Heart failure following cancer therapy in patients with hematological malignancies aged 18 years and under : a linked health data analysis (1996-2009)

Introduction: The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not.

Methods: Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF).

Results: Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) (Figure 1).

Conclusions: This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this population.

Perceptions of the learning context and learning approaches : implications for quality learning outcomes in accounting

This study analyses learning approaches, course perceptions and learning outcomes of a group of second year accounting students at an Australian university using qualitative data analysis techniques. The research method involves the development of a series of matrices linking types of motives and strategies used by students in their study, together with their perceptions of the learning context associated with learning outcomes. The study focuses on assessing the links between learning approaches and a qualitative assessment of students' conceptual understanding of aspects of financial accounting studied at the undergraduate level. The results confirm how individual differences in the perceptions of the learning context relate to study motives and strategies. The findings show how different forms of memorisation relate to study strategies and how the completion of accounting tasks link to students' perceptions of course requirements. There was also some evidence that, in terms of learning outcomes, students with sophisticated levels of understanding of concepts, tended to have consistent deep and achieving approaches to learning. This result was compared with students' academic performance as a measure of learning outcome. Discrepancies between these two measures of learning outcome are highlighted in the conclusions. The findings strengthen the case for further investigation of the use of measures other than academic performance in examining relationships between learning approaches and learning outcomes.

Managing whistleblowing : the significance of quality standards

This research studies the relationship between the existence of whistle blowing procedures and the level of importance placed on whistleblowing procedures, in an environment that claims to have a quality culture. Organisations certified with a basic quality standard, ISO 9000, were surveyed in three separate industries. Certified organisations were selection on the assumption of a basic knowledge and understanding of quality concepts as well as heightened chance of exiting whistleblowing procedures. A combination of quantitative and qualitative data analysis was undertaken. The investigation resulted in evidence that neither the existence of whistleblowing procedures, nor the level of importance placed on whistleblowing procedures, could be predicted by the presence of a quality culture. This investigation highlights the importance of whistleblowing procedures, and identifies further research opportunities on this contentious topic.

Skills in LLB threshold learning outcomes and competency standards for entry-level lawyers – a comparison using CAQDAS

This exploratory study analysed the Threshold Learning Outcomes ("TLOs") specified in the Bachelor of Laws Learning and Teaching Academic Standards Statement December 2010, and the Competency Standards for Entry-Level Lawyers for Practical Legal Training, as updated by the Australasian Professional Legal Education Council and Law Admissions Consultative Committee in February 2002 ("NCS"). The qualitative analysis was undertaken using the NVivo computer assisted qualitative data analysis software ("CAQDAS"), to investigate how skills were categorised and defined in each of the documents. The results were then analysed to compare the respective categorisation and definition of skills, and to point to potential complements, overlaps, conflicts, gaps, or blind spots, between the TLOs and the NCS. The findings, and the methodology adopted, might provide insights for future instructional design, content, and delivery of Practical Legal Training programs, and for future reviews of the TLOs and NCS.

O where are you going? O do you imagine? Reproduction and response : a reflexive sociology of scholarship of teaching and learning in practical legal training

My doctoral research studies Australian PLT practitioners’ engagement with scholarship of teaching and learning. I argue that many PLT practitioners are motivated to engage with scholarship of teaching and learning in their work. There are, however, individual and extra-individual impediments.
PLT practitioners are lawyers that teach in institutional practical legal training (“PLT”). Satisfactory completion of mandatory PLT is an eligibility requirement for admission to the Australian legal profession. The PLT requirement is additional to academic legal qualifications. PLT is undertaken at a post-graduate level with, or after, the academic law degree.
My study investigates PLT practitioners’ motivations and capabilities to engage with scholarship of teaching and learning (“SoTL”). I study organisational symbolic support for SoTL in PLT, and organisational allocation of resources to SoTL in PLT.
The study involves individual and extra-individual domains of PLT practitioners’ work. It considers how social structures (e.g. “the juridical”) are inscribed into individuals’ practices (“teaching”) and, conversely, whether practices influence social structures.
My research adopts qualitative methodologies. These involve inter-disciplinary exchanges between law, legal education, practice research, sociology of law, cultural theory, and theory and practice of teaching and learning. My theoretical framework draws on Pierre Bourdieu’s “reflexive sociology”, and Michel de Certeau’s “heterological science”.
I sourced data from documents, and semi-structured interviews with 36 Australian PLT practitioners. Documentary sources include statutory instruments, speeches, reports, practice directions, histories, and scholarly publications.
To analyse the data I adopted Kelle’s characterisation of “theoretical sensitivity”, drawing on “explicit” and “emergent” analysis strategies derived from “grounded theory”. The explicit strategies were based on my theoretical framework. The emergent strategy involved sensitivity to non-explicit concepts and theories that emerged from the data. Computer-aided qualitative data analysis software expedited these methods.
My findings to date question dominant legal structures’ readiness for change, the implications of this for teaching and learning in PLT, and in particular for PLT practitioners’ engagement with SoTL in PLT.
The espoused rationale for mandatory PLT (in statutes) is improvement for the protection of clients, the administration of justice, and to assure quality legal services. The tacit rationale is improved quality of legal education, and experiences, for lawyers-to-be. My thesis argues dominant structures in legal education impede the espoused and tacit objectives, and impede PLT practitioners’ engagement with scholarship of teaching and learning.

What are the perceived learning needs of Australian general practice registrars for quality prescribing?

BACKGROUND: Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. This study aimed to address this gap. METHODS: GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. RESULTS: The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. CONCLUSIONS: GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing) in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.

The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand

BACKGROUND: People with chronic kidney disease (CKD) face various problems including psychological, socioeconomic and physical effects associated with CKD and its treatment. They need to develop strategies to help them cope with CKD and life challenges. Religion and spirituality are important coping strategies, but their role in helping people cope with CKD and haemodialysis (HD) in Thailand is relatively unknown.

AIMS: To investigate the role of religion and spirituality in coping with CKD and its treatment in Thailand.

DESIGN: An exploratory, qualitative approach was undertaken using semistructured individual interviews.
METHOD: Purposive sampling was used to recruit participants. Face-to-face, in-depth individual interviews using open questions were conducted during January and February 2012. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the framework method of qualitative data analysis.

FINDINGS: Twenty people receiving HD participated: age range 23-77 years, mean 53.7 (±16.38 SD). Ten were women. Participants reported use of religious and spiritual practices to cope with CKD and its treatment, including religious and spiritual explanations for developing CKD, karmic disease, making merit, reading Dharma books, praying and chanting to save life and making a vow to Pran-Boon.

CONCLUSION: Religion and spirituality provide powerful coping strategies that can help Thai people with CKD overcome the associated distress and difficulties. Religion and spirituality cannot be separated in Thai culture because Thai people are both religious and spiritual.

Clinical research 5: quantitative data collection and analysis

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process.

A couple of points:

1. It is artificial to describe research as qualitative or quantitative. Studies often include both dimensions. However, for the purposes of this paper/series, this distinction is drawn for clarity of writing.

2. It is common practice for quantitative studies to refer to study ‘subjects’ and qualitative studies to refer to study ‘participants’. For ease of reading, the latter term will be used throughout this series.

Easier analysis and better reporting : modelling ordinal data in mathematics education research

This article presents an examination of the use of Rasch modelling in a major research project, 'Improving Middle Years Mathematics and Science' (IMYMS). It is unarguable that it is important to take students' perceptions, or views, into account when planning learning and teaching for them. The IMYMS student perceptions survey is an attempt to make visible these student viewpoints, and report them in a way that is accessible to teachers and researchers involved in the project. The project involves four clusters of schools from urban and regions of Victoria to investigate the role of mathematics and science knowledge and subject cultures in mediating change processes in the middle years of schooling. There are five secondary and twenty-eight primary schools. The project has generated both qualitative and quantitative data, with much of the qualitative data being ordinal in nature. Reporting the results of analyses for a range of audiences necessitates careful, well-designed report formats. Some useful new report formats based on Rasch modeling -the Modified Variable Map, the Ordinal Map, the Threshold Map, and the Annotated Ordinal Map - are illustrated using data from the IMYMS project. The Rasch analysis and the derived reporting formats avoid the pitfalls that exist when working with ordinal data and provide insights into the respondents' views about their experiences in schools unavailable by other approaches.

Women exposed to intimate partner violence : expectations and experiences when they encounter health care professionals : a meta-analysis of qualitative studies

Background The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse?

Methods Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis.

Results Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship.

Conclusion Women’s perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.

The impact on family functioning of social media use by depressed adolescents: a qualitative analysis of the family options study

BACKGROUND: Adolescent depression is a prevalent mental health problem, which can have a major impact on family cohesion. In such circumstances, excessive use of the Internet by adolescents may exacerbate family conflict and lack of cohesion. The current study aims to explore these patterns within an intervention study for depressed adolescents.

METHOD: The current study draws upon data collected from parents within the family options randomized controlled trial that examined family based interventions for adolescent depression (12-18 years old) in Melbourne, Australia (2012-2014). Inclusion in the trial required adolescents to meet diagnostic criteria for a major depressive disorder via the Structured Clinical Interview for DSM-IV Childhood Disorders. The transcripts of sessions were examined using qualitative thematic analysis. The transcribed sessions consisted of 56 h of recordings in total from 39 parents who took part in the interventions.

RESULTS: The thematic analysis explored parental perceptions of their adolescent's use of social media (SM) and access to Internet content, focusing on the possible relationship between adolescent Internet use and the adolescent's depressive disorder. Two overarching themes emerged as follows: the sense of loss of parental control over the family environment and parents' perceived inability to protect their adolescent from material encountered on the Internet and social interactions via SM.

CONCLUSION: Parents within the context of family based treatments felt that prolonged exposure to SM exposed their already vulnerable child to additional stressors and risks. The thematic analysis uncovered a sense of parental despair and lack of control, which is consistent with their perception of SM and the Internet as relentless and threatening to their parental authority and family cohesion.

"Beyond number crunching" : applying qualitative techniques in sport marketing research

Valid and reliable research is pivotal to successful sport marketing strategy. Market research may be gathered via either quantitative or qualitative means. This paper explores the theoretical background and practical applications of qualitative research techniques. It explains the appropriate context for qualitative approaches, and discusses sampling procedures with particular emphasis on the powerful but simple technique known as theoretical sampling. In addition, it clarifies and explores data analysis procedures. The purpose of this paper is to provide sport market research practitioners with a model for implementing qualitative methodologies in sport marketing campaigns.

A qualitative study exploring barriers to a model of shared care for pre-school children`s oral health

Objective To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children.

Design Qualitative focus group discussions and semi-structured interviews.

Setting Four rural local government areas in Victoria, Australia, 2003.

Subjects and methods Subjects: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. Data collection: discipline specific focus groups and semi-structured interviews. Data analysis: transcription, coding, clustering and thematic analysis.

Results Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic, focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role.

Conclusions This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

An evaluation framework for the qualitative investigation of a physical activity prescription program in rural Victoria

Physical activity (PA) has consistently been shown to improve ones' physical, social and mental health. Hence, the rationale for promoting regular physical activity is relatively straightforward. However, what is less clear from the literature is the mix of strategies, (i.e. 'what is working and why?'), to increase in physical activity levels within a population. Of particular interest to primary care is the concept of Physical Activity Prescription Programs (PAPPs) delivered by general practitioners (GPs).

Several examples of a PAPP exist within England, America, New Zealand and Australia. These all aim to encourage GPs to deliver physical activity advice to their patients effectively and in a timely manner. Notwithstanding, the authors of a recent review of published literature on PAPPs, reveal a deficit of evidence regarding the components for successful PA interventions.

This research through an ethnographic enquiry aims to build on the evidence formulated to date. Through a case study research design, the researcher has developed a methodology to define what is/is not working within this recent trend.

In two rural Divisions of GP, participants have been identified as key stakeholders in the implementation of a PAPPs. They are categorised according to three theoretical paradigms, namely, Policy Makers, Linkers and Adaptors. Following this the three paradigms will be studied on the contextual factors, the characteristics and behaviours of members within all three paradigms. The study has also further defined certain elements for investigation, these include the:
intention of the players
effort undertaken by players, and
effect of parties within.

Primarily qualitative data will be collected; through Desk Analysis (Policies, Strategic and Business plans), Site Visits (Participant Observation) and semi-structured interviews. This presentation defines a qualitative framework and methodology for investigating the outcome of programs that historically has been evaluated using quantitative measures. Hence, the author of this study aims to present a qualitative investigation and subsequent results, defining aspects of a PAPP that allow for successful and sustainable implementation.

Manual on application of molecular tools in aquaculture and inland fisheries management. Part I : laboratory protocols, data management and analysis

The aim of this manual is to provide a comprehensive practical tool for the generation and analysis of genetic data for subsequent application in aquatic resources management in relation to genetic stock identification in inland fisheries and aquaculture. The material only covers general background on genetics in relation to aquaculture and fisheries resource management, the techniques and relevant methods of data analysis that are commonly used to address questions relating to genetic resource characterisation and population genetic analyses. No attempt is made to include applications of genetic improvement techniques e.g. selective breeding or producing genetically modified organisms (GMOs). The manual includes two ‘stand-alone’ parts, of which this is the second volume: Part 1 – Conceptual basis of population genetic approaches: will provide a basic foundation on genetics in general, and concepts of population genetics. Issues on the choices of molecular markers and project design are also discussed. Part 2 – Laboratory protocols, data management and analysis: will provide step-by-step protocols of the most commonly used molecular genetic techniques utilised in population genetics and systematic studies. In addition, a brief discussion and explanation of how these data are managed and analysed is also included. This manual is expected to enable NACA member country personnel to be trained to undertake molecular genetic studies in their own institutions, and as such is aimed at middle and higher level technical grades. The manual can also provide useful teaching material for specialised advanced level university courses in the region and postgraduate students. The manual has gone through two development/improvement stages. The initial material was tested at a regional workshop and at the second stage feedback from participants was used to improve the contents.