Community nutrition : providing for older citizens

Diet quality is a contributing factor to the health of the increasing number of aged. A fortnightly small group meal program focusing on social interaction was trialled. It was concluded that the program had strong support from participants and that there is scope for expansions of existing food service programs to include alternative styles of presentations; and that the principle of the Community Meals Program should be continued and endorsed.

Factors influencing consistency of triage using the Australasian triage scale : implications for guideline development

Objective: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale.

Methods: A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance.

Results: A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P≤ 0.001; 65.0%; P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P≤ 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05).

Conclusion: We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.

Improving the coordination of care for low back pain patients by creating better links between acute and community services

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Open Access : How Open ? How Accessible? Symposium

Introduction: Anne Horn, University Librarian, Deakin University Library.

Presentations:
Economic impacts of open access implications from studies in Europe and the United States / John Houghton ;
Where is open access in the ARC's ERA? / John Lamp ;
Open access : an academic publisher's perspective / James Mercer.

Includes audio recording of whole Symposium : n21-Oct-Recording

A naturalistic study of treatment outcomes with aripiprazole in young people with first episode psychosis

Objective: Adequate treatment of a first psychotic episode in young people is a difficult challenge but may be of critical importance for changing the course of psychotic illness. Pharmacotherapy is the standard treatment of psychosis, however there is a paucity of data specific to first-episode psychosis.
Methods: In this study 12 young people who presented with a psychotic episode at a specialised early intervention service were commenced on treatment with aripiprazole. They were assessed at baseline and weeks 4, 6, 24 and 48 using a broad battery of outcome measures. Case notes were also examined.
Results: Data was available for 6 participants at week 48, and of those, one remained on treatment with Aripiprazole at endpoint. Case histories were typified by presentations that included illicit substance use and treatments characterised by several changes in medications. No single treatment choice predominated. Most participants tolerated treatment and showed symptomatic improvement with individualised therapy.
Conclusion: Most participants showed improvement during the treatment period. Aripiprazole was one of many medications used in this study and may have been useful for the treatment of some individuals with first episode psychosis.

Proceedings of the rank forum on vitamin D

The Rank Forum on Vitamin D was held on 2nd and 3rd July 2009 at the University of Surrey, Guildford, UK. The workshop consisted of a series of scene-setting presentations to address the current issues and challenges concerning vitamin D and health, and included an open discussion focusing on the identification of the concentrations of serum 25-hydroxyvitamin D (25(OH)D) (a marker of vitamin D status) that may be regarded as optimal, and the implications this process may have in the setting of future dietary reference values for vitamin D in the UK. The Forum was in agreement with the fact that it is desirable for all of the population to have a serum 25(OH)D concentration above 25 nmol/l, but it discussed some uncertainty about the strength of evidence for the need to aim for substantially higher concentrations (25(OH)D concentrations>75 nmol/l). Any discussion of ‘optimal’ concentration of serum 25(OH)D needs to define ‘optimal’ with care since it is important to consider the normal distribution of requirements and the vitamin D needs for a wide range of outcomes. Current UK reference values concentrate on the requirements of particular subgroups of the population; this differs from the approaches used in other European countries where a wider range of age groups tend to be covered. With the re-emergence of rickets and the public health burden of low vitamin D status being already apparent, there is a need for urgent action from policy makers and risk managers. The Forum highlighted concerns regarding the failure of implementation of existing strategies in the UK for achieving current vitamin D recommendations.

Avatar Obama in the age of liquid celebrity

Barak Obama, orator extraordinaire, the embodiment of the American success myth, 'global' prophet of the adoring masses and multi-media auratic figure, is the leading illustration of what is the expanded nexus of celebrity, spectacle and politics in the age of what Zygmund Bauman refers to as liquid modernity or 'the era of disembedding without re-embedding' (2001, p. 89). This is the era in which a traumatic sense of fear, uncertainty and transience defines one's relationship to the nation state, and social (media) centre, as they lose their economic singularity and cultural coherency and cohesiveness in a world system ever inter-connected and driven increasingly, incessantly by supra-corporate concerns and spectacular celebrity-based presentations. In this world of 'togetherness dismantled' (Bauman 2003, p. 119), the disenfranchised individual feels they cannot meet the trans-capital intensive, show reel-like, boundaryless world on solid ground. That adoration, or a liquefied definition of it, is key to this imagined and affective communion between Obama and those who adore him, suggests that there is a terrible wanting and simultaneous waning to those who look for such rootedness and the promise of deliverance in the celebrity political figure. This is a charismatic authority figure who promises this solidity yet streams in and out of material view, unable to fix or properly propagate their communion beyond triumphant spectacularism. Their 'lightness of being' (ibid, p. 123-9) is powerfully seductive and decidedly empty because it echoes the instantaneous (instant) way in which all lives are increasingly led. I will suggest that liquid celebrity is one of the cornerstones of liquid modernity, and Barack Obama is the epitome of this 'runniness'.

Research and diabetes nursing. Part 2 : process of critical review

This article is the second in a six-part series addressing research and the DSN. Crirical review is a key aspect of research and evidencebased care and, therefore, of clinical and professional practice. Critical review is an analytical and reflective process that involves judging the quality of research publicarions and their relevance to practice. This article oudines key aspects of how to review publications and conference presentations, how critical review applies to clinical care, and how this process om help develop writing and critical thinking skills. Also addressed are the general aspects of critical review, and a list of further reading and useful websites is provided. Specific considerations for particular research methods such as quantitative, qualitative, evaluation studies and audits will be addressed in later articles in the series.

The interval between sexual encounters affects male courtship tactics in a desert-dwelling fish

Courtship displays are often important in determining male mating success but can also be costly. Thus, instead of courting females indiscriminately, males might be expected to adjust their signalling effort strategically. Theory, however, predicts that such adjustments should depend on the rate with which males encounter females, a prediction that has been subject to very little empirical testing. Here, we investigate the effects of female encounter rate on male courtship intensity by manipulating the time interval between sequential presentations of large (high quality) and small (low quality) females in a fish, the Australian desert goby Chlamydogobius eremius. Males that were presented with a small female immediately after a large female reduced their courtship intensity significantly. However, males courted large and small females with equal intensity if the interval between the sequential presentations was longer. Our results suggest that mate encounter rate is an important factor shaping male reproductive decisions and, consequently, the evolutionary potential of sexual selection.

Can the Severity of Dependence Scale be usefully applied for 'ecstasy'?

Background/Aims: Although use of 'ecstasy' (drugs sold as containing 3,4-methylenedioxymethamphetamine) is prevalent, it is typically infrequent, and treatment presentations involving ecstasy as a principal problem drug are relatively rare. Human case reports and animal literature suggest dependence potential, although there may be some unique aspects to this syndrome for ecstasy in comparison to other substances. The Severity of Dependence Scale (SDS) was examined to determine whether this could usefully identify 'dependent' ecstasy consumers.

Methods: We conducted a cross-sectional survey of 1,658 frequent (at least monthly) ecstasy consumers across Australia, assessing drug use, associated harms and risk behaviours. Dependence was evaluated with the SDS, using a cut-off of ≥4 to identify potential 'dependence'. Results: One fifth of the participants were screened as potentially dependent. These individuals used ecstasy more frequently, in greater amounts, engaged more extensively in risk behaviours and reported greater role interference than other participants. These findings were independent of methamphetamine use or dependence. The underlying structure of the ecstasy SDS was bifactorial.

Conclusions: The SDS has demonstrated construct validity as a screening tool to identify ecstasy users at elevated risk of experiencing adverse consequences, including features of dependence. The underlying structure of dependence symptoms differs for ecstasy compared to other drug classes, and some dependent consumers use the drug infrequently. The unique neurotoxic potential and entactogenic effects of ecstasy may require a distinct nosological classification for the experience of dependence associated with the drug.

Frailty, aging, and incontinence in the elderly : an interactive case-based discussion of best practices

Urinary incontinence and frailty are both highly prevalent in older adults. Workshop goals include review of available evidence on frailty and differentiation from normal physiological aging. The influence of frailty on continence in older adults will be examined. Presentations will explore associated risks such as falls, pressure ulcers, and nursing home placement, as well as barriers and facilitators of continence care in various living environments. The role of urodynamics and various treatments will be considered. A majority of the session will focus on interactive discussion of case-based examples of common but challenging clinical situations seen in frail older adults.

Patient perspective workshop : moving towards OMERACT guidelines for choosing or developing instruments to measure patient-reported outcomes

The workshop Choosing or Developing Instruments held at the Outcome Measures in Rheumatology (OMERACT) 10 meeting was designed to help participants think about the underlying methods of instrument development. Conference pre-reading material and 3 brief introductory presentations elaborated the issues, and participants broke into discussion groups before reconvening to share insights, engage in a more general discussion of the issues, and vote on recommendations. Trade offs between using current imperfect measures and the long and complex process of developing new instruments were considered, together with the need for rigor in patient-reported outcome (PRO) instrument development. The main considerations for PRO instrument development were listed and a research agenda for action produced. As part of the agenda for action, it is recommended that researchers and patient partners work together to tackle these issues, and that OMERACT bring forward proposals for acceptable instrument development protocols that would meet an enhanced “Truth” statement in the OMERACT Filter.

First probable Australian cases of human infection with Rickettsia felis (cat-flea typhus)

Human infection with Rickettsia felis has been reported in most parts of the world, and R. felis has recently been confirmed in cat fleas in Western Australia. The clinical presentations of R. typhi and R. felis are similar, and in the past, the incidence of R. felis infection may have been underestimated. We describe the first reported cases of probable human R. felis infection in Australia. Two adults and three children in Victoria contracted a rickettsial disease after exposure to fleas from kittens. Molecular testing of fleas demonstrated the presence of R. felis but not R. typhi.