Reference bias : presentation of extreme health states prior to EQ-VAS improves health-related quality of life scores. A randomised crossover trial.

Background: Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as healthrelated quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS) and whether consideration of good and poor health state descriptors immediately changes their selfreport. Methods: A randomised crossover trial was implemented amongst hospitalised older adults (n = 151). Patients were asked to consider descriptions of extremely good (Description-A) and poor (Description-B) health states. The EQ-VAS was administered as a self-report at baseline, after the first descriptors (A or B), then again after the remaining descriptors (B or A respectively). At baseline patients were also asked if they had considered either EQVAS anchors. Results: Overall 106/151 (70%) participants changed their self-evaluation by ≥5 points on the 100 point VAS, with a mean (SD) change of +4.5 (12) points (p < 0.001). A total of 74/151 (49%) participants did not consider the best health VAS anchor, of the 77 who did 59 (77%) thought the good health descriptors were more extreme (better) then they had previously considered. Similarly 85/151 (66%) participants did not consider the worst health anchor of the 66 who did 63 (95%) thought the poor health descriptors were more extreme (worse) then they had previously considered. Conclusions: Health state self-reports may not be well considered. An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring. Caution should be exercised in research and clinical settings when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning. Trial Registration: Australian and New Zealand Clinical Trials Registry (#ACTRN12607000606482) http://www.anzctr. org.au

Defending the sanctity of life principle : a reply to John Keown

This article is a response to Professor Keown’s criticism of my paper “Finding a Way Through the Ethical and Legal Maze: Withdrawal of Medical Treatment and Euthanasia” (2005) 13 (3) Medical Law Review 357. The article takes up and responds to a number of criticisms raised by Keown in an attempt to further the debate concerning the moral and legal status of withdrawing life-sustaining measures, its distinction from euthanasia, and the implications of the lawfulness of withdrawal for the principle of the sanctity of life.

A spoofing detection method for civilian L1 GPS and the E1-B Galileo Safety of Life service

This paper describes an effective method for signal-authentication and spoofing detection for civilian GNSS receivers using the GPS L1 C/A and the Galileo E1-B Safety of Life service. The paper discusses various spoofing attack profiles and how the proposed method is able to detect these attacks. This method is relatively low-cost and can be suitable for numerous mass-market applications. This paper is the subject of a pending patent.

Autonomy versus futility? Barriers to good clinical practice in end-of-life care : a Queensland case

Findings from a Queensland coronial inquest highlight the complex clinical, ethical and legal issues that arise in end-of-life care when clinicians and family members disagree about a diagnosis of clinical futility. The tension between the law and best medical practice is highlighted in this case, as doctors are compelled to seek family consent to not commence a futile intervention. Good communication between doctors and families, as well as community and professional education, is essential to resolve tensions that can arise when there is disagreement about treatment at the end of life.

A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries

Background Home visits (HV) provide excellent opportunities for health promotion. Aim This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. Design A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. Results At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). Conclusions Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

Origins of Australian Football: Victoria's Early History. Volume 1 Amateur Heroes and the Rise of the Clubs, 1858 to 1876

This is volume 1 in a series of four volumes about the origins of Australian football as it evolved in Victoria between 1858 and 1896. This volume addresses its very beginnings as an amateur sport and the rise of the first clubs. Invented by a group of Melbourne cricketers and sports enthusiasts, Australian Rules football was developed through games played on Melbourne's park lands and was originally known as "Melbourne Football Club Rules". This formative period of the game saw the birth of the first 'amateur heroes' of the game. Players such as T.W. Wills, H.C.A. Harrison, Jack Conway, George O'Mullane and Robert Murray Smith emerged as warriors engaged in individual rugby-type scrimmages. The introduction of Challenge Cups was an important spur for this burgeoning sport. Intense competition and growing rivalries between clubs such as Melbourne, South Yarra, Royal Park, and Geelong began to flourish and the game developed as a result. By the 1870s the game "Victorian Rules" had become the most popular outdoor winter sport across the state. In subsequent decades, rapid growth in club football occurred and the game attracted increasing media attention.

A longitudinal study of health-related quality of life, fatigue and physical activity in chronic kidney disease patients

This study assessed the health-related quality of life (HRQoL), fatigue and physical activity levels of 28 persons with chronic kidney disease (CKD) on initial administration of an erythropoietin stimulating agent, and at 3 months, 6 months and 12 months. The sample comprised of 15 females and 13 males whose ages ranged from 31 to 84 years. Physical activity was measured using the Human Activity Profile (HAP): Self-care, Personal/Household work, Entertainment/Social, Independent exercise. Quality of life was measured using the SF-36 which gives scores on physical health (physical functioning, role-physical, bodily pain and general health) and mental health (vitality, social functioning, role-emotional and emotional well-being). Fatigue was measured by the Fatigue Severity Scale (FSS). Across all time points the renal sample engaged in considerably less HAP personal/household work activities and entertainment/social activities compared to healthy adults. The normative sample engaged in three times more independent/exercise activities compared to renal patients. One-way Repeated measures ANOVAs indicated a significant change over time for SF-36 scales of role physical, vitality, emotional well-being and overall mental health. There was a significant difference in fatigue levels over time [F(3,11) = 3.78, p<.05]. Fatigue was highest at baseline and lowest at 6 months. The more breathlessness the CKD patient reported, the fewer activities undertaken and the greater the reported level of fatigue. There were no significant age differences over time for fatigue or physical activity. Age differences were only found for SF-36 mental health at 3 months (t=-2.41, df=14, p<.05). Those younger than 65 years had lower emotional well-being compared to those aged over 65. Males had poorer physical health compared to females at 12 months. There were no significant gender differences on mental health at any time point. In the management of chronic kidney disease, early detection of a person’s inability to engage in routine activities due to fatigue is necessary. Early detection would enable timely interventions to optimise HRQoL and independent exercise.

ICT to enhance the triangle of life : the soil, the seed, and the life-giver farmer

This paper reports on the outcomes of an ICT enabled social sustainability project “Green Lanka1” trialled in the Wilgamuwa village, which is situated in the Dambulla district of Sri Lanka. The main goals of the project were focused towards the provision of information about market prices, transportation options, agricultural decision support and modern agriculture practices of the farmer communities to improve their livelihood with the effective use of technologies. The project used Web and Mobile (SMS) enabled systems. The Green Lanka project was sponsored by the Information Communication Technology Agency (ICTA) of Sri Lanka under the Institutional Capacity Building Programme (ICBP) grant scheme which was sponsored by the World Bank. Six hundred families in Wilgamuwa village participated in the project activities. The project was designed, executed and studied through an Action Research approach. The lessons learned through the project activities provide an important understanding of the complex interaction between different stakeholders in the process of implementation of ICT enabled solutions within digitally divided societies. The paper analyses the processes used to reduce the resistance to change and improved involvement of farmer communities in ICT enabled projects. It also analyses the interaction between stakeholders involved in design and implementation of the project activities to improve the chances of project success.

Outcomes of an early feeding practices intervention to prevent childhood obesity

Objective Use a randomised controlled trial (RCT) to evaluate outcomes of a universal intervention to promote protective feeding practices, which commenced in infancy and aimed to prevent childhood obesity Subjects and Methods The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 (SD=1.0) months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed six months after completion of the second information module, 20 months from baseline and when the children were two years old. Maternal feeding practices were self-reported using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI Z-score. Results Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6/9 subscales and 8/8 items (Ps ≤.03) and overall less ‘controlling feeding practices’ (P<.001). They also more frequently used feeding practices (3/4 items; Ps <.01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI Z-score: P=.11), nor in prevalence of overweight/obesity (control 17.9% vs. intervention 13.8%, P=.23). Conclusions Evaluation of NOURISH at child age two years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of 'protective' feeding practices that potentially support the development of healthy eating and growth patterns in young children.

Towards better end-of-life care : a major opportunity for nurses to contribute to the debate

Integrated care pathways are documents which outline the essential steps of multidisciplinary care in addressing a specific clinical problem (Rotter et al., 2010). They can be used to introduce clinical guidelines and systematic audits of clinical practice, and to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. The Liverpool Care Pathway (LCP) is an example of an integrated care pathway, designed in the 1990s to guide care for people who are in their last days of life (Ellershaw et al., 1997, Ellershaw and Ward, 2003)...

Quality of life for older people in residential care is related to connectedness, willingness to enter care, and co-residents

Aim: To establish associations with quality of life (QOL) of older people in long-term residential care facilities in two New Zealand cities. Methods: The outcome measure of QOL was the Life Satisfaction Index. We used multiple linear regression to explore how broad categories of factors might contribute to QOL. Results: A total of 599 people (median age of 85 years; 74% women) participated. Response rates were 85% for facilities and 83% for residents. A resident's QOL was significantly related to the QOL of co-residents. QOL was higher for people who were more positive about entry to residential care, more physically able, and not depressed, and for those with more family and emotional support. Conclusion: Attending to the circumstances around entry to residential care may enhance QOL, as may promoting physical activity, treating depression and ensuring older people remain emotionally connected to their families. In choosing a facility, noting the QOL of co-residents is important.

Using images to communicate the hidden struggles of life on dialysis

Background: Nurse-patient communication in the hemodialysis context is unique given the amount of time spent together in a confined clinical room. Poor communication may lead to low quality nursing care and undesirable patient outcomes. Aim: To explore the use of images as a visual communication technique for nurses and patients in the hemodialysis context. Methods: Descriptive qualitative design. Fifty two cards containing specific photos, illustrations and words were used in conversations between patients (n = 9) and one of two nurse interviewers about being on hemodialysis. Interview transcripts were thematically analysed. Findings: An overall theme titled ‘revealing the hidden struggles of living on dialysis’ conceptually captured three sub-themes: (1) the increased importance of relationships; (2) the struggle with money; and (3) quality over quantity of life. The cards assisted in uncovering these often covert (to nurses) aspects of dialysis patients’ lives. Conclusion: Nurses may need to be aware of the dialysis patients’ hidden struggles which include the importance of relationships, financial issues and the importance of quality aspects such as travel. The use of images may assist in revealing the important issues for each patient struggling with the restrictive life that is imposed by dialysis.