A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not

Background: Methodological challenges such as recruitment problems and participant burden make clinical trials in palliative care difficult. In 2001-2004, two community-based randomized controlled trials (RCTs) of case conferences in palliative care settings were independently conducted in Australia-the Queensland Case Conferences trial (QCC) and the Palliative Care Trial (PCT). Design: A structured comparative study of the QCC and PCT was conducted, organized by known practical and organizational barriers to clinical trials in palliative care. Results: Differences in funding dictated study designs and recruitment success; PCT had 6 times the budget of QCC. Sample size attainment. Only PCT achieved the sample size goal. QCC focused on reducing attrition through gatekeeping while PCT maximized participation through detailed recruitment strategies and planned for significant attrition. Testing sustainable interventions. QCC achieved a higher percentage of planned case conferences; the QCC strategy required minimal extra work for clinicians while PCT superimposed conferences on normal work schedules. Minimizing participant burden. Differing strategies of data collection were implemented to reduce participant burden. QCC had short survey instruments. PCT incorporated all data collection into normal clinical nursing encounters. Other. Both studies had acceptable withdrawal rates. Intention-to-treat analyses are planned. Both studies included substudies to validate new outcome measures. Conclusions: Health service interventions in palliative care can be studied using RCTs. Detailed comparative information of strategies, successes and challenges can inform the design of future trials. Key lessons include adequate funding, recruitment focus, sustainable interventions, and mechanisms to minimize participant burden.

Capturing strategy as an everyday practice:quantitative methodologies for analysing practice data

Few works address methodological issues of how to conduct strategy-as-practice research and even fewer focus on how to analyse the subsequent data in ways that illuminate strategy as an everyday, social practice. We address this gap by proposing a quantitative method for analysing observational data, which can complement more traditional qualitative methodologies. We propose that rigorous but context-sensitive coding of transcripts can render everyday practice analysable statistically. Such statistical analysis provides a means for analytically representing patterns and shifts within the mundane, repetitive elements through which practice is accomplished. We call this approach the Event Database (EDB) and it consists of five basic coding categories that help us capture the stream of practice. Indexing codes help to index or categorise the data, in order to give context and offer some basic information about the event under discussion. Indexing codes are descriptive codes, which allow us to catalogue and classify events according to their assigned characteristics. Content codes are to do with the qualitative nature of the event; this is the essence of the event. It is a description that helps to inform judgements about the phenomenon. Nature codes help us distinguish between discursive and tangible events. We include this code to acknowledge that some events differ qualitatively from other events. Type events are codes abstracted from the data in order to help us classify events based on their description or nature. This involves significantly more judgement than the index codes but consequently is also more meaningful. Dynamics codes help us capture some of the movement or fluidity of events. This category has been included to let us capture the flow of activity over time.

Developments in assessment and teaching methodologies in modern languages in England and France in response to educational reform (1975-1985)

This comparative study considers the main causative factors for change in recent years in the teaching of modern languages in England and France and seeks to contribute, in a general sense, to the understanding of change in comparable institutions. In England by 1975 the teaching of modern languages in the comprehensive schools was seen to be inappropriate to the needs of children of the whole ability-range. A combination of the external factor of the Council of Europe initiative in devising a needs-based learning approach for adult learners, and the internal factor of teacher-based initiatives in developing a graded-objectives learning approach for the less-able, has reversed this situation to some extent. The study examines and evaluates this reversal, and, in addition, assesses teachers' attitudes towards, and understanding of, the changes involved. In France the imposition of `la reforme Haby' in 1977 and the creation of `le college unique' were the main external factors for change. The subsequent failure of the reform and the socialist government's support of decentralisation policies returning the initiative for renewal to schools are examined and evaluated, as are the internal factors for changes in language-teaching - `groupes de niveau' and the creation of `equipes pedagogiques'. In both countries changes in the function of examinations at 15/16 plus are examined. The final chapter compared the changes in both education systems.