A snapshot of Australian nurse practitioners’ extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.

Clients’ understanding of the role of nurse practitioners

Introduction: Nurse Practitioners (NPs) have an emerging role in the Australian healthcare system. However, there remains a dearth of available data about public understanding of the NP role. ---------- Aim: To evaluate clients’ understanding of the role of the NP and their satisfaction with education received, quality of care and NP knowledge and skill. ---------- Method: All authorised NPs working in a designated NP position in Western Australia and those working in three area health services in New South Wales (NSW) were invited to recruit five consecutive clients to complete the self-administered survey. ---------- Results: Thirty two NPs (NP response rate 93%) recruited 129 clients (client response rate 90%). Two thirds of clients (63%) were aware they were consulting an NP. The majority rated the following NP related outcomes as ‘excellent’ or ‘very good’: education provided (89%); quality of care (95%); and knowledge and skill (93%). Less than half reported an understanding that NPs could prescribe medications (40.5%) or interpret X-rays (33.6%). Clients of NPs practising in a rural or remote setting were more likely than those in an urban setting to have previously consulted an NP (p=0.005), and where applicable would to prefer to see a NP rather than a doctor (p=0.022). ---------- Discussion: Successful implementation and expansion of the NP role requires NP visibility in the community. Despite high levels of satisfaction more awareness of the scope of the NP role is required.

Tips for generating a media release and media coverage : how the media ate up my research on Aussie horror movies

The focus of this paper is preparing research for dissemination by mainstream print, broadcast, and online media. While the rise of the blogosphere and social media is proving an effective way of reaching niche audiences, my own research reached such an audience through traditional media. The first major study of Australian horror cinema, my PhD thesis A Dark New World: Anatomy of Australian Horror Films, generated strong interest from horror movie fans, film scholars, and filmmakers. I worked closely with the Queensland University of Technology’s (QUT) public relations unit to write two separate media releases circulated on October 13, 2008 and October 14, 2009. This chapter reflects upon the process of working with the media and provides tips for reaching audiences, particularly in terms of strategically planning outcomes. It delves into the background of my study which would later influence my approach to the media, the process of drafting media releases, and key outcomes and benefits from popularising research. A key lesson from this experience is that redeveloping research for the media requires a sharp writing style, letting go of academic justification, catchy quotes, and an ability to distil complex details into easy-to-understand concepts. Although my study received strong media coverage, and I have since become a media commentator, my experiences also revealed a number of pitfalls that are likely to arise for other researchers keen on targeting media coverage.

The ecology of Bactrocera tryoni (Froggatt) (Diptera: Tephritdae) : what do we know to assist pest management?

The distribution, systematics and ecology of Bactrocera tryoni, the Queensland fruit fly are reviewed. Bactrocera tryoni is a member of the B. tryoni complex of species, which currently includes four named species, viz. B. tryoni s.s., B. neohumeralis, B. melas and B. aquilonis. The species status of B. melas and B. aquilonis are unclear (they may be junior synonyms of B. tryoni) and their validity, or otherwise, needs to be confirmed as a matter of urgency. While Queensland fruit fly is regarded as a tropical species, it cannot be assumed that its distribution will spread further south under climate change scenarios. Increasing aridity and hot dry summers, as well as more complex, indirect interactions resulting from elevated CO2, make predicting the future distribution and abundance of B. tryoni difficult. The ecology of B. tryoni is reviewed with respect to current control approaches (with the exception of Sterile Insect Technique which is covered in a companion paper). We conclude that there are major gaps in the knowledge required to implement most non-insecticide based management approaches. Priority areas for future research include host plant interactions, protein and cue-lure foraging and use, spatial dynamics, development of new monitoring tools, investigating the use of natural enemies and better integration of fruit flies into general horticultural IPM systems.

A DRD2 polymorphism predicts PANSS score variability in schizophrenia patients treated with antipsychotics

Antipsychotic medications act as either antagonists or partial agonists of the dopamine D2 receptor (DRD2) and antipsychotic drugs vary widely in their binding affinity for the D2 receptor (Kapur and Seeman, 2000). The DRD2 957CNT (rs6277) polymorphism has previously been associated with schizophrenia (Lawford et al., 2005) and the T-allele of the 957CNT polymorphism is associated with reduced mRNA stability and synthesis of the dopamine D2 receptor (Duan et al., 2003). The aim of the study was to determine if the rs6277 polymorphism predicts some of the variability of positive and negative symptoms observed in schizophrenia patients being treated with antipsychotic medication.

Dysbindin (DTNBP1) : a role in psychotic depression?

Previous studies yielded evidence for dysbindin (DTNBP1) to impact the pathogenesis of schizophrenia on the one hand and affective disorders such as bipolar or major depressive disorder (MDD) on the other. Thus, in the present study we investigated whether DTNBP1 variation was associated with psychotic depression as a severe clinical manifestation of MDD possibly constituting an overlapping phenotype between affective disorders and schizophrenia. A sample of 243 Caucasian inpatients with MDD (SCID-I) was genotyped for 12 SNPs spanning 92% of the DTNBP1 gene region. Differences in DTNBP1 genotype distributions across diagnostic subgroups of psychotic (N = 131) vs. non-psychotic depression were estimated by Pearson Chi2 test and logistic regression analyses adjusted for age, gender, Beck Depression Inventory (BDI) and the Global Assessment of Functioning Scale (GAF). Overall, patients with psychotic depression presented with higher BDI and lower GAF scores expressing a higher severity of the illness as compared to depressed patients without psychotic features. Four DTNBP1 SNPs, particularly rs1997679 and rs9370822, and the corresponding haplotypes, respectively, were found to be significantly associated with the risk of psychotic depression in an allele-dose fashion. In summary, the present results provide preliminary support for dysbindin (DTNBP1) gene variation, particularly SNPs rs1997679 and rs9370822, to be associated with the clinical phenotype of psychotic depression suggesting a possible neurobiological mechanism for an intermediate trait on the continuum between affective disorders and schizophrenia.

HapMap tag-SNP analysis confirms a role for COMT in schizophrenia risk and reveals a novel association

Catechol-O-methyl transferase (COMT) encodes an enzyme involved in the metabolism of dopamine and maps to a commonly deleted region that increases schizophrenia risk. A non-synonymous polymorphism (rs4680) in COMT has been previously found to be associated with schizophrenia and results in altered activity levels of COMT. Using a haplotype block-based gene-tagging approach we conducted an association study of seven COMT single nucleotide polymorphisms (SNPs) in 160 patients with a DSM-IV diagnosis of schizophrenia and 250 controls in an Australian population. Two polymorphisms including rs4680 and rs165774 were found to be significantly associated with schizophrenia. The rs4680 results in a Val/Met substitution but the strongest association was shown by the novel SNP, rs165774, which may still be functional even though it is located in intron five. Individuals with schizophrenia were more than twice as likely to carry the GG genotype compared to the AA genotype for both the rs165774 and rs4680 SNPs. This association was slightly improved when males were analysed separately possibly indicating a degree of sexual dimorphism. Our results confirm that COMT is a good candidate for schizophrenia risk, by replicating the association with rs4680 and identifying a novel SNP association.

A polymorphism in the dysbindin gene (DTNBP1) associated with multiple psychiatric disorders including schizophrenia

Background A number of studies have found associations between dysbindin (DTNBP1) polymorphisms and schizophrenia. Recently we identified a DTNBP1 SNP (rs9370822) that is strongly associated with schizophrenia. Individuals diagnosed with schizophrenia were nearly three times as likely to carry the CC genotype compared to the AA genotype. Methods To investigate the importance of this SNP in the function of DTNBP1, a number of psychiatric conditions including addictive behaviours and anxiety disorders were analysed for association with rs9370822. Results The DTNBP1 polymorphism was significantly associated with post-traumatic stress disorder (PTSD) as well as nicotine and opiate dependence but not alcohol dependence. Individuals suffering PTSD were more than three times as likely to carry the CC genotype compared to the AA genotype. Individuals with nicotine or opiate dependence were more than twice as likely to carry the CC genotype compared to the AA genotype. Conclusions This study provides further support for the importance of DTNBP1 in psychiatric conditions and suggests that there is a common underlying molecular defect involving DTNBP1 that contributes to the development of several anxiety and addictive disorders that are generally recognised as separate clinical conditions. These disorders may actually be different expressions of a single metabolic pathway perturbation. As our participant numbers are limited our observations should be viewed with caution until they are independently replicated.

Cyberbullying : legal implications for schools

Most educators are now aware that cyberbullying is bullying through the use of technology. This new form of bullying makes use of the diverse range of technology now available including email, texting, chat rooms, mobile phones, mobile phone cameras, i-pods and websites. Cyberbullying shares many of the same attributes as face-to-face bullying such as a power imbalance which causes a sense of helplessness on the part of the victim, repetition and the intent to hurt.

Mapping the building and construction product system : preliminary report

This Preliminary Report has been prepared by researchers at The Australian Expert Group in Industry Studies (AEGIS) for the Commonwealth Department of Industry, Science and Resources. It is intended to provide a preliminary 'product system map' of the building and construction industries which defines the system, identifies the major segments, describes key industry players and institutions and provides the basis for exploring relationships, innovation and information flows within the industries. This Preliminary Report is the first of a series of five which will explore the building and construction product system in some depth. This first report does not present original research, although it does include some new interview data and analysis of a variety of written sources. This report is rather a reformulation of existing statistical and analytical material from a product system-based perspective. It is intended to provide the basis for subsequent studies by putting what is already known into an alternative framework and allowing us to see it through a new lens.

Cyberbullying in Australia

While bullying at school has long been recognised as existing in Australian literature the empirical study of the phenomenon really did not begin until 1989-90. In 1994 an Australian Commonwealth Senate inquiry into school violence resulted in the publication of an influential report ‘Sticks and Stones: A report on violence in Schools’. This inquiry heralded a nationwide movement to address the issue of school violence,particularly bullying. While the report generally concluded that school violence was not an issue in Australian schools, bullying was. The inquiry raised significant questions regarding the frequency of violence in Australian culture, the impact of violence on the community, and identified the need for intervention programs to reduce violence, particularly that associated with bullying. Overall, in 2003 between one in five and one in seven students reported being bullied face-to-face once a week or more. In Australia victimization is more frequently reported by younger students and girls generally report less victimization than boys. In secondary school the amount of bullying was highest in Years 8 and 9 (Slee,2003)

School-based strategies to address cyber bullying

Bullying and victimisation among school age children is recognised as a major public health problem. The Australian Covert Bullying Prevalence Study (ACBPS) reports that just over one quarter (27%) of school students aged 8 to 14 years were bullied and 9% bullied others on a frequent basis (every few weeks or more often) (Cross et al., 2009). Bullying is associated with a host of detrimental effects, including loneliness (Nansel, Overpeck, Pilla, & Ruan, 2001), low self‐esteem (Jankauskiene, Kardelis, Sukys, & Kardeliene, 2008; Salmivalli, Kaukiainen, Kaistaniemi, & Lagerspetz, 1999), anxiety, depression (Kaltiala‐Heino, Rimpela, Rantanen, & Rimpela, 2000), suicide ideation (Kaltiala‐Heino, Rimpela, Marttunen, Rimpela, & Rantanen, 1999), impaired academic achievement (Nansel et al., 2001), and poorer physical health (Wolke, Woods, Bloomfield, & Karstadt, 2001).

Changing personal epistemologies in early childhood pre-service teachers using an integrated teaching program

This study investigated changes in pre-service teachers’ personal epistemologies as they engaged in an integrated teaching program. Personal epistemology refers to individual beliefs about the nature of knowing and knowledge and has been shown to influence teaching practice. An integrated approach to teaching, based on both an implicit and explicit focus on personal epistemology, was developed by an academic team within a Bachelor of Education (Early Childhood). The teaching program integrated content across four units of study, modelling personal epistemologies implicitly through collaborative reflexive practice. The students were also required to engage in explicit reflections on their personal epistemologies. Quantitative measures of personal epistemology were collected at the beginning and end of the semester using the Epistemological Beliefs Survey (EBS) to assess changes across the teaching period. Results indicated that pre-service teachers’ epistemological beliefs about the integration of knowledge became more sophisticated over the course of the teaching period. Qualitative data included pre-service teachers’ responses to open ended questions and field experience journal reflections about their perceptions of the teaching program and were collected at the end of the semester. These data showed that pre-service teachers held different conceptions about learning as integration, which provided a more nuanced understanding of the EBS data. Understanding pre-service teachers’ epistemological beliefs provides promising directions for teacher preparation and professional enrichment.