Improving supportive care for women with breast cancer in Australia: The challenge of modifying health systems

Although the benefits of many psychosocial support strategies in improving well being in women with breast cancer have been demonstrated, few women receive these programs as part of routine care. This paper provides some recommendations, based on experience in Australia, about how access to evidence-based supportive care strategies might be improved through modification of health systems. It demonstrates the paucity of research about the costs and health service implications of psychosocial support strategies, which is vital to health planning and service delivery change. It outlines the systematic approach taken in Australia to improving psychosocial support nationally by: the development of research reviews; preparation of guidelines about supportive care, implementation of programs to foster the adoption of guidelines through modification of policy, health service delivery and clinician training; and monitoring programs. Coalitions of government, health care professionals and consumers are key to effective lobbying for change. If all women with breast cancer are to receive better supportive care, there is a need for approaches which: refocus the research effort in psycho-oncology; develop more strategic approaches to generating change in health systems and health policy and foster partnerships to advocate for improved resources. Copyright (C) 2003 John Wiley Sons, Ltd.

Accuracy of SRM and power tap power monitoring systems for bicycling

Purpose: Although manufacturers of bicycle power monitoring devices SRM and Power Tap (PT) claim accuracy to within 2.5%, there are limited scientific data available in support. The purpose of this investigation was to assess the accuracy of SRM and PT under different conditions. Methods: First, 19 SRM were calibrated, raced for 11 months, and retested using a dynamic CALRIG (50-1000 W at 100 rpm). Second, using the same procedure, five PT were repeat tested on alternate days. Third, the most accurate SRM and PT were tested for the influence of cadence (60, 80, 100, 120 rpm), temperature (8 and 21degreesC) and time (1 h at similar to300 W) on accuracy. Finally, the same SRM and PT were downloaded and compared after random cadence and gear surges using the CALRIG and on a training ride. Results: The mean error scores for SRM and PT factory calibration over a range of 50-1000 W were 2.3 +/- 4.9% and -2.5 +/- 0.5%, respectively. A second set of trials provided stable results for 15 calibrated SRM after 11 months (-0.8 +/- 1.7%), and follow-up testing of all PT units confirmed these findings (-2.7 +/- 0.1%). Accuracy for SRM and PT was not largely influenced by time and cadence; however. power output readings were noticeably influenced by temperature (5.2% for SRM and 8.4% for PT). During field trials, SRM average and max power were 4.8% and 7.3% lower, respectively, compared with PT. Conclusions: When operated according to manufacturers instructions, both SRM and PT offer the coach, athlete, and sport scientist the ability to accurately monitor power output in the lab and the field. Calibration procedures matching performance tests (duration, power, cadence, and temperature) are, however, advised as the error associated with each unit may vary.

Issues in training in clinical psychology in Australia: Interplay between training goals and legal standards of practice

Training models in clinical psychology vary across regions, as do the laws that regulate professional practice in psychology. Standards for practice and for entry into professional practice may endure past the point of utility in the face of changing health-care systems and evolving international considerations. Herein the authors review aspects of the Australian 4-year training model, including qualifications for entry to the profession, supervision, and the influence of the profession and the universities in maintaining and in changing to a new training model. Aspects of training in clinical psychology in Australia are also discussed, and the Australian and New Zealand accreditation models are contrasted. Suggestions on ways to move forward are offered.

Cardiac contributions to exercise training responses in patients with chronic heart failure: A strain imaging study

The improvement of exercise capacity due to exercise training in heart failure has been associated with peripheral adaptation, but the contribution of cardiac responses is less clear. We sought the extent to which the improvement of functional capacity in patients undergoing exercise training for heart failure was related to myocardial performance. Thirty-seven patients (35 men, age 64 +/- 11) with symptomatic heart failure and left ventricular ejection fraction

Cardiac adaptation to endurance exercise training in rats

No abstract

Online help systems: Learning while working

Most widely-used computer software packages, such as word processors, spreadsheets and web browsers, incorporate comprehensive help systems, partly because the software is meant for those with little technical knowledge. This paper identifies four systematic philosophies or approaches to help system delivery, namely the documentation approach, based on written documents, either paper-based or online; the training approach, either offered before the user starts working on the software or on-the-job; intelligent help, that is online, context-sensitive help or that relying on software agents; and finally an approach based on minimalism, defined as providing help only when and where it is needed.