Thromboyytic therapy for acute ischaemic stroke : successful implementation in an Australian tertiary hospital

Background: The use of tissue-type plasminogen activator (t-PA) in ischaemic stroke outside of experienced stroke centres remains controversial. The aim of this study was to present the initial experience with t-PA in patients with ischaemic stroke at an institution with no prior experience in i.v. stroke thrombolysis and to compare results to published reports.

Methods: Prospective audit of 888 patients with consecutive stroke and transient ischaemic attack admitted to a 426-bed tertiary referral hospital from March 2003 to October 2005. Main outcome measures were treatment rate, exclusion criteria, protocol violations, intracerebral haemorrhage, disability (modified Rankin scale) and mortality at 3 months.

Results: Over the study period, 72 patients received t-PA (11% of ischaemic strokes). The main reason for exclusion was presentation beyond 3 h of onset (44%); if all eligible patients had arrived within 3 h, treatment rate was estimated at 32.5%. Protocol violations occurred in 15 (21%) patients. There were seven (10%) asymptomatic intracerebral haemorrhage and one (1%) non-fatal symptomatic intracerebral haemorrhage. At 3 months, 37% had achieved excellent recovery (modified Rankin scale 0–1) and seven (10%) had died. The delivery and outcomes associated with the use of t-PA were comparable to the results of the National Institute of Neurological Disorders and Stroke trial and meta-analysis of open-labelled studies.

Conclusion: With appropriate infrastructure and protocols, previously inexperienced tertiary referral centres can replicate the experience and outcome measures reported by clinical trials of t-PA in patients with stroke.

Double disability : lived experience of Australian tertiary students with ME/CFS

This research is the exploration of the lived experience of tertiary students in Australia with the medical condition usually known as ME/CFS (Myalgic Encephalomyelitis /Chronic Fatigue Syndrome) seeking to explore issues of equity and human rights from the perspective of the Disability Discrimination Act 1992. Students feel that their difficulties are not caused just by the illness itself but by the failure of the tertiary institutions to understand the effects of this illness on them, the student, especially within the areas of accommodations and assessments. Their lived experiences are studied to ascertain if their experiences differ from those of other tertiary students. Forty participants came from every state and territory of Australia and twenty -four of Australia's universities as well as eight Technical and Further Education/Open Training Education Network (TAFE/OTEN) colleges are represented. The selection of the chosen methodology, Critical Ethnography from a Habermasian perspective, has been circumscribed by the medical condition which placed limitations on methodology and also data gathering methods. Non-structured stories, in which the participants wrote of their lived experience as students, were considered the most appropriate source of data. These were transmitted by electronic mail (with some by postal mail) to the researcher. A short questionnaire provided a participant background to the stories and was also collated for a composite overview of the participants. The stories are analysed in a number of ways: six selected stories are retold and the issues arising from these stories have been weighed against the remainder of the stories. Four intertwined themes were constructed from the issues raised in each story. Apparent infringements of the Disability Discrimination Act (1992) which impact on quality of life, human rights and equity are found. No accommodations are being made by the academic institutions for the cognitive dysfunctions and learning difficulties. Students are stigmatised and lack credibility to negotiate appropriate academic accommodations. A possible means of improving the ability of students to negotiate appropriate accommodations is explored. Finally the researcher reflects on her own involvement in the research as an 'insider' researcher.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Curriculum for entrepreneurial creativity and resourcefulness in New Zealand

This thesis asks: ‘How can tertiary education nurture entrepreneurial creativity?’ Entrepreneurship is considered to be a vital determinant of economic growth and the entrepreneur is understood as someone who innovates and commercialises their own innovation. The setting is New Zealand which is struggling to make the shift from relying on primary production to becoming a ‘creative economy.’ The creative individual has been identified as a new mainstream but it is argued that in New Zealand, education provision is inadequate for supporting the development of the practice of entrepreneurship. The problem is not unique. Various writers are critical of business education generally, and of the mismatch between the passion and chaos in entrepreneurs’ lives and the way education programs are typically organised as a linear sequence of discipline-based courses with prescribed content, activities and outcomes. Rich data were gathered from in-depth interviews with twelve nascent, new or experienced entrepreneurs and two associates (one a marketer, the other a scientist). Each participant was drawn from a different area of economic endeavour. They were asked to share their stories and views about creativity, the connections between creativity and entrepreneurship, business success, formal and informal education, and ways to improve tertiary education programs. The research found that a suitable environment for nurturing creativity will most likely have structure but will also enable chaos. It will present opportunities for experiencing diversity, and will stimulate unconscious and conscious mental processes. It will provide scope for hard work that is fun and involves authentic risk-taking, and will enable both individual and purposeful teamwork. The study also found that business success is not based on knowledge but is rather about being resourceful. The becoming of the creative entrepreneur thus includes developing capability to network with peers and mentors and communicate with customers and staff, and developing passion for and resilience in the pursuit of a dream. The findings suggest that in an age of uncertainty, nurturing entrepreneurial creativity and resourcefulness requires learning to be viewed as a practice-based community process where knowing and doing are interwoven with being. It is argued that this needs to align with Ronald Barnett and Kelly Coate’s (2005) notion of ‘a curriculum for engagement.’ It is suggested that an entire program might simply invite students to work collaboratively to identify and exploit an entrepreneurial opportunity by producing and commercialising an appropriate product/service innovation; to undertake this work as two separate projects – one within an existing organisation, and the other as a new venture; and to theorise their work. It is proposed that a suitable framework lies in William Doll’s (2002) advocacy for a curriculum based on a matrix of five Cs: ‘currere,’ complexity, cosmology, conversation, and community. To these, creativity is added as a sixth C.

Integration at Harryson Primary School : a study of aspects of a primary school's involvement in the integration of students with disabilities into its programs

The integration of students with disabilities, impairments and problems in schooling has been stated government policy in the Victorian education system since 1984. Many schools have become involved in programs whereby students with varying disabilities have participated in the educational and social lives of their local school. This research details one primary school's experiences with the integration program. The involvement of teachers, parents, students, integration aide and principal in mutually supportive roles is described. The role of the Integration Support Group is highlighted. The participation of the students being integrated and their non-disabled peers is described in detail. The roles of the principal, the integration aide and the Integration Support Group are found to be crucial in this school's program.

Curriculum history of business computing in Victorian tertiary institutions from 1960-1985

Fifty years ago there were no stored-program electronic computers in the world. Even thirty years ago a computer was something that few organisations could afford, and few people could use. Suddenly, in the 1960s and 70s, everything changed and computers began to become accessible. Today* the need for education in Business Computing is generally acknowledged, with each of Victoria's seven universities offering courses of this type. What happened to promote the extremely rapid adoption of such courses is the subject of this thesis. I will argue that although Computer Science began in Australia's universities of the 1950s, courses in Business Computing commenced in the 1960s due to the requirement of the Commonwealth Government for computing professionals to fulfil its growing administrative needs. The Commonwealth developed Programmer-in-Training courses were later devolved to the new Colleges of Advanced Education. The movement of several key figures from the Commonwealth Public Service to take up positions in Victorian CAEs was significant, and the courses they subsequently developed became the model for many future courses in Business Computing. The reluctance of the universities to become involved in what they saw as little more than vocational training, opened the way for the CAEs to develop this curriculum area.

Heteroglossia : a space for developing critical language awareness?

This paper reports on research into the challenges of implementing a critical writing pedagogy within a teacher education program in Australia. Participants in this study are student teachers enrolled in a compulsory subject, ‘Language and Literacy in Secondary School’, a subject requiring them to develop a knowledge of the role of language and literacy across the secondary school curriculum and to show personal proficiency in literacy (this is dictated by state government specifications of graduate outcomes for teacher education programs). To develop an understanding of the way that language has shaped their lives, students write a narrative about their early literacy experiences – a task which they all find very challenging, especially in comparison with the formal writing of other university subjects. Rather than simply reminiscing about their early childhood, they are encouraged to juxtapose voices from the past and the present, and to combine a range of texts within their writing. They thereby create a heteroglossic text (Bakhtin, 1981) that stretches their repertoires as language users and enables them to develop a socially critical awareness of language and literacy, including the literacy practices in which they engage as university students. Later in the semester they revisit these accounts of their early literacy experiences, and (in a separate piece of writing) endeavour to place these accounts within the contexts of theories and debates they have encountered in the course of completing this unit.

The students’ writing provides a small window on how they are experiencing their tertiary education, including the managerial controls that are currently shaping university curriculum and pedagogy. Their writing also raises questions as to extent to which tertiary students are actually able to formulate a critical language awareness that will subsequently inform their professional practice as secondary teachers.

Online communication of brand personality : a study of MBA programs of top business schools

Brand personality has often been considered from the perspective of products, corporate brands or countries, but rarely among service offerings. Moreover, there remains the consideration of how these entities are communicated online. This article explores the brand personality dimensions that business schools communicate and whether they differ in putting across clear and distinctive brand personalities in cyberspace. Three clusters from the Financial Times' top 100 full-time global MBA programs in 2005 are used to undertake a combination of computerised content and correspondence analyses. The content analysis was structured using Aaker's five-dimensional framework whilst the positioning maps were produced by examining the data using correspondence analysis. Results indicate that some schools have clear brand personalities while others fail to communicate their brand personalities in a distinct way. This study also illustrates a powerful, but simple and relatively inexpensive way for organisations and brand researchers to study the brand personalities actually being communicated.

Trends in professional education programs for teachers

Increasingly, politicians, bureaucrats, the business community, members of our communities and even members of the teaching profession, are asking questions about professional preparation for teachers, questions like: What is the value of teacher education? What should beginning teachers know and be able to do? How can we make judgements about what they know and are able to do? How can teacher preparation contribute to the retention of high quality beginning teachers who continue to grow and learn?

In this paper, I examine these issues and examine how effective teacher preparation has attempted to respond to these issues, particularly in graduate teacher education programs. I argue that we need to be cognisant of the following aspects when developing and implementing high quality professional education of teachers:

• Connect teacher education to the first year of teaching;
• Prepare teachers who investigate their professional practice within communities of learners
• Prepare teachers with a strong professional knowledge base that helps them make informed professional judgments
• A cohort model that builds strong relationships and professional networks
• Early, regular and sustained school experiences that systematically build professional knowledge and skill. Closely monitored by suitably qualified university personnel and supervising teachers
• Professional standards for beginning teaching and a capstone teacher performance assessment