Building research capacity in General Practice : Incorporating research as a component of GP vocational training

Aims & rationale/Objectives : Australian research shows that most GP registrar supervisors lack confidence to support registrar research projects and themselves have little or no research experience. Assisting registrars to develop critical thinking skills and an understanding of research methods sufficient to enable active use of these tools in general practice is one of the curriculum statements in the RACGP Training Program Curriculum. A University Department of Rural Health (UDRH) and a General Practice Education and Training (GPET) organisation formed a partnership to: Engage basic term registrars in group research and concurrent research skills training program; Improve research skills, confidence, and knowledge; and Contribute research findings relevant to general practice.

Methods : Registrars' initial research knowledge and confidence was measured by a questionnaire. In addition to a final focus group, feedback via evaluation forms was sought from the 11 registrars and two GPET supervisors at the conclusion of each research training session.

Principal findings : Approaches

Implications : Research skills development training and involvement in research can be successfully integrated into a GP vocational training program.

Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice

Female general practitioners (GPs) have higher chlamydia testing rates than male GPs, yet it is unclear whether this is due to lack of knowledge among male GPs or because female GPs consult and test more female patients.

Prevalence and cost of musculoskeletal disorders: a population-based, public hospital system healthcare consumption approach.

Objective: To use a population-level, public-hospital approach to compare the prevalence and cost of musculoskeletal diseases (MSD) with other clinical specialties.

Methods: A healthcare utilization survey of 4 million individual records over 4 years, from all major public hospitals in the state of Victoria (estimated population 4.8 million residents in 2000/01) from 1997/98 to 2000/01. Main outcome measures were inpatient episodes of care, bed-days, and outpatient clinic encounters. MSD was defined as the combination of orthopedics and rheumatology.

Results: After obstetrics, MSD was the most frequent outpatient service, with orthopedics accounting for 9.9% of all visits in 2000/01. The proportion of MSD outpatient encounters (on average 11.6% of the total) was constant over the study period. Among 26 medical specialties, MSD had the sixth highest number of inpatient episodes (6.2% in 2000/01), following renal dialysis (14.6%), general surgery (8.2%), obstetrics (7.6%), gastroenterology (7.1%), and general medicine (6.7%). MSD was the fifth highest consumer of bed-days, occupying on average 7.7% of all beds per annum in the period 1997/98 to 2000/01, behind psychiatry (10.1%), respiratory medicine (8.5%), rehabilitation (8.3%), and general medicine (7.8%). MSD was the third most-costly discipline in 2000/01, with total costs of over A dollars 169 million (9.7% of total inpatient costs that year), behind respiratory medicine (11.6%) and general surgery (11.5%).

Conclusion: Compared to other diseases, MSD consumes a substantial proportion of healthcare resources in Victorian public hospitals. These data have important implications for allocation of healthcare resources, clinical care pathways, and prevention strategies.

Religion in Victoria's government schools : a timely debate

While the role of religion in Australian schools has been vigorously debated since the 1870s, it has recently generated considerable controversy, particularly in the State of Victoria. Despite the Victorian Government’s positive record of promoting multifaith engagement, Christian volunteers – provided by ACCESS Ministries - currently teach 96% of students enrolled in Special Religious Instruction (SRI) classes in Victoria’s Government schools.

Dedicated emergency theatres improve service delivery and surgeons' job satisfaction

Background
There are well-described benefits to separating emergency and elective surgery. Geelong Hospital lacked the resources to implement a separate acute surgical unit, but instituted daily dedicated emergency general surgery operating sessions, managed by an on-site consultant. This study aims to assess the impact of this on service delivery and surgeons' job satisfaction.
Methods
From 1 February 2011, daily half-day operating lists were allocated for general surgical emergencies. Patients treated on these lists were studied prospectively until 31 December 2011. Theatre waiting times and hospital stay were compared with the previous year. A quality-of-life questionnaire was administered to participating surgeons before the project commenced and after 6 months.
Results
A total of 966 patients underwent surgery during an emergency general surgery admission in the control period, and 984 underwent surgery during the study period. The median time from arrival in the emergency department (ED) to surgery was reduced from 19 (18–21) h in the control group to 18 (17–19) h in the study group (P = 0.033). The time from booking surgery to operation was reduced from 4.8 (4.3–5.4) h to 3.9 (3.5–4.3) h (P < 0.0001). For patients undergoing emergency laparotomy, the time from booking to surgery was reduced from 3.1 (2.2–4.1) to 2.4 (1.8–2.9) h, and hospital stay was reduced from 13 (11–15) to 10 (9–12) days (P = 0.0089). The surgeons' responses to the questionnaires showed improvement in job satisfaction (P < 0.0001).
Conclusion
This intervention has improved service delivery for emergency surgery patients, and improved the participating surgeons' job satisfaction.

Teaching general practitioners and doctors-in-training to discuss advance care planning : evaluation of a brief multimodality education programme

To develop and evaluate an interactive advance care planning (ACP) educational programme for general practitioners and doctors-in-training.

New criminal sanctions-inflicting pain through the denial of employment and education

Imprisonments and fines are the standard sanctions employed by most western countries in punishing offenders.  Where neither of these penalties is appropriate, the courts normally have a variety of indeterminate sanctions at their disposal.  However the general effectiveness of these sanctions is questionable.  This paper argues that the criminal justice system has been too slow and unimaginative in developing efficient and effective methods of punishing offenders.  There are ways of inflicting pain on offenders that do not encroach on their liberty or affect their material wealth.  It is suggested that new sentencing options should include the annulment or suspension of an offenders academic qualifications and the making of orders preventing an offender from working or being enrolled in an educational or vocational pursuit.

Football-as-war, coach-as-general: analogy, metaphor and management implications

Sporting terms have been used as metaphor and analogy to describe and prescribe life experiences. It has been suggested that the use of sport terminology can assist in the general understanding of complex terms and situations, however, the use of sport as metaphor and analogy for many aspects of social understanding can have negative consequences. The analogy of sport and war seems to be particularly prevalent within football, irrespective of the code or culture in which it is played. This article demonstrates the popular understanding of Australian Rules ‘football as war’ through two complementary studies. The first study investigates the representation of Australian Rules football as war, specifically through the analysis of both images and text on the front covers of the sport ‘lift-out’ sections of two prominent Melbourne newspapers, The Herald Sun and The Age. The second study examines whether people interpret non-war-like images of Australian Rules football in war-like terms. Forty-five undergraduate sport marketing and management students were asked to write about one of four different images of football players and coaches interacting, which revealed that football is understood as war. Further, when prompted by an image of football players and coaches interacting, people in this study interpreted the interactions as consistently war-like. Coaches were portrayed as militaristic generals and the athletes as soldiers. Implications for management, education and practice are discussed.

Learners' perceptions about the relationship between music education and generic skills development : a case study within the Australian higher education sector

A major issue emerging from the research and debate concerning quality in higher education has been an emphasis on the value of the acquisition of generic skills by undergraduate students, as indicators of quality in education. Music educators have long recognised the contribution music makes to the general education of learners. Learning in and through music can present varied and complex means for the acquisition of generic life skills such as: problem solving, decision-making, critical thinking, oral and written communication and teamwork. This paper documents one particular course of action that was implemented within a university undergraduate primary teacher education program, to systematically gauge learner perceptions about generic skill development/enhancement before and after participation in the music component of the core arts education subject.

Recovery from gynaecological day surgery : are we underestimating the process

This paper reports a study investigating the post operative experiences of 80 women following gynaecological day surgery. Women kept a diary for the first 4 days following surgery. The diary included a recovery rating scale and a symptom management index focusing particularly on symptoms. A telephone interview conducted on post-operative day 10 further explored experiences. Results at day 4 indicated women experienced significant problems with pain, moving around and tiredness. By day 10, women were still experiencing tiredness, pain and other lingering problems. The study indicates that patients experience more problems than discharge education assumes.

Development, implementation, and evaluation of a continence education package in acute and subacute care settings

OBJECTIVE: The objective of the study was to trial and evaluate the effect that a discharge Continence Education Package (CEP) had on patients' continence awareness and management preferences.
DESIGN: An exploratory descriptive design was used.
SETTINGS AND SUBJECTS: A total of 631 participants were included in the study: 352 females (55.8%) and 279 males (44.2%) from 4 rural and regional settings in Victoria, Australia.
INSTRUMENTS AND METHODS: A specifically designed questionnaire was used to assess participants' knowledge of incontinence and its management and also to investigate their treatment preferences and intentions if they experienced this type of problem. Data were collected at 2 time periods. Specifically, patients were interviewed before discharge from acute and subacute settings identified as Time 1 (T1). Then the participants were given the CEP and asked to complete a similar questionnaire.
RESULTS: The findings revealed that fewer than 25% of participants had received information on continence before the study being conducted, yet the majority had indicated that they had experienced continence symptoms. The majority of participants found the CEP easy to understand (98.2%) and helpful (95.3%). Most participants said it provided them with information about types of actions to take and/or treatment options for incontinence problems. It also raised their awareness of the signs and symptoms associated with incontinence and provided them with a useful self-administered gauge with which to assess their continence status.
CONCLUSIONS: These findings suggest that the CEP may be a useful educational tool for use in the general population.

Outdoor education and bush adventure therapy: A social-ecological approach to health and wellbeing.

Together, outdoor education and bush adventure therapy can be seen to constitute a population-wide health intervention strategy. Whether in educational or therapeutic settings, the intentional use of contact with nature, small groups, and adventure provides a unique approach in the promotion of health and wellbeing for the general population, and for individuals with identified health vulnerabilities. This paper explicitly emphasises human and social health, however, an integral assumption is that a healthy and sustainable environment is dependent on healthy human relationships with nature. We invite outdoor educators and bush adventure therapy practitioners to examine the proposition that healthy interactions with nature can create a unique stream of socio-ecological interventions. A spectrum of outdoor adventure programs is provided, allowing outdoor educators and bush adventure therapy practitioners to locate their work according to program context and aims, and participant aims and needs.

The influence of patient complexity and nurses` experience on haemodynamic decision-making following cardiac surgery

Critical care nurses’ haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses’ haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses’ levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses’ decision-making was influenced by interplay between the complexity of patients’ haemodynamic presentations, nurses’ levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses’ utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses’ professional development and education.