Is phase-specific, community-oriented treatment of early psychosis- an economically viable method of improving outcome?

Objective: The Early Psychosis Prevention and Intervention Centre (EPPIC) provides a comprehensive 'real-world' model of early intervention to young people experiencing an emerging psychotic disorder. A prospective study has already provided evidence of improved clinical outcome at 12 months after entry. The present study examined whether the service was also cost-effective.

Method: A cost-effectiveness analysis compared EPPIC with its immediate precursor service, from the perspective of the government funding agency. Only direct costs were included.

Results: EPPIC proved to be more cost-effective. The weighted average cost per patient for the first 12 months was cheaper (by äD 7110 per patient), while treatment outcomes were superior. The savings were due to the marked reduction in in-patient costs outweighing substantial increases in the costs of community care.

Conclusion: These results, while encouraging in terms of the further development of integrated, phase-specific intervention programmes for early psychosis, are not conclusive, and further research is required.

Using clinical trial data and linked administrative health data to reduce the risk of adverse events associated with the uptake of newly released drugs by older Australians : a model process

Background
The study was undertaken to evaluate the contribution of a process which uses clinical trial data plus linked de-identified administrative health data to forecast potential risk of adverse events associated with the use of newly released drugs by older Australian patients.

Methods
The study uses publicly available data from the clinical trials of a newly released drug to ascertain which patient age groups, gender, comorbidities and co-medications were excluded in the trials. It then uses linked de-identified hospital morbidity and medications dispensing data to investigate the comorbidities and co-medications of patients who suffer from the target morbidity of the new drug and who are the likely target population for the drug. The clinical trial information and the linked morbidity and medication data are compared to assess which patient groups could potentially be at risk of an adverse event associated with use of the new drug.

Results
Applying the model in a retrospective real-world scenario identified that the majority of the sample group of Australian patients aged 65 years and over with the target morbidity of the newly released COX-2-selective NSAID rofecoxib also suffered from a major morbidity excluded in the trials of that drug, indicating a substantial potential risk of adverse events amongst those patients. This risk was borne out in post-release morbidity and mortality associated with use of that drug.

Conclusions
Clinical trial data and linked administrative health data can together support a prospective assessment of patient groups who could be at risk of an adverse event if they are prescribed a newly released drug in the context of their age, gender, comorbidities and/or co-medications. Communication of this independent risk information to prescribers has the potential to reduce adverse events in the period after the release of the new drug, which is when the risk is greatest.

Note: The terms 'adverse drug reaction' and 'adverse drug event' have come to be used interchangeably in the current literature. For consistency, the authors have chosen to use the wider term 'adverse drug event' (ADE).

Learning to engage with human rights in heritage

Cultural heritage should not be seen merely as a technical matter or from a narrow visitor management point of view but rather as cultural practice—a form of cultural politics dominated by ruling regimes and social groups in which decisions are made about the future of and access to scarce resources. Several scholars have sought to push this approach further by arguing that heritage studies should take on the protection of human rights as a core consideration in the processes of identifying, inscribing, conserving and interpreting cultural heritage. This paper builds on these previous works to explore what the shift to a rights-based management approach in the World Heritage system might mean for various stakeholders in the heritage protection enterprise as they learn to meet this challenge and to find ways to support people’s right to access, enjoy and maintain cultural heritage. Reaffirming the need to maintain a strong relationship between theory and praxis, the paper draws into the discussion heritage practitioners, decision makers in governments and government agencies, scholars and educators. Of these, the principal emphasis in this paper is on educators who are seen to have a fundamentally important role in developing a critical understanding of the cultural heritage concept, how heritage is created, used and misused and how conservation approaches and programs sit within the broader context of community attitudes and aspirations and governmental responsibilities. A distinction is made between teachers in universities and trainers offering short courses more focused on specific employer needs. The paper focuses on World Heritage but refers to both tangible and intangible aspects. It shows how current moves to establish a rights-based approach to the management of World Heritage sites connects with moves elsewhere in global governance, most notably in the United Nations Permanent Forum on Indigenous Issues and the United Nations Human Rights Commission.

Use of web-conferencing software to enhance practical learning for distance students in a first-year Engineering course

BACKGROUND : For many years, Deakin University has delivered an accredited undergraduate engineering course by means of distance education. One of the chief challenges is to provide the necessary practical instruction and experience in engineering to these students. In first-year physics and first-year materials science, off-campus students normally attend on-campus lab classes either on a Saturday or as part of a residential school. However, because some students live either interstate or overseas, it is sometimes impossible for small groups of students to attend an on-campus lab class. PURPOSE : This paper investigates whether web-conferencing software can be an effective means for delivering practical classes to small groups of distance students in first-year physics and also first-year materials. METHOD : Over three semesters in 2012, we employed the Elluminate-Live! software platform to broadcast six lab practicals in first-year physics, and one practical in first-year materials engineering. The students submitted practical reports as did all the other students in each unit. The students in each unit fell into three groups: on-campus students, off-campus students who performed their practicals on-campus, and off-campus students who performed their practicals “virtually” via an Elluminate-Live! session. RESULTS : The trials showed that it is possible to broadcast both physics and materials practical classes by means of web-conferencing software. Report marks of the students performing practicals by this method were comparable to those in the other groups. CONCLUSIONS : Our experience with four initial trials in delivering practical classes over the Internet was encouraging, and showed that the concept will work if done in an effective way.