Advice to consult a general medical practitioner in Western Australia : Could it be cancer?

Background: Many people will consult a medical practitioner about lower bowel symptoms, and the demand for access to general practitioners (GPs) is growing. We do not know if people recognise the symptoms of lower bowel cancer when advising others about the need to consult a doctor. A structured vignette survey was conducted in Western Australia. Method: Participants were recruited from the waiting rooms at five general practices. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of 64 based on six clinical variables. Twenty-seven vignettes described high-risk bowel cancer scenarios. Respondents were asked if they would recommend a medical consultation for the case described and whether they believed the scenario was a cancer presentation. Logistic regression was used to estimate the independent effects of each variable on the respondent's judgement. Two-hundred and sixty-eight completed responses were collected over eight weeks. Results: The majority (61%) of respondents were female, aged 40 years and older. A history of rectal bleeding, six weeks of symptoms, and weight loss independently increased the odds of recommending a consultation with a medical practitioner by a factor of 7.64, 4.11 and 1.86, respectively. Most cases that were identified as cancer (75.2%) would not be classified as such on current research evidence. Factors that predict recognition of cancer presentations include rectal bleeding, weight loss and diarrhoea.

The CGT small business concessions : recent evidence from the perspective of the tax practitioner

On 21 September 1999 Division 152 was inserted into the Income Tax Assessment Act (1997) (ITAA 1997). It was subsequently subject to amendments in 2006. Division 152 contains the small business CGT concessions, which enables eligible small business taxpayers to reduce the amount of tax payable on capital gains arising from certain CGT events (including the sale of the small business itself) that occur after 11:45 am on 21 September 1999. One of the stated principal objectives of the legislation was to provide a concessionary regime for small business owners who did not have the same ability to access the concessionary superannuation regime (particularly the superannuation guarantee charge) generally available to employees. The then Federal Treasurer, Mr Peter Costello, when announcing the introduction of the concessions, specifically stated that the object of Div 152 was to provide “small business people with access to funds for retirement or expansion”. The purpose of this project is to: one, assess the extent to which small business taxpayers understand the CGT small business concessions, particularly when considering sale of their business; two, determine which of the four small business CGT concessions are being adopted and/or recommended by tax advisors to clients; and three, determine whether the recent superannuation changes announced by the Federal Government in relation to the capping of the concessional superannuation thresholds have had an impact on the use of the small business retirement concession. It is anticipated that the results of this study will reveal that that small business owners are reliant on their tax advisors to explain the operation of Division 152. It is plausible that give the complexity of the CGT concessions, most small business owners are completely unaware of the four small business CGT concessions contained in Division 152 and do not understand how these concessions apply. Our study will also reveal the extent to which each CGT small business concession has been adopted (and reasons why). In particular, emphasis will be placed on the adoption of the small business retirement concession contained in Subdivision 152-D (and specific reasons for its adoption). This study also seeks to understand whether the recent (and impending) changes to the concessional superannuation cap has resulted in the retirement concession being more widely adopted (or recommended) by tax advisors. We would expect that the results of our study to confirm this to be the case, particularly coupled with the recent economic downturn, which has led to lower superannuation fund balances. By providing accounting firms with this information, small business owners will benefit from the information, becoming better placed to be long-term self funded retirees, providing not only financial benefits to the individuals and the country, but a significant increase in social self-assurance by these members of the community.

The voices of the exegesis : Composing the speech genres of the practitioner-researcher into a connective thesis

Postgraduate candidates in the creative arts encounter unique challenges when writing an exegesis (the written document that accompanies creative work as a thesis). As a practitioner-researcher, they must adopt a dual perspective–looking out towards an established field of research, exemplars and theories, as well as inwards towards their experiential creative processes and practice. This dual orientation provides clear benefits, for it enables them to situate the research within its field and make objective claims for the research methodologies and outcomes while maintaining an intimate, voiced relationship with the practice. However, a dual orientation introduces considerable complexities in the writing. It requires a reconciliation of multi-perspectival subject positions: the disinterested academic posture of the observer/ethnographer/analyst/theorist at times; and the invested, subjective stance the practitioner/producer at others. It requires the author to negotiate a range of writing styles and speech genres–from the formal, polemical style of the theorist to the personal, questioning and emotive voice of reflexivity. Moreover, these multi-variant orientations, subject positions, styles and voices must be integrated into a unified and coherent text. In this chapter I offer a conceptual framework and strategies for approaching this relatively new genre of thesis. I begin by summarizing the characteristics of what has begun to emerge as the predominant model of exegesis (the dual-oriented ‘Connective’ exegesis). Framing it against theoretical and philosophical understandings of polyvocality and matrixicality, I go on to point to recent textual models that provide precedents for connecting differently oriented perspectives, subjectivities and voices. I then turn to emergent archives of practice-led research to explain how the challenge of writing a ‘Connective’ exegesis has so far been resolved by higher degree research (HDR) candidates. Exemplars illustrate a range of strategies they have used to compose a multi-perspectival text, reconcile the divergent subject positions of the practitioner researcher, and harmonize the speech genres of a ployvocal text.

Pharmacist, general practitioner, and nurse perceptions, experiences, and knowledge of medication dosage form modification

Background: People often modify oral solid dosage forms when they experience difficulty swallowing them. Modifying dosage forms may cause adverse effects to the patient, and the person undertaking the modification. Pharmacists are often the first point of contact for people in the general community seeking advice regarding medications. Nurses are at the forefront of administering medications to patients and are likely to be most directly affected by a patient’s swallowing ability, while general practitioners (GPs) are expected to consider swallowing abilities when prescribing medications. Objective: To compare the perspectives and experiences of GPs, pharmacists, and nurses regarding medication dosage form modification and their knowledge of medication modification. Method: Questionnaires tailored to each profession were posted to 630 GPs, and links to an online version were distributed to 2,090 pharmacists and 505 nurses. Results: When compared to pharmacists and GPs, nurses perceived that a greater proportion of the general community modified solid dosage forms. Pharmacists and GPs were most likely to consider allergies and medical history when deciding whether to prescribe or dispense a medicine, while nurses’ priorities were allergies and swallowing problems when administering medications. While nurses were more likely to ask their patients about their ability to swallow medications, most health professionals reported that patients “rarely” or “never” volunteered information about swallowing difficulties. The majority of health professionals would advise a patient to crush or split noncoated non-sustained-release tablets, and would consult colleagues or reference sources for sustained-release or coated tablets. Health professionals appeared to rely heavily upon the suffix attached to medication names (which suggest modified release properties) to identify potential problems associated with modifying medications. Conclusion: The different professional roles and responsibilities of GPs, pharmacists, and nurses are associated with different perspectives of, and experiences with, people modifying medications in the general community and knowledge about consequences of medication modification.

New suburbs in the making? Locating master planned estates in a comparative analysis of suburbs in South-East Queensland

In urban scholarship Master Planned Estates (MPEs) are viewed as illustrative of broader changes to the urban environment and characterised as homogenous, affluent enclaves where community life is largely orchestrated by the developer. Yet no study has fully considered if, and to what extent, MPEs can be distinguished from other suburb types in terms of their residential composition and their levels of sociability and community attachment. In this article, we empirically test if MPEs are different from ‘conventional’ suburbs by examining them structurally in terms of their demographic and socio-economic characteristics, as well as in terms of their key community social processes. Using data from a 2008 study of 148 suburbs across Brisbane, Australia (which includes data from two MPEs), we undertake a comparative analysis of suburbs and examine the density of neighbour networks, residents' reports of place attachment and cohesion and neighbourly contact in MPEs compared to other residential suburbs. Our findings suggest that MPEs are not distinct in terms of their degree of homogeneity and socio-economic characteristics, but that connections among residents are lower than other suburbs despite—or perhaps because of—the active interventions of the developer.

Certified pseudonyms colligated with master secret key

A pseudonym provides anonymity by protecting the identity of a legitimate user. A user with a pseudonym can interact with an unknown entity and be confident that his/her identity is secret even if the other entity is dishonest. In this work, we present a system that allows users to create pseudonyms from a trusted master public-secret key pair. The proposed system is based on the intractability of factoring and finding square roots of a quadratic residue modulo a composite number, where the composite number is a product of two large primes. Our proposal is different from previously published pseudonym systems, as in addition to standard notion of protecting privacy of an user, our system offers colligation between seemingly independent pseudonyms. This new property when combined with a trusted platform that stores a master secret key is extremely beneficial to an user as it offers a convenient way to generate a large number of pseudonyms using relatively small storage.

Pragmatic two-way communication : a practitioner perspective on dialogue in public relations

Public relations has traditionally claimed a close association with dialogue, but this research demonstrates that formal notions of dialogue have little relevance to the real world of public relations practice. Instead, practitioners undertake pragmatic forms of two-way communication, because the constraints within which they work mean dialogue is difficult if not impossible to carry out. This qualitative research project shows that although the label of 'dialogue' has been co-opted in both the theory and practice of public relations, this claimed connection is not supported by empirical evidence.

AUSPRAC : The Nurse Practitioner Research Toolkit

Chapter 1: Introduction Overview and background Chapter 2: Conducting clinical audit of nurse practitioner practice The nature and purpose of clinical audit-- Data collection tools for clinical audit-- References and readings Chapter 3: Researching nurse practitioner practice The nature and purpose of clinical practice research-- Data collection tools for researching practice-- References and readings Chapter 4: Researching nurse practitioner service Principles and purpose of health services research-- Data collection tools for researching health services-- References and readings Chapter 5: Researching nurse practitioner patient outcomes Principles and purpose of researching patient outcomes-- Data collection tools for researching patient outcomes-- References and readings Chapter 6: Conducting a nurse practitioner census National workforce census-- Data collection tools for National/State census of nurse practitioners--References and readings

The Nurse Practitioner Standards Project : Toolkit

"The aims of the project have been to conduct research that will inform a description of the core role of the nurse, core competency standards for the nurse and standards for education and program accreditation for nurse preparation leading to regsitration and authorisation. Includes Nurse Practitioner Standards Project: Toolkit, developed from the findings of the Nurse Practitioner standards research project. It presents standards related to Nurse Practitioner practice, education and authorisation/evaluation."--Libraries Australia

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service

Aim To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Background Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Design Pragmatic randomized controlled trial at one site with 260 participants. Methods This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Discussion Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce.

An exploratory study for the development of emergency nurse practitioner specialist clinical practice standards

This thesis presents a mixed methods study to develop specialty specific clinical practice standards for Emergency Nurse Practitioners. This is the first time in Australia that Nurse Practitioners standards have been developed for a clinical specialty. These standards will guide educational preparation for the role and ongoing Continuous Professional Development for endorsed Emergency Nurse Practitioners.

The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

A multidisciplinary review of the teaching and assessment of prescribing : how do professions perform?

Aim To investigate the methods employed to teach and assess the principles of effective prescribing across five non-medical professions in a tertiary institution. Methods The National Prescribing Service MedicineWise Prescribing Competencies Framework was employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing articulated in the competency standards were addressed within the following courses: Master of Nursing Science (Nurse Practitioner), Bachelor of Vision Science, Master of Optometry, Bachelor of Pharmacy, Bachelor of Podiatry, Bachelor of Paramedic Science. The methods employed to teach and assess prescribing principles were documented. For each profession, identified gaps in teaching and/or assessment were noted.