-19.

Drawing on emotional labour theory, this paper explores the barriers to emotionally complex telework, with a specific focus on the space, interface and pace of work. We examine the working lives of mental health counsellors who adapted from in‐person delivery to online delivery whilst working from home, during the Covid‐19 pandemic. Our qualitative data set comprises of semi‐structured online interviews with 31 counsellors across the United Kingdom. Findings reveal that boundary issues, increased technical interruptions, increased screen time and associated fatigue, and increased contact‐ability due to digitalisation were key barriers to conducting emotionally complex tasks and exacerbated the emotional labour of participants creating more negative outcomes. This resulted in heightened emotion management in the home space, emotional dissonance, stress and in some cases, burn‐out

The emotional labour of teleworkers conducting online counselling during Covid‐19

Drawing on emotional labour theory, this paper explores the barriers to emotionally complex telework, with a specific focus on the space, interface and pace of work. We examine the working lives of mental health counsellors who adapted from in‐person delivery to online delivery whilst working from home, during the Covid‐19 pandemic. Our qualitative data set comprises of semi‐structured online interviews with 31 counsellors across the United Kingdom. Findings reveal that boundary issues, increased technical interruptions, increased screen time and associated fatigue, and increased contact‐ability due to digitalisation were key barriers to conducting emotionally complex tasks and exacerbated the emotional labour of participants creating more negative outcomes. This resulted in heightened emotion management in the home space, emotional dissonance, stress and in some cases, burn‐out

Caveats in science-based news stories communicate caution without lowering interest

Science stories in the media are strongly linked to changes in health-related behavior. Science writers (including journalists, press officers, and researchers) must therefore frame their stories to communicate scientific caution without disrupting coherence and disengaging the reader. In this study we investigate whether caveats (“Further research is needed to validate the results”) satisfy this dual requirement. In four experiments participants read news reports with and without caveats. In Experiments 1 to 3, participants judged how cautious or confident researchers were, and how interesting or comprehensible they found the reports. News reports with caveats were judged as more cautious that those without, but levels of reader interest and comprehensibility were unaffected. In a fourth experiment, we created a mock newsroom and recruited journalism students to make judgments about which press releases should be published. Here, neither caveats nor the introduction of qualifying expressions in headlines had an effect on judgments of newsworthiness, consistent with Experiments 1 to 3. The reasons participants gave for rejecting a press release rarely referred to the caveat. Our results therefore suggest that science writers should include caveats in news reporting and that they can do so without fear of disengaging their readers or losing news uptak

‘They gave me an opportunity, and I took it’: motivations and concerns of adult apprentices

In the UK context of an ageing population, degree apprenticeships represent a new opportunity to study for a degree while working. Apprentices are full-time employees granted time to study for a degree with a significant workplace learning component. The aim of this study was to focus on whether degree apprenticeships are working for adult apprentices (aged 26 and up in this context). New apprentices (n=162) in six universities in Scotland, UK were surveyed to gain a better understanding of background, prior work and study experience, motivations and expectations. Results show that adult apprentices join apprenticeship programmes with significant work experience and workplace metaskills, together with a consolidated sense of self as a professional. Adult apprentices aimed to gain a degree while remaining in work, thus increasing skills in situ. The main barrier identified was the challenge of achieving work-study-life balance. The findings can be used to more closely align apprenticeship provision with adult apprentices’ skills needs while reducing barriers to accessing and succeeding in apprenticeships. We make recommendations for more flexibility in terms of advanced entry and Masters-level apprenticeships, with better recognition of prior experience, motivations and anticipated challenges

Communicating with the dead:lipids, lipid mediators and extracellular vesicle

Apoptosis is a key event in the control of inflammation. However, for this to be successful, dying cells must efficiently and effectively communicate their presence to phagocytes to ensure timely removal of dying cells. Here we consider apoptotic cell-derived extracellular vesicles (ACdEV) and the role of contained lipids and lipid mediators in ensuring effective control of inflammation. We discuss key outstanding issues in the study of cell death and cell communication, and introduce the concept of the ‘active extracellular vesicle’ as a metabolically-active and potentially changing intercellular communicator