Demographic and socio-cultural correlates of medical mistrust in two Australian states:Victoria and South Australia

Studies on medical mistrust have mainly focused on depicting the association between medical mistrust and access/utilization of healthcare services. The effect of broader socio-demographic and psycho-social factors on medical mistrust remains poorly documented. The study examined the effect of broader socio-demographic factors, acculturation, and discrimination on medical mistrust among 425 African migrants living in Victoria and South Australia, Australia. After adjusting for socio-demographic factors, low medical mistrust scores (i.e., more trusting of the system) were associated with refugee (β=&minus;4.27, p<0.01) and family reunion (β=&minus;4.01, p<0.01) migration statuses, being Christian (β=&minus;2.21, p<0.001), and living in rural or village areas prior to migration (β=&minus;2.09, p<0.05). Medical mistrust did not vary by the type of acculturation, but was positively related to perceived personal (β=0.43, p<0.001) and societal (β=0.38, p<0.001) discrimination. In order to reduce inequalities in healthcare access and utilisation and health outcomes, programs to enhance trust in the medical system among African migrants and to address discrimination within the community are needed.

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Strategic facilities management for Australian public healthcare operation

This research developed a conceptual framework on strategic Facilities Management for public healthcare organisation in Australia. Findings from this study prove that healthcare users have the same view on building performance and facilities business operation but not on Facilities Management service delivery. The model framework can assist public healthcare organisations to better manage facilities management in healthcare organisation.

Classification of healthcare data using genetic fuzzy logic system and wavelets

Healthcare plays an important role in promoting the general health and well-being of people around the world. The difficulty in healthcare data classification arises from the uncertainty and the high-dimensional nature of the medical data collected. This paper proposes an integration of fuzzy standard additive model (SAM) with genetic algorithm (GA), called GSAM, to deal with uncertainty and computational challenges. GSAM learning process comprises three continual steps: rule initialization by unsupervised learning using the adaptive vector quantization clustering, evolutionary rule optimization by GA and parameter tuning by the gradient descent supervised learning. Wavelet transformation is employed to extract discriminative features for high-dimensional datasets. GSAM becomes highly capable when deployed with small number of wavelet features as its computational burden is remarkably reduced. The proposed method is evaluated using two frequently-used medical datasets: the Wisconsin breast cancer and Cleveland heart disease from the UCI Repository for machine learning. Experiments are organized with a five-fold cross validation and performance of classification techniques are measured by a number of important metrics: accuracy, F-measure, mutual information and area under the receiver operating characteristic curve. Results demonstrate the superiority of the GSAM compared to other machine learning methods including probabilistic neural network, support vector machine, fuzzy ARTMAP, and adaptive neuro-fuzzy inference system. The proposed approach is thus helpful as a decision support system for medical practitioners in the healthcare practice.

Consumer involvement in the tertiary-level education of mental health professionals: a systematic review

A systematic review of the published work on consumer involvement in the education of health professionals was undertaken using the PRISMA guidelines. Searches of the CINAHL, MEDLINE, and PsychINFO electronic databases returned 487 records, and 20 met the inclusion criteria. Further papers were obtained through scanning the reference lists of those articles included from the initial published work search (n = 9) and contacting researchers in the field (n = 1). Thirty papers (representing 28 studies) were included in this review. Findings from three studies indicate that consumer involvement in the education of mental health professionals is limited and variable across professions. Evaluations of consumer involvement in 16 courses suggest that students gain insight into consumers' perspectives of: (i) what life is like for people with mental illness; (ii) mental illness itself; (iii) the experiences of admission to, and treatment within, mental health services; and (iv) how these services could be improved. Some students and educators, however, raised numerous concerns about consumer involvement in education (e.g. whether consumers were pursuing their own agendas, whether consumers' views were representative). Evaluations of consumer involvement in education are limited in that their main focus is on the perceptions of students. The findings of this review suggest that public policy expectations regarding consumer involvement in mental health services appear to be slowly affecting the education of mental health professionals. Future research needs to focus on determining the effect of consumer involvement in education on the behaviours and attitudes of students in healthcare environments.

Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S.

INTRODUCTION: Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years. METHODS: A cohort model was used to simulate the impact of the tax on BMI. Assuming ongoing implementation and effect maintenance, quality-adjusted life-years gained and disability-adjusted life-years and healthcare costs averted were estimated over the 2015-2025 period for the 2015 U.S. POPULATION: Costs and health gains were discounted at 3% annually. Data were analyzed in 2014. RESULTS: Implementing the tax nationally would cost $51 million in the first year. The tax would reduce sugar-sweetened beverage consumption by 20% and mean BMI by 0.16 (95% uncertainty interval [UI]=0.06, 0.37) units among youth and 0.08 (95% UI=0.03, 0.20) units among adults in the second year for a cost of $3.16 (95% UI=$1.24, $8.14) per BMI unit reduced. From 2015 to 2025, the policy would avert 101,000 disability-adjusted life-years (95% UI=34,800, 249,000); gain 871,000 quality-adjusted life-years (95% UI=342,000, 2,030,000); and result in $23.6 billion (95% UI=$9.33 billion, $54.9 billion) in healthcare cost savings. The tax would generate $12.5 billion in annual revenue (95% UI=$8.92, billion, $14.1 billion). CONCLUSIONS: The proposed tax could substantially reduce BMI and healthcare expenditures and increase healthy life expectancy. Concerns regarding the potentially regressive tax may be addressed by reduced obesity disparities and progressive earmarking of tax revenue for health promotion.

They are working every angle. A qualitative study of Australian adults' attitudes towards, and interactions with, gambling industry marketing strategies

As gambling products have diversified so too have the ways in which the gambling industry has been able to target, reach and engage different sectors of the community. Limited research has explored the ways in which individuals conceptualize and respond to gambling marketing strategies. Semi-structured, qualitative interviews were conducted with 100 adults in Victoria, Australia, who had gambled at least once during the previous year. Participants described the multi-layered ways in which gambling was marketed and were concerned about the role of marketing in ‘normalizing’ gambling for some groups. Male participants felt ‘bombarded’ and ‘targeted’ by sports bet marketing. Most women and older men actively resisted gambling marketing strategies. Older women, younger men, moderate and high risk gamblers and those from low socio-economic backgrounds were particularly influenced by incentivization to gambling. This study highlights the complex ways in which different individuals interpret and respond to gambling industry marketing strategies.

Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study

RATIONALE, AIMS AND OBJECTIVES: The implementation of automated dispensing cabinets (ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments (EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. METHODS: Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. RESULTS: A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P&thinsp;=&thinsp;0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. CONCLUSION: The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting.

The environment of inpatient healthcare delivery and its influence on the outcome of care

Aim: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care.

Background: Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety.

Conclusion: There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.

A congestion control scheme based on fuzzy logic in wireless body area networks

One of the major challenges in healthcare wireless body area network (WBAN) applications is to control congestion. Unpredictable traffic load, many-to-one communication nature and limited bandwidth occupancy are among major reasons that can cause congestion in such applications. Congestion has negative impacts on the overall network performance such as packet losses, increasing end-to-end delay and wasting energy consumption due to a large number of retransmissions. In life-critical applications, any delay in transmitting vital signals may lead to death of a patient. Therefore, in order to enhance the network quality of service (QoS), developing a solution for congestion estimation and control is imperative. In this paper, we propose a new congestion detection and control protocol for remote monitoring of patients health status using WBANs. The proposed system is able to detect congestion by considering local information such as buffer capacity and node rate. In case of congestion, the proposed system differentiates between vital signals and assigns priorities to them based on their level of importance. As a result, the proposed approach provides a better quality of service for transmitting highly important vital signs.

Process capability estimation for leukocyte filtering process in blood service: a comparison study

This article considers a comparison study between different non-normal process capability estimation methods and utilizing themin the leukocyte filtering process in blood service sectors. Since the amount of leukocyte in a unit of the blood is a critical issue inthe blood transfusion process and patient safety, estimating and monitoring the capability of the leukocyte filtering process to meetthe target window is very important for blood service sectors. However, observed data from the leukocyte filtering process showthat the leukocyte levels after filtering demonstrate a right skewed distribution and applying conventional methods with a normalityassumption fails to provide trustful results. Hence, we first conduct a simulation study to compare different methods in estimating theprocess capability index of non-normal processes and then we apply these techniques to obtain the process capability of the leukocytefiltering process. The study reveals that the Box-Cox transformation method provides reliable estimation of the process capability ofthe leukocyte filtering process.

Using meta-synthesis to support application of qualitative methods findings in practice: a discussion of meta-ethnography, narrative synthesis, and critical interpretive synthesis

Meta-synthesis refers to a range of approaches by which existing qualitative studies in healthcare can bereviewed and compared. There is increasing use of meta-synthesis to ensure the clinical applicability offindings from qualitative studies, in healthcare generally, and in the creative arts therapies specifically.Qualitative method research can sometimes lack immediate clinical relevance, as such studies usuallyfocus on the experiences of a small number of participants. Additionally, the results are often presented ingreat detail; finely elaborated, and described conceptually. Findings reported in this way can be engaging,and even emotionally compelling, however the utility of these outcomes for clinical practice can belimited. Meta-synthesis of multiple studies aims to ensure that findings from qualitative methods studiescan be more easily, and effectively, applied in health and social care programs. Three approaches to metasynthesisare briefly presented here; meta-ethnography, narrative synthesis, and critical interpretivesynthesis. A procedure for presentation of meta-synthesis reviews is provided.

Journal rankings : does one size fit all?

The question of ranking journals, institutions, individual academics and specific papers is regularly visited within business and management disciplines. The Mort, et al. (2004) study advances the discussion by examining this theme within the context of academic marketing in Australia and New Zealand. In this commentary I comment on three aspects of the study that are left partially unanswered: why rank journals in the first place, how should journals be evaluated, and to what extent are the aspirations of academics in the region met?

Migrant acculturation and consumption motivations : an empirical study of the Vietnamese

The study examines differences in cultural values and travel motivations between Vietnamese migrants (Viet Kieu) and Vietnamese in Vietnam. The study finds that Viet Kieu have acculturated and moved away from traditional cultural values and towards “Western” cultural Values. They are less motivated to travel by a desire to maintain home links than was anticipated by “home” Vietnamese. In promoting travel marketers may be able to use the level of acculturation to appeal to migrants links with both countries and thus complex messages may be required.

The politics of resistance to workplace cultural diversity education for health service providers : an Australian study

This qualitative study has as its focus an exploration of health service providers' perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals, recruited from over 17 different organizational sites. Participants included cultural diversity educators, ethnic liaison officers, health service managers, nurses, health interpreters, allied health professionals, and community-based ethnic welfare organization personnel working in or with select metropolitan health services in Victoria, Australia. Analysis of the data revealed that workplace cultural diversity education in healthcare is a significant site of resistance and struggle. 'Resistance' was expressed in several forms including: the problematization of resources and staff availability to attend cultural diversity education forums; indifferent failure to recognize cultural imperatives in healthcare; deliberate refusal to recognize cultural imperatives in healthcare; selective recognition of cultural imperatives in healthcare ('facts sheets' only); and the angry rejection of cultural imperatives in healthcare. 'Struggle', in turn, largely involved cultural diversity educators having to constantly 'cajole and convince' (and even manipulate) staff to attend cultural diversity education forums and using a 'velvet glove and iron fist' approach to teaching staff who remained resolute in their resistance when participating in educational forums. An important implication of this study is that the politics of workplace cultural diversity education - and the 'politics of resistance' to such programs - need to be better recognized and understood if the status quo is to be successfully challenged and changed. The need for critical debate and further comparative research on the subject are also highlighted.