Motivations and perceived influences on rural and urban general practitioners when prescribing conventional non-steroidal anti-inflammatory drugs or COX-2 inhibitors

Background and objective: Prescribers in rural and remote locations perceive that there are different influences on their prescribing compared with those experienced by urban prescribers. The aim of this study was to compare the motivations and perceived influences on general practitioners (GPs) when prescribing COX-2 inhibitors rather than conventional non-steroidal anti-inflammatory drugs (NSAIDs) between rural and urban-based GPs in Queensland, Australia. Methods: A questionnaire was administered to two geographically distinct groups of GPs, one urban (n = 67) and one rural (n = 67), investigating the reasons that the GP would prescribe a COX-2 inhibitor rather than a conventional NSAID or vice versa and also focusing on patients requesting a prescription for a COX-2 inhibitor. Results and discussion: A 51% response rate (n = 68) was achieved. The difference between the rural and the urban GPs was that the urban GPs were more likely to perceive that they were influenced to prescribe COX-2 inhibitors by their patients' knowledge of these new (at the time) drugs. GPs in both the rural and urban areas perceived the COX-2 selective inhibitors to be safer than conventional NSAIDs, and that there was little difference in terms of efficacy between the two drug classes. However, GPs from both of the study areas stated that conventional NSAIDs were preferred over COX-2 selective inhibitors, primarily due to their expense, if their patients were not at risk for developing a GI bleed. Conclusion: The motivations and perceived influences to prescribe a COX-2 inhibitor in rural and in urban areas of Queensland, Australia were very similar. Almost all surveyed GPs in rural and urban areas had patients request a prescription, or enquire about the COX-2 inhibitors. Urban GPs were more likely to feel pressured to prescribe a COX-2 inhibitor than their rural counterparts, agreeing with other research which found that patient pressure to prescribe appears to be greater in urban general practice.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.

A community-based wildlife survey: the knowledge and attitudes of residents of suburban Brisbane, with a focus on bandicoots

Within the expanding city of Brisbane in south-east Queensland, numerous fragments of native and regrowth vegetation are scattered across the largely urbanised landscape. These fragments provide refuge to a great diversity of native wildlife, and, provide residents with the opportunity to experience nature on their doorstep. To assess the diversity and abundance of this wildlife, recent changes in these parameters, and the value of wildlife and bushland fragments to residents of Brisbane, a questionnaire survey was distributed to 300 households each located adjacent to one of 38 urban bushland fragments. A total of 172 surveys (57%) were returned, producing 768 records of 83 fauna species, dominated by birds and mammals; bandicoots were widely reported from the 38 fragments. Several historical records provided evidence of recent local extinctions within fragments, highlighting the continuing declines in various species of native wildlife within Brisbane. Several human-wildlife conflicts were identified, but overall residents were tolerant of such conflicts. Bandicoots were disliked by a small minority (3%) of residents owing to the holes they dig in lawns and gardens in search of food. and their potential as vectors of ticks. Most respondents expressed ail appreciation for the presence of native wildlife (96%) and bushland fragments (97%) in their local area, emphasising the importance of incorporating human dimension values into the management of this urban biodiversity.

Review of the ecology of Australian urban fauna: A focus on spatially explicit processes

Cities have a major impact on Australian landscapes, especially in coastal regions, to the detriment of native biodiversity. Areas suitable for urban development often coincide with those areas that support high levels of species diversity and endemism. However, there is a paucity of reliable information available to guide urban conservation planning and management, especially regarding the trade-off between investing in protecting and restoring habitat at the landscape level, and investing in programmes to maintain the condition of remnant vegetation at the local (site) level. We review the literature on Australian urban ecology, focusing on urban terrestrial and aquatic vertebrate and invertebrate fauna. We identify four main factors limiting our knowledge of urban fauna: (i) a lack of studies focusing at multiple ecological levels; (ii) a lack of multispecies studies; (iii) an almost total absence of long-term (temporal) studies; and (iv) a need for stronger integration of research outcomes into urban conservation planning and management. We present a set of key principles for the development of a spatially explicit, long-term approach to urban fauna research. This requires an understanding of the importance of local-level habitat quality and condition relative to the composition, configuration and connectivity of habitats within the larger urban landscape. These principles will ultimately strengthen urban fauna management and conservation planning by enabling us to prioritize and allocate limited financial resources to maximize the conservation return.

Testing alternative models for the conservation of koalas in fragmented rural-urban landscapes

Predicting the various responses of different species to changes in landscape structure is a formidable challenge to landscape ecology. Based on expert knowledge and landscape ecological theory, we develop five competing a priori models for predicting the presence/absence of the Koala (Phascolarctos cinereus) in Noosa Shire, south-east Queensland (Australia). A priori predictions were nested within three levels of ecological organization: in situ (site level) habitat (< 1 ha), patch level (100 ha) and landscape level (100-1000 ha). To test the models, Koala surveys and habitat surveys (n = 245) were conducted across the habitat mosaic. After taking into account tree species preferences, the patch and landscape context, and the neighbourhood effect of adjacent present sites, we applied logistic regression and hierarchical partitioning analyses to rank the alternative models and the explanatory variables. The strongest support was for a multilevel model, with Koala presence best predicted by the proportion of the landscape occupied by high quality habitat, the neighbourhood effect, the mean nearest neighbour distance between forest patches, the density of forest patches and the density of sealed roads. When tested against independent data (n = 105) using a receiver operator characteristic curve, the multilevel model performed moderately well. The study is consistent with recent assertions that habitat loss is the major driver of population decline, however, landscape configuration and roads have an important effect that needs to be incorporated into Koala conservation strategies.