Up close and personal with those experiencing homelessness: Pharmacist involvement in a multidisciplinary healthcare team

Introduction. The Brisbane City Council holds a biannual Homeless Connect event which brings together business and community groups on one day to provide free services to people experiencing or at risk of homelessness. Pharmacists were involved in this initiative and provided health services in a multidisciplinary healthcare environment building on the lessons of previous Homeless Connect events (Chan et al, 2015) Aims. To explore pharmacists reflections on their role in a multidisciplinary healthcare team providing services at a community outreach event for those experiencing homelessness. Methods. The pharmacists (n=2) documented the types of services provided during the Homeless Connect event. A semi-structured interview was conducted post-event to investigate barriers, facilitators and changes that would be recommended for future events. Their perceptions of their role in the multidisciplinary healthcare team were also explored. Results. Primarily, the services provided included delivery of primary healthcare, advice on accessing cost effective pharmacy services and addressing medication enquiries. The pharmacists also provided moisturiser samples and health information leaflets. Interdisciplinary referrals were primarily between the pharmacists and podiatrists; no pharmacist-medical practitioner referrals occurred. The pharmacists did believe they had a positive role in this health initiative but improvements could be implemented to improve the delivery of these services in future events. Discussion. Pharmacists can play an important role in providing services to people experiencing or at risk of homelessness and the overall experience was positive for the pharmacists. They were able to integrate into a multidisciplinary healthcare team in this setting but strategies for further collaboration were identified. The possibility of involving pharmacy students in future events was identified.

Multidisciplinary review of teaching and assessing competency attainment by non-medical prescribers

Background Prescribing is a complex task, requiring specific knowledge and skills, and the execution of effective, context-specific clinical reasoning. Systematic reviews indicate medical prescribing errors have a median rate of 7% [IQR 2%-14%] of medication orders [1-3]. For podiatrists pursuing prescribing rights, a clear need exists to ensure practitioners develop a well-defined set of prescribing skills, which will contribute to competent, safe and appropriate practice. Aim To investigate the methods employed to teach and assess the principles of effective prescribing in the undergraduate podiatry program and compare and contrast these findings with four other non-medical professions who undertake prescribing after training at Queensland University of Technology. Method The NPS National Prescribing Competency Standards were employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing principles articulated in the competency standards were addressed by each profession. Results A range of methods are currently utilised to teach prescribing across disciplines. Application of prescribing competencies to the context of each profession appears to influence the teaching methods used. Most competencies were taught using a multimodal format, including interactive lectures, self-directed learning, tutorial sessions and clinical placement. In particular clinical training was identified as the most consistent form of educating safe prescribers across all five disciplines. Assessment of prescribing competency utilised multiple techniques including written and oral examinations and research tasks, case studies, objective structured clinical examination exercises and the assessment of clinical practice. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging e.g. that occurring in the clinical practice environment. Conclusion Recommendations were made to refine curricula and to promote efficient cross-discipline teaching by staff from the disciplines of podiatry, pharmacy, nurse practitioner, optometry and paramedic science. Students now experience a sophisticated level of multidisciplinary learning in the clinical setting which integrates the expertise and skills of experience prescribers combined with innovative information technology platforms (CCTV and live patient assessments). Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings.

Questions about multidisciplinary teams

Multidisciplinary care (MDC) involves health professionals from a range of disciplines working together as a team (a multidisciplinary team – MDT) to deliver comprehensive care that addresses as many of a patient's needs as possible. Writing in 2011, Wilcoxon and others concluded: ‘Multidisciplinary care is accepted as best practice in cancer treatment planning and care.’ Yet their report (of the national audit of multidisciplinary cancer care in Australia) indicated that two-thirds of the surveyed hospitals did not have a MDT. Further, they found that where teams did exist, one-third of patients were not told that their case would be discussed by the team; the MDT-recommended treatment plan was not included in the patient’s record one-quarter of the time; and less than 1 per cent of teams reported routine attendance by the tumour-specific minimum core team. There is sparse case authority as to the potential medico-legal consequences of MDC by MDTs. This article raises five questions about legal aspects of MDC for consideration. The questions are not limited to cancer care, as MDTs are increasingly used in other areas of medicine.

J.W.Lindt’s Colonial man and Aborigine image from the GRAFTON ALBUM : “On chemistry and optics all does not depend, art must with these in triple union blend”

J.W.Lindt’s Colonial man and Aborigine image from the GRAFTON ALBUM: “On chemistry and optics all does not depend, art must with these in triple union blend” (text from J.W. Lindt’s photographic backing card) In this paper, I follow an argument that Lindt held a position in his particular colonial environment where he was simultaneously both an insider and an outsider and that such a position may be considered prerequisite in stimulating exchange. A study of the transition of J.W. Lindt in Grafton, N.S.W. in the 1860s from a traveller to a migrant and subsequently to a professional photographer, as well as Lindt’s photographic career, which evolved through strategic action and technical approaches to photography, bears witness to his cultural relativity. One untitled photograph from this period of work constructs a unique commentary of Australian colonial life that illustrates a non-hegemonic position, particularly as it was included in one of the first albums of photographs of Aborigines that Lindt gifted to an illustrious person (in this case the Mayor of Grafton). As in his other studio constructions, props and backdrops were arranged and sitters were positioned with care, but this photograph is the only one in the album that includes a non-Aborigine in a relationship to an Aborigine. An analysis of the props, technical details of the album and the image suggests a reconciliatory aspect that thwarts the predominant attitudes towards Aborigines in the area at that time.

Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: Awareness, referral and utilization

Primary brain tumors are associated with significant physical, cognitive and psychosocial changes. Although treatment guidelines recommend offering multidisciplinary rehabilitation and support services to address patients’ residual deficits, the extent to which patients access such services is unclear. This study aimed to assess patients’ supportive care needs early after diagnosis, and quantify service awareness, referral and utilization. A population-based sample of 40 adults recently diagnosed with primary brain tumors was recruited through the Queensland Cancer Registry, representing 18.9% of the eligible population of 203 patients. Patients or carer proxies completed surveys of supportive care needs at baseline (approximately three months after diagnosis) and three months later. Descriptive statistics summarized needs and service utilization, and linear regression identified predictors of service use. Unmet supportive care needs were highest at baseline for all domains, and highest for the physical and psychological needs domains at each time point. At follow-up, participants reported awareness of, referral to, and use of 32 informational, support, health professional or practical services. All or almost all participants were aware of at least one informational (100%), health professional (100%), support (97%) or practical service (94%). Participants were most commonly aware of speech therapists (97%), physiotherapists (94%) and diagnostic information from the internet (88%). Clinician referrals were most commonly made to physiotherapists (53%), speech therapists (50%) and diagnostic information booklets (44%), and accordingly, participants most commonly used physiotherapists (56%), diagnostic information booklets (47%), diagnostic information from the internet (47%), and speech therapists (43%). Comparatively low referral to and use of psychosocial services may limit patients’ abilities to cope with their condition and the changes they experience.

The puzzle of falling enrolments in physics and chemistry courses: Putting some pieces together

This paper reports and discusses the principal findings of an Australian study exploring the decisions of high achieving Year 10 students about taking physics and chemistry courses (Lyons, 2003). The study used a ‘multiple worlds’ framework to explore the diverse background characteristics that previous quantitative research had shown were implicated in these decisions. Based on analyses of questionnaire and interview data, the study found that the students’ decisions involved the complex negotiation of a number of cultural characteristics within their school science and family worlds. Many of the students regarded junior high school science as irrelevant, uninteresting and difficult, leaving them with few intrinsic reasons for enrolling in senior science courses. The study found that decisions about taking physical science courses were associated with the resources of cultural and social capital within their families, and the degree to which these resources were congruent with the advantages of choosing these courses. The paper concludes that the low intrinsic value of school science and the erosion of its strategic value contribute to the reluctance of students to choose physical science courses in the senior school.

Surface chemistry, dispersion behavior, and slip casting of Ti 3AlC2 suspensions

The surface chemistry and dispersion properties of aqueous Ti 3AlC2 suspension were studied in terms of hydrolysis, adsorption, electrokinetic, and rheological measurements. The Ti 3AlC2 particle had complex surface hydroxyl groups, such as ≡Ti-OH,=Al-OH, and -OTi-(OH)2, etc. The surface charging of the Ti3AlC2 particle and the ion environment of suspensions were governed by these surface groups, which thus strongly influenced the stability of Ti3AlC2 suspensions. PAA dispersant was added into the Ti3AlC2 suspension to depress the hydrolysis of the surface groups by the adsorption protection mechanism and to increase the stability of the suspension by the steric effect. Ti3AlC2 suspensions with 2.0 dwb% PAA had an excellent stability at pH=∼5 and presented the characteristics of Newtonian fluid. Based on the well-dispersed suspension, dense Ti3AlC2 materials were obtained by slip casting and after pressureless sintering. This work provides a feasible forming method for the engineering applications of MAX-phase ceramics, wherein complex shapes, large dimensions, or controlled microstructures are needed.

IMPOSE (IMProving Outcomes after Sepsis)—the effect of a multidisciplinary follow-up service on health-related quality of life in patients postsepsis syndromes—a double-blinded randomised controlled trial: protocol

Introduction Patients post sepsis syndromes have a poor quality of life and a high rate of recurring illness or mortality. Follow-up clinics have been instituted for patients postgeneral intensive care but evidence is sparse, and there has been no clinic specifically for survivors of sepsis. The aim of this trial is to investigate if targeted screening and appropriate intervention to these patients can result in an improved quality of life (Short Form 36 health survey (SF36V.2)), decreased mortality in the first 12 months, decreased readmission to hospital and/or decreased use of health resources. Methods and analysis 204 patients postsepsis syndromes will be randomised to one of the two groups. The intervention group will attend an outpatient clinic two monthly for 6 months and receive screening and targeted intervention. The usual care group will remain under the care of their physician. To analyse the results, a baseline comparison will be carried out between each group. Generalised estimating equations will compare the SF36 domain scores between groups and across time points. Mortality will be compared between groups using a Cox proportional hazards (time until death) analysis. Time to first readmission will be compared between groups by a survival analysis. Healthcare costs will be compared between groups using a generalised linear model. Economic (health resource) evaluation will be a within-trial incremental cost utility analysis with a societal perspective. Ethics and dissemination Ethical approval has been granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC; HREC/13/QRBW/17), The University of Queensland HREC (2013000543), Griffith University (RHS/08/14/HREC) and the Australian Government Department of Health (26/2013). The results of this study will be submitted to peer-reviewed intensive care journals and presented at national and international intensive care and/or rehabilitation conferences.

Understanding Connectivity between Groundwater Chemistry Data and Geological Stratigraphy via 3D Sub-surface Visualization and Analysis

This paper describes the 3D Water Chemistry Atlas - an open source, Web-based system that enables the three-dimensional (3D) sub-surface visualization of ground water monitoring data, overlaid on the local geological model. Following a review of existing technologies, the system adopts Cesium (an open source Web-based 3D mapping and visualization interface) together with a PostGreSQL/PostGIS database, for the technical architecture. In addition a range of the search, filtering, browse and analysis tools were developed that enable users to interactively explore the groundwater monitoring data and interpret it spatially and temporally relative to the local geological formations and aquifers via the Cesium interface. The result is an integrated 3D visualization system that enables environmental managers and regulators to assess groundwater conditions, identify inconsistencies in the data, manage impacts and risks and make more informed decisions about activities such as coal seam gas extraction, waste water extraction and re-use.