Continuity of cancer care: Where do primary care practitioners fit in?

Cancer is the leading cause of illness in Australia and is a national health priority. Primary care in Australia is well positioned to support individuals diagnosed with cancer and their family/caretakers. However, obstacles exist that impact on the quality and continuity of care that primary care providers and community health professionals can provide. A rapid review of the research available revealed that the knowledge, attitudes and beliefs held by health professionals and patients can impact engagement in early detection, treatment and follow-up care. Health professionals have limited knowledge of evidence-based practices, while cancer literacy among minority groups, including Aboriginal Australians, is lower than the population overall. In this paper, we provide a summary of the rapid review of the literature and provide some recommendations based on our research

Desain Self-propelled Car Barge Untuk Distribusi Mobil Baru Rute Cikarang Bekasi Laut (Cbl) – Tanjung Perak

Berbagai upaya telah dilakukan Pemerintah untuk dapat mengurangi kemacetan jalur Pantura. Mulai dari pemberian jalur alternatif, pelebaran jalan, hingga pembuatan jalan tol baru. Segala upaya tersebut tidak sebanding dengan jumlah kendaraan yang terus meningkat melewati jalur Pantura, khususnya kendaraan-kendaraan barang seperti truk dan kontainer. Hal ini tidak terlepas dari geliat perekonomian yang terus tumbuh. Kawasan industri otomotif di sekitar Cikarang dan Bekasi salah satu contohnya. Jumlah produksi mobil domestik dan permintaan yang terus meningkat ini membutuhkan sarana yang baik dan cepat dalam mendistribusikan mobil baru ke berbagai daerah. Dalam beberapa tahun ini, Jawa Timur merupakan provinsi dengan tingkat permintaan mobil yang cukup tinggi di Indonesia. Oleh karena itu, salah satu solusi yang ditawarkan untuk dapat mengurangi kemacetan di jalur darat adalah berupa pengalihan transportasi darat ke sungai atau laut. Berdasarkan solusi tersebut, maka dibutuhkan alat transportasi pengangkut barang, dalam hal ini mobil, yang dapat melewati sungai dan laut. Self-propelled car barge diharapkan mampu menjadi inovasi yang cukup baik dalam mendistribusikan barang melalui rute Sungai Cikarang Bekasi Laut (CBL) menuju ke Pelabuhan Tanjung Perak. Untuk mendapatkan ukuran utama yang optimum digunakan metode optimation design approach dengan bantuan fitur solver pada program Microsoft Excel dengan menjadikan biaya pembangunan paling minimum sebagai fungsi objektif, serta adanya batasan-batasan dari persyaratan teknis dan regulasi yang ada. Dari proses optimisasi, didapatkan ukuran utama optimum Self-Propelled Car Barge adalah L=53.10 m, B=15.17 m, TFW=3.09 m, TSW=3.02 m, dan H=4.66 m, dengan estimasi biaya pembangunan sebesar $1.435.270,56 atau setara Rp.19.281.424.757,10

Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review

Background: Alongside specialist cancer clinics, general practitioners have an important role in cancer patients’ follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. Methods: Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. Results: A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. Conclusion: Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered

Pengaruh Implementasi Pembelajaran Tematik terhadap Prestasi Belajar Ditinjau dari Motivasi Belajar pada Siswa Kelas IV Gugus Empat di Kecamatan Gianyar

This study aimed to determine (1) the difference between the academic achievement of students who take thematic learning compared to students who take conventional learning, (2) the effect of the interaction between learning strategies with students' motivation to learning achievement, (3) differences in academic achievement between students who following thematic learning compared to students who take conventional learning on students who have high motivation to learn, and (4) differences in academic achievement between students who take the thematic learning compared to students who take conventional learning on students with low learning motivation. Data were analyzed by analysis of variance with two lanes F-test. The results show that: (1) there are differences in student achievement between students who take the thematic learning and students who take conventional learning (FA = 5.008 with p <0.05), (2) There is an interaction effect between learning strategies and motivation toward achievement learning (FAB = 36.762 with p <0.05), (3) In the students who have high motivation to learn, there are differences in student achievement between students who take the thematic learning and students who take conventional learning (t-test = 5.870> t-table = 1.960), and (4) At the student who has a low learning motivation, there is a difference in student achievement between students who take the thematic learning and students who take conventional learning (t-test = 2.705> t-table = 1.960)

The Influence of Management Commitment on the Achievement of Lecturers through Work Motivation and Organizational Citizenship Behavior

Higher education as an organization is responsible for achieving “Tri Dharma,” including teaching, research, and community engagement. Management commitment the organization needs to motivate lecturers and improve performance. The data collected was from 53 lectures in Theological Seminary in Jakarta. Processing and data analysis used Partial Least Square to test the hypothesis. The study results found that management commitment to the Theological Seminary could increase the motivation work of the lecturer because they have a conducive environment. The lecturers management commitment and motivation work can affect the organizational citizenship behavior to bring different behavior for the lecturers. Management commitment and lecturer work motivation can improve lecturer performance by increasing the Tri Dharma of lecturers in teaching, research, and community engagement. This study provides that theoretical development organizations could increase college rankings and increase competitiveness through the power of teamwork and the application of organizational citizenship behavio

Can a community of practice enhance a palliative approach for people drawing close to death with dementia?

This action research study was conducted to trial a strategy intended to support a consistent, high-quality, palliative approach for people with dementia drawing close to death-the implementation of a community of practice. Professionals from community/residential care and hospitals formed this community of practice, which took on the role of an action research group. The group was supported to identify and address practice problems. Four action plans were implemented; outcomes from two are reported. When actioning the plan 'providing education and information for the staff', the staff's ratings of sessions and resources were positive but impacts upon knowledge, views, or confidence were small. When actioning 'supporting families', families providing care in non-hospital settings received information about severe dementia from suitably prepared staff, plus contact details to access support. Family feedback was primarily positive. Reference to additional practice change frameworks and inclusion of specialist palliative care professionals are recommendations for future initiatives; also focusing on targeted, achievable goals over longer timeframes

A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice

Objective To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs). Trial design GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems. Methods Setting Primary care. Participants Practising Australian GPs. Intervention A short or long hospital discharge letter enumerating patient problems. Outcome measure Number of ongoing patient problems out of 10 identified for management by the GPs. Randomisation 1:1 randomisation. Blinding (masking) Single-blind. Results Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information (p<0.001). Those who received the letter immediately identified significantly more health problems (p=0.001). GPs who received a short, delayed discharge letter were less satisfied than those who received a longer delayed letter (p=0.03); however, both groups who received the delayed letter identified a similar number of health problems. GPs who were older, who practised in an inner regional area or who offered more patient sessions per week identified fewer health problems (p values <0.01, <0.05 and <0.05, respectively). Harms Nil. Conclusions Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed. Trial registration number ACTRN12614000403639

Developing and testing a strategy to enhance a palliative approach and care continuity for people who have dementia: Study overview and protocol

Background: Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client’s usual care team. In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations. Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation. Methods/design: This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of additional resources. Change implementation was recorded and explored in interviews, comparisons being made with practice recommendations. Changes in staff/practitioner characteristics were evaluated using survey data. Findings from semi structured interviews and survey administration established outcomes from perspectives of family carers, care providers, and community of practice members. Consideration of processes and outcomes, across the two state based settings, informed identification of barriers and facilitators. Community of practice reflections also informed study recommendations