Bias and precision of measures of survival gain from right‐censored data

In cost‐effectiveness analyses of drugs or health technologies, estimates of life years saved or quality‐adjusted life years saved are required. Randomised controlled trials can provide an estimate of the average treatment effect; for survival data, the treatment effect is the difference in mean survival. However, typically not all patients will have reached the endpoint of interest at the close‐out of a trial, making it difficult to estimate the difference in mean survival. In this situation, it is common to report the more readily estimable difference in median survival. Alternative approaches to estimating the mean have also been proposed. We conducted a simulation study to investigate the bias and precision of the three most commonly used sample measures of absolute survival gain – difference in median, restricted mean and extended mean survival – when used as estimates of the true mean difference, under different censoring proportions, while assuming a range of survival patterns, represented by Weibull survival distributions with constant, increasing and decreasing hazards. Our study showed that the three commonly used methods tended to underestimate the true treatment effect; consequently, the incremental cost‐effectiveness ratio (ICER) would be overestimated. Of the three methods, the least biased is the extended mean survival, which perhaps should be used as the point estimate of the treatment effect to be inputted into the ICER, while the other two approaches could be used in sensitivity analyses. More work on the trade‐offs between simple extrapolation using the exponential distribution and more complicated extrapolation using other methods would be valuable. Copyright © 2015 John Wiley & Sons, Ltd.     

‘Doing it right?’– accessing the narratives of identity of newly qualified social workers through the lens of resilience: ‘I am,I have,I can’

Using narrative enquiry, this paper accesses the construct of identity through exploring resilience in newly qualified social workers based in statutory children's services. In seeking to avoid deficit‐based models of this role, this paper aims to present inductively the ‘voice’ of three social workers in a semi‐rural authority, storying the positive ways in which resilience has developed during their first year. Using the Grotberg resilience framework (1995) –‘I am, I have, I can’– as an analytical tool at the interface of personal, professional and organizational identities, we conclude that ‘I am’ and ‘I have’ are more important than the skills dimension of ‘I can’. Positive role models, trust, ‘managed’ optimism, flexibility of support in and beyond induction, and, crucially, self‐efficacy and space for reflexivity, are more prominent as sources of resilience and strong identity. The reflexivity, inspired by the process of narrative enquiry, is an important contributor to self‐efficacy. We propose that a positive view of growth and identity is preferable to deficit models in the context of the transition between the two ‘communities of practice’ and of the challenges of the workplace. Organizational approaches based on this view will be more likely to promote a sustainable workforce.     

The “Citizen Scientist”: Reflections on the Public Role of Scientists in Response to Emerging Biotechnologies in New Zealand

Much of the traditional discussion on science and society engagement has concentrated on the role (and even duties) of citizens in response to science, and on attempts to scientise civilian consciousness to appreciate the benefits of scientific progress. Irwin’s (1995) concept of “Citizen Science” was an important milestone in our understanding of “science and society” relations, which focused attention on the needs and concerns of citizens and looked to a new form of science “enacted by citizens themselves” (Irwin 1995: ix). In this paper, I consider the other side of the science and society relationship by focusing on the scientist as citizen. Over time, a significant minority of scientists have been active in raising public concerns around the social impacts of science and technology, particularly around biotechnology and nanotechnology. This paper presents results from a New Zealand study that engaged scientists with community groups in dialogue about biotechnology. I discuss how this may represent an emerging form of scientific reflexivity and consider the implications for future engagement practice.     

Fostering family resiliency: a review of the key protective factors

The aim of this integrative review was to identify the protective factors that contribute to family resiliency. Families are comprised of individuals who interact across levels in a socio-ecological system. Family resiliency does not develop through evasion of risk, but through successful application of protective factors to engage in adverse situations and emerge from them stronger. In an effort to move away from pathological labelling, this review provides a foundation for strength-based family interventions. Thirteen peer-reviewed databases were searched for articles and information regarding family resiliency. Careful review yielded 24 protective factors that foster resiliency across three distinct but interactive levels: individual, family and community. The protective factors identified in this review of the literature offer an excellent starting point for development of clinical interventions to support family resiliency.     

Relationships matter: the problems and prospects for social workers' relationships with young children in care

One of the key lessons learnt in the UK from the Laming Inquiry into the death of Victoria Climbié was the importance of social workers developing consistent and long-term relationships with young children in whose lives they are involved. This issue is now informing policy developments, including the proposed Social Work Practices which, based on a similar model to General Practitioner practices, aim to provide a lead professional to act as a parental figure and an advocate for every child in care. This paper begins by confirming the importance of developing relationships between social workers and young children, but questions the ability of the new policy developments to facilitate these. Drawing upon data from research involving interviews with social workers, the paper outlines the factors which hinder social workers' relationships with young children and argues that while the new proposals address some of the more surface structural and organizational factors, they do not address the deeper factors regarding attitudes, values and emotional competence which are crucial if social workers are to successfully build relationships with young children in care.     

Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.