Factors influencing participant enrolment in a diabetes prevention program in general practice: lessons from the Sydney diabetes prevention program

Background: The effectiveness of lifestyle interventions in reducing diabetes incidence has been well established. Little is known, however, about factors influencing the reach of diabetes prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based diabetes prevention program conducted in general practice, New South Wales, Australia from 2008–2011.

Methods: SDPP was an effectiveness trial. Participating general practitioners (GPs) from three Divisions of General Practice invited individuals aged 50–65 years without known diabetes to complete the Australian Type 2 Diabetes Risk Assessment tool. Individuals at high risk of diabetes were invited to participate in a lifestyle modification program. A multivariate model using generalized estimating equations to control for clustering of enrolment outcomes by GPs was used to examine independent predictors of enrolment in the program. Predictors included age, gender, indigenous status, region of birth, socio-economic status, family history of diabetes, history of high glucose, use of anti-hypertensive medication, smoking status, fruit and vegetable intake, physical activity level and waist measurement.

Results: Of the 1821 eligible people identified as high risk, one third chose not to enrol in the lifestyle program. In multivariant analysis, physically inactive individuals (OR: 1.48, P = 0.004) and those with a family history of diabetes (OR: 1.67, P = 0.000) and history of high blood glucose levels (OR: 1.48, P = 0.001) were significantly more likely to enrol in the program. However, high risk individuals who smoked (OR: 0.52, P = 0.000), were born in a country with high diabetes risk (OR: 0.52, P = 0.000), were taking blood pressure lowering medications (OR: 0.80, P = 0.040) and consumed little fruit and vegetables (OR: 0.76, P = 0.047) were significantly less likely to take up the program.

Conclusions: Targeted strategies are likely to be needed to engage groups such as smokers and high risk ethnic groups. Further research is required to better understand factors influencing enrolment in diabetes prevention programs in the primary health care setting, both at the GP and individual level.

The science and practice of lithium therapy

Introduction: Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice.

Objective: The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy.

Method: A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding.

Results: Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application.

Conclusion: Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.

Mana Taonga and the public sphere: a dialogue between indigenous practice and Western theory

Recent re-conceptualizations of the ‘public sphere’ facilitated a much needed shift in thinking about identity politics ‘from a substance … to a movement’ (Weibel and Latour, 2007). This laid the foundation for dissolving the ‘emanatist vision’ (Bourdieu, 1990) of self-explanatory and perpetual systems and structures towards the interrogation of actions and performances that simultaneously constitute and are affected by such wider socio-political realities. Most academic contributions, however, remain on a normative or theoretical level without offering empirical insights.

This article introduces Mana Taonga as an Indigenous Māori concept of cultural politics embedded in current museum practice at the Museum of New Zealand Te Papa Tongarewa (Te Papa). It creates a dialogue between Indigenous Māori practice and Western theory leading to a refined understanding of performative democracy within a museum as forum, or public sphere. The authors argue that a specific museum offers a particular place, space and empirical reality to interrogate seemingly universal concepts such as ‘culture’ and ‘politics’ by blending theoretical notions with an awareness of institutional contexts and practices.

Transition to practice in supercomplex environments: are occupational therapy graduates adequately prepared?

The authors of this viewpoint initially came together as colleagues to debate whether occupational therapy curricula (the programmes that each author teaches into) prepared students to not only survive but thrive within the increasingly complex or supercomplex world of professional practice (Barnett, 2011). Through reflective conversations on our collective experiences working with students at capstone (transition-to-practice) level, coupled with further exploration of literature surrounding graduate attributes, employability and professional issues within occupational therapy practice our attention focussed on capacities of agency and political skill, and specifically, the extent to which our graduates are explicitly or implicitly prepared to be agentic and politically adept in practice. In the context of this viewpoint, we refer to agency as an intentional motivation to work toward strategic goals (both personal and organisational). As a construct, Ferris et al. (2007) propose that political skill is comprised of four critical dimensions: social astuteness; interpersonal influence; networking ability and apparent sincerity. Early professional success in most contemporary workplaces we argue, as have others (e.g. Pollard, Sakellariou & Kronenburg, 2008), relate to graduates’ political adeptness.

Repositioning social work in mental health: challenges and opportunities for critical practice

This paper emerges in response to the recent initiative by the Australian Association of Social Workers (AASW) to mandate the inclusion of specific, clinically based mental health curriculum into qualifying social work programs across Australia. Whilst the authors affirm the importance of an emphasis of mental health in social work education, we further suggest that the professional repositioning of social work in mental health must be informed by critical/postmodern theoretical approaches. If social work is to engender and maintain its unique and vital role in problematising simplistic, depoliticised and individualising constructions of mental health and illness, we need to promote more contextualised and holistic understandings of people’s experiences. The paper concludes by offering an example of critical mental health curriculum.

Utilization of a population health survey in policy and practice: a case study

Background
There is growing interest by funding bodies and researchers in assessing the impact of research on real world policy and practice. Population health monitoring surveys provide an important source of data on the prevalence and patterns of health problems, but few empirical studies have explored if and how such data is used to influence policy or practice decisions. Here we provide a case study analysis of how the findings from an Australian population monitoring survey series of children’s weight and weight-related behaviors (Schools Physical Activity and Nutrition Survey (SPANS)) have been used, and the key facilitators and barriers to their utilization.

Methods
Data collection included semi-structured interviews with the chief investigators (n = 3) and end-users (n = 9) of SPANS data to explore if, how and under what circumstances the survey findings had been used, bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of policy and practice impacts for each of the three survey years (1997, 2004, 2010). Case summaries were then reviewed and discussed by the authors to distil key themes on if, how and why the SPANS findings had been used to guide policy and practice.

Results
We found that the survey findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across a range of sectors. Reported factors influencing use of the findings were: i) the perceived credibility of survey findings; ii) dissemination strategies used; and, iii) a range of contextual factors.

Conclusions
Using a novel approach, our case study provides important new insights into how and under what circumstances population health monitoring data can be used to influence real world policy and practice. The findings highlight the importance of population monitoring programs being conducted by independent credible agencies, researchers engaging end-users from the inception of survey programs and utilizing existing policy networks and structures, and using a range of strategies to disseminate the findings that go beyond traditional peer review publications.

The impact of divergent historical and cultural factors on convergence in global communication practice

Communication practice is increasingly converging around globally consistent approaches and techniques shaped by both globalisation and globalising communications technologies. However, this paper argues, national and regional practice histories and cultural characteristics have shaped, and continue to shape, practice in individual markets. The paper analyses the extent of that these divergent histories and cultures have shaped the structure and practices of the public relations industry in Australia and other countries. The paper challenges the common assumptions about public relations development and industry practice having developed from a predominantly US-based model progressively disseminated globally. It traces the history of public relations in Australia, counterpointing its distinctive origins, to the US-origin thesis. It also examines the impact of demography and diverse national culture on industry shape and practice, comparing the Australian industry to that of other industries around the world. It uses mini-case studies of campaigns in specific countries to assess the extent to which they are culturally bound by historical and cultural differences and the extent to which they are capable of being transferred or adapted to individual markets. For instance, assumptions about globally consistent brand identities are contradicted by McDonald’s’ branding practices in markets such as Canada and Japan. The paper also discusses how emerging market PR industries are being shaped by distinctive and divergent cultures and development paths and may create new structural and practice models as the emerging economies becoming dominant internationally. The authors suggest that history and cultural diversity continue, and will continue to, shape national and regional practices.

A quandary in management practice: Academic research or consulting?

This paper compares the practice of academic action research against management consulting. Consulting is founded upon a body of underpinning knowledge drawn from a different perspective than action research. Nevertheless, consulting and action research, in practice, draw from similar methods of investigation. The difficulty in distinguishing action research from consulting adds to unique ethical problems in practice. In this paper, an ethics quandary is identified, defined and explored with implications for research practice. An example of an action research project is presented to highlight the potential ethical dilemma and conflict of interest points of
the investigation, whether as an academic or a consultant. The authors, by crystallising the boundaries of academic action research and consulting posit that, when designed and executed well, risk can be minimised to gather rich and deep insights into management practice.

Clinical practice recommendations for depression

Objective:  To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making.Method:  A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives.Results:  The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative.Conclusion:  These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.

Clinical practice recommendations for bipolar disorder

Objective:  To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making.Method:  A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives.Results:  The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative.Conclusion:  These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

Teacher practice: a spotlight on the use of feedback and conferencing in the first year of schooling

With the prevalence of statements that refer to a need to “bridge”, “narrow” or “close” gaps in achievement it would appear that Government bodies have an appreciation for the fact that students need not be victims of circumstance. In addition to this, research has suggested that certain skills, such as the acquisition of phonemic awareness, need to be acquired in the early years to ensure that children do not fall behind their peers. Use of feedback is one way in which teachers have attempted to positively influence student outcomes. There are authors, however, who have suggested that not all forms of feedback are necessarily effective. In light of these perspectives, this study sought to investigate whether the incorporation of student/teacher conferences into a pre-existing program could be seen to support the development of phonemic awareness skills of students in their first year of schooling.

Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study

Aim : To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory.

Background : Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory.

Methods : A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations.

Implications for nursing : The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring.

Conclusion : These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.

Mothers' perceptions of Melbourne InFANT Program : informing future practice

Intervention programs to prevent childhood obesity are more likely to be successful when mothers are involved and engaged. Yet programs that involve mothers do not often employ process evaluation to identify aspects of the intervention that participants enjoyed or viewed as useful. The aims of this study were to describe how participants of the Melbourne InFANT Program-an early childhood obesity prevention intervention-engaged in the program and perceived its usefulness. Process evaluation data were collected at multiple time points during and after the intervention, using mixed methods drawing upon both quantitative and qualitative data. Results from short surveys (n = 271) and interview transcripts (n = 26) revealed that the Melbourne InFANT Program was perceived as useful and relevant by most (82-93%) participants. The formats through which the knowledge and skills were delivered were considered concise and effective, and aspects considered particularly useful included group sessions and advice on practical strategies to minimize stress around mealtimes. Findings from this study are important to inform future practice and the development of interventions which are well received by participants.

Universal design practice in Malaysia: Architect's perceptions of its terminology

Universal Design is a concept that embraces and covers issues of accessibility in the built and natural environments. The concept has progressively been introduced into the Malaysian built environment and architecture practice. However, its implementation in Malaysia is still considerably deficient. This paper investigates the contemporary perceptions of Malaysian architects towards the implementation of Universal Design in Malaysian built environment practice with an emphasis on their understanding of the terminology of Universal Design by means of face-to-face interviews. Findings indicate misconceptions towards the terminology of Universal Design exist in Malaysian practice due to a lack of understanding of the terminology that is negating its implementation in built environment practice. © 2014 The authors and IOS Press.