Talking to patients about death and dying

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.INTRODUCTION: Talking about death and dying, either with patients terminally ill or well, presents challenges for the general practitioner. There are few Australian educational resources and little Australian research into this area. METHODS: We undertook two focus groups, an interview process, and a final consultation with palliative care experts and GPs. RESULTS: General practitioners felt they needed support and education in talking about death and dying. This is separate from discussions about 'Advanced Health Care Directives'. General practitioners were open to learning new ways to help patients and families approach dying, but require support and education around initiating discussions, asking the right questions and accessing services. Participating GPs emphasised the importance of utilising palliative care supports and resources to provide ongoing spiritual and physical care. Many were particularly concerned with access to support for dying patients for both indigenous patients and those from other cultures. Advance Health Care Directives were regarded by participating GPs to be tools to facilitate a discussion around death and dying, rather than their primary purpose. DISCUSSION: We developed a booklet to provide practical, useful guidelines for GPs in their daily practice.Teresa A. Burgess, Mary Brooksbank and Justin Beilb

Uptake of spirometry training by GPs

Please see first page of PDF for this item. Copyright © 2006 Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Justin Beilby, Clare Harper, Christine Holton, Judy Proudfoot, Mark Harri

The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study

Extent: 11p.Objectives: To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. Design: A retrospective cohort analysis of linked data. Setting: A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. Participants: 407 CRC patients who had a colonoscopy followed by surgery. Primary outcome measures: Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. Results: Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). Conclusions: Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.David Goldsbury, Mark Harris, Shane Pascoe, Michael Barton, Ian Olver, Allan Spigelman, Justin Beilby, Craig Veitch, David Weller, Dianne L O'Connel

Perspectives of frailty and frailty screening: Protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences

Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.We will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons' perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description.Using stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.Mandy M. Archibald, Rachel Ambagtsheer, Justin Beilby, Mellick J. Chehade, Tiffany K. Gill, Renuka Visvanathan, and Alison L. Kitso

Providing healthcare for people with chronic illness: the views of Australian GPs

The document attached has been archived with permission from the editor of the Medical Journal of Australia (26 April 2007). An external link to the publisher’s copy is included.OBJECTIVES: To explore general practitioners' views on chronic-disease care: the difficulties and rewards, the needs of patients, the impact of government incentive payments, and the changes needed to improve chronic-disease management. DESIGN: Qualitative study, involving semi-structured questions administered to 10 focus groups of GPs, conducted from April to October 2002. PARTICIPANTS AND SETTING: 54 GPs from both urban and rural practices in New South Wales and South Australia. RESULTS: Consistent themes emerged about the complex nature of chronic-disease management, the tension between patients' and GPs' goals for care, the time-consuming aspects of care (exacerbated by federal government requirements), and the conflicting pressures that prevent GPs engaging in structured multidisciplinary care (ie, team-based care involving systems for patient monitoring, recall, and care planning). CONCLUSIONS: Structured multidisciplinary care for people with chronic conditions can be difficult to provide. Barriers include the lack of fit between systems oriented towards acute care and the requirements of chronic-disease care, and between bureaucratic, inflexible structures and the complex, dynamic nature of GP–patient relationships. These problems are exacerbated by administrative pressures associated with federal government initiatives to improve chronic-illness management. Changes are needed in both policies and attitudes to enable GPs to move from episodic care to providing structured long-term care as part of a multidisciplinary team.John Oldroyd, Judith Proudfoot, Fernando A Infante, Gawaine Powell Davies, Tanya Bubner, Chris Holton, Justin J Beilby and Mark F Harri

The impact of a stuttering disorder on Western Australian children and adolescents

In this study, we examined the impact of a stuttering disorder on children (n=50) and adolescents (n=45) living in Western Australia. We compared the reactions and experiences of children and adolescents who stutter to children and adolescents who do not stutter. We compared the participants who stuttered and the fluent participants using adapted versions of the Overall Assessment of the Speaker’s Experience of Stuttering (OASES). We also examined the relationship between biopsychosocial impact and stuttered speech frequency. We saw higher levels of adverse impact in young people who stuttered compared to their fluent peers. In addition, we found moderate correlations between OASES scores and stuttered speech frequency in children. These findings provided a baseline for establishing the degree of negative impact that a stuttering disorder may bring about in children and adolescents. The experiences of young people who stuttered were significantly different from the experiences of young people who were typically fluent. These findings reinforce the notion that stuttering is a disorder that can lead to negative impact for young people

Identifying presence of cybersickness symptoms using AI-based predictive learning algorithms

Cybersickness (CS) affects a large proportion of virtual reality (VR) users causing a combination of nausea, headaches and dizziness which would create barriers to the users, VR designers/developers and the stakeholders in the production industry. Although design principles suggest methods to avoid CS, challenges remain as new demands and systems continue to penetrate the competitive market. The dilemma is whether to use VR technology by experiencing the ultimate virtual world using a head-mounted display (HMD) with possible CS triggers or to avoid the triggers by avoiding using VR. With the huge success and potential in the entertainment industry, it is very important to focus on the solutions to handling CS dilemmas. Therefore, the main observation for the developers is to have a guide around the set of established design principles aiming to broadly reduce CS. In this paper, we provide a method to apply artificial intelligence (AI) techniques and use machine learning (ML) algorithms including support vector machines (SVMs), decision trees (DTs) and K-nearest neighbours (KNNs) to predict CS outcomes. Based on our findings, we have observed that DT and SVM surpassed KNN in test accuracy. Additionally, DT exhibited better results than both SVM and KNN in train accuracy. By exploiting the power of ML, developers will be able to predict the potential occurrence of CS while developing VR projects to find ways to alleviate CS more effectively

V-CarE—A conceptual conceptual design model for providing COVID-19 pandemic awareness : Proposal for a virtual reality design approach to facilitate people with persistent postural-perceptual dizziness

Background: Virtual reality (VR) technology has been solidifying its ground since its existence, where engagement and a sense of presence are key. The contemporary field of development has captured the attention of researchers due to its flexibility and compatibility attributes. During the COVID-19 pandemic, several research outputs have shown promising prospects of continuing research in the field of VR design and development—in health sciences including learning and training. Objective: In this paper, we aim to propose a conceptual development model named V-CarE (Virtual Care Experience) that can facilitate the understanding of pandemics when it comes to a crisis, taking precautionary measures where needed, and getting used to certain actions for preventing pandemic spread through habituation. Moreover, this conceptual model is useful to expand the development strategy to incorporate different types of users and technological aid as per need and requirement. Methods: For a detailed understanding of the proposed model, we have developed a novel design strategy to bring awareness to the user about the current COVID-19 pandemic. VR research in health sciences has shown that with appropriate management and development, VR technology can efficiently support people with health issues and special needs, which motivated our attempts to explore the possibility of employing our proposed model to treat Persistent Postural-Perceptual Dizziness (PPPD)—a persistent nonvertiginous dizziness that could last for 3 months or more. The purpose of including patients with PPPD is to get them engaged in the learning experience and to make them comfortable with VR. We believe this confidence and habituation would help them get engaged with VR for treatment (dizziness alleviation) while practicing the preventive measures during the pandemic in an interactive environment without actually facing any pandemic directly. Subsequently, for advanced development using the V-CarE model, we have briefly discussed that even contemporary technology like internet of things (IoT) for handling devices, can be incorporated without disrupting the complete 3D-immersive experience. Results: In our discussion, we have shown that the proposed model represents a significant step toward the accessibility of VR technology by creating a pathway toward awareness of pandemics and, also, an effective care strategy for PPPD people. Moreover, by introducing advanced technology, we will only further enhance the development for wider accessibility of VR technology while keeping the core purpose of the development intact. Conclusions: V-CarE–based developed VR projects are designed with all the core elements of health sciences, technology, and training making it accessible and engaging for the users and improving their lifestyle by safely experiencing the unknown. We suggest that with further design-based research, the proposed V-CarE model has the potential to be a valuable tool connecting different fields to wider communities

Genome-wide trans-ancestry meta-analysis provides insight into the genetic architecture of type 2 diabetes susceptibility.

To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS), including 26,488 cases and 83,964 controls of European, east Asian, south Asian and Mexican and Mexican American ancestry. We observed a significant excess in the directional consistency of T2D risk alleles across ancestry groups, even at SNPs demonstrating only weak evidence of association. By following up the strongest signals of association from the trans-ethnic meta-analysis in an additional 21,491 cases and 55,647 controls of European ancestry, we identified seven new T2D susceptibility loci. Furthermore, we observed considerable improvements in the fine-mapping resolution of common variant association signals at several T2D susceptibility loci. These observations highlight the benefits of trans-ethnic GWAS for the discovery and characterization of complex trait loci and emphasize an exciting opportunity to extend insight into the genetic architecture and pathogenesis of human diseases across populations of diverse ancestry