Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is ...treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC. Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene expression consistent with a tumour/immune microenvironment predicted to be susceptible to immune checkpoint directed immunotherapy which we will evaluate in the AURORA trial.
AURORA is a single arm, open-label, multicentre,UK phase II clinical trial. 33 patients will be recruited from UK secondary care sites. Patients with UTSCC, suitable for treatment with palliative intent, will receive atezolizumab PD-L1 directed immunotherapy (IV infusion, 1680 mg, every 28 days) for one year if tolerated. Response assessment, by cross sectional imaging will occur every 12 weeks. AURORA uses a Simon's 2-stage optimal design with best overall objective response rate (ORR, by RECIST v1.1) at a minimum of 12 weeks from commencing treatment as the primary endpoint. Secondary endpoints will include overall survival, progression-free survival, duration of response, magnitude of response using waterfall plots of target lesion measurements, quality of life using the EORTC QLQ-C30 tool, safety and tolerability (CTCAE v5) and evaluation of potential biomarkers of treatment response including PD-L1 expression. Archival tumour samples and blood samples will be collected for translational analyses.
If this trial shows atezolizumab to be safe and effective it may lead to a future late phase randomised controlled trial in UTSCC. Ultimately, we hope to provide a new option for treatment for such patients.
EudraCT Number: 2021-001995-32 (issued 8
September 2021); ISRCTN83474167 (registered 11 May 2022); NCT05038657 (issued 9th September 2021).
Work-integrated learning (WIL) has assumed life as a central feature of higher education curriculum design in a wide range of disciplines with the ultimate goal of producing work-ready graduates. ...Under recent Australian government initiatives affecting teacher education, placement forms of WIL have been touted as the panacea for perceived problems with graduate teacher quality; resulting in the national regulation of placement design and length in this discipline. This article reports the findings of a qualitative study into the perspectives of fifteen teacher education students from one regional Australian university. The study investigated these students' placement experiences and the impact of these experiences on their perceptions of readiness for a career in the teaching profession. Thematic analysis is the method used to identify two key themes in the data collected through semi-structured interviews. Despite recognising the benefits of real-world opportunities for skill development and practice inherent in WIL placement experiences, the study highlights important limitations of these forms of WIL on the development of professional readiness arising from the contextual features of particular placement sites; relationships with workplace supervisors and performance pressure associated with assessment during placements. These findings not only confirm the importance of social processes in the preparation of work-ready graduates but question reliance on placement forms of WIL learning for nurturing graduates' readiness for professional work.
This paper explores teachers' use of textbooks in the digital age. After discussing student expectancies and needs, textbook use and the affordances of modern technology, the paper reports the ...results of a small-scale pilot study involving eight higher education teachers in Australia who discuss the use of textbooks in higher education in the digital age. The results indicate that textbooks are generally viewed as reliable tools which provide creditable information that supports and enhances students' understanding of critical concepts, and that they present bite-size chunks of information to cement student learning.
Mental health is a leading health issue facing young people today, particularly those living in rural and regional areas. Although public policy supports schools‐based health promotion, there is ...limited evidence of the efficacy of such programmes and the elements that enhance successful implementation in rural and regional areas. A study was designed to evaluate a mental health promotion programme, delivered collaboratively by nurses, guidance officers, and teachers, to 850 young people from 23 rural and regional high schools in Queensland, Australia. The study aims were to determine what effect the intervention had on young peoples’ resilience, coping, and self‐efficacy, and to understand the implications of delivering the programme in the regional Queensland school setting. Students completed self‐report measures of self‐efficacy, resilience, and coping strategies pre‐ and postprogramme, as well as at 8‐week follow‐up. We found that after programme completion there was a significant increase in self‐efficacy and in the number of positive coping strategies used by the participating young people. Qualitative data indicated that participants benefited from the collaboration between health and education sectors; that is, nurses, guidance officers, and teachers delivered the programme together in ways that were perceived to be respectful of young people and effectively discussion‐based, and engaging.
Approximately three quarters of all major mental disorders begin in adolescence. Finding ways to buffer against stress, access social support and connection and flexibly draw upon a range of coping ...mechanisms are vital strategies that young people can use to promote mental health and wellbeing and to navigate this turbulent life transition successfully. Within Australia, like other parts of the world such as the UK and the USA, it is a sad reality that when young people do become distressed they are not self-caring or supporting others effectively, and not seeking or receiving appropriate help. In order to respond proactively to this issue, a nurse-initiated mental health promotion program was developed. It is termed, iCARE, which stands for Creating Awareness, Resilience and Enhanced Mental Health. The aim of this paper is to discuss the underpinning educational theory that assists in developing in young people a sense of belonging, empathy, self-care and resilience, and why the strategies chosen to engage young people are likely to be effective.
There is a growing acknowledgment of the relationship between students' psychological well-being and educational success. However, relatively few studies have focused on a connection between the ...psychological well-being of students who have high abilities and their school ecology. School-based experiences associated with interactions involving students, individual characteristics, contextual aspects and time-related factors are explored as they relate to the psychological well-being of students with high abilities. Psychological well-being in this article refers to students' motivation, ability to cope with stressors, their expectations for the future, their involvement in the community, and their sense of life satisfaction. This position paper invites researchers, educators, and other school-based stakeholders to consider the importance of the interplay between students' psychological well-being and the ecology in which they work.
Recruitment and retention in cancer trials are long-standing issues, exacerbated by the COVID-19 pandemic. The UK National Institute of Health Research and leading clinicians have emphasised the ...urgency to achieve and surpass prepandemic levels of participation.
Data from a recent UK trial demonstrated the impact of COVID-19 and highlighted factors that limited recruitment. In response to this worldwide problem, studies have identified strategies for remediation at the levels of funding, the research environment, study design and trial team-related aspects, yet evidence of progress is lacking.
Equality, diversity and inclusivity have become central to UK health and social policy during the 2000s. The need for greater inclusivity in trials has become a particular concern for cancer researchers and funders in the UK and in the USA, in recognition of potential bias in results. In the UK trials, the lack of standardised recording of ethnicity data renders interpretation difficult and caution is required in comparisons with the USA.
Recently, the focus of concern has shifted away from the impact of deprivation and low socioeconomic status on trial participation. Barriers created by these factors and their frequent intersection with ethnicity should not be overlooked.
The UK has adopted an advisory approach to broadening recruitment, publishing policy documents, guidance and toolkits. In the USA, by contrast, action on inclusion is increasingly mandated. Within the UK paradigm, the cancer research community is strongly encouraged to adopt a coordinated approach towards standardised digital data collection and embed and evaluate innovative, cocreated, locally relevant strategies.
Purpose
The implementation of mental health promotion is a core part of the role for all mental health professionals. This involves working with individuals and groups to facilitate the uptake and ...application of new knowledge, skills and personal attributes. Recently, an Australian intervention that included teaching nurses and educators the skills of mental health promotion was implemented and evaluated. The purpose of this paper is to report the findings of the qualitative evaluation and explore specific attributes of this facilitation, which helps to clarify and articulate a hidden, and taken-for-granted practice.
Design/methodology/approach
A qualitative mixed-methods study was designed to evaluate the perceived skills and attributes necessary for effective facilitation of a mental health promotion program in schools.
Findings
This evaluation revealed that facilitation is more than simply allowing free-flowing discussion amongst participants. For mental health promotion to be effective, the leader needs to be able to balance content delivery with flexibility, to use interpersonal behaviors that support and empower, and be willing to see the self as always learning and growing.
Practical implications
Without explicit training or discussion of facilitation, it is possible that mental health professionals may slip into teaching didactically. Didactic teaching may not empower learners to articulate their own views, or internalize and demonstrate new skills. A facilitative approach is more fitting to the values of twenty-first-century health promotion. Facilitation is a skill that deserves to be taught explicitly within all mental health promotion courses, so that mental health professionals are inspired to teach in ways that are transactional, and empowering.
Originality/value
A facilitative approach is more fitting to the values of twenty-first-century health promotion. This study confirms that facilitation is a skill that deserves to be taught explicitly to all mental health professionals so they are inspired to implement effec"tive mental health promotion.
Data were predominantly analysed descriptively; chi-squared and Fisher's exact tests were conducted to compare changes to treatment and monitoring due to COVID-19 between age groups, sex and ...diagnosis (NMIBC/MIBC). Fisher's exact tests did not reveal significant differences in treatment disruption between age groups, sex and NMIBC/MIBC. ...for patients undergoing monitoring/follow-up, statistically significant differences were observed for age groups (p = 0.020) and NMIBC/MIBC (p = 0.006)—a higher proportion of younger patients were not scheduled for monitoring (older patients mostly reported that their monitoring occurred as expected), and more patients with NMIBC had their monitoring appointment postponed or cancelled (n = 17) compared with MIBC patients (n = 1).
Developing the knowledge and practical skills for implementing inclusive education is a legislative and policy imperative for contemporary graduate teachers. In this qualitative study, the authors ...investigated the experiences of 18 preservice teachers during their practical school placements in primary and secondary school settings and the impact of these experiences on their attitudes towards students with special needs and their readiness to teach in mainstream inclusive settings. Sixteen of the participants had completed 2 or more placements. Data were collected using semistructured interviews and analysed to categorise the observed and enacted practices and define themes that contribute to a deeper understanding of preservice teachers' learning about inclusion through their practice in schools. The 4 identified themes show that contact, responsibility for instruction, modelled practices, and expectations for student learning all have significant impacts on the quality and outcomes of preservice teachers' placements. Findings suggest that placement settings do not consistently represent contexts where aspiring teachers are exposed to the types of meaningful contact or successful experiences claimed to be fundamental preparation for inclusive practice. The implications for the preservice teachers themselves and for their future practice are discussed.
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