The evidence-based development of an intervention to address the information needs of adults newly diagnosed with primary brain tumours and their carers

Adults diagnosed with primary brain tumours often experience physical, cognitive and neuropsychiatric impairments and decline in quality of life. Although disease and treatment-related information is commonly provided to cancer patients and carers, newly diagnosed brain tumour patients and their carers report unmet information needs. Few interventions have been designed or proven to address these information needs. Accordingly, a three-study research program, that incorporated both qualitative and quantitative research methods, was designed to: 1) identify and select an intervention to improve the provision of information, and meet the needs of patients with a brain tumour; 2) use an evidence-based approach to establish the content, language and format for the intervention; and 3) assess the acceptability of the intervention, and the feasibility of evaluation, with newly diagnosed brain tumour patients. Study 1: Structured concept mapping techniques were undertaken with 30 health professionals, who identified strategies or items for improving care, and rated each of 42 items for importance, feasibility, and the extent to which such care was provided. Participants also provided data to interpret the relationship between items, which were translated into ‘maps’ of relationships between information and other aspects of health care using multidimensional scaling and hierarchical cluster analysis. Results were discussed by participants in small groups and individual interviews to understand the ratings, and facilitators and barriers to implementation. A care coordinator was rated as the most important strategy by health professionals. Two items directly related to information provision were also seen as highly important: "information to enable the patient or carer to ask questions" and "for doctors to encourage patients to ask questions". Qualitative analyses revealed that information provision was individualised, depending on patients’ information needs and preferences, demographic variables and distress, the characteristics of health professionals who provide information, the relationship between the individual patient and health professional, and influenced by the fragmented nature of the health care system. Based on quantitative and qualitative findings, a brain tumour specific question prompt list (QPL) was chosen for development and feasibility testing. A QPL consists of a list of questions that patients and carers may want to ask their doctors. It is designed to encourage the asking of questions in the medical consultation, allowing patients to control the content, and amount of information provided by health professionals. Study 2: The initial structure and content of the brain tumour specific QPL developed was based upon thematic analyses of 1) patient materials for brain tumour patients, 2) QPLs designed for other patient populations, and 3) clinical practice guidelines for the psychosocial care of glioma patients. An iterative process of review and refinement of content was undertaken via telephone interviews with a convenience sample of 18 patients and/or carers. Successive drafts of QPLs were sent to patients and carers and changes made until no new topics or suggestions arose in four successive interviews (saturation). Once QPL content was established, readability analyses and redrafting were conducted to achieve a sixth-grade reading level. The draft QPL was also reviewed by eight health professionals, and shortened and modified based on their feedback. Professional design of the QPL was conducted and sent to patients and carers for further review. The final QPL contained questions in seven colour-coded sections: 1) diagnosis; 2) prognosis; 3) symptoms and problems; 4) treatment; 5) support; 6) after treatment finishes; and 7) the health professional team. Study 3: A feasibility study was conducted to determine the acceptability of the QPL and the appropriateness of methods, to inform a potential future randomised trial to evaluate its effectiveness. A pre-test post-test design was used with a nonrandomised control group. The control group was provided with ‘standard information’, the intervention group with ‘standard information’ plus the QPL. The primary outcome measure was acceptability of the QPL to participants. Twenty patients from four hospitals were recruited a median of 1 month (range 0-46 months) after diagnosis, and 17 completed baseline and follow-up interviews. Six participants would have preferred to receive the information booklet (standard information or QPL) at a different time, most commonly at diagnosis. Seven participants reported on the acceptability of the QPL: all said that the QPL was helpful, and that it contained questions that were useful to them; six said it made it easier to ask questions. Compared with control group participants’ ratings of ‘standard information’, QPL group participants’ views of the QPL were more positive; the QPL had been read more times, was less likely to be reported as ‘overwhelming’ to read, and was more likely to prompt participants to ask questions of their health professionals. The results from the three studies of this research program add to the body of literature on information provision for brain tumour patients. Together, these studies suggest that a QPL may be appropriate for the neuro-oncology setting and acceptable to patients. The QPL aims to assist patients to express their information needs, enabling health professionals to better provide the type and amount of information that patients need to prepare for treatment and the future. This may help health professionals meet the challenge of giving patients sufficient information, without providing ‘too much’ or ‘unnecessary’ information, or taking away hope. Future studies with rigorous designs are now needed to determine the effectiveness of the QPL.

Using ‘think aloud’ as a strategy for learning clinical reasoning in high fidelity case-based simulation for undergraduate nursing students

AIMS This paper reports on the implementation of a research project that trials an educational strategy implemented over six months of an undergraduate third year nursing curriculum. This project aims to explore the effectiveness of ‘think aloud’ as a strategy for learning clinical reasoning for students in simulated clinical settings. BACKGROUND Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting [1]. Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. For students learning to manage complex clinical situations, teaching approaches are required that make these instinctive cognitive processes explicit and clear [2-5]. In line with professional expectations, nursing students in third year at Queensland University of Technology (QUT) are expected to display clinical reasoning skills in practice. This can be a complex proposition for students in practice situations, particularly as the degree of uncertainty or decision complexity increases [6-7]. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students [4, 8]. This project aims to use the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students are assisted to uncover cognitive approaches that best assist them to make effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection on their practice. MEHODS In semester 2 2011 at QUT, third year nursing students will undertake high fidelity simulation, some for the first time commencing in September of 2011. There will be two cohorts for strategy implementation (group 1= use think aloud as a strategy within the simulation, group 2= not given a specific strategy outside of nursing assessment frameworks) in relation to problem solving patient needs. Students will be briefed about the scenario, given a nursing handover, placed into a simulation group and an observer group, and the facilitator/teacher will run the simulation from a control room, and not have contact (as a ‘teacher’) with students during the simulation. Then debriefing will occur as a whole group outside of the simulation room where the session can be reviewed on screen. The think aloud strategy will be described to students in their pre-simulation briefing and allow for clarification of this strategy at this time. All other aspects of the simulations remain the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). RESULTS Methodology of the project and the challenges of implementation will be the focus of this presentation. This will include ethical considerations in designing the project, recruitment of students and implementation of a voluntary research project within a busy educational curriculum which in third year targets 669 students over two campuses. CONCLUSIONS In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs. References 1. Lasater, K., High-fidelity simulation and the development of clinical judgement: students' experiences. Journal of Nursing Education, 2007. 46(6): p. 269-276. 2. Lapkin, S., et al., Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing, 2010. 6(6): p. e207-22. 3. Kaddoura, M.P.C.M.S.N.R.N., New Graduate Nurses' Perceptions of the Effects of Clinical Simulation on Their Critical Thinking, Learning, and Confidence. The Journal of Continuing Education in Nursing, 2010. 41(11): p. 506. 4. Banning, M., The think aloud approach as an educational tool to develop and assess clinical reasoning in undergraduate students. Nurse Education Today, 2008. 28: p. 8-14. 5. Porter-O'Grady, T., Profound change:21st century nursing. Nursing Outlook, 2001. 49(4): p. 182-186. 6. Andersson, A.K., M. Omberg, and M. Svedlund, Triage in the emergency department-a qualitative study of the factors which nurses consider when making decisions. Nursing in Critical Care, 2006. 11(3): p. 136-145. 7. O'Neill, E.S., N.M. Dluhy, and C. Chin, Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing, 2005. 49(1): p. 68-77. 8. Lee, J.E. and N. Ryan-Wenger, The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis. J Pediatr Health Care, 1997. 11(3): p. 101-10.

The development of Monte Carlo techniques for the verification of radiotherapy treatments

Radiotherapy is a cancer treatment modality in which a dose of ionising radiation is delivered to a tumour. The accurate calculation of the dose to the patient is very important in the design of an effective therapeutic strategy. This study aimed to systematically examine the accuracy of the radiotherapy dose calculations performed by clinical treatment planning systems by comparison againstMonte Carlo simulations of the treatment delivery. A suite of software tools known as MCDTK (Monte Carlo DICOM ToolKit) was developed for this purpose, and is capable of: • Importing DICOM-format radiotherapy treatment plans and producing Monte Carlo simulation input files (allowing simple simulation of complex treatments), and calibrating the results; • Analysing the predicted doses of and deviations between the Monte Carlo simulation results and treatment planning system calculations in regions of interest (tumours and organs-at-risk) and generating dose-volume histograms, so that conformity with dose prescriptions can be evaluated. The code has been tested against various treatment planning systems, linear acceleratormodels and treatment complexities. Six clinical head and neck cancer treatments were simulated and the results analysed using this software. The deviations were greatest where the treatment volume encompassed tissues on both sides of an air cavity. This was likely due to the method the planning system used to model low density media.

A design approach to teaching new product development

The educational unit new product development, taught within the industrial design program at the Queensland University of Technology (QUT) introduces the relationship between product design and commercialisation to third year industrial design undergraduate students. In which, they are exposed for the first time to product strategy development aimed at meeting consumer expectations, whilst at the same time achieving corporate objectives. Delivered content such as intellectual property, market opportunities, competitor analysis and investor requirements are taught within the thirteen week semester timeframe. New product development theory is not a new field. However, the design approach to teaching this theory and more importantly how designers can use it in the design process is novel. This paper provides an overview of the curriculum design of this unit as well as its incremental development over the past four year duration period. Student project outcomes and more importantly the process and tools from this unit are also discussed and presented.

A conceptual model to link deep customer insights to both growth opportunities and organisational strategy in SME’s as part of a design led transformation journey

Although Design Led Innovation activities aim to raise the value of design within the business, knowledge about which tools are available to support companies and how to apply them to make the connection between design for new product development and design as a strategic driver of growth is needed. This paper presents a conceptual method to supplement existing process and tools to assist companies to grow through design. The model extends the authors’ previous work to explore how through storytelling, customer observation can be captured and translated into new meaning, then creating new design propositions shaped into product needs, which can drive internal business activities, brand and the strategic vision. The paper contributes to a gap in the theoretical frameworks and literature by highlighting the need to align and scale design processes which match the needs of SME’s as they transition along a trajectory to become design led businesses.

Representational change and strategy use in children's number line estimation during the first years of primary school

Background: The objective of this study was to scrutinize number line estimation behaviors displayed by children in mathematics classrooms during the first three years of schooling. We extend existing research by not only mapping potential logarithmic-linear shifts but also provide a new perspective by studying in detail the estimation strategies of individual target digits within a number range familiar to children. Methods: Typically developing children (n = 67) from Years 1 – 3 completed a number-to-position numerical estimation task (0-20 number line). Estimation behaviors were first analyzed via logarithmic and linear regression modeling. Subsequently, using an analysis of variance we compared the estimation accuracy of each digit, thus identifying target digits that were estimated with the assistance of arithmetic strategy. Results: Our results further confirm a developmental logarithmic-linear shift when utilizing regression modeling; however, uniquely we have identified that children employ variable strategies when completing numerical estimation, with levels of strategy advancing with development. Conclusion: In terms of the existing cognitive research, this strategy factor highlights the limitations of any regression modeling approach, or alternatively, it could underpin the developmental time course of the logarithmic-linear shift. Future studies need to systematically investigate this relationship and also consider the implications for educational practice.

Design and design thinking in business and management education and development

Design and design thinking have been identified as making valuable contributions to business and management and the numbers of higher education programs that teach design thinking to business students, managers and executives are growing. However multiple definitions of design thinking and the range of perspectives have created some confusion about potential pathways. This paper examines notions of design and design thinking and uses these definitions to identify themes in higher educational programs. We present the findings from an initial exploratory investigation of design and design thinking in higher education business programs and define four distinct educational approaches around human centred innovation, integrative thinking, design management and design as strategy. Potential directions for management education programs are presented.

Rethinking comprehension and strategy use in second language listening instruction

In second language classrooms, listening is gaining recognition as an active element in the processes of learning and using a second language. Currently, however, much of the teaching of listening prioritises comprehension without sufficient emphasis on the skills and strategies that enhance learners’ understanding of spoken language. This paper presents an argument for rethinking the emphasis on comprehension and advocates augmenting current teaching with an explicit focus on strategies. Drawing on the literature, the paper provides three models of strategy instruction for the teaching and development of listening skills. The models include steps for implementation that accord with their respective approaches to explicit instruction. The final section of the paper synthesises key points from the models as a guide for application in the second language classroom. The premise underpinning the paper is that the teaching of strategies can provide learners with active and explicit measures for managing and expanding their listening capacities, both in the learning and ‘real world’ use of a second language.

CgDN24 : a gene involved in hyphal development in the fungal phytopathogen Colletotrichum gloeosporioides

A cDNA corresponding to a transcript induced in culture by N starvation, was identified in Colletotrichum gloeosporioides by a differential hybridisation strategy. The cDNA comprised 905 bp and predicted a 215 aa protein; the gene encoding the cDNA was termed CgDN24. No function for CgDN24 could be predicted by database homology searches using the cDNA sequence and no homologues were found in the sequenced fungal genomes. Transcripts of CgDN24 were detected in infected leaves of Stylosanthes guianensis at stages of infection that corresponded with symptom development. The CgDN24 gene was disrupted by homologous recombination and this led to reduced radial growth rates and the production of hyphae with a hyperbranching phenotype. Normal sporulation was observed, and following conidial inoculation of S. guianensis, normal disease development was obtained. These results demonstrate that CgDN24 is necessary for normal hyphal development in axenic culture but dispensable for phytopathogenicity. © 2005 Elsevier GmbH. All rights reserved.

L1 Learning Strategy Instruction does make a difference in EFL listening: An empirical study.

In language learning, listening is the basic skill which learners should begin to develop other skills, namely speaking, reading and writing. This sequence of language learning in most English as Foreign Language (EFL) settings goes against the stream, learning first reading and writing and later listening and speaking. This study investigates the effects of cognitive, process-based approach to instructing EFL listening strategies over 11 weeks during a semester in Persian (L1). Lower intermediate female participants (N = 50) came from a couple of EFL classrooms in an English Language Institute in Iran. The experimental group (n = 25) listened to their classroom activities using a methodology that led learners through four cognitive processes (guessing, making inference, identifying topics and repetition) in Persian was basically successful in EFL listening. The same teacher taught the control group (n = 25), which listened to the same classroom listening activities without any guided attention to the learning strategy process in Persian. A pre and post listening test made by a group of experts in the language institute tracked any development in light of cognitive learning strategy instruction in EFL listening through L1. The hypothesis was that the experimental group received the guided attention in L1 during the classroom listening activities made greater gains and was verified despite the partial improvement of the control group.

Development priority zoning (DPZ)-led scenario simulation for regional land use change : the case of Suichang County, China

China has experienced an extraordinary level of economic development since the 1990s, following excessive competition between different regions. This has resulted in many resource and environmental problems. Land resources, for example, are either abused or wasted in many regions. The strategy of development priority zoning (DPZ), proposed by the Chinese National 11th Five-Year Plan, provides an opportunity to solve these problems by coordinating regional development and protection. In line with the rational utilization of land, it is proposed that the DPZ strategy should be integrated with regional land use policy. As there has been little research to date on this issue, this paper introduces a system dynamic (SD) model for assessing land use change in China led by the DPZ strategy. Land use is characterized by the prioritization of land development, land utilization, land harness and land protection (D-U-H-P). By using the Delphi method, a corresponding suitable prioritization of D-U-H-P for the four types of DPZ, including optimized development zones (ODZ), key development zones (KDZ), restricted development zones (RDZ), and forbidden development zones (FDZ) are identified. Suichang County is used as a case study in which to conduct the simulation of land use change under the RDZ strategy. The findings enable a conceptualization to be made of DPZ-led land use change and the identification of further implications for land use planning generally. The SD model also provides a potential tool for local government to combine DPZ strategy at the national level with land use planning at the local level.

ACE research vignette 005 : success or failure - what makes the difference in managing new product development?

This series of research vignettes is aimed at sharing current and interesting findings from our team of international Entrepreneurship researchers. In this vignette, Dr Henri Burgers considers some of the factors that can make a difference in managing new product development.

Metacognitive strategy instruction in English as Foreign Language (EFL) listening skill

Listening skill is a critical part of language learning in general, and second, and foreign language learning, in particular. However, the process of this basic skill has been overlooked compared to other skills such as speaking, reading and writing, in terms of an explicit instruction, and the product of listening is instead mainly tested indirectly through comprehension questions in classrooms. Instruction of metacognitive strategies demonstrates the pivotal impact on second language listening skill development. In this vein, this study used a mixed method with an experimental male group (N = 30) listened to texts using process-approach pedagogy directed students through metacognitive strategies over a semester (10 weeks) in Iran. To investigate the impact of metacognitive strategy instruction, the following approaches were implemented. First, IELTS listening test was used to track any development of listening comprehension. Second, using Vandergrift et al. (2006) Metacognitive Awareness Listening Questionnaire (MALQ) helped examine students’ use of metacognitive strategies in listening comprehension. Finally, interviews were used to examine students’ use of strategies in listening. The results showed that students had a development in comprehension of IELTS listening test, but no statistical significant development of metacognitive awareness in listening was demonstrated. Students and teacher reported in the interviews students used multiple strategies to approach listening comprehension besides metacognitive strategies.

The impact of English as a Foreign Language (EFL) listening comprehension through first language (L1) listening strategy training

Listening is the basic and complementary skill in second language learning. The term listening is used in language teaching to refer to a complex process that allows us to understand spoken language. Listening, the most widely used language skill, is often used in conjunction with the other skills of speaking, reading and writing. Listening is not only a skill area in primary language performance (L1), but is also a critical means of acquiring a second language (L2). Listening is the channel in which we process language in real time – employing pacing, units of encoding and decoding (the 2 processes are central to interpretation and meaning making) and pausing (allows for reflection) that are unique to spoken language. Despite the wide range of areas investigated in listening strategies during training, there is a lack of research looking specifically at how effectively L1 listening strategy training may transfer to L2. To investigate the development of any such transfer patterns the instructional design and implementation of listening strategy of L1 will be critical.

Measuring literalism and symbolism in advertisements : scale development and validation

A basic element in advertising strategy is the choice of an appeal. Many researchers have studied communication message form and specifically forms of literalism and symbolism, or some variation. The motives for such study are grounded in increasing the effectiveness of commercial communication messages, especially advertising messages. Advertising research studies typically use forms of literalism (e.g. informativeness) or symbolism (e.g. metaphoric, tropes, schemes figures of speech, and rhetorical figures) as independent variables and compare these against one or more of the traditional advertising effectiveness measures as dependent variable(s). The main challenge in assessing the effectiveness of literalism or symbolism in message content is the discreet identification of the construct. However, no standard, empirically-tested measure was located in the literature.