Protocol for Care After Lymphoma (CALy) trial: a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care

Introduction: Lymphoma is the sixth most common cancer diagnosed in Australia and internationally. Owing to the aggressive nature of the disease and intensity of treatment, survivors face long-term effects that impact on quality of life. Current models of follow-up post-treatment fail to address these complex issues. Given that 74% of patients with lymphoma cancer now survive 5 years beyond diagnosis and treatment, it is important to address this gap in care. Aim: To determine self-reported informational and practical needs, anxiety, depression, stress, coping and empowerment at baseline, 3 and 6 months. Methods and analysis: A pilot randomised controlled trial will test the effect of a nurse-led lymphoma survivorship clinic compared with usual post-treatment care at a large tertiary cancer centre in Western Australia. The intervention will comprise three face-to-face appointments with delivery of tailored resources, a survivorship care plan and treatment summary (SCP TS). The SCP TS will be given to the participant and general practitioner (GP). Intervention participants will be interviewed at completion to explore the perceived value of the intervention components and preferred dose. An evaluation developed for GPs will assess receipt and use of SCP TS. The primary intent of analysis will be to address the feasibility of a larger trial and requisite effect and sample size. Ethics and dissemination: Ethics approval has been granted by the University of Notre Dame Australia and Sir Charles Gairdner Hospital in Western Australia. Peer-reviewed publications and conference presentations will report the results of this phase II trial. Trial registration number: ANZCTRN12615000530527; Pre-results

Therapists' experiences of alliance formation in short-term counselling

Title and Abstract also available in German, Spanish, Italian, French, and Greek.While therapeutic alliance formation has been widely researched over many sessions of psychotherapy, the question of alliance formation in short-term counselling has been less explored. Given the increasing evidence in the literature for the positive impact of alliances on therapy outcomes, providing counsellors - who may work with clients for a limited number of sessions - with enhanced insight into alliance formation will be of value. This qualitative study investigated the experiences of eight counsellors forming alliances with clients over short periods. Semi-structured interviews were analysed using interpretive phenomenological analysis. Five major themes emerged, that while congruent with the alliance literature, add some details relevant to day-to-day practice. These themes included: the importance of strong alliances; the need for psychologically comfortable environments; the timing of alliance formation; and the impact of counsellor personal qualities - such as being real - in strengthening and maintaining alliances. In addition, an unexpected sixth theme revealed that body language was highly valued as an indicator of strong or weak alliances. Implications for increasing the use of body language to enhance counselling practice and education are discussed.Mark R. Pearson and Caroline Bulsar

Supernarrow spectral peaks near a kinetic phase transition in a driven, nonlinear micromechanical oscillator

We measure the spectral densities of fluctuations of an underdamped nonlinear micromechanical oscillator. By applying a sufficiently large periodic excitation, two stable dynamical states are obtained within a particular range of driving frequency. White noise is injected into the excitation, allowing the system to overcome the activation barrier and switch between the two states. While the oscillator predominately resides in one of the two states for most excitation frequencies, a narrow range of frequencies exist where the occupations of the two states are approximately equal. At these frequencies, the oscillator undergoes a kinetic phase transition that resembles the phase transition of thermal equilibrium systems. We observe a supernarrow peak in the power spectral densities of fluctuations of the oscillator. This peak is centered at the excitation frequency and arises as a result of noise-induced transitions between the two dynamical states.Comment: 4 pages, 4 figure

Predictors of ceasing or reducing statin medication following a large increase in the consumer co-payment for medications: A retrospective observation study

Objectives: Previous Australian research has shown that following the 21% increase in the patient co-payments in 2005, the use of lipid-lowering therapy declined by 5%. This study aimed to determine the demographic and clinical characteristics of individuals who continued, reduced or ceased their use of statin medication in 2005. Study type: Retrospective observational study using routinely collected administrative data. Method: Pharmaceutical claims, hospital separations, and mortality records from 2000–2005 were used from the Western Australian (WA) population. The cohort comprised stable users of statin medication in 2004. We identified individuals who i) continued using statins, ii) reduced their use by ≥20%, or iii) ceased therapy for at least the first six months in 2005, based on changes in statin use between 2004 and 2005. Multivariate logistic regression models were used to determine whether the demographic and clinical characteristics of the three groups differed. Results: There were 205 924 statin users identified in Australia in 2004. After the January 2005 Pharmaceutical Benefits Scheme (PBS) co-payment increase, 3.2% of individuals ceased their regular statin therapy, 12.9% reduced statin use and 83.9% continued statin usage. This was an increase of 2.1% in statin users reducing or ceasing therapy compared to 2004. Predictors of cessation and reduction of statin therapy included younger age, greater socio-economic disadvantage, residing in very remote areas, having general beneficiary status, being a new statin user, having no prior history of ischaemic heart disease, having no prior history of a coronary artery revascularisation procedure, taking no other cardiovascular medication or diabetic medication, taking an increased number of medications and having a lower adherence level to statin medication in 2004. Conclusion: Compared to 2004, an additional 2.1% of statin users reduced or discontinued medication use in 2005, which may be attributed to an increase in the medication co-payment. Individuals with general beneficiary status, younger and healthier people were at particular risk of cessation or reduction in statin use in 2005

Patient preferences for adjuvant radiotherapy in early breast cancer are strongly influenced by treatment received through random assignment

Objective: TARGIT‐A randomised women with early breast cancer to receive external beam radiotherapy (EBRT) or intraoperative radiotherapy (TARGIT‐IORT). This study aimed to identify what extra risk of recurrence patients would accept for per‐ ceived benefits and risks of different radiotherapy treatments. Methods: Patient preferences were determined by self‐rated trade‐off question‐ naires in two studies: Stage (1) 209 TARGIT‐A participants (TARGIT‐IORT n = 108, EBRT n = 101); Stage (2) 123 non‐trial patients yet to receive radiotherapy (pre‐treat‐ ment group), with 85 also surveyed post‐radiotherapy. Patients traded‐off risks of local recurrence in preference selection between TARGIT‐IORT and EBRT. Results: TARGIT‐IORT patients were more accepting of IORT than EBRT patients with 60% accepting the highest increased risk presented (4%–6%) compared to 12% of EBRT patients, and 2% not accepting IORT at all compared to 43% of EBRT pa‐ tients. Pre‐treatment patients were more accepting of IORT than post‐treatment pa‐ tients with 23% accepting the highest increased risk presented compared to 15% of post‐treatment patients, and 15% not accepting IORT at all compared to 41% of pre‐ treatment patients. Conclusions: Breast cancer patients yet to receive radiotherapy accept a higher recurrence risk than the actual risk found in TARGIT‐A. Measured patient preferences are highly influenced by experience of treatment received. This finding challenges the validity of post‐treatment preference studies

Impact of consumer copayments for subsidised medicines on health services use and outcomes: A protocol using linked administrative data from Western Australia

Introduction: Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government. In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes. Methods and analysis: This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used. This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change

Breastfeeding and motor development: A longitudinal cohort study

Background: While there is a large body of work supporting the importance of early feeding practices on cognitive, immunity, behavioural and mental outcomes, few longitudinal studies have focused on motor development. The relationship between duration of breast feeding and motor development outcomes at 10, 14, and 17 years were examined. Methods: Data were obtained from the Western Australian Pregnancy (Raine) Study. There were 2868 live births recorded and children were examined for motor proficiency at 10 (M = 10.54, SD = 2.27), 14 (M = 14.02, SD = 2.33) and 17 (M = 16.99, SD = 2.97) years using the McCarron Assessment of Neuromuscular Development (MAND). Using linear mixed models, adjusted for covariates known to affect motor development, the influence of predominant breast feeding for⩾6 months on motor development outcomes was examined. Results: Breast feeding for ⩾6 months was positively associated with improved motor development outcomes at 10, 14 and 17 years of age (p = 0.019, β 1.38) when adjusted for child’s sex, maternal age, alcohol intake, family income, hypertensive status, gestational stress and mode of delivery. Conclusion: Early life feeding practices have an influence on motor development outcomes into late childhood and adolescence independent of sociodemographic factors. Abbreviations: MAND, McCarron Assessment of Neuromuscular Development; NDI, Neuromuscular Development Index; BP, Blood Pressure; APGAR, appearance pulse, grimace, activity, respiration; SRM, spontaneous rupture of membranes; LC-PUFA, long chain polyunsaturated fatty acids; AA, arachidonic acid; DA, docosahexaenoic aci

Living with multiple myeloma: A focus group study of unmet needs and preferences for survivorship care

Purpose: To describe the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with multiple myeloma to inform the development of relevant, personcentered, survivorship services. Methods: An exploratory, descriptive study using 2 focus groups with 14 participants, 6 to 49 months postdiagnosis. Results: Thematic analysis revealed 7 key themes: information needs, experience with health-care professionals, coping with side effects, communicating with family and friends, dealing with emotions, support needs, and living with the chronicity of myeloma. Participants described key characteristics of survivorship care relevant to their needs and indicated they would like a more whole of person approach to follow-up when the main treatment phases had completed. Conclusion: Participants in this study described unmet needs across a breadth of domains that varied over time. The development of flexible, person-centered approaches to comprehensive survivorship care is needed to address the considerable quality-of-life issues experienced by people living with multiple myeloma. Nurse-led care may offer 1 viable model to deliver enhanced patient experience—providing the vital “link” that people described as missing from their survivorship care