Timeliness and Clinical Impact of Hospital-Initiated Medication Reviews

Background: Medication-related problems often occur in the immediate post-discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes. Aim: To determine if hospital-initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity-specific questions on the quality of reports. Method: Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post-discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance. Results: HIMRs were conducted within 11.6 6.6 days postdischarge. 36 HIMR reports were evaluated and 1442 issues identified - information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised. Conclusion: HIMRs can be facilitated in a more timely manner than post-discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports.

Effect of cold water immersion on repeated cycling performance and limb blood flow

The purpose of the present study was to compare the effects of cold water immersion (CWI) and active recovery (ACT) on resting limb blood flow, rectal temperature and repeated cycling performance in the heat. Ten subjects completed two testing sessions separated by 1 week; each trial consisted of an initial all-out 35-min exercise bout, one of two 15-min recovery interventions (randomised: CWI or ACT), followed by a 40-min passive recovery period before repeating the 35-min exercise bout. Performance was measured as the change in total work completed during the exercise bouts. Resting limb blood flow, heart rate, rectal temperature and blood lactate were recorded throughout the testing sessions. There was a significant decline in performance after ACT (mean (SD) −1.81% (1.05%)) compared with CWI where performance remained unchanged (0.10% (0.71%)). Rectal temperature was reduced after CWI (36.8°C (1.0°C)) compared with ACT (38.3°C (0.4°C)), as was blood flow to the arms (CWI 3.64 (1.47) ml/100 ml/min; ACT 16.85 (3.57) ml/100 ml/min) and legs (CW 4.83 (2.49) ml/100 ml/min; ACT 4.83 (2.49) ml/100 ml/min). Leg blood flow at the end of the second exercise bout was not different between the active (15.25 (4.33) ml/100 ml/min) and cold trials (14.99 (4.96) ml/100 ml/min), whereas rectal temperature (CWI 38.1°C (0.3°C); ACT 38.8°C (0.2°C)) and arm blood flow (CWI 20.55 (3.78) ml/100 ml/min; ACT 23.83 (5.32) ml/100 ml/min) remained depressed until the end of the cold trial. These findings indicate that CWI is an effective intervention for maintaining repeat cycling performance in the heat and this performance benefit is associated with alterations in core temperature and limb blood flow.

Psychosocial predictors of rule following in hostels for women experiencing homelessness

This study examined the psychosocial factors impacting upon the rule-following behaviour of residents of a hostel providing crisis accommodation to women who are homeless. After their arrival, residents of a women’s hostel (N = 83) completed questionnaires assessing the Theory of Planned Behaviour constructs of attitude, subjective norm, perceived behavioural control (PBC), and intentions related to rule-following while residing at the hostel. Perceived resident group norms for rule-following were assessed also. Follow-up staff evaluations of the target behaviour were completed after participants ceased their hostel residence. As expected, attitude, subjective norm, PBC, and group norm significantly predicted intention to follow hostel rules, and intention and PBC predicted rule following behaviour. As rule following is a crucial requirement for continuation of their stay, these findings can inform strategies to improve the experiences and outcomes of women’s short-term hostel stays.

Using self-report anger assessments in school settings

Students who experience high levels of anger both in and out of school are at risk of exhibiting multiple negative developmental outcomes including poor school performance, peer problems, behavioral difficulties, and concurrent emotional distress. Given this developmental trajectory, it is important for mental health professionals working within school settings to accurately identify those students manifesting anger-related problems at an early age. This chapter provides an overview of instruments designed to assess levels of anger and associated cognitive and behavioral manifestations in children and youth. Among those instruments highlighted is the Multidimensional School Anger Inventory (MSAI)specifically designed to measure anger, hostility, and aggressive behavioral expression in school settings. The role of anger assessment in developing appropriate early intervention and anger management treatment plans is also discussed.

The effect of emotional and attentional load on attentional startle modulation

The interactive effects of emotion and attention on attentional startle modulation were investigated in two experiments. Participants performed a discrimination and counting task with two visual stimuli during which acoustic eyeblink startle-eliciting probes were presented at long lead intervals. In Experiment 1, this task was combined with aversive Pavlovian conditioning. In Group Attend CS+, the attended stimulus was followed by an aversive unconditional stimulus (US) and the ignored stimulus was presented alone whereas the ignored stimulus was paired with the US in Group Attend CS−. In Experiment 2, a non-aversive reaction time task US replaced the aversive US. Regardless of the conditioning manipulation and consistent with a modality non-specific account of attentional startle modulation, startle magnitude was larger during attended than ignored stimuli in both experiments. Blink latency shortening was differentially affected by the conditioning manipulations suggesting additive effects of conditioning and discrimination and counting task on blink startle.

New evaluation methodologies for public art programs in cultural instiutions

I put my abstract in for this conference back in March, based on some evaluation work I had been doing in 2010 with my colleague Professor Greg Hearn for the 3C Regional Writing NeoGreography Project. I had been swapping notes with a colleague from the Smithsonian’s Centre for Folklife and Cultural Heritage about their evaluation work, and stuck inside during the rains of January, I decided to apply for a Qld Smithsonian fellowship based on the quandary of evaluation-particular in public histories (oral histories) and digital storytelling. In July I was awarded the fellowship, so I have tweaked my presentation to talk about what we hope to do with this collaboration, to propel the importance placed on evaluation in public arts programs in Qld and beyond.

A least squares based finite volume method for the Cahn-Hilliard and Cahn-Hilliard-reaction equations

A vertex-centred finite volume method (FVM) for the Cahn-Hilliard (CH) and recently proposed Cahn-Hilliard-reaction (CHR) equations is presented. Information at control volume faces is computed using a high-order least-squares approach based on Taylor series approximations. This least-squares problem explicitly includes the variational boundary condition (VBC) that ensures that the discrete equations satisfy all of the boundary conditions. We use this approach to solve the CH and CHR equations in one and two dimensions and show that our scheme satisfies the VBC to at least second order. For the CH equation we show evidence of conservative, gradient stable solutions, however for the CHR equation, strict gradient-stability is more challenging to achieve.

How research findings can inform legislation and school policy on cyberbullying.

Recent empirical research has found that the psychological consequences for young people involved in cyberbullying are more severe than in the case of traditional bullying (Campbell, Spears, Slee, Butler, & Kift, 2012; Perren, Dooley, Shaw, & Cross, 2010). Cybervictimisation has been found to be a significant predictor of depressive symptoms over and above that of being victimised by traditional bullying (Perren et al., 2010). Cybervictims also have reported higher anxiety scores and social difficulties than traditional victims, with those students who had been bullied by both forms showing similar anxiety and depression scores to cyberbullying victims (Campbell et al., 2012). This is supported by the subjective views of many young people, not involved in bullying, who believed that cyberbullying is far more harmful than traditional bullying (Cross et al., 2009). However, students who were traditionally bullied thought the consequences of traditional bullying were harsher than did those students who were cyberbullied (Campbell, et al., 2012). In Slonje and Smith’s study (2008), students reported that text messaging and email bullying had less of an impact than traditional bullying, but that bullying by pictures or video clips had more negative impact than traditional bullying.

The interaction between exercise, appetite and food intake : implications for weight control

Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, “Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?” Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.

Negligible heat strain in armored vehicle officers wearing personal body armor

Objectives This study evaluated the heat strain experienced by armored vehicle officers (AVOs) wearing personal body armor (PBA) in a sub-tropical climate. Methods Twelve male AVOs, aged 35-58 years, undertook an eight hour shift while wearing PBA. Heart rate and core temperature were monitored continuously. Urine specific gravity (USG) was measured before and after, and with any urination during the shift. Results Heart rate indicated an intermittent and low-intensity nature of the work. USG revealed six AVOs were dehydrated from pre through post shift, and two others became dehydrated. Core temperature averaged 37.4 ± 0.3°C, with maximum's of 37.7 ± 0.2°C. Conclusions Despite increased age, body mass, and poor hydration practices, and Wet-Bulb Globe Temperatures in excess of 30°C; the intermittent nature and low intensity of the work prevented excessive heat strain from developing.

When the right to be counted doesn’t count : the politics and challenges of researching the health of asylum seekers

A fundamental prerequisite of population health research is the ability to establish an accurate denominator. This in turn requires that every individual in the study population is counted. However, this seemingly simple principle has become a point of conflict between researchers whose aim is to produce evidence of disparities in population health outcomes and governments whose policies promote(intentionally or not) inequalities that are the underlying causes of health disparities. Research into the health of asylum seekers is a case in point. There is a growing body of evidence documenting the adverse affects of recent changes in asylum-seeking legislation, including mandatory detention. However, much of this evidence has been dismissed by some governments as being unsound, biased and unscientific because, it is argued, evidence is derived from small samples or from case studies. Yet, it is the policies of governments that are the key barrier to the conduct of rigorous population health research on asylum seekers. In this paper, the authors discuss the challenges of counting asylum seekers and the limitations of data reported in some industrialized countries. They argue that the lack of accurate statistical data on asylum seekers has been an effective neo-conservative strategy for erasing the health inequalities in this vulnerable population, indeed a strategy that renders invisible this population. They describe some alternative strategies that may be used by researchers to obtain denominator data on hard-to-reach populations such as asylum seekers.

Volume-dependent response of precooling for intermittent-sprint exercise in the heat

Purpose: To assess the effects of pre-cooling volume on neuromuscular function and performance in free-paced intermittent-sprint exercise in the heat. Methods: Ten male, teamsport athletes completed four randomized trials involving an 85-min free-paced intermittentsprint exercise protocol in 33°C±33% relative humidity. Pre-cooling sessions included whole body (WB), head+hand (HH), head (H) and no cooling (CONT), applied for 20-min pre-exercise and 5-min mid exercise. Maximal voluntary contractions (MVC) were assessed pre- and postintervention and mid- and post-exercise. Exercise performance was assessed with sprint times, % decline and distances covered during free-paced bouts. Measures of core(Tc) and skin (Tsk) temperatures, heart rate, perceptual exertion and thermal stress were monitored throughout. Venous and capillary blood was analyzed for metabolite, muscle damage and inflammatory markers. Results: WB pre-cooling facilitated the maintenance of sprint times during the exercise protocol with reduced % decline (P=0.04). Mean and total hard running distances increased with pre cooling 12% compared to CONT (P<0.05), specifically, WB was 6-7% greater than HH (P=0.02) and H (P=0.001) respectively. No change was evident in mean voluntary or evoked force pre- to post-exercise with WB and HH cooling (P>0.05). WB and HH cooling reduced Tc by 0.1-0.3°C compared to other conditions (P<0.05). WB Tsk was suppressed for the entire session(P=0.001). HR responses following WB cooling were reduced(P=0.05; d=1.07) compared to CONT conditions during exercise. Conclusion: A relationship between pre-cooling volume and exercise performance seems apparent, as larger surface area coverage augmented subsequent free-paced exercise capacity, in conjunction with greater suppression of physiological load. Maintenance of MVC with pre-cooling, despite increased work output suggests the role of centrally-mediated mechanisms in exercise pacing regulation and subsequent performance.