Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

Objective: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. Design: A qualitative study using individual semi-structured interviews. Setting: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. Participants: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. Main outcome measures: Analysis of qualitative themes from questions about the key mental health issues facing the town, bow they might be addressed and what challenges would be faced in addressing them. Results: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. C onclusions: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.

Views of general practitioners and benzodiazepine users on benzodiazepines : a qualitative analysis

Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners’ (GPs)and benzodiazepine users’ views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semistructured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment.

Burden of care and general health in families of patients with schizophrenia

Background: De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. Method: Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). Results: Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. Conclusions: In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.

A news story as big as a doctoral thesis? : deploying journalistic methodology in academic research

The purpose of this paper is to identify and recommend the emergence of an academic research methodology for Journalism the academic discipline, through reviewing various journalistic methods of research – those making up a key element in such methodology. Its focus is on journalistic styles of work employed in academic contexts especially research on mass media issues. It proposes that channelling such activity into disciplined academic forms will enhance both: allowing the former to provide more durable and deeper outcomes, injecting additional energy and intensity of purpose into the latter. It will briefly consider characteristics of research methodologies and methods, generally; characteristics of the Journalism discipline, and its relationship with mass media industries and professions. The model of journalism used here is the Western liberal stream. A proposition is made, that teaching and research in universities focused on professional preparation of journalists, has developed so that it is a mature academic discipline. Its adherents are for the most part academics with background in journalistic practice, and so able to deploy intellectual skills of journalists, while also accredited with Higher Degrees principally in humanities. Research produced in this discipline area stands to show two characteristics: (a) it employs practices used generally in academic research, e.g. qualitative research methods such as ethnographic studies or participant observation, or review of documents including archived media products, and (b) within such contexts it may use more specifically journalistic techniques, e.g. interviewing styles, reflection on practice of journalism, and in creative practice research, journalistic forms of writing – highlighting journalistic / practitioner capabilities of the author. So the Journalism discipline, as a discipline closely allied to a working profession, is described as one where individual professional skills and background preparation for media work will be applicable to academic research. In this connection the core modus operandi will be the directly research-related practices of: insistent establishment of facts, adept crafting of reportage, and economising well with time. Prospective fields for continuing research are described:- work in new media; closer investigation of relations among media producers and audiences; journalism as creative practice, and general publishing by journalists, e.g. writing histories.

Dancing the Thesis : Potentials and Pitfalls in Practice-led Research

Practice-led or multi modal theses (describing examinable outcomes of postgraduate study which comprise the practice of dancing/choreography with an accompanying exegesis) are an emerging strength of dance scholarship; a form of enquiry that has been gaining momentum for over a decade, particularly in Australia and the United Kingdom. It has been strongly argued that, in this form of research, legitimate claims to new knowledge are embodied predominantly within the practice itself (Pakes, 2003) and that these findings are emergent, contingent and often interstitial, contained within both the material form of the practice and in the symbolic languages surrounding the form. In a recent study on ‘dancing’ theses Phillips, Stock, Vincs (2009) found that there was general agreement from academics and artists that ‘there could be more flexibility in matching written language with conceptual thought expressed in practice’. The authors discuss how the seemingly intangible nature of danced / embodied research, reliant on what Melrose (2003) terms ‘performance mastery’ by the ‘expert practitioner’ (2006, Point 4) involving ‘expert’ intuition (2006, Point 5), might be accessed, articulated and validated in terms of alternative ways of knowing through exploring an ongoing dialogue in which the danced practice develops emergent theory. They also propose ways in which the danced thesis can be ‘converted’ into the required ‘durable’ artefact which the ephemerality of live performance denies, drawing on the work of Rye’s ‘multi-view’ digital record (2003) and Stapleton’s ‘multi-voiced audio visual document’(2006, 82). Building on a two-year research project (2007-2008) Dancing Between Diversity and Consistency: Refining Assessment in Postgraduate Degrees in Dance, which examined such issues in relation to assessment in an Australian context, the three researchers have further explored issues around interdisciplinarity, cultural differences and documentation through engaging with the following questions:  How do we represent research in which understandings, meanings and findings are situated within the body of the dancer/choreographer?  Do these need a form of ‘translating’ into textual form in order to be accessed as research?  What kind of language structures can be developed to effect this translation: metaphor, allusion, symbol?  How important is contextualising the creative practice?  How do we incorporate differing cultural inflections and practices into our reading and evaluation?  What kind of layered documentation can assist in producing a ‘durable’ research artefact from a non-reproduce-able live event?

Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

Background: Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia.----- Methods: Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA) and internal reliability testing (Cronbach's alpha) were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent).----- Results: The PCA identified five scales with acceptable levels of internal consistency were: (1) social support (ten items), alpha 0.86; (2) perceived interpersonal care (five items), alpha 0.87, (3) concerns about availability of health care and accessibility to health care (eight items), alpha 0.80, (4) value of good health (five items), alpha 0.79, and (5) attitudes towards health care (three items), alpha 0.75.----- Conclusion The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.

Signs, symptoms and comorbidities in contact lens-related microbial keratitis

Purpose: The aim of this study was to characterize the clinical signs, symptoms, and ocular and systemic comorbidities in a large case series of contact lens-related microbial keratitis. Methods: Two hundred ninety-seven cases of contact lens-related microbial keratitis, aged between 15 and 64 years were detected through surveillance of hospital and community based ophthalmic practitioners in Australia and New Zealand. Full clinical data were available for 190 cases and 90 were interviewed by telephone. Clinical data included the size, location, and degree of anterior chamber response. Symptom data were available from the practitioner and from participant self-report. Associations between symptoms and disease severity were evaluated. Data on ocular and systemic disease were collected from participants and practitioners. The frequency of comorbidities was compared between the different severities of disease and to population norms. Results: More severe disease was associated with greater symptom severity and pain was the most prevalent symptom reported. Ninety-one percent of cases showed progression of ocular symptoms after lens removal, and symptom progression was associated with all severities of disease. Twenty-five percent of cases reported prior episodes requiring emergency attention. Thyroid disease (p 0.05) and self-reported poor health (p 0.001) were more common in cases compared with age-matched population norms. Discussion: Information on the signs, symptoms, and comorbidities associated with contact lens-related microbial keratitis may be useful in patient education and for practitioners involved in the fitting of lenses and management of complications. Although pain was the most common symptom experienced, progression of symptoms despite lens removal was close to universal. Poor general health, particularly respiratory disease and thyroid disease was more common in cases than in the general population, which may prompt practitioners to recommend flexibility in wear schedules when in poor health or the selection of a lower risk wear schedule in at risk patients

Practitioner influence on contact lens prescribing in the UK

Contact lenses are mainly fitted by registered optometrists and contact lens opticians in the UK. Data we have gathered from annual contact lens fitting surveys over the past 12 years indicate that, on average, registered optometrists and contact lens opticians undertake 3.2 and 7.1 contact lens fits per week (p < 0.0001). More experienced practitioners tend to fit older patients. Practitioners fitting more lenses per year tend to fit a higher proportion of soft lenses. Contact lens opticians tend to fit a higher proportion of patients with planned replacement and daily disposable lenses compared with optometrists.

A general approach to control a positive buck-boost converter to achieve robustness against input voltage fluctuations and load changes

A Positive Buck-Boost converter is a known DC-DC converter which may be controlled to act as Buck or Boost converter with same polarity of the input voltage. This converter has four switching states which include all the switching states of the above mentioned DC-DC converters. In addition there is one switching state which provides a degree of freedom for the positive Buck-Boost converter in comparison to the Buck, Boost, and inverting Buck-Boost converters. In other words the Positive Buck-Boost Converter shows a higher level of flexibility for its inductor current control compared to the other DC-DC converters. In this paper this extra degree of freedom is utilised to increase the robustness against input voltage fluctuations and load changes. To address this capacity of the positive Buck-Boost converter, two different control strategies are proposed which control the inductor current and output voltage against any fluctuations in input voltage and load changes. Mathematical analysis for dynamic and steady state conditions are presented in this paper and simulation results verify the proposed method.

“Filling out the forms was a nightmare” : project evaluation and the reflective practitioner in community theatre in contemporary Northern Ireland

Since the Good Friday Agreement of 1998, large sums have been invested in community theatre projects in Northern Ireland, in the interests of conflict transformation and peace building. While this injection of funds has resulted in an unprecedented level of applied theatre activity, opportunities to maximise learning from this activity are being missed. It is generally assumed that project evaluation is undertaken at least partly to assess the degree of success of projects against important social objectives, with a view to learning what works, what does not, and what might work in the future. However, three ethnographic case studies of organisations delivering applied theatre projects in Northern Ireland indicate that current processes used to evaluate such projects are both flawed and inadequate for this purpose. Practitioners report that the administrative work involved in applying for and justifying funding is onerous, burdensome, and occurs at the expense of artistic activity. This is a very real concern when the time and effort devoted to ‘filling out the forms’ does not ultimately result in useful evaluative information. There are strong disincentives for organisations to report honestly on their experiences of difficulties, or undesirable impacts of projects, and this problem is not transcended by the use of external evaluators. Current evaluation processes provide little opportunity to capture unexpected benefits of projects, and small but significant successes which occur in the context of over-ambitious objectives. Little or no attempt is made to assess long-term impacts of projects on communities. Finally, official evaluation mechanisms fail to capture the reflective practice and dialogic analysis of practitioners, which would richly inform future projects. The authors argue that there is a need for clearer lines of communication, and more opportunities for mutual learning, among stakeholders involved in community development. In particular, greater involvement of the higher education sector in partnership with government and non-government agencies could yield significant benefits in terms of optimizing learning from applied theatre project evaluations.

Do research thesis examiners need training? : practitioner stories

We are thesis examiners within the Australian academic system who formed a “community of practice” to try to resolve some of the issues we were facing. Stories of examiners reflecting on and examining their own practice are a notable silence in the higher degree research literature. In this study we have adopted a storytelling inquiry method that involved telling our practitioner stories, firstly to each other and then to a wider audience through this paper. We then identified issues that we believe are relevant to other thesis examiners. We have also found that engaging in a “community of practice” is itself a valuable form of examiner professional development. Key Words: Thesis Examiner Training, Storytelling, and Practitioner Research

The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Accounting information systems in a centrally planned economy : the case of the General Company for Pipelines (GCP)

The paper has a twofold purpose. First it highlights the importance of accounting information in the economic development of developing countries, with a particular focus on the nation of Libya. Secondly, using the case of Libya's General Company for Pipelines (GCP), it demonstrates that the use of accounting information to achieve economic development goals is determined to a large extent by the political/ideological setting in which it is generated. The study is based on a literature review and archival research, reinforced by a qualitative case study comprised of interviews, attendance at meetings and a study of internal documents. A study of The General Company for Pipelines (GCP) revealed that frequent politically driven changes in the structure and number of popular congresses and committees severely limited the use of accounting information, relegating it to a formal role. In consequence, accounting information had litle effect on stimulating economic development in Libya. This study focuses on one case study which does limit generalisability. However, it also suggests fruitful research areas considering the historic factors which have determined the accounting role in developing and planned economies. By providing insights about social factors which have determined the use of accounting in a planned economy, this study has implications for similar economies as they move towards a more globalised mode of operations which enhance the role of accounting in meeting economic development needs. If devleoping countries are to harness the potential of accounting aid in the achievement of their development plans, the social and political setting in which accounting has been conducted needs to be understood.