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INTRODUCTION: A proportion of patients with lung cancer will not be suitable for anti-cancer treatment and are managed with best supportive care (BSC). The aim of this retrospective case series analysis was to critically review the use of diagnostic and staging investigations in patients who were ultimately managed with BSC. METHODS: A retrospective review of all lung cancer patients with a multidisciplinary team outcome of BSC from 01 June 2018 to 01 June 2019 was performed. Patients were categorised into those with an early BSC decision and those that underwent further investigations prior to a BSC decision (investigations beyond initial computed tomography (CT)). Patient demographics, clinical characteristics and outcomes were collated and analysed. RESULTS: Seventy-seven lung cancer patients managed with BSC were identified. Patients were elderly (average age 79 years), functionally limited (80% World Health Organization performance status ≥3), frail (70% clinical frailty score ≥6) and had advanced stage disease (90% stage III/IV). Thirty-one (40%) underwent further investigations beyond the initial CT prior to the BSC decision. The most common types of further investigations were endobronchial ultrasound-guided transbronchial needle aspiration (27/31; 74%), positron emission tomography – CT (18/31; 45%) and CT-guided lung biopsy (7/31; 23%). This is despite high levels of consultant chest physician review at first assessment (71%), cancer nurse specialist involvement (97%), specialist palliative care involvement (65%), a high pathological confirmation rate of sampling procedures (89%) and adequacy of molecular testing. The most common reason for a BSC recommendation was a lack of fitness for systemic therapy (17/31; 55%). Six out of thirty-one (19%) patients deteriorated rapidly and died on the cancer pathway and 5/31 (16%) patients had inadequate renal function for systemic anti-cancer treatment. There was low utilisation of serum epidermal growth factor receptor mutation testing across the study cohort (2/77; 3%). DISCUSSION: In an older, functionally limited and frail patient with lung cancer, there is a risk of over-investigation. Impaired renal function is an important clinical factor to identify early to support discussions in this cohort. There will always be an unavoidable proportion of patients that undergo further investigations (often in search of rare targetable mutations) and are then ultimately recommended for best supportive care; such cases could form the basis of specific review and learning for lung cancer services.

Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCOEver-smokers aged 55-74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCOPLCOProspective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCO

Background This study examined the influence that perceptions and stereotypes of the nursing role had on future career choice of rural secondary students. Objective The study was undertaken to identify a method of attracting final year secondary school students to an undergraduate nursing degree at a rural University. Design A mixed method study using a pre–post-interventional design. Setting The rural campus of an Australian university. Participants 71 secondary students attending a secondary school career development program at a rural Australian university. Method Semi structured questionnaires were used for data collection. The surveys were analysed using descriptive statistics and content analysis of open-ended survey questions. Results The research supports the importance of being aware of young people's impressions about nurses and nursing as a career, to ensure the successful implementation of targeted recruitment. Conclusion Targeted recruitment strategies can increase students' awareness of the wide variety of pathways within nursing, rather than leaving awareness to what family, friends or career advisers tell them, or how nurses are portrayed on television, movies and the media.

BackgroundChest drain displacement is a common clinical problem that occurs in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement.MethodsA prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively defined unintentional or accidental chest drain displacement.Results267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5 of 128, 3.9%; standard care displacement 13 of 129, 10.1%) but this was not statistically significant (OR for drain displacement 0.36, 95% CI 0.13–1.0, Chi-squared 1 degree of freedom (df)=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall-out rate (adjusted OR 0.27, 95% CI 0.08–0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59 of 131, 45.0%; standard care 18 of 132, 13.6%; Chi-squared 1 df=31.3, pConclusionBalloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.

Immunotherapies that target CD1d-restricted invariant NKT (iNKT) cells can prevent tumor growth in murine models but trials in humans have shown limited clinical efficacy. Here, we show that iNKT cells are depleted from blood and bronchial lavage samples from patients with non-small cell lung cancer (NSCLC) suggesting a role for these cells in immunity against NSCLC. We interrogated the Lung Cancer Explorer and Kaplan-Meier Plotter databases of NSCLC patients and found that pulmonary CD1d expression is reduced in patients with NSCLC and that low expression of CD1d mRNA is significantly associated with poor patient survival. We hypothesized that CD1d expression in NSCLC is epigenetically regulated and can be modulated using epigenetic targeting therapies. Treatment of the CD1d-negative NSCLC cell lines, A549 and SK-MES-1, with DNA methyltransferase inhibitors and histone deacetylase inhibitors resulted in a dose-dependent induction of CD1d mRNA and protein expression. Chromatin immunoprecipitation analysis indicated that this induction of CD1d expression directly involved chromatin remodelling. Induction of CD1d expression by A549 and SK-MES-1 cells using therapeutic low doses of DNA methyltransferase inhibitors and histone deacetylase inhibitors made them targets for iNKT cell-mediated cytolytic degranulation. Thus, epigenetic manipulation of CD1d expression may augment the efficacy of iNKT cell-based immunotherapies for NSCLC.

Background Flexible online programs are becoming increasingly popular method of education for students, allowing them to complete programs in their own time and cater for lifestyle differences. A mixture of delivery modes is one way which allows for enhanced learning. Peer learning is another method of learning which is shown to foster collaboration and prepare healthcare students for their future careers. This paper reports on a project to combine peer and online learning to teach pharmacology to nursing students. Objectives To explore undergraduate nursing student opinions of working in peer groups for online learning sessions in a pharmacology course. Design A qualitative study utilising a self-reported questionnaire. Setting A rural campus of an Australian university. Participants Second year nursing students enrolled in a Bachelor of Nursing Program. Methods A hard copy questionnaire was distributed to all students who attended the final semester lecture for the course. Content analysis of open-ended survey questions was used to identify themes in the written data. Results Of the 61 students enrolled in the nursing subject, 35 students chose to complete the survey (57%). Students reported a mixed view of the benefits and disadvantages of peer online learning. Sixty 6% (66%) of students liked peer online learning, whilst 29% disliked it and 6% were undecided. Convenience and ease of completion were reported as the most common reason to like peer online learning, whilst Information Technology issues, communication and non-preferred learning method were reasons for not liking peer online learning. Conclusion Peer online learning groups’ acted as one further method to facilitate student learning experiences. Blending peer online learning with traditional face-to-face learning increases the variety of learning methods available to students to enhance their overall learning experience.

Peer review of teaching at higher education institutions can mean many things to different individuals, faculties, universities and governments. In this chapter we cover a broad canvas, drawing upon the expertise of international academics as well as the results of studies at several different universities around the world. The result is an incisive analysis of a range of issues relating to peer review. We begin by exploring the wide varieties of peer review mechanisms and then focus on the central aspect of any peer review method: how to establish trust between the participants. Next we examine the tension between peer reviews for evaluative versus formative purposes, and provide a case study on how that gap can be closed. We follow this with some practical advice on the role of educational developers in helping set up successful peer review programs, and suggestions for areas of training for participants. We close with a proposal that peer review be seen as an important subject for inquiry-based scholarship.

This presentation will clarify contemporary ideas on the role of technology in education and how it can be employed to improve student learning experiences and outcomes. The paper will emphasise RMIT's role in providing quality education that is relevant to today's world and professional practice. It will examine a specific collaborative (RMITACU), interdisciplinary project 'Pregnancy Simulator: Developing and Enhancing Student Learning of Assessment Skills'. This project consist of a physical pregnancy model connected to a multi-media computer-assisted learning package for the purpose of enhancing student learning of abdominal assessment skills. Our paper outlines an innovative technology-based teaching project and includes current educational issues or problems encountered in professional education, steps already taken to address these difficulties and how this project intends to facilitate learning. It identifies expected learning outcomes for midwives, nurses and medical students, and examines pedagogical principles applied to technological applications designed to provide guided discovery for allowing students to build confidence and competence in professional education. The case-based physical and computer simulations contextualise learning to assist transfer of learning to real world situations. This paper will also discuss how technology-based projects can be evaluated and integrated into university curricula to enhance student learning.

Application of learning technologies within the curricula often takes place at the point at which activities for teaching and learning are considered and generally occurs after a systematic process of curriculum renewal of courses (programmes) in higher education such as constructive alignment. Considering learning technology at this activity phase of curriculum design tends to focus on technologies as the delivery mechanisms of the instruction through the selection of corporate/institutional supported technologies. The risk with this approach is that technology guides the design of learning rather than technology being guided by pedagogical principles to facilitate learning. A “bolt-on” approach to learning technologies is adopted at the expense of the “built-in” design of learning activities that is informed by educational theories. This chapter presents an adaptive model that embeds learning technologies into pedagogical design at an early phase of curriculum renewal and development. The course design intensive (CDI) model demonstrates the processes and resources needed for a learning design approach that integrates technologies into curricula for sustainable practices. Factors that are critical to the success of CDI model are presented: the collaborative decision-making process, ownership of the design by faculty academics and peer review by cross-disciplinary “critical friends”. Examples are presented of the CDI models that illustrate the design intensive process of developing learning activities with appropriate media to facilitate student learning outcomes and experiences. These processes embed theoretical perspectives and address challenges that academics face in achieving goals of design and development of technology-rich curricula that develop graduate capabilities.

Summary Background Innovative curriculum designs are vital for effective learning in contemporary nursing education where traditional modes of delivery are not adequate to meet the learning needs of postgraduate students. This instance of postgraduate teaching in a distributed learning environment offered the opportunity to design a flexible learning model for teaching advanced clinical skills. Aim To present a sustainable model for flexible learning that enables specialist nurses to gain postgraduate qualifications without on-campus class attendance by teaching and assessing clinical health care skills in an authentic workplace setting. Methods An action research methodology was used to gather evidence and report on the process of curriculum development of a core unit, Comprehensive Health Assessment (CHA), within 13 different postgraduate speciality courses. Qualitative data was collected from 27 teaching academics, 21 clinical specialist staff, and 7 hospital managers via interviews, focus groups and journal reflections. Evaluations from the initial iteration of CHA from 36 students were obtained. Data was analyzed to develop and evaluate the curriculum design of CHA. Results The key factors indicated by participants in the curriculum design process were coordination and structuring of teaching and assessment; integration of content development; working with technologies, balancing specialities and core knowledge; and managing induction and expectations. Conclusions A set of recommendations emerged as a result of the action research process. These included: a constructive alignment approach to curriculum design; the production of a facilitator's guide that specifies expectations and unit information for academic and clinical education staff; an agreed template for content authors; and the inclusion of synchronous communication for real-time online tutoring. The highlight of the project was that it built curriculum design capabilities of clinicians and students which can sustain this alternative model of online learning.

This paper reports on the planning and implementation of an evaluation of the final prototype of a physical and computer based simulation in a postgraduate midwifery program. The evaluation framework was designed to reflect the pedagogy of Laurillard’s conversational framework, which had been used to structure the learning experiences in the simulation. Data collection methods and analysis highlighted the themes of discussion, interaction, reflection and adaptation of student learning actions as well as intrinsic feedback - all central to the conversational framework. An action learning approach to evaluation planning and implementation involving an external mentor is described in the following paper including the relationship to the conversational framework, the findings on the student learning environment and the student learning processes and outcomes. The lessons learned about evaluation are also elaborated.

To continually develop as a discipline, a profession needs to generate a knowledge base that can evolve from education and practice. Midwifery reflective practitioners have the potential to develop clinical expertise directed towards achieving desirable, safe and effective practice. Midwives are 'with woman', providing the family with supportive and helpful relationships as they share the deep and profound experiences of childbirth. To become skilled helpers students need to develop reflective skills and valid midwifery knowledge grounded in their personal experiences and practice. Midwife educators and practitioners can assist students and enhance their learning by expanding the scope of practice, encouraging self-assessment and the development of reflective and professional skills. This paper explores journal writing as a learning strategy for the development of reflective skills within midwifery and explores its value for midwifery education. It also examines, through the use of critical social theory and adult learning principles, how midwives can assist and thus enhance students learning through the development of professional and reflective skills for midwifery practice.

Focusing attention on models of teaching and learning during design and development phases can become the key to integrating evaluation in a teaching development project. This article reflects on an experience in planning and conducting an evaluation of a prototype of a new technology-based teaching initiative. The learning experiences designed as part of the prototype were explicitly built on a model of teaching and learning. This had implications for evaluation not recognised in many evaluation manuals. Aligning evaluation to a model of teaching and learning is revealed to be complex in the sense that an initial model needs to be interpreted and extended to include reference to underlying epistemological assumptions. Yet aligning evaluation with an extended model of teaching and learning simplifies and assists the process of evaluation including the choice of methods, analysis of the data and determining improvements. It directly links evaluation to design and development.

The current "crisis of legitimacy" affecting higher education in the United States is seen as a result of incompatible demands on the university by its internal versus external constituencies. From this perspective, information on the nature of student power sentiment is crucial input for understanding the current crisis, and particularly for understanding the role of university administrations, who find themselves at the intersection of conflicting pressures. Recent data from two state universities are brought to bear on this issue, confirming the basic incompatibility of student and "outside" forces for change, and the substantial but probably tenuous legitimacy afforded university administrations.