Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

<b>Background.</b> Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). <br /><br /><b>Methods</b>. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. <br /><br /><b>Results</b>. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. <br /><br /><b>Conclusion.</b> A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

Enabling electronic medicine at Kiwicare : the case of video conferencing adoption for psychiatry in New Zealand

Telemedicine emerges as a viable solution to New Zealand health providers in reaching out to rural patients, in offering medical services and conducting administrative meetings and training. No research exists about adoption of telemedicine in New Zealand. The purpose of this case study was to explain factors influencing adoption of telemedicine utilizing video conferencing technology (TMVC) within a New Zealand hospital known as KiwiCare. Since TMVC is part of IT, tackling it from within technological innovation literature may assist in providing an insight into its adoption within KiwiCare and into the literature. Findings indicate weak presence of critical assessment into technological innovation factors prior to the adoption decision, thereby leading to its weak utilization. Factors like complexity, compatibility and trialability were not assessed extensively by KiwiCare and would have hindered TMVC adoption. TMVC was mainly assessed according to its relative advantage and to its cost effectiveness along with other facilitating and accelerating factors. This is essential but should be alongside technological and other influencing factors highlighted in the literature.<br />

Operating a studio within a research culture: the urban heart surgery design research forum

The question of whether or not design can be considered research has perplexed schools of architecture ever since they were first introduced into universities. It was at the center of the Oxbridge union debates in the early 1900s. It formed one of the corner stones of the Oxford conference on education organized by the RIBA in 1958 (Martin 1958) and came under scrutiny again in the UK with the introduction of the Research Assessment Exercise (RAE) in 1992. While the arguments both for and against are considerable1, &ldquo;in order to understand the questions and the possibilities of architectural research and to respond to the difficulties that confront us now, we have to have a model which acknowledges what schools of architecture really are, and could be, and then work with that&rdquo; 2.<br />Drawing on professionally oriented research models, such as qualitative &lsquo;clinical research&rsquo;, from Medicine and the Health Sciences - where the processes of exploration, observation, investigation, recording and communication are conducted in-situ by the &lsquo;practitioner-as-researcher&rsquo; 3 - the following paper outlines an initiative introduced in 1999, referred to as the &lsquo;Urban Heart Surgery&rsquo; 4. The program actively integrates students entering their second degree program into a studio based design research culture and allows them to engage in critical discourse by working on high profile strategic design projects in three areas significant to Victoria&rsquo;s future growth: Metropolitan Urbanism, Urbanism on the Periphery, and Regional Urbanism.<br />With a growing core of industrial and community based partnerships, including: four regional councils (Bendigo, Ballarat, Geelong and Warrnambool) and three metropolitan municipalities (Melbourne City, Port Phillip and Wyndham), the forum actively facilitates a graduate/practice research agenda through the ARC linkage grant program.<br />

Social structures of science and approaches to outcomes-based medical research

Recently, two seemingly divergent approaches have emerged in outcomes-based medical research. Proponents of evidence-based medicine (EBM) argue that the most effective treatments will be found by adopting a hierarchical approach that gives pre-eminence to randomized controlled clinical trials, where these are available. Proponents of participatory medical research argue that research undertaken with consumers and other partners in the community will produce the best outcomes. While one approach marginalizes consumer experience the other approach draws consumers into it. EBM assumes a high level of consensus in a scientific community, while participatory medical research relies on co-opting consumer experience. This paper indicates that each approach involves a particular view of social structure in science. The paper uses theories of social relations among scientists for the purpose of critically assessing EBM and the participatory model.<br />

Understanding environmental influences on walking - Review and research agenda

<b>Background</b><br />Understanding how environmental attributes can influence particular physical activity behaviors is a public health research priority. Walking is the most common physical activity behavior of adults; environmental innovations may be able to influence rates of participation.<br /><br /><b>Method</b><br />Review of studies on relationships of objectively assessed and perceived environmental attributes with walking. Associations with environmental attributes were examined separately for exercise and recreational walking, walking to get to and from places, and total walking.<br /><br /><b>Results</b><br />Eighteen studies were identified. Aesthetic attributes, convenience of facilities for walking (sidewalks, trails); accessibility of destinations (stores, park, beach); and perceptions about traffic and busy roads were found to be associated with walking for particular purposes. Attributes associated with walking for exercise were different from those associated with walking to get to and from places.<br /><b><br />Conclusions</b><br />While few studies have examined specific environment&ndash;walking relationships, early evidence is promising. Key elements of the research agenda are developing reliable and valid measures of environmental attributes and walking behaviors, determining whether environment&ndash;behavior relationships are causal, and developing theoretical models that account for environmental influences and their interactions with other determinants.<br />

Action research in health promotion

<b>Objectives </b>This article aims to define what is action research and where it fits in with health promotion practice, through drawing upon associated literature and personal action research experience. It also seeks to investigate the possible reasons why it is that health promotion researchers have not readily taken on the processes of action research strategies.<br /><br /><b>Rationale</b> The place of action research in health promotion programmes is an important yet relatively unacknowledged and understated activity. It has proven to be very popular with other professional groups, such as in the education, management and social sciences. In terms of health service activity, it is widely established in the fields of nursing and mental health and is beginning to establish itself in medicine. While there are a few health promotion examples to draw upon, they tend to be isolated, dated and often lie outside of the mainstream literature. It is suggested that this continuing state of affairs denies many health promotion researchers a valuable resource for managing effective change in practice.<b> <br /><br />Conclusion </b>The authors suggest that action research is both a valid and<br />important research method for health promotion researchers, who are advised to further consider its merits in future studies. This article draws attention to the National Health Service (NHS) South West Regional Office-commissioned Our Healthier Nation: Improving the Competence of the Workforce in Health Promotion participatory action research project, as a means of promoting and validating action research strategy. The authors were all actively involved in this project.<br />

Communication outside the humanities in media 'effect' research

This paper draws on the case study of a recent review of research literature on the influences (harms and benefits) on children and families of electronic media content and usage, undertaken on behalf of a Federal regulatory body (Australian Communications and Media Authority) by a multidisciplinary research team. Recent critiques of psychological studies of children and media have challenged the positivist social sciences to look outside of their own disciplinary warrants and to fully answer cultural studies critiques of &lsquo;media effects&rsquo; research. Making connections outside the humanities in this case study involved making the rationales of communications and cultural studies methodologies available to those policy makers who normally may not consider such findings to be evidence-based or policy relevant. But it also involved providing a historical and institutional contextualization of positivist social and medical science findings, a contextualization not enabled by the underlying warrants and discourses of these disciplines. This paper focuses on those sections of the case study project concerned with psychological research on the effects of violent media and epidemiological and public health research on childhood obesity.<br />

Clincial pharmacogenetics and potential application in personalized medicine

The current `fixed-dosage strategy' approach to medicine, means there is much inter-individual variation in drug response. Pharmacogenetics is the study of how inter-individual variations in the DNA sequence of specific genes affect drug responses. This article will highlight current&nbsp; pharmacogenetic knowledge on important drug metabolizing enzymes, drug transporters and drug targets to understand interindividual variability in drug clearance and responses in clinical practice and potential use in&nbsp; personalized medicine. Polymorphisms in the cytochrome P450 (CYP) family may have had the most impact on the fate of pharmaceutical drugs. CYP2D6, CYP2C19 and CYP2C9 gene polymorphisms and gene duplications account for the most frequent variations in phase I metabolism of drugs since nearly 80% of drugs in use today are metabolised by these enzymes. Approximately 5% of Europeans and 1% of Asians lack CYP2D6 activity, and these&nbsp; individuals are known as poor metabolizers. CYP2C9 is another clinically significant drug metabolising enzyme that demonstrates genetic variants. Studies into CYP2C9 polymorphism have highlighted the importance of the CYP2C9*2 and CYP2C9*3 alleles. Extensive polymorphism also occurs in a majority of Phase II drug metabolizing enzymes. One of the most important polymorphisms is thiopurine S-methyl transferases (TPMT) that catalyzes the S-methylation of thiopurine drugs. With respect to drug transport&nbsp; polymorphism, the most extensively studied drug transporter is&nbsp; P-glycoprotein (P-gp/MDR1), but the current data on the clinical impact is limited. Polymorphisms in drug transporters may change drug's distribution, excretion and response. Recent advances in molecular research have revealed many of the genes that encode drug targets demonstrate genetic polymorphism. These variations, in many cases, have altered the targets sensitivity to the specific drug molecule and thus have a profound effect on drug efficacy and toxicity. For example, the &beta;2-adrenoreceptor, which is encoded by the ADRB2 gene, illustrates a clinically significant genetic variation in drug targets. The variable number tandem repeat polymorphisms in serotonin transporter (SERT/SLC6A4) gene are associated with response to antidepressants. The distribution of the common variant alleles of genes that encode drug metabolizing enzymes, drug transporters and drug targets has been found to vary among different populations. The promise of pharmacogenetics lies in its potential to identify the right drug at the right dose for the right individual. Drugs with a narrow therapeutic index are thought to benefit more from pharmacogenetic studies. For example, warfarin serves as a good practical example of how pharmacogenetics can be utilized prior to commencement of therapy in order to achieve maximum efficacy and minimum toxicity. As such, pharmacogenetics has the potential to achieve optimal quality use of medicines, and to improve the efficacy and safety of both prospective and licensed drugs.<br />

Reaching and influencing consumers in the prescription medicine market

<b>Purpose &ndash;</b> Celebrex became the first of a new class of drugs known as COX-2 selective non-steroidal anti-inflammatory drugs. It improves treatment for arthritis sufferers without compromising the protective lining of the stomach. The purpose of this paper is to illustrate how direct-to-consumer advertising (DTCA) of prescription medicines can be used to rebuild faith in the cyclooxygenase-2 (COX-2) product category. <br /><br /><b>Design/methodology/approach &ndash;</b> The case is developed using published sources and no input is required from company representatives. The presentation style follows the classic comprehensive case format used in postgraduate teaching programmes. <br /><b><br />Findings &ndash; </b>Business executives and strategic marketing students would benefit from a discussion on how external environmental factors can suddenly impose a review of marketing strategy. The reader learns how management addresses the business dilemma using DTCA. <br /><b><br />Research limitations/implications &ndash;</b> A blockbuster rival drug Vioxx is withdrawn due to cardiovascular (CV) health safety concerns. A resulting dominant market situation soon becomes a business dilemma. The Federal Drug Administration calls for a &ldquo;black box&rdquo; warning label on Celebrex, the most serious type of warning. <br /><b><br />Practical implications &ndash;</b> The implications are that having a product in a class of its own is not enough. It highlights the need to communicate to different audiences, to both the medical profession and the end-user. Getting doctors to recommend the medicine and pulling the product through the channel by stimulating patient demand after a health scare are paramount. <br /><b><br />Originality/value &ndash;</b> This is the first pharmaceutical business case where the withdrawal of a rival product leaves the dominant competitor in a monopoly situation. Contrary to expectation, market share plummets despite the absence of competition.<br />

What's needed to increase research capacity in rural primary health care

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main&nbsp; outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians&rsquo; research&nbsp; involvement. The results showed that popular delivery modes for research training and support were courses and &ldquo;one-to- one&rdquo; advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian&nbsp; consultations on research needs in primary health conducted with a diverse&nbsp; range of clinicians at the clinician level. It will direct future research capacity&nbsp; building efforts towards maximising face-to-face discipline specific options and&nbsp; minimising technology use.<br />