Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality-adjusted life years

OBJECTIVE: This study compared the cost-effectiveness of a psychologist-led, individualised cognitive behavioural intervention (PI) to a nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers.

METHODS: This was an economic evaluation conducted alongside a randomised trial of highly distressed adult cancer patients and carers calling cancer helplines. Services used by participants were measured using a resource use questionnaire, and quality-adjusted life years were measured using the assessment of quality of life - eight-dimension - instrument collected through a computer-assisted telephone interview. The base case analysis stratified participants based on the baseline score on the Brief Symptom Inventory. Incremental cost-effectiveness ratio confidence intervals were calculated with a nonparametric bootstrap to reflect sampling uncertainty. The results were subjected to sensitivity analysis by varying unit costs for resource use and the method for handling missing data.

RESULTS: No significant differences were found in overall total costs or quality-adjusted life years (QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probability of lower cost and greater QALYs for both carers and patients with high distress at baseline. For patients with low levels of distress at baseline, the PI had a higher probability of greater QALYs but at additional cost. Sensitivity analysis showed the results were robust.

CONCLUSIONS: The PI may be cost-effective compared with the nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. More intensive psychological intervention for patients with greater levels of distress appears warranted.

Evaluation of the fineness of degummed bast fibers

Fiber fineness characteristics are important for yarn production and quality. In this paper, degummed bast fibers such as hemp, flax and ramie have been examined with the Optical Fiber Diameter Analyzer (OFDA100 and OFDA2000) systems for fiber fineness, in comparison with the conventional image analysis and the Wira airflow tester. The correlation between the results from these measurements was analysed. The results indicate that there is a significant linear co-relation between the fiber fineness measurement results obtained from those different systems. In addition, the mean fiber width and its coefficient of variation obtained from the OFDA100 system are smaller than those obtained from the OFDA2000 system, due to the difference in sample preparation methods. The OFDA2000 system can also measure the fiber fineness profile along the bast fiber plants, which can be useful for plant breeding.

Training quality managers-do they practice what they preach?

This paper discusses the personal and professional development needs of Quality Managers. It has been presumed that training is the most important factor to improve quality, once commitment is present. This paper poses the question as to whether Quality training is objectively, systematically, and continuously performed in Australia. In previous research by the authors, it was ascertained that training is often initiated by individuals and provided by private providers as directed by the client. It is of interest to determine if the two largest professional associations for Quality, Australian Organisation for Quality (AOQ) and SAI (Global) perform in this respect. Questions of interest included: what do they offer; how do they determine the needs of their members; who provides these programmes; how do they communicate these programmes to their members; how do they evaluate the success or otherwise of their programmes; and by what process of evaluation do they determine future needs. These data have been collated and analysed and it is concluded that a specifically designed and comprehensive training needs analysis for Quality Managers is being neglected and that the initiation for professional development remains with the individual.

Land use, water quality and ecological responses in Lake Colac – trends from Australia

Purpose - Recently, Colac Otway Shire in Australia released its management plan for Lake Colac, claiming over-enrichment of the lake with nutrients and degraded water quality. This paper aims to investigate these claims by establishing a correlation between key water and ecological indicators and land uses.

Design/methodology/approach - Examines the correlation between impairment and stressors in Lake Colac. This was achieved by identifying the likely sources of pollutants into Lake Colac; identifying any existing monitoring program; and characterizing the water and sediment inputs. The likely impacts of increased nutrients and sediment levels on indigenous flora and fauna were also examined. The use of meiofauna (very small benthic metazoan animals) was investigated as an indicator of degraded sites. Plankton diversity as a measure of water health was also assessed.

Findings - Water quality in Lake Colac was found to vary both temporally and spatially, and exhibited low attainment against acceptable trigger values/objectives. At current levels the lake can be classified as poorly degraded. Likely sources of pollution were identified to be related to land uses in the catchments. The biota of the lake, investigated at four study sites, yielded a sparse, benthic macrofaunal assemblage that was dominated by oligochaetes. In contrast, an abundant and taxonomically diverse meiofaunal assemblage was noted. Future meiofaunal analyses are likely to resolve suitable biotic indicator species of free-living nematodes in response to land use and waterway threats specified in the study. Originality value - This work will provide a better understanding of integrated environmental systems to enable development of best management practices, thus transforming the way the land and water are used in the future. Following the present work, other key water and ecological indicators (increased dispersion and dominance of biological species) at five additional sites were studied. Alternative management options for the effluent generated at Colac Sewage Treatment Plant and possible ecological effects of each option were also evaluated. More recently, a sediment characterization study was also carried out at sensitive sites representative of locations where build up of sediments and algae outbreaks are reported. This will enable classification of sediment and evaluation of dredging options.

Impact evaluation of a five-day short course in health promotion: workforce development in action

Issue addressed: This paper reports on impact evaluation of a series of five-day Short Courses in Health Promotion that have been delivered to more than 2,000 people since 2002 as part of a statewide workforce development strategy.

Methods: A triangulated mixed methods research design was selected for the evaluation. Data were collected through a mail survey, key informant interviews, focus groups and organisational case studies. Stakeholder and participant involvement were central to the evaluation.

Results: Organisational change emerged as a key theme. Impacts of the short course were felt in relation to health promotion practice and on organisational capacity to conduct health promotion, while the development of confidence and skills of participants to engage in collaborative opportunities was a not unexpected, but important, benefit of the course.

Conclusions: A short course is effective if attention is given to quality delivery, adult learning methods, participant involvement, appropriate targeting, good planning, and adequate funding. However, respondents commonly report the need for organisational change in order for health promotion practice to be embedded into organisations and for practitioners to be supported in their efforts to re-orient services towards health promotion.

Ensuring quality during monitoring of the learning environment of government primary schools achieved through EUI-PDP for teachers and head teachers

A positive change in the learning environment in schools is visible through ongoing professional development of teachers and administrators. Monitoring the professional development program and providing support to teachers and administrators to transfer their learnings into the school environment ensures some measures of quality. Quality issues led to the launching of the Professional Development Program (PDP) for Primary School Teachers (PSTs) of Sindh by the United Educational Initiative (UEI), a consortium of five Governmental and Non-Governmental Organizations, working under the supervision of Education Sector Reform Assistance (ESRA). Implementation of the UEI-PDP in four districts of Sindh, is ensured by a team of professionals in each district. Recognising that capacity building of district education employees would improve the educational system in the country, 130 Master Trainers were selected, on merit, from the District Education Office for the training of 17,000 teachers and 3000 Head teachers/administrators over a period of two years. This paper developed the design of a Monitoring Process for a Professional Development Program for Primary School Teachers and Administrators. Data was collected through Pre/Post observations, Interviews, Questionnaires and Reports. Such tools make it possible for the monitoring teams to observe, to inquire further, and, along with the Managers, Master Trainers and School Support Team, seek to explain the progress of the program and take corrective action where indicated. Both formative evaluations as well as summative  evaluation techniques are utilized for evaluating the program. The monitoring process that assisted in formative evaluations is described. In order to assist in summative evaluation, data collected through the monitoring process was further developed to categorize the schools where teachers and head teachers are trained. It is hoped that the categorization of the schools may lead to further improvements in those schools which fall in the group for need improvement. It may also initiate further research as to reasons behind why some schools are in the good category and why others fall in the average category.

Personality, quality and satisfaction in airline services

This paper examines some issues related to the influence of consumers’ perception of service evaluation according to their personality characteristics. The paper discusses the application of personality traits, including the Jungian personality types, as a possible predictor of perceived satisfaction levels. The existing literature has not fully explored the relationship between airline flights’ service satisfaction levels and consumers’ personality characteristics. A well-known UK leisure airline allowed a survey to be conducted in 1998-2000. The findings suggest that there is a weak correlation between personality types and satisfaction levels, but a stronger relationship between perceptions of quality and satisfaction. The adaptation of the Jungian personality types, for use in the evaluation of leisure airlines’ service attributes, appears to be worthy of further examination.

Evaluating a measure of content quality for accounting narratives (with an empirical application to narratives from Australia, Hong Kong, and the United States)

This paper evaluates a texture-based approach developed by Sydserff and Weetman (1999), to examine corporate annual report narratives. This is achieved by using the texture index to evaluate information content (which includes readability) in accounting narratives. Specifically, we examine the letter to shareholders of reports from Australia, Hong Kong and the United States.

We suggest a texture-based evaluation provides a robust measure of narrative quality due to the incorporation of readability and content analysis. The ability to measure content quality assists in promoting accountability, with the aim of improving usefulness of corporate
information and disclosures, and greater investor confidence in capital markets.

This paper also investigates these exploratory results to consider variations in quality between different countries. Considerable differences were found between the countries with Hong Kong reports generally superior. These tentative findings provide a small contribution to the comparative annual report literature and the emerging area of narrative evaluation.

Obesity prevention programs demand high-quality evaluations

Obesity prevention programs are at last underway or being planned in Australia and New Zealand. However, it is imperative that they are well-evaluated so that they can contribute to continuous program improvement and add much-needed evidence to the international literature on what works and does not work to prevent obesity. Three critical components of program evaluation are especially at risk when the funding comes from service delivery rather than research sources. These are: the need for comparison groups; the need for measured height and weight; and the need for sufficient process and context information. There is an important opportunity to build collaborative mechanisms across community-based obesity prevention sites to enhance the program and evaluation quality and to accelerate knowledge translation into practice and policy.

RQF publication quality measures: methodoligical issues

The Research Quality Framework uses Thomson-ISI citation benchmarks as its main set of objective measures of research quality. The Thomson-ISI measures rely on identifying a core set of journals in which the major publications for a discipline are to be found. The core for a discipline is determined by applying a nontransparent process that is partly based on Bradford’s Law (1934). Yet Bradford was not seeking measures about quality of publications or journals. How valid then is it to base measures of publication quality on Bradford’s Law? We explore this by returning to Bradford’s Law and subsequent related research asking ‘what is Bradford’s Law really about?’ We go further, and ask ‘does Bradford’s Law apply in Information Systems?’ We use data from John Lamp’s internationally respected Index of Information Systems Journals to explore the latter question. We have found that Information Systems may have a core of journals only a subset of which is also in the list of Thomson-ISI journals. There remain many unanswered questions about the RQF metrics based on Thomson-ISI and their applicability to information systems.

Consumers' evaluation of free service trial offers

Largely unexplored, a free service trial may be defined as an offer to the consumer to experience, at no monetary cost, all or part of a core, augmented or facilitating service from a provider that the consumer does not currently use. Free service trials are worth studying for two reasons. First they are one of the important examples of inequitable exchange between supplier and purchaser – one that is likely to lead to a sense of obligation among those who adopt the trial offer. Second, they are a very common promotional device. This paper proposes that free service trials are more problematic than tangible product trials. The value of what is offered may be limited by time, the scope of trial, or because only a partial, facilitating or augmented service is offered. Judgments about the perceived value of the complete service in its paid form will also contribute to the evaluation of the trial offer. In deciding whether they accept the trial, the paper proposes that consumers make attributions about the motives of the service trial provider and the consumer’s consequent obligations if they accept it. Obligations are likely to be felt more acutely where the trial is interpersonal (e.g. a facial massage) rather than impersonal (e.g. anti-virus service). Such evaluations are also likely to be affected by past experience with the service category, consumer skepticism and personal norms of reciprocity. A program of research is proposed which would systematically examine the consumers’ evaluations of free trial offers.

Quality-of-life measurement in patients undergoing radiation therapy for head and neck cancer: a Hong Kong experience

The aims of this study are (1) to establish a reliable and valid quality-of-life (QOL) questionnaire for Chinese patients with head and neck (H&N) cancer who are treated with radiation therapy and (2) to evaluate the impact of the immediate side effects of treatment on the QOL of these patients. The 39-item "Quality of Life Radiation Therapy Instrument with Head and Neck Companion Module" (QOL-RTI/H&N) was translated into Chinese. In the reliability evaluation phase (study module 1), the questionnaire was administered twice to 56 H&N cancer patients, 7 days apart, during the second and third week of radiation therapy. In the validity evaluation phase (study module 2), 138 patients completed the QOL-RTI/H&N before starting and at the end of radiation therapy. Sixty-nine of these 138 patients also completed the QOL-RTI/H&N during the second week of their radiation therapy, at the same time as completing the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire. Cronbach alpha coefficients were 0.88 for the general-tool QOL-RTI and 0.90 for the H&N subscale. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.89 for the general-tool QOL-RTI and 0.75 for the H&N subscale. The instrument can discriminate between patients with stage I or II disease and those with stage III or IV disease (P < .05). Concurrent validity was established by the good agreement with the FACT-H&N (r = 0.86, P < .001). A highly significant deterioration was in the QOL from the baseline to the end of treatment (mean difference for general tool = 1.95, P < .001; mean difference for H&N subscale = 4.85, P < .001). The Chinese QOL-RTI/H&N is a reliable and valid tool for determining the QOL in H&N cancer patients receiving radiation therapy. The immediate side effects of treatment had a significantly negative impact on the patients' QOL. The impact was relatively large for the functional and treatment-site aspects.

Evaluation of the environments for health framework

Environments for Health, Five Years On…
Since its release in 2001, Victoria’s Environments for Health Municipal Public Heath Planning Framework, has represented a leading edge approach to supporting quality public health planning at the local government level.

In 2006 the Department of Human Services appointed an external evaluation team from Deakin and Melbourne Universities to assess the introduction of the Environments for Health framework to municipal public health planning and to make recommendations for its future direction.

The evaluation aimed to determine the extent to which Environments for Health and related implementation activities had:

* been incorporated by local governments in their policies and practices
* created greater opportunities for health gain, and
* been supported effectively by the Department of Human Services and other stakeholders

The evaluation project involved participation from a broad range of key stakeholders, including all local Councils within Victoria. Data collection covered four distinct stages - document analysis, key informant interviews, state-wide survey of practitioners, and council and stakeholder forums, all with opportunities for input to the evaluation.

QTP in Victoria: listening to teachers leads to quality professional development

How do you get information and communication technology working for authentic learning across the curriculum? It depends on quality professional development. The author draws on her research and evaluation work on a Quality Teacher Program pilot project by the Victorian Department of Education and Training to explain why listening to teachers is leading to just that.