Quality of life of women with lower limb swelling or lymphedema 3-5 years following endometrial cancer

Objective To quantitatively assess and compare the quality of life (QoL) of women with a self-reported diagnosis of lower limb lymphedema (LLL), to women with lower limb swelling (LLS), and to women without LLL or LLS following treatment for endometrial cancer. Methods 1399 participants in the Australian National Endometrial Cancer Study were sent a follow-up questionnaire 3–5 years after diagnosis. Women were asked if they had experienced swelling in the lower limbs and, if so, whether they had received a diagnosis of lymphedema by a health professional. The 639 women who responded were categorised as: Women with LLL (n = 68), women with LLS (n = 177) and women without LLL or LLS (n = 394). Multivariable-adjusted generalized linear models were used to compare women’s physical and mental QoL by LLL status. Results On average, women were 65 years of age and 4 years after diagnosis. Women with LLL had clinically lower physical QoL (M= 41.8, SE= 1.4) than women without LLL or LLS (M= 45.1, SE= 0.8, p = .07), however, their mental QoL was within the normative range (M= 49.6; SE= 1.1 p = 1.0). Women with LLS had significantly lower physical (M= 41.0, SE= 1.0, p = .003) and mental QoL (M= 46.8; SE= 0.8, p < .0001) than women without LLL or LLS (Mental QoL: M= 50.6, SE= 0.8). Conclusion Although LLL was associated with reductions in physical QoL, LLS was related to reductions in both physical and mental QoL 3-5 years after cancer treatment. Early referral to evidence-based lymphedema programs may prevent long-term impairments to women’s QoL.

Quantitative data collection and study validity

The quality of data collection methods selected and the integrity of the data collected are integral tot eh success of a study. This chapter focuses on data collection and study validity. After reading the chapter, readers should be able to define types of data collection methods in quantitative research; list advantages and disadvantages of each method; discuss factors related to internal and external validity; critically evaluate data collection methods and discuss the need to operationalise variables of interest for data collection.

A bricoleur (or two) in the consulting room

In popular contemporary use, the French term bricolage refers to the activities of the home handyman. It is sometimes used in a disparaging way to refer to work that is improvised, uninformed by expertise or specialist knowledge, and probably inferior in its results when compared with the work of a tradesman or professional. In 1962, anthropologist and philosopher Claude Lévi-Strauss argued that bricolage is a modality of human thought. Since then, the importance of bricolage as a mental activity has been identified in relation to art and architecture, as well as other fields of cultural activity. In this paper I consider bricolage as an activity of the ego and explore its role in the consulting room. I argue that by necessity the psychoanalytic work undertaken between patient and analyst relies on this modality of thought and, furthermore, that the use of bricolage is entirely compatible with evidence-based practice.

Attracting and retaining specialist teachers and non-teaching professionals in Queensland secondary schools : a report to the Queensland Department of Education and Training

This report provides the Queensland Department of Education and Training (DET) with independent evidence based data to enable the identification of barriers and enablers to effective attraction and retention of suitably qualified people to specialist teaching and non‐teaching roles in Queensland secondary schools. The scope of this report is to consider the strategic imperatives, trends, and drivers as they apply to the recruitment and retention of specialised teachers and non‐teaching professionals. The research was specifically designed to inform DET on innovative and novel strategies to recruit and retain staff within Education Queensland in areas specifically identified as at risk of experiencing shortages in the near future. Those areas considered to be at risk of experiencing shortages included: • Teaching principals • Specialist teachers in mathematics, science, industrial technology and design, and special education • Non‐teaching professional roles, such as speech pathologists, occupational therapists, physiotherapists and registered nurses providing services in schools to students with special needs.

Prevention of surgical site infection in total joint arthroplasty : an international tertiary care center survery

Background Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population. Questions/Purposes What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA? Patients and Methods A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared. Results Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention. Conclusion Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.

New Knowledge for Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advancing practice in pain management Conclusions References

Challenges of recruiting hospice patients with advanced cancer to research : reflections on a delirium screening study

Introduction Delirium research in palliative care, particularly in the dying phase, is possible but is frequently met with ethical and methodological challenges. This paper describes the challenges faced in a previous delirium screening study. Methods Within 72 hours of admission to an acute inpatient specialist palliative care unit one hundred consecutive patients over 18 years of age with advanced cancer were invited to be screened for delirium using validated screening tools. Results Of the 100 consecutive admissions 49 patients were unable to participate including seven who did not meet the inclusion criteria and nine (six families and three patients) who withheld consent. The remaining 33 patients were more unwell and closer to death than those who were recruited. Reasons for non- participation included being too unwell (ten), unresponsive (nine), died (two) or discharged (three) before recruitment and exceeding the 72hour time limit (nine). Conclusion Gate keeping and physical condition of patients were the main obstacles to recruitment and is consistent with barriers faced in previous studies involving palliative care and dying patients. While it is possible and necessary to conduct studies in palliative care, including the terminal phase, as reflective practitioners we must maintain the balance between the demands for evidence-based practice and our compassion and respect for our most vulnerable of patients.

Making context work in primary health care

Health care in the community setting is one of the more challenging contexts for evidence-based practice. Community-based care comprises more than simply transplanting hospital care into people’s homes; in addition to the provision of supportive services, it also takes a range of approaches to health care practice that promotes optimal health and builds the capacity of individuals and communities to respond to their health needs. Primary health care is comprised of the diverse activities that build sustainable community capacity to achieve health and well-being throughout all of life’s stages. The expansive nature of primary health care means that a map for practice is not feasible; however a framework which can be adapted to suit the variety of situations and practice settings can be identified. The focus of this chapter is to broadly define and explore the principles of primary health care and consider the contexts of primary health care in relation to evidence-based practice.

Mindfulness and dancers

This chapter provides an overview of the relevant theory, history and evidence-based research regarding mindfulness interventions and practice within the dance profession. Further applied information will be provided to assist professionals and performers utilise and employ mindfulness techniques to the performance.

Experimenting with the future of journalism : social capital as a desideratum for networked journalism research

The aim of this article is to position social capital as a theoretical framework for investigating online communities, specifically pro-am operations. It will review pertinent literature on social capital and the future of journalism in this context, and detail how the broader field of Sociology and this dynamic field of Journalism converge to produce a unique opportunity for pro-am research. Currently, much concern has been expressed regarding the future of journalism institutions in society, and while journalism itself is seen as a cornerstone of democracy, the form of structures that facilitate such practice has been questioned. Compounding this problem is a lack of research that produces data suitable for meta-analysis. For example, case-study data of start-up operations in this volatile field do not provide sufficient grounds for conclusions that could result in evidence-based policy. In response to these dynamics, this article will propose experimentation as a method of research for pro-am start-ups.

Vocational education in science technology, engineering and maths (STEM) : Curriculum innovation through industry school partnerships

Governments have recognised that the technological trades rely on knowledge embedded traditionally in science, technology, engineering and mathematics (STEM) disciplines. In this paper, we report preliminary findings on the development of two curricula that attempt to integrate science and mathematics with workplace knowledge and practices. We argue that these curricula provide educational opportunities for students to pursue their preferred career pathways. These curricula were co-developed by industry and educational personnel across two industry sectors, namely, mining and aerospace. The aim was to provide knowledge appropriate for students moving from school to the workplace in the respective industries. The analysis of curriculum and associated policy documents reveals that the curricula adopt applied learning orientations through teaching strategies and assessment practices which focus on practical skills. However, although key theoretical science and maths concepts have been well incorporated, the extent to which knowledge deriving from workplace practices is included varies across the curricula. Our findings highlight the importance of teachers having substantial practical industry experience and the role that whole school policies play in attempts to align the range of learning experiences with the needs of industry.

Linking research and practice

Understanding the key factors that influence the evidentiary basis for practice and using skills in retrieving evidence that informs practice change are essential to the development of a health professional's career, regardless of the discipline. This chapter focuses on the key links between research and practice, particularly how health professionals use various sources of evidence and new knowledge to inform and improve the effectiveness of their practice in order to benefit the health of clients. Evidence-based practice and research utilisation are two major global research/practice initiatives that form the basis for this chapter. Examples that illustrate the real-world application of these initiatives are included in the Research Alive and Case Study sections. How practice change can be facilitated within health organisations is also briefly introduced.

The importance of social support for students with intellectual disability : an intervention to promote mental health and well-being

Children and adolescents with intellectual disability have higher rates of mental health problems compared with there typically developing peers. Social support has been identified as an important protective factor for psychological well - being. In this paper we discuss the benefits of social support networks, and consider approaches for promoting children’s perceptions of the availability of social support. We describe an evidence-based intervention that has been specially adapted and implemented for students with intellectual disability in school settings. In a randomised controlled trial, the Aussie Optimism Resilience Skills Program was associated with improved perceptions of social support following a 10-week intervention. Educators need to be aware of the increased vulnerability of students with intellectual disability to the development mental health problems and the proactive ways in which they can promote psychological well - being within their classrooms.

Modelling the economic benefits of gold standard care for chronic wounds in a community setting

Chronic leg ulcers are costly to manage for health service providers. Although evidence-based care leads to improved healing rates and reduced costs, a significant evidence-practice gap is known to exist. Lack of access to specialist skills in wound care is one reason suggested for this gap. The aim of this study was to model the change to total costs and health outcomes under two versions of health services for patients with leg ulcers: routine health services for community-living patients; and care provided by specialist wound clinics. Mean weekly treatment and health services costs were estimated from participants’ data (n=70) for the twelve months prior to their entry to a study specialist wound clinic, and prospectively for 24 weeks after entry. For the retrospective phase mean weekly costs of care were $AU130.30 (SD $12.64) and these fell to $AU53.32 (SD $6.47) for the prospective phase. Analysis at a population level suggests if 10,000 individuals receive 12 weeks of specialist evidence-based care, the cost savings are likely to be AU$9,238,800. Significant savings could be made by the adoption of evidence-based care such as that provided by the community and outpatient specialist wound clinics in this study.

Creating regional resilience in Australia

This paper explores the impact that extreme weather events can have on communities. Using the Brisbane floods of 2011 to examine the recovery operations, the paper highlights the effectiveness of recovery and rebuilding in already strong and resilient communities. Our research has shown that communities which have a strong sense of identity, as well as organized places to meet, develop resilient networks that come into play in times of crisis. The increasing trend of the fly-in/fly-out (FIFO) or drive-in/drive-out (DIDO) workforce to service regional areas has undermined the resilience of existing communities. The first hint of this occurs with community groups not knowing who their neighbours are. The paper is based on research examining the needs of groups in regional communities with the goal to better equip regional communities with the capacity to respond positively to change (and crisis) through in-novative, evidence-based policies, resilience strategies and tools. Part of this process was to build an evidence-base to address a range of challenges associated with the place-based environments and the sharing of information systems within communities and decision makers. The first part of the paper explores the context in which communities have been required to mobilize in response to crises; the issues that have galvanized a common purpose; and the methods by which these communities shared their knowledge. The second part of the paper examines how communities could plan for and mitigate natural disasters in the future by developing better decision making tools. The paper defines the requirements for information systems that will link data models of built infrastruc-ture with data from the disaster and response plans. These will then form the basis for the use of social media to coordinate activities between official crews and the public to improve response coordination and provide the technology that could reduce the time required to allow communities to resume some semblance of normality.