Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

The early postnatal period : exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Background: There is growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period is less than ideal for both women and care providers. Many health services face increasing pressure on hospital beds and have limited physical space available to care for mothers and their babies. We aimed to gain a more in-depth understanding of women's views, expectations and experiences of early postnatal care.

Methods: We conducted focus groups in rural and metropolitan Victoria, Australia in 2006. Fifty-two people participated in eight focus groups and four interviews. Participants included eight pregnant women, of whom seven were pregnant with their first baby; 42 women who were in the postpartum period (some up to twelve months after the birth of their baby); and two partners. All participants were fluent in English. Focus group guides were developed specifically for the study and explored participants' experiences and/or expectations of early postnatal care in hospital and at home, with an emphasis on length of hospital stay, professional and social support, continuity of care, and rest. Discussions were audio-taped and transcribed verbatim. A thematic network was constructed to describe and connect categories with emerging basic, organizing, and global themes.

Results: Global themes that emerged were: anxiety and/or fear; and the transition to motherhood and parenting. The needs of first time mothers were considered to be different to the needs of women who had already experienced motherhood. The women in this study were generally concerned about the safety of their new baby, and lacked confidence in themselves as new mothers regarding their ability to care for their baby. There was a consistent view that the physical presence and availability of professional support helped alleviate these concerns, and this was especially the case for women having a first baby.

Conclusion: Women have anxieties and fears around early parenting and their changing role, and may consider that the physical availability of professional care providers will help during this time. Care providers should be cognisant of these potential issues. It is crucial that women's concerns and needs be considered when service delivery changes are planned. If anxiety around new parenting is a predominant view then care providers need to recognise this and ensure care is individualised to address each woman's/families particular concerns.

The curious case of the Occidental and Regal : the evolution of solvency and disclosure standards in the Australian life insurance industry

In 1990, the Australian life insurance industry was rocked by a scandal that threatened to destabilize consumer confidence in the ability of insurance providers to meet policyholder liabilities. The incident highlighted the nature of the agency problems that arise when conditions of asymmetric information exist. It revealed systemic weaknesses in accounting, solvency and disclosure standards as they applied to life insurers. This article uses an evolutionary concept of agency to analyse government and industry responses to this event. It is argued that initial adaptive responses stabilized the industry and averted a more serious crisis. Longer term innovative responses led to the introduction of a new and more rigorous approach to reporting and solvency standards, which has improved information flows and agency outcomes.

Evolving governance arrangements in multi-tenure reserve networks

Multi-tenure reserve networks (MTRNs) aim to connect areas managed for biodiversity conservation across public and private land (for example biosphere reserves (BRs) and conservation management networks (CMNs)). A key function of MTRNs is facilitating communication, information exchange and management activities between land managers of differing tenures not usually in contact with each other; governance arrangements are therefore crucial. Australian MTRNs vary greatly in their goals and measures of success, criteria for entry, ecosystems targeted, geographic extent and financial arrangements. The successful operation of a MTRN is likely to be influenced by a manager's confidence in the governance model/coordination arrangements (Belcher & Wellman 1991). We analysed the organizational structure of three Australian MTRNs (Fig. 1) including the objectives and role of the coordinating body, entry requirements, goals and measures of success, restrictions placed on the geographic or ecological extent of the network and financial arrangements. We highlight how substantial changes in governance arrangements have occurred for two of three networks studied, suggesting a fluid evolution of MTRN structures is likely.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Background : Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care ‘packages’ that could provide an alternative approach to early postnatal care.

Methods : Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants’ experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what ‘value’ women placed on the various components of care.

Findings : Overall, women expressed a preference for what they had experienced or expected, which may be explained by the ‘what is must be best’ phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors.

Key conclusions and implications for practice : Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's individual needs.

Detection of depression in patients with low vision

Purpose. Depression is common in people with vision impairment and further reduces levels of functioning independent of vision loss. However, depression most often remains undetected and untreated this group. Eye health  professionals (EHPs) (ophthalmic nurses, ophthalmologists, optometrists, and orthoptists) and rehabilitation workers (RWs) may be able to play a role in detecting depression. This study aimed to identify current practice and investigate factors associated with depression management strategies.
Methods. A self-administered cross-sectional survey of EHPs and RWs assessed current practice including confidence in working with depressed people with vision impairment; barriers to recognition, assessment, and management of depression; beliefs about the consequences, duration, and efficacy of treatment for depression in individuals with vision impariment.
Results. Ninety-four participants aged 23 to 69 years took part. Thirty-seven participants (39.8%) stated that they attempted to identify depression as part of patient management, with RWs significantly more likely to do so (n = 17, 60.7%) than EHPs (n = 20, 30.8%; p = 0.007). Intention to identify depression was not associated with sociodemographic factors, professional experience in eye care services, or the length and number of patient consultations, but a significant relationship was found for confidence, barriers, and beliefs about depression (p < 0.05). No consistent depression management strategy emerged and a range of barriers were highlighted.
Conclusions. Training programs are needed to provide EHPs and RWs with the skills and resources to address depression in people with vision loss under their care and to support the development of procedures by which concerns about depression can be identified objectively, documented, and included as part of a referral to appropriate services.

Casting yield improvement in graphite iron castings

A well designed runner and feeding system should produce castings with minimal defects and low pour weight. This thesis investigates how the filling regime and solidification of the mould influences defects in the castings produced from that mould. Design guidelines to reduce such defects are proposed and tested. An existing shrinkage fault in a Grey Iron disc brake casting is simulated using a commercial finite-difference computer program. Three criteria are used to predict the defect and the effect of changes to the feeder geometry. Critical Fraction Solidification analysis is used to determine whether the feeder remains in liquid contact with the casting during solidification and this approach is shown to correctly predict the presence or absence of porosity* The feeder block is extended below the ingate of the casting to improve liquid contact between the casting and feeder without significantly increasing the feeder mass. Plant trials confirm the change to the feeder eliminates the porosity defect. The runner system and mould venting for a thin walled Ductile Iron casting are investigated. Trials show that by setting the total mould vent area to be greater than the net ingate area of the castings, the cold-shut frequency is halved. A method for runner system design based on peak linear flow velocity in the runner during mould filling is proposed. A new pressurised runner system produces castings with significantly fewer defects and reduced pour weight when runner areas are designed to maintain peak velocity below 1 m/s. Peak velocity and magnesium levels are demonstrated to be critical factors in the elimination of cold-shut defects. A pressurised runner system is also shown to isolate inclusion defects from castings more effectively than an unpressurised system. From this work, a technique is proposed which allows the yield of an existing runner and feeder system for iron castings to be improved with confidence in the results.

Patient education and self-management programs in arthritis

♦ Arthritis self-management programs (ASMPs) are integrated into many clinical practice guidelines and policies, and are the core business of Arthritis Foundations.

♦ Australian Arthritis Foundations are embarking on a National Quality Assurance Program which should raise awareness and improve confidence in such programs.

♦ ASMPs aim to empower people, improve quality of life while living with chronic disease, increase healthy activities and improve self-monitoring — each of which can assist with clinical management, but can be difficult to evaluate.

♦ Although there is modest high-quality evidence of traditional “clinical outcomes” from ASMPs, these programs are strongly endorsed by consumers, are being used as a vehicle for healthcare reform, and have the potential to substantially improve public health.

♦ Coordinated national delivery of patient education programs has the potential to improve healthcare and outcomes for people with arthritis.

Assurance of sustainability reports : impact on report users' confidence and perceptions of information credibility

This study examines whether (1) assurance, (2) the level of assurance (reasonable vs limited) and (3) the type of assurance practitioner (accountant vs specialist consultant) affect users' perceptions of reliability of sustainability reports. Based on an experimental questionnaire, we find that the provision of assurance improves perceived reliability of the environmental and social information. There are no significant main effects for both the level of assurance and type of assurance practitioner. However, a significant interaction is found between these two experimental factors and report users' perceptions of reliability of such reports. More specifically, report users place more confidence in sustainability reports when the level of assurance provided is reasonable (that is, high but not absolute), and when such assurance is provided by a top tier accountancy firm, compared to when the assurance is provided by a specialist consultant. No such difference is found when the level of assurance provided is limited for either type of assurance practitioner group. The results of this study thus highlight the relevance of assurance for sustainability reporting.

Maternal effects in the Zebra Finch : a model mother reviewed

Birds are a particularly good group with which to examine the importance of maternal effects, as parental contributions can be relatively easily quantified compared with other groups. There have undoubtedly been more studies on maternal effects in the Zebra Finch than any other single bird species. Studies of this species have examined the importance of maternal effects mediated through sex allocation, size, nutrients and hormones of of eggs, incubation behaviour and provisioning levels. A synthesis of all of this work illustrates some contrasting results (e.g. many high-profile results have failed to be replicated), some very common patterns (e.g. investment shifts through the laying sequence), and potentially interesting and complex interactions between traits (e.g. between sex of offspring and hormonal profiles of eggs). This extensive collection of work on the Zebra Finch provides useful general insight into the patterns of maternal investment in birds and the effects on offspring phenotype. However, we caution that the literature is probably littered with studies that have overemphasised the importance of some maternal effects and recent studies have highlighted analytical and logical flaws that have probably led to misplaced confidence in some of the findings reported to date. Finally, it is worth considering that the bulk of the literature is based on studies of captive domesticated birds and ecological and physiological data from individuals in the wild is currently lacking. The biological relevance of maternal effects documented in this model species is therefore unclear.

A Rasch analysis of the teachers music confidence scale

This article presents a new measure of teachers’ confidence to conduct musical activities with young children; Teachers Music Confidence Scale (TMCS). The TMCS was developed using a sample of 284 in-service and pre-service early childhood teachers in Hong Kong Special Administrative Region (HKSAR). The TMCS consisted of 10 musical activities. Teachers rated their confidence levels to conduct each activity on a scale from 1 (Not confident at all) to 5 (Very confident). An exploratory factor analysis retained a 10-item single factor that was replicated using confirmatory factor analysis procedures. All items of the TMCS fitted the Rasch model adequately. In-service teachers showed higher confidence levels to conduct several musical activities with young children than pre-service teachers. Implications of these findings for measuring teachers’ confidence to conduct musical activities with young children were discussed.

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

Introduction and Aims. High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness.This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.
Design and Methods. Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age = 35.49, SD = 9.53; 64% male) telephoning an AOD service over a 5 week period. Measures included severity of HPMH problems,AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.
Results. Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.
Discussion and Conclusions. Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling.Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport.Evaluations revealed low confidence in treating HPMH issues in-house.Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services’ ability to move towards dual diagnosis capability.

Evaluating parts-of-speech taggers for use in a text-to-scene conversion system

This paper presents parts-of-speech tagging as a first step towards an autonomous text-to-scene conversion system. It categorizes some freely available taggers, according to the techniques used by each in order to automatically identify word-classes. In addition, the performance of each identified tagger is verified experimentally. The SUSANNE corpus is used for testing and reveals the complexity of working with different tagsets, resulting in substantially lower accuracies in our tests than in those reported by the developers of each tagger. The taggers are then grouped to form a voting system to attempt to raise accuracies, but in no cases do the combined results improve upon the individual accuracies. Additionally a new metric, agreement, is tentatively proposed as an indication of confidence in the output of a group of taggers where such output cannot be validated.

How did we ever arrive at the conclusion that teachers are the problem? A critical reading in the discourses of Australian schooling

A Quality Teacher debate is presented within historical and contemporary contexts, including a political history of Australian schooling over the last 20 or so years. It is argued that there is a crisis of confidence in schooling, which is currently being played out by positioning teachers as the 'problem' and not just the 'solution' to this crisis.