Evaluation of advanced breast cancer multidisciplinary team meatings

Background: Multidisciplinary team meetings (MDMs) have become an important decision-making forum in oncology. These meetings bring together expertise from each relevant field to improve continuity of care and health care outcomes for cancer patients. However there is a lack of evidence demonstrating the effectiveness of MDT meetings in improving cancer patient outcomes. The aim of this study was to explore the perceived value and potential usefulness of multidisciplinary team meetings for patients with advanced breast cancer (ABC).

Methods: ABC MDMs have been conducted since 2002 at two sites of Eastern Health, the second largest health service in Melbourne. Attendees were invited to complete a confidential questionnaire in November 2007 that comprised seven areas aimed to assess their judgment of how well the MDMs have improved patient management, including medical recommendations, psychosocial care, palliative care, community care, and team development. Average scores were calculated for improvement of each area.

Results: A total of 16 (69%) health practitioners participated in the survey, with main representation from nursing (37%), allied health (25%) and medicine (19%). Preliminary results indicate that the broad areas members reported the meeting had improved patient outcomes were in palliative care and medical management. Specific areas of perceived improvement were medical outcomes for patients; early referral to palliative care services; confirmation of diagnosis; referral to supportive care; and appropriateness of palliative care referrals. Conversely, the area that had least improved was community care, as there was no input from GPs or community services other than palliative care. Attendance by GPs and radiologists were considered important for further improving medical outcomes for patients.

Conclusions: This study demonstrates the perceived value of the MDT approach in the care of ABC patients, particularly in improving patient outcomes. The next stage of this research is to conduct a survey of ABC patient satisfaction level.

The migrant house as a site of conflicting cultural identity

This paper amis to explore how migrants attempt to maintain cultural identity while creating a feeling of being at home in the houses of their adopted counrties.  It draws on data collected through a visual study of suburban streetscapes with large proportions of south-east Asian born residents in Melbourne's western suburbs.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

Longitudinal examination of the family food environment and weight status among children

Objective. To examine whether aspects of the family food environment were associated with body mass index (BMI) z-score and weight status in children, cross-sectionally and prospectively over 3 years.

Methods. Four aspects of the family food environment (breakfast eating patterns, food consumption while watching television, parental provision of energy-dense foods and child consumption of energy-dense food at home and away from home) were assessed with a questionnaire completed by parents of 161 children aged 5-6 years and 132 children aged 10-12 years in Melbourne, Australia in 2002/03. In 2002/03 and 2006, children's BMI z-score and weight status (non-overweight or overweight) was calculated from measured height and weight. Results. At baseline, 19% of younger and 21% of older children were overweight. Three years later, a greater proportion of younger (now aged 8-9 years) compared with older (aged 13-15 years) children were classified as overweight (28% versus 18%). Few of the family food environment variables were associated with children's BMI z-score and weight status cross-sectionally and longitudinally. However, among older children, more frequent dinner consumption while watching television was associated with a higher BMI z-score longitudinally (B = 0.3, 95% CI = 0.0, 0.6), less frequent breakfast consumption was associated with higher odds of overweight longitudinally (OR = 2.2, 95% CI = 1.1-4.7), and more frequent fast food consumption at home was associated with higher odds of overweight cross-sectionally (OR = 3.1, 95% CI = 1.4-7.0).

Conclusions. This study found few significant associations between aspects of the family food environment and BMI z-score or weight status in a sample of Australian children.

Positive pathways for couples and families : meeting existing and emerging challenges of relationships

There is a growing need to develop an understanding of the positive pathways that strengthen the relationships of Australian couples and families. The couples and families in contemporary society are faced with many challenges and pressures that can mitigate against maintaining satisfying and enduring couple and family relationships. For example, increasing need for dual income families, longer working hours and demographic shifts that see older people living longer and children staying at home longer mean that couples are often required to provide familial care across two generations – frail ageing parents and children. These highlight just some of the pressures faced which can lead to couples not taking the time to cultivate their relationships. The aim of the workshop was to deal with many of these issues by linking research, policy and practice in ways that would help families meet such challenges. The two-day workshop, held 1-2 November 2008 in Melbourne, brought together leading and emerging Australian and international relationship researchers with practitioners, educators, policy makers and service-delivery organisations. Alongside the Academy, the event was sponsored by Deakin University, the University of Queensland, the Department of Families, Housing and Community Services and Indigenous Affairs (FaCHSIA), the Attorney General's Department (AG Department), the Australian Institute of Family Studies (AIFS) and Lifeworks. The workshop comprised seven sessions and two break-out discussions. A total of 28 participants attended the workshop. Of these participants, there were 19 speakers and 7 delegates from the various sponsor organisations that took part in group discussions.

Mother–infant psychotherapy and perinatal psychiatry: current clinical practice and future directions

Objective: To explore trends in the practice of mother-infant psychotherapy among perinatal psychiatry clinicians based in Melbourne.Methods: A cross-sectional survey with a purpose designed self-report questionnaire was used to assess the attitudes and practices of 47 perinatal and infant psychiatry clinicians in their use and understanding of mother-infant psychotherapy.Results: Seventy per cent of clinicians in this field of psychotherapy who responded to the questionnaire subscribe to a psychodynamic model, although cognitive behavioural models are also used. The interventions were mostly used in conjunction with other interventions, would be more accurately described as 'parent-infant psychotherapy', and non-psychiatrists in the area tended to be more likely to be formally trained in psychotherapy, but only 4% were formally trained in specific mother-infant psychotherapy. There was a unanimous request for further clinical training in this area.Conclusions: The emerging field of perinatal psychiatry needs to develop coherent therapeutic models and conduct outcome trials on specific interventions. Specific trainings in these models, in assessment and in diagnostic frameworks are required to enhance clinical efficacy, for research and service development purposes.

Understanding residential house prices : examining the contribution of social area analysis

A complete understanding of residential housing markets, particularly in relation to variations in house prices both within and between suburbs, continues to present challenges to property researchers and forecasters. Factors affecting changes in housing demand are not yet completely understood, and accordingly market changes cannot always be confidently predicted. Most urban cities contain precincts that have high or low house values at the same time, regardless of characteristics such as distance to the city centre, location of transport or topography. Exactly why these variations in suburb values occur is often unclear, although local residents are able to easily identify differences between the status of each suburb, especially when one area is clearly perceived as superior to another. Consequently, houses in premium suburbs are sold for substantially more than houses in other areas, primarily due to this perceived higher demand. An understanding of reasons behind varying levels of buyer demand has always been difficult to fully encapsulate in housing studies, even though clear links have been observed between housing affordability and the type of inhabitant that would live in a particular area. This study confirms that traditional economic indicators can not always observe the degree of purchaser and vendor willingness in the residential property market, as per the International Valuation Standards Committee definition of market value, and substantial consideration must also be given to characteristics of individual buyers and sellers within the marketplace. No longer can the focus be narrowly focussed just on endogenous factors such as interest rates and inflation levels.
Accordingly, this research draws the disciplines of demography and housing research closer together and looks to social indicators for an insight into the level of house prices. To establish this link, a two-stage process is adopted where social area analysis initially identifies the characteristics of suburbs within an urban area. This information is then used to examine variations in suburb values, resulting in a clearer understanding of the relationship between demographic variables and house prices. This research analysed changes in the value of established residential house prices in Melbourne, Australia as well as the relationship with social structure. The added dimension of time highlighted change, with data drawn from 1996 and 2001. The results confirmed the existence of strong linkages between social constructs and established house prices. Whilst acknowledging that the overall level of house values is influenced by external economic and political factors, differences between suburb values can be explained by demographic variables. The results confirm that increased emphasis must be placed upon demography when seeking to understand variations in residential property values between urban areas.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Reinvigorating the public sphere : the role of voluntary associations

This thesis examines the key question: can voluntary associations enhance democracy? It tests critical claims made by Habermas and others that voluntary associations have the potential to reinvigorate a public sphere in a state of atrophy. The thesis outlines the major theoretical arguments pertaining to these areas and then presents the results of empirical work within voluntary organisations. Specifically the thesis: Critically examines the concept of the public sphere, being a sphere between the state and civil society and investigates why theorists have advocated voluntary associations, claimed to be the core institutions of civil society, as sites where democratic ideals can be secured; Goes on to examine the concept of civil society and reviews the recent literature that has attempted to define and analyse the role of voluntary associations in contemporary society; Tests empirically the normative ideals that have been advocated on behalf of voluntary associations through the presentation of data obtained using qualitative methodology. The analysis of the data collected during interviews with key employees and members of six voluntary associations in Melbourne, Australia allows for a more informed knowledge regarding the key concepts and themes of the thesis. The thesis ends by directly addressing the following points: whether or not the public sphere is in a state of atrophy; the particular nature of voluntary associations contemporary engagement in the public sphere; and whether voluntary associations can indeed, be sites where democracy can be enhanced and democratic ideals be secured. It is concluded that voluntary associations operate within Habermasian public spheres, counterspheres, and postmodern public spheres and that unitary notions of the public sphere, such as those Habermas proposes, do not adequately explain voluntary associations engagement in the public sphere. Accordingly, it is concluded that voluntary associations have the potential to invigorate public spheres, though not in ways that many theorists writing on the subject suggest.

Hope seen through the eyes of ten Australian youth

In this study I explored the phenomenon of hope, seen through the eyes often Australian youth. Specifically, the participants of this study were self-identified Spirit-filled Christian youth residing in Melbourne and youth who were marginalised and disenfranchised from main stream society and receiving care and supportive services within an outreach organisation located in another state in Australia at the time of their interview. The rationale for the selection of these youth for inclusion in this study is contained in this thesis in Chapter 4, The Study Method A phenomenological study, using the philosophical underpinnings of Hans Georg Gadamer (1989), was selected to explicate the meaning of and to distil the essence of hope seen through the eyes of these participants, and is the main aim of this study.

A model of predictors of attendance at major sporting events

Sports events represent a major category of event revenue contributing economic benefits to cities and regions. Attendance at sports events is recognised as an important activity (Shamir and Ruskin 1984), but over the past 20 years sports event attendance expenditure has declined (Ross 2006). Consequently, understanding the factors that influence sports event attendance is crucial to the sustainability of these events. This study identifies the antecedents of sports event attendance among 460 respondents who were surveyed in Melbourne, Australia. Structural Equation Modelling was used to test an empirical model of attendance motivations. The model identifies constructs relating to emotional responses and facilities, as the predictors of event attendance.

The little con

The little con was created as a collective in 2005 to support and promote the vibrant community of dance improvisation in Melbourne. It is a monthly curated evening of spontaneous choreography.

Belonging to a Victorian community choir : ageing, music and culture

Australia's ageing population created challenges for maintaining well-being and combating social isolation. Older Australians frequently rely on community arts organizations to enhance quality of life, specifically in health, happiness and community. Arts engagement takes place in many different contexts, from formal to informal and throughout the lifespan of the individual. Culture shapes the way in which we age and cultural identity is celebrated through the arts. This study will explore ageing and cultural diversity within Australian society through an examination of community arts engagement, specifically a community choir in Melbourne, Victoria, Australia. Much previous research concerning music engagement by older people has focused on its therapeutic applications, but there have been less attention given to healthy older people still living in communities. This paper reports on how music engagement can facilitate successful ageing be encouraging a sense of community, enhancing well-being and supporting cultural identity.

Agency-nursing work : perceptions and experiences of agency nurses

This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, individual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.

Rope dancer : a novel and accompanying essay

The thesis combines a novel and a critical essay. The novel tells of a group of people in Melbourne, some of whom write, party, have sex, take drugs, go climbing and die. The essay discusses four aspects of the novel: climbing fiction, Nietzsche in literature, place and fiction and character as hero.