Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: results from a nationally representative cross-sectional general practice study.

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Christopher Harrison

Full Text Available OBJECTIVES: Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. METHODS: Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners. Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012. Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007 and post-vaccine (July 2007-June 2012 were also calculated. RESULTS: Management rate of genital warts among women potentially covered by program (aged 15-27 years decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (p<0.0001 and a significant increase in the management rate of control conditions per year (p<0.0001. For all other age-sex groups there was no significant change in the management rate of genital warts between the Pre- and Post-program periods. CONCLUSION: The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community.

A critical incident study of general practice trainees in their basic general practice term.

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Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Inequality in provider continuity for children by Australian general practitioners

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Reynolds Graham

2011-09-01

Full Text Available Abstract Background There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children. Method Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child's usual GP and practice address between 2001 and 2008. Results Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p = Conclusions Many GPs (39% were reported to provide continuity of care for in the ACT region and some GPs (20% displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice.

Sphygmomanometers--an audit in general practice.

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Shah, Nayankumar C; Sibbritt, David W; Heaney, Susan; Sharples, Jan

2004-11-01

The accuracy of sphygmomanometers used in Australian general practice is unknown but potentially important. We measured the accuracy of sphygmomanometers in general practice in the Hunter region of New South Wales using a gold standard. Practices were recruited by an advertisement in the division newsletter. Sixty practices (35%) volunteered. A total of 404 instruments were checked. Over 95% of sphygmomanometers were within 4 mmHg of gold standard sphygmomanometer across the clinical pressure range. Mercury sphygmomanometers were more accurate than aneroid (pmercury.

How common is multiple general practice attendance in Australia?

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Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

2018-05-01

Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.

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Eley, Diann S; Patterson, Elizabeth; Young, Jacqui; Fahey, Paul P; Del Mar, Chris B; Hegney, Desley G; Synnott, Robyn L; Mahomed, Rosemary; Baker, Peter G; Scuffham, Paul A

2013-01-01

The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study.

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Magin, Parker; Stewart, Rebecca; Turnock, Allison; Tapley, Amanda; Holliday, Elizabeth; Cooling, Nick

2017-10-01

Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation. We conducted a retrospective cohort study of trainees from a large Australian regionally-based GP training organization. The outcome factor was requirement for formal remediation. Independent variables were demographic factors and a range of formative assessments conducted immediately prior to or during early-stage training. Analyses employed univariate and multivariate logistic regression of each predictor assessment modality with the outcome, adjusting for potential confounders. Of 248 trainees, 26 (10.5 %) required formal remediation. Performance on the Colleague Feedback Evaluation Tool (entailing feedback from a trainee's clinical colleagues on clinical performance, communication and probity) and External Clinical Teaching Visits (half-day sessions of the trainee's clinical consultations observed directly by an experienced GP), along with non-Australian primary medical qualification, were significantly associated with requiring remediation. There was a non-significant trend for association with performance on the Doctors Interpersonal Skills Questionnaire (patient feedback on interpersonal elements of the consultation). There were no significant associations with entry-selection scores or formative exam or assessment scores. Our finding that 'in vivo' assessments of complex behaviour, but not 'in vitro' knowledge-based assessments, predict need for remediation is consistent with theoretical understanding of the nature of remediation decision-making and

Team climate for innovation: what difference does it make in general practice?

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Proudfoot, Judith; Jayasinghe, Upali W; Holton, Chris; Grimm, Jane; Bubner, Tanya; Amoroso, Cheryl; Beilby, Justin; Harris, Mark F

2007-06-01

Teamwork in primary healthcare is associated with patient care processes and staff outcomes. The ability of teams to be innovative is a hypothesized mechanism. We examined the characteristics of general practices with good team climate for innovation, and assessed the impact of climate on chronically ill patients' assessment of their care and on the job satisfaction of the staff. Large cross-sectional study. Australian general practices. A total of 654 general practitioners and staff and 7505 chronically ill patients from 93 general practices in 6 Australian states and territories. The Team Climate Inventory and the Overall Job Satisfaction Scale, customized for use with general practices, were administered to general practitioners and practice staff, and the General Practice Assessment Survey was administered to patients. Practice characteristics were collected by survey from the principal doctor or practice manager. Mean scores of team climate in Australian general practices were similar to those reported in the UK, except that in our study there was no association between the number of doctors in a practice and their team climate. Better team climate was found in practices with fewer non-clinical staff. Team climate predicted the job satisfaction of the general practitioners and staff, irrespective of the number of practice staff. Better team climate was associated with greater satisfaction by patients with their care. Team climate is important for patient and staff satisfaction. In large general practices, separate sub-cultures may exist between administrative and clinical staff, which has implications for designing effective team interventions.

A spatial analysis of the expanding roles of nurses in general practice

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Pearce Christopher

2012-08-01

Full Text Available Abstract Background Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. Method This study used a mixed methods, ‘rapid appraisal’ approach involving observation, photographs, and interviews. Results Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. Conclusion The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

Guidelines for computer security in general practice.

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Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making

Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia.

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Wardle, J; Adams, J; Sibbritt, D

2013-07-01

Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs). A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional New South Wales, Australia (response rate 40.7%). Few GPs in this study utilised homeopathy in their personal practice, with only 0.5% of GPs prescribing homeopathy in the past 12 months, and 8.5% referring patients for homeopathic treatment at least a few times over the past 12 months. Nearly two-thirds of GPs (63.9%) reported that they would not refer for homeopathy under any circumstances. Being in a remote location, receiving patient requests for homeopathy, observing positive responses from homeopathy previously, using complementary and alternative medicine (CAM) practitioners as information sources, higher levels of knowledge of homeopathy, and being interested in increasing CAM knowledge were all independently predictive of increased referral to homeopathy amongst GPs in this study. GPs in this study were less likely to refer to homeopathy if they used peer-reviewed literature as the major source of their information on CAM. Homeopathy is not integrated significantly in rural general practice either via GP utilisation or referral. There is significant opposition to homeopathy referral amongst rural and regional GPs, though some level of interaction with homeopathic providers exists. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

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Marie Ludlow

2017-06-01

Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

Stakeholder experiences with general practice pharmacist services: a qualitative study.

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Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of

Text-Messaging Practices and Links to General Spelling Skill: A Study of Australian Children

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Bushnell, Catherine; Kemp, Nenagh; Martin, Frances Heritage

2011-01-01

This study investigated 10- to 12-year-old Australian children's text-messaging practices and their relationship to traditional spelling ability. Of the 227 children tested, 82% reported sending text-messages; a median of 5 per day. Use of predictive and multi-press entry methods was roughly equal. Children produced a wide range of text-message…

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

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Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

2017-05-01

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

Sexual violence associated with poor mental health in women attending Australian general practices.

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Tarzia, Laura; Maxwell, Sarah; Valpied, Jodie; Novy, Kitty; Quake, Rebecca; Hegarty, Kelsey

2017-10-01

Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base. A descriptive, cross-sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor. More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling for other factors. Women who had experienced adult SV were more likely to feel down, depressed or hopeless than women who had not; however, this association disappeared after controlling for childhood sexual abuse. The findings support the association between SV and poor mental health, even when 'lesser' incidents have occurred. Implications for public health: General practitioners should consider an experience of SV as a possible factor in otherwise unexplained anxiety and depressive symptoms in female patients. © 2017 The Authors.

A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars

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Cooke Georga PE

2013-01-01

Full Text Available Abstract Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%. Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia

A qualitative study of collaboration in general practice: understanding the general practice nurse's role.

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McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

2017-07-01

To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. © 2016 John Wiley & Sons Ltd.

Australian survey on current practices for breast radiotherapy.

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Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois

2015-12-01

Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

Mentoring medical students in your general practice.

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Fraser, John

2016-05-01

Mentoring medical students in general practices is becoming more common in Australia due to formalised scholarship programs and informal approaches by students. This paper defines mentoring in Australian general practice. Practical suggestions are made on how to structure a mentorship program in your practice. Mentoring differs from leadership and teaching. It is a long-term relationship between a student and an experienced general practitioner. Avoiding summative assessment in mentorship is important to its success. Mentoring is about forming a safe place to confidentially discuss personal and professional issues between a mentor and student. This is based on defining roles and mutual trust. At the same time, students crave formative feedback. Unfortunately, present feedback models are based on teaching principles that can blur the differences between assessor, teacher and mentor. Mentorship can provide students with orientation and learning experiences so that they are prepared for practice as an intern.

Automated data extraction from general practice records in an Australian setting: trends in influenza-like illness in sentinel general practices and emergency departments.

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Liljeqvist, Gösta T H; Staff, Michael; Puech, Michele; Blom, Hans; Torvaldsen, Siranda

2011-06-06

Influenza intelligence in New South Wales (NSW), Australia is derived mainly from emergency department (ED) presentations and hospital and intensive care admissions, which represent only a portion of influenza-like illness (ILI) in the population. A substantial amount of the remaining data lies hidden in general practice (GP) records. Previous attempts in Australia to gather ILI data from GPs have given them extra work. We explored the possibility of applying automated data extraction from GP records in sentinel surveillance in an Australian setting.The two research questions asked in designing the study were: Can syndromic ILI data be extracted automatically from routine GP data? How do ILI trends in sentinel general practice compare with ILI trends in EDs? We adapted a software program already capable of automated data extraction to identify records of patients with ILI in routine electronic GP records in two of the most commonly used commercial programs. This tool was applied in sentinel sites to gather retrospective data for May-October 2007-2009 and in real-time for the same interval in 2010. The data were compared with that provided by the Public Health Real-time Emergency Department Surveillance System (PHREDSS) and with ED data for the same periods. The GP surveillance tool identified seasonal trends in ILI both retrospectively and in near real-time. The curve of seasonal ILI was more responsive and less volatile than that of PHREDSS on a local area level. The number of weekly ILI presentations ranged from 8 to 128 at GP sites and from 0 to 18 in EDs in non-pandemic years. Automated data extraction from routine GP records offers a means to gather data without introducing any additional work for the practitioner. Adding this method to current surveillance programs will enhance their ability to monitor ILI and to detect early warning signals of new ILI events.

Readiness for organisational change among general practice staff.

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Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

2010-10-01

Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; pchange which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

Case Studies of Mental Health in General practice(28)---HIV and Mood Disturbance

Institute of Scientific and Technical Information of China (English)

Fiona Judd; Leon Piterman; Grant Blashki; Hui Yang

2014-01-01

The Journal presents the Column of Case Studies of Mental Health in General Practice;with aca-demic support from Australian eXperts in general practice,psychology and psychiatry from Monash University and the University of Mel-bourne. The Columnˊs purpose is to respond to the increasing need for the development of mental health services in China. Through study and analysis of mental health cases,we hope to improve understanding of mental illnesses in Chinese primary health settings,and to build capaci-ty amongst community health professionals in managing mental illnesses and psychological problems in general practice. A patient - centred whole - person approach in general practice is the best way to maintain and improve the physical and mental health of residents. Our hope is that these case studies will lead the new wave of general practice and mental health service development both in practice and research. A num-ber of Australian eXperts from the disciplines of general practice,mental health and psychiatry will contribute to the Column. Professor Blash-ki,Professor Judd and Professor Piterman are authors of the teXt General Practice Psychiatry;the Chinese version of the book to be published in 2014. The Journal cases are helping to prepare for the translation and publication of a Chinese version of the book in China. We believe Chi-nese mental health in primary health care will reach new heights under this international cooperation.

Sexually active older Australian's knowledge of sexually transmitted infections and safer sexual practices.

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Lyons, Anthony; Heywood, Wendy; Fileborn, Bianca; Minichiello, Victor; Barrett, Catherine; Brown, Graham; Hinchliff, Sharron; Malta, Sue; Crameri, Pauline

2017-06-01

Rates of sexually transmitted infections (STIs) are rising among older Australians. We conducted a large survey of older people's knowledge of STIs and safer sexual practices. A total of 2,137 Australians aged 60 years and older completed the survey, which included 15 questions assessing knowledge of STIs and safer sexual practices. We examined both levels of knowledge and factors associated with an overall knowledge score. In total, 1,652 respondents reported having sex in the past five years and answered all knowledge questions. This group had good general knowledge but poorer knowledge in areas such as the protection offered by condoms and potential transmission modes for specific STIs. Women had better knowledge than men. Men in their 60s, men with higher education levels, and men who thought they were at risk of STIs reported better knowledge than other men. Knowledge was also better among men and women who had been tested for STIs or reported 'other' sources of knowledge on STIs. Many older Australians lack knowledge of STIs and safer sexual practices. Implications for public health: To reverse current trends toward increasing STI diagnoses in this population, policies and education campaigns aimed at improving knowledge levels may need to be considered. © 2017 The Authors.

Workplace bullying--what's it got to do with general practice?

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Askew, Deborah A; Schluter, Philip J; Dick, Marie-Louise

2013-04-01

Workplace bullying is repeated systematic, interpersonal abusive behaviours that negatively affect the targeted individual and the organisation in which they work. It is generally the result of actual or perceived power imbalances between perpetrator and victim, and includes behaviours that intimidate, offend, degrade or humiliate a worker. It is illegal, and bullied employees can take legal action against their employers for a breach of implied duty of trust and confidence. Despite this, workplace bullying occurs in many Australian workplaces, including Australian general practices. This article explores the issue of workplace bullying with particular reference to bullying within general practice and provides a framework for managing these situations. All general practices need organisation-wide anti-bullying policies that are endorsed by senior management, clearly define workplace bullying, and provide a safe procedure for reporting bullying behaviours. General practitioners should investigate whether workplace issues are a potential contributor to patients who present with depression and/or anxiety and assess the mental health of patients who do disclose that they are victims of workplace bullying, Importantly, the GP should reassure their patient that bullying is unacceptable and illegal, and that everyone has the right to a safe workplace free from violence, harassment and bullying. The time has come for all workplaces to acknowledge that workplace bullying is unacceptable and intolerable.

Research productivity in Australian general practice: what has changed since the 1990s?

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Askew, Deborah A; Schluter, Philip J; Gunn, Jane M

2008-07-21

The Primary Health Care Research, Evaluation and Development (PHCRED) Strategy aims to improve Australia's output of high-quality research from primary care. We compared publication rates from general practice, medicine and surgery for the period 2000-2007, and found that general practice publications increased since 1990-1999 from 1.0 to 3.0 publications per 1000 general practitioners per year. However, general practice publication rates have plateaued since 2000, and represent only 2%-5% of the equivalent rates for medicine and surgery. This finding suggests that more time and sustained investment in PHCRED are essential to see tangible outputs from funded research in general practice.

Occupational therapy in Australian acute hospitals: A modified practice.

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Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

2016-08-01

Ongoing changes to health-care funding Australia wide continue to influence how occupational therapists practise in acute hospitals. This study describes the practice challenges experienced by Western Australian acute care occupational therapists. Then, it explores if and how acute care occupational therapists are modifying their practice in response to these practice changes. This study used a qualitative grounded theory approach. Semi-structured interviews were completed with 13 purposively selected acute care occupational therapists from four Western Australian metropolitan hospitals. Data were analysed using a constant comparative method to provide detailed descriptions of acute care occupational therapy practice and to generate theory. Five conceptual categories were developed. The first two addressed practice challenges: pragmatic organisational influences on client care and establishing a professional identity within the multidisciplinary team. Three categories related to therapist responses are as follows: becoming the client advocate, being the facilitator and applying clinical reasoning. Finally, modified practice was identified as the core category which explains the process whereby acute care occupational therapists are ensuring they remain relevant and authentic in the acute care context. Western Australian acute care occupational therapists are practising in a highly complex health context that presents many challenges. They are responding by using a modified form of practice that ensures occupational therapy skills remain relevant within the narrow confines of this health setting. © 2016 Occupational Therapy Australia.

Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices.

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Kirby, Catherine N; Segal, Ahuva Y; Hinds, Rupert; Jones, Kay M; Piterman, Leon

2016-01-01

The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Leadership and management skills of general practice nurses: experience or education?

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Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

2014-12-01

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

The use of financial incentives in Australian general practice.

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Kecmanovic, Milica; Hall, Jane P

2015-05-18

To examine the uptake of financial incentive payments in general practice, and identify what types of practitioners are more likely to participate in these schemes. Analysis of data on general practitioners and GP registrars from the Medicine in Australia - Balancing Employment and Life (MABEL) longitudinal panel survey of medical practitioners in Australia, from 2008 to 2011. Income received by GPs from government incentive schemes and grants and factors associated with the likelihood of claiming such incentives. Around half of GPs reported receiving income from financial incentives in 2008, and there was a small fall in this proportion by 2011. There was considerable movement into and out of the incentives schemes, with more GPs exiting than taking up grants and payments. GPs working in larger practices with greater administrative support, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments. Administrative support available to GPs appears to be an increasingly important predictor of incentive use, suggesting that the administrative burden of claiming incentives is large and not always worth the effort. It is, therefore, crucial to consider such costs (especially relative to the size of the payment) when designing incentive payments. As market conditions are also likely to influence participation in incentive schemes, the impact of incentives can change over time and these schemes should be reviewed regularly.

Decolonising Australian Psychology: Discourses, Strategies, and Practice

Directory of Open Access Journals (Sweden)

Pat Dudgeon

2015-08-01

Full Text Available Colonisation in Australia has had a devastating and lasting impact on the wellbeing of Aboriginal and Torres Strait Islander peoples in Australia (herein referred to as Indigenous Australians. This paper discusses the role of psychology in Australia and the negative impact that certain disciplinary theories and practices have had on Indigenous Australians. The impact has been further exacerbated by the failure of mainstream policy makers and mental health practitioners to recognise the key, distinctive cultural and social determinants that contribute to Aboriginal health and wellbeing. There is a growing response by Aboriginal psychologists, critical social theorists, and their allies to decolonise psychological theory and practice to redress this situation. This paper outlines key decolonising strategies that have been effective in interrupting those aspects of psychology that are inimical to Aboriginal wellbeing.

A survey of Australian chiropractors' attitudes and beliefs about evidence-based practice and their use of research literature and clinical practice guidelines.

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Walker, Bruce F; Stomski, Norman J; Hebert, Jeff J; French, Simon D

2013-12-17

Research into chiropractors' use of evidence in clinical practice appears limited to a single small qualitative study. The paucity of research in this area suggests that it is timely to undertake a more extensive study to build a more detailed understanding of the factors that influence chiropractors' adoption of evidence-based practice (EBP) principles. This study aimed to identify Australian chiropractors' attitudes and beliefs towards EBP in clinical practice, and also examine their use of research literature and clinical practice guidelines. We used an online questionnaire about attitudes, beliefs and behaviours towards the use of EBP in clinical practice that had been developed to survey physiotherapists and modified it to ensure that it was relevant to chiropractic practice. We endeavoured to survey all registered Australian chiropractors (n = 4378) via email invitation distributed by Australian chiropractic professional organisations and the Chiropractic Board of Australia. Logistic regression analyses were conducted to examine univariate associations between responses to items measuring attitudes and beliefs with items measuring: age; years since registration; attention to literature; and use of clinical practice guidelines. Questionnaires were returned by 584 respondents (response rate approximately 13%). The respondents' perceptions of EBP were generally positive: most agreed that the application of EBP is necessary (77.9%), literature and research findings are useful (80.2%), EBP helps them make decisions about patient care (66.5%), and expressed an interest in learning or improving EBP skills (74.9%). Almost half of the respondents (45.1%) read between two to five articles a month. Close to half of the respondents (44.7%) used literature in the process of clinical decision making two to five times each month. About half of the respondents (52.4%) agreed that they used clinical practice guidelines, and around half (54.4%) agreed that they were able

Factors influencing early retirement intentions in Australian rural general practitioners.

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Pit, S W; Hansen, V

2014-06-01

The Australian general practice workforce is ageing. This and a trend towards higher exit intentions and earlier retirement make it increasingly important to identify those work and personal factors affecting intention to leave, which are amenable to change. To assess the various work, occupational and individual health factors associated with early retirement intentions among Australian rural general practitioners (GPs) that may be amenable to intervention. A cross-sectional study of GPs practising in rural Australia. Odds ratios of early retirement intentions across work, occupational and individual health factors were calculated. There were 92 participants (response rate 56%), and 47% of responders intended to retire before 65. GPs with medium to high burnout levels had higher odds of intending to retire. Increased job satisfaction and work ability scores were associated with decreased retirement intentions, whereas increased physical and mental work ability demands were associated with an increase in retirement intentions. Absenteeism was not related to retirement intentions but presenteeism was. GPs reporting any work-related sleep problems were found to have a 3-fold increase in the odds of early retirement intentions. The odds of early retirement intentions also increased with higher psychological distress, worsening general health and longer working hours. From a health policy reform perspective, the greatest impact on reducing early retirement intentions among ageing GPs could potentially be made by intervening in areas of working hours, burnout and work-related sleep issues, followed by job satisfaction, psychological distress, health, general workability and mental and physical work ability. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accessibility and spatial distribution of general practice services in an Australian city by levels of social disadvantage.

Science.gov (United States)

Hyndman, J C; Holman, C D

2001-12-01

The accessibility and spatial distribution of health services provided by the main source of primary medical care in Australia--the general practice surgery--was investigated by level of social disadvantage of local catchment areas. All 459 general practice surgeries in Perth, an Australian city of 1.2 million residents, were surveyed with a 94% response. Amount of service provision was measured using weekly doctor-hours, available from consulting rooms during opening hours, and associated nurse-hours of service. Access factors were defined as the distance to the nearest surgery, provision of Sunday and evening services, ease of making a same day appointment, bulk-billing, and whether the surgery offered a choice of gender of doctor. There were relatively more surgeries in disadvantaged areas and doctor-hours of service provision were also greater (41.0 h/1,000 most disadvantaged vs. 37.9 h/1000 least disadvantaged). Bulk-billing care, at no direct cost to the patient, was more likely to be provided in most disadvantaged areas compared with least disadvantaged areas (61 vs. 38%). However, populations living in the most disadvantaged areas were less likely to be able to see the local GP at short notice (91 vs. 95%), to have access to a local female GP (56 vs. 62%) or a local service in the evenings (42 vs. 51%). While the overall picture of accessibility was favourable, there was considerable variation in the type of services provided to different socioeconomic groups. Health care planners should investigate the reasons for these differences and advise Government to ensure that access factors affecting publicly funded services are equitably distributed.

Datasets collected in general practice: an international comparison using the example of obesity.

Science.gov (United States)

Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not

Practice and research in Australian massage therapy: a national workforce survey

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Wardle, Jonathan L.; Barnett, Rebecca; Adams, Jon

2015-01-01

Background Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is being increasingly integrated into the Australian health care system. However, despite the increasing importance of massage therapists in Australian health care delivery, or the increased practice and education obligations this may entail, there has been little exploration of practice, research, and education characteristics of the Australian massage therapist workforce. Purpose To identify practice, research, and education characteristics among the Australian massage therapist workforce. Settings The Australian massage therapy profession. Participants 301 randomly selected members of the Association of Massage Therapists (Australia). Research Design A 15-item, cross-sectional telephone survey. Main Outcomes Measures Massage therapists’ demographic information, practice characteristics, and education and research characteristics. Results Most respondents (73.8%) worked 20 hours per week or less practising massage, nearly half of all respondents (46.8%) treated fewer than 10 massage clients per week, and over three-quarters (81.7%) of respondents were self-employed. Massage therapy was the sole source of income for just over half (55.0%) of the study respondents. Only 5.7% of respondents earned over the average wage ($50,000) through their massage activities. Nearly half of all respondents (43.3%) reported regularly exceeding their continuing professional education (CPE) quota mandated by their professional association. However, 21.1% reported struggling to achieve their CPE quota each year. Over one-third of respondents (35.6%) were not interested in acquiring further CPE points beyond minimum requirements. Respondents were significantly more likely to have an active approach to research if they had higher income (p = .015). Multivariate analysis showed factors associated with access to

Sources of practice knowledge among Australian fitness trainers.

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Bennie, Jason A; Wiesner, Glen H; van Uffelen, Jannique G Z; Harvey, Jack T; Biddle, Stuart J H

2017-12-01

Few studies have examined the sources of practice knowledge fitness trainers use to inform their training methods and update knowledge. This study aims to describe sources of practice knowledge among Australian fitness trainers. In July 2014, 9100 Australian fitness trainers were invited to complete an online survey. Respondents reported the frequency of use of eight sources of practice knowledge (e.g. fitness magazines, academic texts). In a separate survey, exercise science experts (n = 27) ranked each source as either (1) 'high-quality' or (2) 'low-quality'. Proportions of users of 'high-quality' sources were calculated across demographic (age, sex) and fitness industry-related characteristics (qualification, setting, role). A multivariate logistic regression analysis assessed the odds of being classified as a user of high-quality sources, adjusting for demographic and fitness industry-related factors. Out of 1185 fitness trainers (response rate = 13.0%), aged 17-72 years, 47.6% (95% CI, 44.7-50.4%) were classified as frequent users of high-quality sources of practice knowledge. In the adjusted analysis, compared to trainers aged 17-26 years, those aged ≥61 years (OR, 2.15; 95% CI, 1.05-4.38) and 40-50 years (OR, 1.54; 95% CI, 1.02-2.31) were more likely to be classified as a user of high-quality sources. When compared to trainers working in large centres, those working in outdoor settings (OR, 1.81; 95% CI, 1.23-2.65) and medium centres (OR, 1.59; 95% CI, 1.12-2.29) were more likely to be classified as users of high-quality sources. Our findings suggest that efforts should be made to improve the quality of knowledge acquisition among Australian fitness trainers.

Who attracts whom to rural general practice? Variation in temperament and character profiles of GP registrars across different vocational training pathways.

Science.gov (United States)

Eley, Diann S; Laurence, Caroline; Cloninger, C R; Walters, Lucie

2015-01-01

The ongoing rural doctor workforce shortage continues to stimulate interest in new strategies to alleviate the situation. Alongside increasingly promising approaches is the notion that attracting and nurturing the 'right' individuals may be paramount to achieving long-term success in recruitment and retention. This study compares the patterns of demographic and temperament and character trait profiles of general practice registrars in training across three Australian vocational training pathways: the Australian College of Rural and Remote Medicine independent rural pathway, and the rural and general pathways of Australian general practice training. The aim is to describe the predominant personalities of existing trainees. At its foundation, this study strives to obtain more information about those individuals choosing rural practice, which may inform ways to enhance future recruitment and training into rural medicine. This rationale has been explored with medical students using intention as the dependent variable, but registrars are that much closer to their final career choice, and therefore may provide more practical and reliable indicators of the notion of who attracts whom into rural practice. A cross-sectional design sampled four registrar training groups: one from the Australian College of Rural and Remote Medicine, one Australian general practice training rural only, and two Australian general practice training rural and general pathway regional training providers. Registrars (451) completed a questionnaire that gathered basic demographics and a personality trait profile using the Temperament and Character Inventory plus a measure of resilience. Statistical analysis explored the relationships between variables (multivariate analyses of variance) and compared levels of traits between registrar groups (analyses of variance). Registrars training via the Australian College of Rural and Remote Medicine pathway were more likely to be male, older, have a definite

Mammographic screening practices among Chinese-Australian women.

Science.gov (United States)

Kwok, Cannas; Fethney, Judith; White, Kate

2012-03-01

To report mammographic screening practice among Chinese-Australian women, and to examine the relationship between demographic characteristics, acculturation factors (English proficiency and length of stay in Australia), cultural beliefs, and having a mammogram as recommended. Cross-sectional and descriptive. The study was conducted in 2009 in Sydney, Australia. Of 988 Chinese-Australian women over 18 years of age invited to participate in the study, 785 (79%) completed and returned the questionnaire. Of these women, 320 (40.8%) were in the target age range of 50 to 69 years. The Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) was used as a data collection instrument. Analysis included descriptive statistics, bivariate analysis using chi-square and t tests, and logistic regression. Of the 320 women in the targeted age range of 50 to 69 years, 238 (74.4%) had a mammogram as recommended biannually. Being married-de facto, in the 60 to 69 age group, and speaking Cantonese at home were positively associated with women's mammographic screening practice. However, no statistically significant differences in acculturation factors and having a mammogram as recommended were found. In terms of CBCSB score, women who had mammograms as recommended had more positive attitudes toward health checkups and perceived fewer barriers to mammographic screening. Effort should be focused on specific subgroups of Chinese-Australian women in order to fully understand the barriers involved in participating in mammographic screening. Nurses can use the findings from the present study to design culturally sensitive breast cancer screening programs to encourage women's participation in mammography. © 2011 Sigma Theta Tau International.

Using/designing Digital Technologies Of Representation In Aboriginal Australian Knowledge Practices

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Helen Verran

2007-01-01

Full Text Available Indigenous Australians are often keen to use digital technologies in their struggle to develop sustainable livelihoods on their own lands. This paper tells of gradually coming to recognize how an Aboriginal Australian elder struggled against the grain of digital technologies designed to represent, in using them in Aboriginal Australian knowledge practices where knowledge is always actively performative rather than representional. The performance of Aboriginal knowledge must express the remaking of an ancestral reality. At the same time, this man exploited possibilities the technologies offered for representation in achieving political ends in dealing with representatives of mainstream Australia.

Financial Management and Young Australian Workers

Science.gov (United States)

Dowling, Nicki; Hoiles, Lauren; Corney, Tim; Clark, David

2008-01-01

In two studies of young Australian workers, participants generally displayed positive attitudes towards financial management practices; however, a substantial proportion failed to display positive financial management practices, experienced financial problems and dissatisfaction, and reported low rates of seeking financial assistance, particularly…

Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice.

Science.gov (United States)

Mahomed, Rosemary; St John, Winsome; Patterson, Elizabeth

2012-11-01

  To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice.   Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses.   A grounded theory study underpinned by a relativist ontological position and a relativist epistemology.   Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods.   Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care.   Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction. © 2012 Blackwell Publishing Ltd.

Flexible but boring: medical students' perceptions of a career in general practice.

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Koehler, Nicole; McMenamin, Christine

2016-07-01

Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

Time to talk, time to see: changing microeconomies of professional practice among nurses and doctors in Australian general practice.

Science.gov (United States)

Phillips, Christine; Dwan, Kathryn; Pearce, Christopher; Hall, Sally; Porritt, Julie; Yates, Rachel; Sibbald, Bonnie

2007-08-01

In Australia, more nurses are entering general practice, and nurses' work is being funded in increasingly complex ways through Medicare. Little research has explored the ways doctors and nurses realign their priorities and activities when working together in general practice. We undertook rapid, intensive multimethod studies of 25 general practices to explore the ways in which the labour of nurses and doctors was structured, and the implicit decisions made by both professions about the values placed on different ways of working and on their time. Data collected included photographs, floor-plans, interviews with 37 nurses, 24 doctors and 22 practice managers, and 50 hours of structured observation. Nursing time was constructed by both nurses and doctors as being fluid and non-contingent; they were regarded as being 'available' to patients in a way that doctors were not. Compared to medical time, nursing time could be disposed more flexibly, underpinning a valorized attribute of nursing: deep clinical and personal contact with patients. The location of practice nurses' desks in areas of traffic, such as administrative stations, or in the treatment room, underpinned this valuable unstructured contact with patients. Changes to the practice nurse role through direct fee-for-service items for nurses may lead to greater congruence between the microeconomies of nursing and medicine in general practice. In a time of pressure upon a primary care workforce, this is likely to lead to more independent clinical work by nurses, but may also lead to a decrease in flexible contact with patients.

Preventive evidence into practice (PEP study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Harris Mark F

2013-01-01

Full Text Available Abstract Background There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession. Methods We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20% and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%; and lifestyle and physiological risk factors of patients at risk (by 5%. Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews. Discussion We plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.

Differences between Irish and Australian psychiatric nurses' family-focused practice in adult mental health services

LENUS (Irish Health Repository)

Grant, Anne

2016-04-01

Psychiatric nurses\\' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses\\' family-focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family-focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family-focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.

Investigation of fatigue by Australian general practice registrars: a cross-sectional study.

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Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Thomson, Allison; Wilson, Jessica; Scott, John; Spike, Neil A; McArthur, Lawrie; van Driel, Mieke L; Magin, Parker J

2015-06-01

Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars. To document the investigation-ordering behaviour of GP registrars in managing patients with a new diagnosis of unexplained fatigue. This was a cross-sectional analysis of data from Registrar Clinical Encounters in Training (ReCEnT), an ongoing cohort study of GP registrars' consultations. We established the prevalence of new diagnoses of unexplained fatigue and associations with that diagnosis, the rate of test ordering and the number and types of investigations ordered. 644 registrars contributed data from 68 986 encounters. In 0.78% of patient encounters, a new diagnosis of unexplained fatigue was made. Pathology was ordered in 78.4% of these problems (versus 18.1% in non-fatigue problems), at a rate of 488 tests per 100 new fatigue problems. Our study suggests that unexplained fatigue elicits a non-rational approach to test ordering by registrars. These findings contribute to the understanding of GP registrar management of fatigue, and undifferentiated presentations more broadly, and suggest educational approaches to improve practice, including dealing with uncertainty.

Microbiological quality control practices at Australian Radioisotopes

International Nuclear Information System (INIS)

Saunders, M.

1987-01-01

As a domestic manufacturer of therapeutic substances, Australian Radioisotopes (ARI) must adhere to guidelines set out by the Commonwealth Department of Health in the Code of Good Manufacturing Practices for Therapeutic Goods 1983 (GMP). The GMP gives guidelines for staff training, building requirements, sanitation, documentation and quality control practices. These guidelines form the basis for regular audits performed by officers of the National Biological Standards Laboratories. At Lucas Heights, ARI has combined the principles of the GMP with the overriding precautions introduced for environmental and staff safety and protection. Its policy is to maintain a high level of quality assurance for product identity, purity and sterility and apyrogenicity during all stages of product manufacture

Measures of Rheumatoid Arthritis Disease Activity in Australian Clinical Practice

OpenAIRE

Taylor, Andrew; Bagga, Hanish

2011-01-01

Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological...

Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report.

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Barr, Nigel; Holmes, Mark; Roiko, Anne; Dunn, Peter; Lord, Bill

2018-06-01

This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Exploring the Use of Evidence in Practice by Australian Special Librarians

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Howlett, Alisa; Howard, Zaana

2015-01-01

Introduction: Evidence-based practice is a process through which evidence in its various forms is sourced, appraised and applied in order to solve a problem, inform decision making, or improve practice. The purpose of this paper is to share findings from a qualitative research study that sought to identify evidence used by Australian special…

Organizational determinants of evaluation practice in Australian prevention agencies.

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Schwarzman, J; Bauman, A; Gabbe, B; Rissel, C; Shilton, T; Smith, B J

2018-06-01

Program evaluation is essential to inform decision making, contribute to the evidence base for strategies, and facilitate learning in health promotion and disease prevention organizations. Theoretical frameworks of organizational learning, and studies of evaluation capacity building describe the organization as central to evaluation capacity. Australian prevention organizations recognize limitations to current evaluation effectiveness and are seeking guidance to build evaluation capacity. This qualitative study identifies organizational facilitators and barriers to evaluation practice, and explores their interactions in Australian prevention organizations. We conducted semi-structured interviews with 40 experienced practitioners from government and non-government organizations. Using thematic analysis, we identified seven key themes that influence evaluation practice: leadership, organizational culture, organizational systems and structures, partnerships, resources, workforce development and training and recruitment and skills mix. We found organizational determinants of evaluation to have multi-level interactions. Leadership and organizational culture influenced organizational systems, resource allocation and support of staff. Partnerships were important to overcome resource deficits, and systems were critical to embed evaluation within the organization. Organizational factors also influenced the opportunities for staff to develop skills and confidence. We argue that investment to improve these factors would allow organizations to address evaluation capacity at multiple levels, and ultimately facilitate effective evaluation practice.

Supporting near-peer teaching in general practice: a national survey.

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van de Mortel, Thea F; Silberberg, Peter L; Ahern, Christine M; Pit, Sabrina W

2016-05-12

Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support

Measures of rheumatoid arthritis disease activity in Australian clinical practice.

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Taylor, Andrew; Bagga, Hanish

2011-01-01

Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.

Validation of an instrument to measure inter-organisational linkages in general practice.

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Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high

Validation of an instrument to measure inter-organisational linkages in general practice

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Cheryl Amoroso

2007-11-01

Full Text Available Purpose: Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice’s linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. Methods: An interview to measure surgery-level (rather than individual clinician-level clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations. Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. Results: The resulting General Practice Clinical Linkages Interview (GP-CLI is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. Conclusions: The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples

Aspects of work-life balance of Australian general practitioners: determinants and possible consequences.

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Shrestha, Durga; Joyce, Catherine M

2011-01-01

The Australian general practitioner (GP) workforce, especially younger generation GPs and female GPs, increasingly prioritises work-life balance (WLB). Good WLB is associated with decreased interest of medical students in general practice as a speciality choice as well as good health and wellbeing, and decisions of GPs to retire early. Therefore, understanding the role played by different factors in achieving WLB is crucial to ensure a sufficient GP workforce necessary to meet the rising demands of health care. There is a dearth of empirical, quantitative, large, population-based studies assessing the level of WLB in the Australian GP population as well as contributing and consequent factors. Our study fills this identified gap in the current literature. This study aimed to investigate the extent, determinants and possible consequences of WLB of Australian GPs. Data for this study come from the baseline cohort of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal, population-level survey. Questionnaires tailored specifically for GPs and GP registrars were sent to all clinically active GPs registered in the Australian Medical Publishing Co. (AMPCo) database (n=22137), with a choice of completing either a paper or online version. Data were collected between June and December 2008. STATA (10.0) was used for conducting weighted data analyses. Regression methods were applied for assessing the associations between dependent and independent variables. Of the 3906 GPs (17.6%) who responded, 53% reported that the balance between their personal and professional commitments was about right. Generation X GPs and females reported a better WLB than baby boomers and males respectively. However, those reporting good WLB also worked significantly fewer hours than those reporting poor WLB. GPs who reported good opportunities for leisure activities and perceived that they have good health also reported better WLB. Contrastingly, those reporting difficulty

Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice

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Elaine P. M. Lum

2017-10-01

appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.

Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice.

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Lum, Elaine P M; Page, Katie; Nissen, Lisa; Doust, Jenny; Graves, Nicholas

2017-10-10

for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.

Nursing in general practice: organizational possibilities for decision latitude, created skill, social support and identity derived from role.

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Merrick, Eamon; Duffield, Christine; Baldwin, Richard; Fry, Margaret

2012-03-01

This article is a report of a study to describe the factors that support organizational opportunities for practice nurse decision-making and skill development for nurses employed in general practice in New South Wales, Australia. Corresponding to the availability of subsidies from the Australian universal health insurer (Medicare), there has been an increase in the number of nurses employed in general practice. Currently, there is no Australian evidence as to the organizational possibilities for these practice nurses to make decisions, develop their own skills and abilities, derive identity from their role or how their role is influenced by social support. Over a 8-month period in 2008 practice, nurses employed in general practice in the State of New South Wales were invited to complete a 26-item self-administered online questionnaire utilizing constructs from Karaseks (1998) Job Content Questionnaire (valid n = 160). Confirmatory Factor Analysis indicated that all scales demonstrated acceptable levels of internal consistency. Sequential regression models revealed that social support exerts a weak influence on decision latitude (R(2) = 0·07); the addition of self-identity through work significantly improved the predictive ability of the model (R(2) = 0·16). Social support and self-identity through work exerted a negative influence on created skill (R(2) = 0·347), whereas social support was effective in predicting self-identity through work (R(2) = 0·148).   Collegial and supervisory support in the work environment predicts organizational possibilities for practice nurse decision-making. © 2011 Blackwell Publishing Ltd.

Managing corneal foreign bodies in office-based general practice.

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Fraenkel, Alison; Lee, Lawrence R; Lee, Graham A

2017-03-01

Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

Values Education as Good Practice Pedagogy: Evidence from Australian Empirical Research

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Lovat, Terence

2017-01-01

This article focuses on the Australian Government's Values Education Program and, within its context, the "Values Education Good Practice Schools Project" (VEGPSP) Reports and the "Project to Test and Measure the Impact of Values Education on Student Effects and School Ambience," funded federally from 2003 to 2010. Findings…

The social world of Australian practice nurses and the influence of medical dominance: an analysis of the literature.

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Mills, Jane; Hallinan, Christine

2009-12-01

In Australia, the number of practice nurses is growing at a rapid rate. On the nursing landscape, this group of nurses stand out because of their relationship with the Australian Government who both fund them, and concern themselves with their continuing professional development. This paper provides a construction of the social world of Australian practice nurses, identifying stakeholders in the business of practice nursing. Literature produced by the various social world segments is analysed for the influence of medical dominance on the role, image, power and politics of practice nurses.

A methodological protocol for selecting and quantifying low-value prescribing practices in routinely collected data: an Australian case study.

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Brett, Jonathan; Elshaug, Adam G; Bhatia, R Sacha; Chalmers, Kelsey; Badgery-Parker, Tim; Pearson, Sallie-Anne

2017-05-03

Growing imperatives for safety, quality and responsible resource allocation have prompted renewed efforts to identify and quantify harmful or wasteful (low-value) medical practices such as test ordering, procedures and prescribing. Quantifying these practices at a population level using routinely collected health data allows us to understand the scale of low-value medical practices, measure practice change following specific interventions and prioritise policy decisions. To date, almost all research examining health care through the low-value lens has focused on medical services (tests and procedures) rather than on prescribing. The protocol described herein outlines a program of research funded by Australia's National Health and Medical Research Council to select and quantify low-value prescribing practices within Australian routinely collected health data. We start by describing our process for identifying and cataloguing international low-value prescribing practices. We then outline our approach to translate these prescribing practices into indicators that can be applied to Australian routinely collected health data. Next, we detail methods of using Australian health data to quantify these prescribing practices (e.g. prevalence of low-value prescribing and related costs) and their downstream health consequences. We have approval from the necessary Australian state and commonwealth human research ethics and data access committees to undertake this work. The lack of systematic and transparent approaches to quantification of low-value practices in routinely collected data has been noted in recent reviews. Here, we present a methodology applied in the Australian context with the aim of demonstrating principles that can be applied across jurisdictions in order to harmonise international efforts to measure low-value prescribing. The outcomes of this research will be submitted to international peer-reviewed journals. Results will also be presented at national and

'Chasing the numbers': Australian Bachelor of Midwifery students' experiences of achieving midwifery practice requirements for registration.

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Licqurish, Sharon; Seibold, Camel

2013-06-01

to explore one aspect of the findings from a qualitative study exploring Australian Bachelor of Midwifery students' experiences of achieving competency for beginning practice. a qualitative study using grounded theory, incorporating situational analysis. Data were collected by interviews, field observation and students' documents. one university in Victoria, Australia, which was a member of a consortium of universities that first implemented Bachelor of Midwifery curricula. 19 women, aged 20-40 years, completing the Bachelor of Midwifery course between the years 2005 and 2008. data analysis revealed an overarching social process of assimilation, and three related subprocesses namely realisation, adaptation and consolidation. This paper focuses on consolidation in terms of competency achievement in relation to set requirements. while generally found competent for beginning practice, the Bachelor of Midwifery students in this study felt that their ability to achieve competency according to professional midwifery standards, was constrained by the restricted nature of midwifery practice and medical dominance in the hospitals where they were placed. Furthermore, they found it challenging to achieve the minimum midwifery experience requirements, as well as their own personal learning objectives, within the clinical practicum hours provided in the curriculum. a review of the clinical hours provided by Bachelor of Midwifery curricula is required, with a view to ensure that clinical hours are consistent with recommended hours suggested by Australian Bachelor of Midwifery course accreditation standards. Universities implementing midwifery curricula in Australia need to be cognisant of the theory-practice gap and therefore the applicability of professional competency standards to the education of midwives. The concerns about the reliability of competency standards need to be addressed. Finally, further research is required to validate the current number of, minimum practice

Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

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Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

2017-08-10

Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (Pinterest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to

Themes Underlying Australian General Practitioner Views towards Chiropractic and Osteopathy: An Assessment of Free Text Data from a Cross-Sectional Survey

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Sandra Grace

2018-01-01

Full Text Available The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care. A qualitative analysis of open-ended responses to a survey of 630 Australian GPs was conducted. Unfavourable attitudes of GPs towards chiropractors and osteopaths included perceived lack of safety, efficacy, and inadequacy of training, despite chiropractic’s and osteopathy’s reliance on the same evidence base and similar training to those of other manual therapy professions such as physiotherapy. These attitudes may be underpinned by the professional biases against chiropractic and osteopathy that continue to marginalise the professions within the Australian healthcare system. Continued investment in the research base for chiropractic and osteopathic practice is required, along with raising the awareness of GPs about the education and skills of chiropractors and osteopaths.

Evaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices.

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Shephard, Mark D; Mazzachi, Beryl C; Watkinson, Les; Shephard, Anne K; Laurence, Caroline; Gialamas, Angela; Bubner, Tanya

2009-01-01

From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program. An education and training resource package was developed for the Trial consisting of a training manual, a set of A3 laminated posters and a CD ROM. Five initial training workshops were held for intervention practices from each geographic region between August and October 2005

Owners' insights into private practice dentistry in New South Wales and the Australian Capital Territory.

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Fischer, J E; Marchant, T

2010-12-01

The aim of this study was to investigate aspects of practice ownership including debt on graduation, the time period between graduation and acquiring practice ownership and small business skills. A mail survey of 400 dentists with practice ownership, in New South Wales (NSW) and the Australian Capital Territory (ACT), addressed demographics, setting up practice, technology and business management. Most respondents were male and nearly half had 20 years of practice ownership. Dentists agreed with the need to be taught small business management skills. Average debt on graduation was AUD$18 000 and the figure was higher for post 1995 graduates. On average, it took five years to acquire some form of practice ownership, but nearly half acquired ownership within three years. Few favoured opening a new practice. Staff were the most frequently nominated contributors to a successful practice, with fees, profit and parking noted least frequently. There was no question that these experienced dentists thought small business skills should be taught to the dental fraternity. Given the significance of staff to a successful practice, dentists may need to learn more about advanced human resource management including professional development and performance management. © 2010 Australian Dental Association.

Incorporating online teaching in an introductory pharmaceutical practice course: a study of student perceptions within an Australian University.

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Benino, Diana; Girardi, Antonia; Czarniak, Petra

2011-10-01

To examine student perceptions regarding online lectures and quizzes undertaken during a pharmaceutical practice course for first year undergraduate students enrolled in the Bachelor of Pharmacy course at an Australian University. The University uses a standard instrument to collect feedback from students regarding unit satisfaction. Data were collected for three different teaching modalities: traditional face-to-face, online and partially online. Descriptive statistics support that, from a student's perspective, partial online delivery is the preferred teaching methodology for an introductory pharmaceutical practice unit. This study has served to highlight that while there are a few points of significant difference between traditional and online teaching and learning, a combination of the two provides a reasonable avenue for teaching exploration. This result has implications for teaching practice generally, and within the pharmacy discipline, specifically.

Adoption of Obesity Prevention Policies and Practices by Australian Primary Schools: 2006 to 2013

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Nathan, N.; Wolfenden, L.; Williams, C. M.; Yoong, S. L.; Lecathelinais, C.; Bell, A. C.; Wyse, R.; Sutherland, R.; Wiggers, J.

2015-01-01

Despite significant investment in many countries, the extent of schools' adoption of obesity prevention policies and practices has not been widely reported. The aims of this article are to describe Australian schools' adoption of healthy eating and physical activity policies and practices over an 8-year period and to determine if their adoption…

A survey of general surgery clerkships in Australian and New Zealand medical schools.

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Yu, Tzu-Chieh; Wheeler, Benjamin Robert Logan; Hill, Andrew Graham

2010-12-01

Surgical clerkships facilitate development of knowledge and competency, but their structure and content vary. Establishment of new medical schools and raising student numbers are new challenges to the provision of standardized surgical teaching across Australasian medical schools. A survey was conducted to investigate how Australian and New Zealand medical schools structure their general surgery clerkships. Between April and August 2009, a 30-item web-based survey was electronically sent to academic and administrative staff members of 22 Australian and New Zealand medical schools. Eighteen surveys were returned by 16 medical schools, summarizing 20 clerkships. Ten schools utilize five or more different clinical teaching sites for general surgery clerkships and these include urban and rural hospitals from both public and private health sectors. Student teaching and assessment methods are similar between clerkships and standardized across clinical sites during 10 and 16 of the clerkships, respectively. Only eight of the surveyed clerkships use centralized assessments to evaluate student learning outcomes across different clinical sites. Four clerkships do not routinely use direct observational student assessments. Australian and New Zealand medical schools commonly assign students to multiple diverse clinical sites during general surgery clerkships and they vary in their approaches to standardizing curriculum delivery and student assessment across these sites. Differences in student learning are likely to exist and deficiencies in clinical ability may go undetected. This should be a focus for future improvement. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

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Freeman Christopher

2012-08-01

Full Text Available Abstract Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models. Conclusions These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

The scope of private practice nursing in an Australian sample.

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Wilson, Anne; Averis, Andrea; Walsh, Ken

2004-01-01

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.

Associations between yoga practice and joint problems: a cross-sectional survey among 9151 Australian women.

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Lauche, Romy; Schumann, Dania; Sibbritt, David; Adams, Jon; Cramer, Holger

2017-07-01

Yoga exercises have been associated with joint problems recently, indicating that yoga practice might be potentially dangerous for joint health. This study aimed to analyse whether regular yoga practice is associated with the frequency of joint problems in upper middle-aged Australian women. Women aged 62-67 years from the Australian Longitudinal Study on Women's Health (ALSWH) were questioned in 2013 whether they experienced regular joint pain or problems in the past 12 months and whether they regularly practiced yoga. Associations of joint problems with yoga practice were analysed using Chi-squared tests and multiple logistic regression modelling. Of 9151 women, 29.8% reported regular problems with stiff or painful joints, and 15.2, 11.9, 18.1 and 15.9% reported regular problems with shoulders, hips, knees and feet, respectively, in the past 12 months. Yoga was practiced sometimes by 10.1% and often by 8.4% of women. Practicing yoga was not associated with upper or lower limb joint problems. No association between yoga practice and joint problems has been identified. Further studies are warranted for conclusive judgement of benefits and safety of yoga in relation to joint problems.

Incorporating online teaching in an introductory pharmaceutical practice course: a study of student perceptions within an Australian University

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Benino D

2011-12-01

Full Text Available Objectives: To examine student perceptions regarding online lectures and quizzes undertaken during a pharmaceutical practice course for first year undergraduate students enrolled in the Bachelor of Pharmacy course at an Australian University.Methods: The University uses a standard instrument to collect feedback from students regarding unit satisfaction. Data were collected for three different teaching modalities: traditional face-to-face, online and partially online. Results: Descriptive statistics support that, from a student's perspective, partial online delivery is the preferred teaching methodology for an introductory pharmaceutical practice unit. Conclusion: This study has served to highlight that while there are a few points of significant difference between traditional and online teaching and learning, a combination of the two provides a reasonable avenue for teaching exploration. This result has implications for teaching practice generally, and within the pharmacy discipline, specifically.

Perceptions of primary care staff on a regional data quality intervention in Australian general practice: a qualitative study.

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Ghosh, Abhijeet; McCarthy, Sandra; Halcomb, Elizabeth

2016-04-26

Technological advances in clinical data capturing and storage systems have led to recent attempts at disease surveillance and region specific population health planning through regularly collected primary care administrative clinical data. However the accuracy and comprehensiveness of primary care health records remain questionable. We aimed to explore the perceptions and experiences of general practice staff in maintaining accurate patient health data within clinical software used in primary care settings of regional NSW. Focus groups were conducted with general practitioners, practice nurses and practice administrative staff from 17 practices in the Illawarra-Shoalhaven region of the state of New South Wales (NSW) in Australia that had participated in the Sentinel Practices Data Sourcing (SPDS) project - a general practice based chronic disease surveillance and data quality improvement study. A total of 25 respondents that included 12 general practitioners (GPs) and 13 practice staff participated in the 6 focus groups. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken. Five key themes emerged from the data. Firstly, the theme of resourcing data management raised issues of time constraints, the lack of a dedicated data management role and the importance of multidisciplinary involvement, including a data champion. The need for incentives was identified as being important to motivate ongoing commitment to maintaining data quality. However, quality of software packages, including coding issues and software limitations and information technology skills were seen as key barriers. The final theme provided insight into the lessons learnt from the project and the increased awareness of the importance of data quality amongst practice staff. The move towards electronic methods of maintaining general practice patient records offers significant potential benefits in terms of both patient care and monitoring of health

The Experience of Evidence-Based Practice in an Australian Public Library: An Ethnography

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Gillespie, Ann; Partridge, Helen; Bruce, Christine; Howlett, Alisa

2016-01-01

Introduction: This paper presents the findings from a project that investigated the lived experiences of library and information professionals in relation to evidence-based practice within an Australian public library. Method: The project employed ethnography, which allows holistic description of people's experiences within a particular community…

The informal curriculum - general practitioner perceptions of ethics in clinical practice.

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Sturman, Nancy J; Parker, Malcolm; van Driel, Mieke L

2012-12-01

Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting. Interviews were conducted with a convenience sample of 13 general practitioner teachers. They were asked to reflect on common and/or important ethical issues in their day-to-day practice. An inductive thematic analysis of the data was performed by two investigators, who reached a consensus on major themes using an iterative, dialogic process. Participants reported negotiating ethical issues frequently. Major themes included patient-doctor relationships, professional differences, truth-telling, ethically 'grey' areas and the personal demands of ethical decision making. General practitioners in this study describe sometimes needing to apply judgement and compromise in situations involving legal or ethical issues, in order to act in the best interests of patients and to successfully negotiate the patient-doctor relationship. Students learning in this clinical context may perceive mixed messages and ethical lapses in these challenging 'grey' areas. The ethical acumen and emotional resilience of both students and clinical teachers may be enhanced by ongoing reflective discussion with colleagues.

A review of methodologies applied in Australian practice to evaluate long-term coastal adaptation options

Directory of Open Access Journals (Sweden)

Timothy David Ramm

2017-01-01

Full Text Available Rising sea levels have the potential to alter coastal flooding regimes around the world and local governments are beginning to consider how to manage uncertain coastal change. In doing so, there is increasing recognition that such change is deeply uncertain and unable to be reliably described with probabilities or a small number of scenarios. Characteristics of methodologies applied in Australian practice to evaluate long-term coastal adaptation options are reviewed and benchmarked against two state-of-the-art international methods suited for conditions of uncertainty (Robust Decision Making and Dynamic Adaptive Policy Pathways. Seven out of the ten Australian case studies assumed the uncertain parameters, such as sea level rise, could be described deterministically or stochastically when identifying risk and evaluating adaptation options across multi-decadal periods. This basis is not considered sophisticated enough for long-term decision-making, implying that Australian practice needs to increase the use of scenarios to explore a much larger uncertainty space when assessing the performance of adaptation options. Two Australian case studies mapped flexible adaptation pathways to manage uncertainty, and there remains an opportunity to incorporate quantitative methodologies to support the identification of risk thresholds. The contextual framing of risk, including the approach taken to identify risk (top-down or bottom-up and treatment of uncertain parameters, were found to be fundamental characteristics that influenced the methodology selected to evaluate adaptation options. The small sample of case studies available suggests that long-term coastal adaptation in Australian is in its infancy and there is a timely opportunity to guide local government towards robust methodologies for developing long-term coastal adaptation plans.

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

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Bowden Francis J

2010-09-01

Full Text Available Abstract Background Genital chlamydia is the most commonly notified sexually transmissible infection (STI in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis. Methods In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT. Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed. Results Perceived barriers to patients telling partners (patient referral included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not

The desire and capability of Australian general practitioners to change their working hours.

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Norman, Richard; Hall, Jane P

2014-04-21

To explore factors associated with general practitioners' desire to work less and their success in making that change. Waves 3 and 4 (conducted in 2010 and 2011) of a national longitudinal survey of Australian doctors in clinical practice (Medicine in Australia: Balancing Employment and Life). Of the broader group of medical practitioners in the survey, there were 3664 and 3436 GP completers in Waves 3 and 4, respectively. The association between the desire to reduce hours and doctor, job and geographic characteristics; the association between predictors of the capability to reduce hours and these same doctor, job and geographic characteristics. Over 40% of GPs stated a preference to reduce their working hours. Characteristics that predicted this preference were being middle-aged, being female, working ≥ 40 hours per week (all P working hours were being in excellent health, being satisfied or very satisfied with work (both P working hours, 26.8% successfully managed to do so in the subsequent year (where reduction was defined as reducing hours by at least 5 per week). Predictors of successfully reducing hours were being younger, female and working ≥ 40 hours per week (all P hours and their subsequent success in doing so. Declining working hours have contributed to the perceived shortage in GPs. Therefore, designing policies that address not just the absolute number of medical graduates but also their subsequent level of work may alleviate some of the pressures on the Australian primary health care system.

Childhood obesity in secondary care: national prospective audit of Australian pediatric practice.

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Campbell, Michele; Bryson, Hannah E; Price, Anna M H; Wake, Melissa

2013-01-01

In many countries, pediatricians offer skilled secondary care for children with conditions more challenging than can readily be managed in the primary care sector, but the extent to which this sector engages with the detection and management of obesity remains largely unexplored. This study aimed to audit the prevalence, diagnosis, patient, and consultation characteristics of obesity in Australian pediatric practices. This was a national prospective patient audit in Australia. During the course of 2 weeks, members of the Australian Paediatric Research Network prospectively recorded consecutive outpatient consultations by using a brief standardized data collection form. Measures included height, weight, demographics, child and parent health ratings, diagnoses, referrals, investigations, and consultation characteristics. We compared the prevalence of pediatrician-diagnosed and measured obesity (body mass index ≥95th percentile) and top-ranked diagnoses, patient, and consultation characteristics in (a) obese and nonobese children, and (b) obese children with and without a diagnosis. A total of 198 pediatricians recorded 5466 consultations with 2-17 year olds, with body mass index z-scores calculated for 3436 (62.9%). Of the 12.6% obese children, only one-third received an "overweight/obese" diagnosis. Obese children diagnosed as overweight/obese were heavier, older, and in poorer health than those not diagnosed and incurred more Medicare (government-funded health system) cost and referrals. Obesity is infrequently clinically diagnosed by Australian pediatricians and measurement practices vary widely. Further research could focus on supporting and normalizing clinical obesity activities from which pediatricians and parents could see clear benefits. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Investment practices in Australian coal: the practice and profit of quasi-integration in the Australia-Japan coal trade

International Nuclear Information System (INIS)

Colley, Peter

1997-01-01

The Australian coal industry has frequently been described as a perpetual case of 'profitless prosperity'. Industry literature on the subject usually sources this problem to government charges on the industry and to labour costs. However, these alleged problems do not appear to have diminished the enthusiasm for new investment in the industry. This study argues that a more complete explanation must look at who is investing in the Australian coal industry, what the rationale for those investments is, how they are financed and what their specific profitability is. The particular examination made here is of the quasi-integration investment practices of Japanese trading, steel and power companies -easily the largest group of buyers in the international coal trade. The close co-operation between Japanese government and business in this strategic raw materials industry is documented, as are the methods of subsidised investment. An examination of the financial performance of these companies' Australian coal investments shows that the profitability of their investments is significantly below that of most other investors in Australian mining over a recent 5-year period. Taken together, there is significant support for the conclusion that a process of co-ordinated quasi-integration has taken place and that the principal aim of such investments has not been to make profits from coal-mining. (author)

Australian Correctional Management Practices for Terrorist Prisoners

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Nathan Tompson

2018-03-01

Full Text Available Management practices for incarcerated terrorists is an important counterterrorism policy consideration. Moreover, there is a misconception that once incarcerated, terrorists cease to be a risk. If correctional management regimes are implemented poorly, terrorist prisoners may be afforded the opportunity to remain active while incarcerated, including the recruitment of other prisoners, and the planning of future attacks. Equally, they may be viewed as role models or martyrs for sympathisers to aspire to. Despite the magnitude of the consequences, there is no agreed approach to managing Australian terrorist prisoners. As such, a dichotomy of dominant models has emerged; that is, to either segregate terrorist prisoners, or conversely, to disperse them throughout the wider prisoner population. Each strategy presents its own set of benefits and risks. This paper compares the management practices for terrorist prisoners in the states of New South Wales and Victoria to determine the strengths and vulnerabilities of each of these approaches. The paper concludes that policy-makers should consider reassessing current strategies. It suggests that a focus that extends the immediate containment considerations to encompass post-release factors would bring benefits for society.

A Confirmatory Factor Analysis of the Student Evidence-Based Practice Questionnaire (S-EBPQ) in an Australian sample.

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Beccaria, Lisa; Beccaria, Gavin; McCosker, Catherine

2018-03-01

It is crucial that nursing students develop skills and confidence in using Evidence-Based Practice principles early in their education. This should be assessed with valid tools however, to date, few measures have been developed and applied to the student population. To examine the structural validity of the Student Evidence-Based Practice Questionnaire (S-EBPQ), with an Australian online nursing student cohort. A cross-sectional study for constructing validity. Three hundred and forty-five undergraduate nursing students from an Australian regional university were recruited across two semesters. Confirmatory Factor Analysis was used to examine the structural validity. Confirmatory Factor Analysis was applied which resulted in a good fitting model, based on a revised 20-item tool. The S-EBPQ tool remains a psychometrically robust measure of evidence-based practice use, attitudes, and knowledge and skills and can be applied in an online Australian student context. The findings of this study provided further evidence of the reliability and four factor structure of the S-EBPQ. Opportunities for further refinement of the tool may result in improvements in structural validity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Policy Change and Its Effect on Australian Community-Based Natural Resource Management Practices

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Cooke, Penelope R.; Hemmings, Brian C.

2016-01-01

The authors of this article report on a qualitative study of Australian community-based natural resource management groups known as Landcare groups. They discuss how four Landcare groups contributed to sustainability practices and how a policy change implemented in 2003 influenced the efforts of the groups to remain active in their activities.…

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.

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Martin, Louise; Leveritt, Michael D; Desbrow, Ben; Ball, Lauren E

2014-04-01

Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated. The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities. A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored. Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role. Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.

A survey of Australian chiropractors’ attitudes and beliefs about evidence-based practice and their use of research literature and clinical practice guidelines

OpenAIRE

Walker, Bruce F; Stomski, Norman J; Hebert, Jeff J; French, Simon D

2013-01-01

Background Research into chiropractors’ use of evidence in clinical practice appears limited to a single small qualitative study. The paucity of research in this area suggests that it is timely to undertake a more extensive study to build a more detailed understanding of the factors that influence chiropractors’ adoption of evidence-based practice (EBP) principles. This study aimed to identify Australian chiropractors’ attitudes and beliefs towards EBP in clinical practice, and also examine t...

Medication management policy, practice and research in Australian residential aged care: Current and future directions.

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Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

2017-02-01

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges.

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Lee, Rebekah Yeaun; Moles, Rebekah; Chaar, Betty

2015-01-01

The recent legalization of mifepristone has given women in Australia a new option for termination of pregnancy. Pharmacists are well positioned to provide information and supply mifepristone for patients. However, there are ethical and legal concerns in Australia regarding the supply of mifepristone, as pharmacists may choose to conscientiously object to supplying mifepristone and are subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore attitudes and knowledge of Australian pharmacists about mifepristone. Semistructured interviews were conducted with 41 registered pharmacists working in a pharmacy or hospital in Sydney, Australia. When data saturation was achieved, audiotaped transcripts were deidentified and transcribed verbatim. Data were thematically analyzed using a framework approach for applied policy research and categorized into the following themes: contextual, diagnostic, evaluative and strategic. Analysis of the transcripts yielded four themes: (a) pharmacists' contextual view on pregnancy termination, the role of the pharmacist and impact on the pharmacy workplace; (b) diagnostic reasons for differing views; (c) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (d) strategies to improve pharmacists' services, awareness and education. Australian pharmacists in this study perceived themselves to have a potentially important role as medicine experts in patient health care and safety in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation. To ensure patient safety, well-being and autonomy, there is an imperative need for pharmacist-specific training and guidelines to be made available and open discussion to be initiated within the profession to raise awareness, in particular regarding professional accountability for full

General practice registrars' views on maternity care in general practice in New Zealand.

Science.gov (United States)

Preston, Hanna; Jaye, Chrystal; Miller, Dawn L

2015-12-01

The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.

"Body Practices--Exposure and Effect of a Sporting Culture?" "Stories from Three Australian Swimmers"

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McMahon, Jenny; Penney, Dawn; Dinan-Thompson, Maree

2012-01-01

This paper contributes to sport, sociology and the body literature by exploring the "exposure and effect" of culture, in particular bodily practices placed on three adolescent swimmers immersed in the Australian swimming culture using an ethnographic framework. The research reported is particularly notable as it addresses two distinct…

Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations.

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Reilly, T; Crawford, G; Lobo, R; Leavy, J; Jancey, J

2016-04-01

Issue addressed Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations. Methods Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed. Results The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing. Conclusion The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings. So what? Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics-evidence gap.

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

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Farrer, Louise M; Walker, Jennie; Harrison, Christopher; Banfield, Michelle

2018-01-01

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

Relationship between general nutrition knowledge and diet quality in Australian military personnel.

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Kullen, Charina J; Farrugia, Jamie-Lee; Prvan, Tania; O'Connor, Helen T

2016-04-01

A balanced diet informed by sound nutrition knowledge is key for operational readiness and the health of military personnel. Unfortunately, research suggests that military personnel have inadequate dietary intakes. This study assessed general nutrition knowledge, diet quality and their association in Australian military personnel. A convenience sample of male military personnel (n 211) including Army soldiers and officers completed a validated general nutrition knowledge questionnaire (GNKQ) and FFQ. The GNKQ assessed knowledge of dietary guidelines (Section A), sources of nutrients (Section B), choosing everyday foods (Section C) and diet-disease relationships (Section D). The Australian Recommended Food Score (ARFS) was used to assess diet quality from FFQ data. Statistical analyses included the χ 2 test, Spearman's correlation test, t test, median test, ANCOVA and ordinal logistic regression. The mean total GNKQ score was 52·7 %. Participants performed best on Section A (58·5 %) followed by Sections B (57·3 %) and C (57·0 %) and worst on Section D (31·0 %). Overall, officers scored significantly higher than soldiers (58·7 v. 51·9 %, P=0·001). Age was weakly but positively correlated with GNKQ total scores (r 0·307; Pdiet quality are recommended in this population, especially in soldiers.

Divisions of general practice in Australia: how do they measure up in the international context?

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Smith, Judith; Sibthorpe, Beverly

2007-07-13

Since the late 1980s, there has been evidence of an international trend towards more organised primary care. This has taken a number of forms including the emergence of primary care organisations. Underpinning such developments is an inherent belief in evidence that suggests that well-developed primary care is associated with improved health outcomes and greater cost-effectiveness within health systems. In Australia, primary care organisations have emerged as divisions of general practice. These are professionally-led, regionally-based, and largely government-funded voluntary associations of general practitioners that seek to co-ordinate local primary care services, and improve the quality of care and health outcomes for local communities. In this paper, we examine and debate the development of divisions in the international context, using six roles of primary care organisations outlined in published research. The six roles that are used as the basis for the critique are the ability of primary care organisations to: improve health outcomes; manage demand and control costs; engage primary care physicians; enable greater integration of health services; develop more accessible services in community and primary care settings; and enable greater scrutiny and assurance of quality of primary care services. We conclude that there has been an evolutionary approach to divisions' development and they now appear embedded as geographically-based planning and development organisations within the Australian primary health care system. The Australian Government has to date been cautious in its approach to intervention in divisions' direction and performance. However, options for the next phase include: making greater use of contracts between government and divisions; introducing and extending proposed national quality targets for divisions, linked with financial or other incentives for performance; government sub-contracting with state-based organisations to act as purchasers of

Management of food allergy: a survey of Australian paediatricians.

Science.gov (United States)

Morawetz, Deborah Y; Hiscock, Harriet; Allen, Katrina J; Davies, Sarah; Danchin, Margie H

2014-06-01

The prevalence of Immunoglobulin E (IgE)-mediated food allergy in the developed world is increasing, overwhelming tertiary allergy services. Alternative models of care are required. General paediatricians could provide this care but may require further training to do so. We aimed to determine Australian general paediatricians': (i) knowledge and management of IgE-mediated food allergy; (ii) access to and use of diagnostic services; and (iii) interest in further training. Members of the Australian Paediatric Research Network completed an online survey in 2011/12. A case study elicited paediatrician's knowledge of diagnostic history taking, testing and key management principles. Study-designed questions assessed paediatricians' current practice, access to allergy services and interest in further training. One hundred sixty-eight (43%) of 390 paediatricians responded; 93 paediatricians reported managing food allergy. Diagnostic and management practices varied widely. Paediatricians had high levels of agreement (>90%) for only three of 13 questions pertaining to diagnosis and management. Only 56 (61%) correctly identified that a diagnosis of IgE-mediated food allergy requires a history consistent with a clinical reaction and a positive specific serum IgE antibody or skin prick test result. Reported waiting times for tertiary allergy services ranged from 5.4 (private) to 10.6 months (public). Most (91%) paediatricians expressed interest in further training. General paediatricians would benefit from further training if they are to practice allergy care as their diagnosis and management is often inconsistent with international guidelines. Training could be delivered online to maximise reach and uptake. If effective, such a model could relieve some of the burden experienced by Australian tertiary allergy services. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners.

Science.gov (United States)

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.

Cancer Investigation in General Practice

DEFF Research Database (Denmark)

Jensen, Jacob Reinholdt; Møller, Henrik; Thomsen, Janus Laust

2014-01-01

Initiation of cancer investigations in general practice Background Close to 90% of all cancers are diagnosed because the patient presents symptoms and signs. Of these patients, 85% initiate the diagnostic pathway in general practice. Therefore, the initiation of a diagnostic pathway in general...... practice becomes extremely important. On average, a general practitioner (GP) is involved in 7500 consultations each year, and in the diagnostic process of 8-10 incident cancers. One half of cancer patients consult their GP with either general symptoms, which are not indicative of cancer, or vague and non......-specific symptoms. The other half present with what the GP assess as alarm symptoms. Three months prior to diagnosis, patients who are later diagnosed with cancer have twice as many GP consultations than a comparable reference population. Thus the complex diagnostic process in general practice requires the GP...

The continuing medical education activities and attitudes of Australian doctors working in different clinical specialties and practice locations.

Science.gov (United States)

Stewart, Grant D; Khadra, Mohamed H

2009-02-01

Currently, it is not clear which continuing medical education (CME) methods are being used by senior doctors and what their attitudes towards them are. The aims of this study were to investigate which modes of CME delivery senior Australian doctors utilise, to assess doctors' attitudes towards CME and to determine any differences in modes used and attitudes between clinical specialties and practice locations. A 52-statement questionnaire enquiring about doctors' current CME activities and their attitudes towards CME was distributed to 1336 senior Australian doctors. 494 doctors responded to the questionnaire. Traditional forms of CME (eg, meetings, conferences, journals and lectures) were most commonly used. Doctors thought CME involving face-to-face interaction was superior to electronic forms of CME. All doctors, especially those in hospital practice, had a positive attitude towards CME but found lack of time a barrier to learning. Rural doctors found CME sessions more difficult to attend than did their metropolitan colleagues. Traditional forms of CME were more popular than modern CME approaches, such as e-learning. Australian doctors had a positive attitude towards undertaking CME despite struggling to find time to perform CME. The differences in attitudes towards CME demonstrated between specialties and different practice location will aid future CME planning.

Nigerian Journal of General Practice: Submissions

African Journals Online (AJOL)

Author Guidelines. The Nigerian Journal of General Practice is the Official Publication of the Association of General and Private Medical Practitioners of Nigeria [AGPMPN] and a forum for family private/general practice medicine education and research. The Nigerian Journal of General Practice invites scholarly manuscripts ...

Language Practices and Attitudes of Australian Children of Indian Descent in a Primary Education Setting

Science.gov (United States)

Bissoonauth, Anu

2018-01-01

This paper investigated linguistic practices and choices of Australian children of Indian descent, an under-researched group, who are studying Hindi in primary education. Data was collected using a questionnaire and semi-structured interviews with sixty participants across 3 primary schools in the Sydney area. The findings revealed, as expected,…

ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.

Science.gov (United States)

Ingham, Gerard; Fry, Jennifer; Morgan, Simon; Ward, Bernadette

2015-12-10

Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments. A sample of general practice medical educators and matched registrars were recruited. Following the ARCADO workplace assessment, semi-structured qualitative interviews were conducted. The data was analysed thematically. Ten registrars and eight medical educators participated. Four major themes emerged - formative versus summative assessment; strengths (acceptability, flexibility, time efficiency, complementarity and authenticity); weaknesses (reduced observation and integrity risks); and contextual factors (variation in assessment content, assessment timing, registrar-medical educator relationship, medical educator's approach and registrar ability). ARCADO is a well-accepted workplace-based formative assessment perceived by registrars and assessors to be valid and flexible. The use of ARCADO enabled complementary insights that would not have been achieved with direct observation alone. Whilst there are some contextual factors to be considered in its implementation, ARCADO appears to have utility as formative assessment and, subject to further evaluation, high-stakes assessment.

Methodological practicalities in analytical generalization

DEFF Research Database (Denmark)

Halkier, Bente

2011-01-01

generalization. Theoretically, the argumentation in the article is based on practice theory. The main part of the article describes three different examples of ways of generalizing on the basis of the same qualitative data material. There is a particular focus on describing the methodological strategies......In this article, I argue that the existing literature on qualitative methodologies tend to discuss analytical generalization at a relatively abstract and general theoretical level. It is, however, not particularly straightforward to “translate” such abstract epistemological principles into more...... operative methodological strategies for producing analytical generalizations in research practices. Thus, the aim of the article is to contribute to the discussions among qualitatively working researchers about generalizing by way of exemplifying some of the methodological practicalities in analytical...

Infant Feeding Practices and Nut Allergy over Time in Australian School Entrant Children

Directory of Open Access Journals (Sweden)

Jessica Paton

2012-01-01

Full Text Available Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2% and 307 (3.9%, children, respectively. There was a positive association between parent reported nut allergy and breast feeding (OR=1.53; 1.11–2.11 and having a regular general practitioner (GP (OR=1.42; 1.05–1.92. A protective effect was found in children who were fed foods other than breast milk in the first six months (OR=0.71; 0.60–0.84. Conclusion. Children were at an increased risk of developing a parent-reported nut allergy if they were breast fed in the first six months of life.

Prescribing Data in General Practice Demonstration (PDGPD project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

Directory of Open Access Journals (Sweden)

Williamson Margaret

2012-08-01

Full Text Available Abstract Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1 hypertension (HT and 2 chronic heart failure (CHF. The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI intervention on prescribing practice among Australian general practitioners (GP in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion with each group undertaking the clinical topics (CHF and HT in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a

Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke.

Science.gov (United States)

Sekhon, Jasvinder K; Douglas, Jacinta; Rose, Miranda L

2015-06-01

Psychological well-being is essential to overall health; however, there is a paucity of research on how to address psychological well-being in stroke survivors with aphasia. This study describes the current beliefs, attitudes and practices of Australian speech-language pathologists in addressing psychological well-being in people with aphasia after stroke. A 26-item web-based survey consisting of open and closed questions was distributed to Australian speech-language pathologists through four electronic databases. Australian speech-language pathologists (n = 111) utilized counselling and clinical approaches to address psychological well-being in people with post-stroke aphasia. The majority of speech-language pathologists did not feel comfortable with addressing psychological well-being in people with aphasia and sought support from other health professionals in this practice. Self-perception of being under-skilled was the main barrier identified to adequate practice in this domain, followed by inadequate time, inadequate staffing and people with aphasia declining referral to counselling. The main facilitators reported by speech-language pathologists to address psychological well-being included personal interest, personal and professional experience and availability of counselling health professionals for people with aphasia. There were small-to-medium statistically significant correlations between speech-language pathologists reporting additional training in counselling and perceived knowledge of, confidence in and satisfaction with managing psychological well-being in people with aphasia. This study identifies factors requiring attention in order to enable speech-language pathologists to facilitate improved psychological well-being in people with aphasia.

Australian dentists: characteristics of those who employ or are willing to employ oral health therapists.

Science.gov (United States)

Kempster, C; Luzzi, L; Roberts-Thomson, K

2015-06-01

There has been an increase in the availability of oral health therapists (OHTs) in the oral health workforce in the last decade. The impact these clinicians will have on the oral health of the general public is dependent on access pathways and utilization. This study aimed to profile Australian dentists who employ or are willing to employ OHTs and to explore the degree of association between dentist characteristics and employment decisions. This cross-sectional study used a random sample of Australian dentists (n = 1169) from the Federal Australian Dental Association register in 2009. Participants were sent a postal questionnaire capturing dentist characteristics and oral health practitioner employment information. An adjusted response rate of 55% was obtained. Dentists willing to employ OHTs included non-metropolitan dentists, dentists in multiple surgery practices and those considering practice expansion. Age, gender and sector of practice were not significantly associated with retrospective employment decisions or willingness to employ in the future. Certain characteristics of dentists or of their practice are associated with their history of employment and willingness to employ OHTs. Employment decisions are more commonly related to entrepreneurial aspirations (expressed as a willingness to expand), sector of practice, surgery capacity and regionality over gender and age. Understanding the factors that influence the employment of OHTs is important in enhancing access pathways to the services provided by OHTs. © 2015 Australian Dental Association.

Engaging diverse student audiences in contemporary blended learning environments in Australian higher business education: Implications for Design and Practice

Directory of Open Access Journals (Sweden)

Graeme Pye

2015-11-01

Full Text Available This research reports on a student audience engaging in an Australian university’s undergraduate commerce program core unit that is offered across three separate geographic campus locations and online. The research extends upon work undertaken on student engagement in online settings and lies in the domain of blended learning design and practice in the Australian higher education business context. Findings, inter alia, are presented across six major student engagement dimensions as applied to the interplay between online and located/campus learning (i.e. Online Active Learning, Online Social Interaction, Online Collaboration, Online Teaching, Online Assessment, and Online Contact with Staff. Implications for blended learning design, eLearning and practice in such complex environments are examined.

Weight Management Practices of Australian Olympic Combat Sport Athletes.

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Reale, Reid; Slater, Gary; Burke, Louise M

2017-09-05

Combat sport athletes undertake chronic and rapid weight loss (RWL) practices to qualify for weight divisions lower than their training weight. Variation between sports in the prevalence, methods, and magnitude of weight loss as well as recovery practices may be influenced by factors including competition level and culture. Differences in methodologies of previous research in combat sports make direct comparisons difficult, thus this study aimed to examine weight loss practices among all Olympic combat sports in Australia, using standardised methodology. High calibre competitors in wrestling, boxing, judo and taekwondo (n=260) at Australian competitions were surveyed using a validated tool which provides quantification of how extreme an athlete's weight loss practices are; the RWL score (RWLS). Additional qualitative and quantitative survey data were also collected. Neither sport, sex or weight division group had an effect on RWLS however a significant effect of athlete calibre was detected [F (2,215) = 4.953, MSE = 4.757, p = 0.00792]. Differences between sports were also evident for: most weight ever lost in order to compete [H = 19.92, p = 0.0002), age at which weight cutting began (H = 16.34, p = 0.001) and selected methods/patterns of RWL (p < 0.001). Weight cycling between competitions was common among all sports as were influences on athlete's behaviours. While many similarities in weight loss practices and experiences exist between combat sports, specific differences were evident. Nuanced, context/culturally specific guidelines should be devised to assist fighters' in optimising performance while minimising health implications.

Disease Risk Perception and Safety Practices: A Survey of Australian Flying Fox Rehabilitators.

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Cecilia A Sánchez

2016-02-01

Full Text Available Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators' gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from <1 to 30 years (median 5 years. Respondents were highly educated. All rehabilitators were vaccinated against rabies and 94% received a rabies titre check at least every two years. Sixty-three percent of carers did not perceive viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1 the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2 that the responsible government agencies in Australia support

Psycho-Educational Assessment of Specific Learning Disabilities: Views and Practices of Australian Psychologists and Guidance Counsellors

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Meteyard, John D.; Gilmore, Linda

2015-01-01

This article reports an investigation of the views and practices of 203 Australian psychologists and guidance counsellors with respect to psycho-educational assessment of students with specific learning disabilities (SLDs). Results from an online survey indicated that practitioners draw upon a wide range of theoretical perspectives when…

全科医学中的心理健康病案研究(十五)——一位老人的抑郁(第二部分)%Case Studies of Mental Health in General Practice(15)--Depression in An Old Person(Part Two)

Institute of Scientific and Technical Information of China (English)

Fiona Judd; Grant Blashki; Leon Piterman; 杨辉

2013-01-01

The Journal presents the Column of Case Studies of Mental Health in General Practice; with academic support from Australian experts in general practice, psychology and psychiatry from Monash University and the U-niversity of Melbourne. The Column's purpose is to respond to the increasing needs of mental health services in China. Through study and analysis of mental health cases, we hope to improve understanding of mental illnesses in Chinese primary health settings , and to build capacity of community health professional in managing of mental illnesses in general practice. Patient - centred and whole - person approach in general practice is the best way to maintain and improve the physical and mental health of residents. Our hope is that these case studies will lead new wave of general practice and mental health development both in practice and academic research. A number of Australian experts from the disciplines of general practice, mental health and psychiatry will contribute to the Column. You will find A/Professor Blashki, Professor Judd and Professor Piterman are authors of General Practice Psychiatry. The Journal cases are helping to prepare for the translation and publication of a Chinese version of the book in China. We believe Chinese mental health in primary health care will step up to a new level under this international cooperation.

Biosecurity practices on Australian commercial layer and meat chicken farms: Performance and perceptions of farmers.

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Scott, Angela Bullanday; Singh, Mini; Groves, Peter; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Black, Amanda; Toribio, Jenny-Ann

2018-01-01

This paper describes the level of adoption of biosecurity practices performed on Australian commercial chicken meat and layer farms and farmer-perceived importance of these practices. On-farm interviews were conducted on 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. There was a high level of treatment of drinking water across all farm types; town water was the most common source. In general, meat chicken farms had a higher level of adoption of biosecurity practices than layer farms. Cage layer farms had the shortest median distance between sheds (7.75m) and between sheds and waterbodies (30m). Equipment sharing between sheds was performed on 43% of free range meat chicken farms compared to 92% of free range layer farms. There was little disinfection of this shared equipment across all farm types. Footbaths and visitor recording books were used by the majority of farms for all farm types except cage layer farms (25%). Wild birds in sheds were most commonly reported in free range meat chicken farms (73%). Dogs and cats were kept across all farm types, from 56% of barn layer farms to 89% of cage layer farms, and they had access to the sheds in the majority (67%) of cage layer farms and on the range in some free range layer farms (44%). Most biosecurity practices were rated on average as 'very important' by farmers. A logistic regression analysis revealed that for most biosecurity practices, performing a practice was significantly associated with higher perceived farmer importance of that biosecurity practice. These findings help identify farm types and certain biosecurity practices with low adoption levels. This information can aid decision-making on efforts used to improve adoption levels.

Accreditation in general practice in Denmark

DEFF Research Database (Denmark)

Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert

2017-01-01

Background: Accreditation is used increasingly in health systems worldwide. However, there is a lack of evidence on the effects of accreditation, particularly in general practice. In 2016 a mandatory accreditation scheme was initiated in Denmark, and during a 3-year period all practices, as default...... general practitioners in Denmark. Practices allocated to accreditation in 2016 serve as the intervention group, and practices allocated to accreditation in 2018 serve as controls. The selected outcomes should meet the following criteria: (1) a high degree of clinical relevance; (2) the possibility...... practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. Discussion: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general...

Why and how do general practitioners teach? An exploration of the motivations and experiences of rural Australian general practitioner supervisors.

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Ingham, Gerard; Fry, Jennifer; O'Meara, Peter; Tourle, Vianne

2015-10-29

In medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching. Little is known about what motivates Australian GP supervisors and how they currently teach. A qualitative study involving semi-structured interviews with 20 rural GP supervisors who work within one Regional Training Provider region in Australia explored their reasons for being a supervisor and how they performed their role. Data was analysed using a thematic analysis approach. GP supervisors identified both personal and professional benefits in being a supervisor, as well as some benefits for their practice. Supervision fulfilled a perceived broader responsibility to the profession and community, though they felt it had little impact on rural retention of doctors. While financial issues did not provide significant motivation to teach, the increasing financial inequity compared with providing direct patient care might impact negatively on the decision to be or to remain a supervisor in the future. The principal challenge for supervisors was finding time for teaching. Despite this, there was little evidence of supervisors adopting strategies to reduce teaching load. Teaching methods were reported in the majority to be case-based with styles extending from didactic to coach/facilitator. The two-way collegiate relationship with a registrar was valued, with supervisors taking an interest in the registrars beyond their development as a clinician. Supervisors report positively on their teaching and mentoring roles. Recruitment strategies that highlight the personal and professional benefits that supervision offers are needed. Practices need assistance to adopt models of supervision and teaching that will help supervisors productively manage the increasing

Australian health professionals' health website recommendation trends.

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Usher, Wayne T

2011-08-01

This study was concerned with indentifying motivations and trends associated with a health website recommendation from eight of Australia's major health professions to the health consumer. Health professions included in this study are: psychiatrists, general practitioners, social workers, dietitians, chiropractors, physiotherapists, optometrists and pharmacists. An online survey (www.limesurvey.org) was developed from a common set of questions negotiated between all eight health professions. Survey questions were constructed in an attempt to identify participants' reasons for or against recommending a health website to a patient. A 5-point scale (not, slightly, neutral, moderately, strongly) to measure influence was used throughout the question set. This study indicates that Australian general practitioners (GPs) were the highest Australian health professionals to undertake a health website recommendation (86%), followed by psychiatrists (80%), with the lowest being physiotherapists (42%) and optometrists (33%). A profile of the Australian health professional who recommends a health website is identified as male, aged above 50 years, has had more than 10 years experience, works in a major city, is in private practice and has patient numbers exceeding 500 in a 12-month period (2009). Recommendations from this study include the need to develop mechanisms that identify high-quality online medical information and the development and implementation of Continuing Professional Development (CPD) courses which up-skill health professionals concerning the recommendation of health websites for health care delivery.

Australianness as fairness

DEFF Research Database (Denmark)

Plage, Stefanie; Willing, Indigo; Skrbis, Zlatko

2017-01-01

This article provides an account of interwoven and often competing repertoires of cosmopolitanism and nationalism on which Australians draw when encountering diversity. Using interview and focus group data the article first explores how the notion of Australianness grounded in civic virtues such ......-go’ principle at times conceptually overlaps with cosmopolitan ethics. However, it also bears the potential to hinder cosmopolitan practices. Ultimately national and cosmopolitan ethical frameworks have to be interrogated simultaneously when applied to micro-level interactions....

Factors that affect general practice as a choice of medical speciality: implications for policy development.

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Vohra, Amit; Ladyshewsky, Richard; Trumble, Stephen

2017-11-28

Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking

Australian Aboriginal Astronomy: Overview

OpenAIRE

Norris, Ray P.; Hamacher, Duane W.

2013-01-01

The traditional cultures of Aboriginal Australians include a significant astronomical component, perpetuated through oral tradition, ceremony, and art. This astronomical component includes a deep understanding of the motion of objects in the sky, and this knowledge was used for practical purposes, such as constructing calendars. There is also evidence that traditional Aboriginal Australians made careful records and measurements of cyclical phenomena, paid careful attention to unexpected pheno...

The role of culture in breast health practices among Chinese-Australian women.

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Kwok, Cannas; Sullivan, Gerard; Cant, Rosemary

2006-12-01

Exploring how cultural meanings of the breast impact on perceived images of breast cancer and breast health practices. In-depth interviews were conducted with 20 Chinese-Australian women in their native language (Cantonese). The findings revealed that the meanings of the breast are constructed within the women's social and cultural context where breasts are associated with sex; and talking about, being concerned with or expressing curiosity about breasts is considered inappropriate. These views have a significant impact on (1) the way the informants viewed breast cancer; (2) perceptions of breast health practices; and (3) the explanations of breast cancer and associated risk perception. Understanding the nature of culturally-based barriers to utilization of breast cancer screening is the first step to discovering solutions for making screening tests more acceptable to women from other cultures. This study provides insight about obstacles for breast health promotion practices and for developing culturally appropriate health education programs and counselling strategies.

The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation.

Directory of Open Access Journals (Sweden)

Laura Elizabeth Downie

Full Text Available The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional, therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas.A survey was electronically distributed to Australian optometrists (n = 4,242. Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior.A total of 283 completed surveys were received (completed survey response rate: 6.7%. Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05 less likely to enquire about patients' smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05. Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2% and dry eye disease (63.9%. The primary source of evidence used to guide practitioners' nutrition-related patient management was reported to be peer-reviewed publications.These findings

Blending work-integrated learning with distance education in an Australian radiation therapy advanced practice curriculum

International Nuclear Information System (INIS)

Matthews, Kristie; Wright, Caroline; Osborne, Catherine

2014-01-01

Advanced practice for radiation therapists has been a part of the international landscape for several years; however formal implementation into the Australian health care system is yet to happen. Despite this, three short course radiation therapy advanced practitioner programs have been established by an Australian tertiary institution in response to clinical service needs at several organisations. This paper describes the rationale for curriculum design and development of the program materials, the small-scale implementation of the programs at pilot sites, and the evolution of the curriculum to be available to registered radiation therapists nationally. Each program has been designed around a specific clinical role, where flexibility of delivery to busy practitioners was central to the decision to offer them via distance education. The curriculum comprises theoretical units of study which run in parallel to and underpin clinical practice units, where advanced competence in the specific area of practice is overseen by an experienced radiation oncologist mentor. Given the nature of the disparate clinical services requiring an advanced radiation therapy practitioner, the workplace learning component of the course is individually negotiated at a local level. Outcomes suggest that the flexible clinically based training underpinned by a distance education academic curriculum is able to support the development of advanced radiation therapy practitioners responsive to local service need, and ultimately may improve the patient experience

Are we there yet? Travel vaccinations for Australian children.

Science.gov (United States)

Slonim, Marnie; Starr, Mike; Blashki, Grant

2014-06-01

Australians travel overseas frequently and general practitioners (GPs) are often asked to provide detailed advice on travel vaccinations for children. Planning a safe and effective vaccination schedule is dependent on the context: where and when the family is travelling, the individual child's medical needs and past vaccination history, and if they are visiting family and friends. In this paper we provide an overview of the issues to consider when vaccinating Australian children for overseas travel. We also list the suite of common travel vaccinations and discuss some clinical scenarios that are likely to present in Australian general practice. Australians love to travel overseas and, increasingly, GPs are asked by patients to provide detailed advice on travel vaccinations for their children. Decisions regarding vaccinations for travelling children can be complex and the advice often differs from that provided for adults. Children differ from adults in their vulnerability to illnesses and side effects of medications. These differences, as well as their status regarding routine childhood vaccinations, all need to be taken into account. As with adults, it is important to consider the location and duration of travel and time until departure. The age of the child is also important and there may be a case for accelerating the routine childhood vaccinations in some children. The aim of this paper is to provide a clear and simple outline of the vaccination recommendations for children travelling overseas from Australia.

Conversion Disorder in Australian Pediatric Practice

Science.gov (United States)

Kozlowska, Kasia; Nunn, Kenneth P.; Rose, Donna; Morris, Anne; Ouvrier, Robert A.; Varghese, John

2007-01-01

Objectives: To describe the incidence and clinical features of children presenting to Australian child health specialists with conversion disorder. Method: Active, national surveillance of conversion disorder in children younger than 16 years of age during 2002 and 2003. Results: A total of 194 children were reported on. The average age was 11.8…

Opioid dependence - management in general practice.

Science.gov (United States)

Frei, Matthew

2010-08-01

Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain. To outline the management of opioid dependence using opioid pharmacotherapy as part of a comprehensive chronic illness management strategy. The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.

The rural pipeline to longer-term rural practice: General practitioners and specialists.

Directory of Open Access Journals (Sweden)

Marcella M S Kwan

Full Text Available Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS. In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs and specialists.A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002-2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP among GPs and medical specialists. The main exposures were rural background (RB or metropolitan background (MB, and attendance at a metropolitan clinical school (MCS or the Rural Clinical School for one year (RCS-1 or two years (RCS-2.Independent predictors of LTRP (odds ratio [95% confidence interval] were RB (2.10 [1.37-3.20], RCS-1 (2.85 [1.77-4.58], RCS-2 (5.38 [3.15-9.20], GP (3.40 [2.13-5.43], and bonded scholarship (2.11 [1.19-3.76]. Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21-0.57]. The effects of RB and RCS were additive-compared to MB and MCS (Reference group: RB and RCS-1 (6.58[3.32-13.04], RB and RCS-2 (10.36[4.89-21.93]. Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent.Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan

Teaching Australian Football in Physical Education: Constraints Theory in Practice

Science.gov (United States)

Pill, Shane

2013-01-01

This article outlines a constraints-led process of exploring, modifying, experimenting, adapting, and developing game appreciation known as Game Sense (Australian Sports Commission, 1997; den Duyn, 1996, 1997) for the teaching of Australian football. The game acts as teacher in this constraints-led process. Rather than a linear system that…

Australian Early Childhood Educators: From Government Policy to University Practice

Science.gov (United States)

Davies, Sharon; Trinidad, Sue

2013-01-01

This article provides an overview of the Australian Federal Government initiatives in the area of early childhood with regard to the provision of early childhood education and care. These changes have influenced a Western Australian university to develop an innovative birth to 8 years preservice educator education curriculum. Using an ecological…

Breast cancer knowledge, attitudes and screening behaviors among Indian-Australian women.

Science.gov (United States)

Kwok, C; Tranberg, R; Lee, F C

2015-12-01

The aims of the study were to report breast cancer screening practices among Indian-Australian women and to examine the relationship between demographic characteristics, cultural beliefs and women's breast cancer screening (BCS) behaviors. A descriptive and cross-sectional method was used. Two hundred and forty two Indian-Australian women were recruited from several Indian organizations. English versions of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) were administered. The main research variables are BCS practices, demographic characteristics and total scores on each of the BCSBQ subscales. The majority of participants (72.7%-81.4%) had heard of breast awareness, clinical breast examination (CBE) and mammograms. Only 28.9% performed a BSE monthly and although 60% had practiced CBE, only 27.3% of women within the targeted age group had annual CBE. Only 23.6% of women within the targeted age group reported they had a mammogram biennial. Marital status and length of stay in Australia were positively associated with women's screening behaviors. In terms of BCSBQ score, women who had the three screening practices regularly as recommended obtained significantly higher scores on the "attitude towards general health check-ups" and "barriers to mammographic screening" subscales. There was a significant difference in the mean score of the "knowledge and perceptions about breast cancer" between women who did and who did not engage in breast awareness. Our study reveals that attitudes toward health check-ups and perceived barriers to mammographic screening were influential in determining compliance with breast cancer screening practices among Indian-Australian women. Copyright © 2015 Elsevier Ltd. All rights reserved.

Behavioural science in general practice.

Science.gov (United States)

Wood, D R

1979-10-01

Dr Peter Sowerby has written an important criticism of Michael Balint's work based on his understanding of Karl Popper's writings. I dispute Sowerby's interpretation of Popper and disagree with his conclusions, which I suggest would lead general practice into a retreat. I believe Balint made a major contribution to general practice and has helped us towards practising whole-person medicine.

The global financial crisis and Australian general practice.

Science.gov (United States)

McRae, Ian S; Paolucci, Francesco

2011-02-01

To explore the potential effects of the global financial crisis (GFC) on the market for general practitioner (GP) services in Australia. We estimate the impact of changes in unemployment rates on demand for GP services and the impact of lost asset values on GP retirement plans and work patterns. Combining these supply and demand effects, we estimate the potential effect of the GFC on the market for GP services under various scenarios. If deferral of retirement increases GP availability by 2%, and historic trends to reduce GP working hours are halved, at the current level of ~5.2% unemployment average fees would decline by $0.23 per GP consultation and volumes of GP services would rise by 2.53% with almost no change in average GP gross earnings over what would otherwise have occurred. With 8.5% unemployment, as initially predicted by Treasury, GP fees would increase by $0.91 and GP income by nearly 3%. The GFC is likely to increase activity in the GP market and potentially to reduce fee levels relative to the pre-GFC trends. Net effects on average GP incomes are likely to be small at current unemployment levels.

The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation.

Science.gov (United States)

Downie, Laura Elizabeth; Keller, Peter Richard

2015-01-01

The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health.

Health improvement and prevention study (HIPS - evaluation of an intervention to prevent vascular disease in general practice

Directory of Open Access Journals (Sweden)

Davies Gawaine

2010-08-01

intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice. Discussion This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care. Trial Registration ACTRN12607000423415

Organization and change in general practice

DEFF Research Database (Denmark)

Andersen, John Sahl

Organization and change in general practice Abstract for a symposium at Nordic Congress for General Practice Thursday 14 May at 15.30-17.00 General practice is under increasing pressure to assume new tasks, adopt new technologies and engage in new organizational structures. However, in a field...... of multiple actors and concerns such visions are rarely straightforward to realize. This symposium explores the significance of various organizational, cultural and regulative features of general practice in relation to proposals for change in the sector. Presentations: Thorkil Thorsen, Marius Kousgaard...... primary care. One purpose is to give more freedom to the patients to choose care-givers. Another is to create a more competitive health care system. These reforms will be evaluated in a research project to be presented. Chairman: John Sahl Andersen MESH-terms: Delivery of Health Care, Health Care Reform...

Child obesity prevention in primary health care: investigating practice nurse roles, attitudes and current practices.

Science.gov (United States)

Robinson, Alison; Denney-Wilson, Elizabeth; Laws, Rachel; Harris, Mark

2013-04-01

Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting. PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10). Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training. Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Using MIQUEST in General Practice

Directory of Open Access Journals (Sweden)

Victoria Hammersley

1998-11-01

Full Text Available This paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS. There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations.

The Australian radiation protection and Nuclear Safety Agency

International Nuclear Information System (INIS)

Macnab, D.; Burn, P.; Rubendra, R.

1998-01-01

The author talks about the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), the new regulatory authority which will combine the existing resources of the Australian Radiation Laboratory and the Nuclear Safety Bureau. Most uses of radiation in Australia are regulated by State or Territory authorities, but there is presently no regulatory authority for Commonwealth uses of radiation. To provide for regulation of the radiation practices of the Commonwealth, the Australian Government has decided to establish the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) and a Bill has passed through the House of Representatives and will go to the Spring sitting of the Senate. The new agency will subsume the resources and functions of the Nuclear Safety Bureau and the Australian Radiation Laboratory, with additional functions including the regulation of radiation protection and nuclear safety of Commonwealth practices. Another function of ARPANSA will be the promotion of uniform regulatory requirements for radiation protection across Australia. This will be done by developing, in consultation with the States and Territories, radiation health policies and practices for adoption by the Commonwealth, States and Territories. ARPANSA will also provide research and services for radiation health, and in support of the regulatory and uniformity functions. The establishment of ARPANSA will ensure that the proposed replacement research reactor, the future low level radioactive waste repository and other Commonwealth nuclear facilities and radiation practices are subject to a regulatory regime which reflects the accumulated experience of the States and Territories and best international practice, and meets public expectations

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.

Science.gov (United States)

Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun

2012-01-01

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?

Assessment and monitoring practices of Australian fitness professionals.

Science.gov (United States)

Bennie, Jason A; Wiesner, Glen H; van Uffelen, Jannique G Z; Harvey, Jack T; Craike, Melinda J; Biddle, Stuart J H

2018-04-01

Assessment and monitoring of client health and fitness is a key part of fitness professionals' practices. However, little is known about prevalence of this practice. This study describes the assessment/monitoring practices of a large sample of Australian fitness professionals. Cross-sectional. In 2014, 1206 fitness professionals completed an online survey. Respondents reported their frequency (4 point-scale: [1] 'never' to [4] 'always') of assessment/monitoring of eight health and fitness constructs (e.g. body composition, aerobic fitness). This was classified as: (i) 'high' ('always' assessing/monitoring ≥5 constructs); (ii) 'medium' (1-4 constructs); (iii) 'low' (0 constructs). Classifications are reported by demographic and fitness industry characteristics. The odds of being classified as a 'high assessor/monitor' according to social ecological correlates were examined using a multiple-factor logistic regression model. Mean age of respondents was 39.3 (±11.6) years and 71.6% were female. A total of 15.8% (95% CI: 13.7%-17.9%) were classified as a 'high' assessor/monitor. Constructs with the largest proportion of being 'always' assessed were body composition (47.7%; 95% CI: 45.0%-50.1%) and aerobic fitness (42.5%; 95% CI: 39.6%-45.3%). Those with the lowest proportion of being 'always' assessed were balance (24.0%; 95% CI: 24.7%-26.5%) and mental health (20.2%; 95% CI: 18.1%-29.6%). A perceived lack of client interest and fitness professionals not considering assessing their responsibility were associated with lower odds of being classified as a 'high assessor/monitor'. Most fitness professionals do not routinely assess/monitor client fitness and health. Key factors limiting client health assessment and monitoring include a perceived lack of client interest and professionals not considering this their role. Copyright © 2017. Published by Elsevier Ltd.

Emergency medicine and general practice

OpenAIRE

Abela, Gunther

2005-01-01

Emergency Medicine and Immediate Medical Care are relatively new specialties. In Malta, there is quite a considerable area of overlap between these specialties and general practice. Indeed, the family physician is confronted with some sort of medical emergency quite regularly. The brief of this article is to go through recent developments in Emergency Medicine as applied to General Practice. The areas considered are Basic Life Support, Head Injury, Asthma, Anaphylaxis, Community Acquired Pneu...

Spot-checks to measure general hygiene practice.

Science.gov (United States)

Sonego, Ina L; Mosler, Hans-Joachim

2016-01-01

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

Patients' satisfaction with healthcare: comparing general practice ...

African Journals Online (AJOL)

Patients' satisfaction with healthcare: comparing general practice services in a tertiary and primary healthcare settings. ... Nigerian Health Journal ... This research compared the level of patients' satisfaction with general practice care delivered at physicians-manned General Outpatient clinics at tertiary and primary health ...

Management of venous leg ulcers in general practice - a practical guideline.

Science.gov (United States)

Sinha, Sankar; Sreedharan, Sadhishaan

2014-09-01

Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.

Sun protection attitudes and behaviours among first generation Australians with darker skin types: results from focus groups.

Science.gov (United States)

Bryant, Jamie; Zucca, Alison; Brozek, Irena; Rock, Vanessa; Bonevski, Billie

2015-02-01

Despite residing in a country that has the highest rates of skin cancer in the world, little is known about the knowledge, attitudes and sun protection practices of first generation Australian-born individuals with olive and darker skin types. Six focus groups with first generation Australian-born individuals of Asian, Mediterranean, Middle Eastern and Indian background were conducted. Participants had good knowledge of the dangers of skin cancer. Most correctly perceived darker skin types as protective and believed they were at low risk of skin cancer. Most participants could recall high profile mass media sun protection campaigns. Several participants suggested that greater representation of ethnic minorities and/or individuals with darker skin types would increase the personal relevance of campaigns. Beliefs that sun protection is not necessary on the basis of skin type highlights the need for further studies to explore fundamental differences in attitudes and practices between those with olive and darker skin and the general Australian population.

Family Violence: An Insight Into Perspectives and Practices of Australian Health Practitioners.

Science.gov (United States)

Soh, Han Jie; Grigg, Jasmin; Gurvich, Caroline; Gavrilidis, Emmy; Kulkarni, Jayashri

2018-03-01

Family violence is threatening behavior carried out by a person to coerce or control another member of the family or causes the family member to be fearful. Health practitioners are well placed to play a pivotal role in identifying and responding to family violence; however, their perceived capacity to respond to patients experiencing family violence is not well understood. We aim to explore Australian health practitioners' current perspectives, practices, and perceived barriers in working with family violence, including perceived confidence in responding effectively to cases of family violence encountered during their work with patients. A total of 1,707 health practitioners primarily practicing in the wider Melbourne region were identified, and 114 health practitioners participated in the study between March 2016 and August 2016 by completing an investigator-developed questionnaire. Descriptive, qualitative, and thematic analyses were performed. The majority of participants recognized family violence to be a health issue and that family violence would impact the mental health of afflicted persons. Despite this, only a fifth of participants felt they were very confident in screening, supporting, and referring patients with family violence experiences. Perceived barriers to inquire about family violence included time constraints and greater importance placed on screening for other health issues. Health practitioners reported that additional training on screening, supporting, and referring patients would be beneficial. Australian health practitioners need to be upskilled. Recently, in Australia, state-relevant toolkits have been developed to provide succinct information about responding to initial patient presentations of family violence, how to inquire about family violence, and how to handle disclosures (and nondisclosures) by patients. Further resources could be developed to aid health practitioners in providing assistance to their patients as indicated. These

Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners - Findings from the Australian National Survey of High Impact Psychosis.

Science.gov (United States)

Waterreus, Anna; Morgan, Vera A

2017-09-01

To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.

Nigerian Journal of General Practice: Journal Sponsorship

African Journals Online (AJOL)

Nigerian Journal of General Practice: Journal Sponsorship. Journal Home > About the Journal > Nigerian Journal of General Practice: Journal Sponsorship. Log in or Register to get access to full text downloads.

General practice registrars' intentions for future practice: implications for rural medical workforce planning.

Science.gov (United States)

Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

2016-11-01

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, Pmedical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

Specialization and the Current Practices of General Surgeons

Science.gov (United States)

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

Radiofrequency radiation: safe working practices in the Royal Australian Air Force

International Nuclear Information System (INIS)

Joyner, K.H.; Stone, K.R.

1988-01-01

The Royal Australian Air Force (RAAF) has long recognised the value of its work force and the need to preserve their health and wellbeing to achieve operational objectives. The Directorate of Air Force Safety (DAFS) is required by the Chief of the Air Staff to take all measures possible to prevent accidents and incidents in the RAAF, under the provisions of the Defence Instruction, 'Air Force Safety and Occupational Health Policy'. Consequently, the RAAF has exercised a pragmatic approach to radiofrequency radiation (RFR) and has always adopted and implemented strict exposure standards. DAFS receives technical advice on RFR from the Directorate of Telecommunications Engineering (DTELENG) and on occupational health from the Directorate General of Air Force Health Services (DGAFHS)

1980 Australian coal conference. Conference papers

Energy Technology Data Exchange (ETDEWEB)

1980-01-01

Papers were presented under the following headings: supply and demand for coal; government policies - coal development; mining finance and taxation; Australian coal mining practices; research and development; infrastructure and transportation; legislation and safe working practices; and industrial relations.

Quality of stroke prevention in general practice: relationship with practice organization

NARCIS (Netherlands)

J.S. de Koning (Johan); N.S. Klazinga (Niek); P.J. Koudstaal (Peter Jan); A. Prins (Ad); G.J.J.M. Borsboom (Gerard); J.P. Mackenbach (Johan)

2005-01-01

textabstractOBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the

The Australian synchrotron research program

International Nuclear Information System (INIS)

Garrett, R.F.

1998-01-01

Full text: The Australian Synchrotron Research Program (ASRP) was established in 1996 under a 5 year grant from the Australian Government, and is managed by ANSTO on behalf of a consortium of Australian universities and research organisations. It has taken over the operation of the Australian National Beamline Facility (ANBF) at the Photon Factory, and has joined two CATS at the Advanced Photon Source: the Synchrotron Radiation Instrumentation CAT (SRI-CAT) and the Consortium for Advanced Radiation Sources (CARS). The ASRP thus manages a comprehensive range of synchrotron radiation research facilities for Australian science. The ANBF is a general purpose hard X-ray beamline which has been in operation at the Photon Factory since 1993. It currently caters for about 35 Australian research teams per year. The facilities available at the ANBF will be presented and the research program will be summarised. The ASRP facilities at the APS comprise the 5 sectors operated by SRI-CAT, BioCARS and ChemMatCARS. A brief description will be given of the ASRP research programs at the APS, which will considerably broaden the scope of Australian synchrotron science

Quality of stroke prevention in general practice: relationship with practice organization

NARCIS (Netherlands)

de Koning, Johan S.; Klazinga, Niek; Koudstaal, Peter J.; Prins, A. D.; Borsboom, Gerard J. J. M.; Mackenbach, Johan P.

2005-01-01

Objective. To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. Design. This study was conducted among 69 Dutch general practitioners in the Rotterdam region.

Quit in General Practice: a cluster randomised trial of enhanced in-practice support for smoking cessation

Directory of Open Access Journals (Sweden)

Zwar Nicholas

2010-08-01

, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice. Trial Registration ACTRN12609001040257

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.

Science.gov (United States)

Galletly, Cherrie; Castle, David; Dark, Frances; Humberstone, Verity; Jablensky, Assen; Killackey, Eóin; Kulkarni, Jayashri; McGorry, Patrick; Nielssen, Olav; Tran, Nga

2016-05-01

This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. The

Menstruation, menstrual protection and menstrual cycle problems. The knowledge, attitudes and practices of young Australian women.

Science.gov (United States)

Abraham, S; Fraser, I; Gebski, V; Knight, C; Llewellyn-Jones, D; Mira, M; McNeil, D

1985-02-18

The results of a survey of 1377 young Australian women aged 14 to 19 years, conducted to determine their attitudes, state of knowledge and practices with regard to menstruation, are presented. The young women, as a group, lacked sufficient information about menstruation, about the time of ovulation, about menstrual discharge, and about the use of tampons. A high proportion (80%) considered menstruation to be inconvenient or embarrassing. Certain measures aimed at remedial action are suggested.

Shared learning in general practice--facilitators and barriers.

Science.gov (United States)

van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

2013-03-01

Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

Rating scales in general practice depression

DEFF Research Database (Denmark)

Bech, Per; Paykel, Eugene; Sireling, Lester

2015-01-01

BACKGROUND: Our objective was to investigate to what extent the Clinical Interview for Depression (CID) used in the general practice setting covers clinically valid subscales (depression, anxiety, and apathy) which can measure outcome of antidepressant therapy as well as identifying subsyndromes...... within major depressive disorder. The CID was compared to the Hamilton Depression Rating Scale (HAM-D17). METHODS: 146 patients from a previous study in general practice with the CID were investigated. The item response theory model established by Rasch was used to investigate the scalability (a scale...... (approximately 20%) had an atypical depression. LIMITATIONS: The samples were derived from a single study and were all rated by a single rater. CONCLUSION: The CID contains subscales of depression, anxiety, and apathy with an acceptable scalability for use in general practice. A subsyndrome of atypical...

Translation of tobacco policy into practice in disadvantaged and marginalized subpopulations: a study of challenges and opportunities in remote Australian Indigenous communities

Directory of Open Access Journals (Sweden)

Robertson Jan A

2012-07-01

Full Text Available Abstract Background In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT, extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive

Australian Aboriginal Astronomy - An Overview

Science.gov (United States)

Norris, Ray P.; Hamacher, Duane W.

The traditional cultures of Aboriginal Australians include a significant astronomical component, perpetuated through oral tradition, ceremony, and art. This astronomical component includes a deep understanding of the motion of objects in the sky, and this knowledge was used for practical purposes such as constructing calendars. There is also evidence that traditional Aboriginal Australians made careful records and measurements of cyclical phenomena, paid careful attention to unexpected phenomena such as eclipses and meteorite impacts, and could determine the cardinal points to an accuracy of a few degrees.

Job satisfaction of practice assistants in general practice in Germany: an observational study.

Science.gov (United States)

Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim

2013-08-01

Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.

The role of the general practitioner in the Australian approach to HIV care: interviews with 'key informants' from government, non-government and professional organisations.

Science.gov (United States)

Newman, Christy E; de Wit, John B F; Kippax, Susan C; Reynolds, Robert H; Canavan, Peter G; Kidd, Michael R

2012-03-01

HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of 'key informants' described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs.

Exploring the professional values of Australian physiotherapists.

Science.gov (United States)

Aguilar, Alejandra; Stupans, Ieva; Scutter, Sheila; King, Sharron

2013-03-01

A profession's values guide daily practice and professional behaviours. They clarify what professionalism means to a profession, by providing insight into the values that members of the profession aim to uphold and profess. There has been limited research into the values of the Australian physiotherapy profession, and as such, the values that guide practice and constitute professionalism are not explicit. This study aimed to make a preliminary identification of the values of the profession, by exploring the shared professional values of 14 Australian physiotherapists. This study was guided by a qualitative approach and constructivist paradigm. Purposive sampling was employed to identify physiotherapists who could contribute rich information to the study. Semi-structured interviews were conducted and analysed using an inductive data analysis method. The emerging professional values formed three main themes. The first theme, 'the patient and the patient-therapist partnership', incorporated values such as having patient trust and working collaboratively with patients. The theme labelled 'physiotherapy knowledge, skills and practice' included the values of having an evidence base and respecting professional boundaries. The last theme, 'altruistic values', was inclusive of values such as honesty, empathy and caring. The values that emerged went beyond philanthropic values, to values that guided every day practice, professional relationships and the responsibilities of being a professional. The results contribute to research orientated towards identifying the values of the profession and in doing so, clarifying what professionalism means to the Australian physiotherapy profession. Differences between the values identified by the American Physical Therapy Association and the study reported in this paper highlight the importance of identifying the values of the profession within the Australian context. In terms of practice implications, physiotherapists may be prompted to

General practice training and virtual communities of practice - a review of the literature.

Science.gov (United States)

Barnett, Stephen; Jones, Sandra C; Bennett, Sue; Iverson, Don; Bonney, Andrew

2012-08-21

Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Major online databases Scopus, Psychlit and Pubmed were searched for the terms "Community of Practice" (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR "Allied Health"). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders rather than single company VCoPs. Specific goals are important

The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.

OpenAIRE

Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de

2005-01-01

A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners, practices) and included morbidity (self-report and presented to general practitioners), diagnostic and therapeutic interventions, doctor-patient communication, and background characteristics. Compared ...

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar.

Science.gov (United States)

Scott-Jones, Joseph; Lucas, Sarah

2013-09-01

Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

Living Smart Homes: A Pilot Australian Sustainability Education Programme

Science.gov (United States)

Miller, Evonne; Buys, Laurie; Bell, Lorraine

2009-01-01

This article documents the rationale and experience of a pilot Australian sustainability education programme, "Living Smart Homes" (LSH) based on a community-based social marketing model. Inspired by the Australian "Land for Wildlife" scheme, LSH is designed to engage homeowners with sustainable practices through face-to-face…

Going for gold: the health promoting general practice.

Science.gov (United States)

Watson, Michael

2008-01-01

The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

Parental fatigue and parenting practices during early childhood: an Australian community survey.

Science.gov (United States)

Cooklin, A R; Giallo, R; Rose, N

2012-09-01

Parenting behaviours are influenced by a range of factors, including parental functioning. Although common, the influence of parental fatigue on parenting practices is not known. The first aim of this study was to investigate the relationship between fatigue and parenting practices. The second aim was to identify parental psychosocial factors significantly associated with fatigue. A sample of 1276 Australian parents, of at least one child aged 0-5 years, completed a survey. Demographic, psychosocial (social support, coping responses) and parental sleep and self-care information was collected. Hierarchical regression was performed to assess the contribution of fatigue (modified Fatigue Assessment Scale) to parental practices (warmth, irritability and involvement), and parenting experiences (Parenting Stress Index, Parenting Sense of Competence Scale). Hierarchical multiple regression assessed the contribution of a range of parental sleep, psychosocial (social support, coping responses) and self-care variables to fatigue when demographic characteristics were held constant. Higher fatigue was significantly associated with lower parental competence (β=-0.17, P parenting stress (β= 0.21, P parent-child interactions (β= 0.11, P parental fatigue, including inadequate social support, poorer diet, poorer sleep quality and ineffective coping styles including self-blame and behaviour disengagement. Fatigue is common, and results suggest that fatigue contributes to adverse parental practices and experiences. However, possible risk factors for higher fatigue were identified in this study, indicating opportunities for intervention, management and support for parents. © 2011 Blackwell Publishing Ltd.

The Australian litigation landscape - oral and maxillofacial surgery and general dentistry (oral surgery procedures): an analysis of litigation cases.

Science.gov (United States)

Badenoch-Jones, E K; White, B P; Lynham, A J

2016-09-01

There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and oral and maxillofacial surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients' claims of injury, findings of negligence and damages awarded. A thematic analysis of the cases was undertaken to determine trends. Fifteen cases over a 20-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved oral and maxillofacial surgeons). Eleven of the 15 cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the 15 cases related to molar extractions (eight specifically to third molar). Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Preoperative radiographs, good medical records and processes to ensure appropriate follow-up are also important. © 2015 Australian Dental Association.

General practice training and virtual communities of practice - a review of the literature

Directory of Open Access Journals (Sweden)

Barnett Stephen

2012-08-01

Full Text Available Abstract Background Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Methods Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP AND (Online OR Virtual OR Electronic AND (health OR healthcare OR medicine OR “Allied Health”. Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. Results The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders

BOOMERANG - the Australian light source

International Nuclear Information System (INIS)

Boldeman, J.W.; Garrett, R.L.

1999-01-01

A proposal has been prepared for the installation in Australia of a national high performance synchrotron light facility called Boomerang. The Boomerang proposal had its origin in the establishment of the Australian Synchrotron Research Program (ASRP) which was one of the seven Major National Research Facilities announced by the Federal Government in December 1995. The ASRP provides the opportunity and funding for Australian researchers to access international synchrotron facilities, specifically two consortia at the Advanced Photon Source (APS) at the Argonne National Laboratory, USA and continued interaction with the Photon Factory at the KEK Laboratory in Japan. The ASRP was the successor to the Australian National Beamline Facility project (ANBF) which began in 1991 following the ASTEC inquiry titled 'Small Country - Big Science'. The Federal Government also provided funding for a Feasibility Study to determine the value of establishing an Australian-based synchrotron radiation facility. The Feasibility Study was completed in August 1998 and endorsed by the institutional members of the ASRP and the research community in general. The study concluded that, on the data available in Australia, there was a strong case for the installation of an Australian-based facility. The study considered several options for an Australian-based facility and recommended that these options and the data supporting the general conclusions receive further investigation. A mission was arranged to a select group of overseas laboratories to explore these questions in detail. The review team included a mix of scientific and industrial experience and also represented the interests of the ASRP and an Industrial Synchrotron Consortium based in Victoria. Based on the conclusions of the overseas mission and incorporating the advice of all international specialists in the design and use of synchrotron facilities consulted during the mission, the most cost-effective option was an extended

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

Directory of Open Access Journals (Sweden)

Bunker Jeremy M

2012-09-01

quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. Trial registration ACTRN12610000592044

General practice ethnicity data: evaluation of a tool

Directory of Open Access Journals (Sweden)

Neuwelt P

2014-03-01

Full Text Available INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed.

Sporting Chance: Indigenous Participation in Australian Sport History

Directory of Open Access Journals (Sweden)

Sean Gorman

2010-08-01

Full Text Available For many non-Indigenous Australians the only time they have any engagement with Indigenous peoples, history or issues is through watching sport on television or being at a football match at the MCG. This general myopia and indifference by settler Australians with Indigenous Australians manifests itself in many ways but perhaps most obscenely in the simple fact that Indigenous Australians die nearly 20 years younger than the rest of Australias citizens. Many non-Indigenous Australians do not know this. Sport in many ways has offered Indigenous Australians a platform from which to begin the slow, hard process for social justice and equity to be actualised. This paper will discuss the participation of Indigenous Australians in sport and show how sport has enabled Indigenous Australians to create a space so that they can speak out against the injustices they have experienced and to further improve on relations going into the future. The central contention is that through sport all Australians can begin a process of engaging with Indigenous history as a means to improve race relations between the two groups.

Management in general practice: the challenge of the new General Medical Services contract.

Science.gov (United States)

Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the

Weight Changes in General Practice

DEFF Research Database (Denmark)

Køster-Rasmussen, Rasmus

2015-01-01

INTRODUCTION: This PhD thesis is about weight changes. What determines long-term weight changes in the adult general population? Is it possible that weight loss may not always be healthy? The present clinical guidelines for general practice advice most overweight persons and patients with type 2 ...... lifestyle changes like for instance Mediterranean diet and increased exercise....

Open Access to General Practice Was Associated with Burnout among General Practitioners

DEFF Research Database (Denmark)

Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

2013-01-01

Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without....... In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach...... Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters...

Integrating postgraduate and undergraduate general practice education: qualitative study.

Science.gov (United States)

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial.

Science.gov (United States)

Hayek, Adina; Joshi, Rohina; Usherwood, Tim; Webster, Ruth; Kaur, Baldeep; Saini, Bandana; Armour, Carol; Krass, Ines; Laba, Tracey-Lea; Reid, Christopher; Shiel, Louise; Hespe, Charlotte; Hersch, Fred; Jan, Stephen; Lo, Serigne; Peiris, David; Rodgers, Anthony; Patel, Anushka

2016-09-23

Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18 months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Australian New Zealand Clinical Trials Registry ACTRN12616000233426.

[General practice research units in Denmark: multidisciplinary research in support of practical work].

Science.gov (United States)

Reventlow, Susanne; Broholm, Katalin Alexa Király; Mäkelä, Marjukka

2014-01-01

In Denmark the general practice research units operating in connection with universities provide a home base, training and methodology support for researchers in the field from medical students to general practitioners carrying out practical work. Research issues frequently require a multidisciplinary approach and use of different kinds of materials. Problems arising from the practical work of general practitioners take priority in the wide selection of topics. The units have networked efficiently with organizations of general practitioners and medical education. The combination of research environments has created synergy benefiting everybody and increased the scientific productivity and visibility of the field.

The association between regular yoga and meditation practice and falls and injuries: Results of a national cross-sectional survey among Australian women.

Science.gov (United States)

Cramer, Holger; Sibbritt, David; Adams, Jon; Lauche, Romy

2016-02-01

Falls are the leading cause of injuries in women across all ages. While yoga has been shown to increase balance, it has also been associated with injuries due to falls during practice. This study aimed to analyse whether regular yoga or meditation practice is associated with the frequency of falls and fall-related injuries in upper middle-aged Australian women. Women aged 59-64 years from the Australian Longitudinal Study on Women's Health (ALSWH) were queried regarding falls and falls-related injuries; and whether they regularly practiced yoga or meditation. Associations of falls and falls-related injuries with yoga or meditation practice were analysed using chi-squared tests and multiple logistic regression modelling. Of 10,011 women, 4413 (44.1%) had slipped, tripped or stumbled, 2770 (27.7%) had fallen to the ground, 1398 (14.0%) had been injured as a result of falling, and 901 (9.0%) women had sought medical attention for a fall-related injury within the previous 12 months. Yoga or meditation was practiced regularly by 746 (7.5%) women. No associations of falls, fall-related injuries and treatment due to falls-related injury with yoga or meditation practice were found. No association between yoga or meditation practice and falls or fall-related injuries have been found. Further studies are warranted for conclusive judgement of benefits and safety of yoga and meditation in relation to balance, falls and fall-related injuries. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar

Directory of Open Access Journals (Sweden)

Scott-Jones J

2013-09-01

Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

Non-Standard Assessment Practices in the Evaluation of Communication in Australian Aboriginal Children

Science.gov (United States)

Gould, Judith

2008-01-01

Australian Aboriginal children typically receive communication assessment services from Standard Australian English (SAE) speaking non-Aboriginal speech-language pathologists (SLPs). Educational assessments, including intelligence testing, are also primarily conducted by non-Aboriginal educational professionals. While the current paper will show…

The Diabetes Care Project: an Australian multicentre, cluster randomised controlled trial [study protocol].

Science.gov (United States)

Leach, Matthew J; Segal, Leonie; Esterman, Adrian; Armour, Caroline; McDermott, Robyn; Fountaine, Tim

2013-12-20

Diabetes mellitus is an increasingly prevalent metabolic disorder that is associated with substantial disease burden. Australia has an opportunity to improve ways of caring for the growing number of people with diabetes, but this may require changes to the way care is funded, organised and delivered. To inform how best to care for people with diabetes, and to identify the extent of change that is required to achieve this, the Diabetes Care Project (DCP) will evaluate the impact of two different, evidence-based models of care (compared to usual care) on clinical quality, patient and provider experience, and cost. The DCP uses a pragmatic, cluster randomised controlled trial design. Accredited general practices that are situated within any of the seven Australian Medicare Locals/Divisions of General Practice that have agreed to take part in the study were invited to participate. Consenting practices will be randomly assigned to one of three treatment groups for approximately 18 to 22 months: (a) control group (usual care); (b) Intervention 1 (which tests improvements that could be made within the current funding model, facilitated through the use of an online chronic disease management network); or (c) Intervention 2 (which includes the same components as Intervention 1, as well as altered funding to support voluntary patient registration with their practice, incentive payments and a care facilitator). Adult patients who attend the enrolled practices and have established (≥12 month's duration) type 1 diabetes mellitus or newly diagnosed or established type 2 diabetes mellitus are invited to participate. Multiple outcomes will be studied, including changes in glycosylated haemoglobin (primary outcome), changes in other biochemical and clinical metrics, incidence of diabetes-related complications, quality of life, clinical depression, success of tailored care, patient and practitioner satisfaction, and budget sustainability. This project responds to a need for robust

Association between Australian-Indian mothers' controlling feeding practices and children's appetite traits.

Science.gov (United States)

Jani, Rati; Mallan, Kimberley M; Daniels, Lynne

2015-01-01

This cross-sectional study examined the association between controlling feeding practices and children's appetite traits. The secondary aim studied the relationship between controlling feeding practices and two proxy indicators of diet quality. Participants were 203 Australian-Indian mothers with children aged 1-5 years. Controlling feeding practices (pressure to eat, restriction, monitoring) and children's appetite traits (food approach traits: food responsiveness, enjoyment of food, desire to drink, emotional overeating; food avoidance traits: satiety responsiveness, slowness in eating, fussiness and emotional undereating) were measured using self-reported, previously validated scales/questionnaires. Children's daily frequency of consumption of core and non-core foods was estimated using a 49-item list of foods eaten (yes/no) in the previous 24 hours as an indicator of diet quality. Higher pressure to eat was associated with higher scores for satiety responsiveness, slowness in eating, fussiness and lower score for enjoyment of food. Higher restriction was related to higher scores for food responsiveness and emotional overeating. Higher monitoring was inversely associated with fussiness, slowness in eating, food responsiveness and emotional overeating and positively associated with enjoyment of food. Pressure to eat and monitoring were related to lower number of core and non-core foods consumed in the previous 24 hours, respectively. All associations remained significant after adjusting for maternal and child covariates (n = 152 due to missing data). In conclusion, pressure to eat was associated with higher food avoidance traits and lower consumption of core foods. Restrictive feeding practices were associated with higher food approach traits. In contrast, monitoring practices were related to lower food avoidance and food approach traits and lower non-core food consumption. Copyright © 2014 Elsevier Ltd. All rights reserved.

Small business, cash budgets and general practice.

Science.gov (United States)

Jackson, A R

1991-01-01

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

Learner discipline: An Australian perspective

Directory of Open Access Journals (Sweden)

D. Stewart

2004-07-01

Full Text Available Australian schools by and large are safe schools. Nonetheless discipline problems do exist – including bullying behaviour. For this kind of problem schools should have management policies in place. As traditional behaviour-management practices – including corporal punishment – are largely prohibited in Australian schools, contemporary practices centre on management through supportive school programmes, including appropriate curricula and school-support structures. This article supports the belief that measures such as the exclusion of misbehaving learners should be treated with caution. Measures such as this might not reflect accepted international principles and practices and should only be exercised in the most extreme circumstances. The article also supports the view that it is part of the school’s role to ensure that all learners are aware of the reality that while they have rights, they also have corresponding responsibilities. This awareness is more likely to be achieved in a supportive school culture where each learner is recognised as having unique qualities that can mature and grow in an appropriate learning environment.

Undergraduate teaching in UK general practice: a geographical snapshot.

Science.gov (United States)

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-06-01

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

Ten “Big Bangs” in Theory and Practice that Have Made a Difference to Australian Policing in the Last Three Decades

Directory of Open Access Journals (Sweden)

Rick Sarre

2016-05-01

Full Text Available This paper discusses what could be considered the top ten innovations that have occurred in policing in the last thirty years. The intent is to focus attention on how practice could be further inspired by additional innovation. The innovations are discussed here as “Big Bangs” as a way of drawing attention to the significant impact they have had on policing, in the same way that the cosmological Big Bang was an important watershed event in the universe’s existence. These ten policing innovations ushered in, it is argued, a new mindset, pattern or trend, and they affected Australian policing profoundly; although many had their roots in other settings long before Australian policy-makers implemented them.

Open Access to General Practice Was Associated with Burnout among General Practitioners.

Science.gov (United States)

Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

2013-01-01

Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice.

[The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of general practice

NARCIS (Netherlands)

Bosch, W.J.H.M. van den

2002-01-01

The Dutch College of General Practitioners' practice guideline on the menopause will not be any major cause for discussion. The hot issue of giving oestrogens to peri- and postmenopausal women to prevent osteoporosis or cardiovascular disease was already covered in the practice guideline on

Doctors' attitudes and confidence towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice registrars and general practitioners.

Science.gov (United States)

Crowley, Jennifer; Ball, Lauren; Han, Dug Yeo; McGill, Anne-Thea; Arroll, Bruce; Leveritt, Michael; Wall, Clare

2015-09-01

Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases. This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care. A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs. All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (ppractice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (pmedical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.

The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.

NARCIS (Netherlands)

Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de

2005-01-01

A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners,

The Arts and Australian Education: Realising Potential. Australian Education Review No. 58

Science.gov (United States)

Ewing, Robyn

2011-01-01

Australian Education Review (AER) 58 surveys the international and national research on the role and effect of arts-rich programming in schools and in the broader community, and examines the policies and practices that inhibit or support these initiatives. It puts the case that embedding the Arts in learning would be a powerful catalyst for…

How Australian and New Zealand schools of optometry prepare students for culturally competent practice.

Science.gov (United States)

Truong, Mandy; Bentley, Sharon A; Napper, Genevieve A; Guest, Daryl J; Anjou, Mitchell D

2014-11-01

This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity. All Australian and New Zealand schools of optometry were invited to participate in the study. Data were collected with two surveys: a curriculum survey about the content of the optometric courses in relation to cultural competency issues and a survey for second year optometry students containing questions in relation to cultural awareness, cultural sensitivity and attitudes to cultural diversity. Four schools of optometry participated in the curriculum survey (Deakin University, Flinders University, University of Melbourne and University of New South Wales). Sixty-three students (22.3 per cent) from these four schools as well as the University of Auckland participated in the student survey. Cultural competency training was reported to be included in the curriculum of some schools, to varying degrees in terms of structure, content, teaching method and hours of teaching. Among second year optometry students across Australia and New Zealand, training in cultural diversity issues was the strongest predictor of cultural awareness and sensitivity after adjusting for school, age, gender, country of birth and language other than English. This study provides some evidence that previous cultural competency-related training is associated with better cultural awareness and sensitivity among optometric students. The variable approaches to cultural competency training reported by the schools of optometry participating in the study suggest that there may be opportunity for further development in all schools to consider best practice training in cultural competency. © 2014 The

E-dietician in general practice

DEFF Research Database (Denmark)

Brandt, Carl J.; Arendal, Cecilia; Glintborg, Dorte

2010-01-01

Obesity is according to WHO one of the greatest health challenges of our time. The aim of the pilot project was to investigate the weight loss efficacy and the cost of individual dietetic internet-based consultations in a Danish medical centre in combination with an internet community. A total...... of 46 obese patients in general practice were offered participation in a cohort study during May 15th to December 1st 2008. Patients from three different health centers were included. 32 patients gave informed consent to participate and were given access to weekly e-mail consultations with a dietician...... weight loss treatments in general practice. The utilization of e-mail consultations can furthermore result in a saving in expenses and premises if the e-mail correspondences are held outside of the health centre....

The problem of diagnostic variability in general practice.

Science.gov (United States)

Crombie, D L; Cross, K W; Fleming, D M

1992-08-01

The aim was to examine the scale, source, and relevance of variation between general practices in respect of the rates with which patients consulted with illnesses falling in each of several diagnostic groups. This study involved a general practice morbidity survey conducted over two years, 1970-72. All patients who consulted their general practitioners were identified and the number of these who consulted with diagnoses attributable to each of the 18 main chapters of the International classification of diseases were counted. Patients who consulted for more than one diagnosis within a chapter were counted once only; those who consulted for one or more diagnoses in each of several chapters were counted once for each chapter. This was a national survey involving general practitioners in England and Wales. The study involved 214,524 patients from 53 selected general practices (115 doctors) who were registered with their general practitioners for the whole of the year 1970-71 and for whom their morbidity data had been linked with their social data from the 1971 census. Using the numbers of patients on the practice lists as denominators, practice patient consulting rates (PPCR) were calculated for each practice and for each ICD chapter. Variability in chapter PPCR was examined by calculating coefficients of variation and, after allowance for random variation, coefficients of residual variation. There were large interpractice (doctor) variations in all chapter rates. These variations were only marginally attributable to: chance; different age, sex and social class mixes of practice populations; geographical locations; and practice organisation. The rates were, however, consistent from one year to the next for any one practice. Approximately half of the interpractice (doctor) diagnostic variability was associated with overall patient consulting behaviour. When the effects of this behaviour were discounted, any major residual diagnostic variability was confined largely to

Microbiological Safety and Food Handling Practices of Seed Sprout Products in the Australian State of Victoria.

Science.gov (United States)

Symes, Sally; Goldsmith, Paul; Haines, Heather

2015-07-01

Seed sprouts have been implicated as vehicles for numerous foodborne outbreaks worldwide. Seed sprouts pose a unique food safety concern because of the ease of microbiological seed contamination, the inherent ability of the sprouting process to support microbial growth, and their consumption either raw or lightly cooked. To examine seed sprout safety in the Australian state of Victoria, a survey was conducted to detect specific microbes in seed sprout samples and to investigate food handling practices relating to seed sprouts. A total of 298 seed sprout samples were collected from across 33 local council areas. Escherichia coli was detected in 14.8%, Listeria spp. in 12.3%, and Listeria monocytogenes in 1.3% of samples analyzed. Salmonella spp. were not detected in any of the samples. A range of seed sprout handling practices were identified as potential food safety issues in some food businesses, including temperature control, washing practices, length of storage, and storage in proximity to unpackaged ready-to-eat potentially hazardous foods.

Structure, dynamics and movement patterns of the Australian pig industry.

Science.gov (United States)

East, I J; Davis, J; Sergeant, E S G; Garner, M G

2014-03-01

To assess management practices and movement patterns that could influence the establishment and spread of exotic animal diseases (EAD) in pigs in Australia. A literature review of published information and a telephone survey of 370 pig producers owning >10 pigs who were registered with the PigPass national vendor declaration scheme. The movement and marketing patterns of Australian pig producers interviewed were divided into two groups based predominantly on the size of the herd. Major pig producers maintain closed herds, use artificial insemination and market direct to abattoirs. Smaller producers continue to purchase from saleyards and market to other farms, abattoirs and through saleyards in an apparently opportunistic fashion. The role of saleyards in the Australian pig industry continues to decline, with 92% of all pigs marketed directly from farm to abattoir. This survey described movement patterns that will assist in modelling the potential spread of EAD in the Australian pig industry. Continued movement towards vertical integration and closed herds in the Australian pig industry effectively divides the industry into a number of compartments that mitigate against the widespread dissemination of disease to farms adopting these practices. © 2014 Australian Veterinary Association.

Economic costs of chemotherapy-induced febrile neutropenia among patients with non-Hodgkin’s lymphoma in European and Australian clinical practice

Directory of Open Access Journals (Sweden)

Weycker Derek

2012-08-01

Full Text Available Abstract Background Economic implications of chemotherapy-induced febrile neutropenia (FN in European and Australian clinical practice are largely unknown. Methods Data were obtained from a European (97% and Australian (3% observational study of patients with non-Hodgkin’s lymphoma (NHL receiving CHOP (±rituximab chemotherapy. For each patient, each cycle of chemotherapy within the course, and each occurrence of FN within cycles, was identified. Patients developing FN in a given cycle (“FN patients”, starting with the first, were matched to those who did not develop FN in that cycle (“comparison patients”, irrespective of subsequent FN events. FN-related healthcare costs (£2010 were tallied for the initial FN event as well as follow-on care and FN events in subsequent cycles. Results Mean total cost was £5776 (95%CI £4928-£6713 higher for FN patients (n = 295 versus comparison patients, comprising £4051 (£3633-£4485 for the initial event and a difference of £1725 (£978-£2498 in subsequent cycles. Among FN patients requiring inpatient care (76% of all FN patients, mean total cost was higher by £7259 (£6327-£8205, comprising £5281 (£4810-£5774 for the initial hospitalization and a difference of £1978 (£1262-£2801 in subsequent cycles. Conclusions Cost of chemotherapy-induced FN among NHL patients in European and Australian clinical practice is substantial; a sizable percentage is attributable to follow-on care and subsequent FN events.

The existential dimension in general practice

DEFF Research Database (Denmark)

Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette

2016-01-01

Objective: The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP–patient encounter. Design: A qualitative methodology with semi......-structured focus group interviews was employed. Setting: General practice setting in Denmark. Subjects: Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Results: Although understood to involve broad life conditions such as present and future being...... points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP–patient encounter. The existential dimension is understood to involve broad and universal life conditions...

The existential dimension in general practice

DEFF Research Database (Denmark)

Assing Hvidt, Elisabeth; Søndergård, Jens; Ammentorp, Jette

2016-01-01

OBJECTIVE: The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter. DESIGN: A qualitative methodology with semi......-structured focus group interviews was employed. SETTING: General practice setting in Denmark. SUBJECTS: Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. RESULTS: Although understood to involve broad life conditions such as present and future being...... POINTS: Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions...

Sex differences among recipients of benzodiazepines in Dutch general practice.

NARCIS (Netherlands)

Waals, F.W. van der; Mohrs, J.; Foets, M.

1993-01-01

Objective: To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting: Practices of 45 general practitioners monitored during 1 April to 30

SEX-DIFFERENCES AMONG RECIPIENTS OF BENZODIAZEPINES IN DUTCH GENERAL-PRACTICE

NARCIS (Netherlands)

van der Waals, F. W.; Mohrs, J.; Foets, M.

1993-01-01

Objective-To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting-Practices of 45 general practitioners monitored during 1 April to 30

Laboratory-supported influenza surveillance in Victorian sentinel general practices.

Science.gov (United States)

Kelly, H; Murphy, A; Leong, W; Leydon, J; Tresise, P; Gerrard, M; Chibo, D; Birch, C; Andrews, R; Catton, M

2000-12-01

Laboratory-supported influenza surveillance is important as part of pandemic preparedness, for identifying and isolating candidate vaccine strains, for supporting trials of anti-influenza drugs and for refining the influenza surveillance case definition in practice. This study describes the implementation of laboratory-supported influenza surveillance in Victorian sentinel general practices and provides an estimate of the proportion of patients with an influenza-like illness proven to have influenza. During 1998 and 1999, 25 sentinel general practices contributed clinical surveillance data and 16 metropolitan practices participated in laboratory surveillance. Serological, virus-antigen detection, virus culture and multiplex polymerase chain reaction procedures were used to establish the diagnosis of influenza. Two laboratories at major teaching hospitals in Melbourne provided additional data on influenza virus identification. General practice sentinel surveillance and laboratory identification of influenza provided similar data on the pattern of influenza in the community between May and September. The clinical suspicion of influenza was confirmed in 49 to 54 per cent of cases seen in general practice.

Nigerian Journal of General Practice

African Journals Online (AJOL)

Nigerian Journal of General Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 1 (2011) >. Log in or Register to get access to full text downloads.

Multiple mini interview (MMI) for general practice training selection in Australia: interviewers' motivation.

Science.gov (United States)

Burgess, Annette; Roberts, Chris; Sureshkumar, Premala; Mossman, Karyn

2018-01-25

Multiple Mini Interviews (MMIs) are being used by a growing number of postgraduate training programs and medical schools as their interview process for selection entry. The Australian General Practice and Training (AGPT) used a National Assessment Centre (NAC) approach to selection into General Practice (GP) Training, which include MMIs. Interviewing is a resource intensive process, and implementation of the MMI requires a large number of interviewers, with a number of candidates being interviewed simultaneously. In 2015, 308 interviewers participated in the MMI process - a decrease from 340 interviewers in 2014, and 310 in 2013. At the same time, the number of applicants has steadily increased, with 1930 applications received in 2013; 2254 in 2014; and 2360 in 2015. This has raised concerns regarding the increasing recruitment needs, and the need to retain interviewers for subsequent years of MMIs. In order to investigate interviewers' reasons for participating in MMIs, we utilised self-determination theory (SDT) to consider interviewers' motivation to take part in MMIs at national selection centres. In 2015, 308 interviewers were recruited from 17 Regional Training Providers (RTPs) to participate in the MMI process at one of 15 NACs. For this study, a convenience sample of NAC sites was used. Forty interviewers were interviewed (n = 40; 40/308 = 13%) from five NACs. Framework analysis was used to code and categorise data into themes. Interviewers' motivation to take part as interviewers were largely related to their sense of duty, their desire to contribute their expertise to the process, and their desire to have input into selection of GP Registrars; a sense of duty to their profession; and an opportunity to meet with colleagues and future trainees. Interviewers also highlighted factors hindering motivation, which sometimes included the large number of candidates seen in one day. Interviewers' motivation for contributing to the MMIs was largely related

The Role of Collaborative Learning on Training and Development Practices within the Australian Men's Shed Movement: A Study of Five Men's Sheds

Science.gov (United States)

Cavanagh, Jillian; Southcombe, Amie; Bartram, Tim

2014-01-01

This study examines the role and impact of collaborative learning on training and development practices in Australian Men's Sheds. We use a case study approach, underpinned by Peters and Armstrong's theoretical framework of collaborative learning in adult education, to investigate five Men's Sheds. Semi-structured interviews were carried out with…

The mouth as a site of structural inequalities; the experience of Aboriginal Australians.

Science.gov (United States)

Durey, A; Bessarab, D; Slack-Smith, L

2016-06-01

To address the mouth as a site of structural inequalities looking through the lens of Aboriginal Australian experience. This is a critical review of published literature relevant to our objective. Criteria for selection included articles on: the social context of oral and general health inequalities for Aboriginal Australians; Aboriginal perceptions and meanings of the mouth and experiences of oral health care and the role of the current political-economic climate in promoting or compromising oral health for Aboriginal Australians. Evidence suggests oral health is important for Aboriginal Australians yet constrained by challenges beyond their control as individuals, including accessing dental services. Competing demands on limited budgets often led to oral health dropping off the radar unless there was an emergency. Structural (social, political and economic) factors often inhibited Aboriginal people making optimum health choices to prevent oral disease and access services for treatment. Factors included cost of services, limited education about oral health, intense advertising of sugary drinks and discrimination from service providers. Yet the literature indicates individuals, rather than structural factors, are held responsible and blamed for the poor state of their oral health. The current neoliberal climate focuses on individual responsibility for health and wellbeing often ignoring the social context. To avoid the mouth becoming an ongoing site for structural inequality, critically reviewing oral health policies and practices for whether they promote or compromise Aboriginal Australians' oral health is a step towards accountability-related oral health outcomes.

Management of needlestick injuries in general dental practice

OpenAIRE

Smith, A.J.; Cameron, S.O.; Bagg, J.; Kennedy, D.

2001-01-01

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing con...

Australian Queer Science Fiction Fans.

Science.gov (United States)

Kerry, Stephen Craig

2017-10-23

Science fiction (sf) does more than provide a fleeting moment of entertainment; it has many personal and social functions. In addition to offering audiences "romantic escapism" (Gerrold, 1996, pp. 5-6), sf also enables the "postulation of an alternative reality from which to contemplate this one" (Gerrold, 1996, pp. 5-6); as such, it is especially important "for groups which have had limited stakes in the status quo" (Jenkins, 1995, p. 242). To date, no research has been undertaken on the relationship between Australian queers and sf fandom. This article reports the findings of an online survey and explores the psycho-social features of Australian queer sf fans and why they like the genre. While the characteristics of this sample mirror those of Australian queers generally, they also have slightly higher rates of mental illness and are far more likely to state they have "no religion." Furthermore, while enjoying the "sciency" (P10, bisexual woman) aspects of sf, Australian queers also like the "poignant metaphors for our own civilization" (P45, asexual man).

Gastroenteritis in sentinel general practices, the Netherlands.

NARCIS (Netherlands)

Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

2001-01-01

From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for

Supervision--growing and building a sustainable general practice supervisor system.

Science.gov (United States)

Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

2011-06-06

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

Australian midwives and provision of nutrition education during pregnancy: A cross sectional survey of nutrition knowledge, attitudes, and confidence.

Science.gov (United States)

Arrish, Jamila; Yeatman, Heather; Williamson, Moira

2016-10-01

Maternal nutrition during pregnancy affects the health of the mother and the baby. Midwives are ideally placed to provide nutrition education to pregnant women. There is limited published research evidence of Australian midwives' nutrition knowledge, attitudes and confidence. To investigate Australian midwives' nutrition knowledge, attitudes and confidence in providing nutrition education during pregnancy. Members of the Australian College of Midwives (n=4770) were sent an invitation email to participate in a web-based survey, followed by two reminders. The completion rate was 6.9% (329 of 4770). The majority (86.6% and 75.7%, respectively) highly rated the importance of nutrition during pregnancy and the significance of their role in nutrition education. Midwives' nutrition knowledge was inadequate in several areas such as weight gain, dairy serves and iodine requirements (73.3%, 73.2% and 79.9% incorrect responses, respectively). The level of confidence in discussing general and specific nutrition issues ranged mostly from moderate to low. The majority of the midwives (93%) provided nutrition advice to pregnant women. This advice was mostly described as 'general' and focused on general nutrition topics. Only half of the midwives reported receiving nutrition education during midwifery education (51.1%) or after registration (54.1%). Australian midwives' attitudes towards nutrition during pregnancy and their role in educating pregnant women about it were positive but their knowledge and confidence did not align with these attitudes. This could be due to minimal nutrition education during midwifery education or during practice. Continued education to improve midwives' nutrition knowledge and confidence is essential. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Open-access ultrasound referrals from general practice.

LENUS (Irish Health Repository)

Hughes, P

2015-03-01

Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

Education in General Practice in the Netherlands*

African Journals Online (AJOL)

practice and the other half to research and group discus- sions with the students. In the 4th, 6th and 7th years, group discussions are held with students about capita selecta chosen in consultation with the students and about casuis- tics in the general practitioner~ practice. In Utrecht a university group-practice is Jeveloping,.

A narrative analysis of a speech pathologist's work with Indigenous Australians with acquired communication disorders.

Science.gov (United States)

Hersh, Deborah; Armstrong, Elizabeth; Bourke, Noni

2015-01-01

To explore in detail the narrative of a speech pathologist (SP) working with Indigenous Australian clients with acquired communication disorders following stroke or brain injury. There is some evidence that Indigenous clients do not find speech pathology rehabilitation to be culturally appropriate but, currently, there is very little published on the nature of this service or the experiences of SPs who provide this rehabilitation. This research uses both thematic and structural narrative analysis of data from a semi-structured, in-depth interview with a SP to examine the adaptations that she made to address the needs of her adult neurological caseload of (mainly) Indigenous Australians from both urban and remote regions. The thematic analysis resulted in a core theme of flexibility and four other sub-themes: awareness of cultural context, client focus/person-centredness, being practical and working ethically. The structural narrative analysis allowed insight into the nature of clinical reasoning in a context lacking predictability and where previous clinical certainties required adaptation. Individual, detailed narratives are useful in exposing the challenges and clinical reasoning behind culturally sensitive practice. Implications for Rehabilitation Speech pathologists (SPs) can learn from hearing the clinical stories of colleagues with experience of providing rehabilitation in culturally diverse contexts, as well as from ongoing training in culturally competent and safe practices. Such stories help bridge understanding from the general to the particular. SPs working with Indigenous Australians with acquired communication disorders post-stroke and brain injury may find it helpful to consider how the themes, drawn from an interview with the clinician in this study - flexibility, awareness of cultural context, person-centredness, being practical and working ethically - might apply to their practice. Narratives may be helpful in staff training and form an important

Australian high-dose-rate brachytherapy protocols for gynaecological malignancy

International Nuclear Information System (INIS)

MacLeod, C.; Dally, M.; Stevens, M.; Thornton, D.; Carruthers, S.; Jeal, P.

2001-01-01

There is no consensus over the optimal dose fractionation schedules for high-dose-rate (HDR) brachytherapy used for gynaecological malignancy. In Australian public hospital departments of radiation oncology, HDR brachytherapy for gynaecological cancer is being more commonly used. A survey of public departments that are using this technology, or that plan to introduce this technology, was performed. Their current protocols are presented. In general, protocols are similar biologically; however, the practical aspects such as the number of fractions given do vary and may reflect resource restrictions or, alternatively, differences in interpretations of the literature and of the best protocols by clinicians. Copyright (2001) Blackwell Science Pty Ltd

Informal care and the self-management partnership: implications for Australian health policy and practice.

Science.gov (United States)

Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

Post-traumatic stress disorder--best practice GP guidelines.

Science.gov (United States)

Forbes, David; Wolfgang, Bronwyn; Cooper, John; Creamer, Mark; Barton, David

2009-03-01

Approximately 50-65% of Australians are exposed to a traumatic event during their lifetime. Approximately 250 000 Australians suffer from post-traumatic stress disorder (PTSD) at any given time, making it one of the most common anxiety disorders. In May 2007, the Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder was published. In order to facilitate translation of evidence regarding PTSD into busy clinical practice, and particularly for general practitioners, a more succinct version of the guidelines has been developed. This article describes a brief algorithm based on the Australian guidelines and outlines key recommendations. General practitioners are often the first point of contact with the health care system for someone who has experienced a traumatic event. Patients experiencing trauma within the past 2 weeks require psychological first aid, and monitoring and assessment for the development of acute stress disorder and symptoms of PTSD. If the patient wishes to talk about the event with you, support them in doing so. However, it is important not to push those who prefer not to talk about the event. Trauma focused psychological treatment is the first line of treatment for PTSD, although antidepressant medication may have an adjuvant role in some patients or in those with comorbidities.

Envisaging the use of evidence-based practice (EBP): how nurse academics facilitate EBP use in theory and practice across Australian undergraduate programmes.

Science.gov (United States)

Malik, Gulzar; McKenna, Lisa; Griffiths, Debra

2017-09-01

This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive

Ecstasy use and depression: a 4-year longitudinal study among an Australian general community sample.

Science.gov (United States)

George, Amanda M; Olesen, Sarah; Tait, Robert J

2013-10-01

Longitudinal, population-based studies can better assess the relationship of ecstasy use with depression. We examined whether change in ecstasy use was associated with change in depressive symptoms/probable depression over a 4-year period, among a large Australian sample. The Personality and Total Health project is a longitudinal general community study of Australians from Canberra and Queanbeyan. Data from the youngest cohort when aged 24-30 (N = 2, 128) and 4 years later (N = 1, 977) was included. The Goldberg depression scale and the Brief Patient Health Questionnaire measured depressive symptoms and probable depression, respectively. Multilevel growth models also considered demographics, psychosocial characteristics, and other drug use. Ecstasy use was not associated with long-term depressive symptoms or greater odds of depression in multivariate analyses. Users had more self-reported depressive symptoms when using ecstasy compared to not using. However, differences between people who had and had not ever used ecstasy largely accounted for this. Other factors were more important in the prediction of depression. It would be premature to conclude that ecstasy use is not related to the development of long-term depressive symptoms, given the relatively low level of ecstasy and other drug use in this community sample. Results showed that other factors need to be considered when investigating ecstasy use and depression.

Whole-organism concentration ratios in wildlife inhabiting Australian uranium mining environments

Energy Technology Data Exchange (ETDEWEB)

Hirth, Gillian A.; Carpenter, Julia G. [Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Rd, Yallambie, 3085, Victoria (Australia); Bollhoefer, Andreas [Environmental Research Institute of the Supervising Scientist, GPO Box 461, Darwin, 0801 Northern Territory (Australia); Johansen, Mathew P. [Australian Nuclear Science and Technology Organisation, Locked Bag 2001, Kirrawee, DC, NSW 2232 (Australia); Beresford, Nicholas A. [NERC Centre for Ecology and Hydrology, Bailrigg, Lancaster LA1 4AP (United Kingdom)

2014-07-01

Environmental impact assessments conducted for Australian mine sites involving naturally occurring radioactive material require an assessment of radiation doses to wildlife. Whole-organism concentration ratios (CR{sub wo}) are pivotal in these assessments and previous reviews have identified a need for a more complete and consolidated database of Australian-specific CR{sub wo} that could be used. Concern had also been expressed by some stakeholders in Australia about the suitability of the default CR{sub wo} values provided in standard biota dose models (e.g., ERICA Tool, RESRAD-BIOTA, ICRP framework) for Australian wildlife and environmental conditions. In order to address these concerns and support the implementation of best-practice standards in environmental radiological assessment, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), with support from the Department of Resources, Energy and Tourism (RET), undertook an evaluation of existing data relating to wildlife inhabiting Australian uranium mining environments. CR{sub wo} values were calculated using data from a range of original sources. These included scientific journal publications, technical reports from Australian government organisations, site-specific data from mining operators and data from baseline environmental surveys undertaken during the 1970's and 1980's. The Australian data previously included in the international Wildlife Transfer Database (WTD, www.wildlifetransferdatabase.org) were also reviewed and updated. This paper discusses the data analysis process and associated uncertainties. CR{sub wo} values are reported for uranium, thorium, radium-226, lead-210 and polonium-210 for a range of endemic and introduced wildlife, with a focus on plants and animals from both terrestrial and freshwater environments where uranium mining has been proposed or undertaken. This has resulted in the calculation of more than 500 CR{sub wo} values for inclusion in the database

Parental perceptions of the learner driver log book system in two Australian states.

Science.gov (United States)

Bates, Lyndel; Watson, Barry; King, Mark Johann

2014-01-01

Though many jurisdictions internationally now require learner drivers to complete a specified number of hours of supervised driving practice before being able to drive unaccompanied, very few require learner drivers to complete a log book to record this practice and then present it to the licensing authority. Learner drivers in most Australian jurisdictions must complete a log book that records their practice, thereby confirming to the licensing authority that they have met the mandated hours of practice requirement. These log books facilitate the management and enforcement of minimum supervised hours of driving requirements. Parents of learner drivers in 2 Australian states, Queensland and New South Wales, completed an online survey assessing a range of factors, including their perceptions of the accuracy of their child's learner log book and the effectiveness of the log book system. The study indicates that the large majority of parents believe that their child's learner log book is accurate. However, they generally report that the log book system is only moderately effective as a system to measure the number of hours of supervised practice a learner driver has completed. The results of this study suggest the presence of a paradox, with many parents possibly believing that others are not as diligent in the use of log books as they are or that the system is too open to misuse. Given that many parents report that their child's log book is accurate, this study has important implications for the development and ongoing monitoring of hours of practice requirements in graduated driver licensing systems.

The Future of General Surgery: Evolving to Meet a Changing Practice.

Science.gov (United States)

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Australian and South African perspectives on the implementation of flexible work practices (Fwp: an exploratory study

Directory of Open Access Journals (Sweden)

Aletta Odendaal

2002-10-01

Full Text Available The purpose of this study was to identify examples of good and innovative practices of Flexible Work Practices to benchmark against and then to use the information to develop strategies of implementation that will assist South African organisations to emulate their success. One hundred-and-twenty (120 individuals, representing different stakeholder groups were requested to complete a questionnaire, based on an Australian study. Comparative findings of both countries strongly confirmed variables that are positively associated with the adoption and successful implementation of Flexible Work Practices (FWP. Opsomming Die doel van hierdie studie was om voorbeelde van goeie en innoverende gebruike van Buigsame Werkspraktyke te identifiseer ten einde daarteen te kan vergelyk, en dan om hierdie inligting te gebruik ten einde implementeringstrategieë te ontwikkel wat Suid Afrikaanse maatskappye kan gebruik om sukses na te volg. Honderd en twintig (120 individue, wat verskillende belangegroepe verteenwoordig, is genader om ‘n vraelys, gebaseer op ‘n Australiese studie, te voltooi. Vergelykende bevindinge van beide lande bevestig veranderlikes wat positief geassosieer word met die aanvaarding en suksesvolle implementering van Buigsame Werkspraktyke (BWP.

Life Satisfaction of Young Australians: Relationships between Further Education, Training and Employment and General and Career Satisfaction. Longitudinal Surveys of Australian Youth Research Report 43

Science.gov (United States)

Hillman, Kylie; McMillan, Julie

2005-01-01

Prepared by the Australian Council for Educational Research (ACER) under an agreement with the Australian Government Department of Education, Science and Training (DEST), this report has three broad aims: (1) To describe the relationship between life satisfaction and participation in a range of post-school education, training and labour market…

Age-related differences in internalizing psychopathology amongst the Australian general population.

Science.gov (United States)

Sunderland, Matthew; Slade, Tim; Carragher, Natacha; Batterham, Philip; Buchan, Heather

2013-11-01

Two methodological criticisms have limited the reliability and validity of findings from previous studies that seek to examine change across the life span in levels of internalizing psychopathology using general population surveys. The first criticism involves the potential influence of cohort effects that confound true age-related changes whereas the second criticism involves the use of a single form of assessment to measure and compare levels of internalizing psychopathology. This study seeks to address these criticisms by modeling age-related change using multiple measures and multiple surveys. Data from 2 epidemiological surveys conducted 10 years apart in the Australian general population were combined and used for the current study. The latent construct of internalizing psychopathology was modeled using a combination of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) depression and anxiety diagnoses as well as items from the Kessler Psychological Distress scale (K10; Kessler et al., 2002). Confirmatory factor analysis (CFA) indicated that a single internalizing dimension provided good model fit to the data. Multigroup CFA indicated that strict measurement invariance of the model can be assumed across survey administrations and age bands, justifying comparisons of mean differences in latent trait levels. Significant changes in mean levels of latent internalizing psychopathology were evident between respondents aged 30-39 years old in 1997 and respondents aged 40-49 years old in 2007, suggesting a minor but significant increase in psychopathology across middle age. By contrast, a minor but significant decrease in psychopathology was noted when transitioning from late middle age (50-59 years old) to old age (60-69 years old). The majority of individuals in the general population will experience constant levels of internalizing psychopathology as they age, suggesting that the construct is relatively

Shoulder disorders in general practice : Prognostic indicators of outcome

NARCIS (Netherlands)

Van Der Windt, Daniëlle A W M; Koes, Bart W.; Boeke, A. Joan P; Devillé, Walter; De Jong, Bareld A.; Bouter, Lex M.

Background. Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. Aim. To study the course of shoulder disorders in general practice and to determine prognostic indicators of

Effectiveness of empathy in general practice: a systematic review

NARCIS (Netherlands)

Derksen, F.; Bensing, J.; Lagro-Janssen, A.

2013-01-01

BACKGROUND: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice.

Effectiveness of empathy in general practice: a systematic review.

NARCIS (Netherlands)

Derksen, F.; Bensing, J.; Lagro-Janssen, A.

2013-01-01

Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice.

Relational Coordination in Danish General Practice

DEFF Research Database (Denmark)

Lundstrøm, Sanne Lykke

. The dissertation present the research study and a collection of three research papers prepared during the period from May 2010 to June 2014. Relational coordination and organisational social capital are measures of novel aspects of an organisation's performance. Relational coordination analyse the communication...... and relationship networks through which work is coordinated across functional and organisational boundaries. Previous studies have shown that relational coordination is positively associated with delivery of care for patients with chronic illness. Organisational social capital is used when analysing...... the psychosocial work environment in organisations, and is seen as a powerful resources for improving organisational performance. Relational coordination and organisational social capital may oer new insight and opportunities for general practice to learn. General practice provides cost-efficient, first...

Is the practice of yoga or meditation associated with a healthy lifestyle? Results of a national cross-sectional survey of 28,695 Australian women.

Science.gov (United States)

Cramer, Holger; Sibbritt, David; Park, Crystal L; Adams, Jon; Lauche, Romy

2017-10-01

To examine the relationship between yoga/meditation practice and health behavior in Australian women. Women aged 19-25years, 31-36years, and 62-67years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behavior; and whether they practiced yoga/meditation on a regular basis. Associations of health behaviors with yoga/meditation practice were analyzed using multiple logistic regression modelling. 11,344, 8200, and 9151 women aged 19-25years, 31-36years, and 62-67years, respectively, were included of which 29.0%, 21.7%, and 20.7%, respectively, practiced yoga/meditation. Women practicing yoga/meditation were significantly more likely to report at least moderate physical activity levels (OR=1.50-2.79), to follow a vegetarian (OR=1.67-3.22) or vegan (OR=2.26-3.68) diet, and to report the use of marijuana (OR=1.28-1.89) and illicit drugs in the last 12 months (OR=1.23-1.98). Yoga/meditation practice was associated with higher physical activity levels, a higher likelihood of vegetarian or vegan diet use, and a higher likelihood of drug use. While health professionals should keep the potential vulnerability of yoga/meditation practitioners to drug use in mind, the positive associations of yoga/meditation with a variety of positive health behaviors warrant its consideration in preventive medicine and healthcare. Copyright © 2017 Elsevier Inc. All rights reserved.

Not addressing the root cause: An analysis of submissions made to the South Australian Government on a Proposal to Protect Midwifery Practice.

Science.gov (United States)

Rigg, Elizabeth; Schmied, Virginia; Peters, Kath; Dahlen, Hannah

2015-06-01

Reports of unregulated birth workers attending birth at home, with no registered midwife in attendance (freebirth), have become more frequent in Australia in recent years. A Coronial Inquiry (2012) into the deaths of three babies born at home in South Australia resulted in a call for legislation to restrict the practice of midwifery to registered midwives. A Proposal to Protect Midwifery Practice in South Australia was issued as a consultation paper in January 2013. To report the views of those making a submission to the Proposal to Protect Midwifery Practice in South Australia. Thirty submissions to the South Australian Government were downloaded, read and thematically analysed. Twenty-five (81%) submissions supported the legislation, 5 (16%) opposed it and 2 (6%) were neither for nor against. Support for the proposed legislation was strong, however the underlying root causes that have led to the rise of UBWs attending homebirth in Australia were not addressed. Recommendations called for all stakeholders to work with women to develop a better framework of care that respected and met their needs and choices whilst safeguarding maternal and neonatal health. The Proposal to Protect Midwifery Practice may promote greater protection of midwifery practice however, Private Indemnity Insurance (PII), collaborative agreements and power struggles associated with the medical domination of childbirth continue to marginalise homebirth and prevent women from accessing the care they want and need. These unresolved issues represent the root causes for UBWs attending homebirth; hence the proposal is only a partial solution. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

General practice and primary health care in Denmark

DEFF Research Database (Denmark)

Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens

2012-01-01

General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized...... education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges...... by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment; (3...

Management of upper dyspepsia in general practice

DEFF Research Database (Denmark)

Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures...... of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...

Recruitment of general practices

DEFF Research Database (Denmark)

Riis, Allan; Jensen, Cathrine Elgaard; Maindal, Helle Terkildsen

2016-01-01

-factors as determinants for successfully recruiting healthcare professionals: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect. Method: This is a process evaluation of the seven R-factors. We applied these factors to guide the design of our recruitment strategy as well as to make......Introduction: Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R...... adjustments when recruiting general practices in a guideline implementation study. In the guideline implementation study, we studied the effect of outreach visits, quality reports, and new patient stratification tools for low back pain patients. Results: During a period of 15 months, we recruited 60 practices...

Regulation of online pharmacy: an Australian perspective.

Science.gov (United States)

Bernath, Paul

2003-02-01

This article argues that existing Australian regulations do not adequately cover online pharmacies or Internet advertising of medicines and that existing penalties and sanctions are often ineffective, potentially placing public health and safety at risk. Suggestions are made for future regulatory approaches. It is concluded that as well as an effective program of public education, cautious domestic legislative reform is necessary to ensure specific regulation of Australian online pharmacy practice and Internet advertising of medicines. In addition, the global nature of the Internet demands international co-operation and increased regulator and consumer vigilance.

Organisational Change and the Management of Training in Australian Enterprises.

Science.gov (United States)

Smith, Andrew; Oczkowski, Edward; Macklin, Robert; Noble, Charles

2003-01-01

A survey of 584 Australian companies investigated the impact of 5 management practices (total quality management, teamwork, lean production, reengineering, learning organizations) in relation to 8 training practices. New management practices had significant but differing effects on the organization of training: total quality management had the…

Australian energy statistics - Australian energy update 2005

Energy Technology Data Exchange (ETDEWEB)

Donaldson, K.

2005-06-15

ABARE's energy statistics include comprehensive coverage of Australian energy consumption, by state, by industry and by fuel. Australian Energy Update 2005 provides an overview of recent trends and description of the full coverage of the dataset. There are 14 Australian energy statistical tables available as free downloads (product codes 13172 to 13185).

Job satisfaction of practice assistants in general practice in Germany: an observational study

NARCIS (Netherlands)

Goetz, K.; Campbell, S.; Broge, B.; Brodowski, M.; Steinhaeuser, J.; Wensing, M.; Szecsenyi, J.

2013-01-01

BACKGROUND: Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. OBJECTIVE: To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction,

Undertreatment of urinary incontinence in general practice.

NARCIS (Netherlands)

Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.

2005-01-01

BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To

Cheques and challenges: business performance in New Zealand general practice.

Science.gov (United States)

Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

2017-09-01

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

Antibiotic prescribing in Danish general practice 2004-13

DEFF Research Database (Denmark)

Aabenhus, Rune; Siersma, Volkert; Plejdrup Hansen, Malene

2016-01-01

Objectives: Antibiotic consumption in the primary care sector is often perceived as synonymous with consumption in general practice despite the fact that few countries stratify the primary care sector by providers' medical specialty. We aimed to characterize and quantify antibiotic use in Danish...... general practice relative to the entire primary care sector. Methods: This was a registry-based study including all patients who redeemed an antibiotic prescription between July 2004 and June 2013 at a Danish community pharmacy. Antibiotic use was expressed as DDDs and treatments/1000 inhabitants....../day (DIDs and TIDs, respectively) and assessed according to antibiotic spectrum (narrow versus broad) and their anatomical therapeutic classification codes in total as well as in six age groups. Results: The contribution of general practice to the entire antibiotic use in the primary care sector declined...

Australian health professionals' social media (Web 2.0) adoption trends: early 21st century health care delivery and practice promotion.

Science.gov (United States)

Usher, Wayne T

2012-01-01

This study was concerned with identifying reasons behind patterns of social media (Web 2.0) usage associated with eight of Australia's major health professions. Attention was given to uncovering some of the more significant motivations for the resistance or adoption of Web 2.0 technologies for health care delivery and practice promotion by Australian health professionals. Surveys were developed from a common set of questions with specific variations between professions negotiated with professional health societies. Survey questions were constructed in an attempt to identify Web 2.0 adoption trends. An online survey (www.limesurvey.org) was used to collect data. Initial data preparation involved the development of one integrated SPSS file to incorporate all responses from the eight surveys undertaken. Initial data analysis applied Frequencies and Crosstabs to the identified groups and provided a profile of respondents by key business and demographic characteristics. Of the 935 respondents, 9.5% of participants indicated that they used Web 2.0 for their professional work, 19.1% of them did not use it for work but used it for their personal needs and 71.3% of them did not use Web 2.0 at all. Participants have indicated that the main reason for 'choosing not to adopt' Web 2.0 applications as a way of delivering health care to their patients is due to the health professionals' lack of understanding of Web 2.0 (83.3%), while the main reason for 'choosing to adopt' Web 2.0 applications is the perception of Web 2.0 as a quick and effective method of communication (73.0%). This study has indicated that Australian health professionals 'choose not to adopt' Web 2.0 usage as a way of delivering health care primarily due to 'a lack of understanding as to how social media would be used in health care' (83.3%). This study identifies that Australian health professionals are interacting with Web 2.0 technologies in their private lives but are failing to see how such technologies

Video-assisted feedback in general practice internships using German general practitioner's guidelines

NARCIS (Netherlands)

Bolter, R.; Freund, T.; Ledig, T.; Boll, B.; Szecsenyi, J.; Roos, M.

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the

Zoonotic disease risk perceptions and infection control practices of Australian veterinarians: call for change in work culture.

Science.gov (United States)

Dowd, Karen; Taylor, Melanie; Toribio, Jenny-Ann L M L; Hooker, Claire; Dhand, Navneet K

2013-08-01

This study was conducted to determine the perceptions of zoonotic disease risk among Australian veterinarians, the infection control practices they use to protect themselves from zoonotic diseases, and the factors influencing their use of these protective practices. A questionnaire was designed and piloted prior to its administration to veterinarians at the annual Australian Veterinary Association Conference in May 2011. The questionnaire comprised 21 closed, semi-closed and open questions. Data from the questionnaire were analyzed using ordinal logistic regression analyses to determine significant factors for veterinarians' use of personal protective equipment (PPE). A total of 344 veterinarians completed the questionnaire of which 63.7% were women, 63.2% worked in small/companion animal practice, and 79.9% worked in private veterinary practice. Of the respondents, 44.9% reported contracting a zoonosis during their careers with 19.7% reporting a suspected case and 25.2% reporting a confirmed incidence. Around 40-60% of veterinarians perceived exposure to zoonosis likely or very likely in a variety of situations. With reference to current national industry guidelines, the reported use of PPE was less than "adequate" for most scenarios except for performing postmortems, surgery or dental procedures. No PPE was used by 60-70% of veterinarians for treating respiratory and neurological cases and by 40-50% when treating gastrointestinal and dermatological cases. Workplace conditions need improvement as 34.8% of workplaces did not have isolation units for infected animals, 21.1% did not have separate eating areas for staff, and 57.1% did not have complete PPE kits for use. Veterinarians were more likely to use PPE if they had undertaken postgraduate education, perceived that zoonosis exposure from animals and procedures was likely, consciously considered PPE use for every case they dealt with and believed that liability issues and risks encouraged use of PPE. In contrast

[The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

NARCIS (Netherlands)

Bosch, W.J.H.M. van den

2003-01-01

The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general

Preventive care in general practice among healthy older New South Wales residents.

Science.gov (United States)

Harris, Mark F; Islam, Fakhrul Md; Jalaludin, Bin; Chen, Jack; Bauman, Adrian E; Comino, Elizabeth J

2013-06-16

despite being at higher risk of health problems, were less likely to report receiving preventive care. This suggests the need for greater effort to promote preventive care for these groups in Australian general practice.

Safety Climate of Ab-Initio Flying Training Organizations: The Case of an Australian Tertiary (Collegiate) Aviation Program

OpenAIRE

Gao, Yi; Rajendran, Natalia

2017-01-01

A healthy safety culture is essential to the safe operation of any aviation organization, including flight schools. This study aimed to assess the safety climate of an Australian tertiary (collegiate) aviation program using a self-constructed instrument. Factor analysis of the instrument identified four safety themes, which are Safety Reporting Culture, Safety Reporting Procedure, Organizational Culture and Practice, and General Safety Knowledge. The responses of student pilots suggested that...

Australian Government Information Resources

OpenAIRE

Chapman, Bert

2017-01-01

Provides an overview of Australian Government information resources. Features content from Australian Government agency websites such as the Department of Environment and Energy, Department of Defence, Australian National Maritime Museum, ANZAC Memorial in Sydney, Department of Immigration & Border Protection, Australian Bureau of Statistics, Australian Dept. of Agriculture and Water Resources, Australian Parliament, Australian Treasury, Australian Transport Safety Board, and Australian Parl...

Australian men's sexual practices in saunas, sex clubs and other male sex on premises venues.

Science.gov (United States)

Lyons, Anthony; Smith, Anthony M A; Grierson, Jeffrey W; von Doussa, Henry

2010-06-01

Sex on premises venues (SOPVs) where men have sex with men have been implicated in the spread of sexually transmissible infections, but few studies have described men's sexual encounters in SOPVs, particularly the degree to which men from different backgrounds engage in risky sexual practices. Interviewer administered surveys were conducted with 186 Australian men who have sex with men (MSM) within 48 h of visiting an SOPV. They reported their sexual practices, the characteristics of their partners and other circumstances surrounding their sexual encounters. All analyses were based on the number of sexual encounters (n = 430). Oral sex was the most common practice, occurring in 74.9% of encounters, followed by massage, frottage or kissing (53.7%), solo or mutual masturbation (36.3%), and anal sex (32.1%). Multivariate analyses revealed age as a significant factor for having protected anal sex (P = 0.001), insertive anal sex (P = 0.004) and receptive anal sex (P practices were more frequent in encounters among younger men, while masturbation (P = 0.03) was more frequent among older men. When men's sexual partners were affected by alcohol, encounters were less likely to involve unprotected anal intercourse (P = 0.006) and more likely to involve massage, frottage or kissing (P = 0.009). Men disclosed their HIV status in only 7.7% of encounters. With the likelihood of risky sexual practices varying according to background, results from this study should be used to guide interventions aiming to promote safer sex in SOPVs.

Potential Effectiveness of Specific Anti-Smoking Mass Media Advertisements among Australian Indigenous Smokers

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Stewart, Harold S.; Bowden, Jacqueline A.; Bayly, Megan C.; Sharplin, Greg R.; Durkin, Sarah J.; Miller, Caroline L.; Givans, Sharon E.; Warne, Charles D.; Wakefield, Melanie A.

2011-01-01

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156…

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners.

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Kilgour, Catherine; Bogossian, Fiona Elizabeth; Callaway, Leonie; Gallois, Cindy

2018-05-04

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Purposive sampling and convergent interviews explored participants' communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Clinicians who provided maternity care at a tertiary referral hospital (n=13) in Queensland, Australia, and general practitioners (n=16) who provided maternity shared care with that hospital between December 2012 and July 2013. Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights

The quality of COPD care in general practice

DEFF Research Database (Denmark)

Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.

2008-01-01

We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p quality of management. We conclude that participation in an educational...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

Antibiotic Prescription in Danish General Practice

DEFF Research Database (Denmark)

Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov

2016-01-01

1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...... will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria...

Strengthening health promotion in Australian workplaces.

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Fisher, K J; Deeds, S; Siebel, R; Allen, J

1997-01-01

The Australian workplace has emerged as an important venue for influencing the health of employees through regulations and behaviour change programs. Recent surveys have highlighted a growth in this activity but the effectiveness of these programs in changing unhealthy work practices and policies is questionable. The need for strengthening programs by stronger designs and evaluation, and addressing organisational factors and employee participation in planning and implementation processes is documented. Efforts in that direction in Queensland are cited, Building on these existing foundations, redirecting existing resources, and building intersectoral cooperation in public-private partnerships hold a creative, exemplary vision of the future for Australian workplace programming.

Problem drinking - detection and assessment in general practice.

Science.gov (United States)

Demirkol, Apo; Haber, Paul; Conigrave, Katherine

2011-08-01

Alcohol has long been an integral part of the social life of many Australians. However, alcohol is associated with significant harm to drinkers, and also to nondrinkers. This article explores the role of the general practitioner in the detection and assessment of problem drinking. Excessive alcohol use is a major public health problem and the majority of people who drink excessively go undetected. General practitioners are in a good position to detect excessive alcohol consumption; earlier intervention can help improve outcomes. AUDIT-C is an effective screening tool for the detection of problem drinking. National Health and Medical Research Council guidelines suggest that no more than two standard drinks on each occasion will keep lifetime risk of death from alcohol related disease or injury at a low level. Once an alcohol problem is detected it is important to assess for alcohol dependence, other substance use, motivation to change, psychiatric comorbidities and examination and investigation findings that may be associated with excessive alcohol use. A comprehensive assessment of the impact and risk of harm of the patient's drinking to themselves and others is vital, and may require several consultations.

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.

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Dawson, Angela J; Nicolls, Rachel; Bateson, Deborah; Doab, Anna; Estoesta, Jane; Brassil, Ann; Sullivan, Elizabeth A

2017-03-14

Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition

Exploring how Australian occupational therapists and physiotherapists understand each other's professional values: implications for interprofessional education and practice.

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Aguilar, Alejandra; Stupans, Ieva; Scutter, Sheila; King, Sharron

2014-01-01

This article provides insight into the values Australian occupational therapists and physiotherapists consider essential for their practice and the values that they perceive as important for each other. Findings from a study that employed the Delphi technique to identify the values occupational therapists and physiotherapists consider essential for their practice were compared with interview results that provide insight into how these professionals perceive one another's values. The results from this comparison indicate that occupational therapy and physiotherapy participants have limited knowledge of each other's values. This is evidenced by participants only identifying a minority of the values considered essential within the other profession and not identifying many of the values that guide daily practice within the other profession. The results hold implications for interprofessional education and practice, where knowledge of the values of other professions in the team is essential. To enable interprofessional collaboration, professions need to make their values explicit and provide their students, practitioners and educators with opportunities to learn about their own values and the values of other professions.

Perceptions of the role of general practice and practical support measures for carers of stroke survivors: a qualitative study

Directory of Open Access Journals (Sweden)

Harris Ruth

2011-06-01

Full Text Available Abstract Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for

Engaging Musical Practices: A Sourcebook for Middle School General Music

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Burton, Suzanne L., Ed.

2012-01-01

Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

Periodontal Emergencies in General Practice.

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Wadia, Reena; Ide, Mark

2017-05-01

Diagnosing and managing periodontal emergencies is a common part of general dental practice. This article summarises the presentation, aetiology and management of the key periodontal emergencies, including gingival abscess, periodontal abscess, peri-coronitis/peri-coronal abscess, perio-endo lesion/ abscess, necrotising gingivitis and periodontitis, acute herpetic gingivostomatitis, acute physical/chemical/thermal injury and subgingival root fracture.

Globalization and Classroom Practice: Insights on Learning about the World in Swedish and Australian Schools

Directory of Open Access Journals (Sweden)

Ruth Reynolds

2013-08-01

Full Text Available Globalization and global education implies changes to practices at the classroom level to adapt to new imperatives associated with technology use and awareness, and environmental sustainability. It also implies much more. It implies that teachers apply their classroom pedagogy to take account of students’ new found global understandings of which they, and the school community, is largely unaware. This article addresses and discuses three key consequences of globalization for classrooms worldwide; an increased diversity of experience of the students within the classroom, an increased competitiveness of educational outcomes between national states and subsequently some standardisation of curriculum across nations to enable this, and an increased emphasis on teaching skills and values associated with intercultural understanding. Young children’s map knowledge and their resultant, and associated, interpretations of the world from a comparative study a from Swedish and Australian primary classrooms is used as examples of some of these implications of the impact of ‘global culture’ and ‘global issues’ on current and future classroom practice.

Astronomical Symbolism in Australian Aboriginal Rock Art

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Norris, Ray P.; Hamacher, Duane W.

2011-05-01

Traditional Aboriginal Australian cultures include a significant astronomical component, perpetuated through oral tradition and ceremony. This knowledge has practical navigational and calendrical functions, and sometimes extends to a deep understanding of the motion of objects in the sky. Here we explore whether this astronomical tradition is reflected in the rock art of Aboriginal Australians. We find several plausible examples of depictions of astronomical figures and symbols, and also evidence that astronomical observations were used to set out stone arrangements. However, we recognise that the case is not yet strong enough to make an unequivocal statement, and describe our plans for further research.

Television and Popular Culture: Reflections on British and Australian Critical Practice.

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Fiske, John

1986-01-01

Traces the development of British and Australian television criticism from the mid-seventies. Suggests a conscious study of the characteristics of television as a cultural agent and as a text within a sociocultural context. (MS)

How compliant are dental practice Facebook pages with Australian health care advertising regulations? A Netnographic review.

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Holden, Acl; Spallek, H

2018-03-01

The National Law that regulates the dental and other health care professions in Australia sets out regulations that dictate how dental practices are to advertise. This study examines the extent to which the profession complies with these regulations and the potential impact that advertising may have upon professionalism. A Facebook search of 38 local government areas in Sydney, New South Wales, was carried out to identify dental practices that had pages on this social media site. A framework for assessment of compliance was developed using the regulatory guidelines and was used to conduct a netnographic review. Two hundred and sixty-six practice pages were identified from across the 38 regions. Of these pages, 71.05% were in breach of the National Law in their use of testimonials, 5.26% displayed misleading or false information, 4.14% displayed offers that had no clear terms and conditions or had inexact pricing, 19.55% had pictures or text that was likely to create unrealistic expectations of treatment benefit and 16.92% encouraged the indiscriminate and unnecessary utilization of health services. This study found that compliance with the National Law by the Facebook pages surveyed was poor. © 2017 Australian Dental Association.

Physical activity coaching by Australian Exercise Physiologists is cost effective for patients referred from general practice.

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Ewald, Ben; Stacey, Fiona; Johnson, Natalie; Plotnikoff, Ronald C; Holliday, Elizabeth; Brown, Wendy; James, Erica L

2018-02-01

Interventions to promote physical activity for sedentary patients seen in general practice may be a way to reduce the burden of chronic disease. Coaching by an exercise physiologist is publicly funded in Australia, but cost effectiveness has not been documented. In a three-arm randomised controlled trial, face-to-face coaching and telephone coaching over 12 weeks were compared with a control group using the outcome of step count for one week at baseline, three months and twelve months. Program costs and time-based costs were considered. Quality of life was measured as a secondary outcome. At 12 months, the intervention groups were more active than controls by 1,002 steps per day (95%CI 244, 1,759). This was achieved at a cost of AUD$245 per person. There was no change in reported quality of life or utility values. Coaching achieved a modest increase in activity equivalent to 10 minutes walking per day, at a cost of AUD$245 per person. Face-to-face and telephone counselling were both effective. Implication for public health: Persistence of increases nine months after the end of coaching suggests it creates long-term change and is a good value health intervention. © 2017 The Authors.

Supporting primary care nurses to work at an advanced level through changing practices.

Science.gov (United States)

Forsdike, Kirsty; Murphy, Tracy Ann; Hegarty, Kelsey

2018-04-06

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.

Incentives for industrial R&D: The Australian experience

OpenAIRE

Peter Hall

1996-01-01

The effects of Australian measures to influence investment in industrial R&D (IRD) are anafysed. Australian experience tends to suggest that, while selective schemes have performed a little better than a tax concession alone, the advantage to selectivity would look less pronounced if general incentives were extended at an appropriate rate to firms in tax loss. Even with relatively low inducement rates, such incentives appear to have the advantage, from an evolutionary perspective, of encourag...

Younger people with Type 2 diabetes have poorer self-care practices compared with older people: results from the Australian National Diabetes Audit.

Science.gov (United States)

Nanayakkara, N; Pease, A J; Ranasinha, S; Wischer, N; Andrikopoulos, S; de Courten, B; Zoungas, S

2018-05-05

This cross-sectional study compares the self-care practices of younger and older people with Type 2 diabetes. Data were analysed from the Australian National Diabetes Audit (ANDA) including 2552 adults with Type 2 diabetes from Australian Diabetes Centres. Pre-specified demographic and clinical variables were obtained. Self-care variables (physical activity, following dietary recommendations, medication adherence and monitoring blood glucose levels) were compared in people ≤ 64 and > 64 years of age. Mean age (± sd) of participants was 63 ± 13 years overall, 53 ± 9 years for the younger group and 73 ± 6 years for the older group. A greater proportion of younger people had HbA 1c levels > 53 mmol/mol (> 7.0%) (76% vs. 68%), reported difficulty following dietary recommendations (50% vs. 32%) and forgetting medications (37% vs. 22%) compared with older people (all P-values  64 years required insulin therapy (59% vs. 57%, P = 0.200). Younger age was associated with a twofold increase in the odds of not following the recommended self-care practices after adjustment for gender, smoking, insulin therapy, depression and allied health attendance (all P < 0.001). Despite shorter diabetes duration, younger age was associated with worse glycaemic control and poorer diabetes self-care practices among people with Type 2 diabetes. Targeted strategies are required to optimize diabetes self-care practices and thereby glycaemic control. © 2018 Diabetes UK.

Aboriginal Agency and Marginalisation in Australian Society

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Terry Moore

2014-09-01

Full Text Available It is often argued that while state rhetoric may be inclusionary, policies and practices may be exclusionary. This can imply that the power to include rests only with the state. In some ways, the implication is valid in respect of Aboriginal Australians. For instance, the Australian state has gained control of Aboriginal inclusion via a singular, bounded category and Aboriginal ideal type. However, the implication is also limited in their respect. Aborigines are abject but also agents in their relationship with the wider society. Their politics contributes to the construction of the very category and type that governs them, and presses individuals to resist state inclusionary efforts. Aboriginal political elites police the performance of an Aboriginality dominated by notions of difference and resistance. The combined processes of governance act to deny Aborigines the potential of being both Aboriginal and Australian, being different and belonging. They maintain Aborigines’ marginality.

Best Practice Benchmarking in Australian Agriculture: Issues and Challenges

OpenAIRE

Ronan, Glenn; Cleary, Gordon

2000-01-01

The quest to shape Australian agriculture for improved and sustainable profitability is leading Research and Development Corporations, agri-service consultants and government to devote substantial effort into development of new farm business analysis and benchmarking programs. ‘Biz Check’, ‘Pork Biz’, ‘Wool Enterprise Benchmarking’, ‘Dairy Business Focus’ and ‘Business Skills and Best Practice’ for beef and sheep meat producers are examples of current farm management and training programs whe...

Learning a novel technique to identify possible melanomas: are Australian general practitioners better than their U.K. colleagues?

Directory of Open Access Journals (Sweden)

Watson Tony

2009-04-01

Full Text Available Abstract Background Spectrophotometric intracutaneous analysis (SIAscopy™ is a multispectral imaging technique that is used to identify 'suspicious' (i.e. potentially malignant pigmented skin lesions for further investigation. The MoleMate™ system is a hand-held scanner that captures SIAscopy™ images that are then classified by the clinician using a computerized diagnostic algorithm designed for the primary health care setting. The objectives of this study were to test the effectiveness of a computer program designed to train health care workers to identify the diagnostic features of SIAscopy™ images and compare the results of a group of Australian and a group of English general practitioners (GPs. Methods Thirty GPs recruited from the Perth (Western Australia metropolitan area completed the training program at a workshop held in March 2008. The accuracy and speed of their pre- and post-test scores were then compared with those of a group of 18 GPs (including 10 GP registrars who completed a similar program at two workshops held in Cambridge (U.K. in March and April, 2007. Results The median test score of the Australian GPs improved from 79.5% to 86.5% (median increase 5.5%; p Conclusion Most of the SIAscopy™ features can be learnt to a reasonable degree of accuracy with this brief computer training program. Although the Australian GPs scored higher in the pre-test, both groups had similar levels of accuracy and speed in interpreting the SIAscopy™ features after completing the program. Scores were not affected by previous dermoscopy experience or dermatology training, which suggests that the MoleMate™ system is relatively easy to learn.

Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial.

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McKenzie, Joanne E; French, Simon D; O'Connor, Denise A; Mortimer, Duncan S; Browning, Colette J; Russell, Grant M; Grimshaw, Jeremy M; Eccles, Martin P; Francis, Jill J; Michie, Susan; Murphy, Kerry; Kossenas, Fiona; Green, Sally E

2013-08-19

Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers. This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs' (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial). The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs' detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In

Clinical indications for antibiotic use in Danish general practice

DEFF Research Database (Denmark)

Aabenhus, Rune; Hansen, Malene Plejdrup; Siersma, Volkert Dirk

2017-01-01

of routine electronic antibiotic prescriptions from Danish general practice. Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013). Main outcome measures: Number of prescriptions per clinical indication. Number......Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice. Design: Retrospective cohort register-based study including the Danish National Prescription Register. Setting: Population-based study...... from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation...

Knowledge, attitudes and beliefs towards management of men with locally advanced prostate cancer following radical prostatectomy: an Australian survey of urologists.

Science.gov (United States)

Brown, Bernadette; Young, Jane; Kneebone, Andrew B; Brooks, Andrew J; Dominello, Amanda; Haines, Mary

2016-04-01

To investigate Australian urologists' knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. A nationwide mailed and web-based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). 157 surveys were included in the analysis (45% response rate). Just over half of respondents (54%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists' attitudes and beliefs towards the specific recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = 0.520, P towards clinical practice guidelines in general were positive. There remains clinical equipoise among Australian urologists in relation to adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice

DEFF Research Database (Denmark)

Lundstrøm, Sanne Lykke; Edwards, Kasper; Bøllingtoft Knudsen, Thomas

2014-01-01

Background. Relational coordination (RC) and organisational social capital (OSC) aremeasures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives.The aim of this studywas to analyse the associations between RC and OSC......, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC...... and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type...

Mixed Messages: Inconsistent Sexual Scripts in Australian Teenage Magazines and Implications for Sexual Health Practices

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Burns, Melanie C.

2018-01-01

Condom use among Australian adolescents has been shown to be variable, despite good knowledge among this group about sexual health risks and the promotion of condoms as a simple way to reduce the spread of sexually transmitted infections. This study explores dominant constructions of condom use within two Australian lifestyle magazines targeted…

[Trends among medical students towards general practice or specialization].

Science.gov (United States)

Breinbauer K, Hayo; Fromm R, Germán; Fleck L, Daniela; Araya C, Luis

2009-07-01

A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Fifty three percent of students desired to enter a specialization program. Only 20% would work as a general practitioner (27% were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p specialized medicine in the teaching environment. Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

Will Australians pay for health care advice from a community pharmacist? A video vignette study.

Science.gov (United States)

Sriram, Deepa; McManus, Alexandra; Emmerton, Lynne; Jiwa, Moyez

2015-01-01

Large proportion of Australians have access to pharmacists' health advice at no cost. The impact of a proposed co-payment levy for general practitioner (GP) consultation by Australian government is unclear. This raises an interesting question about consumers' perceived value of health-related consultations. This survey of representative sample of Western Australians explores the hypothesis that Australians are willing to pay for advanced model of pharmacy consultation. Two videos illustrating current-services and quality-enhanced-service (QES) incorporating systematic assessment of symptoms and referral to GP if necessary, were used. Participants viewed videos online and completed a willingness-to-pay (WTP) questionnaire about their perception and WTP for each service. Logistic regression and McNemar tests were used to identify WTP groups. Of the 175 respondents, one in nine (19/175, 11%) were willing to pay and (35/175) 20% might consider paying for advice at pharmacies as per current-practice. Almost one in four (49/175, 28%) were willing to pay and (47/175) 27% would consider paying for QES (McNemar Test P pay for consultation at pharmacies that offers more private, time-intensive experience with documented GP referral where required. Further research is warranted to test WTP with actual customers to confirm these results. Copyright © 2015 Elsevier Inc. All rights reserved.

School Libraries Empowering Learning: The Australian Landscape.

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Todd, Ross J.

2003-01-01

Describes school libraries in Australia. Highlights include the title of teacher librarian and their education; the history of the role of school libraries in Australian education; empowerment; information skills and benchmarks; national standards for school libraries; information literacy; learning outcomes; evidence-based practice; digital…

The new era of postgraduate certified general practice training in Japan.

Science.gov (United States)

Takamura, Akiteru

2016-09-01

This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

Changes in pathology test ordering by early career general practitioners: a longitudinal study.

Science.gov (United States)

Magin, Parker J; Tapley, Amanda; Morgan, Simon; Henderson, Kim; Holliday, Elizabeth G; Davey, Andrew R; Ball, Jean; Catzikiris, Nigel F; Mulquiney, Katie J; van Driel, Mieke L

2017-07-17

To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8-15%; P pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns.

Classifying Australian PhD Theses: Linking Research and Library Practices

Science.gov (United States)

Macauley, Peter; Evans, Terry; Pearson, Margot

2010-01-01

This article draws on the findings from, and the methods and approach used in the provision of a database of Australian PhD thesis records for the period 1987 to 2006, coded by Research Fields, Courses and Disciplines (RFCD) fields of study. Importantly, the project was not merely the creation of yet another database but something that constitutes…

Treatment of urinary incontinence in women in general practice: observational study.

OpenAIRE

Seim, A.; Sivertsen, B.; Eriksen, B. C.; Hunskaar, S.

1996-01-01

OBJECTIVE--To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN--Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING--General practice in the rural district of Rissa, Norway. SUBJECTS--105 women aged 20 or more with urinary incontinence. INTERVENTIONS--Treatment with pelvic floor exercises, electrostimula...

What is at stake? Exploring the moral experience of stigma with Indian-Australians and Anglo-Australians living with depression.

Science.gov (United States)

Brijnath, Bianca; Antoniades, Josefine

2018-04-01

This article applies the framework of moral experience to examine the cultural experience of stigma with Indian-Australians and Anglo-Australians living with depression in Melbourne, Australia. To date few studies have examined this dynamic in relation to mental illness and culture, and no studies have applied this framework in a culturally comparative way. Based on 58 in-depth interviews with people with depression recruited from the community, we explicate how stigma modulates what is at stake upon disclosure of depression, participants' lived experience following that disclosure, and how practices of health-seeking become stigmatised. Findings show that the social acceptance of depression jars against participants' experience of living with it. Denialism and fear of disclosure were overwhelming themes to emerge from our analysis with significant cultural differences; the Anglo-Australians disclosed their depression to family and friends and encountered significant resistance about the legitimacy of their illness. In contrast, many Indian-Australians, especially men, did not disclose their illness for fear of a damaged reputation and damaged social relations. For Indian-Australians, social relations in the community were at stake, whereas for Anglo-Australians workplace relations (but not community relations) were at stake. Participants' experiences in these settings also influenced their patterns of health-seeking behaviors and age and inter-generational relationships were important mediators of stigma and social support. These findings illuminate how stigma, culture, and setting are linked and they provide critical information necessary to identify and develop customised strategies to mitigate the harmful effects of stigma in particular cultural groups.

Teaching nursing's history: a national survey of Australian Schools of Nursing, 2007-2008.

Science.gov (United States)

McAllister, Margaret; Madsen, Wendy; Godden, Judith; Greenhill, Jennene; Reed, Rachel

2010-05-01

This paper reports on a survey of Australian Schools of Nursing that took place over an 8months period between 2007 and 2008. This study was implemented to extend understanding of effective teaching of nursing history, an area not previously researched in Australia. A critical interpretive method enabled us to problematise the issue, to highlight what was said about the importance of history teaching as well as ad hoc practices and barriers. The study found that participants value history of nursing teaching, but the crowded curriculum is erasing history's place and potential. It revealed ideological tensions shaping and constraining history of nursing teaching. In Australia, the way nursing's history is taught varies and teaching content, strategies and resources utilised are not evenly available. Pedagogical innovations are not effectively disseminated. Our recommendations for Australian Schools of Nursing that have more general applicability are: (1) Nursing curriculum needs to be developed from a set of principles and standards that define the attributes of the professional nurse, not in response to interest groups and (2) History of nursing pedagogy should be systematically developed and disseminated through a national virtual centre, linked to international centres, to enhance teachers' understanding of the discipline area and to support their teaching practice. Copyright 2009 Elsevier Ltd. All rights reserved.

The Australian optometric workforce 2005, analysed by local government areas.

Science.gov (United States)

Kiely, Patricia M; Horton, Peregrine; Chakman, Joseph

2007-03-01

Previous studies of the Australian optometric workforce have taken a coarse view of the distribution of optometrists, at best comparing concentrations of optometrists in city and country areas and between states and territories. A more discriminating approach recognising the size and variation in population density of the country is necessary for a more realistic insight into the optometric workforce. This study addresses the distribution of optometrists across smaller geographic units, known as local government areas (LGAs). The number of equivalent full-time optometrists in each Australian LGA was determined using data from the Optometrists Association Australia database. Data from the Australian Bureau of Statistics and the Australian national health program (Medicare) were applied to determine the demand for services based on age distributions in LGAs and to calculate the adequacy of the number of optometrists. Optometrists are concentrated in areas of high population with capital city regions and their surrounds well-serviced but with rural and remote LGAs with low populations generally not having optometrists. The highest excesses of optometrists occur in the capital city LGAs of Melbourne, Sydney and Adelaide (64, 60 and 28.4 equivalent full-time optometrists respectively). The highest deficits occur in Casey (Victoria), Lake Macquarie (New South Wales) and Onkaparinga (South Australia), (-16.4, -15.6 and -13.4 equivalent full-time optometrists, respectively). There are substantial variations in the distribution of optometrists across LGAs in Australia but the variation is often a poor indicator of the ease with which people can access optometric services. In metropolitan areas, people may live close to an optometric practice in a neighbouring LGA. In rural areas, an LGA may appear to have an adequate number of optometrists but some residents may be several hours from the nearest optometrist or the optometric service is provided on a part-time basis.

Social environment and frequent attendance in Danish general practice

DEFF Research Database (Denmark)

Vedsted, Peter; Olesen, Frede

2005-01-01

inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross......BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social...... during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total...

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

Directory of Open Access Journals (Sweden)

Grol Richard

2009-07-01

Full Text Available Abstract Background The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Methods Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Results and discussion Workload and job stress are associated with practice performance. Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16. After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45. When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care. Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21 and insufficient practice management (b = 0.25. Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35. Conclusion Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.

Science.gov (United States)

van den Hombergh, Pieter; Künzi, Beat; Elwyn, Glyn; van Doremalen, Jan; Akkermans, Reinier; Grol, Richard; Wensing, Michel

2009-07-15

The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Workload and job stress are associated with practice performance.Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care.Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35). Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP.

The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice.

Science.gov (United States)

Henderson, Amanda J; Davies, Jan; Willet, Michaela R

2006-11-01

This paper describes a qualitative program evaluation which sought to identify factors that either assist or impede the adoption of clinical evidence in everyday practice. Thirteen Australian projects were funded in a competitive grant program to adopt innovative strategies to improve the uptake of research evidence in everyday clinical practice. Project leaders' reports were analysed to collate common themes related to 1) critical elements in successful application of research knowledge, 2) barriers to implementing evidence, and 3) lessons for other organisations that might implement a similar project. Despite the diversity of the methods used to establish projects and the range of topics and clinical settings, many similarities were identified in the perceived critical success elements, barriers, and lessons for adopting clinical evidence. Eighteen themes emerged across the data including: leadership support; key stakeholder involvement; practice changes; communication; resources; education of staff; evaluation of outcomes; consumers; knowledge gaps; adoption/implementing staff; access to knowledge; risk assessment; collaboration; effectiveness of clinical research evidence; structure/organisation; cultural barriers; previous experiences; and information technology. Leaders of projects to adopt evidence in clinical practice identified barriers, critical success elements and lessons that impacted on their projects. A range of influences on the adoption of evidence were identified, and this knowledge can be used to assist others undertaking similar projects.

Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

Science.gov (United States)

Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

2008-01-01

The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

Nigerian Journal of General Practice: About this journal

African Journals Online (AJOL)

Policies. » Focus and Scope; » Section Policies; » Peer Review Process; » Publication Frequency; » Subscriptions; » The Association of General and Private Medical Practitioners of Nigeria [AGPMPN]; » Advertising in the Nigerian Journal of General Practice; » NJGP Editorial Board ...

Structuring diabetes care in general practices: many improvements, remaining challenges.

LENUS (Irish Health Repository)

Jennings, S

2009-08-07

BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

Refugee experiences of general practice in countries of resettlement: a literature review.

Science.gov (United States)

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Topics from Australian Conferences on Teaching Statistics

CERN Document Server

Phillips, Brian; Martin, Michael

2014-01-01

The first OZCOTS conference in 1998 was inspired by papers contributed by Australians to the 5th International Conference on Teaching Statistics. In 2008, as part of the program of one of the first National Senior Teaching Fellowships, the 6th OZCOTS was held in conjunction with the Australian Statistical Conference, with Fellowship keynotes and contributed papers, optional refereeing and proceedings. This venture was so successful that the 7th and 8th OZCOTS were similarly run, conjoined with Australian Statistical Conferences in 2010 and 2012. Authors of papers from these OZCOTS conferences were invited to develop chapters for refereeing and inclusion in this volume. There are sections on keynote topics, undergraduate curriculum and learning, professional development, postgraduate learning, and papers from OZCOTS 2012. Because OZCOTS aim to unite statisticians and statistics educators, the approaches this volume takes are immediately relevant to all who have a vested interest in good teaching practices. Glo...

General practice-based clinical trials in Germany - a problem analysis

Directory of Open Access Journals (Sweden)

Hummers-Pradier Eva

2012-11-01

Full Text Available Abstract Background In Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy. Methods Based on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented. Results In Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1 problem analysis, and definition of (2 structural prerequisites and (3 procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs, templates, checklists and other supporting materials for researchers. Conclusion All in all, our problem analyses revealed that

Global adaptation patterns of Australian and CIMMYT spring bread wheat.

Science.gov (United States)

Mathews, Ky L; Chapman, Scott C; Trethowan, Richard; Pfeiffer, Wolfgang; van Ginkel, Maarten; Crossa, Jose; Payne, Thomas; Delacy, Ian; Fox, Paul N; Cooper, Mark

2007-10-01

The International Adaptation Trial (IAT) is a special purpose nursery designed to investigate the genotype-by-environment interactions and worldwide adaptation for grain yield of Australian and CIMMYT spring bread wheat (Triticum aestivum L.) and durum wheat (T. turgidum L. var. durum). The IAT contains lines representing Australian and CIMMYT wheat breeding programs and was distributed to 91 countries between 2000 and 2004. Yield data of 41 reference lines from 106 trials were analysed. A multiplicative mixed model accounted for trial variance heterogeneity and inter-trial correlations characteristic of multi-environment trials. A factor analytic model explained 48% of the genetic variance for the reference lines. Pedigree information was then incorporated to partition the genetic line effects into additive and non-additive components. This model explained 67 and 56% of the additive by environment and non-additive by environment genetic variances, respectively. Australian and CIMMYT germplasm showed good adaptation to their respective target production environments. In general, Australian lines performed well in south and west Australia, South America, southern Africa, Iran and high latitude European and Canadian locations. CIMMYT lines performed well at CIMMYT's key yield testing location in Mexico (CIANO), north-eastern Australia, the Indo-Gangetic plains, West Asia North Africa and locations in Europe and Canada. Maturity explained some of the global adaptation patterns. In general, southern Australian germplasm were later maturing than CIMMYT material. While CIANO continues to provide adapted lines to northern Australia, selecting for yield among later maturing CIMMYT material in CIANO may identify lines adapted to southern and western Australian environments.

Promoting Mental Health and Preventing Mental Illness in General Practice.

Science.gov (United States)

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

Referrals and relationships: in-practice referrals meetings in a general practice.

Science.gov (United States)

Rowlands, G; Willis, S; Singleton, A

2001-08-01

GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted

Influences on final year medical students' attitudes to general practice as a career.

Science.gov (United States)

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: a descriptive exploratory cohort study.

Science.gov (United States)

Baldwin, Richard; Duffield, Christine Margaret; Fry, Margaret; Roche, Michael; Stasa, Helen; Solman, Annette

2013-03-01

The NSW Health Policy Directive (NSW Department of Health, 2000) lists clinical service and consultancy; clinical leadership; research; education; clinical services planning and management as the five domains of practice for nurses appointed as Clinical Nurse Consultants (CNCs), an Australian advanced practice nurse (APN) role. However, there is no clear definition of what is meant by advanced practice in the Australian nursing context. Nowhere is this more evident than in differentiating between the roles of Clinical Nurse Consultants (CNCs) and Nurse Practitioners (NP) in NSW. To date, limited empirical research has been done to characterise or delineate CNC role activity and responsibility. To investigate (i) the nature of CNC roles, activities and responsibilities, (ii) differentiate between CNCs by their work patterns and activities, and (iii) empirically conceptualize and differentiate ways CNCs practice in terms of an APN typology. The study sample was 56 CNCs at one tertiary level public hospital in Australia. A descriptive exploratory cohort study was conducted to explore CNC role characteristics and patterns of activity. Data were triangulated using an online survey, a follow-up survey, and semi-structured interviews. The data were analysed using descriptive statistics to examine differences between CNC work patterns and role activities. The survey data and the individual reports were thematically analysed to investigate for difference across the population of CNCs. Interpretation of survey and interview data led to an analyst-developed CNC typology of four CNC categories based on the work patterns and activities of Sole Practitioner, Clinic Coordinator, Clinical Team Coordinator and Clinical Leader. The typology was based on the themes interprofessional, role focus, clinical focus and setting as these themes distinguished and differentiated CNC roles. The study provides evidence of great diversity and prioritization within CNC roles. The CNC typology

Practices, patients and (imperfect data - feasibility of a randomised controlled clinical drug trial in German general practices

Directory of Open Access Journals (Sweden)

Hummers-Pradier Eva

2011-04-01

Full Text Available Abstract Background Randomised controlled clinical (drug trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01 to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI. Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP standards as defined by the International Conference on Harmonisation (ICH in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1 successful practice recruitment, 2 sufficient patient recruitment, 3 complete and accurate data collection and 4 appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and

Australian Hospital-Based Nurse Educators' Perceptions of Their Role.

Science.gov (United States)

Thornton, Karleen

2018-06-01

This article presents the findings from a phenomenological study that explored the understandings of Australian hospital-based nurse educators' experiences of their role. Purposive sampling resulted in 11 nurse educators from four large metropolitan hospitals within an Australian jurisdiction. The participants were asked how they understand their role and translate that understanding into practice. Thematic analysis identified four themes representative of nurse educators' understanding of their role: Becoming an Educator, Capability Building, Panacea, and Tension. A coherent picture emerged from subthemes highlighting that nurse educators were undervalued and value is added. Being undervalued and value adding are translated into nurse educator practice as resilience, being educationally literate, investing, and having a presence. This article identifies a gap in knowledge related to understanding the nurse educator role and informs recruitment and subsequent retention of nurses into nurse educator roles at a time when the nursing workforce in Australia and internationally is about to experience a major shortfall. Findings are specific to the Australian context and are not necessarily generalizable to other hospital jurisdictions. J Contin Educ Nurs. 2018;49(6):274-281. Copyright 2018, SLACK Incorporated.

Playing With Antidepressants: Perspectives From Indian Australians and Anglo-Australians Living With Depression.

Science.gov (United States)

Brijnath, Bianca; Antoniades, Josefine

2017-11-01

Patient perspectives were explored on the meaning and experience of antidepressant use by applying Johan Huizinga's theory of play to interviews from Indian Australians and Anglo-Australians diagnosed with depression. Through the analysis, the centrality of Huizinga's "magic circle" emerged, that is, defining the boundaries within which one could safely play. Consumption of antidepressants involved learning, breaking, and modulating rules of the game of adherence, then forging a new "magic circle." In these games, there were playful elements including experimentation, improvisation, absorption, and experiential learning. This application of Huizinga's theory in relation to antidepressant use is a novel approach in the literature on medication non/adherence. This application not only opens a new theoretical line of inquiry but also shows that antidepressant non/adherence is not a static practice but dynamic and changing, revealing critical insights around participant's agency, capabilities, desires, and notions of selfhood with regard to managing their depression and conceptualizing their recovery.

'It Opened My Eyes'-examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory.

Science.gov (United States)

Yeung, Anna; Hocking, Jane; Guy, Rebecca; Fairley, Christopher K; Smith, Kirsty; Vaisey, Alaina; Donovan, Basil; Imrie, John; Gunn, Jane; Temple-Smith, Meredith

2018-03-28

Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.

Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap.

Science.gov (United States)

Demaio, Alessandro; Drysdale, Marlene; de Courten, Maximilian

2012-06-01

Health promotion for Australian Aboriginal and Torres Strait Islander communities and their people has generally had limited efficacy and poor sustainability. It has largely failed to recognise and appreciate the importance of local cultures and continues to have minimal emphasis on capacity building, community empowerment and local ownership. Culturally Appropriate Health Promotion is a framework of principles developed in 2008 with the World Health Organization and the Global Alliance for Health Promotion. It serves as a guide for community-focused health promotion practice to be built on and shaped by the respect for understanding and utilisation of local knowledge and culture. Culturally Appropriate Health Promotion is not about targeting, intervening or responding. Rather, it encourages health programme planners and policymakers to have a greater understanding, respect, a sense of empowerment and collaboration with communities, and their sociocultural environment to improve health. This commentary aims to examine and apply the eight principles of Culturally Appropriate Health Promotion to the Australian Aboriginal and Torres Strait Islander context. It proposes a widespread adoption of the framework for a more respectful, collaborative, locally suitable and therefore appropriate approach to Australian Aboriginal and Torres Strait Islander health promotion.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders.

Science.gov (United States)

Hay, Phillipa; Chinn, David; Forbes, David; Madden, Sloane; Newton, Richard; Sugenor, Lois; Touyz, Stephen; Ward, Warren

2014-11-01

This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014. The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified. In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to

Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

Science.gov (United States)

Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

2015-01-01

Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve

Ambulatory blood pressure monitoring for hypertension in general practice.

OpenAIRE

Taylor, R S; Stockman, J; Kernick, D; Reinhold, D; Shore, A C; Tooke, J E

1998-01-01

Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-ho...

Culture and personality disorder: a focus on Indigenous Australians.

Science.gov (United States)

Balaratnasingam, Sivasankaran; Janca, Aleksandar

2017-01-01

To examine the validity of concept and diagnosis of personality disorder in transcultural settings using Indigenous Australian people as an example. There are significant deficits in comparative research on personality disorders across cultures. There is also a dearth of information regarding Indigenous Australians, and cultural applicability and clinical utility of the diagnosis of personality disorder in this group. The concept of culture is generally ignored when making a diagnosis of personality disorder. A valid diagnosis should incorporate what would be considered understandable and adaptive behavior in a person's culture. In Indigenous Australian culture, making diagnosis of a personality disorder is complicated by historical trauma from colonization, disruption of kinship networks, and ongoing effects of poverty and social marginalization.

Clinical accuracy of point-of-care urine culture in general practice

DEFF Research Database (Denmark)

Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller

2017-01-01

OBJECTIVE: To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. DESIGN: Prospective diagnostic...... uncomplicated, symptomatic UTI. MAIN OUTCOME MEASURES: (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply...... general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci...

Use of general practice by intravenous heroin users on a methadone programme.

OpenAIRE

Leaver, E J; Elford, J; Morris, J K; Cohen, J

1992-01-01

Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number ...

Potential for Australian involvement in ITER

International Nuclear Information System (INIS)

O'Connor, D. J.; Collins, G. A.; Hole, M. J.

2006-01-01

Full text: Full text: Fusion, the process that powers the sun and stars, offers a solution to the world's long-term energy needs: providing large scale energy production with zero greenhouse gas emissions, short-lived radio-active waste compared to conventional nuclear fission cycles, and a virtually limitless supply of fuel. Almost three decades of fusion research has produced spectacular progress. Present-day experiments have a power gain ratio of approximately 1 (ratio of power out to power in), with a power output in the 10's of megawatts. The world's next major fusion experiment, the International Thermonuclear Experimental Reactor (ITER), will be a pre-prototype power plant. Since announcement of the ITER site in June 2005, the ITER project, has gained momentum and political support. Despite Australia's foundation role in the field of fusion science, through the pioneering work of Sir Mark Oliphant, and significant contributions to the international fusion program over the succeeding years, Australia is not involved in the ITER project. In this talk, the activities of a recently formed consortium of scientists and engineers, the Australian ITER Forum will be outlined. The Forum is drawn from five Universities, ANSTO (the Australian Nuclear Science and Technology Organisation) and AINSE (the Australian Institute for Nuclear Science and Engineering), and seeks to promote fusion energy in the Australian community and negotiate a role for Australia in the ITER project. As part of this activity, the Australian government recently funded a workshop that discussed the ways and means of engaging Australia in ITER. The workshop brought the research, industrial, government and general public communities, together with the ITER partners, and forged an opportunity for ITER engagement; with scientific, industrial, and energy security rewards for Australia. We will report on the emerging scope for Australian involvement

Breast milk banking: current opinion and practice in Australian neonatal intensive care units.

Science.gov (United States)

Lam, Eva Y; Kecskés, Zsuzsoka; Abdel-Latif, Mohamed E

2012-09-01

To find out the knowledge and attitudes of health-care professionals (HCPs) in Australian neonatal intensive care units (NICUs) towards breast milk banking (BMBg) and pasteurised donated breast milk (PDBM). Cross-sectional structured survey of HCPs in all 25 NICUs in Australia. Response rate was 43.4% (n= 358 of 825). Participants included nurses and midwives (291, 81.3%) and the remainder were neonatologists and neonatal trainees (67, 18.7%). A variable number of HCPs agreed that PDBM would decrease the risk of necrotising enterocolitis (81%) and allergies (48.9%), 8.4% thought PDBM will carry risk of infections and 78.8% agreed that PDBM is preferable over formula, but only 67.5% thought that establishing breast milk banks (BMBs) are justifiable. Significant differences were found between doctors and nurses/midwives, with 19.4% of doctors compared with 5.8% of nurses/midwives agreed that PDBM carried an increased risk of infection. Although, over 90% of nurses/midwives and 70% of doctors agreed that the donation of breast milk is important, only 71% of nurses/midwives and 52.2% of doctors thought that setting up a BMB was justifiable. The opinions about BMBg differ widely between HCPs; however, the majority support the practice. HCPs had different knowledge gaps in regard to BMBg. Nurses/midwives positively view the practice of BMBg more strongly compared with neonatologists. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

Science.gov (United States)

Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

2015-04-01

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations

Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice.

Science.gov (United States)

Abell, Bridget; Glasziou, Paul; Briffa, Tom; Hoffmann, Tammy

2016-01-01

Exercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia. Cross-sectional survey. Australian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics. 297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1-2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (technology, such as mobile phones or the internet, to deliver or support exercise training. While advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients.

Regionalisation of general practice training--are we meeting the needs of rural Australia?

Science.gov (United States)

Campbell, David G; Greacen, Jane H; Giddings, Patrick H; Skinner, Lesley P

2011-06-06

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

Science.gov (United States)

Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

2018-03-01

Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible

Australian public attitudes towards uranium mining and export

International Nuclear Information System (INIS)

Shirvington, P.J.

1987-01-01

The Australian nuclear debate is focused on Australia's role as a uranium supplier, on the risks that this uranium might be diverted to nuclear weapons and on the risks of nuclear weapons generally. The results of a survey which was designed to measure the importance of uranium as an issue and reveal underlying influences and information behind public perceptions are presented. The methods and questions asked are given as well as the results. The results show that Australians are fairly unconcerned about uranium. However, many fear the possible application of civil nuclear technology to nuclear weapons, a fear not recognised or expected by the nuclear industry. The public image of the industry could, and should, be improved by television, films and documentaries to inform the general public about the nuclear industry. (U.K.)

Effects of electronic communication in general practice

NARCIS (Netherlands)

van der Kam, WJ; Moorman, PW; Koppejan-Mulder, MJ

2000-01-01

Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE

Retirement intentions of general practitioners aged 45-65 years.

Science.gov (United States)

Brett, Thomas D; Arnold-Reed, Diane E; Hince, Dana A; Wood, Ian K; Moorhead, Robert G

2009-07-20

To ascertain the retirement intentions of a cohort of Australian general practitioners. Postal questionnaire survey of members of four Divisions of General Practice in Western Australia, sent out November 2007 - January 2008. A sample of 178 GPs aged 45-65 years. Intention to work in general practice until retirement; reasons for retiring before age 65 years; factors that might encourage working beyond chosen retirement age; and perceived obstacles to working in general practice. 63% of GPs intended to work to at least age 65 years, with men more likely to retire early. Of 63 GPs intending to retire early, 46% gave pressure of work, exhaustion and burnout as reasons for early retirement. Better remuneration, better staffing levels and more general support were incentives to continue working for 46% of the 64 GPs who responded to the question about incentives, and more flexible working hours, part-time work and reduced workload for 41%. Of 169 participants, 65% gave increasing bureaucracy, poor job satisfaction and disillusionment with the medical system or Medicare as obstacles to working in general practice in Australia, whereas workforce shortage, increasing patient demands and diminishing lifestyle through overwork were obstacles named by 48%. Many GPs are planning to retire early, reflecting an emerging trend among professionals and society generally. Declining job satisfaction, falling workforce numbers, excessive workload and increasing bureaucracy were recurrent concerns of older WA GPs considering premature retirement.

Bribery: What do Australian managers know and what do they do?

OpenAIRE

Michael Segon; Chris Booth

2014-01-01

The recent conviction and gaoling of former Rio Tinto executive Stern Hu and as well as a further 18 Australian citizens facing charges in relation to "fraud and other economic crimes raises a number of questions regarding ethical business practice. A key issue that should be considered is whether Australian businesses are as ethical and transparent as the current high ranking in the Transparency International corruption index tends to suggest.This paper reviews literature pertaining to the n...

Australian Radiation Protection and Nuclear Safety Act 1998. Guide to the Australian radiation protection and nuclear safety licensing framework. 1. ed.

International Nuclear Information System (INIS)

1999-03-01

The purpose of this guide is to provide information to Commonwealth entities who may require a license under the Australian Radiation Protection and Nuclear Safety (ARPANS) Act 1998 to enable them to posses, have control of, use, operate or dispose of radiation sources. The guide describes to which agencies and what activities require licensing. It also addresses general administrative and legal matters such as appeal procedures, ongoing licensing requirements, monitoring and compliance. Applicants are advised to consult the Australian Radiation Protection and Nuclear Safety Act 1998 and accompanying Regulations when submitting applications

Australian Radiation Protection and Nuclear Safety Act 1998. Guide to the Australian radiation protection and nuclear safety licensing framework; 1. ed

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-03-01

The purpose of this guide is to provide information to Commonwealth entities who may require a license under the Australian Radiation Protection and Nuclear Safety (ARPANS) Act 1998 to enable them to posses, have control of, use, operate or dispose of radiation sources. The guide describes to which agencies and what activities require licensing. It also addresses general administrative and legal matters such as appeal procedures, ongoing licensing requirements, monitoring and compliance. Applicants are advised to consult the Australian Radiation Protection and Nuclear Safety Act 1998 and accompanying Regulations when submitting applications

Practice patterns and career satisfaction of Canadian female general surgeons.

Science.gov (United States)

Hebbard, Pamela C; Wirtzfeld, Debrah A

2009-06-01

We wanted to study how female general surgeons in Canada manage lifestyle and career demands. All female Canadian general surgeons registered with the Royal College of Physicians and Surgeons of Canada were asked to complete a survey evaluating their practice patterns, personal lives, and levels of satisfaction related to these factors. Eighty-five surveys (66%) were returned. Most respondents work in full-time clinical practices. While it was rare to find women in part-time or shared practices, 35% of women reported interest in these alternative models. Respondents described the necessary factors for a transition into alternative models. Job satisfaction was high (3.8 out of 5), with personal and parenting satisfaction being less highly rated (3.3 and 3.2, respectively). Canadian female general surgeons have active and satisfying careers, although many would like to work in alternative practice models that better conform to their lifestyle demands. This pressure will have a significant impact on the future surgical workforce.

Closing the Gap: The Maturing of Quality Assurance in Australian University Libraries

Science.gov (United States)

Tang, Karen

2012-01-01

A benchmarking review of the quality assurance practices of the libraries of the Australian Technology Network conducted in 2006 revealed exemplars of best practice, but also sector-wide gaps. A follow-up review in 2010 indicated the best practices that remain relevant. While some gaps persist, there has been improvement across the libraries and…

General practice and the new science emerging from the theories of 'chaos' and complexity.

OpenAIRE

Griffiths, F; Byrne, D

1998-01-01

This paper outlines the general practice world view and introduces the main features of the theories of 'chaos' and complexity. From this, analogies are drawn between general practice and the theories, which suggest a different way of understanding general practice and point to future developments in general practice research. A conceptual and practical link between qualitative and quantitative methods of research is suggested. Methods of combining data about social context with data about in...

Delivering stepped care for depression in general practice : Results of a survey amongst general practitioners in the Netherlands

NARCIS (Netherlands)

Sinnema, Henny; Franx, Gerdien; Spijker, Jan; Ruiter, Marijke; van Haastrecht, Harry; Verhaak, Peter; Nuyen, Jasper

2013-01-01

Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice. Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important

The Governor-General's Apology: Reflections on Anzac Day

Directory of Open Access Journals (Sweden)

Gerhard Fischer

2012-11-01

Full Text Available In September 1999, the then governor-general of Australia, Sir William Deane, gave a speech to the Australian Conference on Lutheran Education where he offered an apology to members of the German Australian community for the 'tragic, and often shameful, discrimination against Australians of German origin fostered during the world wars'. This article reflects on a number of issues raised by the Governor-General's statement, most importantly on our understanding of the Anzac historiography and its various narratives.

Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

Directory of Open Access Journals (Sweden)

Wagner AC

2010-09-01

Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

Best practice in situ recovery uranium mining in Australia

International Nuclear Information System (INIS)

Lambert, I.B.; McKay, A.D.; Carson, L.J.

2010-01-01

The Australian Government policy is to ensure that uranium mining, milling and rehabilitation is based on world best practice standards. A best practice guide for in situ recovery (ISR) uranium mining has been developed to communicate the Australian Government's expectations with a view to achieving greater certainty that ISR mining projects meet Australian Government policy and consistency in the assessment of ISR mine proposals within multiple government regulatory processes. The guide focuses on the main perceived risks; impacts on groundwaters, disposal of mining residues, and radiation protection. World best practice does not amount to a universal template for ISR mining because the characteristics of individual ore bodies determine the best practice. (author)

CareTrack Kids—part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review

Science.gov (United States)

Hooper, Tamara D; Hibbert, Peter D; Mealing, Nicole; Wiles, Louise K; Jaffe, Adam; White, Les; Cowell, Christopher T; Runciman, William B; Goldstein, Stan; Hallahan, Andrew R; Wakefield, John G; Murphy, Elisabeth; Lau, Annie; Wheaton, Gavin; Williams, Helena M; Hughes, Clifford; Braithwaite, Jeffrey

2015-01-01

Introduction Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. Methods and analysis A random sample of 6000–8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged <16 years who presented with at least one of the study conditions during 2012 and 2013 will be reviewed. Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service and Women's and Children's Hospital Network (South Australia). An application is under review for the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and offer oral presentations to researchers, clinicians and policymakers at national and international conferences. PMID:25854977

PROBLEMS OF GENERAL PRACTICE IN RURAL CALIFORNIA

Science.gov (United States)

Carey, Hollis L.; Andrews, Carroll B.

1949-01-01

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.” Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods. The problem of providing additional adequately equipped and staffed hospitals must receive much consideration. Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice. PMID:18116230

Management Communication for the New Millennium: An Australian Perspective.

Science.gov (United States)

More, Elizabeth A.; Irwin, Harry T.

2000-01-01

Discusses management communications in the general area of identity, and the Australian situation involving management communication scholarship, management communication education, and the future of the field in Australia. (NH)

Theory and interpretation in qualitative studies from general practice

DEFF Research Database (Denmark)

Malterud, Kirsti

2016-01-01

Objective: In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches.  Approach: I discuss different theoretical aspects of qualitative research and present the basic foundations...... theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject...... in qualitative analysis are presented, emphasizing substantive theories to sharpen the interpretative focus. Such approaches are clearly within reach for a general practice researcher contributing to clinical practice by doing more than summarizing what the participants talked about, without trying to become...

Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method

Science.gov (United States)

Power, Emma; Thomas, Emma; Worrall, Linda; Rose, Miranda; Togher, Leanne; Nickels, Lyndsey; Hersh, Deborah; Godecke, Erin; O'Halloran, Robyn; Lamont, Sue; O'Connor, Claire; Clarke, Kim

2015-01-01

Objectives To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Design Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). Participants A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Main outcome measures Statements that achieved a high level of agreement and an overall median score of 7–9 on a nine-point scale were rated as ‘appropriate’. Results 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. Conclusions This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation. PMID:26137883

Collaborative care for depression in general practice

DEFF Research Database (Denmark)

Brinck-Claussen, Ursula Ødum; Curth, Nadja Kehler; Davidsen, Annette Sofie

2017-01-01

Background: Depression is a common illness with great human costs and a significant burden on the public economy. Previous studies have indicated that collaborative care (CC) has a positive effect on symptoms when provided to people with depression, but CC has not yet been applied in a Danish...... context. We therefore developed a model for CC (the Collabri model) to treat people with depression in general practice in Denmark. Since systematic identification of patients is an “active ingredient” in CC and some literature suggests case finding as the best alternative to standard detection, the two...... detection methods are examined as part of the study. The aim is to investigate if treatment according to the Collabri model has an effect on depression symptoms when provided to people with depression in general practice in Denmark, and to examine if case finding is a better method to detect depression...

Towards vertical integration in general practice education: literature review and discussion paper.

Science.gov (United States)

O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

2013-09-01

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

GPs' job satisfaction: doctors who chose general practice early or late.

Science.gov (United States)

Lambert, Trevor; Smith, Fay; Goldacre, Michael

2013-11-01

In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. To compare job satisfaction of GPs who chose general practice early or later in their career. Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the 'more than 5 years' group. For example, in response to the statement 'I find enjoyment in my current post', the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to 'I am doing interesting and challenging work' the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career.

The role of general practice in postgraduate basic training

DEFF Research Database (Denmark)

Kjaer, Niels Kristian; Kodal, Troels; Qvesel, Dorte

2010-01-01

BACKGROUND: In recent years, there has been growing interest in the role of primary care in postgraduate training. Relatively little has been published about benefits of early and sustained postgraduate basic training in general practice, especially for doctors with other ambitions than family...... scale and qualitative questions. We used a phenomenological approach. RESULTS: Almost all of the young Danish doctors responding felt that training in general practice is a necessary part of a postgraduate basic training programme. Early training in primary care not only gives doctors a broad...

Australian mineral industry annual review for 1982

Energy Technology Data Exchange (ETDEWEB)

1984-01-01

The Australian mineral industry annual review records the activities and development of the Australian mineral industry and reports production, consumption, treatment, trade, prices, new developments, exploration and resources for mineral commodities including fuels, and summarises equivalent developments abroad. The present volume reviews activities and developments in 1982. Part 1 (General Review) - after briefly surveying the world mineral industry, summarises developments in the Australian mineral industry as a whole, under the headings: the industry in the national economy; important recent developments; production; overseas trade; prices; exploration expenditure; investment; income tax; royalties; structural data; wages and salaries; industrial disputes; and government assistance, legislation and controls. Part 2 (Commodity Review) - covers industrial mineral commodities, from abrasives to zirconium. Part 3 (Mining Census) - tabulates statistics extracted from the mining census, together with some mineral processing statistics from the manufacturing census. Part 4 (Miscellaneous) - tabulates quantum and value data on mineral output provided by State departments of mines and their equivalents.

Prevalence of fatigue in general practice.

Science.gov (United States)

Cullen, W; Kearney, Y; Bury, G

2002-01-01

Fatigue is an important symptom in general practice due to its association with physical, psychological and social problems. To determine the prevalence of fatigue as an unsolicited symptom during general practice consultations. A random sample of GPs practising in Ireland was invited to provide data on consultations held over one day. Data were recorded on the presence of fatigue as a main or supporting symptom, social and demographic characteristics. Data were recorded by 89 GPs on 1,428 consultations. The prevalence of fatigue was 25%. It was the main reason for attending the doctor in 6.5% and a secondary reason in 19%. Sixty-two per cent of patients were female and 48% were eligible for free GP services. The mean age was 47.1 years. The presence of fatigue was associated with: attending a female GP, being female, attending a GP who had been qualified for fewer years and attending the GP frequently. The prevalence of fatigue reported in this study is over three times higher than that reported in earlier work. Doctor characteristics appear to be as important as patient characteristics in determining fatigue.

Group-based education for patients with type 2 diabetes: a survey of Australian dietitians.

Science.gov (United States)

Odgers-Jewell, Kate; Isenring, Elisabeth A; Thomas, Rae; Reidlinger, Dianne P

2017-09-01

Group-based education has the potential to substantially improve the outcomes of individuals with type 2 diabetes mellitus (T2DM) and reduce the enormous burden that chronic diseases place on healthcare systems worldwide. Despite this proven effectiveness, the utilisation of group services for the management of T2DM by Australian dietitians is surprisingly low. This study surveyed a sample of 263 Australian dietitians to explore the utilisation of group-based education for T2DM, as well as dietitians' preferences for practice and training. The results of this study indicate that Australian dietitians are currently under-utilising group-based education programs for the management of T2DM, with the primary reasons identified as a lack of training provided to dietitians in the area, limited access to facilities suitable for conducting group education, the perceived poor cost-effectiveness of these programs, and the lack of evidence-based practice guidelines for the group-based management of persons with T2DM. Additionally, the majority of preferences for further training were for either face-to-face or web-based formal training conducted over 3-6h. Clear, evidence-based practice guidelines and training resources for group education for the management of T2DM are needed in order to encourage better utilisation of group-based education by Australian dietitians.

Epilepsy care in general practice.

LENUS (Irish Health Repository)

Varley, J

2009-06-01

Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

["General Practice is a great job anyway" - a qualitative study with vocational trainees].

Science.gov (United States)

Steinhäuser, Jost; Paulus, Jan; Roos, Marco; Peters-Klimm, Frank; Ledig, Thomas; Szecsenyi, Joachim; Joos, Stefanie

2011-01-01

Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession. Copyright © 2010. Published by Elsevier GmbH.

Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.

Science.gov (United States)

Jansen, Sarah; Ball, Lauren; Lowe, Catherine

2015-04-01

This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.

Implementation of an Arranged Preventive Consultation in Danish General Practice

DEFF Research Database (Denmark)

Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust

Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences...... with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs....../nurses, but must be accompanied with a basic belief in the effect of preventive consultations in general practice. The better payment of the 0106-service is used to spend more time per consultation and it makes the GPs/nurses feel rewarded for the preventive work they perform. The consultation frames a social...

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.

NARCIS (Netherlands)

Hombergh, P. van den; Kunzi, B.; Elwyn, G.; Doremalen, J.H.M. van; Akkermans, R.P.; Grol, R.P.T.M.; Wensing, M.J.P.

2009-01-01

BACKGROUND: The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. METHODS: Secondary analysis of data

Stigmatising attitudes towards people with mental disorders: a comparison of Australian health professionals with the general community.

Science.gov (United States)

Reavley, Nicola J; Mackinnon, Andrew J; Morgan, Amy J; Jorm, Anthony F

2014-05-01

The aim of this paper was to explore attitudes towards people with mental disorders among Australian health professionals (psychiatrists, psychologists and general practitioners (GPs)) and to compare their attitudes with members of the general community. The study involved a postal survey of 518 GPs, 506 psychiatrists and 498 clinical psychologists and a telephone survey of 6019 members of the general community. Participants were given a case vignette describing a person with either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, post-traumatic stress disorder (PTSD) or social phobia and two questionnaires to assess stigmatising attitudes (the Depression Stigma Scale and the Social Distance Scale). Exploratory structural equation modelling was used to elucidate the structure of stigma as measured by the two scales, to establish dimensions of stigma and to compare patterns of association according to gender, age, vignette and professional grouping. The measurement characteristics of stigmatising attitudes in health professionals were found to be comparable to those in members of the general community in social distance and also in personal and perceived attitude stigma, with each forming distinct dimensions and each comprising 'Weak-not-sick' and 'Dangerous/unpredictable' components. Among health professionals, female gender, age and being a GP were associated with higher scores on the personal stigma scales. Mental health professionals had lower scores on the personal 'Weak-not-sick' and 'Dangerous/unpredictable' scales than members of the general community, while there were no significant differences in the desire for social distance between health professionals and the general community. While mental health professionals have less stigmatising attitudes than the general public, the greater beliefs in dangerousness and personal weakness by GPs should be addressed.

Medical rosters and the Trade Practices Act.

Science.gov (United States)

Pengilley, Warren

2003-04-07

Medical rosters are not free of trade practices problems, notwithstanding assurances by the Australian Competition and Consumer Commission (ACCC). Neither the ACCC nor the recently convened Wilkinson Committee has applied rigorous legal principles in interpreting the Trade Practices Act 1974 (Cwlth) to reach its conclusions. The Australian law should be changed to bring it into line with that of the United States and New Zealand.

The purpose of the general practice consultation from the patients perspective - theoretical aspects

DEFF Research Database (Denmark)

Thorsen, Hanne; Witt, Klaus; Malterud, Kirsti

2001-01-01

Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness......Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness...

Experiences of using email for general practice consultations: a qualitative study.

Science.gov (United States)

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-11-01

Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

Monitor Soil Degradation or Triage for Soil Security? An Australian Challenge

Directory of Open Access Journals (Sweden)

Andrea Koch

2015-04-01

Full Text Available The Australian National Soil Research, Development and Extension Strategy identifies soil security as a foundation for the current and future productivity and profitability of Australian agriculture. Current agricultural production is attenuated by soil degradation. Future production is highly dependent on the condition of Australian soils. Soil degradation in Australia is dominated in its areal extent by soil erosion. We reiterate the use of soil erosion as a reliable indicator of soil condition/quality and a practical measure of soil degradation. We describe three key phases of soil degradation since European settlement, and show a clear link between inappropriate agricultural practices and the resultant soil degradation. We demonstrate that modern agricultural practices have had a marked effect on reducing erosion. Current advances in agricultural soil management could lead to further stabilization and slowing of soil degradation in addition to improving productivity. However, policy complacency towards soil degradation, combined with future climate projections of increased rainfall intensity but decreased volumes, warmer temperatures and increased time in drought may once again accelerate soil degradation and susceptibility to erosion and thus limit the ability of agriculture to advance without further improving soil management practices. Monitoring soil degradation may indicate land degradation, but we contend that monitoring will not lead to soil security. We propose the adoption of a triaging approach to soil degradation using the soil security framework, to prioritise treatment plans that engage science and agriculture to develop practices that simultaneously increase productivity and improve soil condition. This will provide a public policy platform for efficient allocation of public and private resources to secure Australia’s soil resource.

[Dealing with diagnostic uncertainty in general practice].

Science.gov (United States)

Wübken, Magdalena; Oswald, Jana; Schneider, Antonius

2013-01-01

In general, the prevalence of diseases is low in primary care. Therefore, the positive predictive value of diagnostic tests is lower than in hospitals where patients are highly selected. In addition, the patients present with milder forms of disease; and many diseases might hide behind the initial symptom(s). These facts lead to diagnostic uncertainty which is somewhat inherent to general practice. This narrative review discusses different sources of and reasons for uncertainty and strategies to deal with it in the context of the current literature. Fear of uncertainty correlates with higher diagnostic activities. The attitude towards uncertainty correlates with the choice of medical speciality by vocational trainees or medical students. An intolerance of uncertainty, which still increases as medicine is making steady progress, might partly explain the growing shortage of general practitioners. The bio-psycho-social context appears to be important to diagnostic decision-making. The effect of intuition and heuristics are investigated by cognitive psychologists. It is still unclear whether these aspects are prone to bias or useful, which might depend on the context of medical decisions. Good communication is of great importance to share uncertainty with the patients in a transparent way and to alleviate shared decision-making. Dealing with uncertainty should be seen as an important core component of general practice and needs to be investigated in more detail to improve the respective medical decisions. Copyright © 2013. Published by Elsevier GmbH.

Mapping the (Invisible Salaried Woman Architect: the Australian Parlour Research Project

Directory of Open Access Journals (Sweden)

Karen Lisa Burns

2015-12-01

Full Text Available Since the 1970s, feminist historians and polemicists have struggled to uncover the ordinary lives of women. They believe that gender ideals and biases are a critical part of the weft and weave of daily life. But the quotidian has been a restricted field in our discipline, often used to define a particular building type rather than the lives of architects. For example, we know little about the workdays of professionals or their labour in the workplace. The architectural office - its daily transactions and everyday culture - remains obscure. Even when represented in histories of the profession, the architectural office is filtered through a top-down lens trained on practice directors. The labour and lives of architecture’s male and female employees is unexplored terrain, but we could begin with the demographics: up to three-quarters of Australian women in architecture are salaried workers, continuing a historical trend. In the past, women generally worked for others. The gendering of salaried architectural workers raises questions about the relationship between gender and office work. Feminist historians and theorists have suggested that the office plays a role in forming gender ideals and practices. This paper endeavours to critically describe the lives and labour of women architects at the office, using survey and interview data from a large-scale Australian research project, publicly known through its website Parlour. This research inquires into gender disadvantage and investigates how gender ideals and norms shape the culture of the architectural workplace. The project’s research questions, evidence and explanations form the basis of this essay. The Parlour project is an ongoing platform for sharing information and research, but it gives particular voice to women’s experience in architecture, an experience largely shaped by salaried employment, studentship and the ownership of small practices.

Influencing Safety in Australian Agriculture and Fisheries.

Science.gov (United States)

McBain-Rigg, Kristin E; Franklin, Richard C; King, Jemma C; Lower, Tony

2017-01-01

Improving the health and safety of those working in Australian agriculture and fishery industries is a recognized priority area for preventative activities. With Australian agricultural industries being among the nation's most dangerous workplaces, there is a need for action. While there are currently known solutions, their implementation is limited. Influential agents, i.e., people who can influence others, are important for helping engender action to enact solutions into practice. This study examines agents that influence safety behavior either negatively (barriers) or positively (facilitators), in the Australian agriculture and fishery industries. Focus groups were conducted with producers and industry representatives. Thematic analysis identified barriers and facilitators to improve health and safety. These were assessed against the Socioecological Model, which considers the various, and often intersecting, human (intrapersonal, i.e. values and attitudes, peers, familial, and cultural) factors influencing safety behavior. Seven categories of human influences were identified: self, peers, family, intergenerational change, industry agents, government agents, and other. Peers (including direct managers) and family were seen to be direct influencers. Individuals signal to others that safety is valued and important. This is reinforced by experience, skill, attitudes, and behavior. Safety practice knowledge acquisition occurred via the family unit, specific training, industry, or knowledge transfer between industries. Government influence predominately focused on legislation and while the source of this influence is distant, it does influence behavior. There is a need to support comprehensive programs. These should include strengthening relationships via peer-to-peer networking, sharing information about safety initiatives, appropriate legislation, and enhancing leadership of all influencers with regard to safety.

[What factors aid in the recruitment of general practice as a career? An enquiry by interview of general practitioners].

Science.gov (United States)

Natanzon, Iris; Ose, D; Szecsenyi, J; Joos, S

2010-05-01

In some parts of Germany there is already a lack of general practitioners (GPs). The reasons for this lack are complex. On the one hand there is an increasing demand for GPs as a result to demographic changes and an increase in the number of chronic diseases. On the other hand fewer medical students decide to become a general practitioner. The aim of this study was to explore, from the perspective of GPs, factors influencing the choice of general practice as a career. Also analysed is the extent to which those factors influence medical students in their carrier choice. 16 GPs were interviewed. Qualitative content analysis according to Mayring has been assisted by the Atlas.ti software program. GPs thought that the occupational orientation of medical students would be strongly dependent on the attractiveness of their future profession. Factors affecting the day-to-day work of general practice and may deterring the carrier choice of students were: poor working and general conditions leading to an increasing dissatisfaction among GPs; decreasing prestige of GPs caused by changed personal and occupational values and attitudes within the society; as well as poor representation and image of general practice as a discipline within the medical curriculum. Various approaches aimed at different target groups can be derived from these identified factors: the government providing general and occupational conditions that would relieve GPs of excessive bureaucracy; universities and medical associations meeting the challenge by improving undergraduate and postgraduate education in general practice; and GPs themselves giving a more self-confident presentation of general practice. Georg Thieme Verlag KG Stuttgart * New York.

COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice.