Methodological aspects of multi-arm adaptive clinical trials

In the present healthcare climate, there is an urgent need to increase the efficiency with which novel therapies are evaluated. Multi-arm adaptive trials allow multiple treatments to be tested within a single protocol and offer the facility to respond to emerging data. Such trials allow treatment arms to be dropped or even added partway through the trial, directing resources to promising treatments. In this thesis, methodologies for two-stage adaptive trials with binary outcomes are explored, focussing on those approaches in which an intermediate outcome may be used for the purposes of treatment selection. Methodology for the multi-arm multi-stage approach developed by Royston et al. (2003, 2011), here denoted MAMS(R), is extended so that feasible and admissible trial designs may be obtained under the log odds ratio parameterisation. A simulation study suggests that these MAMS(R) designs perform favourably compared with the well-established combination method when a common outcome is monitored, but not when an intermediate outcome is incorporated. A proposal is made for increasing the efficiency and flexibility of MAMS(R) methodology by implementing conditional error calculations within a closed testing procedure. This approach allows the trial design to be updated at the interim analysis, resulting in gains in efficiency, particularly in trials where an intermediate outcome is used and where some promising treatments are dropped. The conditional error approach is then extended to offer the facility of adding a new treatment arm to an ongoing multi-arm adaptive trial. The procedure achieves good power, ensures Type I error rate control and performs particularly well if a new treatment arm is added when promising treatments have been dropped from the trial. Recommendations for using the new developments are given. It is hoped that this research will widen the use of MAMS(R) methodology in practice

The cycle of student and staff wellbeing: Emotional labour and extension requests in Higher Education. A Practice Report

This work is licensed under a Creative Commons Attribution 4.0 Licence. As an open access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.This paper suggests that the sociological theory of emotional labour is a useful way to interpret how teaching practices in Higher Education often involve the simultaneous management of both staff and student wellbeing. This paper applies Berry and Cassidy’s Higher Education Emotional Labour model (2013) to the management of extension requests. We put forward a case study of processing a significant number of extension requests in a short space of time in a large, first year Health Sciences topic. We consider the responsibilities and risks for staff and students in this scenario, and ponder the implications for future practice and pedagogy. We argue that student and staff wellbeing must always be considered as interrelated, and that academic administrative procedures need to be developed with this mind

Teaching in Focus: The value of implementing a program-specific teaching support project for staff wellbeing and student success

This work is licensed under a Creative Commons Attribution 4.0 Licence. As an open access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.This paper reports on a program-level teaching support initiative that was implemented in a Health Sciences undergraduate degree with a large and highly casualised teaching team. It has been argued that to improve student retention and success, universities need to consider implementing comprehensive teaching support models that address institutional, program, and individual level needs. We report on the implementation of our project and reflect on participant feedback, which demonstrated the value of the program for improving staff wellbeing. We argue that introducing support strategies for staff at a local level is essential not only for delivery of high quality learning experiences, but also for staff wellbeing which, in turn, has important implications for student success and retention

After hours nurse staffing, work intensity and quality of care - Missed Care Study: South Australia

During November, 2012, the Flinders University After Hours Nurse Staffing, Work Intensity and Quality of Care project team, in collaboration with the Australian Nursing and Midwifery Federation, SA Branch (ANMFSA), administered the MISSCARE survey to a sample of 354 nurse/midwife members of ANMFSA. The survey contained 13 demographic questions, 28 questions that explored working conditions, 96 questions concerning missed nursing care (defined as care that is omitted, postponed, or incomplete) and 17 questions concerning perceived reasons care is omitted in the settings in which the nurse/midwives practice. In addition, respondents were asked to add comments of their own concerning nursing care that is missed and why

Nurses and midwives perceptions of missed nursing care – A South Australian study

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository. NOTICE: this is the author’s version of a work that was accepted for publication in Collegian. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in COLLEGIAN, [2014] DOI:10.1016/ j.colegn.2014.09.001Background Budgetary restrictions and shorter hospital admission times have increased demands upon nursing time leading to nurses missing or rationing care. Previous research studies involving perceptions of missed care have predominantly occurred outside of Australia. This paper reports findings from the first South Australian study to explore missed nursing care. Aim To determine and explore nurses’ perceptions of reasons for missed care within the South Australian context and across a variety of healthcare settings. Method The survey was a collaborative venture between the Flinders University of South Australia, After Hours Nurse Staffing Work Intensity and Quality of Care project team and the Australian Nursing and Midwifery Federation, SA Branch. Electronic invitations using Survey Monkey were sent to randomly selected nurses and midwives and available online for two months. Three hundred and fifty four nurses and midwives responded. Recurring issues were identified from qualitative data within the survey and three main reasons for missed care emerged. Findings Three main reasons for missed care were determined as: competing demands that reduce time for patient care; ineffective methods for determining staffing levels; and skill mix including inadequate staff numbers. These broad issues represented respondents’ perceptions of missed care. Conclusion Issues around staffing levels, skill mix and the ability to predict workload play a major role in the delivery of care. This study identified the increasing work demands on nurses/midwifes. Solutions to the rationing of care need further exploration

Taking Risks With Their Hearts: Risk And Emotion In Innovative Forms Of Assessment

Research involving student and tutor responses to a ‘pedagogy of the heart’ approach in a first year university health science topic revealed anxiety, insecurity and perceptions of unpredictability in relation to an innovative arts-based assignment designed to elicit and assess experiential or imaginal knowledge. Using the lens of contemporary theories of risk, and explicitly considering the role of emotion in assessment, this paper identifies both the effectiveness of and challenges encountered in this form of assessment. It also explores the relationships between risk and emotion, and between risk and assessment, particularly for young people in the higher education context. By comparing the risks involved with the benefits to be gained, the efficacy of adopting such a pedagogical approach is reviewed

Work Integrated Learning: What do the students want? A qualitative study of Health Sciences students’ experiences of a non-competency based placement

<p><em>Work Integrated Learning (WIL) offers students the opportunity to explore and expand on theoretical concepts encountered throughout their academic studies in an applied real-life context. WIL also assists students in their transition from educational to professional practice informed by experience, engagement and reflection. Traditionally, disciplines such as Medicine, Nursing, Education, and Law have incorporated WIL into their programs. Literature outlines the benefits of a WIL placement to measure learned competencies, which are integral to such fields of practice. Currently, the scope for a WIL experience is expanding into other non-clinical courses due to increasing pressure for universities to produce “work ready” graduates. However, in generalist degrees such as Health Sciences, where clinical or explicit skill competencies are not required, the WIL experience is generic. This study sought the perceptions of past Health Sciences students’ WIL experiences in order to develop appropriate resources for future students. </em></p><p> </p

Interrogating education of the heart

This paper reports students&rsquo; responses to a curriculum focused on integrating critical approaches, and evidence-based knowledge, with an education of the heart pedagogy. A focus group was conducted with 12 student representatives from a large first year undergraduate sociology of health and illness topic taught to a number of health professional students. Discussion centred on student views and feelings about the emotional or lived experience components of the topic portrayed through films, plays and poetry as well as the arts-based assessment exercise. Student responses indicate that they found the arts-based portrayals of the lived experience insightful for developing their own theory of care, but this was tempered by feelings of insecurity in completing these forms of assessment in the competitive environment where grades are important for achieving transfer to their program of choice.&nbsp;</div

Physical activity from early childhood to adolescence: A literature review of issues and interventions in disadvantaged populations

Adelaid

Mapping social processes at work in nursing knowledge development

Harvey, CL ORCiD: 0000-0001-9016-8840In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta-analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially-sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions - based on social processes of authority, credibility, and prestige - have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement. © 2014 Wiley Publishing Asia Pty Ltd