Sticking up for Victoria? - Victoria's Legislative Council inquires into the performance of the Australian Health Practitioner Regulation Agency

This article analyses the report of the Victorian Legislative Council’s Legal and Social Issues Legislation Committee (‘Committee’) from its Inquiry into the Performance of the Australian Health Practitioner Regulation Agency (AHPRA). AHPRA is a national body that provides administrative support for the National Registration and Accreditation Scheme (NRAS), under which practitioners in 14 health professions across Australia are regulated. The article considers the Committee’s fi ndings and recommendations in light of the impetuses for the creation of the NRAS, as well as the structure and implementation of the NRAS and AHPRA. It is argued that that the value of the Committee’s report is confi ned to its identifi cation of important issues concerning the NRAS and AHPRA that, in the near future, will require a more critical and comprehensive investigation than the Committee undertook.

E-learning opportunities and challenges for legal education in rural Victoria

Access to justice extends beyond consideration of the systems and institutions of justice; it includes infrastructure such as transport, health, education and communications. Rural, regional and remote (‘RRR’) communities are more likely to face difficulties in accessing advice and accurate information on laws and processes available for resolution of disputes. Perhaps more fundamentally, they rarely have a voice in effecting reforms in laws and related policies. For several decades, community legal centres, legal aid, courts, and a range of other institutions have used community legal education programs to improve knowledge and access to law and justice systems, services and organisations. The recent Productivity Commission Inquiry into Access to Justice Arrangements notes that, ‘Better coordination and greater quality control in the development and delivery of these [community legal education, legal information] services would improve their value and reach.’ At the same time, research into the professional needs of RRR legal practitioners has found that many of these practitioners face considerable difficulties accessing good quality continuing professional development (‘CPD’) and informal networking/support opportunities.6 Current and emerging internet-based technologies open up opportunities for legal organisations to better meet the educational needs of both rural communities and legal practitioners. Though limitations still exist at multiple levels, relatively low-cost, media-rich, synchronous and tailored education programs can now be delivered effectively in many rural and remote areas. However, complex layers of decisions are required to critically assess, harness and optimise technologies to best suit the needs of users, and to utilise teaching and learning techniques that best match the technologies and participant needs. Getting these elements — needs, technology and learning technique — right, nevertheless offers extraordinary opportunities. Sound decisions and good practices should enable state-wide and specialist law and justice-related services interested in improving their engagement with RRR communities to dramatically improve the reach and quality of outcomes, not only for distant participants but the spectrum of stakeholders.

Retrospective analysis of cancer survival across South-Western Victoria in Australia

OBJECTIVE: This paper aims to describe cancer survival and examine association between survival and socio-demographic characteristics across Barwon South-Western region (BSWR) in Victoria, Australia. DESIGN: This study is based on the retrospective cohort database of patients accessing oncology services across BSWR. SETTING: Six rural and three urban hospital settings across the BSWR. PARTICIPANTS: The participants were patients who were diagnosed with cancer in 2009. MAIN OUTCOME MEASURES: Overall survival (OS) of participants was the main outcome measure. RESULTS: Total of 1778 eligible patients had four-year OS for all cancers combined of 59.7% (95% CI, 57.4-62.0). Improved OS was observed for patients in the upper socio-economic tertile (64.2%; 95% CI, 60.9-67.5) compared to the middle (59.3%; 95% CI, 55.5-63.1) and lowest tertiles (49.6%; 95% CI, 44.2-54.9) (P < 0.01). On multivariate analyses, higher socio-economic status remained a significant predictor of OS adjusting for gender, remoteness and age (HR [hazard ratio] 0.81; 95% CI 0.74-0.89; P < 0.01). Remoteness was significantly associated with improved OS after adjusting for age, gender and socio-economic status (HR 0.86; 95% CI, 0.77-0.97; P = 0.01). Older age ≥70 years compared to <70 years conferred inferior OS (HR 3.08; 95% CI, 2.64-3.59; P < 0.01). CONCLUSIONS: Our study confirmed improved survival outcomes for patients of higher socio-economic status and younger age. Future research to explain the unexpected survival benefit in patients who lived in more remote areas should examine factors including the correlation between geographical residence and eventual treatment facility as well as compare the BSWR care model to other regions' approaches.

The origins, development and perceived effectiveness of horticulture-based therapy in Victoria

 This study found that horticulture based therapy in Victoria provides a wide range of benefits in health and community settings. Programs were largely informal and provided by dedicated individuals. A higher profile and professional systems and structure would assist therapeutic horticulture to reach its potential in Victoria.

Change of school in early adolescence and adverse obesity-related dietary behavior: a longitudinal cohort study, Victoria, Australia, 2013-2014

INTRODUCTION: Environments that facilitate energy-dense, nutrient-poor diets are associated with childhood obesity. We examined the effect of a change of school environment on the prevalence of obesity and related dietary behavior in early adolescence. METHODS: Fifteen schools in Victoria, Australia, were recruited at random from the bottom 2 strata of a 5-level socioeconomic scale. In 9 schools, students in grade 6 primary school transitioned to different schools for grade 7 secondary school, whereas in 6 schools, students remained in the same school from grade 6 to grade 7. Time 1 measures were collected from students (N = 245) in grade 6 (aged 11-13 y). Time 2 data were collected from 243 (99%) of the original cohort in grade 7. Data collected were dietary recall self-reported by students via questionnaire, measured height and weight of students, and aspects of the school food environment via school staff survey. Comparative and mixed model regression analyses were conducted. RESULTS: Of 243 students, 63% (n = 152) changed schools from time 1 to time 2, with no significant difference in weight status. Students who changed schools reported an increase in purchases of after-school snack food, greater sweetened beverage intake, fewer fruit-and-vegetable classroom breaks, and less encouragement for healthy eating compared with students who remained in the same school. School staff surveys showed that more primary than secondary schools had written healthy canteen policies and fewer days of canteen or food services operation. CONCLUSION: A change of school environment has negative effects on children's obesity-related dietary behavior. Consistent policy is needed across school types to support healthy eating in school environments.

Complementary medicine use among people living with HIV/AIDS in Victoria, Australia: practices, attitudes and perceptions

There is limited evidence suggesting the underlying reasons for the use of complementary and alternative medicines (CAMs) by people with HIV/AIDS, or individual attitudes and beliefs about the use of CAMs. Using focus groups and a survey with 151 individuals attending the HIV Clinics at The Alfred Hospital, Melbourne, we aimed to provide insights into factors that influence the use of CAMs among people living with HIV/AIDS. Roughly half (49%) of the participants had used CAMs to manage their HIV/AIDs. Users of CAMs utilized a wide range of treatments in managing their condition, but costs of the CAMs meant that users were not necessarily able to use them as much as they might have liked. Use of CAMs was based on a desire to find something beneficial rather than on being dissatisfied with conventional medicine. Further research is needed into (a) the effects of CAMs and (b) the enhancement of communication and collaboration between patients, doctors and complementary medicine practitioners.

Assessing spatio-temporal hydrologic variability: a case-study in western Victoria

This research explored spatial and temporal variability in the relationships between land cover, topography, and climate on streamflows and wetland extents in western Victoria.

The corrections Victoria program change manual

This manual has been written to guide the assessment of change in each of the programs currently offered by the Offending Behaviour Programs Branch, Corrections Victoria. The aim is to identify a set of outcome measures that can be used to both evaluate the overall effectiveness of a program as well as inform judgements about the changes that individual offenders have made over the course of their program participation. Accordingly, the focus is on the assessment of short-term change and not on other areas of assessment, such as assessing changes in risk of reoffending, identifying intervention needs, or establishing an offender’s suitability or eligibility to take part in a program.

Peer group patterns of adolescent alcohol using behaviours in Victoria, Australia and Washington State, US

 The goal of this study was to examine and cross-nationally compare the peer group patterns of alcohol-drinking behaviors among cohorts of early adolescents (ages 11–14 years) in Victoria, Australia, and Washington State, United States. Latent transition analysis revealed that after 1 year, transitions congruent with peer influence (whereby non-drinking adolescents initiated alcohol use in the presence of drinking peers) and reverse peer influence were observed in both states; however, transitions congruent with peer selection (whereby drinking adolescents self-selected into drinking peer groups) were only observed among Victorian early adolescents. Findings were interpreted to suggest that Australian family and cultural norms that more commonly allow early adolescent alcohol use lead to a higher rate of peer selection.

Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals

Aim: Poor nutritional status has negative effects on post-operative outcomes, further compounded by surgical stress and fasting, places gastrointestinal surgery patients at high risk of malnutrition. Recent published research has challenged historic surgical nutrition practices; however, changes to practice in Australia have been slow. The aim of this study was to investigate current nutritional management of gastrointestinal surgery patients and compare this with the best practice guidelines, while exploring enablers to implementation of best practice. Methods: A 30-question telephone survey was developed to explore demographics and nutritional management of gastrointestinal surgical patients during pre-admission, inpatient stay and post-operative care. Forty-one gastrointestinal surgery dietitians were identified and contacted from 31 public hospitals in Victoria, Australia, and invited to participate. Results: Twenty-five dietitians participated in the survey (response rate 61%). Very few dietitians (12%) were funded for pre-admission clinics or outpatient clinics, and, overwhelmingly, dietitians reported not being involved in nutritional decision-making, and reported feeling unsatisfied with current nutritional management of patients. Despite half the hospitals reporting following best practice guidelines, only 22% implemented guidelines completely. There was no correlation observed between dietitian experience, department size or full-time equivalents allocated to surgery and nutritional intervention; however, the presence of a care pathway made a significant difference to the dietitian's overall satisfaction with dietetic care (P = 0.002). Conclusions: Current nutritional management of gastrointestinal surgery patients in Victorian hospitals is far from best practice. The implementation of a care pathway is the most effective way of ensuring best practice nutritional management of gastrointestinal surgical patients.