Identifying the core competencies of mental health telephone triage

Aims and objectives. The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage.
Background. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice.
Design. An observational design was employed to address the research aims.
Methods. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011.
Results. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation.
Conclusions. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Re-composing the elephant' : bringing the big picture back into IS research

Information Systems is a practice-based discipline. It experiences periodic debates about the rigour and relevance of its research. The tensions between pretensions to be a ‘real’ science (rigour) and the need to contribute to practice (relevance) are intensified at a time of low student enrolment, lack of a clear identity, and uncertainties about the viability of our discipline. This essay argues that decomposing phenomena into narrow topics of research to achieve rigour is damaging to our discipline if we fail to then ‘recompose’ or integrate these back into understanding, lessons and guidelines for application to real-world practices. This argument is illustrated through recent work on the motors that drive changes in technology appropriation. It highlights the importance of plurality of theories and methods in understanding complex real-world phenomena in order to achieve both rigour and relevance.

Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic

AIMS AND OBJECTIVES: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied. BACKGROUND: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments. DESIGN: This study used a test-retest design with inter-scale comparisons. METHODS: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic. RESULTS: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score. CONCLUSIONS: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice. RELEVANCE TO CLINICAL PRACTICE: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Challenging librarians : the relevance of the doctorate in professional practice

We, as librarians, are adept at challenging academics, students and administrators about the crucial role of information literacy in higher education and lifelong learning. Consequently, the push for strategic partnerships with academics is frequently in the foreground of our thinking. Concomitantly, the push for academic status for librarians is raised occasionally, particularly as a pay and equity issue. Yet, our purposes may appear somewhat misguided or rhetorical when contrasted to the nominal prerequisites required for professional practice, especially when compared with those of academics. The issues of information literacy and knowledge production within a knowledge economy compound such debate. This paper argues that ‘credential creep’ is catching up with librarians in the university sector. In order to be regarded as integral to academic endeavour, those of us who ‘teach’ information literacy may need to match the qualifications normally required by academics. Consonant with this proposal is the Australian and New Zealand Information Literacy Framework: Principles, Standards and Practice (Bundy, 2004) of the Australian and New Zealand Institute for Information Literacy (ANZIIL) and the Council of Australian University Librarians (CAUL). The Framework mirrors many of the desired outcomes of a doctoral degree, a degree possessed by approximately one per cent of Australian librarians but, in comparison, by more than fi fty-four per cent of Australian academics. This paper challenges—not academics—but librarians, to embrace the notion of undertaking doctoral study to enhance our professional (or amateur) practice and our information literacy. The recommendation is derived in essence from my study on doctoral research and information literacy (Macauley, 2001). It also incorporates the current discourse on these issues and uses personal narrative to articulate the findings. It seeks also to explore those tensions and contradictions commensurate with practising what we preach.

A role for glutathione in the pathophysiology of bipolar disorder and schizophrenia? Animal models and relevance to clinical practice.

The tripeptide, glutathione (glutamylcysteinylglycine) is the primary endogenous free radical scavenger in the human body. When glutathione (GSH) levels are reduced there is an increased potential for cellular oxidative stress, characterised by an increase and accruement of reactive oxygen species (ROS). Oxidative stress has been implicated in the pathology of schizophrenia and bipolar disorder. This could partly be caused by alterations in dopaminergic and glutamatergic activity that are implicated in these illnesses. Glutamate and dopamine are highly redox reactive molecules and produce ROS during normal neurotransmission. Alterations to these neurotransmitter pathways may therefore increase the oxidative burden in the brain. Furthermore, mitochondrial dysfunction, as a source of oxidative stress, has been documented in both schizophrenia and bipolar disorder. The combination of altered neurotransmission and this mitochondrial dysfunction leading to oxidative damage may ultimately contribute to illness symptoms. Animal models have been established to investigate the involvement of glutathione depletion in aspects of schizophrenia and bipolar disorder to further characterise the role of oxidative stress in psychopathology. Stemming from preclinical evidence, clinical studies have recently shown antioxidant precursor treatment to be effective in schizophrenia and bipolar disorder, providing a novel clinical angle to augment often suboptimal conventional treatments.

Coronary angiography observations: evidence-based or ritualistic practice?

Objective: The purposes of this study were to describe the incidence and occurrence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between  current postangiogram observation protocols and the detection of  complications.

Design: This was a prospective descriptive study.

Setting: The study was conducted in 3 university hospitals in Melbourne, Australia.

Patients: Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male.

Results: About 5.1% of patients had 1 or more incidents of bleeding  requiring manual compression. In 4.2% of patients, bleeding occurred within 6 hours of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes, Q3 = 4.31 hours) after angiography. Patients without pressure bandaging bled a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angiography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleeding was detected through the patient’s call for assistance, and in 59.4% of cases nurses noted bleeding while checking the puncture site. Postcatheter observations were recorded 23.70 (SD, 14.60) minutes before the bleeding incident. There were no significant changes in vital signs, systolic blood pressure (P > .05), diastolic blood pressure (P > .05), or pulse (P > .05) before or during a bleeding episode. All were within normal parameters. No neurovascular assessment anomalies were detected.

Conclusion: The use of pressure bandaging has a significant effect on the incidence and pattern of bleeding. Routine vital sign measurement has no relevance in detecting local complications after angiography. The most significant complication is bleeding that requires manual compression. Detection is through frequent puncture site observation and patient recognition and communication.

The relevance of import competition to merger assessment in Australia

The Australian Competition and Consumer Commission has been criticised for failing to take due account of the impact import competition has on domestic firms when assessing whether or not a proposed merger will be likely to substantially lessen competition. This article reviews the approach taken by the ACCC to import competition in its merger assessments. Consideration is given to both the policy adopted by the ACCC and the statistical relevance that has, in fact, been placed on import competition in merger assessment. A conclusion is then drawn as to the appropriateness of the ACCC's current policy and practice.

Reflexivity, its meanings and relevance for social work: a critical review of the literature

The concept of "reflexivity" has become increasingly significant in social work literature in relation to social work education, theory and practice. However, our reading of the literature indicates that there is a lack of clarity about the concept in terms of who is being exhorted to be "reflexive," when and how. This article addresses these questions through a critical review of social work literature since the 1990s that discusses the concept of "reflexivity." Given that many authors seem to use the concepts of "reflexivity" and "(critical) reflection" interchangeably, we also apply this analysis to "reflection" and "critical reflection." This article raises important questions about how the concepts of "reflexivity," "critical reflection" and "reflectivity" are defined and the different consequences such definitions might have for social work education, theory and practice.

An exploration of massively multiplayer online role playing games : their application to public relations education and possible future public relations practice

Social communication technologies present exciting and challenging opportunities for public relations professionals. Although not new the latest online attraction grabbing the attention of educators and companies around the globe are the virtual worlds known as Massively-Multiplayer Online Role-Playing Games (MMORPGs). This paper will examine MMORPGs - in particular Second Life - and consider their potential as an educational medium and relevance to the practice of public relations. The paper argues that MMORPGs slwuld be taken seriously by educators and public relations professionals alike and not simply be treated as online entertainment.

From policy to practice: the development of an integrated health promotion plan for children's services at Plenty Valley Community Health Inc.

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children’s Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children’s Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children’s Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.

Evidence-based paediatric practice and its relation to the Cochrane Collaboration

Focuses on the relation between evidence-based pediatric practice and the Cochrane Collaboration on health care. Formation of the collaboration; Aim of Cochrane Collaboration; Reaction of pediatricians to the collaboration; Ways by which the collaboration ensures its relevance to pediatrics and child health.

Traversing the international rainbow of academia and architectural practice

In the context of contemporary tertiary education immersed as such in internationalisation strategies and internationalised curricula, the cultivation and promotion of international awareness in Australian graduates can be expected to lead to desirable lifelong attributes. Consideration of the need to be prepared for a globalised professional and cultural climate is integral to sustaining and growing the future and the fortunes of many. For the architectural community, the combined phenomena of globalisation and internationalisation strategies herald implications for the education and professional preparation of architects which traverse academia and architectural practice. This paper presents the case for exploring potential benefits of establishing closer links between academia and architecture practice, discusses the relevance of international student practice experience for the twenty first century and looks at its role within an intemationalised curriculum in preparing graduates for the future. Analysis of a survey of work experience as a component of Australian architecture courses is used to gauge the extent of current programs that seek to integrate the academic curriculum with practice experience, and the Deakin study (a work in progress) of architecture students in international practice contexts is presented as a vehicle for exploring the degree to which the combination of professional practice education and cultural experience may be beneficial to architecture students, academia and the profession more generally.

Tonic Sol-fa in contemporary choral music practice : a South African case study

The Tonic Sol-fa method of teaching choral singing was propagated throughout Britain during the nineteenth century with the dual objectives of enhancing Christian worship and achieving social reform. It was then imported to South Africa where it was introduced to indigenous people principally through Christian missionary activity and government schools. Although entirely of foreign origin, Tonic Sol-fa was so fully assimilated into African culture that it became effectively 'indigenised'. Due to its widespread use, it became the mainstay of community choral singing and may now be said to represent a significant exogenous aspect of present-day South African musical identity. However, there is little documentation regarding the type and extent of its use in contemporary choral music practice.

This paper will report on the use of Tonic Sol-fa in representative present-day choral music settings. Interview data collected from choir directors, trainers and teachers in Cape Town indicate that there is far from unanimous agreement on several aspects - in particular, the future of Tonic Sol-fa as a pedagogy and notational system. Improving educational opportunities for indigenous South Africans to undertake professional training in music are now threatening the traditional dominance of Tonic Sol-fa in indigenous culture. Nevertheless this research represents a useful case study of the continuing relevance of Tonic Sol-fa to an indigenous population who have 'made it their own' and developed a vibrant choral tradition which continues to both enrich and sustain their lives.