CPR training in households of patients with chest pain

The objectives of this study are to (1) quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2) evaluate the willingness of household members to undertake CPR training; and (3) identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

Teaching business process modelling : experiences and recommendations

A curriculum for a university-level course called Business Process Modeling is presented in order to provide guidance for the increasing number of institutions who are currently developing such contents. The course caters to undergraduate and post graduate students. Its content is drawn from recent research, industry practice, and established teaching material, and teaches ways of specifying business processes for the analysis and design of process-aware information systems. The teaching approach is a blend of lectures and classroom exercises with innovative case studies, as well as reviews of research material. Students are asked to conceptualize, analyze, and articulate real life process scenarios. Tutorials and cheat sheets assist with the learning experience. Course evaluations from 40 students suggest the adequacy of the teaching approach. Specifically, evaluations show a high degree of satisfaction with course relevance, content presentation, and teaching approach.

Reading Squadron: Crossing borders in literacy experiences for preservice teachers.

Teaching literacy requires accurate and current knowledge in the field (Commonwealth of Australia, 2005). There have been persistent inquiries into what constitutes specialist knowledge and skills for teaching students to be literate. Preservice teacher education is fundamental to literacy development, which includes the approaches universities employ to prepare graduates for teaching literacy. Indeed, preservice teacher programs and literacy education also elicit insatiable media coverage. There is a continued push to improve literacy outcomes for school students across the nation and prepare the literacy knowledge and skills of Australian teachers. This study mainly focuses on 10 final-year preservice teachers attending a regional university campus who volunteered for further experiences to teach students to read traditional texts. These preservice teachers completed three university literacy units before commencing with practical applications. A literacy program, titled Reading Squadron, was developed in partnership between a local primary school and the university. Primary students were identified by the school as requiring literacy support. Preservice teachers attended a whole day training session run by school staff at the university and then visited the school for two one-hour sessions each week over a six-week period. Each preservice teacher was assigned two students and worked with each student for half an hour twice a week. The aim of this small-scale qualitative study was to investigate the perceptions of the preservice teachers and school staff as a result of their involvement in the Reading Squadron program. The preservice teachers completed a questionnaire to determine their views of the program and ascertain how it assisted their development. Further data were gathered from the preservice teachers through individual face-to-face interviews. Three school staff involved in the program also completed a questionnaire to determine the value of the program. Results indicated that the preservice teachers made links between theory and practice, and felt they gained knowledge about teaching reading. Three preservice teachers noted it was difficult to work around timetable commitments but gained from the experience and suggested embedding such experiences into university literacy units. Data gathered from school staff indicated that six-weeks was not sufficient time to measure improvements in the school students, however, they were supportive of such a program, particularly for its continuation. Collaborations between schools and universities can provide opportunities for preservice teachers to use theoretical knowledge gained from core university subjects with application to assist primary students’ literacy development in schools. Teachers in this study were supportive of the Reading Squadron program, however, more data needed to be collected to understand the literacy improvement of students. Longitudinal studies are required to ascertain specific knowledge and skills gained by preservice teachers to teach reading and how these programs enhance students’ literacy levels.

"Over The Hill" is not so far away : crossing teaching contexts to create benefits for all through rural teaching experiences.

Attracting and retaining quality teachers to rural and remote areas has been a challenge over the last decade. Many preservice teachers are reluctant to experience a rural and remote practicum and may not consider applying to teach in such areas when they graduate. Education departments and universities need to explore innovative ways that will encourage graduates to consider undertaking a teaching position in the bush. As a way forward, preservice teachers from a regional campus of a Queensland University were invited to participate in a six-day rural experience entitled ‘Over the Hill’ that included being billeted with local families, participating in community activities and observing and teaching in classrooms. Fifteen preservice teachers were accompanied by two university academics who returned to work in a classroom as teacher for their own rural and remote professional experience. The aim of this qualitative study was to explore and describe the perceptions of a rural and remote teaching experience from the perspectives of the preservice teachers, the accompanying academics and the school staff hosting the program. Data were collected from the preservice teachers and accompanying academics in the form of written reflections while fourteen school staff completed a related questionnaire. The results indicated that a six-day rural and remote teaching program can provide professional benefits for all involved, preservice teachers, accompanying academics and the school staff hosting the program. Indeed, this study indicates that short experiences such as “Over the Hill” not only assist preservice teachers to make informed decisions about teaching in rural and remote areas but can provide professional benefits for accompanying academics and the schools.

Intentions and willingness to use complementary and alternative medicines : what potential patients believe about CAMs

This paper explores the intentions and willingness of a sample of Australian consumers (N = 356) to use Complementary and Alternative Medicine (CAM). Participants considered using CAMs at least once in the next two months and rated the likelihood of certain consequences of CAM use, whether important others would approve, and if barriers would prevent them from using CAMs. People intending to use CAMs (high intenders) were more likely than those low on intention (low intenders) to endorse positive outcomes of CAM use and believe that important others would support their CAM use. High intenders were less likely than low intenders to believe that barriers would prevent use. Low intenders (n = 200) were also asked to consider their response to a free CAM trial. Those willing to accept a trial were more likely than those unwilling to believe that CAMs could improve health and less likely to believe that laziness would prevent use. These results identify important beliefs which may influence people’s decisions to use CAMs.

Nutritional status and information needs of medical oncology patients receiving treatment at an Australian public hospital

This study aimed to identify: i) the prevalence of malnutrition according to the scored Patient Generated-Subjective Global Assessment (PG-SGA); ii) utilization of available nutrition resources; iii) patient nutrition information needs; and iv) external sources of nutrition information. An observational, cross-sectional study was undertaken at an Australian public hospital on 191 patients receiving oncology services. According to PG-SGA, 49% of patients were malnourished and 46% required improved symptom management and/or nutrition intervention. Commonly reported nutrition-impact symptoms included: peculiar tastes (31%), no appetite (24%) and nausea (24%). External sources of nutrition information were accessed by 37%, with popular choices being media/internet (n=19) and family/friends (n=13). In a sub-sample (n=65), 32 patients were aware of the available nutrition resources, 23 thought the information sufficient and 19 patients had actually read them. Additional information on supplements and modifying side effects was requested by 26 patients. Malnutrition is common in oncology patients receiving treatment at an Australian public hospital and almost half require improved symptom management and/or nutrition intervention. Patients who read the available nutrition information found it useful, however awareness of these nutrition resources and the provision of information on supplementation and managing symptoms requires attention.

Integrating Engineering Experiences within the Elementary Mathematics Curriculum

Engineering education for elementary school students is a new and increasingly important domain of research by mathematics, science, technology, and engineering educators. Recent research has raised questions about the context of engineering problems that are meaningful, engaging, and inspiring for young students. In the present study an environmental engineering activity was implemented in two classes of 11-year-old students in Cyprus. The problem required students to use the data to develop a procedure for selecting among alternative countries from which to buy water. Students created a range of models that adequately solved the problem although not all models took into account all of the data provided. The models varied in the number of problem factors taken into consideration and also in the different approaches adopted in dealing with the problem factors. At least two groups of students integrated into their models the environmental aspect of the problem (energy consumption, water pollution) and further refined their models. Results provide evidence that engineering model-eliciting activities can be successfully integrated in the elementary mathematics curriculum. These activities provide rich opportunities for students to deal with engineering contexts and to apply their learning in mathematics and science to solving real-world engineering problems.

Recent Italian cinema : spaces, contexts, experiences

The book is an in-depth view of recent Italian cinema - bringing an interdisciplinary knowledge to the study of a complex cinema industry. The book aims to address a number of questions about Italian cinema of the last twenty years, bringing interdisciplinary knowledge to a cinema that eschews traditional definitions and categories, and challenges critical assumption about a film industry that is struggling to find a new direction. In doing so, Recent Italian Cinema offers a transverse analysis of the Italian cinema industry in its dealings with national and international production, and of the themes and issues that have emerged in films produced during the period 1980-2006.

Breastfeeding experiences of Japanese women living in Perth, Australia

The aim of this study was to document the breastfeeding practices of Japanese-Australian mothers living in Perth. A cross-sectional survey of mothers who had delivered babies in Japan or Australia or both was carried out on a sample of 163 mothers recruited through Japanese social and cultural groups in Perth and by a 'snowball' technique. Factors involved in the decision to breastfeed were analysed using multivariate regression analysis. The main outcome measures were the initiation and duration of breastfeeding and cultural beliefs about breastfeeding. Breastfeeding initiation rates of the Japanese- Australian mothers in Japan and in Australia were higher than for other Australians and are consistent with breastfeeding rates in Japan. In Australia, 65% of Japanese-Australian mothers were still breastfeeding at six months. The most common reason for the decision to cease breastfeeding was 'insufficient breastmilk'. The significant factors in breastfeeding duration were 'the time the infant was introduced to infant formula', 'the time when the feeding decision was made', 'doctors support breastfeeding' and 'the mother received enough help from hospital staff'; these were positively associated with the duration of breastfeeding. Japanese mothers take a lot of notice of advice given by health professionals about infant feeding practices.

Postpartum fatigue and driving : relating experiences, thoughts and opinions 12 weeks post-birth

Fatigue in the postnatal period is such a common experience for most mothers that the term ‘postpartum fatigue’ (PPF) has been coined to describe it. When new mothers experience extreme fatigue, it follows that their physical health, mental health, and social-wellbeing is negatively affected. It is interesting to note that there is a distinct lack of empirical investigations focusing on the link between PPF and increased risk of injury; particularly when the links between fatigue and increased risk of road crashes are well documented. The purpose of this investigation was to undertake pilot research to develop an understanding of the duration of PPF and the performance impairments experienced by new mothers when involved in safety-sensitive activities, such as driving a motor vehicle. Semi-structured interviews were undertaken with women (N = 24) at 12 weeks postpartum living in South-east Queensland, Australia. Key themes were identified; with a particular emphasis towards understanding the link between the participant’s experience of postpartum fatigue and the impact this has on their overall cognitive and physiological functioning, as well as their experience of the driving task. Further, sleep/wake data was collected and using the Karolinska Sleepiness Scale (KSS) the potential crash risk for this group of mothers is discussed. It is proposed that the findings of this investigation could be used to improve current knowledge among new mothers and practitioners regarding the mechanisms and consequences of fatigue and to inform interventions that lead to a decreased risk of injury associated with postpartum fatigue.

Effects and feasibility of a multi-disciplinary orientation program for newly registered cancer patients : design of a randomised controlled trial

Background Diagnosis and treatment of cancer can contribute to psychological distress and anxiety amongst patients. Evidence indicates that information giving can be beneficial in reducing patient anxiety, so oncology specific information may have a major impact on this patient group. This study investigates the effects of an orientation program on levels of anxiety and self-efficacy amongst newly registered cancer patients who are about to undergo chemotherapy and/or radiation therapy in the cancer care centre of a large tertiary Australian hospital. Methods The concept of interventions for orienting new cancer patients needs revisiting due to the dynamic health care system. Historically, most orientation programs at this cancer centre were conducted by one nurse. A randomised controlled trial has been designed to test the effectiveness of an orientation program with bundled interventions; a face-to-face program which includes introduction to the hospital facilities, introduction to the multi-disciplinary team and an overview of treatment side effects and self care strategies. The aim is to orientate patients to the cancer centre and to meet the health care team. We hypothesize that patients who receive this orientation will experience lower levels of anxiety and distress, and a higher level of self-efficacy. Discussion An orientation program is a common health care service provided by cancer care centres for new cancer patients. Such programs aim to give information to patients at the beginning of their encounter at a cancer care centre. It is clear in the literature that interventions that aim to improve self-efficacy in patients may demonstrate potential improvement in health outcomes. Yet, evidence on the effects of orientation programs for cancer patients on self-efficacy remains scarce, particularly with respect to the use of multidisciplinary team members. This paper presents the design of a randomised controlled trial that will evaluate the effects and feasibility of a multidisciplinary orientation program for new cancer patients.

Expressed emotion as predictor of relapse in patients with comorbid psychoses and substance use disorder

Objective: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue. Method: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview. Results: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow up Q1 and (surprisingly) an absence of childhood attention deficit hyperactivity disorder. Conclusions: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.

Burden of care and general health in families of patients with schizophrenia

Background: De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. Method: Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). Results: Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. Conclusions: In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.