Aboriginal Men’s Business: A Literature Review of Factors Affecting Aboriginal Men Accessing Sexual Health Services

Introduction: Aboriginal men are relatively young, with a median age of 22 years, nearly half that of their non-Aboriginal counterparts. Aboriginal men also have the highest mortality rates and have the lowest life expectancy. Sexually Transmissible Infection (STI) rates are extremely overrepresented in lower socio-economic groups, including minority populations. STI rates among Aboriginal communities are significantly higher when compared to the non-Aboriginal population. Aims: In the context of multiple factors impinging on the sexual health of Aboriginal men, we sought to conduct a comprehensive review of the literature for the purpose of developing a framework through which needs and actions to improve sexual health could be identified and understood. Methods: A targeted, comprehensive search strategy was developed using keywords and synonyms related to the aims of the project. The search included scholarly peer reviewed academic literature available and grey literature from the Wollongong Hospital and the NSW Health library. The search was made more efficient by entering search terms into the Deakin University EBSCOhost search engine, and Google Scholar was searched separately. Grey literature searching was conducted with Clinical Information Access Portal (CIAP), Informit and the Commonwealth Scientific and Industrial Research Organisation (CSIRO). Results: The search produced a total number of 385 papers from peer reviewed publications and grey literature. A total of 95 duplicates were removed, leaving 290 papers. After incorporating the screening process, exclusion and inclusion criteria, the total number of articles selected for review was 31 articles. Discussion: The thematic analysis identified that cultural considerations of Aboriginal ‘Men’s business’ involving traditional lifestyle, cultural practices and the impact of colonisation were only briefly covered in the included studies. The findings of the literature review indicated that Aboriginal men’s health is deeply influenced by their socio-economic status and cultural wellbeing. This review provided limited findings relating to service provision support for Aboriginal men. Conclusion: Overall, this review presented several concerning factors and evidence of the difficulties for Aboriginal and Torres Strait Islander men accessing sexual health services. Literature identified the long-standing health statistics and deterioration of health and social and emotional wellbeing for Aboriginal and Torres Strait Islander men. While both mainstream health and non-government services are offering limited provision of culturally safe and appropriate healthcare pathways

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

Background: Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy. Methods: Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company. Results: Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research. Conclusion: Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy. © 2009 Campbell et al; licensee BioMed Central Ltd

Emergency nurses’ experiences of the implementation of early goal-directed fluid resuscitation therapy in the management of sepsis

Background: Severe sepsis is a life-threatening condition caused by the body’s overwhelming immune response to an infection. It can lead to organ failure and death if immediate treatment, such as intravenous (IV) fluids and antibiotics, are not commenced within the first hour. While a large number of studies have analysed the administration of first-dose antibiotics, the time-critical initiation of IV fluids has not always been given its deserved priority. To date, studies have not explored factors that inhibit timely IV fluid administration and the experience of emergency nurses relating to initiating early goal-directed fluid resuscitation (EGDFR). Purpose: To explore the experiences of emergency nurses related to initiating EGDFR in the care of patients with sepsis Methods: A qualitative exploratory approach, encompassing face-to-face semi-structured interviews, was used for data collection. Ten registered nurses were interviewed, who were currently practicing in emergency settings across New South Wales (NSW). Braun and Clarke’s (2006) thematic analysis framework guided the data analysis. Findings: Three themes and associated subthemes were identified. The three themes are (i) Nurses’ perceptions and experiences regarding IV fluid administration in sepsis, (ii) Challenges related to initiating IV fluid, and (iii) Strategies to improve compliance with EGDFR. Participants described various factors they found that inhibited timely initiation of IV fluids, including busyness of the department, delayed diagnosis of sepsis, complex patient presentations and limited scope of nurses’ practice to initiate IV fluids. Conclusion: It is anticipated that the outcomes of this research will provide an impetus for re-evaluating current protocol guidelines to provide a positive impact on the scope of emergency nurse practice for initiating EGDFR

Quality of drinking and recreational water in the Hunter New England region of New South Wales: bridging the gap between research, practice and policy

Introduction Population health research may include primary data collection and analysis; analysis of existing data; and systematic reviews for problem definition, solution generation, and evaluation. The main objective of this thesis was to analyse routinely collected data and primary data to assess drinking and recreational water quality management in the Hunter New England region of New South Wales (NSW), Australia. This research was practitionerled and designed to bridge the gap between research and policy in drinking water management in NSW. When used with a specific research goal, routinely collected data obtained for performance monitoring purposes is an important tool for improving the quality of water supplies. Such practitioner-led research may be directly translated into local practice to improve public health service delivery. Continuous interactions between practitioner-researchers, academics, decision makers and other stakeholders throughout the research process provided impetus for evidence adoption through sustained evaluation of public health benefits. This thesis provides a firm foundation for the design of future environmental health interventions for the translation of research evidence to policy decision outcomes, leading to improved water quality and public health in rural areas. Setting In NSW, the NSW Public Health Act 2010 (NSW Government, 2010) regulates water suppliers to provide safe water to consumers. NSW Health provides drinking water supply protocols that include monitoring, reporting, and public notifications. The NSW Health's Drinking Water Monitoring Program provides free water testing for suppliers throughout the state. Public water suppliers (utilities) are allocated barcoded-labels for the recommended number of samples for each water supply system each year. Compliance is measured by the adequacy of sampling, in which at least 98% should yield no E. coli detections. The Program centrally manages the internet-based NSW Drinking Water Database, which has recorded more than 20 000 sample results per year since 2001. Therefore, there is sufficient routinely collected data to assess drinking water quality in NSW. Method A Participatory Action Research (PAR) process was applied using a mixed methods framework. The practitioner researcher's research and collaborations with academics, policy makers and stakeholders from the planning through to the implementation of projects ensured that expectations were clear. An 'adopt and intervene as-we-go' philosophy was applied. The evidence was interrogated and areas of intervention were applied. Further projects were then designed to evaluate the identified areas of intervention. Four approaches were taken to explore and bring about change in drinking water quality management through advocacy: • Working with departmental staff to analyse routinely collected microbiological water quality data for reticulated water supplies to improve drinking water quality management within existing work budgets; • Working with recreational parks authorities to collect and analyse data to assess and improve private drinking water management; • Working with an Aboriginal community to assess reticulated drinking water supply quality and acceptance and promote consumption of safe drinking water; and • Working with departmental staff to pilot Enterococci testing to assess recreational swimming water quality at popular swimming sites to design new policy to reduce public health risk. Regular research briefs and reports to share findings, dissemination and advocacy through peer reviewed journal articles and presentations at professional conferences were used to share the research evidence to stakeholders, policy-makers and peer environmental health practitioners. Results and outcomes Public drinking water sampling adequacy significantly improved (p = 0.002) during the study period. Sampling adequacy was significantly lower in smaller populations (p = 0.013). E. coli detections significantly improved (p < 0.0001) but were significantly higher in smaller communities (p< 0.001). There was a strong inverse correlation between sampling compliance and E. coli detection (p<0.001; R² Linear = 0.72). NSW Health has assisted utilities to develop and implement Drinking Water Management Systems throughout the State. All recreational parks developed and implemented drinking water quality assurance programs. All recreational parks that provided water but do not treat or regularly monitor the quality of the water supplies have installed appropriate warning signs by the NSW Private Water Supply Guidelines, to warn visitors. Private drinking water supplies have now been included in the NSW Public Health Act, and Private Drinking Water Supply Guidelines were amended to include the development and implementation of drinking water quality assurance plans. Aesthetic factors such as water hardness, taste, colour, odours and societal values influence perceptions of risk and quality. Plans are underway to soften town water supply, as requested by the participating Aboriginal community, as this was a major barrier to consumption. All swimming sites exceeded the threshold NHMRC Enterococci illness transmission recreational level of 40 CFU/100 ml. There is a need for risk-based water quality management at informal recreational swimming sites. Conclusion The research demonstrated that improving drinking water sampling frequency was associated with enhanced microbiological water safety. However, there is room for improvement in sampling adequacy and water quality (E. coli detections) in smaller communities. Further dialogue, research, and policy focus is needed that includes partnerships with discrete NSW Aboriginal communities, in order to develop a deeper understanding of their perceptions of drinking water and to encourage consumption of safe water. This research promoted interaction between practitioners, managers and academics in environmental health program development to promote public health. The research clearly demonstrated how using routinely collected data coupled with primary data collection results in strong environmental health practitioner-led research with important policy outcomes. Future research should build on these key strengths, linking environmental health practitioners' fieldwork with productive collaborative networks between academics and policy makers, to promote the development of knowledge that provides evidence-based policy changes for public health benefit

How do mobile devices support clinical work on hospital wards: an investigation of the selection and use of computing devices

The mobile and information intensive nature of clinical work in hospital settings presents a critical challenge: how to provide clinicians with access to information at the time and place of need? This challenge is particularly pertinent to decision-makers responsible for the selection of computing devices. Mobile devices are often promoted as a means to meet this challenge, with existing literature tending to portray the mobility of devices as inherently beneficial. However, evidence to clearly demonstrate how mobile devices support clinical work is limited. This research aimed to generate new knowledge to contribute to answering two significant questions: (i) how do decision-makers select computing devices? and (ii) how do mobile devices support clinical work practices? The research was conducted in two stages. In stage one, interviews were conducted with 28 individuals involved in decisions regarding the selection of computing devices for hospital wards. Decision-makers reported a range of factors that influenced device selection. Role of the user, types of tasks, and location of tasks, for example, were deemed important. In stage two, a mixed methods design comprising structured observations, interviews, and field notes was employed. A sample of 38 clinicians, on two wards of a metropolitan hospital, was observed for 90 hours. In total 4,423 clinical tasks were recorded, capturing key information about tasks doctors and nurses undertake, where, and devices used. The findings provide evidence validating core assumptions about mobile devices: namely, that they support clinicians work by facilitating access to information at patients bedsides. Notably, mobile devices also supported work away from the bedside and whilst clinicians were in transit, allowing continuity in work processes. However, mobile devices did not provide the best fit for all tasks and additional factors, such as the temporal rhythms of the ward and structure of ward round teams, affected how mobile devices supported work. Integration of findings from the two stages resulted in the development of a detailed list of factors that influence the use of mobile devices on hospital wards. This new evidence provides valuable knowledge to guide the selection of computing devices to support, and potentially optimise, clinical work

Department of Defense Dictionary of Military and Associated Terms

The Joint Publication 1-02, Department of Defense Dictionary of Military and Associated Terms sets forth standard US military and associated terminology to encompass the joint activity of the Armed Forces of the United States. These military and associated terms, together with their definitions, constitute approved Department of Defense (DOD) terminology for general use by all DOD components