The impact of rehabilitation support services on health-related quality of life for women with breast cancer

As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre/post-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20-40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

Background: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. Methods: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/ use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. Results: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. Conclusion: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Wireless telemedicine for the delivery of specialist paediatric services to the bedside

A mobile interactive online health system was used to conduct virtual ward rounds at a regional hospital which had no specialist paediatrician. The system was wireless, which allowed telepaediatric services to be delivered direct to the bedside. Between December 2004 and May 2005, 43 virtual ward rounds were coordinated between specialists based in Brisbane and local staff at the Gladstone Hospital. Eighty-six consultations were provided for 64 patients. The most common conditions included asthma (27%), chest infections (12%), gastroenteritis (10%) and urinary tract infections (10%). In the majority of cases, there were partial (67%) or complete changes (11%) in the clinical management of patients. Specialist services were offered by a team of 13 clinicians at the Royal Children's Hospital: 10 general paediatricians, two physiotherapists and one registered nurse. Feedback from all consultants involved in the service and local staff in Gladstone was extremely positive. In 43 videoconference calls there were three technical problems, probably due to an intermittent mains power supply at the regional hospital. There appears to be potential for other rural and regional hospitals to adopt this model of service delivery.

Delivery of child development services by videoconferencing: a review of four years' experience in Queensland

In 2001 the Child Development Unit (CDU) in Brisbane piloted a series of monthly multidisciplinary case discussions via videoconference in the area of child development. During 2001 two sessions were provided; during 2004 there were 40. The substantial growth in 2004 was due to the expansion of child development services to include special interest group meetings and multipoint case conference meetings. In 2004, a total of 49 h of videoconferencing was conducted. The average session length was 75 min. Education and training sessions were delivered to 32 hospitals and health centres in Queensland and northern New South Wales. The maximum number of sites involved during a single videoconference was 25. The average number of attendees for each videoconference was five per site, including allied health staff, nurses and paediatricians. The delivery of child development services via videoconference has been shown to be useful in Queensland, especially for allied health staff working in regional and remote areas. The growth of the programme indicates its acceptance as a mainstream child development service in Queensland.

Fear of crime in Brisbane - Individual, social and neighbourhood factors in perspective

Numerous theories apply to fear of crime and each are associated with different kinds of variables. Most studies use only one theory, though this study examines the relative importance of different kinds of variables across a number of theories. The study uses data from a survey of residents in Brisbane, Australia to examine the relative importance of individual attributes, neighbourhood disorder, social processes and neighbourhood structure in predicting fear of crime. Individual attributes and neighbourhood disorder were found to be important predictors of fear of crime, while social processes and neighbourhood structure were found to be far less important. The theoretical implications are that the vulnerability hypothesis and the incivilities thesis are most appropriate for investigating fear of crime, though social disorganization theory does provide conceptual support for the incivilities thesis. Although social processes are less important in predicting fear of crime than neighbourhood incivilities, they are still integrally related to fear of crime: they explain how incivilities arise, they buffer against fear of crime, and they are affected by fear of crime.

The effect of music therapy services on classroom behaviours of newly arrived refugee students in Australia

This pilot study examined the effects of a short-term music therapy program on the classroom behaviours of newly arrived refugee students who were attending an intensive 'English as a Second Language' secondary school. A cross-over design with two five-week intervention periods was employed with group music therapy sessions conducted one or two times per week. Data from the Behaviour Assessment Scale for Children were used to evaluate a range of positive and negative school behaviours. A significant decrease in externalising behaviours was found with particular reference to hyperactivity and aggression. No significant differences were found in other behaviours. Explanations and implications of these findings are discussed.

Performance measurement of intensive care services in hospitals:The case of Barbados

The Intensive Care Unit (ICU) being one of those vital areas of a hospital providing clinical care, the quality of service rendered must be monitored and measured quantitatively. It is, therefore, essential to know the performance of an ICU, in order to identify any deficits and enable the service providers to improve the quality of service. Although there have been many attempts to do this with the help of illness severity scoring systems, the relative lack of success using these methods has led to the search for a form of measurement, which would encompass all the different aspects of an ICU in a holistic manner. The Analytic Hierarchy Process (AHP), a multiple-attribute, decision-making technique is utilised in this study to evolve a system to measure the performance of ICU services reliably. This tool has been applied to a surgical ICU in Barbados; we recommend AHP as a valuable tool to quantify the performance of an ICU. Copyright © 2004 Inderscience Enterprises Ltd.

To link or not to link: a test of the case linkage principles using serial car theft data

The purpose of the present study is to test the case linkage principles of behavioural consistency and behavioural distinctiveness using serial vehicle theft data. Data from 386 solved vehicle thefts committed by 193 offenders were analysed using Jaccard's, regression and Receiver Operating Characteristic analyses to determine whether objectively observable aspects of crime scene behaviour could be used to distinguish crimes committed by the same offender from those committed by different offenders. The findings indicate that spatial behaviour, specifically the distance between theft locations and between dump locations, is a highly consistent and distinctive aspect of vehicle theft behaviour; thus, intercrime and interdump distance represent the most useful aspects of vehicle theft for the purpose of case linkage analysis. The findings have theoretical and practical implications for understanding of criminal behaviour and for the development of decision-support tools to assist police investigation and apprehension of serial vehicle theft offenders.

Assessing the effectiveness of business support services in England:evidence from a theory based evaluation

In England, publicly supported advice to small firms is organized primarily through the Business Link (BL) network. Using the programme theory underlying this business support, we develop four propositions and test these empirically using data from a new survey of over 3000 English SMEs. We find strong support for the value to BL operators of a high profile to boost take-up. We find support for the BL’s market segmentation that targets intensive assistance to younger firms and those with limited liability. Allowing for sample selection, we find no significant effects on growth from ‘other’ assistance but find a significant employment boost from intensive assistance. This partially supports the programme theory assertion that BL improves business growth and strongly supports the proposition that there are differential outcomes from intensive and other assistance. This suggests an improvement in the BL network, compared with earlier studies, notably Roper et al. (2001), Roper and Hart (2005).

A profile of low vision services in England the Low Vision Service Model Evaluation (LOVSME) project

In the UK, low vision rehabilitation is delivered by a wide variety of providers with different strategies being used to integrate services from health, social care and the voluntary sector. In order to capture the current diversity of service provision the Low vision Service Model Evaluation (LOVSME) project aimed to profile selected low vision services using published standards for service delivery as a guide. Seven geographically and organizationally varied low-vision services across England were chosen for their diversity and all agreed to participate. A series of questionnaires and follow-up visits were undertaken to obtain a comprehensive description of each service, including the staff workloads and the cost of providing the service. In this paper the strengths of each model of delivery are discussed, and examples of good practice identified. As a result of the project, an Assessment Framework tool has been developed that aims to help other service providers evaluate different aspects of their own service to identify any gaps in existing service provision, and will act as a benchmark for future service development.

The investigation of crime:the myths and the reality

Initially the study focussed on the factors affecting the ability of the police to solve crimes. An analysts of over twenty thousand police deployments revealed the proportion of time spent investigating crime contrasted to its perceived importance and the time spent on other activities. The fictional portrayal of skills believed important in successful crime investigation were identified and compared to the professional training and 'taught skills’ given to police and detectives. Police practitioners and middle management provided views on the skills needed to solve crimes. The relative importance of the forensic science role. fingerprint examination and interrogation skills were contrasted with changes in police methods resulting from the Police and Criminal Evidence Act and its effect on confessions. The study revealed that existing police systems for investigating crime excluding specifically cases of murder and other serious offences, were unsystematic, uncoordinated, unsupervised and unproductive in using police resources. The study examined relevant and contemporary research in the United States and United Kingdom and with organisational support introduced an experimental system of data capture and initial investigation with features of case screening and management. Preliminary results indicated increases in the collection of essential information and more effective use of investigative resources. In the managerial framework within which this study has been conducted, research has been undertaken in the knowledge elicitation area as a basis for an expert system of crime investigation and the potential organisational benefits of utilising the Lap computer in the first stages of data gathering and investigation. The conclusions demonstrate the need for a totally integrated system of criminal investigation with emphasis on an organisational rather than individual response. In some areas the evidence produced is sufficient to warrant replication, in others additional research is needed to further explore other concepts and proposed systems pioneered by this study.