Invasion and metastasis markers in cancers

Over 90% of all adults human cancers are of epithelial origin comprising mainly of skin and aero-digestive tract cancers. A significant proportion of our discipline's workload consists of management of these cancers. This review article is to provide clinicians with a summary of the current research findings in invasion and metastasis of epithelial cancers and the translation of some of this information to clinical use particularly related to skin and head and neck cancers (HNSCC). Metastasis is the leading cause of death in cancer patients. Although surgical resection of isolated metastases is beneficial for some patients, the overall efficacy of surgery, chemotherapy or radiotherapy is limited. Clearly, with today's advances in surgery a majority of these primary cancers are resectable and a cure attainable if surgeons could control or inhibit metastasis.

General practitioner, specialist providers case conferences in palliative care: Lessons learned from 56 case conferences

OBJECTIVE: To describe the utility and acceptability to general practitioners and palliative care staff of case conferences in palliative care. METHOD: Research focussed on case conferences conducted between GPs and staff of three specialist palliative care units (in an inner urban, outer metropolitan and regional setting), at the time of referral of patients to the service. Telephone interviews were conducted with all GPs who participated in a case conference, and focus groups were conducted with palliative care staff. RESULTS: For most GPs, case conferences by teleconference were a time effective and immediate means of information transfer. The best instances for a conference were at time of patient referral, time of discharge to the community, or where the case was complex. General practitioners appreciated access to multiple professionals simultaneously. Workload pressures were a drawback of participation for both GPs and specialists. Palliative care team members thought case conferences gave GPs an appreciation of a team approach, and reduced professional isolation. The usefulness of the case conferences depended on the willingness of the GP to participate. General practitioners would participate again provided they did not have to organise the case conference. Specialist staff were concerned by the financial cost of organising case conferences. DISCUSSION: Case conferences provide useful information exchange between GPs and specialist staff, and are acceptable to both parties. Much depends on the individual GPs attitude toward participation, as well as the timing of the conferences in the course of the patient's illness. Organisation needs to be a task of the specialist units, who would need administrative support to organise them. (author abstract)

The reliability and validity of the Therapeutic activity index

Purpose To assess the psychometric properties of the Simplified Therapeutic Intervention Scoring System (TISS 28) scale. Materials and Methods A prospective observational design was used. Patients were recruited from a medical-surgical intensive care unit (ICU) and 4 rehabilitation wards of 2 university-affiliated hospitals in Hong Kong. Results Data necessary for the calculation of the TISS 28, the Therapeutic Intervention Scoring System (TISS 76), and severity of illness scoring system (Simplified Acute Physiology Score [SAPS II]) were recorded for each patient during the first 24 hours after his/her admission to an ICU. A significant positive correlation was found between the TISS 76 and the TISS 28 scores as well as the TISS 28 and the SAPS II scores. There was a significant difference between the TISS 28 scores among ICU patients and patients in rehabilitation wards. A significant correlation was found between the TISS 28 scores of the first and second set of TISS 28 scores. Conclusions Although the findings supported the validity and reliability of the TISS 28, there were limitations of the TISS 28 in measuring nursing workload in ICUs. Hence, continued amendment and validation of the TISS 28 on larger samples in different ICUs would be required so as to provide clinical nurses with a valid and reliable assessment of nursing workload.

The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.

An analysis of relational complexity in an air traffic control conflict detection task

Theoretical analyses of air traffic complexity were carried out using the Method for the Analysis of Relational Complexity. Twenty-two air traffic controllers examined static air traffic displays and were required to detect and resolve conflicts. Objective measures of performance included conflict detection time and accuracy. Subjective perceptions of mental workload were assessed by a complexity-sorting task and subjective ratings of the difficulty of different aspects of the task. A metric quantifying the complexity of pair-wise relations among aircraft was able to account for a substantial portion of the variance in the perceived complexity and difficulty of conflict detection problems, as well as reaction time. Other variables that influenced performance included the mean minimum separation between aircraft pairs and the amount of time that aircraft spent in conflict.

Australian Clinical Psychology Training Program Directors Survey

A survey of clinical psychology program directors was conducted to provide an illustrative snapshot of clinical training in Australia. Postgraduate clinical psychology program directors from 27 universities in all States in Australia and the Australian Capital Territory offering postgraduate clinical training programs were emailed the survey; 19 surveys were returned. The present paper reports on a range of issues of relevance to clinical training programs, including numbers of students, types and content of courses, staff workload, relationship with professional bodies, practical training and university-based clinics, and concerns raised by directors. The information is intended to assist those responsible for training in clinical psychology in Australia in their work of increasing the quality of postgraduate training by being informed of the practices of other programs.

The effect of music on monitoring a simulated anaesthetised patient with sonfication

The idea of sonifying anaesthetised patients’ vital signs is gaining acceptance, but some anaesthetists are concerned about additional noise in the operating theatre. We tested the effect of ambient music (jazz, classical and rock) on participants’ ability to monitor a simulated anaesthetised patient with sonification and visual monitors. Participants liked working with ambient music when workload was low. Participants preferred rock music, but reported working better with classical. Ambient music has less effect on participants’ ability to monitor the simulated patient than a distractor task does. We discuss practical implications of these findings.

Simulation of air traffic controllers' behaviour using the operator choice model

The Operator Choice Model (OCM) was developed to model the behaviour of operators attending to complex tasks involving interdependent concurrent activities, such as in Air Traffic Control (ATC). The purpose of the OCM is to provide a flexible framework for modelling and simulation that can be used for quantitative analyses in human reliability assessment, comparison between human computer interaction (HCI) designs, and analysis of operator workload. The OCM virtual operator is essentially a cycle of four processes: Scan Classify Decide Action Perform Action. Once a cycle is complete, the operator will return to the Scan process. It is also possible to truncate a cycle and return to Scan after each of the processes. These processes are described using Continuous Time Probabilistic Automata (CTPA). The details of the probability and timing models are specific to the domain of application, and need to be specified using domain experts. We are building an application of the OCM for use in ATC. In order to develop a realistic model we are calibrating the probability and timing models that comprise each process using experimental data from a series of experiments conducted with student subjects. These experiments have identified the factors that influence perception and decision making in simplified conflict detection and resolution tasks. This paper presents an application of the OCM approach to a simple ATC conflict detection experiment. The aim is to calibrate the OCM so that its behaviour resembles that of the experimental subjects when it is challenged with the same task. Its behaviour should also interpolate when challenged with scenarios similar to those used to calibrate it. The approach illustrated here uses logistic regression to model the classifications made by the subjects. This model is fitted to the calibration data, and provides an extrapolation to classifications in scenarios outside of the calibration data. A simple strategy is used to calibrate the timing component of the model, and the results for reaction times are compared between the OCM and the student subjects. While this approach to timing does not capture the full complexity of the reaction time distribution seen in the data from the student subjects, the mean and the tail of the distributions are similar.

The changing nature and role of the head of department

There is little doubt that devolution of responsibility to schools and the growth of school-based management have impacted upon the role and workload of school leaders. Not only Principals have been affected by these changes as Welch (1996) argues that Principals of public secondary schools have passed responsibility down to Deputy-principals and to Heads of Department. As such, the Head of Department role, like other school administration positions, has undergone significant change. Of interest to this paper is the changing role of Heads of Department in secondary schools. This study reports on the findings of semi-structured interviews with eight Heads of Department from four public secondary schools and Principals from each of these schools in South East Queensland. Four years after the first set of interviews, two heads of department were reinterviewed. Both sets of interviews focused upon the role, change, and the importance of leadership. The research generated eight specific themes each of which was considered consistent with the nature of the role in a period of significant cultural change. These were the difference in perceptions regarding the Head of Department role, held by Principals and Heads of Department; Head of Department leadership in terms of a curriculum framed department or whole school leadership; how individuals perceived leadership, and how they learned of leadership; the impact of the changing culture upon the individual Head of Department; the growing influence of situational factors upon the role; the impact of managerialism; the changing nature of a secondary school department; and a growing and more complex workload, and the need for different skills. Furthermore, the findings pointed towards the need for effective change processes and a reconceptualized head of department role. The paper concludes with some implications for the ongoing professional development needs of Heads of Department.

Managing the airspace: A task analysis of Australian air traffic control

The aim of this study was to examine the way Australian air traffic controllers manage their airspace. Fourteen controllers ranging from 7 to 30 years experience were sampled from the Brisbane air traffic control centre. All had previously been endorsed for en route radar sectors. Five static pictures varying in workload level (low, medium and high) were presented to participants. Controllers were asked to work through the scenarios and describe aloud how they would resolve any potential conflicts between the aircraft. Following this controllers were asked a set of probe questions based on the critical decision method, to extract further information about the way they manage their airspace. A content analysis was used to assess patterns in the way controllers scan, strategies used in conflict detection and conflict resolution and the effect of workload on strategy choice. Findings revealed that controllers use specific strategies (such as working in a left to right scan or prioritising levels) when managing their airspace. Further analyses are still planned however a model based on the processes controllers used to resolve conflicts has been developed and will be presented as a summary of the results.