A pragmatic 2 × 2 × 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care—methodology of the Palliative Care Trial [ISRCTN 81117481]

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005. (c) 2005 Elsevier Inc. All rights reserved.

'Hybrids' and the gendering of computing jobs in Australia

This paper presents recent Australian evidence on the extent to which women are entering “hybrid” computing jobs combining technical and communication or “people management” skills, and the way these skill combinations are valued at organisational level. We draw on a survey of detailed occupational roles in large IT firms to examine the representation of women in a range of jobs consistent with the notion of “hybrid”, and analyse the discourse around these sorts of skills in a set of organisational case studies. Our research shows a traditional picture of labour market segmentation, with limited representation of women in high status jobs, and their relatively greater prevalence in more routine areas of the industry. While our case studies highlight perceptions of the need for hybrid roles and assumptions about the suitability of women for such jobs, the ongoing masculinity of core development functions appears untouched by this discourse.