Nothing about us without us : exploring issues of researching the O/other

How do we understand the experiences of people where the researcher is 'outside' these social groups? How do we undertake research in ways that does not further colonise or disempower these people?

This seminar aims to explore issues and approaches to research in contexts where the researcher is 'outside' the social/cultural group of the participants. If research is understood as an act of knowledge production, then both the positioning of the researcher and the act of research are inevitably political, where the power over the representation and categorisation of marginalised peoples and their social experiences is with others not of these groups, (usually aligned with dominant epistemologies). The net result of this kind of research and social activity is the catch cry from marginalised groups, summed up by that now in use in the disability field: 'nothing about us without us'. This paper focuses on the central importance of the meaning making process and offers a method for building meanings and understandings that explicitly draw on the located contexts of their production. The paper offers a set of 'ethics of meaning making' that support appropriate work in these contexts, and focuses on articulating one step of the method that supports these.

Improving the communication between care providers of individuals who may require joint replacement surgery (JRS) a framework for referral

Aims & rationale/Objectives : The objective of the project was to specify the information required in referrals to public hospital orthopaedic outpatient departments in order to streamline the care and prioritisation of individuals who may require JRS. It was envisaged that an evidence-based GP-Orthopaedic derived referral system would assist in ensuring that the right person accessed the right care at the right time.

Methods : In collaboration with the RACGP and the Commonwealth Department of Health and Ageing, a national stakeholder working group was convened. A scoping document was prepared with input from key stakeholders. A review of primary research was undertaken as well as a review of relevant guidelines. Information on the implementation and evaluation of similar programs in Australia and overseas also informed the referral specification.

Principal findings : The initial scoping processes with key stakeholders provided clear information on core components of the referral. These were the use of standardised and respected assessment tools to determine the severity of arthritis, fitness for surgery and willingness of affected individuals to undergo surgery.

Discussion : About 20,000 JRS occur each year in public hospitals which emanate from 5 to 10 fold number of referrals. Arthritis and musculoskeletal diseases are a national health priority area reflecting the high burden of disease associated with these conditions. Various initiatives are being undertaken to address the quality of life of affected individuals. This project has revealed areas of potential improvement in the communication between care providers of individuals who may need JRS.

Implications : The project will result in the development of a standard referral form and guidelines to assist referring practitioners to communicate more effectively with the multidisciplinary care team, in particular orthopaedic care providers. The guidelines will be piloted in a large rural setting.

Case studies of change : addressing family support needs of rural GPs

The National Rural Faculty of The Royal Australian College of General Practitioners received commonwealth funding between 2000–2002 to develop a rural medical family support project. There were three elements to this project:

* a counselling and communication skills or ‘mentoring’ workshop for rural GP spouses in each state
* the development of a resource kit of existing rural medical family support strategies, and
* the piloting of a range of strategies designed to address family support needs in collaboration with rural GPs, registrars and their families.

This article focusses on the last of these three elements.

Improving collaboration between private psychiatrists, the public mental health sector and general practitioners : evaluation of the Partnership Project

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies.

Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles.

Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

Challenging the dominant discourses of the state aid debate

The state aid debate is one of the longest running and most intractable issues in the public policy sphere in Australia. Recent decisions by the Commonwealth government to increase funding to private schools has reignited the debate. But the traditional defences of public education have proved inadequate to the task of hanging the course of current neo-liberal education policy trajectories. As the percentage of students attending private schools continues to grow, and as the spectre of a residualised public education system looms larger, so the need to rethink Australian public education becomes a more urgent project. In this paper we analyse what is happening and why; identify a range of concerns from the standpoint of a social democratic educational agenda; and theorise some possible strategies which might be pursued by those committed to a vibrant public schooling
system in Australia.

Radiation exposure and the justification of computed tomography scanning in an Australian hospital emergency department

In an emergency department (ED), computed tomography (CT) is particularly beneficial in the investigation of high-speed trauma patients. With the advent of multidetector CT (MDCT) scanners, it is becoming faster and easier to conduct scans. In recent years, this has become evident with an increasing number of CT requests. Patients who have multiple CT scans during their hospital stay can receive radiation doses that have an increased theoretical risk of induction of cancer. It is essential that the clinical justification for each CT scan be considered on an individual basis and that due consideration is given to the radiation risk and possible diagnostic benefit. The current lack of a central State or Commonwealth data repository for medical images is a contributing factor to excessive radiation dosage to the population. The principles of justification and radiation risks are discussed in this study.

Benzodiazepine and pharmaceutical opioid misuse and their relationship to crime : an examination of illicit prescription drug markets in Melbourne, Hobart and Darwin : Victorian report

This report presents the findings of the major research project 'benzodiazepine and pharmaceutical opioid misuse and their relationship to crime', and is an examination of illicit prescription drug markets in Melbourne.

An innovation framework based on best practice exemplars from the Australian School Innovation in Science, Technology and Mathematics (ASISTM) project

This report describes research into 16 ASISTM projects selected to be broadly representative of exemplars in innovation. Case studies of each project were constructed from interviews with a range of key participants, and used to develop and refine an innovation framework that is used to make sense of and describe the key features of each project. The major issue binding these projects was found to be that of student interest and engagement, and this was pursued through involving students in contemporary science, technology and mathematics (STM) practices in authentic settings. The findings point to an enriched set of purposes of STM education implicit in these projects, a set of pedagogical practices that are varied and consistent with contemporary educational thinking, and a varied array of 'actors' recruited to these projects.