Patients' decision-making strategies for managing postoperative pain

Despite technological advances, many postoperative patients continue to suffer unrelieved pain. The aim of this study was to identify the strategies used by postoperative patients to bring about pain management decisions. A single-group noncomparative study design was chosen using observations as the means of examining pain activities in 2 surgical units of a metropolitan teaching hospital in Melbourne, Australia. A total of 52 nurses and 312 patients participated in the study, and 316 pain activities were observed. The most common strategy used was patients acting as a passive recipient for pain relief (60%), whereas problem solving (23%) and active negotiation (17%) were less commonly used. Patients in this study were admitted for surgical treatment of a particular condition, and their subsequent pain was specifically related to this acute event. Therefore, the lack of familiarity of the situation and the severity of pain experienced may have encouraged passivity. Patients may have also felt uncertain about how to approach the pain decision, preferring to defer to nurses. Because increased pain levels can be associated with fear, patients could have been unwilling to speak with nurses to discuss their need for pain relief.

Patient engagement and coaching for health: the PEACH study- a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

Background
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.
Methods/design
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.
Discussion
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Improving infant sleep and maternal mental health: a cluster randomised trial

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system.

Design: Cluster randomised trial.

Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia.

Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003.

Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care.

Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.

Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference –1.4 (–2.3 to –0.4) and 12 months (–1.7 (–2.6 to –0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.

Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.

Family, school, peer and individual influences on early adolescent alcohol use: first-year impact of the Resilient Families programme

Introduction and Aims:  This study aimed to examine: (a) the influence of family factors relative to school, peer and individual influences on the development of adolescent alcohol use during the first year of secondary school; and (b) the feasibility of preventing adolescent alcohol use by modifying family factors. Design and Methods:  Twenty-four schools in Melbourne, Australia were randomly assigned to either the 'Resilient Families' intervention or a control condition. A baseline cohort of 2315 grade 7 students (mean age 12.3 years) were followed-up one year later (n = 2128 for longitudinal analyses). A sub-set of parents (n = 1166) also returned baseline surveys. Results: The prevalence of lifetime alcohol use in year 7 was 33% and rose to 47% by year 8. Student-reported predictors of year 8 alcohol use included baseline alcohol [Odds Ratio (OR) 3.64] and tobacco use (2.68), and school friend's alcohol (1.41) and tobacco use (1.64). After adjusting for other influences, student-reported family factors were not maintained as significant predictors of year 8 alcohol use. Parent-report predictors of student-reported alcohol use included allowing alcohol use in the home (2.55), parental alcohol use (1.88) and child hyperactivity (1.85). Protective factors included attendance at brief parent education (0.60) and parent involvement in school education (0.65). Discussion and Conclusions: The intervention appeared to benefit education-related outcomes, but no overall effect in reducing student alcohol use was found in year 8. Intervention effects on alcohol misuse may become significant in later secondary school once the entire program has been implemented. Considerable alcohol use was detected in early secondary school,   suggesting that interventions to reduce alcohol use may be usefully implemented prior to this period.

The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences

Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.

Associations between family circumstance and weight status of Australian children

To examine associations between weight status and multiple indicators of family circumstance in Australian elementary school children. Data were combined from the 2001 Children's Leisure Activities Study (CLAS Study) and 2002/3 Health, Eating and Play Study (HEAP Study), involving 2520 children in Grades Prep (mean age 6 years) and 5-6 (mean age 11 years) in Melbourne, Australia. Children's body mass index (BMI) was calculated from measured height and weight. Weight status (non-overweight or overweight) was determined according to International Obesity Taskforce cut-off points and BMI was transformed to z-scores based on the 2000 US growth chart data. Parents reported family circumstance (number of parents in the home, marital status, presence of siblings, parental education, parental employment status, parental work hours [HEAP Study only]) and parental BMI. Regression analyses were conducted for the sample overall and separately for young girls, young boys, older girls and older boys. Children in single-parent homes, those without siblings, and those with less educated mothers and fathers tended to have higher z-BMIs (p=0.002, p=0.003, p<0.001 and p<0.001, respectively) and were more likely to be overweight (p=0.003, p<0.001, p<0.001 and p=0.02, respectively). Associations were stronger for older children. Parental employment and work hours were not consistently associated with child weight status. The multivariable models did not demonstrate a cumulative explanatory effect (R2=0.02), except when maternal BMI was included (R2=0.07). Individual measures of family circumstance were differentially associated with child weight status and appeared to be largely independent of other measures of family circumstance. Childhood overweight interventions may need to be tailored based on the age, gender, maternal BMI and family circumstances of the target group.

Associations of children's perceived neighborhood environments with walking and physical activity

Purpose. To examine associations between children's perceptions of the neighborhood environment and walking and physical activity.
Design. Cross-sectional study of a school-based sample.
Setting. Elementary schools in Melbourne, Australia.
Subjects. 280 children aged 10 years (response rate 78%).
Measures. A self-report survey assessed children's perceptions of the neighborhood physical and social environments and their weekly walking frequency. Physical activity was also objectively measured using accelerometers.
Results. Multiple linear regression analyses showed a positive association between walking frequency and the number of accessible destinations in the neighborhood among boys; having a neighborhood that was easy to walk/cycle around and perceiving lots of graffiti were positively associated with walking frequency among girls. Perceiving lots of litter and rubbish was positively associated with boys' overall physical activity, but no environmental variables were associated with girls' overall physical activity.
Conclusion. Several different environmental factors were associated with walking and physical activity. Perceptions of the neighborhood environment were more strongly associated with girls' walking than with objectively-measured physical activity. Future studies should confirm these findings using objective measures and prospective study designs.

The normative distribution of chest tube drainage volume after coronary artery bypass grafting

Background
Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG).

Objectives
The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG.

Design

This was a retrospective, descriptive study.
Patients
The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia.

Results
The sample (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders.

Conclusions
Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.

Coetzee's haunting of Australian literature

In June 2006, the Good Weekend, the magazine supplementing Saturday’s the Age in Melbourne, ran the following cover story by Catharine Lumby: “Worried TV will turn your child into a zombie?” The cover featured a science-fiction image of a boy’s upturned face. Televisions were reflected in his pupils, giving them the effect of being square instead of round. The message, though, was ultimately non-alarmist with the subheading already instructing “Relax. It’s all good”. Stories like this appear regularly in the press, and while I am not interested in debating whether TV is good or bad for children, I am interested in the popular image of children—or, for that matter, adults—as being akin to zombies when they watch TV, if only because something similar happens when we read books. Although it is not as fashionable to talk about it, we become emptied of ourselves, possessed by something other.

The death and life of the great Australian suburb

Inspired by the approach to understanding, critiquing and rebuilding both planning and the urban environment that Jane Jacobs did so well in her Death and Life of Great American Cities, this paper begins with the personal experience of living in one suburban neighborhood in Melbourne, Victoria. Particular elements which make this both a positive and negative experience are then connected to the geographical, planning and urban studies literature to offer a broader context in which better suburbs can be planned, developed and activated.

Are squash players protecting their eyes?

Methods: A survey of 303 players (aged ≥18 years) was conducted at three squash venues in Melbourne, Australia over a three week period in June 2000 to obtain information about protective eyewear use.

Results: Of 303 participants the response rate was 98.1%; 66.1% were males, with a mean age of 40.5 years. The majority (68.4%) had played squash for 10 years or more. Although 18.8% of players reported using protective eyewear, only 8.9% reported wearing approved eyewear. Both age group (p<0.05) and years of squash experience (p<0.01) were significantly associated with any eyewear use. The two main influences were personal experience of eye injuries (50.0%) and knowledge of eye injury risk (33.9%). A commonly reported barrier was restriction of vision (34.2%).

Conclusion: These findings demonstrate a low prevalence of voluntary use of appropriate protective eyewear. Future prevention strategies incorporating education campaigns should focus on increasing players' knowledge of risks. The barriers to use and misconceptions about which types of eyewear is most protective need to be addressed as a priority.

Marketing research and small travel agents: an exploratory study

The research study reported on in this paper examined the marketing research (MR) orientation of small Australian travel agents. A survey was undertaken involving personal interviews with 91 travel agents in Melbourne, each agency having fewer than 20 employees. Agents were asked about their organisation with regard to MR, which MR activities were undertaken and wich MR techniques were employed. Additional questions gathered data on organisational and individual demographics, and some perceptual and attitudinal data. Although approximately half the respondents had no employee assigned to MR, the majority of agents reported engaging in most of the MR activities nominated, although most agents did not use most of the MR techniques covered in the study. Most general demographics were not related to MR participation, although greater devotion of resources to MR was reflected in more comprehensive usage of MR, and a more positive attitude to the cost-effectiveness of MR in small organisations. The desirability of travel agents considering seriously the role of MR in assisting in clarifying the future options for the sector is noted.

Intentional overdose among heroin overdose survivors

Previous studies have reported varying rates of intentional overdose among heroin overdose survivors. This article reports on the prevalence of intentional heroin overdose among a sample of overdose survivors in Melbourne, Australia. This is part of a larger study examining the risk factors associated with nonfatal overdose. The study involved interviews, with 256 heroin overdose survivors successfully resuscitated by Melbourne Ambulance Service paramedics. A substantial minority (17%) of the sample indicated that they had ever had an intentional overdose, and 67% had one within the last 6 months (11% of the total sample). Of those who had ever intentionally overdosed, 21% did so at the overdose for which they were recruited into the study (4% of total sample). Self-reported reasons for intentional heroin overdose fell into two categories: precipitating events and emotional states prior to use. Intentional overdose appears to comprise a relatively low proportion of overall heroin overdoses. However, given the complexity of suicidal thought and behavior, it is possible that some heroin overdose survivors who report their overdose to be unintentional were in fact experiencing some degree of suicidal thinking at the time of the overdose. Future research could address the potentially ambiguous nature of some intentional heroin overdoses.

It starts with the parents and ends with the parents

Alcohol is the most popular recreational drug in Australia. Despite the fact that many people gain enjoyment from alcohol related industries, alcohol is also implicated in much personal trauma and social damage. Parents play a key role in influencing alcohol use and driver behaviour in young people. The aim of this study was to gain an understanding of the attitudes and concerns of parents in Melbourne in relation to their teenage children's use of alcohol and how they educate and/or provide role models for their adolescents with respect to alcohol usage. A convenience sample of parents with adolescent children participated in focus groups. Parents described patterns of alcohol use and perceived influences on consumption. They reported that they wanted to create safe environments for adolescents to consume alcohol but that they needed more support and information on which to base these decisions. There i, an opportunity for public health policy makers to specifically address parents and enhance their role in alcohol related road safety.

Team-based strategy at Varian Australia : a case study

This article discusses the use of work teams at Varian Australia, a manufacturing organisation based in Melbourne, Australia. The company manufactures high-technology instruments that are largely exported to the USA and Europe. The paper describes the experiences of the company with continuous improvement process teams (CIP) and corrective action team (CATs) over a decade, from 1990 to 2000. The article discusses the reasons for the slow down of the process improvement program and the appropriate changes that were made to relaunch the continuous improvement strategy at Varian Australia. Based on the qualitative analysis in this article, a number of interesting lessons can be learned. The main lesson is that voluntary, cross-functional teams are more effective than compulsory membership, as team members are motivated to work towards their goals and better understand the processes. Team members found that by working together the result of their combined effort was much greater than the combined results of their individual efforts. This approach reduced the product development cycle on Varian projects by up to 50%.