A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings

The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies. This randomized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aimed to optimize patients' ability to manage pain. One week post-intervention, patients receiving the pain management intervention (PMI) had a significantly greater increase in self-reported pain knowledge, perceived control over pain, and number of pain treatments recommended. Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain, concerns about addiction and side effects, being a "good" patient, and tolerance to pain relieving medication. The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes, which can potentially act as barriers to effective pain management. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

Outpatient management of abnormal smears

Objectives: To review the results of the first 403 women treated at the Abnormal Smear and Colposcopy Unit with special reference to the utility, efficacy, acceptability and economy of in-office treatment of cervical lesions by large loop or Fischer cone excision. Design: Retrospective chart review of consecutive patients treated following, referral with an abnormal smear or abnormal cervical morphology, between 1 September 1996 and I August 2001. Setting: Inner city private practice. Sample: A total of 403 consecutive General Practitioner referred women. Methods: Details of referral smear result, colposcopically directed biopsy result, subsequent treatment type and histological result including assessability number of specimens submitted, complications and follow-up assessment were extracted at chart review. Costs of public hospital inpatient and outpatient care, supplied by the Casemix and Clinical Benchmarking Service, Mater Miseraecordae Public Hospitals (with permission to publish), were compared with Medicare rebates. Main outcome measures: A total of 187 women were treated by large loop excision of the transformation zone, and 216 by Fischer cone excision. The number of women who were treated as outpatients under local anaesthetic were 395, while eight patients were treated under general anaesthesia as inpatients. There was poor correlation between referring smear, biopsy and subsequent treatment results. Eight patients had abnormal cytology at follow-up, of whom two have been retreated. Three patients had primary or secondary bleeding requiring treatment and two developed cervical stenosis. Outpatient private practice treatment of women with abnormal smears allows significant savings to the public purse over public or private hospital care. Conclusions: Outpatient treatment of women with abnormal smears, using the Fischer cone technique, is safe, wen accepted, effective and the most cost efficient solution to this public health problem.

Periextubation caffeine in preterm neonates: A randomized dose response trial

Objective: To compare the effectiveness of three dosing regimens of caffeine for preterm infants in the periextubation period. Methods: A randomized double-blind clinical trial of three dosing regimens of caffeine citrate ( 3, 15 and 30 mg/kg) for periextubation management of ventilated preterm infants was undertaken. Infants born < 32 weeks gestation who were ventilated for > 48 h were eligible for the study. Caffeine citrate was given as a once daily dose for a period of 6 days commencing 24 h prior to a planned extubation, or within 6 h of an unplanned extubation. The primary outcome measure was extubation failure, defined as neonates who were unable to be extubated within 48 h of caffeine loading or who required reventilation or doxapram dose within 7 days of caffeine loading. Continuous recordings of oxygen saturation and heart rate were undertaken in a subgroup of enrolled infants. Results: A total of 127 babies were enrolled into the study ( 42, 40, 45, in the 3, 15, and 30 mg/kg groups, respectively). No statistically significant difference was demonstrated in the incidence of extubation failure between dosing groups ( 19, 10, and 11 infants in the 3, 15, and 30 mg/kg groups, respectively), however, infants in the two higher dose groups had statistically significantly less documented apnoea than the lowest dose group. Of the 37 neonates with continuous pulse oximetry recordings, those on higher doses of caffeine recorded a statistically significantly higher mean heart rate, oxygen saturations and less time with oxygen saturations < 85%. Conclusions: This trial indicated there were short-term benefits of decreased apnoea in the immediate periextubation period for ventilated infants born < 32 weeks gestation receiving higher doses of caffeine. Further studies with larger numbers of infants assessing longer-term outcomes are necessary to determine the optimal dosing regimen of caffeine in preterm infants.

Action research to explore perceptions of risk in project management

Uses research in a major UK company on the introduction of an electronic document management system to explore perceptions of, and attitudes to, risk. Phenomenological methods were used; with subsequent dialogue transcripts evaluated with Winmax dialogue software, using an adapted theoretical framework based upon an analysis of the literature. The paper identifies a number of factors, and builds a framework, that should support a greater understanding of risk assessment and project management by the academic community and practitioners.

Fragmented coherence: Solid waste management in Colombo

Notwithstanding the increasingly fragmented organizational relationships within Colombo's urban governance system, the cooperative nature of stakeholder relationships lends a high level of coherence to the overall system. Since 1995, Colombo's solid waste management system has been characterized by the increased role of the private sector, community-based organizations and NGOs. Whilst the increasingly fragmented nature of this system exhibits some deeply ingrained problems, there are also a number of positives associated with the increased role of civil society actors and, in particular, the informal sector. Reforming regulatory frameworks so as to integrate some of the social norms that are integral to the lives of the majority of urban residents will contribute to regulatory frameworks being considerably more enforceable than is currently the case. Such reform requires that institutional and regulatory frameworks need to be flexible enough to adapt to the changing social, political and economic context. In the Colombo case, effective cooperation between public sector and civil society stakeholders illustrates that adaptive institutional arrangements grounded in pragmatism are feasible. The challenge that arises is to translate these institutional arrangements into adaptive regulatory frameworks - something that would require a significant mind shift on the part of planners and urban managers.

The International Consortium on Mental Health Policy and Services: objectives, design and project implementation

The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network-the International Consortium on Mental Health Policy and Services-are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.

Constraints to organizational learning during major change at a mental health services facility

This paper explains what happened during a three years long qualitative study at a mental health services organization. The study focuses on differences between espoused theory and theory in use during the implementation of a new service delivery model. This major organizational change occurred in a National policy environment of major health budget cutbacks. Primarily as a result of poor resourcing provided to bring about policy change and poor implementation of a series of termination plans, a number of constraints to learning contributed to the difficulties in implementing the new service delivery model. The study explores what occurred during the change process. Rather than blame participants of change for the poor outcomes, the study is set in a broader context of a policy environment—that of major health cutbacks.

Scalable location management for context-aware systems

Location information is commonly used in context-aware applications and pervasive systems. These applications and systems may require knowledge, of the location of users, devices and services. This paper presents a location management system able to gather, process and manage location information from a variety of physical and virtual location sensors. The system scales to the complexity of context-aware applications, to a variety of types and large number of location sensors and clients, and to geographical size of the system. The proposed location management system provides conflict resolution of location information and mechanisms to ensure privacy.

Migrating eprints.org data to a Fez repository

This document records the process of migrating eprints.org data to a Fez repository. Fez is a Web-based digital repository and workflow management system based on Fedora (http://www.fedora.info/). At the time of migration, the University of Queensland Library was using EPrints 2.2.1 [pepper] for its ePrintsUQ repository. Once we began to develop Fez, we did not upgrade to later versions of eprints.org software since we knew we would be migrating data from ePrintsUQ to the Fez-based UQ eSpace. Since this document records our experiences of migration from an earlier version of eprints.org, anyone seeking to migrate eprints.org data into a Fez repository might encounter some small differences. Moving UQ publication data from an eprints.org repository into a Fez repository (hereafter called UQ eSpace (http://espace.uq.edu.au/) was part of a plan to integrate metadata (and, in some cases, full texts) about all UQ research outputs, including theses, images, multimedia and datasets, in a single repository. This tied in with the plan to identify and capture the research output of a single institution, the main task of the eScholarshipUQ testbed for the Australian Partnership for Sustainable Repositories project (http://www.apsr.edu.au/). The migration could not occur at UQ until the functionality in Fez was at least equal to that of the existing ePrintsUQ repository. Accordingly, as Fez development occurred throughout 2006, a list of eprints.org functionality not currently supported in Fez was created so that programming of such development could be planned for and implemented.

Hydrochemistry, mineralogy and sulphur isotope geochemistry of acid mine drainage at the Mt Morgan mine environment, Queensland, Australia

Mineralogical, hydrochemical and S isotope data were used to constrain hydrogeochemical processes that produce acid mine drainage from sulfidic waste at the historic Mount Morgan Au–Cu mine, and the factors controlling the concentration of SO4 and environmentally hazardous metals in the nearby Dee River in Queensland, Australia. Some highly contaminated acid waters, with metal contents up to hundreds of orders of magnitude greater than the Australia–New Zealand environmental standards, by-pass the water management system at the site and drain into the adjacent Dee River. Mine drainage precipitates at Mt. Morgan were classified into 4 major groups and were identified as hydrous sulfates and hydroxides of Fe and Al with various contents of other metals. These minerals contain adsorbed or mineralogically bound metals that are released into the water system after rainfall events. Sulfate in open pit water and collection sumps generally has a narrow range of S isotope compositions (δ34S = 1.8–3.7‰) that is comparable to the orebody sulfides and makes S isotopes useful for tracing SO4 back to its source. The higher δ34S values for No. 2 Mill Diesel sump may be attributed to a difference in the source. Dissolved SO4 in the river above the mine influence and 20 km downstream show distinctive heavier isotope compositions (δ34S = 5.4–6.8‰). The Dee River downstream of the mine is enriched in 34S (δ34S = 2.8–5.4‰) compared with mine drainage possibly as a result of bacterial SO4 reduction in the weir pools, and in the water bodies within the river channel. The SO4 and metals attenuate downstream by a combination of dilution with the receiving waters, SO4 reduction, and the precipitation of Fe and Al sulfates and hydroxides. It is suggested here that in subtropical Queensland, with distinct wet and dry seasons, temporary reducing environments in the river play an important role in S isotope systematics