Implementation of the nurse practitioner role within a Victorian healthcare network : an organisational perspective

Objective
This paper presents a discussion of the development of a framework to implement and sustain the nurse practitioner (NP) role within one health service designed to strengthen the capacity of the health system and which could be readily transferable to other health services.
Setting
Eastern Health (EH) is a multi‑campus tertiary health care organisation servicing a population of approximately 800,000 people in the east and outer eastern suburbs of Melbourne, Australia. EH is committed to advancing the nursing profession and exploring innovative, research based models of practice that are responsive to the needs of the community it serves.
Primary argument
The Framework documents the processes of providing a new career pathway for advanced practice nurses that incorporates education and training, and utilises current evidenced‑based practice guidelines to define and promote the scope of practice.
Conclusion
Strong organisational support to facilitate interdisciplinary and multidisciplinary learning opportunities assists integration of the NP role into the healthcare team. Role clarity will assist interprofessional teams to understand and value the role NPs provide.

Pressurized internal lenticular cracks at healed mica interfaces

The equilibrium states of internal penny cracks at interfaces in thin-sheet bodies are investigated. Consideration is given to cracks held open by a center-loading force from an entrapped particle in combination with a uniform pressure from a fixed mass of entrapped gas. A fracture mechanics analysis indicates that under these conditions the cracks are stable, but are amenable to growth from an enhancement in net pressure (increase in internal pressure or decrease in external pressure) or effective particle size. Essential details of the theory are confirmed by experiments on lenticular cracks at healed interfaces in muscovite mica. The results are pertinent to flaw responses in brittle ceramic systems where structural integrity is an issue.

Untitled : live cinema performance

Over the last 30 years Melbourne-based film-maker, writer and academic Dirk de Bruyn has made numerous experimental, documentary and animation films and videos, continuing to maintain a no-budget, independent, self-funded focus for much of his work. De Bruyns distinctive style entails cut-up collages that draw on animation, found footage and fragments of dialogue - dyeing, painting, incising and stencilling the film strip. Live De Bruyn’s anarchic multi projection performances can involve performance, freeform vocal workouts and De Bruyn, ‘bent over and mouthing into a microphone like a demented seagull, totally involved in the relentlessly unravelling collage of home-processed footage’.Penny Webb. Ian Helliwell provided a live electronic soundtrack.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

Australia's health 2002 : the eighth biennial report of the Australian Institute of Health and Welfare

Australia's Health 2002 is the eighth biennial health report of the Australian Institute of Health and Welfare. It is the nation's authoritative source of information on patterns of health and illness, determinants of health, the supply and use of health services, and health service costs and performance. Australia's Health 2002 is an essential reference and information resource for all Australians with an interest in health.

Caffeine as an ingredient in sugar sweetened beverages

Caffeine is the most widely used psychoactive drug in the world, with more than 80% of the US population classed as regular consumers (Garrett and Griffiths 1998). An analysis of the Continuing Survey of Food Intakes by Individuals (CSFII) in the US indicates that 870/o of US population over 2 years of age consumed caffeine daily and the average intake in caffeine consumers was 193 mg per day or 1.2 mgkg-l per day (Frary er a/ 2005). SSB were the primary source of caffeine in children and adolescents under 18 years of age and provided between 50-64% of the daily caffeine intake. For adults 18-34 years, SSB provided 30% of total daily caffeine, dropping fo llo/o for adults 34 years and older (Frary et a|2005). The total daily intake of caffeine observed in the CSFII is slightly lower that than observed in the 1995 National Nutrition Survey of Australian adults who reported consuming on average 270 mg of caffeine per day. Caffeine intakes amongst children, aged2 to 14 years, were reported as 17 mg per day. It is suggested that cola flavored SSB provide around 62o/, of this intake (Desbrow et al 2004).

Is the popularity of caffeinated foods mere coincidence? Is the flavor coffee, chocolate, tea and cola soft drinks such that without caffeine they would still be widely consumed? Or is the popularity of caffeine containing foods due to the influence of caffeine in the body?

The acute effects of caffeine in a sugar-sweetened beverage on energy consumption

Background: It has been suggested that those who are habitually high caffeine consumers ingest greater quantities of snack foods both in and outside the laboratory. Sugar-sweetened beverages (SSBs) are a major contributor to caffeine consumption and evidence links SSB consumption with poor dietary intake.

Objective: To determine whether varying the concentration of caffeine in SSBs influences snack food consumption and energy intake.

Methods: Caffeine taste thresholds were assessed using the International Standards Organization method for assessing taste sensitivity. In a crossover study design, participants (n=23, 26±5 years old, 58% female) were provided with a standardized meal on 4 days and simultaneously consumed SSBs with varied levels of caffeine (0, 0.67, 1.16, and 1.65 mM). The intake of food and beverage was recorded following each meal session.

Results: A one way between groups analysis of variance revealed no significant main effect of caffeine concentration on consumption of SSBs [F (3, 92)=0.154, p=0.927] or food [F (3, 92)=0.305, p=0.822]. Pearson correlation analysis identified no significant correlations between the amount of food and SSB consumed (R=−0.031–0.415, p=0.062–0.893), or the amount of food and SSB consumed with body mass index and waist circumference (R=0.000 to −0.380, p=0.073–0.999). An individual's oral sensitivity to caffeine was not associated with SSB consumption (R=0.045 to −0.309, p=0.152–0.839) or the consumption of food (R=−0.052 to −0.327, p=0.128–0.812).

Conclusions: The concentration of caffeine in SSBs did not influence the amount of food or SSB consumed.

Podcasting and pedagogy

This chapter explores the engagement of tertiary students in interviewing “green” experts. Using Engeström’s expansive activity model, the study finds that integrating podcasting into a course with strong links to other activities and resources helped students assimilate and develop the concepts of the course. The project promotes functionalist values of independent, experimental learning and deep engagement with learning material, it invokes authentic field experience, accommodates different learning styles and it provides considerable motivation.

The study suggests that mobile learning embodies the means to change relationships between learner and expert and that such connecting is a key attribute of contemporary subjective association and recontextualization. The chapter provides a brief review of the literature on podcasting in education, followed by the teaching and learning context and the application of Engeström’s “expansive activity model” (1994, 2001, 2002, 2004, 2008, 2010). I describe the student group undertaking the exercises in a Level 5 Sociology course, and the project (which subsequently extended into a later course: “The Sustainable Business Environment”, because many of the podcast students had pre-enrolled in that course).

The paper discusses the methodological approach that was used, offering two strands of analysis: students’ use of the podcasts and how the latter were placed in their learning about sustainable development. The discussion section elaborates the model and offers suggestions for advancing the educational use of podcasts. Last, I offer some thoughts on how Engeström’s model might be extended in education to develop not just new objects, but also the new use of objects.

Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES – Australia.

Aim: To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas.

Methods: Diabetes MILES—Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%).

Results: Respondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83–0.97) and T2DM (RR 0.69, 95% CI 0.59–0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25–3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07–1.36) or dietician (RR 1.17, 95% CI 1.07–1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators.

Conclusions: Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.