131 research outputs found
Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample
No full textBackground
While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP).
Methods
Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks).
Results
The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 – 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 – 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 – 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 – 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 – 1.07, p = 0.74).
Conclusions
Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised
Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey
No full textOBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.DESIGN: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.RESULTS: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.CONCLUSIONS: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.</p
Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey.
No full textOBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences. DESIGN: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer. PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden. PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate. RESULTS: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables. CONCLUSIONS: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes
An exploration of the effects of group summative assessment marking on higher education students’ overall marks
No full textGroupwork and group summative assessment (GSA) are important learning, teaching and assessment methods used by many educational institutions, not just universities. The differences between the marks that HEI students were awarded for their own independent individual summative assessment (IISA) work and their GSA marks were explored.
The study topic presented itself while the author was contemplating studying for a first degree, when it became apparent that group working and group summative assessment was included in summative assessment methods used in the chosen programme.
Three data sources were from UK undergraduates and graduates, and one was from Australian PG students. Module marks data were collected from over 4000 HE students. They were divided into eighteen faculty/year data sets from four HEI sources.
A systematic difference was found between the distributions of GSA and IISA marks, supporting Lejk et al. (1999). Lower IISA ability students scored higher in GSA modules than in IISA modules. Higher IISA ability students scored lower in GSA modules.
In addition, the mean GSA mark was higher than the mean IISA mark. The standard deviation of the GSA marks was lower than the SD of the IISA marks. Both of these findings support Downie (2001). The relationship was found to vary between the data sets, modules, assessment items and especially between faculties.
The results and conclusions from this study will empower stakeholders, enabling them to be better informed in their choice of first-degree study programmes. They will also allow the use and impact of GSA to be more transparent and better understood, leading to further research and improvement in practice
Patients' and oncologists' views on the treatment and care of advanced ovarian cancer in the UK:results from the ADVOCATE study
No full textBackground:Most patients presenting with advanced ovarian cancer (AOC) eventually relapse. Symptom palliation, maintenance of quality of life (QoL) and prolongation of life are primary therapeutic goals.Methods:Sixty-six UK oncologists completed an online survey about AOC management. Two hundred and two patients were interviewed about care, treatment experiences and expectations.Results:Prior to diagnosis, 34% (69 out of 202) of women had 3 symptoms associated with AOC. Twenty-one per cent (43 out of 202) thought poor symptom recognition by general practitioners (GPs) delayed diagnosis. Amelioration of side effects experienced was variable, for example, only 54% (68 out of 127) distressed by alopecia had received sufficient information about it. Clinicians were asked 'What minimum gain in progression-free survival (PFS) would make you feel it worthwhile to offer maintenance therapy?'; 48% (24 out of 50) indicated 5-6 months, but 52% (26 out of 50) believed patients would find PFS of 3-4 months acceptable. When patients were presented with hypothetical scenarios, 33% (52 out of 160) would require 1-2 months extra life, 6% (10 out of 160) 3-4 months, 31% (49 out of 160) 5-6 months, and 31% (49 out of 160) 7 months. However, 86% (173 out of 202) would accept treatment that improved QoL without prolongation of life. When asked what was most important, 33% (67 out of 201) said QoL, 9% (19 out of 201) length of life and 57% (115 out of 201) said both were equally important.Conclusion:Clinicians' and patients' experiences, expectations and priorities about OC management may differ.British Journal of Cancer advance online publication 7 May 2013; doi:10.1038/bjc.2013.223 www.bjcancer.com
Development and deployment of document management technology into Rover : executive summary
No full textDocument Management is a technology that allows the input, storage,
management and control of an image under the supervision of a computer based
system. A document may be an electronically scanned image of a hard copy
document or an electronic image such as a word-processed file, sound file, video
file, or graphics file. Once the document has entered the system, a full history of
that document is maintained throughout its lifecycle.
The author was responsible for the introduction, development and deployment of
Document Management technology into Rover Group. The task given to the
author was to implement Document Management technology purely as a
repository and distribution management system for engineering drawings.
However, by adopting an innovative approach to the application of Document
Management technology, substantial benefits were realised.
As the author became more conversant with Document Management technology,
greater benefits became apparent. Following detailed analysis of Rover's existing
`Engineering drawing release process' the author re-engineered the process to
allow electronic paperless release of all engineering drawings. This re-engineering
provided Rover with substantial tangible and intangible benefits including cost
reduction, improved quality of data, reduced `time to market', improved access,
improved cycle time and reductions in manual labour.
Three projects detailed in the portfolio demonstrate how this technology was
applied to existing systems and processes. In particular, the `Hams Hall' project
clearly demonstrates innovation in the way in which the author used the
technology to manage working practices and data structure for a multi-disciplined
team located in different countries.
With changes implemented by the author, Rover now hold substantially more
digital data than before the implementation of Document Management
technology. Following research work by the author into both the types of data
held and the use to which that data was put, the legality of that data came into
question. This prompted a detailed analysis of the legal requirements of digitally
stored data that allowed the author to advise Rover Group of their current status
and make recommendations to ensure legal admissibility.
The work reported shows how a combination of technical expertise and an
appreciation of business issues and drivers, is crucial to the effective and
successful implementations of information systems. Other organisations have
shown considerable interest in the improved Document Management technology
enabled business processes, developed by the author
Development of the Balance module to support stroke patients during treadmill-based gait rehabilitation training
No full textAfter a stroke, patients often need gait rehabilitation training to regain a safe walking pattern to participate in daily activities again. Good gait rehabilitation training comprises high intensity, which can be achieved using support systems, such as treadmills. Research pointed out that there are insufficient support systems for patients with Functional Ambulation Category (FAC) score 2 and 3. The C-Mill, an existing treadmill used for patients with FAC 5, can be adjusted to the supporting needs of patients with a lower FAC score while maintaining high intensity using additional modules. A first module, the Active Body Weight Support (ABWS), supports the first prerequisite of walking by lifting the body weight, lowering the covering target group to patients with FAC 3½. The goal of this project is to develop a new additional module, the Balance module, which will support the second prerequisite of walking by supporting balance and lower the target group to patients with FAC 2. The C-Mill combined with additional modules will be one product that can be purchased by clinics for patients with FAC 2-5, instead of needing several individual products for this target group. A set of requirements is formulated to develop the Balance module with optimal properties for high intensity gait rehabilitation training. The mechanical requirements ensure that the correct forces are applied on the patient at the moment the patient loses balance. Furthermore, it is required that the mass of parts of the Balance module that are attached to the patient does not influence the natural gait of the patient. Biomedical requirements ensure comfort of the patient and therapist in posture and force excitation. Force excitation of 100 N is required in lateral direction and 50 N in anterior-posterior direction. It is preferable that the Balance module can support rotational activation, to support the swinging leg of the patient. Design requirements make sure that the Balance module will be appealing for both therapist and patient. Moreover, the product must fit within the current product line design of the C-Mill. With morphological charts, three concepts were created that are evaluated by means of function models. Using Harris profiles a concept is chosen, which is further developed into the Balance module. The final Balance module consists of two pillars which are attached to the C-Mill. The patient is wearing a harness which is connected with the Balance module using a minimal number of attachments to limit preparation time and prevent wrong alignments. The connection consists of ropes and tubes for force transfer of the motors. The four motors are DC motors, which can be activated for all needed and desired directions. The Balance module uses ‘assist as needed control’, which means that support is only given at the moment balance is lost. No force sensors are needed for desirable flowing movements, because the chosen motor type has a low projected inertia and can exert enough force in all directions. The moment and the amount of force needed is determined with the extrapolated Centre Of Mass (xCOM) which uses the position of the Centre Of Mass (COM) and the Centre Of Pressure (COP). The COM of the patient is determined using position feedback from the motors and the COP is provided by forceplates of the C-Mill. The attachments of the tubes and ropes are made flexible with ball-joints and movable pulleys to ensure the comfort of the patient and no limitation on DOF. Height adjustments of the Balance module are possible to satisfy the antropometrics of each patient. The design has an optimal space use and fits with the C-Mill’s design. Elegant lines of the Balance module will not discourage patient and therapist of usage. Touchable parts are clearly identified by means of colours and shapes. To evaluate the working principle of the Balance module, a prototype is build. Satisfaction of the requirements for the Balance module is checked. Several requirements will be reviewed during a subsequent project of testing, like the control system and methods, influence of inertia and design satisfaction. All other requirements are reached and the desired rotational stimulation can be done. One desired option of extending the anterior-posterior movement freedom was not achieved for the prototype. Improvements on control actuation must be made during an additional project. More improvements can be made on a program including feedback for therapists, to quantify the level of balance of the patient. Moreover, better integration with the new design of the C-Mill is preferred for unity appearance and a clean design.BiomechatronicsBioMechanical EngineeringMechanical, Maritime and Materials Engineerin
Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions
No full textBackground: Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer - the 'threshold' risk level at which they investigate or refer to a specialist for consideration of possible cancer - and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis. Methods: The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature. A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English. Results: This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems. Conclusions: The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries
Evaluation of a primer used to orient students and instructors to the role of a sign language interpreter in the classroom: a focus group study
No full textPlan BThe Center for Special Needs at Milwaukee Area Technical College (MATC) provides interpreting services to deaf and hard-of-hearing students enrolling in a wide range of classes and programs across the institution. A primer entitled An Interpreter in the Classroom was devised to clearly delineate the roles and responsibilities of students, interpreters, and instructors in a classroom interpreting situation. The manual was printed and found to have numerous errors and shortcomings. The purpose of this study was to develop recommendations for the revision of the primer. Fifteen potential users of the manual were recruited from MATC to attend the focus group sessions. The objectives of these focus groups were to: identify information in the current primer that was incorrect or outdated; develop suggestions for incorporating specific changes in the field of interpreting (or education as a whole) into an update
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Bridging the 'gap‘ between migrants and the banking system: an innovative business model promoting financial integration, financial stability, and profitability
No full textThe thesis probes a specific area - the banking system and the business niche concerned with migrants' remittances - and considers the flows of these people and their money in today‘s global economy (over 3% of the world's population). It argues that the banking system has failed to understand the changing "paradigm" of the migrant market and thus has not updated its business plan or business model for this business segment in response. In failing to harness the liquidity of the migrant market, the author argues, the banking industry is missing out on a potentially profitable business segment that could create financial stability within the industry and the world's economies. Furthermore, by ignoring the "gap" that exists between the financial products on offer to the migrant sector and their needs in this respect in both the host and origin countries - providing a service at "both ends of the corridor" - the industry is also in danger of losing site of its commitment to social responsibility and the financial integration of migrants. At the heart of the argument for financial stability and financial integration is the proposition that there is a lack of communication among stakeholders, namely academic and financial institutions, governments, Diaspora associations and other decision makers
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