Preliminary experiences with a single-patient trials service in general practice

Objective: To pilot a single-patient trials (SPTs) service in general practice, designed to improve decision-making about long-term medications for chronic conditions. Design: 12-week within-patient, randomised, double-blind, placebo-controlled, crossover comparison of ibuprofen with paracetamol for osteoarthritis, involving three pairs of two-week treatment periods for each participating patient. Setting and patients: Patients attending an academic general practice with a clinical diagnosis of osteoarthritis, with pain of at least a month's duration severe enough to warrant consideration of long-term non-steroidal anti-inflammatory drug (NSAID) use. Main outcome measures: Pain and stiffness; measures of overall arthritis compared with previous fortnight; preference for NSAID at the end of each two-week treatment period; use of escape analgesia; side effects; and management changes as a result of the SPTs. Results: Eight of 14 patients completed SPTs. One was a clear responder to NSAIDs, five were non-responders, and two were indefinite. Of the five who were using NSAIDs before the SPT, two continued and three ceased using them. Clinically useful information assisted decision-making for all eight participants. Medication management changed for six. Conclusions: Single-patient trials can be successfully implemented in general practice and might be a valuable method for GPs to identify patients who respond to medication for chronic stable conditions such as osteoarthritis, in which individual response to medication is variable.

Building family/general practice research capacity

To promote the range of interventions for building family/general practice (family medicine) research capacity, we describe successful international examples. Such examples of interventions that build research capacity focus on diseases and illness research, as well as process research; monitor the output of research in family/general practice (family medicine); increase the number of family medicine research journals; encourage and enable research skills acquisition (including making it part of professional training); strengthen the academic base; and promote research networks and collaborations. The responsibility for these interventions lies with the government, colleges and academies, and universities. There are exciting and varied methods of building research capacity in family medicine.

Agency as discursive practice: From nobody to somebody as an international student in Australia

As more and more students pursue an international education, there is a need to investigate how these students deal with the demands of their study programs in the new academic context. This paper introduces one such student, a Thai English teacher named Woody,2 and looks at the ways that he engaged with a Master of Education program in Australia. I analyse the transcripts of two interviews that I conducted with Woody in his first semester using Fairclough's model of Critical Discourse Analysis (CDA). The analysis is interested in the social and institutional demands that Woody identified as impacting on the course, and the strategic action that he took in response to them. I argue that by undertaking this action, Woody was “working” as an agent of his own change. The analysis highlights a proactive and strategic engagement on Woody's part, a point that has been missed in much of the literature on the international student experience in Australia.

Assessing professionalism: theory and practice

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather titan attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Is corrections correcting? An examination of prisoner rehabilitation policy and practice in Queensland

This article provides an analysis of the policy and practice of prisoner rehabilitation in Queensland, and the extent to which they accord with international best practice. Actual practice was identified through interviews and written submissions from 20 ex-prisoners and 18 prisoner service providers (including two past staff members from Queensland prisons), as well as through an examination of reported judicial review decisions and Department of Corrective Services statistics. The results demonstrate that although the legislation and procedures suggest that a best practice system of prisoner rehabilitation exists in Queensland, there is a significant gulf between policy and practice. Far from being sufficiently prepared for release, Queensland prisoners are generally released directly from high security facilities into a community which they have great difficulty reintegrating into. The results suggest that the corrective services system in Queensland is not succeeding in fulfilling its primary purpose, 'correction', or in meeting its well-publicised goal of ensuring community safety.

Bridging the divide between theory and practice. Experiential learning approaches for tourism and hospitality education

Experiential learning approaches such as role-play have been found to be valuable methods of bridging the divide between academic knowledge and practical skills, a problem often cited in tourism and hospitality management education. Such approaches have been found to contribute towards deeper learning by enhancing students' interest, motivation, participation, knowledge and skill development. This paper reports on the implementation of an experiential learning approach designed to encourage and facilitate deeper learning approaches, with the contributing aims of providing students with a more interesting learning experience and a broader set of skills for future employment.

Investigating Concept Mapping and Stimulated Recall to Reveal Academic Teacher Beliefs and how they are enacted through learning designs for the Web

Increasingly, academic teachers are designing their own web sites to add value to or replace other forms of university teaching. These web sites are tangible and dynamic constructions that represent the teachers thinking and decisions derived from an implicit belief system about teaching and learning. The emphasis of this study is to explore the potential of the research techniques of concept-mapping and stimulated recall to locate the implicit pedagogies of academic teachers and investigate how they are enacted through the learning designs of their web sites. The rationale behind such an investigation is that once these implicit belief systems are made visible, then conversations can commence about how these beliefs are transformed into practice, providing a potent departure point for academic development.

Prevalence of Parkinson’s disease in metropolitan and rural Queensland: A general practice survey

The prevalence of idiopathic Parkinson’s disease (IPD) in Australia is unclear. We estimated the prevalence of IPD, and other forms of parkinsonism, through the study of typical caseloads in general practice. A random sample of general practitioners (GPs) throughout Queensland (401 responses from 528 validated practice addresses) was asked to estimate the numbers of patients with IPD and parkinsonism seen in the preceding year. The estimated prevalence of diagnosed IPD in Queensland was 146 per 100 000 (95% CI = 136–155). A further 51 per 100 000 in the population were suspected by doctors to have IPD without formal diagnosis, whereas another 51 per 100 000 people may have non-idiopathic parkinsonism. Idiopathic Parkinson’s disease was more common in rural than metropolitan areas. Although most GPs were confident in making diagnoses of IPD, the majority had little or no confidence in their ability to treat the disease, especially in its later stages. Support from neurologists was perceived by GPs to be very good in cities, but poor in remote areas.

Popper's Explications of Ad hocness: Circularity, Empirical Content, and Scientific Practice

Popper's explications of 'ad hoc' in relation to hypotheses and explanations turn out to be either trivial, confused or mistaken. One such explication I discuss at length is circularity; another is reduction in empirical content. I argue that non-circularity is preferable to non-ad hocness for an acceptable explanation or explanans, and I isolate some persistent errors in his analysis. Second, Popper is barking up the wrong tree in proscribing reductions in empirical content in novel hypotheses. Such reductions may constitute scientific progress. He fails to show that ad hoc hypothesis are the threat to science he claims.