A Model for Large-Scale, Interprofessional, Compulsory Cross-Cultural Education with an Indigenous Focus

Cultural competency training for health professionals is now a recognised strategy to address health disparities between minority and white populations in Western nations. In Australia, urgent action is required to "Close the Gap" between the health outcomes of Indigenous Australians and the dominant European population, and significantly, cultural competency development for health professionals has been identified as an important element to providing culturally safe care. This paper describes a compulsory interprofessional first-year unit in a large health sciences faculty in Australia, which aims to begin students on their journey to becoming culturally competent health professionals. Reporting primarily on qualitative student feedback from the unit's first year of implementation as well as the structure, learning objects, assessment, and approach to coordinating the unit, this paper provides a model for implementing quality wide-scale, interprofessional cultural competence education within a postcolonial context. Critical factors for the unit's implementation and ongoing success are also discussed

Sleep disorders among Aboriginal Australians with Machado-Joseph Disease: Quantitative results from a multiple methods study to assess the experience of people living with the disease and their caregivers

Objective: To investigate frequency and characteristics of sleep disorders and their association with health-related quality of life and psychosocial wellbeing for Aboriginal Australians living with MJD. Methods: A convenience sample of MJD participants n = 24 participated in a semi-attended, ambulatory diagnostic sleep study to capture polysomnography, actigraphy and sleep diary data. Self-report measures collected were the Pittsburgh Sleep Quality Index (PSQI), STOP-BANG Questionnaire for Obstructive Sleep Apnoea (OSA), International Restless Legs Syndrome Study Group rating scale (IRLS), Kessler-5 (K5) and EuroQoL-5 Dimension (EQ5D). Caregivers (n = 22) reported EQ-5D, K5 and bed partners’ sleep behaviour (Mayo Sleep Questionnaire-Informant). Environmental factors were measured. Results: We observed Nocturia, Sleep Related Leg Cramps, OSA, REM Behaviour Disorder, and RLS, respectively in 100%, 71%, 47%, 43%, and 33% of participants with a significant positive correlation between Body mass index (BMI) and Apnoea hypopnea index (AHI). The majority of sleep was spent in non-rapid eye movement sleep (NREM)-N2 stage (77.8% (67.7, 81.6)). Overcrowding (92%) and overnight care needs (42%) interrupted sleep. MJD participants and caregivers reported high psychological distress (K5 median 12.5 IQR 7, 16.5 & 8 IQR 6, 12 respectively). Conclusion: Poor sleep quality and sleep disturbances are prevalent among this cohort. Disease manifestations and environmental factors are driving factors. Larger sample sizes are required to predict risk factors and confirm observed associations

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Developing Indigenous Australian cultural competence: a model for implementing Indigenous content into curricula

This case study describes the implementation of a stand-alone unit on Indigenous Australian culture and health within a nursing and midwifery program, and presents quantitative and qualitative data from the university's anonymous online student teaching and learning questionnaire. In doing so, this study aims to determine whether a single, compulsory unit has the capacity to develop graduate Indigenous Australian cultural competence. Qualitative data from the nine teaching periods over the five years the unit was taught is analysed to determine student satisfaction and motivation. A total of 1742 students enrolled in the unit over five years and 748 completed the online questionnaire (a response rate of 43%). Qualitative data from the same teaching and learning questionnaire is drawn on to highlight the impact of the unit on student attitudes towards Aboriginal and Torres Strait Islander peoples, as well as the pedagogical approaches adopted to teach compulsory Aboriginal studies to predominately non-Aboriginal students.Data suggests that overall students were satisfied and engaged with the unit. For many the experience was transformative, not having had prior experience with Indigenous Australians or Aboriginal studies' content. A discrete unit on Indigenous culture and health has the capacity to assist students to begin their journey to cultural competence. However, to be successful and sustainable, such a unit must be aligned with the three key areas identified in a Reconciliation Action Plan: relationships, respect and opportunities. Furthermore, key pedagogical approaches are required to ensure students are motivated to engage with the content