Exploring attitudes towards a randomised controlled trial of venous access devices – a nested pre-trial qualitative study

Purpose: This pre-trial qualitative research study was carried out to explore patient and clinical staff attitudes to central venous access devices (CVADs). In addition, views about participation in a randomised controlled trial (RCT) were explored with the aim of maximising recruitment to an imminent RCT of three CVADs. Methods: Three patient focus groups (each comprising three patients) and 23 interviews with clinical staff were conducted. Interviews and focus group discussions were digitally recorded, transcribed verbatim, anonymised, uploaded to the QSR NVivo10 qualitative software programme and thematically analysed. Results: Analysis of focus group interviews revealed the added challenges that a CVAD poses to patients with cancer. Four key themes emerged: continuity of daily life, pain and discomfort, stigma (a mark of disgrace associated with certain conditions) and self-preservation. The findings show the impact of a CVAD on patients’ ability to manage their condition. Clinical staff interviews highlighted several potential barriers to recruitment; a lack of equipoise (genuine clinical uncertainty as to which intervention is the most beneficial), concerns about the logistics of device insertion and a perceived requirement for education and training. Conclusions: This qualitative study raises awareness of key areas of concern to patients who need a CVAD for chemotherapy delivery. It was identified that there is a need for clearer patient information around CVADs. Additionally it allows investigators to identify barriers to recruitment in a timely manner in order to minimise the potential for conflict between the roles of carer and researcher and consequently, maximise recruitment to the RCT

Current and emerging therapies for the treatment of pancreatic cancer

Pancreatic adenocarcinoma carries a dismal prognosis and remains a significant cause of cancer morbidity and mortality. Most patients survive less than 1 year; chemotherapeutic options prolong life minimally. The best chance for long-term survival is complete resection, which offers a 3-year survival of only 15%. Most patients who do undergo resection will go on to die of their disease. Research in chemotherapy for metastatic disease has made only modest progress and the standard of care remains the purine analog gemcitabine. For resectable pancreatic cancer, presumed micrometastases provide the rationale for adjuvant chemotherapy and chemoradiation (CRT) to supplement surgical management. Numerous randomized control trials, none definitive, of adjuvant chemotherapy and CRT have been conducted and are summarized in this review, along with recent developments in how unresectable disease can be subcategorized according to the potential for eventual curative resection. This review will also emphasize palliative care and discuss some avenues of research that show early promise

DEMAND FOR NUTRIENTS: THE HOUSEHOLD PRODUCTION APPROACH

The household production approach is used to characterize the household's preference toward nutrients in food consumption. Elasticities of substitution and Hicksian price elasticities are estimated, price- and expenditure-nutrient elasticities are calculated. Results show that protein is the most expensive nutrient, and that nutrients played an important role in determining households' food consumption.Consumer/Household Economics, Demand and Price Analysis, Food Consumption/Nutrition/Food Safety,

Perfectionism among young female competitive Irish dancers: prevalence and relationship with injury responses

This study investigated the prevalence of perfectionism among young female competitive Irish dancers and examined the relationships between perfectionistic tendencies and coping strategies used when experiencing injury. Sixty-eight female dancers (Mean age: 14 ± 2.3 years) completed the Child-Adolescent Perfectionism Scale and the Ways of Coping Questionnaire and provided a record of injuries incurred during their championship careers. Participants reported 189 injuries, mostly involving the lower extremities. Seventy-nine percent of dancers reported perfectionistic tendencies (mixed perfectionism 40%, pure self-oriented perfectionism 29%, pure socially prescribed perfectionism 10%), and most frequently adopted “planful problemsolving,” “seeking social support,” “distancing,” and “self-controlling” strategies to cope with injury. Perfectionism and two coping strategies were found to be significantly related (p = 0.03); “planful problem-solving” was typically used “quite a bit or a great deal” by the mixed perfectionism group, but only “somewhat” by the non-perfectionism group, whereas “confrontive coping” was typically not used by the non-perfectionism group but was used “somewhat” by the mixed perfectionism group. Given the presence of such a large degree of perfectionism and the simultaneous employment of problem- and emotion-focused strategies when coping with injuries, it is suggested that medical practitioners acknowledge such tendencies when supporting their dancers in order to reduce the likelihood of negative psychological impact

Teacher quality, recruitment, and retention: Rapid Evidence Assessment

This rapid evidence assessment identifies areas for future research on teacher quality, recruitment and retention, with the aim of informing the focus of the Education Endowment Foundation’s (EEF’s) future research commissioning on this topic. Given that ensuring access to quality teaching for disadvantaged pupils is expected to be a key mechanism for narrowing the disadvantage gap in attainment, there is a strong rationale for the EEF to build the evidence base on the recruitment and retention of quality teachers. The report set out to scope the field and summarise existing evidence on this topic. The report also identifies gaps in the research; for example, areas that have been researched qualitatively but not investigated experimentally or developed into a testable intervention. The rapid evidence assessment includes two reviews, each summarising a key area of research: - Review 1 focused on measures of (or proxies for) teacher quality commonly used in the literature. - Review 2 focused on strategies for the recruitment, retention and distribution of quality teachers to schools serving disadvantaged communities

Killing Sacred Cows: Challenging Assumptions about Digital Asset Management

The pace at which a technology moves from emerging to production continues to increase. The support systems around that technology must match that pace. A modern DAM needs to work with just about any kind of file type and make them all discoverable. And while metadata may be king, adhering to a one-size-fits-all structure may not be the best way to serve the needs of today\u27s researchers and teachers. We\u27ve worked to build an open-source digital library capable of keeping up with the demands placed on it by rapid innovation. By utilizing a cloud-computing platform with dynamic metadata capabilities, pluggable support for new technologies, and strong extensibility, this library aims to make sure storage and categorization is never a hindrance to innovation. Our platform challenges many of the existing conventions of digital asset repositories, by flipping to a user-centric, content-delivery focused approach. This allows us to be responsive and flexible as users express their needs. And by opening our repository up via a standards-based, public API, we allow innovators to leverage our content in new and exciting ways. In this session, we will discuss the capabilities of this new system, the research that led to its design, and the ways in which we are already seeing it grow and expand

A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial.

BACKGROUND: The additional sensitivity of HPV testing compared with cytology could permit extended cervical screening intervals. We wished to determine, through a further (third) round of screening in the ARTISTIC trial, the protection provided by a negative baseline HPV screen compared with that of cytology over a 6 year period. METHODS: Cumulative rates of CIN2 or worse (CIN2+) and CIN3 or worse (CIN3+) were correlated with baseline HPV status and cytology. HPV was detected using the Hybrid Capture 2 (Qiagen) assay for high risk types and genotyped using the Linear Array (Roche) and Papillocheck (Greiner) assays. LBC was performed using ThinPrep (Hologic). FINDINGS: Round 3 included 8,873 women of whom 6,337 had been screened in both rounds 1 and 2 and 2,536 had not been screened since round 1. The median duration of follow-up was 72.7 months. The cumulative rate of CIN2+ over three rounds was 3.88% (95%CI 3.59%, 4.17%) overall; 2.39% in round 1, 0.78% in round 2 and 0.74% in round 3. Cumulative rates by baseline status were 20.53% (95%CI 19.04%, 22.08%) for abnormal cytology, 20.12% (95%CI 18.68%, 21.61%) for HPV detection, 1.41% (95%CI 1.19%, 1.65%) for negative cytology and 0.87% (95%CI 0.70%, 1.06%) for a negative HPV test. In HPV negative women aged over 50 the cumulative rate was 0.16% (95%CI 0.07%, 0.34%). Women who were HPV positive/cytology negative at entry had a cumulative CIN2+ rate of 7.73% (95%CI 6.29%, 9.36%) over 6 years, twice the overall rate. INTERPRETATION: A negative HPV test was significantly more protective than normal cytology over three rounds. The findings of this extension of ARTISTIC suggest that the screening interval could be extended to 6 years if HPV testing replaced cytology as the primary screening test

Increasing mortality in the United States from cholangiocarcinoma: an analysis of the National Center for Health Statistics Database

CCA Mortality Rate by Year among Asians; raw data file with query terms. (TXT 6 kb

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level) . Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme