The utility of the personal wellbeing index intellectual disability scale in an Australian sample

Background Subjective wellbeing (SWB) in people with intellectual disabilities has been the focus of increased interest in the identification of support needs and as an outcome measure for interventions and service delivery evaluations. It is therefore important to conduct further research in this area, and to develop appropriate scales to measure SWB.

Methods A new scale, the Personal Wellbeing Index-Intellectual Disability (PWI-ID) was administered to 114 adults with mild (n = 82) or moderate (n = 32) level ID in Victoria, Australia.

Results The PWI-ID demonstrated good reliability and validity. A comparison of the findings with previous research indicates that participants' SWB levels are within the normative range, and are similar to those reported by the general population.

Conclusions The results support the notion that individuals with ID do not experience life quality lower than normal, which can be explained theoretically by the Theory of Subjective Wellbeing Homeostasis. The use of the PWI-ID may ultimately assist in ensuring that the needs of people with ID are being met and inform the planning and delivery of congruent resources and services.

Pregnant women's alcohol consumption : the predictive utility of intention to drink and prepregnancy drinking behaviour

Objective: This study had two aims: (1) to examine pregnant women's alcohol consumption across time from prepregnancy until childbirth and (2) to explore whether prepregnancy drinking and intention to drink predict prenatal alcohol consumption while controlling for relevant demographic variables.

Methods: At 17–21 weeks, 248 pregnant women completed questions about demographics, intention to drink alcohol during the subsequent pregnancy, and retrospective measures of prepregnancy and early pregnancy consumption. After this time, calendars were sent fortnightly assessing daily alcohol consumption until birth.

Results: For women who drank both prepregnancy and postpregnancy confirmation, average fortnight alcohol consumption in the first weeks of pregnancy was lower than during prepregnancy, and consumption continued to decrease between gestational weeks 1 and 8, particularly following pregnancy confirmation, after which it remained relatively stable. When predicting whether women drank in late pregnancy, intention accounted for unique variance after controlling for income and prepregnancy drinking. For women who drank after pregnancy confirmation, prepregnancy drinking quantity significantly predicted intention to drink, which in turn predicted fortnight alcohol consumption in later pregnancy, after controlling for prepregnancy drinking and income.

Conclusions: Findings highlight the need to measure alcohol consumption at multiple time points across pregnancy, the need for educating and supporting women to reduce consumption when planning pregnancies, and the usefulness of intention to drink as a predictor of drinking during pregnancy.

Bridie McCarthy reviews Yvette Holt, Javant Biarujia and Martin Harrison

Book review of three books of Australian poetry

A preliminary investigation of the utility of the "Behavior support plan quality evaluation guide II" for use in Australia

Background The quality of behaviour support plans (BSPs) can be an important influence on the quality of the support provided to people with disability who show challenging behaviours. The Behavior Support Plan Quality Evaluation Guide II (BSP-QE II) is one tool that may be useful in assessing the quality of behaviour support plans. It has previously been used to assess BSPs to support children in schools in the USA. In this preliminary study, we examined the utility of the BSP-QE II for assessing behaviour support plans designed for adults with an intellectual disability in community support services in Australia.

Method  Experienced practitioners were surveyed concerning the relevance of BSP-QE II components to the evaluation of BSPs in Australia, and an audit was conducted of randomly selected BSPs submitted as a statutory requirement to the Office of the Senior Practitioner.

Results  The BSP-QE II showed evidence of acceptable construct validity and interrater reliability. There was evidence of a need for substantial improvement in the quality of BSPs, consistent with previous findings conducted using other audit tools.

Conclusions The findings support the utility of the BSP-QE II, to inform and evaluate service planning in supporting adults with intellectual disability who show challenging behaviour.

A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.

Methods
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/ the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.

Discussion
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial Registration ACTRN12611000661976

The rural and regional ambulance paramedic : moving beyond emergency response - report to the Council of Ambulance Authorities Inc. March 2006

Serious long-term recruitment and retention problems amongst rural health workers in Australiacontribute to inequitable health service access for rural Australians. In response, new healthcaremodels with flexible workforce roles are emerging including expanded-scope paramedic roles.

This research project was born from the view that expanding ambulance paramedics’ scope ofpractice offers the potential to improve patient care and the general health of the community.New healthcare models with flexible workforce roles are clearly needed in rural Australia andexpanded-scope paramedic roles are valuable innovations.

Policing services with mentally ill people : developing greater understanding and best practice

Although it is now well known that there is a disproportionate number of people with mental illnesses in the criminal justice system, surprising little attention has been paid to the challenges faced by policing people with mental illnesses in the community. This article provides an overview of some of the key findings from a programme of research undertaken in Victoria to further understand and develop a best practice model at this interface. The areas covered will include the prevalence of psychiatric symptoms and mental illnesses among police cell detainees; the existing knowledge base and attitudes of police towards mentally ill people; the relationship between mental illness and offending; the frequency and nature of police apprehensions of mentally ill people under the Mental Health Act; the association among mental disorder, police shootings, and other injuries to people as a result of these encounters; and police interactions with victims of crime. The work highlights the need for ongoing improvements in policing people with mental illnesses, and particularly the need for improved inter-agency practices for dealing with them.

Testing the validity, reliability and utility of the Self-Administration of Medication (SAM) tool in patients undergoing rehabilitation.

Determination of patients' ability to self-administer medications in the hospital has largely been determined using the subjective judgment of health professionals.