Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT)

BACKGROUND/PURPOSE: The effectiveness and costs of very early rehabilitation after stroke are unknown. This study assessed the cost effectiveness of very early mobilisation in addition to standard care (VEM) compared with standard care alone (SC). METHODS: Cost-effectiveness analysis alongside a phase II, multi-centre, randomised controlled trial (RCT) with blinded outcome assessments. Less than 24 h after stroke, patients were recruited from two stroke units and randomised to receive VEM or SC. The intervention continued until discharge or 14 days, whichever was sooner. The efficacy measure was a dichotomised modified Rankin Scale (mRS) at 3 months with mRS < or =2 representing good outcome. Costs were determined from medical records and patient interviews at 3, 6 and 12 months. National average (where available) or local costs were applied for the reference year 2004. Differences in mean total costs at 3 and 12 months were tested using t test assuming unequal variances. An incremental cost-effectiveness ratio was calculated and probabilistic uncertainty analysis was undertaken. RESULTS: The sample consisted of 38 VEM and 33 SC patients. A trend for good outcome with VEM compared to SC was found (adjusted OR 4.10, 95% CI 0.99-16.88, p = 0.051). Patients receiving VEM incurred significantly less costs at 3 months (AUD 13,559) compared with SC (AUD 21,860; p = 0.02). This difference in mean per patient total cost persisted at the 12-month assessment (VEM: AUD 17,564; SC: AUD 29,750; p = 0.03). VEM was found to be a 'dominant' (more effective, less cost) intervention when compared to SC at 3 months. CONCLUSION: These findings provide preliminary evidence that VEM is likely to be cost-effective. A large RCT is currently underway to confirm the cost effectiveness of VEM.

Where is a corporation's "centre of main interests" in international insolvency?

The international community has long sought the appropriate means by which insolvencies involving several jurisdictions should be conducted. Central to the solution proposed is the view that jurisdictions should primarily co-operate with the proceeding underway in a company's "centre of main interests". This concept will be of increasing importance to Australia with the passing of the Cross Border Insolvency Act 2008 , which enacts domestically the provisions of the United Nations Commission on International Trade Law Model Law on Cross Border Insolvency. This article examines how this concept was intended to operate, the actual provisions of the relevant Instruments together with how it has been judicially interpreted. It will be shown that while some certainties concerning the operation of this concept have been achieved, determining this actual location remains surrounded with considerable vagueness. This article proceeds to suggest the most appropriate interpretation of this "centre of main interests" concept.

Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Strategies to change body shape among men and women who attend fitness centre

The current study examined the association between exercise behaviors, disordered eating, and other behaviors to change body shape among fitness center attendees. The participants were 520 adults (245 men, 275 women) who attended fitness centers. Data were gathered using an anonymous questionnaire. Women who attended fitness centers were generally trying to lose weight and improve fitness; men were generally trying to increase their muscles and improve their fitness level. Reasons for exercise predicted the nature of the body change strategies adopted by respondents. Regression analyses demonstrated that exercises performed by people who attend fitness centers are a reflection of whether or not they want to lose weight, increase muscle or improve fitness. All groups were equally likely to engage in health risk behaviors, but the specific nature of these behaviors varied by group. The implications of these findings for health-related messages among people who attend fitness centers are discussed.

Management framework for corporate telecommunication and data centre information security

Network security, particularly Internet security, is at the forefront of business and government networks. This research has discovered weaknesses in current professional practice, particularly in mitigation strategies to reduce the impacts of security violations in corporate telecommunications and data centres. The importance of integrating security policies, processes and operational practice is demonstrated. Leadership models and innovation mechanisms best suited to improved security design are also identified.

Potential utilisation of assessment centre methodology to enhance student placement outcomes, experiences and employability

Background: Placements are of particular importance due to the richness of learning associated with placement experiences and the wider links they represent to industry and the community. Students often refer to placements as the most significant, productive and memorable component of their training. Importantly, placements also provide the opportunity for students to become work ready, i.e., integrate their knowledge into a new set of employable skills and personal qualities. There is now increased emphasis on employability by employers and universities alike; in fact, it now represents a critical performance measure for Australian universities. Despite these key points, there appears to be inconsistencies in approaches to maximising work placements across and within Universities. Assessment centre methodology may represent a useful approach to standardise and optimise work placements for all stakeholders. Assessment centre methodology has been used successfully for selection purposes in industry for the past 50 years. However, their use as a developmental tool is less prominent. Furthermore, their application in the higher education setting, particularly in the context of placements and student development appears under researched.
Overview of issue: Only one published study was found that reported the use of a developmental assessment centre with a post-graduate sample. That study took place over 10 years ago when the concept of employability was still gaining recognition and work placements were less common. The current paper reviews this unique concept in the context of the existing literature and the current needs of Universities, employers and students.
Discussion: It is argued that the reconsideration of assessment centre methodology for development represents an innovative approach to consistently maximising work placement outcomes, experiences and employability.
Conclusions: Given the importance and increased use of placements, the application of assessment centre methodology within the placement curriculum warrants further research. This methodology represents a standardised approach for implementation within a range of placement programs to enhance student development, placement outcomes and employability.