Chronic heart failure programs : does more equal less? (BENCH study)

The national multi-centre study (49 programs, 1158 patients) developed a quality score (HF-IS) and the national benchmarks for heart programs. The higher a program scored on the HF-IS the greater the reduction in hospital admissions and mortality. This score has the potential to change national nursing practice and improve health outcomes of patients.

Combined continuous wave and pulsed plasma modes : For more stable interfaces with higher functionality on metal and semiconductor surfaces

A novel approach to producing improved bio-interfaces by combining continuous wave (CW) and pulsed plasma polymerization (PP) modes is reported. This approach has enabled the generation of stable interfaces with a higher density of primary amine functionality on metal, ceramic and semiconductor surfaces. Heptylamine (HA) was used as the amine-precursor. In this new design, a thin CW PPHA layer is introduced to provide strong cross-linking and attachment to the metal or semiconductor surfaces and to provide a good foundation for better bonding a pulsed PPHA layer with high retention of functional groups. The combined mode provides the pulsed mode advantage of a 3-fold higher density of primary amines, while retaining much of the markedly higher stability in aqueous solutions of the continuous mode.

Sudan's Darfur : peace or more war on the horizon?

This year marks Sudan’s fiftieth year of independence. Unfortunately, it has very little to celebrate. Sudan, the largest country in Africa is best known for its long history of maladministration, human rights abuses, coups d’état, and for the past three years a ruthless government-backed assault on the people of Darfur in western Sudan.

Written by Dr Claude Rakisits, a consultant focusing on developments in Africa, the Middle East and South Asia, the paper examines the latest developments in Darfur and the factors that will determine whether there will finally be peace for the people of Darfur and the Australian Government’s policy options for contributing to a possible UN peacekeeping operation in Darfur.

Towards a more holistic approach to quality improvements in aluminium die casting

This work evaluates the feasibility of using a holistic approach, based on dynamical system theory,
to reduce porosity defects in high pressure aluminum die casting. Quality improvements, from a
dynamical system perspective mean the ability to move the die casting process out of its natural
equilibrium to a more beneficial state and the ability to maintain this new process state. This more beneficial state may be achieved in several ways. One way is to increase the amount of forcing to overcome natural process resistance. This forcing approach is represented by typical continuous intervention policy, with modifications in die/part design and/or process parameters. An alternative approach is to reduce the amount of natural process resistance, in particular the amount of process disturbance, allowing the process to move out of its natural equilibrium with much less forcing. This alternative uses the self-regulating ability of dynamical systems thus decreasing the amount of human intervention required. In this respect, the influence of vacuum on time on chattering at the first stage of the casting shot was identified as a good process candidate for testing using dynamical system theory. A significant reduction in porosity defects was achieved, which also set the process on a path of slow but consistent self-improvement.

Healthy minds for country youth : help-seeking for depression among rural adolescents

Objective: To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents.

Design: Cross-sectional survey.

Setting: Two rural secondary schools in south-east South Australia.

Participants: Seventy-four secondary school students aged 14 to 16 years.

Main outcome measure(s): Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire.

Results: Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0–100.0%) than a doctor (82.4%, 72.1–89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories.

Conclusions: Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.

Using simulated patients to develop doctors' skills in facilitating bahaviour change : addressing childhood obesity

Objectives : This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity.

Methods : Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5–9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits.

Results : Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman's rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho − 0.45; Visit 2, rho − 0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them.

Conclusions : Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.

The quality and outcomes framework reduces disparities in health outcomes for cardiovascular disease

Jamie Robinson, the Berkeley health economist, famously remarked in 2001 that ‘the three worst ways to pay doctors are salary, capitation and fee-for-service.’ Different financial incentives produce different clinical and service outcomes, sometimes perversely.1 In 2004, the UK government introduced pay for performance (P4P) for general practitioners, the Quality and Outcomes Framework (QOF). Its introduction was associated with the general trend in the National Health Service away from placing implicit trust in doctors and more active monitoring of their performance. One-quarter of GP pay can be earned from achieving scores on 147 indicators.2 These indicators were acceptable to doctors because the majority are evidence-based clinical outcome measures for 10 chronic diseases. Others relate to patient access and satisfaction, and practice organisation.

Is dietary management a responsibility of general practitioners? The views of Victorian general practitioners

Rationale : Australia is experiencing an evolving healthcare system, resulting in an aim of systematic managed care for patients with chronic disease. One outcome has been debate on doctors' dietary management responsibilities.
Aim : To identify general practitioners' perceptions of their dietary management responsibilities for adult cardiac patients.
Methods : A Two phase study was conducted. First, semi-structured interviews with 30 Melbourne general practitioners were conducted to gather preliminary information about dietary management. The results informed a questionnaire for the second phase. This was completed by 248 general practitioners (30%) in Victoria.
Principal findings : Themes arising in interviews, and also supported by cross-sectional survey showed that doctors perceive themselves as filling one or more of three roles. The majority (87.4%) endorsed an 'Influencing' role, 27.4% endorsed 'Dietary Educator' and 44.0% a 'Coordinator' role. The Influencer role was characterised by encouragement of dietary behaviour change, such as discussing benefits and consequences of inaction to dietary change. The Educator role was characterised by the provision of a range of behaviour change strategies- 'how to' achieve change. 'Coordinators' reported the provision of dietary counselling belonged to dietitians alone.
Implications : The results indicate doctors' awareness of need for patients' dietary education should be increased. This could be accomplished by one-on-one education. Patients' access to dietary education should also be facilitated by doctors' referring on. Embedding dietary management protocols in doctors' managed care templates could improve patients' access to dietary education and enhance doctor's collaborative roles.
Presentation type : Paper
Session theme : Getting Evidence into Practice 2