Being philosophical regarding the evidence of 'what works'.

In this paper I am arguing that the debate regarding ‘what works’ in education practice should become more philosophical. By becoming more philosophical professional educators will be enabled to further recognise how unscientific and undemocratic the research which claims to represent ‘what works’ currently is by understanding more clearly the nature of its ‘evidence-base’ and its relation to education. This paper is structured into three parts. The first will address the philosophical aspect which is intrinsic to the discourse of education itself. The second section will offer a differentiation between empiricism and science which is important if we are to recognise the limitations of empirical ‘evidence’ regarding ‘what works’. The third and final section will draw upon Biesta’s notion of the ‘democratic deficit’ to make the case that if the evidence regarding ‘what works’ is only empirical rather than scientific then it is not the sort of evidence appropriate to the discourse of education.

Responding to domestic violence in primary care : we know more about what works but questions remain

This commissioned editorial examines what we know about responding to domestic violence in primary care in the light of the recent publication of findings from the first randomised controlled trial in the United Kingdom on domestic violence.

RAN-Vic : renal access nurses of Victoria unite.

The Renal Access Nurse has recently become an integral member of the renal health care team in Australia. Research has shown that the introduction of a Renal Access Nurse into dialysis units enhances the referral process for new access, improves survival rates, and success of access creation. Australia has been relatively slow in the introduction of the role of the Renal Access Nurse. The USA, UK and Europe have been utilising Renal Access Nurses in renal units for many years and their roles are firmly entrenched.

The first Renal Access Nurse was introduced in Victoria in 2003, increasing to 7 in 2007. It was evident in 2006 that a networking system for Renal Access Nurses was needed in Victoria, so RAN-Vic was born.

RAN-Vic consists of 6 Renal Access Nurses from the major hubs in Melbourne and Geelong, thus covering a large part of the Victorian dialysis community through satellite units throughout the state.

The group meet quarterly, with the main goals being to network, share ideas, support each other with challenges arising from the new role, benchmark, undertake quality initiatives and education of renal nursing staff. By doing this, we hope to improve outcomes for patients, improve work practices pertaining to renal access, and further redefine the new role.

RAN-Vic is the first of its kind in Australia, providing care for renal access for the dialysis population throughout Victoria. We recommend for all states in Australia to consider forming a Renal Access Group to help improve renal access outcomes.

Early symptomatic presbyopes - what correction modality works best?

Purpose: To compare the performance of a low-addition silicone hydrogel multifocal soft lens with other soft lens correction options in a group of habitual soft lens wearers of distance correction who are symptomatic of early presbyopia.

Method: This clinical study was designed as a prospective, double-masked, randomized, crossover, dispensing trial consisting of four 1-week phases, one for each of the correction modalities: a low-addition silicone hydrogel multifocal soft lens, monovision, habitual correction, and optimized distance visual correction. The prescriptions of all modalities were finalized at a single fitting visit, and the lenses were worn according to a randomized schedule. All lenses were made from lotrafilcon B material. A series of objective vision tests were conducted: high- and low-contrast LogMAR under high- and low-room lighting conditions, stereopsis, and critical print size. A number of other data collection methods used were novel: some data were collected under controlled laboratory-based conditions and others under real-world conditions, some of which were completed on a BlackBerry hand-held communication device.

Results: All participants were able to be fit with all four correction modalities. Objective vision tests showed no statistical difference between the lens modalities except in the case of low-contrast near LogMAR acuity under low-lighting levels where monovision (+0.29 ± 0.10) performed better than the multifocal (+0.33 ± 0.11, P=0.027) and the habitual (+0.37 ± 0.12, P<0.001) modalities. Subjective ratings indicated a statistically better performance provided by the multifocal correction compared with monovision, particularly for the vision associated with driving tasks such as driving during the daytime (93.3 ± 8.8 vs. 84.2 ± 23.7, P=0.05), at nighttime (88.8 ± 11.7 vs. 74.9 ± 23.6, P=0.001), any associated haloes or glare (92.0 ± 10.6 vs. 78.0 ± 22.8, P=0.003), and observing road signs (90.1 ± 11.8 vs. 79.4 ± 20.2, P=0.027). Preference for the multifocal compared with monovision was also reported when watching television (95.0 ± 6.4 vs. 82.6 ± 20.1, P=0.001) and when changing focus from distance to near (87.0 ± 13.4 vs. 66.1 ± 32.2, P<0.001).

Conclusions: For this group of early presbyopes, the AIR OPTIX AQUA MULTIFOCAL-Low Add provided a successful option for visual correction, which was supported by the results of subjective ratings, many of which were made during or immediately after performing such activities as reading, using a computer, watching television, and driving. These results suggest that making a prediction of success or not based on consulting room acuity tests alone is probably unwise.