Improving Opportunities for Research Training for Specialist Registrars in Australasia

Research is an important, and formally assessed, component of physician training in Australasia. Experience in the development and implementation of clinical research is a crucial aspect of professional development in medicine. In order to continue to improve clinical practice, and hence patient outcomes, there must be an ongoing commitment to clinical research, and education to enable specialist registrars to develop their own research programs and develop the skills to critically analyse the results of research published by others. However, the interface between clinical practice and clinical research is inherently complex. There exist a plurality of stakeholders involved in the funding, design and implementation of a clinical trial, and the eventual utilization of the intervention being investigated. The transition from clinical practice to clinical research is challenging for many specialist training registrars, but ultimately, is crucial for their professional development

Medical specialists' accounts of the impact of the Internet on the doctor/ patient relationship

In the context of health service delivery, deprofessionalization denotes a trend towards a demystification of medical expertise and increasing lay scepticism about health professionals, suggesting a decline in the power and status of the medical profession. This process has been linked to increasing consumerism, the rise of complementary medicine and the emergence of the Internet. Drawing on data from in-depth interviews with prostate cancer specialists, this article explores their experiences of the Internet user within the context of the medical consultation. Results suggest that the deprofessionalization thesis is inadequate for capturing the complex and varying ways in which specialists view, and respond to, the Internet-informed patient. It is argued that the ways in which these specialists are adapting to the Internet and the Internet user should be viewed as strategic responses, rather than reflecting a breakdown in their authority or status. ‘Enlistment’ and ‘translation’ are presented as useful conceptual tools for understanding specialists’ experiences of the Internet

The Spectre of Superbugs: Waste, Structural Violence and Antimicrobial Resistance in India

At first glance there may seem to be no clear connections between two of humanity’s most pressing problems: environmental waste and antimicrobial resistance (AMR). In fact, as we posit in this paper, there is an inevitable convergence across these medical and environmental domains that hinge on social and economic inequalities. Such intersections have not been given nearly enough emphasis. Here we offer a series of considerations regarding the potential nexus of environmental pollution, waste-work, poverty and the decreasing viability of antimicrobials. We suggest that AMR and environmental pollution will fundamentally shape one another over the course of the coming decades, with differential impacts across socio-economic divides. More perniciously, the coalescing of waste, environmental pollution and reduced potency of pharmaceutical infection management will in turn likely escalate cultural prejudices around hygiene, ‘untouchability’, exclusion and privilege. That is, this nexus of waste and bacterial risk will polarise and divide communities, disproportionately affecting poorer communities. This paper is intended to chart an agenda for the study of this increasingly critical site of bacterial-human-environmental relations. It does so by examining the cycle of infection, risk and vulnerability amongst the most disadvantaged sections of the population in India

Sampling Social Experiences in School: Feasibility of Experience Sampling Methodology on an iPlatform

This paper reports on a pilot study testing the feasibility of an app as a survey tool for exploring the social experiences of high school students who are vision impaired. The Participation in Everyday Life Survey app was designed for use with the Experience Sampling Method. This method uses in-the-moment surveys to understand individuals’ experiences of everyday activities and situations. Pilot testing shows the app to be usable and accessible for people with vision impairments and high school students who are sighted but who have other disabilities. This pilot study has also shown that the Experience Sampling Method has the potential to provide useful insights into the social experiences of high school students who are vision impaired

Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: an examination of a nationally representative sample of 1835 Australian women

Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy. Design: a survey-based cohort sub-study from the nationally-representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010. Participants: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (. n=2445) from the younger cohort (. n=8012) of ALSWH were recruited for the study. Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (. n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post partum/intrapartum haemorrhage. Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth

Multidisciplinary team meetings in prosthetic joint infection management: A qualitative study

Prosthetic joint infections (PJIs) cause substantial morbidity to patients and are extremely challenging for clinicians. Their management can include multiple operations, antibiotics, and prolonged hospital admissions. Multidisciplinary team meetings (MDTM) are increasingly used for collaborative decision-making around the management of PJIs, but thus far there has been no examination of the role of MDTM in decisions and management. This study aimed to examine interactions in a PJI MDTM to identify the dynamics in decision-making, and inter-specialty relationships more broadly

The social meanings of choice in living-with advanced breast cancer

Individual choice is valorised as a core social value; yet the necessity and desirability of making choices takes on new significance for people living with incurable cancer who are required to make often difficult decisions about treatment, care and family life, amidst considerable vulnerability and precariousness. There has been comparatively little exploration of how choice is negotiated and made meaningful under the spectre of incurability and a contracted future. In this paper, drawing on multiple qualitative interviews with 38 women with metastatic breast cancer, we explore how they experience and give meaning to choice in relation to their health (and beyond) in their daily lives. Our analysis highlights that while exercising choice was sometimes a concealed or silent pursuit, choice was always a socially negotiated and temporally unfolding process, nested within relational and interpersonal dynamics. Choices were also often constrained, even foreclosed, due to situational and relational dynamics. Yet even in the absence of choice, the idea of choice-as-control was discursively embraced by women. We argue that greater attention is needed to the affective, temporal and economic dimensions of choice, and how treatment decisions are asymmetrically structured when considered within the normative context of cancer

The administration of harm: From unintended consequences to harm by design

Harm is a recurring theme in the social sciences. Scholars in a range of empirical areas have documented the deleterious outcomes that at times emerge from social structures, institutions and systems of governance. Yet these harms have often been presented under the rubric of ‘unintended consequences’. The outcomes of systems are designed to appear devoid of intentionality, in motion without any clear agency involved, and thus particularly adept at evading accountability structures and forms of responsibility. Drawing insights from decades of social theory – as well as three illustrative examples from Australia’s health, welfare and immigration systems – this article argues that many social structures are in fact intended to cause harm, but designed not to appear so. In presenting this argument, we offer a clear theoretical framework for conceptualising harm as actively administered. We also challenge scholars from across the social sciences to reconsider the partially depoliticising narrative of ‘unintended consequences’, and to be bolder in naming the intended harms that permeate social life, often serving powerful political and economic interests

Fibre prestressed composites: theoretical and numerical modelling of unidirectional and plain-weave fibre reinforcement forms

The objective of this study is to analyse the residual stresses induced in fibre prestressed composites. Both theoretical and numerical methods have been included in the analysis. Macro-mechanical approach of fibre reinforced composite has been developed to include the prestressing effect that suitable for analysing both unidirectional and plain-weave fabric composites. A new simplistic theoretical model was also derived to estimate residual stresses in composite constituents due to releasing the fibre pretension load. This model can be successfully used for composites reinforced by unidirectional fibres. Prestressed composites were modelled numerically in order to validate the theoretical results and estimate the full distribution of residual stresses within the composite constituent more precisely. Good agreement has been obtained between theoretical and numerical results. The results obtained in this study clearly showed that the level of induced residual stresses within the composite constituents depends not only on fibre pretention level, but also on the composite elastic properties

Injury, Interiority, and Isolation in Men’s Suicidality

Men’s high suicide rates have been linked to individual risk factors including history of being abused as a child, single marital status, and financial difficulties. While it has also been suggested that the normative influences of hegemonic masculinities are implicated in men’s suicide, the gendered experiences of male suicidality are poorly understood. In the current photovoice study, 20 men who previously had suicidal thoughts, plans, and/or attempts were interviewed as a means to better understanding the connections between masculinities and their experiences of suicidality. The study findings revealed injury, interiority, and isolation as interconnected themes characterizing men’s suicidality. Injury comprised an array of childhood and/or cumulative traumas that fueled men’s ruminating thoughts inhibiting recovery and limiting hopes for improved life quality. In attempting to blunt these traumas, many men described self-injuring through the overuse of alcohol and other drugs. The interiority theme revealed how suicidal thoughts can fuel hopelessness amid summonsing remedies from within. The challenges to self-manage, especially when experiencing muddled thinking and negative thought were evident, and led some participants to summons exterior resources to counter suicidality. Isolation included separateness from others, and was linked to abandonment issues and not having a job and/or partner. Self-isolating also featured as a protection strategy to avoid troubling others and/or reducing exposure to additional noxious stimuli. The study findings suggest multiple intervention points and strategies, the majority of which are premised on promoting men’s social connectedness. The destigmatizing value of photovoice methods is also discussed