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

Optimizing patient risk stratification for colonoscopy screening and surveillance of colorectal cancer: The role for linked data

No abstract available for this article

Models for community based day care for older people: A narrative review

Objectives: Older Australians are choosing to live within the community and there are a number of initiatives to enable this sector of the population to do so for longer. In an effort to ensure that they remain both physically and psychologically engaged, one initiative has been to provide community based day care (CBDC). Method: A narrative review was undertaken through searching MEDLINE, CINAHL Plus, Scopus and AgeInfo using keywords related to facility related, target group related and purpose/program of CBDC services. Results: Results indicated that there is a much research investigating different approaches but little consensus regarding the optimal delivery model thereby rendering it difficult to make a direct correlation as to the most effective CBDC. Discussion: The review presents an overview of the array of models providing centre based day care for older people. The challenge for future service delivery is to determine which of CBDC services are most successful in catering for the needs of older community dwelling adult or are new innovative models of CBDC require

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

Male or nurse what comes first? Challenges men face on their journey to nurse registration

Objective: This paper aims to provide an account of the first phase of a qualitative longitudinal study that explored the initial challenges men in nursing face to become registered. What is known is that men, a minority group within nursing, face the usual challenges of all new nurses in their quest to register as nurses. In addition, they have added pressures that hinder their quest due to being male. Primary Argument: An Australian nursing shortage is looming due to nurses retiring from this female-dominate profession. Hence, the retention of men in nursing is an area requiring attention in order to support a sustainable workforce. Subjects and Setting: Nine newly graduated male registered nurses participated. These nurses had recently commenced employment in the Western Australian metropolitan health region. Findings: Individual face-to-face interviews produced the theme of role misconception with a major focus on male or nurse what comes first. This theme was derived from the categories of gender stereotyping and marginalisation. Conclusion: This study suggests the need for a gender-neutral image when promoting nursing within and outside the professional environment. Furthermore, consideration for a professional title mutually accepted by both women and men in nursing, with the gender-neutral ‘nurse’ title preferred by the men in this study. Moreover to acknowledge that men in nursing will augment a technical savvy workforce that will complement emergent complex nursing practices, and enhance a more comprehensive Australian nursing workforce that will assist with meeting the health care needs of a diverse population

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

A fine balance and a shared learning journey: Exploring healthcare engagement through the experiences of youth with neuromuscular disorders

BACKGROUND: Youth with Neuromuscular Disorders (NMD) who are wheelchair users can now survive well into adulthood if their multisystem comorbidities are prudently managed. Uptake of health behaviors may optimize their health outcomes. OBJECTIVE: To explore youths’ perceptions of health, health behaviors and healthcare engagement. METHODS: This qualitative study purposefully recruited 11 youth with NMD from a concurrent, population-based study for variability of age, gender, type of NMD and their ratings of motivation and engagement. Interview data were analyzed and synthesized by thematic content. RESULTS: Participants perceived healthcare engagement as being given tools (knowledge and responsibility) and using them to maintain their finely balanced health. Nested in adequate social, emotional and physical support, they took responsibility for creatively integrating health behaviors they felt were informed by credible knowledge, gained primarily through personal experience. CONCLUSION: Cognizant of their compromised health, youth with NMD in this study were motivated to maintain their physical health. Limited NMD condition specific knowledge challenged youths’ uptake of health behaviors. They valued a learning partnership with their healthcare professionals. By embracing the youth’s experience based knowledge and through facilitating supportive relationships, healthcare professionals co-construct youth’s healthcare engagement that may optimize health behaviors and outcomes

Clinical specialty training in UK undergraduate medical schools: A retrospective observational study

Objectives: To determine if increased exposure to clinical specialties at medical school is associated with increased interest in pursuing that specialty as a career after foundation training. Design: A retrospective observational study. Setting: 31 UK medical schools were asked how much time students spend in each of the clinical specialties. We excluded two schools that were solely Graduate Entry, and two schools were excluded for insufficient information. Main outcome measures: Time spent on clinical placement from UK undergraduate medical schools, and the training destinations of graduates from each school. A general linear model was used to analyse the relationship between the number of weeks spent in a specialty at medical school and the percentage of graduates from that medical school entering each of the Core Training (CT1)/Specialty Training (ST1) specialties directly after Foundation Year 2 (FY2). Results: Students spend a median of 85 weeks in clinical training. This includes a median of 28 weeks on medical firms, 15 weeks in surgical firms, and 8 weeks in general practice (GP). In general, the number of training posts available in a specialty was proportionate to the number of weeks spent in medical school, with some notable exceptions including GP. Importantly, we found that the number of weeks spent in a specialty at medical school did not predict the percentage of graduates of that school training in that specialty at CT1/ST1 level (ß coefficient=0.061, p=0.228). Conclusions: This study found that there was no correlation between the percentage of FY2 doctors appointed directly to a CT1/ST1 specialty and the length of time that they would have spent in those specialties at medical school. This suggests that curriculum adjustments focusing solely on length of time spent in a specialty in medical school would be unlikely to solve recruitment gaps in individual specialties

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