Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

What's wrong with me? Concerns about online medical self-diagnosis

Self-service technologies (SSTs) are becoming increasingly commonplace in healthcare. However, research on the customer (patient) experience in this context is rare. This paper focuses on online medical self-diagnosis, a type of e-health service. This SST can provide customers with benefits such as greater convenience and control, yet we argue that this form of do-it-yourself doctoring also raises concerns for customers. This paper contributes to the service domain by presenting research propositions on the potential negative implications for customers, and their antecedents, of online medical self-diagnosis. We propose that this form of self-diagnosis is related to harms, such as customer anxiety, customer willingness to bypass healthcare professionals, and self-medication. Future research opportunities are discussed, along with implications for policy and practice.

Oxygen delivery to patients after cardiac surgery : a medical record audit

OBJECTIVE: To describe how intensive care nurses manage the administration of supplemental oxygen to patients during the first 24 hours after cardiac surgery.
METHODS: A retrospective audit was conducted of the medical records of 245 adult patients who underwent cardiac surgery between 1 January 2005 and 31 May 2008 in an Australian metropolitan hospital. Physiological data (oxygen saturation measured by pulse oximetry and respiratory rate) and intensive care unit management data (oxygen delivery device, oxygen flow rate and duration of mechanical ventilation) were collected at hourly intervals over the first 24 hours of ICU care.
RESULTS: Of the 245 patients whose records were audited, 185 were male; mean age was 70 years (SD, 10), and mean APACHE II score was 17.5 (SD, 5.14). Almost half the patients (122, 49.8%) were extubated within 8 hours of ICU admission. The most common oxygen delivery device used immediately after extubation was the simple face mask (214 patients, 87%). Following extubation, patients received supplemental oxygen via, on average, two different delivery devices (range, 1-3), and had the delivery device changed an average of 1.38 times (range, 0-6) during the 24 hours studied. Twenty-two patients (9%) received non-invasive ventilation or high-flow oxygen therapy, and 16 (7%) experienced one or more episode of hypoxaemia during mechanical ventilation. A total of 148 patients (60%) experienced one or more episodes of low oxygenation or abnormal respiratory rate during the first 24 hours of ICU care despite receiving supplemental oxygen.
CONCLUSION: These findings suggest that the ICU environment does not protect cardiac surgical patients from suboptimal oxygen delivery, and highlights the need for strategies to prompt the early initiation of interventions aimed at optimising blood oxygen levels in cardiac surgical patients in the ICU.

The influence of medical enduring power of attorney and advance directives on decision making by Australian intensive care doctors

OBJECTIVE: Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans.
DESIGN: We surveyed Australian intensive care doctors, using a hypothetical clinical scenario, to evaluate how potential end-of-life treatment decisions might be influenced by advance planning - the appointment of a medical enduring power of attorney (MEPA) or an advance care plan (ACP). Using open-ended questions we sought to explore the reasoning behind the doctors' decisions.
RESULTS: 275 surveys were returned (18.3% response rate). We found that opinions expressed by an MEPA and ACP have some influence on treatment decisions, but that intensive care doctors had major reservations. Most did not follow the request for palliation made by the MEPA in the hypothetical scenario.
CONCLUSIONS: Many intensive care doctors believe end-of-life decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.

Critique of "cultural fit" in relation to the recruitment of Indian information technologists for the Y2K project in Australia

In this study of intercultural communication, I investigate the multi-faceted meaning of the expression " cultural fit " in the sense that it is used by recruiters when shortlisting Indian information technologists to fill skills shortages for the Y2K project in Australia. The data is in the form of ten videotaped interviews in Bangalore and the recruiter commentary on those tapes in Melbourne. A crucial decision to be made by recruiters in any shortlisting process is " How will the candidate fit into the workplace?" This question becomes more problematical when applied to overseas-trained professionals. I take a critical approach, drawing principally on the research traditions of linguistics where studies of intercultural communication and workplace interaction intersect, employing chiefly the tools of Critical Discourse Analysis and Interactional Sociolinguistics and the more abstract notions of Bourdieu. A bridge between these different discourse approaches is provided by Sarangi & Roberts < 1999 < who show the connection between the larger institutional order and interactional routines, through an elaboration of frontstage talk and backstage talk following Goffman < 1959 < . An analysis of the interviews < frontstage talk < reveals "cultural fit" to involve a knowledge of institutional talk, in particular, directness. The recruiter commentary < backstage talk < draws attention to issues of intelligibility, body language, technical expertise and workplace values. the study shows that Indian Information Technologists have "partial fit" in that they possess technical fit but do not demonstrate, or lack the opportunity to demonstrate in the interview, Australian workplace values such as small talk, humour and informality. The recruiter judgments were fleeting and apart from checking for intelligibility, were made on the basis of candidates' body language thus highlighting its importance and its relative absence from the discourse approaches mentioned above. This study shows clearly that there is room for more communicative flexibility on the part of all the stakeholders.

Australian legal regime on animal based bio-medical research

This thesis, by using evaluative criteria based on overseas law, scientific evidence, philosophy and ethics, concluded that the Australian legal regime regarding animal based bio-medical research for human benefit only partly met one of that regime's major objectives of adequately protecting research animals during the entire research process.

Surgical sterilisation : medical power, women's knowledge

An exploration of women's experience of tubal ligation and the social context in which their contraceptive decision making occurs. This study gives priority to women's knowledge about their own bodies and investigates how women negotiate contraceptive risks, the information provision process, the outcome of tubal ligation in terms of side-effects and the medical responses to women's reporting of their problems. It makes recommendations about the information women should have to meet the requirement of an informed consent when accepting contraceptive surgery.

Interpersonal features of talk in interpreted medical consultations

This linguistic study examined the interpersonal features of the talk between doctors and patients in consultations where a professional medical interpreter was required for them to communicate. Such features affect the relationship between doctor and patient and can impact on medical outcomes. The findings will assist interpreters and doctors in talking to patients and forms part of a larger project to develop a theory of medical interpreting.

A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage

Background: Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years.

Aim: To compare the effectiveness and safety of medical and expectant management with surgical management for first trimester incomplete or inevitable miscarriage.

Methods: Forty women were recruited following diagnosis of incomplete or inevitable miscarriage, and randomised to surgical, medical or expectant care via an off-site, computerised enrolment system. The primary outcome was the effectiveness of medical (vaginal misoprostol) and expectant management relative to surgical evacuation, assessed at 10–14 days and 8 weeks post-recruitment. Infection, pain, bleeding, anxiety, depression, physical and emotional recovery were assessed also. Analysis was by intention-to-treat.

Results: Effectiveness at 8 weeks was lower for medical (80.0%) and expectant (78.6%) than for surgical management (100.0%). Two women in the medical group had confirmed infections. Bleeding lasted longer in the expectant group than in the surgical group. There were no significant differences in pain, physical recovery, anxiety or depression between the groups. 54.6%, 42.9% and 57.1% of the surgical, medical and expectant groups respectively would opt for the same treatment again.

Conclusion: Expectant care appears to be sufficiently safe and effective to be offered as an option for women. Medical management might carry a higher risk of infection than surgical or expectant care.