Small fibre neuropathy in patients with latent autoimmune diabetes in adults

The prevalence of latent autoimmune diabetes in adults (LADA) in patients diagnosed with type 2 diabetes mellitus (T2DM) ranges from 7 to 10% (1). They present at a younger age and have a lower BMI but poorer glycemic control, which may increase the risk of complications (2). However, a recent analysis of the Collaborative Atorvastatin Diabetes Study (CARDS) has demonstrated no difference in macrovascular or microvascular events between patients with LADA and T2DM, but neuropathy was not assessed (3). Previous studies quantifying neuropathy in patients with LADA are limited. In this study, we aimed to accurately quantify neuropathy in subjects with LADA compared with matched patients with T2DM.

Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Objectives: We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Design, setting and participants: Prospectively collected data on ED patients presenting with suspected ACS between November 2008 and February 2011 was used, including data on presentation and at 30 days after presentation. Information on patient disposition, length of stay and costs incurred was extracted from hospital administration records. Main outcome measures: Primary outcomes were mean and median cost and length of hospital stay. Secondary outcomes were diagnosis of ACS, other cardiovascular conditions or non-cardiovascular conditions within 30 days of presentation. Results: An ACS was diagnosed in 103 (11.1%) of the 926 patients recruited. 193 patients (20.8%) were diagnosed with other cardiovascular-related conditions and 622 patients (67.2%) had non-cardiac-related chest pain. ACS events occurred in 0 and 11 (1.9%) of the low-risk and intermediate-risk groups, respectively. Ninety-two (28.0%) of the 329 high-risk patients had an ACS event. Patients with a proven ACS, high-grade atrioventricular block, pulmonary embolism and other respiratory conditions had the longest length of stay. The mean cost was highest in the ACS group ($13 509; 95% CI, $11 794–$15 223) followed by other cardiovascular conditions ($7283; 95% CI, $6152–$8415) and non-cardiovascular conditions ($3331; 95% CI, $2976–$3685). Conclusions: Most ED patients with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources. Investigation of strategies to shorten this process or reduce the need for objective cardiac testing in patients at intermediate risk according to the National Heart Foundation and Cardiac Society of Australia and New Zealand guideline is required.

Drink driving among indigenous people in Far North Queensland and Northern New South Wales: A summary of qualitative findings

In response to the threat that drink drivers pose to themselves and others, drink driving programs form an important part of a suite of countermeasures used in Australia and internationally. Unlike New Zealand/Aotearoa, United States and Canada that have programs catering for their First Peoples, all Australian programs are designed for the general driver population. The aim of this study was to identify the factors that contribute to Indigenous drink driving in order to inform appropriate recommendations related to developing a community-based program for Indigenous communities. Broader drivers licensing policy recommendations are also discussed. A sample of 73 Indigenous people from Queensland and in New South Wales with one or more drink driving convictions completed a semi-structured interview regarding their drink driving behaviour. Participants were asked to disclose information regarding their drink driving history, and alcohol and drug use. If participants self-reported no longer drink driving, they were probed about what factors had assisted them to avoid further offending. Key themes which emerged to maintain drink driving include motivations to drink and drive, and belief in the ability to manage the associated risks. Factors that appeared to support others from avoiding further offending include re-connecting with culture and family support. A range of recommendations regarding delivery and content of a program for regional and remote communities as well as other policy implications are discussed.

Embedding Indigenous knowledges: An Australian case study of urban and remote teaching practicum

In this chapter we propose that there are certain conditions that enable the agency of pre-service teachers to enact curriculum decision-making within their pedagogical relationships with their supervising teachers as they endeavour to embed Indigenous knowledges (IK) during the teaching practicum. The case study, underpinned by decolonising methodologies, centred upon pre-service teacher preparation at one Australian university, where we investigated how role modelling in urban and remote schools occurred in the learning and teaching relationships between pre-service teachers on practicum and their supervising teachers. This chapter draws from an Office of Learning and Teaching (OLT) sponsored project at one Australian university; a full report on this project has been documented (see McLaughlin, Whatman and Nielsen, 2014). We commence with a discussion of decolonising and critical pedagogical spaces as the conceptual framework for the embedding Indigenous knowledges and perspectives in curricula and pedagogy. Our focus then shifts to a contextual overview of the development of Indigenous Knowledges (IK) in Australian school and university curriculum, providing a standpoint from which to consider the unfolding case study.

Drink driving among Indigenous Australians in outer regional and remote communities and development of a drink driving program: A summary of findings and recommendations

Drink driving is a leading cause of criminal justice system contact for Indigenous Australians. National and state strategies recommend Indigenous road safety initiatives are warranted. However, there is sparse evidence to inform drink driving-related preventive and treatment measures. Using quantitative and qualitative methods, the study examines the profile of Queensland’s Indigenous drink drivers using court convictions and identifies the contributing psycho-social, cultural and contextual factors through qualitative interviews.

Classifying patients by their characteristics and clinical presentations; the use of latent class analysis

In this article, we introduce the general statistical analysis approach known as latent class analysis and discuss some of the issues associated with this type of analysis in practice. Two recent examples from the respiratory health literature are used to highlight the types of research questions that have been addressed using this approach.

Bringing up Children Gran’s Way: Insights from a research project on Indigenous child and youth mental health

Background In 2000, the Mater Child and Youth Mental Health Service Indigenous consultant saw that Indigenous families were isolated from kinship networks following the assimilation policy and clinicians were largely unaware of these socio-cultural histories. Experiences of marginalisation by mainstream society and services were exacerbated by assumptions clinicians made about this population. To enhance Mater’s care the consultant undertook research with Indigenous Elders. The project, “Bringing up Children Gran’s Way”, on which the presenter is the research advisor, was funded by AIATSIS. Aims Increase service quality Improve staff confidence, skills and satisfaction working with this population Promote the wellbeing of Indigenous families Acknowledge the significance of Elders and extended family networks. Methods Over 2006/07 the team used narrative and Indigenous methodologies, (e.g. yarning circles and the use of Indigenous research staff) to arrange and audio-record structured interviews with 19 Aboriginal Elders, on growing up and parenting. The participants were recruited by the Indigenous consultant and gave written consent, following ethical approval and information giving. The team immersed themselves in the material by repeated reading of the transcripts to note recurring themes in Elders’ narratives. Findings The recurring themes included the importance of cultural protocols and extended family; impacts of being ‘under the Act and stories of surviving change; culture, spiritualty and religion; trans-generational impacts; childrearing and the need to reconcile with Elders. Discussion The narratives show Elders resilience in the face of enduring impact of policies of genocide and assimilation. Clinicians need to approach their work with a deeper understanding of the diversity of clients’ social experience and cultural identity. Clinicians need to examine their own cultural assumptions about this population. Conclusion The dissemination of the knowledge and experience of Elders is a matter of social justice and crucial for the well-being of future generations and for improved service access.

The experience of Indigenous students in a Bachelor of Nursing Program in Australia: cultural safety and decolonising nurse education

Background In Australia significant health inequalities, such as an 11year life expectancy gap, impact on the continent’s traditional owners, the Aboriginal peoples and Torres Strait Islanders. Evidence suggests links between improved Indigenous health and a greater proportion of Indigenous people employed in all sectors. Achieving a greater proportion of Indigenous people in health services and in the health education workforce, requires improved higher education completion rates. Currently Indigenous people are under-represented in higher education and attrition rates amongst those who do participate are high. We argue these circumstances make health and education matters of social justice, largely related to unexamined relations of power within universities where the pedagogical and social environment revolve around the norms and common-sense of the dominant culture. Project Research at Queensland University of Technology in 2010-2012, aimed to gain insights into attrition/retention in the Bachelor of Nursing. A literature review on Indigenous participation in higher education in nursing contextualised a mixed methods study. The project examined enrolment, attrition and success by an analysis of enrolment data from 1984-2012. Using Indigenous Research Assistants we then conducted 20 in-depth interviews with Indigenous students followed by a thematic analysis seeking to gain insights into the impact of students’ university experience on retention. Our findings indicate that cultural safety, mentorship, acceptance and support are crucial in student academic success. They also indicate that inflexible systems based on ethnocentric assumptions exacerbate the structural issues that impact on the students’ everyday life and are also part of the story of attrition. The findings reinforced the assumption that educational environments and processes are inherently cultural and political. This perspective calls into question the role of the students’ cultural experience at university in attrition rates. A partnership between the School of Nursing and the Indigenous Education Unit is working to better support Indigenous students.

Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: A qualitative process evaluation

- Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. - Design A qualitative exploratory study. - Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. - Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. - Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

Patient preferences for receiving remote communication support for lifestyle physical activity behaviour change: The perspective of patients with musculoskeletal disorders from three hospital services

This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods People with musculoskeletal disorders ( n=221 of 296 eligible) accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”). Results Most (n=155, 70%) desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001), telephone calls (coefficient = 3.000, p<0.001), and email (coefficient = 2.059, p=0.02). Older age was associated with lower preference for email (coefficient = −0.100, p<0.001), texting (coefficient = −0.096, p<0.001), and social network messages (coefficient = −0.065, p<0.001). Conclusion Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

Economic consideration for reducing hospital presentations among patients with decompensated cirrhosis: not all presentations avoided can be considered equal

Individuals with decompensated cirrhosis and ascites requiring paracentesis utilize exceptionally high levels of hospital resources. Consequently, potential modifications to existing models of healthcare to assist patients in the management of their liver disease and reduce the need for hospital encounters have potential to improve patients’ health and reduce demand on acute hospital services. However, there is a paucity of data examining how much healthcare resources could be re-directed to interventions that prevent hospitalizations without net annual budgetary disadvantage (from the hospital’s perspective). The purpose of this study was to probabilistically examine how much healthcare resourcing could be saved per hospital presentation avoided among this clinical population.

Indigenous cultural landscapes: Equitably defining the 'authenticity' of the intangible

Over hundreds of generations, indigenous groups around the world have passed down their traditional landscape associations, a number of which are intangible and therefore unquantifiable. Yet, these associative relationships with nature have been, and continue to be, pivotal in cultural evolution. Determining the authenticity of intangible landscape associations has caused much controversy, and in recent decades, indigenous groups have begun seeking protection of their places of significance. In response, the United Nations Educational, Scientific and Cultural Organisation (UNESCO) World Heritage Committee (WHC) developed a criterion that intended to assist in the identification and protection of cultural landscapes. The WHC has therefore become the global authority responsible for determining the authenticity of cultural landscapes, including those with intangible associations rather than material cultural evidence. However, even with the support of the United Nations, UNESCO and the WHC, it is unlikely that every tangible cultural landscape will be sufficiently recognised and protected. Therefore, this research paper explores the effectiveness of current approaches to gauging authenticity in instances where multiple landscapes are valued according to similar characteristics. Further, this work studies the inherent relationship between the indigenous Maori population of the South Island of New Zealand, in particular Kai Tahi peoples, and their significant landscape features, as a means of considering the breadth and depth of historic intangible associations. In light of these findings, this research challenges the appropriateness of the term 'authenticity' when analysing not only the subjective, but more pressingly, the intangible. It therefore questions the role of empirical data in demonstrating authenticity, while recognising that a prolific list of such intangible cultural landscapes has the potential to diminish integrity. This, this paper addresses an urgent need for increased social research in this area, namely in identifying cultural landscape protection methods that empower all local indigenous communities, not just those which are the most critically acclaimed.

Remembering the Peel Island Lazaret through re-imagining the Teerk Roo Ra forest

This paper discusses my current research which aims to re-member the site of the Peel Island Lazaret through re-imagining the Teerk Roo Ra forest as a series of animated artworks. Teerk Roo Ra National Park (formally known as Peel Island) is a small island in Moreton Bay, Queensland and is visible on the ferry journey from Cleveland to Stradbroke Island. The island has an intriguing history, and is the site of a former Lazaret and quarantine station. The Lazaret treated patients diagnosed with Hansen’s disease (or Leprosy), and operated between 1907 and 1959. In this paper I will discuss conceptions of the non-indigenous historical context of the Peel Island Lazaret and the notion of the liminal state (Turner,1967). Through this discussion conceptions of place from Australian cultural theorist Ross Gibson are also examined. The concept of two overlapping realms is then explored through the clues and shared stories about the people who inhabited the site. There is then an explanation of my own approach to re-member this place through re-imagining the forest that witnessed the events of the Lazaret. I then draw on theories of the uncanny from German Psychiatrist Ernst Jentsch, Austrian Neurologist Sigmund Freud and South African animation theorist Meg Rickards to argue that my experience of the forest of Teerk Roo Ra was an uncanny experience where two worlds or states of mind existed simultaneously and overlapped, causing a viscerally unsettling uncanny experience. Through an analysis of Czech Surrealist Animator Jan Švankmajer’s cinematic narrative Down to the cellar (1982), my creative work Structure #24(2011), and Australian Artist Patricia Piccinini’s cinematic artwork The Gathering (2007), I discuss the situation of the inanimate and the animate co-existing simultaneously. Using this approach I propose an understanding of the uncanny as an intellectual uncertainty as outlined by Jentsch (1906). I also develop the notion of the familiar being concealed and becoming unfamiliar through mimicry (Freud, 1919). These discussions form an introduction to my creative work Nocturne #5(2014) which re-members the forests of Teerk Roo Ra as an uncanny place primarily expressed through animation.

Patients with physical debility undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence

Background: Hospitalised older adults often experience a decline in physical functioning and mobility in the lead up to (or during) an acute hospital admission. During acute illness and hospitalisation, older adults may also experience a decline or fluctuation in their cognitive functioning. Previous studies have demonstrated that patients with or without reduced cognitive functioning on admission to subacute inpatient rehabilitation have considerable potential to improve their physical functioning and quality of life.

Editorial of "International Journal of Critical Indigenous Studies Volume 1, Number 1, 2008"

We perceive the epistemological boundaries of Critical Indigenous Studies as marked by analyses of contemporary colonising power in its multiple forms in different contexts. This first issue brings together a diverse group of international Indigenous scholars who are politically and intellectually engaged in theorising from their respective standpoints as well as spatial and geographic locations. As such these essays enable dialogue across and within different colonial power contexts addressing epistemological ethical and methodological concerns within the broad field of Indigenous studies. In each essay a connecting theme is the need for intercultural and comparative work and to import Indigenous agency in the writing of history...