Healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions: A qualitative systematic review protocol

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users’ experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, “healthcare users” will be taken to include children who have life-limiting conditions and their families. The question to be addressed is: - What are healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions? INCLUSION CRITERIA - Types of participants: This review will consider all qualitative studies that focus on users of healthcare services for children who have life-limiting conditions. These users are anticipated to include children who have a life-limiting condition and their family members. In instances where children are not under the legal care of one or both parents, service users may also include other types of legal guardians. - Phenomena of interest: This review will consider experiences of communicating with healthcare professionals about children who have life-limiting conditions. - Context: This review will consider studies relating to communication with healthcare professionals about children who have a life-limiting condition, irrespective of whether the healthcare service is based in a hospital, hospice, or community setting. There is no restriction on the country in which a study was conducted.

Sorghum stay-green QTL individually reduce post-flowering drought-induced leaf senescence

Sorghum is an important source of food, feed, and biofuel, especially in the semi-arid tropics because this cereal is well adapted to harsh, drought-prone environments. Post-flowering drought adaptation in sorghum is associated with the stay-green phenotype. Alleles that contribute to this complex trait have been mapped to four major QTL, Stg1-Stg4, using a population derived from BTx642 and RTx7000. Near-isogenic RTx7000 lines containing BTx642 DNA spanning one or more of the four stay-green QTL were constructed. The size and location of BTx642 DNA regions in each RTx7000 NIL were analysed using 62 DNA markers spanning the four stay-green QTL. RTx7000 NILs were identified that contained BTx642 DNA completely or partially spanning Stg1, Stg2, Stg3, or Stg4. NILs were also identified that contained sub-portions of each QTL and various combinations of the four major stay-green QTL. Physiological analysis of four RTx7000 NILs containing only Stg1, Stg2, Stg3, or Stg4 showed that BTx642 alleles in each of these loci could contribute to the stay-green phenotype. RTx7000 NILs containing BTx642 DNA corresponding to Stg2 retained more green leaf area at maturity under terminal drought conditions than RTx7000 or the other RTx7000 NILs. Under post-anthesis water deficit, a trend for delayed onset of leaf senescence compared with RTx7000 was also exhibited by the Stg2, Stg3, and Stg4 NILs, while significantly lower rates of leaf senescence in relation to RTx7000 were displayed by all of the Stg NILs to varying degrees, but particularly by the Stg2 NIL. Greener leaves at anthesis relative to RTx7000, indicated by higher SPAD values, were exhibited by the Stg1 and Stg4 NILs. The RTx7000 NILs created in this study provide the starting point for in-depth analysis of stay-green physiology, interaction among stay-green QTL and map-based cloning of the genes that underlie this trait.

Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: A qualitative study

Objective To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. Methods Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. Results Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. Conclusion The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. Practice implications Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.

Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.

Value-adding Australian sardines: Factors affecting rates of deterioration in sardine (Sardinops sagax) quality during post-harvest handling

Deficiencies in sardine post-harvest handling methods were seen as major impediments to development of a value-adding sector supplying Australian bait and human consumption markets. Factors affecting sardine deterioration rates in the immediate post-harvest period were investigated and recommendations made for alternative handling procedures to optimise sardine quality. Net to factory sampling showed that post-mortem autolysis was probably caused by digestive enzyme activity contributing to the observed temporal increase in sardine Quality Index. Belly burst was not an issue. Sardine quality could be maintained by reducing tank loading, and rapid temperature reduction using dedicated, on-board value-adding tanks. Fish should be iced between the jetty and the processing factory, and transport bins chilled using an efficient cooling medium such as flow ice.

Responses in carcass lean pH at 24 hours post-mortem in lines of Large White pigs selected for growth rate on a fixed ration over a set time

A restricted maximum likelihood analysis applied to an animal model showed no significant differences (P > 0.05) in pH value of the longissimus dorsi measured at 24 h post-mortem (pH24) between high and low lines of Large White pigs selected over 4 years for post-weaning growth rate on restricted feeding. Genetic and phenotypic correlations between pH24 and production and carcass traits were estimated using all performance testing records combined with the pH24 measurements (5.05-7.02) on slaughtered animals. The estimate of heritability for pH24 was moderate (0.29 ± 0.18). Genetic correlations between pH24 and production or carcass composition traits, except for ultrasonic backfat (UBF), were not significantly different from zero. UBF had a moderate, positive genetic correlation with pH24 (0.24 ± 0.33). These estimates of genetic correlations affirmed that selection for increased growth rate on restricted feeding is likely to result in limited changes in pH24 and pork quality since the selection does not put a high emphasis on reduced fatness.

Effects of hooking damage and hook type on post-release survival of sand flathead (Platycephalus bassensis)

This study examined post-release survival in sand flathead (Platycephalus bassensis) and whether there were survival benefits from the use of circle hooks over conventional hook patterns. Anatomical hooking location was the major factor contributing to mortality, with an almost 100% survival rate for fish hooked in the lip, mouth or eye (shallow-hooked) compared with around 64% for fish hooked in the throat or gut (deep-hooked). Mortality in deep-hooked fish was generally associated with injuries to vital organs (gills, heart, liver) and survival was significantly lower if bleeding was associated with injury (54% compared with 85% for non-bleeders). Circle hooks resulted in significantly lower deep-hooking rates (1%) compared with conventional hook types (4-9%) and, based on catch rates, were at least as effective as conventional hook patterns. Estimated survival rates for line-caught sand flathead were high, over 99% for circle hooks and between 94 and 97% for conventional hooks. These findings support the efficacy of management strategies based on size and bag limits and the practice of catch-and-release fishing for sand flathead, as well as a potential conservation benefit from the use of circle hooks.

Post-school needs of young people with high-functioning Autism Spectrum Disorder

This study describes the post-school circumstances and service needs of older teenagers and adults with high-functioning Autism Spectrum Disorder, living in Queensland, Australia. The respondents were 95 parents. Results indicated that the majority of the young people lived in the family home and were unemployed. Of those who worked, 56% had unskilled jobs. They were estimated to spend a significant proportion of their time engaged in solitary, technology-based activities, and comparatively little time in employment or socialising. Parents rated employment support as the greatest service priority for their sons and daughters, followed by specialised support to assist with completing post-school education and training, assistance to support the transition from high school to adulthood, and social skills training.

The acceptability, usability and short-term outcomes of Get Real: A web-based program for psychotic-like experiences (PLEs)

Background Psychotic-like experiences (PLEs) are subclinical delusional ideas and perceptual disturbances that have been associated with a range of adverse mental health outcomes. This study reports a qualitative and quantitative analysis of the acceptability, usability and short term outcomes of Get Real, a web program for PLEs in young people. Methods Participants were twelve respondents to an online survey, who reported at least one PLE in the previous 3 months, and were currently distressed. Ratings of the program were collected after participants trialled it for a month. Individual semi-structured interviews then elicited qualitative feedback, which was analyzed using Consensual Qualitative Research (CQR) methodology. PLEs and distress were reassessed at 3 months post-baseline. Results User ratings supported the program's acceptability, usability and perceived utility. Significant reductions in the number, frequency and severity of PLE-related distress were found at 3 months follow-up. The CQR analysis identified four qualitative domains: initial and current understandings of PLEs, responses to the program, and context of its use. Initial understanding involved emotional reactions, avoidance or minimization, limited coping skills and non-psychotic attributions. After using the program, participants saw PLEs as normal and common, had greater self-awareness and understanding of stress, and reported increased capacity to cope and accept experiences. Positive responses to the program focused on its normalization of PLEs, usefulness of its strategies, self-monitoring of mood, and information putting PLEs into perspective. Some respondents wanted more specific and individualized information, thought the program would be more useful for other audiences, or doubted its effectiveness. The program was mostly used in low-stress situations. Conclusions The current study provided initial support for the acceptability, utility and positive short-term outcomes of Get Real. The program now requires efficacy testing in randomized controlled trials.

A qualitative exploration of Internet-based treatment for comorbid depression and alcohol misuse

Background Many Internet-based treatments for depression and for alcohol misuse have a positive impact, yet little is known about how these treatments work. Most research on web-based interventions involves efficacy trials which, while important, offer little explanation about how people perceive and use online programs. Objective This study aimed to undertake a qualitative exploration of participants' experience, perceived impact and use of an integrated web-based program for comorbid depression and alcohol misuse. Specifically, it explored users' perspectives on the intensity of their treatment and the level of support they received. Methods Interviewees were drawn from participants in a randomised controlled trial of the OnTrack web-based treatment for depression and alcohol misuse, which compared Brief Self-Guided, Comprehensive Self-Guided and Comprehensive Therapist-Assisted versions of the program. Twenty-nine people (9–11 from each condition) completed semi-structured telephone interviews asking about their impressions and experiences with the program. Interview transcriptions were subject to a 6-step thematic analysis, employing a conceptual matrix to identify thematic differences across groups. Results Positive experiences and outcomes were more pronounced among participants receiving the comprehensive treatments than the brief one, but other responses were relatively consistent across conditions. A major theme was a wish for more individualisation and human contact, even in participants receiving emailed assistance. Some confused follow-up research assessments with therapist support. There was little correspondence between the perceived impact of the program and the amount reportedly completed, and some participants said they used strategies offline or completed exercises mentally. Conclusions This study highlighted discrepancies between how web-based treatments are intended to be used and how people actually engage with them. A challenge for the next wave of these interventions is the provision of individualised responses and coaching that retains an emphasis on self-management and constrains cost.

Design thinking using a collaborative model for skin cancer prevention

Physical activity is well recognised as a means to reduce cancer risk; however, outdoor activity can increase sun exposure and consequential skin cancer risk. It is proposed, one of the key potential solutions to promote active lifestyles whilst enhancing protection against skin cancer is design resolution for active apparel that considers Australia’s sub-tropical climate whilst maintaining comfort, aesthetic appeal and performance. Using a design thinking approach, facilitated through collaboration between an NGO and a university, student designers were tasked with developing apparel prototypes to explore this challenge. Through practical ideation of problems, potential design solutions were developed within a modest NGO budget and adherence to specific brand guidelines. This project is novel as it demonstrates a low cost yet effective way of collaboratively creating a product to meet multiple needs, rather than reactively assessing already manufactured sun protection products for endorsement. It is a nimble and unique stepping stone in integrating sun safety considerations into clothing that is appealing to the population and creating cross-industry understandings of how design can better contribute to human health and wellbeing. Outcomes to be shared include empirical insights for updating sun safe clothing guidelines, issues around the aesthetic nature of sun safe apparel, and the role of design education for sun safety.

Post capture necrosis of the feet caused by soft-catch traps – incidents, cause and prevention.

When recapturing satellite collared wild dogs that had been trapped one month previous in padded foothold traps, we noticed varying degrees of pitting on the pads of their trapped paw. Veterinary advice, based on images taken of the injuries, suggests that the necrosis was caused by vascular compromise. Five of six dingoes we recaptured had varying degrees of necrosis restricted only to the trapped foot and ranging from single 5 mm holes to 25% sections of the toe pads missing or deformed, including loss of nails. The traps used were rubber-padded, two–coiled, Victor Soft Catch #3 traps. The springs are not standard Victor springs but were Beefer springs; these modifications slightly increase trap speed and the jaw pressure on the trapped foot. Despite this modification the spring pressure is still relatively mild in comparison to conventional long spring or four-coiled wild dog traps. The five wild dogs developing necrosis were trapped in November 2006 at 5-6 months of age. Traps were checked each morning so the dogs were unlikely to have been restrained in the trap for more than 12 hours. All dogs exhibited a small degree of paw damage at capture which presented itself as a swollen paw and compression at the capture point. In contrast, eight wild dogs, 7-8 month-old, were captured two months later in February. Upon their release, on advice from a veterinarian, we massaged the trapped foot to get blood flow back in to the foot and applied a bruise treatment (Heparinoid 8.33 mg/ml) to assist restoring blood flow. These animals were subsequently recaptured several months later and showed no signs of necrosis. While post-capture foot injuries are unlikely to be an issue in conventional control programs where the animal is immediately destroyed, caution needs to be used when releasing accidentally captured domestic dogs or research animals captured in rubber-padded traps. We have demonstrated that 7-8 month old dogs can be trapped and released without any evidence of subsequent necrosis following minimal veterinary treatment. We suspect that the rubber padding on traps may increase the tourniquet effect by wrapping around the paw and recommend the evaluation of offset laminated steel jaw traps as an alternative. Offset laminated steel jaw traps have been shown to be relatively humane producing as few foot injuries as rubber-jawed traps.

Mikä jatko-opiskelijaa motivoi? Tavoitteet ja tiedeyhteisö väitöskirjaprosessissa.

Motivation has an important role in academic learning for learning is regulated by motivation. Further motivation is centrally manifested by goals. Goals reflect values and regulate individual s orientation and what they strive for. In spite of the central role of motivation in academic learning, discussions on post-graduate education has somewhat overlooked motivational processes and concentrated on the excellence of performance. The aim of this study was to investigate what kind of goals PhD students have and how they experience their role in their own scientific community. It was also purpose to study how these goals and experienced roles are in relation with study each other, context, possible intentions of quitting studies and prolongation of studies. Furthermore, the aim was to investigate how different postgraduates differ in terms of how they experience their learning environment. The data was collected with the From PhD students to academic experts survey (Pyhältö & Lonka, 2006) from four complementary domains: medicine, arts, psychology and education. The survey consisted of both likert-scaled items and open ended questions. The participants were 601 postgraduate students. The goals and the experienced role in scientific community were analysed in terms of qualitative content analysis. The relation between goals and experienced role and background variables were tested using ?² and the differences between different postgraduate groups using one way analysis of variances (ANOVA). The results indicated that postgraduates goals varied based on whether they brought up goals related to the product (outcome of the thesis process), the process (thesis process as whole) or both the product and the process. Product goals consisted of for example career qualification and better status as process goals consisted for example of learning and influencing ones own discipline. The experienced role of the postgraduates differed in terms of whether the conception was organised, unorganised or controversial. Both the goals and the experienced roles were in relation with study context and commitment to the studies. The different postgraduate groups also differed in terms of how they experienced their own learning environment.

Opettajan uskomukset opetustyön lähtökohtana : näkökulmia pedagogiseen ajatteluun

The purpose of this research was to examine teacher’s pedagogical thinking based on beliefs. It aimed to investigate and identify beliefs from teachers’ speech when they were reflecting their own teaching. Placement of beliefs in levels of pedagogical thinking was also examined. The second starting point for a study was the Instrumental Enrichment -intervention, which aims to enhance learning potential and cognitive functioning of students. The goal of this research was to investigate how five main principles of the intervention come forward in teachers’ thinking. Specifying research question was: how similar teachers’ beliefs are to the main principles of intervention. The teacher-thinking paradigm provided the framework for this study. The essential concepts of this study are determined exactly in the theoretical framework. Model of pedagogical thinking was important in the examination of teachers’ thinking. Beliefs were approached through the referencing of varied different theories. Feuerstein theory of Structural cognitive modifiability and Mediated learning experience completed the theory of teacher thinking. The research material was gathered in two parts. In the first part two mathematics lessons of three class teachers were videotaped. In second part the teachers were interviewed by using a stimulated recall method. Interviews were recorded and analysed by qualitative content analysis. Teachers’ beliefs were divided in themes and contents of these themes were described. This part of analysis was inductive. Second part was deductive and it was based on theories of pedagogical thinking levels and Instrumental Enrichment -intervention. According to the research results, three subcategories of teachers’ beliefs were found: beliefs about learning, beliefs about teaching and beliefs about students. When the teachers discussed learning, they emphasized the importance of understanding. In teaching related beliefs student-centrality was highlighted. The teachers also brought out some demands for good education. They were: clarity, diversity and planning. Beliefs about students were divided into two groups. The teachers believed that there are learning differences between students and that students have improved over the years. Because most of the beliefs were close to practice and related to concrete classroom situation, they were situated in Action level of pedagogical thinking. Some teaching and learning related beliefs of individual teachers were situated in Object theory level. Metatheory level beliefs were not found. Occurrence of main principles of intervention differed between teachers. They were much more consistent and transparent in the beliefs of one teacher than of the other two teachers. Differences also occurred between principles. For example reciprocity came up in every teacher’s beliefs, but modifiability was only found in the beliefs of one teacher. Results of this research were consistent with other research made in the field. Teachers’ beliefs about teaching were individual. Even though shared themes were found, the teachers emphasized different aspects of their work. Occurrence of beliefs that were in accordance with the intervention were teacher-specific. Inconsistencies were also found within teachers and their individual beliefs.

Yliopiston oppimis- ja opetuskäsitykset murroksessa : Teknillistieteellisen alan opettajien käsityksiä ja lähestymistapoja alan oppimiseen ja opetukseen

The starting point for this study was university teaching and teachers and specifically their changing role when confronting the Finnish University Reform and the student-focused theories of learning. Teachers’ pedagogical thinking and pedagogical content knowledge were also part of the theoretical framework. In the research of conceptions of and approaches to learning and teaching, the qualitative classifications of Säljö and Marton (1976; 1997), Ramsden (1992), Kember (1997) and Trigwell and Prosser (1999) were utilised. Two study questions were raised (1) What kind of conceptions of and approaches to learning do engineering science teachers have? and (2) What kind of conceptions of and approaches to teaching do engineering science teachers have? The relationship between teachers’ conceptions and teaching was also examined. The research material was collected in autumn 2008 by interviewing teachers and by observing teaching in the Department of Energy Technology at Helsinki University of Technology. Altogether two tutorials and ten lectures were observed. Each teacher of the observed lectures was interviewed once. The interviews were carried out as semi-structured theme interviews. In the analysis of the research material phenomenographical approach was adapted. The study revealed many kinds of conceptions of and approaches to learning and teaching in the teachers’ speech. On the basis of the research material, the conceptions and approaches that the teachers declare do not always reflect their actions in the teaching situation. The surface approaches to learning and teacher-focused approaches to teaching and conceptions of receiving and transmission of knowledge were parallel. Instead the teachers’ declarations of the deep approaches to learning and student-focused approaches to teaching were partly in conflict with how the teacher taught. When striving towards student-centered teaching culture attention should be paid to the development of teachers’ pedagogical thinking and pedagogical content knowledge. The culture and the structures of the educational institution should also be considered.