Delirium in advanced cancer : screening for the incidence on admission to an inpatient hospice unit

Background Delirium is a common underdiagnosed condition in advanced cancer leading to increased distress, morbidity, and mortality. Screening improves detection but there is no consensus as to the best screening tool to use with patients with advanced cancer. Objective To determine the incidence of delirium in patients with advanced cancer within 72 hours of admission to an acute inpatient hospice using clinical judgement and validated screening tools. Method One hundred consecutive patients with advanced cancer were invited to be screened for delirium within 72 hours of admission to an acute inpatient hospice unit. Two validated tools were used, the Delirium Rating Scale-Revised 98 (DRS-R-98) and the Confusion Assessment Method (CAM) shortened diagnostic algorithm. These results were compared with clinical assessment by review of medical charts. Results Of 100 consecutive admissions 51 participated and of these 22 (43.1%) screened positive for delirium with CAM and/or DRS-R-98 compared to 15 (29.4%) by clinical assessment. Eleven (21.6%) were identified as hypoactive delirium and 5 (9.8%) as subsyndromal delirium. Conclusion This study confirms that delirium is a common condition in patients with advanced cancer.While there remains a lack of consensus regarding the choice of delirium screening tool this study supports theCAMas being appropriate. Further research may determine the optimal screening tool for delirium enabling the development of best practice clinical guidelines for routinemedical practice.

Stochastic ranking method for thermostatically controllable appliances to provide regulation services

Demand response can be used for providing regulation services in the electricity markets. The retailers can bid in a day-ahead market and respond to real-time regulation signal by load control. This paper proposes a new stochastic ranking method to provide regulation services via demand response. A pool of thermostatically controllable appliances (TCAs) such as air conditioners and water heaters are adjusted using direct load control method. The selection of appliances is based on a probabilistic ranking technique utilizing attributes such as temperature variation and statuses of TCAs. These attributes are stochastically forecasted for the next time step using day-ahead information. System performance is analyzed with a sample regulation signal. Network capability to provide regulation services under various seasons is analyzed. The effect of network size on the regulation services is also investigated.

Prevalence, predictors, and correlates of supportive care needs among women 3–5 years after a diagnosis of endometrial cancer

Purpose The purpose of this study is to examine the prevalence, sociodemographic and clinical predictors, and physical and psychosocial correlates of unmet needs among women 3–5 years following treatment for endometrial cancer. Methods Women with endometrial cancer completed a survey around the time of diagnosis and again 3–5 years later. The follow-up survey asked women about their physical and psychosocial functioning and supportive care needs (CaSUN). Multivariable-adjusted logistic regression identified the predictors and correlates of women’s unmet needs 3–5 years after diagnosis. Results Of the 629 women who completed the cancer survivors’ unmet needs measure (CaSUN), 24 % (n = 153) women reported one or more unmet supportive care needs in the last month. Unmet needs at 3–5 years post-diagnosis were predicted by younger age (OR = 4.47; 95 % CI: 2.09–9.56) and advanced disease stage at diagnosis (OR = 2.47; 95 % CI: 1.38–4.45) and correlated with greater cancer symptoms (OR = 1.78; 95 % CI: 1.05–3.02), lower limb swelling (OR = 2.50; 95 % CI: 1.51–4.15), symptoms of anxiety (OR = 2.21; 95 % CI: 1.31–3.72), and less availability of social support (OR = 3.42; 95 % CI: 1.92–6.11). Women with a history of comorbidities (OR = 0.47; 95 % CI: 0.27–0.82) and those living in a rural area at the time of diagnosis (OR = 0.56; 95 % CI: 0.34–0.92) were less likely to report unmet needs. Conclusions Sociodemographic, health, and psychosocial factors seem important for identifying women who will or will not have unmet needs several years following endometrial cancer. Longitudinal assessments of people’s needs over the course of their cancer trajectory may be an effective way to identify areas that should receive further attention by health providers.

The long and winding road : health services for clients with chronic leg ulcers in the community

The prevalence of leg ulcers of is 0.12%–1.1% and >3,000 lower limb amputations are performed yearly in Australia due to non-healing leg or foot ulcers. Although evidence on leg ulcer management is available, a significant evidence-practice gap exists. To identify current leg ulcer management, a cross-sectional retrospective study was undertaken in Brisbane, Australia. A sample of 104 clients was recruited from a community specialist wound clinic and a tertiary hospital outpatient’s specialist wound clinic. All clients had an ulcer below their knee or on their foot for ≥4 weeks. Data were collected on ulcer care, health service usage and clinical history for the year prior to admission. On admission, participants reported having their ulcer for a median of 25 weeks (range 2-728 weeks); with 51% (53/104) reporting an ulcer duration of ≥24 weeks. Including the wound clinic, participants sought ulcer care from a median of 3 health care providers (range 2-7). General Practitioners provided ulcer care to 82% of participants. Nearly half (42%) had self-cared for their ulcer; 29% (30/104) received treatment by a community nurse. A gap was found between the community-based ulcer care experienced by this population and evidence-based guidelines in regards to assessment, management, advice, and referrals.

Modelling the intention to adopt cloud computing services : a transaction cost theory perspective

This paper uses transaction cost theory to study cloud computing adoption. A model is developed and tested with data from an Australian survey. According to the results, perceived vendor opportunism and perceived legislative uncertainty around cloud computing were significantly associated with perceived cloud computing security risk. There was also a significant negative relationship between perceived cloud computing security risk and the intention to adopt cloud services. This study also reports on adoption rates of cloud computing in terms of applications, as well as the types of services used.

E-health: potential benefits and challenges in providing and accessing sexual health services

BACKGROUND: E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. DISCUSSION: The paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services. There are important issues in relation to utilising and providing online sexual health services. For healthcare providers, e-health can act as an opportunity to enhance their clients' sexual health care by facilitating communication with full privacy and confidentiality, reducing administrative costs and improving efficiency and flexibility as well as market sexual health services and products. Sexual health is one of the common health topics which both younger and older people explore on the internet and they increasingly prefer sexual health education to be interactive, non-discriminate and anonymous. This commentary presents and discusses the benefits of e-sexual health and provides recommendations towards addressing some of the emerging challenges. FUTURE DIRECTIONS: The provision of sexual health services can be enhanced through E-health technology. Doing this can empower consumers to engage with information technology to enhance their sexual health knowledge and quality of life and address some of the stigma associated with diversity in sexualities and sexual health experiences. In addition, e-sexual health may better support and enhance the relationship between consumers and their health care providers across different locations. However, a systematic and focused approach to research and the application of findings in policy and practice is required to ensure that E-health benefits all population groups and the information is current and clinically valid and effective, including preventative approaches for various client groups with diverse needs.

Business transformation management : composition and orchestration of management services

This research develops a better understanding on how large-scale and complex IT-enabled business transformations are managed. Evidence from three global case studies suggest that business transformations can be composed and orchestrated like a jazz band, where improvisation plays a fundamental role to maintain the melody, harmony and rhythm of such initiatives. The thesis details how the jazz metaphor can assist senior management on how to reuse and reconfigure capabilities as services for transforming organizations. To the academic body of knowledge, the thesis provides a study on the use of management services as a theoretical lens to examine Business Transformation Management.

Identifying influential users of micro-blogging services : a dynamic action-based network approach

In this paper, we present a dynamic model to identify influential users of micro-blogging services. Micro-blogging services, such as Twitter, allow their users (twitterers) to publish tweets and choose to follow other users to receive tweets. Previous work on user influence on Twitter, concerns more on following link structure and the contents user published, seldom emphasizes the importance of interactions among users. We argue that, by emphasizing on user actions in micro-blogging platform, user influence could be measured more accurately. Since micro-blogging is a powerful social media and communication platform, identifying influential users according to user interactions has more practical meanings, e.g., advertisers may concern how many actions – buying, in this scenario – the influential users could initiate rather than how many advertisements they spread. By introducing the idea of PageRank algorithm, innovatively, we propose our model using action-based network which could capture the ability of influential users when they interacting with micro-blogging platform. Taking the evolving prosperity of micro-blogging into consideration, we extend our actionbaseduser influence model into a dynamic one, which could distinguish influential users in different time periods. Simulation results demonstrate that our models could support and give reasonable explanations for the scenarios that we considered.

Analysing children’s persuasive texts : the use of hedging and intensification

Research Quality This is a dialogue between two Australian literacy scholars about two persuasive writing techniques that posed difficulty for the students in our research. This dialogue flows from the analysis of Year 6 writing samples from an ARC Linkage Project, URLearning (2009-2013) - the focus of the symposium. We use vivid examples of writing from students’ handwritten persuasive texts on topics that were chosen by teachers. The persuasive structure in the texts followed the Toulmin (2003) model: a thesis statement, three arguments with evidence, and a conclusion. The findings show that to realise the effective power of rhetorical persuasion, students need an expanded lexicon that does not rely on intensifiers, and which employs a greater range of advanced hedging techniques to use to their advantage. National & International Importance The study is potentially of national and international relevance, given that argumentation or persuasion is a key life skill in many professional, personal, and discourses. It is also a requirement in the International English Language Testing Systems (IELTS) tests, which are a critical gateway for tertiary studies in many English-speaking countries (Coffin, 2004). Timeliness The research is timely given the Australian Curriculum English, in which persuasive texts figure prominently from Preparatory to Year 10 (ACARA, 2014). The recommendations are also timely in the context of educational policies in other parts of the world. For example, in the United States, the Common Core Standards: English Language Arts, mandates the teaching of persuasive texts (Council of Chief State School Officers & National Governors Association, 2013) Implications for practice/policy The findings of the study have specific practical implications for teachers, who can address the persuasive writing techniques of hedging and intensification with which children need targeted support and explicit instruction. The presentation is positioned at the nexus of teacher practice to better address the national priorities of the Australian Curriculum: English (ACARA, 2014), while having implications for applied linguistics research by identifying common problems in students' persuasive writing.

Corporate governance quality, audit fees and non-audit services fees

This paper extends prior research on the relationship between governance quality and auditor remuneration.We examine the influence of audit committee effectiveness (ACE), a proxy for governance quality, on audit fees (AF) and non-audit services fees (NASF) using a new composite measure comprising audit committee independence, expertise, diligence and size. We find that after controlling for board of director characteristics, there is a significant positive association between ACE and AF only for larger clients. Our results indicate that effective audit committees undertake more monitoring which results in wider audit scope and higher audit fees. Contrary to our expectations, we find the association between ACE and NASF to be positive and significant, especially for larger clients. This suggests that larger clients are more likely to purchase non-audit services (NAS) even in the presence of effective audit committees probably due to the complexity of their activities. Overall, our findings support regulatory initiatives aimed at improving corporate governance quality.

The pathophysiology of ischaemic stroke : considerations for emergency department advanced practice nursing

Stroke is the fourth most important cause of death in Singapore. Its major predisposing factors include hypertension, type 2 diabetes mellitus and hyperlipidaemia; all modifiable diseases if treated early. However, with Singapore’s elderly population, the risk and rates of stroke are ever increasing. The nature of a stroke can be categorised as eitherh aemorrhagic or ischaemic; the former caused by arterial rupture, the latter by arterial blockage; both can be devastating in their prognosis and outcome. This paper will discuss the pathophysiology of ischaemic stroke while identifying some of the key features of ischaemia on different areas of the brain relative to the artery that feeds them. Thoughts for Emergency Department advanced practice nursing will also be discussed.

The educational context and services of children with additional needs in their first years of school in Australia

In Australia, children with additional needs are now primarily educated in mainstream regular classes and schools. While discussion has focused on teacher attitudes, teacher preparation and professional development to support the academic progress of children with additional needs, there is limited research examining the educational contexts and services provided to such children in Australian schools. This descriptive paper examines the educational contexts of 563 Australian children with additional needs, in reference to 3600 of their typically developing peers. Data in relation to educational setting, retention, prevalence of additional needs, access to specialist services, learning support, and individual programming are reported.

The feasibility of a community pharmacy delivered in-pharmacy influenza vaccination service

Pharmacist-administered vaccination is a reality in many counties including USA, Canada, UK, Portugal, Ireland and New Zealand. In Australia the role of pharmacist administered vaccination has long been supported by the profession particularly the Pharmaceutical Society of Australia and Pharmacy Guild of Australia, however legislation prohibits this practice in each state and territory. In 2013 the only available in-pharmacy vaccination services are those delivered by an immunization nurse, nurse practitioner or general practitioner.

Can synchronous online counselling increase uptake of counselling services in secondary schools and what can promote or inhibit implementation?

This research showed that online counselling has the potential to increase the help-seeking of secondary school students - especially those who suffer from high levels of psychological distress. An investigation of why school counsellors are currently reluctant to provide an online counselling service identified a number of barriers to implementing such a potentially vital service. Response to focus groups and surveys completed by students and school counsellors indicated that more distressed students prefer to use online counselling and they would use it for sensitive topics. School counsellors remain concerned about effectiveness, ethical, legal and privacy issues as well as potential misuse of the service. Recommendations for implementation are made.

Women with self-reported lower-limb lymphedema after treatment for gynecological cancers: Are they more likely to self-report psychosocial symptoms and less likely to use services?

Background: Due to improved screening and treatment for gynaecological cancers survivorship has increased. Use of supportive care services after treatment is important to improve quality of life. Objective: To assess self-reported lower-limb lymphoedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynaecological cancer survivors. Methods: In 2010 a population-based cross-sectional mail survey was conducted (n=160 gynaecological cancer survivors 5 to 30 month post-diagnosis (53% response rate)). Results: Overall, 30% of women self-reported LLL, 21% and 24% depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and with these symptoms had higher unmet supportive care needs. Services needed but not used by 10-15% of women with LLL, anxiety or depression respectively were lymphoedema specialist, pain specialist and physiotherapist, or psychiatrists, psychologists and pain specialists. Limitations: Small sample size, self-report data, limited generalisation to other countries, underrepresentation of older women (age >70) and women from non-Caucasian backgrounds. Conclusions: Women with LLL or high distress were less likely to use services they needed. Funding: This study was funded by Cancer Australia.