Engineering the fitness of older patients for chemotherapy : an exploration of Comprehensive Geriatric Assessment in practice

Clinicians often report that currently available methods to assess older patients, including standard clinical consultations, do not elicit the information necessary to make an appropriate cancer treatment recommendation for older cancer patients. An increasingly popular way of assessing the potential of older patients to cope with chemotherapy is a Comprehensive Geriatric Assessment. What constitutes Comprehensive Geriatric Assessment, however, is open to interpretation and varies from one setting to another. Furthermore, Comprehensive Geriatric Assessment’s usefulness as a predictor of fitness for chemotherapy and as a determinant of actual treatment is not well understood. In this article, we analyse how Comprehensive Geriatric Assessment was developed for use in a large cancer service in an Australian capital city. Drawing upon Actor–Network Theory, our findings reveal how, during its development, Comprehensive Geriatric Assessment was made both a tool and a science. Furthermore, we briefly explore the tensions that we experienced as scholars who analyse medico-scientific practices and as practitioner–designers charged with improving the very tools we critique. Our study contributes towards geriatric oncology by scrutinising the medicalisation of ageing, unravelling the practices of standardisation and illuminating the multiplicity of ‘fitness for chemotherapy’.

Malnutrition and chemotherapy : implications for nursing practice

Background: Malnutrition before and during chemotherapy is associated with poor treatment outcomes. The risk of cancer-related malnutrition is exacerbated by common nutrition impact symptoms during chemotherapy, such as nausea, diarrhoea and mucositis. Aim of presentation: To describe the prevalence of malnutrition/ malnutrition risk in two samples of patients treated in a quaternary-level chemotherapy unit. Research design: Cross sectional survey. Sample 1: Patients ≥ 65 years prior to chemotherapy treatment (n=175). Instrument: Nurse-administered Malnutrition Screening Tool to screen for malnutrition risk and body mass index (BMI). Sample 2: Patients ≥ 18 years receiving chemotherapy (n=121). Instrument: Dietitian-administered Patient Generated Subjective Global Assessment to assess malnutrition, malnutrition risk and BMI. Findings Sample 1: 93/175 (53%) of older patients were at risk of malnutrition prior to chemotherapy. 27 (15%) were underweight (BMI <21.9); 84 (48%) were overweight (BMI >27). Findings Sample 2: 31/121 patients (26%) were malnourished; 12 (10%) had intake-limiting nausea or vomiting; 22 (20%) reported significant weight loss; and 20 (18%) required improved nutritional symptom management during treatment. 13 participants with malnutrition/nutrition impact symptoms (35%) had no dietitian contact; the majority of these participants were overweight. Implications for nursing: Patients with, or at risk of, malnutrition before and during chemotherapy can be overlooked, particularly if they are overweight. Older patients seem particularly at risk. Nurses can easily and quickly identify risk with the regular use of the Malnutrition Screening Tool, and refer patients to expert dietetic support, to ensure optimal treatment outcomes.

An overview of level I evidence for the management of radiation dermatitis literature

Background: Despite the technologic advances, radiation dermatitis is still a prevalent and distressing symptom in patients with cancer undergoing radiotherapy. Systematic reviews (SRs) are regarded as level I evidence providing direction for clinical practice and guidelines. This overview aims to provide a critical appraisal of SRs published on interventions for the prevention/management of radiation dermatitis. Methodology: We searched the following electronic databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Library (up to Feb 2012). We also hand-searched reference lists of potentially eligible articles and a number of key journals in the area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using the “A Measurement Tool to Assess Systematic Reviews” (AMSTAR). Results: Of 1837 potential titles, six SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/non-steroidal topical agents, systematic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews may create biases to the overall results or recommendations for clinical practice. Conclusions and implications: An up-to-date high quality SR in preventing/managing radiation dermatitis is needed to guide practice and direction for future research. Clinicians or guideline developers are recommended to critically evaluate the information of SRs in their decision making.

Radiographic projections for acute shoulder trauma: A review of current practice

A review of radiographers was undertaken to determine the specific projections currently performed for patients with acute presentation for shoulder trauma. Radiographers were asked to indicate projections they would perform for specific patient presentations. This poster presents a snapshot of the diversity of projections performed and a review of the current evidence of the most appropriate projections

General practice patients in the emergency department

One of the mysteries of public policy is that at times the public discourse settles on a perspective that is based on flimsy or even contradictory evidence. One such discussion relates to the factors that contribute to the congestion of hospital emergency departments (EDs) in Australia.

Capitalising on mixed methods research : design, examples, and practice

Overview: - Development of mixed methods research - Benefits and challenges of “mixing” - Different models - Good design - Two examples - How to report? - Have a go!

The practice of adaptation : turning fact and fiction into theatre

Adaptation of novels and other source texts into theatre has proven to be a recurring and popular form of writing through the ages. This study argues that as the theoretical discourse has moved on from outmoded notions of fidelity to original sources, the practice of adaptation is a method of re-invigorating theatre forms and inventing new ones. This practice-led research employed a tripartite methodology comprised of the writing of two play adaptations, participation by the author/researcher in their productions, and exegetical components focused on the development and deployment of analytical tools. These tools were derived from theoretical literature and a creative practice based on acquired professional artistry "learnt by doing" over a longstanding professional career as actor, director and writer. A suite of analytical tools was developed through the three phases of the first project, the adaptation of Nick Earls’ novel Perfect Skin. The tools draw on Cardwell’s "comparative analysis", which encompasses close consideration of generic context, authorial context and medium-specific context; and on Stam’s "mechanics of narrative": order, duration, frequency, the narrator and point of view. A third analytical lens was developed from an awareness of the significance of the commissioning brief and ethical considerations and obligations to the source text and its author and audience. The tripartite methodology provided an adaptation template that was applied to the writing and production of the second play Red Cap, which used factual and anecdotal sources. The second play’s exegesis (Chapter 10) analyses the effectiveness of the suite of analytical tools and the reception of the production in order to conclude the study with a workable model for use in the practice of adapting existing texts, both factual and fictional, for the theatre.

Building contemporary urban spaces of knowledge and innovation : Lessons from Australian practice

In the era of global knowledge economy, urban regions that are seeking to increase their competitive edge, become destinations for talent and investment, and provide prosperity and quality of life to their inhabitants have little chance achieving their development goals without forming effective knowledge-based urban development strategies. This paper aims to shed light on the planning and development of the knowledge-based urban development phenomenon with respect to the construction of knowledge community precincts aimed at building contemporary urban spaces of knowledge and innovation. Following to a thorough review of the literature on knowledge-based urban development, the paper undertakes policy and best practice analyses to learn from the internationally renowned Australian knowledge community precincts, from Sydney, Melbourne and Brisbane, to better understand the dynamics of knowledge community precinct development practices. The paper provides a discussion on the study findings and recommendations for successfully establishing contemporary urban spaces of knowledge and innovation.

Exploring the role of Twitter in the professional practice of LIS professionals : a pilot study

This paper presents the findings of a pilot study that explores LIS professionals’ experiences of using Twitter as part of their professional practice. The researchers used a qualitative research methodology to undertake the study. Semi-structured interviews and observation were used for data collection. The researchers conducted two in-depth, semi-structured interviews per participant (one pre-observation and one post-observation). The observations were conducted for a period of one week after the first interview. In total, six interviews and three observations were conducted. The researchers used Descriptive Coding and In Vivo Coding methods to analyse the data and found three themes emerged from this study: being connected; building network; and staying informed. This study was undertaken as a part of Master of Information Technology study at QUT. As such, the findings of this research are preliminary in nature. It is expected that the preliminary data of this study can be used to design a much larger and more complex future research project in this area.

Reorganizing a technical services division using collaborative evidence based information practice at Auraria Library

The article focuses on the evidence-based information practice (EBIP) applied at the Auraria Library in Denver, Colorado during the reorganization of its technical services division. Collaboration processes were established for the technical services division through the reorganization and redefinition of workflows. There are several factors that form part of the redefinition of roles including personal interests, department needs, and library needs. A collaborative EBIP environment was created in the division by addressing issues of workplace hierarchies, by the distribution of problem solving, and by the encouragement of reflective dialogue.

Culturally safe practice in social work

This presentation discusses the use of field experiences in educating social work students in culturally safe practice with Aboriginal and Torres Strait Islander peoples and communities.

Nursing practice environment, quality of care and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses’ perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.

From solving puzzles to designing solutions : integrating design thinking into evidence based practice

Evidence based practice (EBP) focuses on solving ‘tame’ problems, where literature supports question construction toward determining a solution. What happens when there is no existing evidence, or when the need for agility precludes a full EBP implementation? How might we build a more agile and innovative practice that facilitates the design of solutions to complex and wicked problems, particularly in cases where there is no existing literature? As problem solving and innovation methods, EBP and design thinking overlap considerably. The literature indicates the potential benefits to be gained for evidence based practice from adopting a human-centred rather than literature-focused foundation. The design thinking process is social and collaborative by nature, which enables it to be more agile and produce more innovative results than evidence based practice. This paper recommends a hybrid approach to maximise the strengths and benefits of the two methods for designing solutions to wicked problems. Incorporating design thinking principles and tools into EBP has the potential to move its applicability beyond tame problems and continuous improvement, and toward wicked problem solving and innovation. The potential of this hybrid approach in practice is yet to be explored.

Making space and place for knowledge communities : lessons for Australian practice

This paper aims to shed light on the planning and development processes of the knowledge-based urban development phenomenon, with respect to the construction of knowledge community precincts. We undertake policy and best practice analyses to learn from the planning and development processes of internationally renowned knowledge community precincts—from Copenhagen, Eindhoven and Singapore. In the light of this, we scrutinise major Australian knowledge community precinct initiatives—from Sydney, Melbourne and Brisbane—to better understand the dynamics of national practices, and benchmark them against the international best practice cases. The paper concludes with a discussion on the study findings and successfully establishing space and place for both knowledge economy and society in Australian cities.