25074678
Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice.
There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.
32957442
Approach to sustainable primary health care service delivery for rural and remote South Australia.
We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.
31260021
Improving transfer of mental health care for rural and remote consumers in South Australia.
In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.
42040828
The Station Community Mental Health Centre Inc: nurturing and empowering.
INTRODUCTION
Consumer-driven community mental health services play an important role in rehabilitation, recovery, and advocacy in rural and remote Australia. The origins of services often lie in the need to provide options for people with mental illness and their carers when there is a lack of on-the-ground support. This article adds to the information about the strengths and limitations of consumer-driven mental health services by presenting the findings of an evaluation of The Station Inc. in rural South Australia. This consumer-driven mental health service provides a safe and supportive environment, social connections, and activities for its members (those with a lived experience of mental illness). Using a realist evaluation approach, the evaluation identified the contextual factors and the program mechanisms that produce positive outcomes for members.


METHOD
The evaluation was conducted as participatory action research with The Station members, volunteers, management committee members, and staff involved in all phases of the research process. Because of the complexity of The Station's functioning a realist evaluation using qualitative data was conducted to identify how the program worked, for whom, and in what circumstances. Twenty-five in-depth interviews were conducted with participants who were randomly selected from within the groups identified above. Interviews focused on The Station's role in assisting recovery from mental illness, the limitations and strengths of the program, and relationships with the mental health system. The Station's goals, policies and procedures, and the role of stakeholders were analysed in order to identify any links among these contextual factors, program mechanisms, and program outcomes. Qualitative data were entered into descriptive categories in N6 software (QSR; www.qsr.international.com). Data from the stakeholder analysis were entered into Microsoft Excel. Using an iterative approach to include the three data sets, a model was developed that identified important contextual factors that linked with two groups of program mechanisms that produced positive outcomes for members.


RESULTS
Program mechanisms are categorised by descriptive themes referred to as 'nurturing' and 'empowering'. Nurturing' is experienced as feeling of belonging and being accepted 'as one is' and 'empowerment' mechanisms engender a belief in oneself. Respondents identified features of The Station's program, policies, atmosphere, connections and networks, stakeholder relationships, and staff and volunteers that are nurturing and empowering. Five key contextual factors enable the program mechanisms to work. The Station's coordinators ensure that nurturing and empowerment processes are highlighted through careful facilitation. The governance arrangements, policies, and administrative systems at The Station are well developed but flexibly implemented so that they support the nurturing and empowerment processes. Support and legitimacy for the program is obtained from the mental health system at state and local levels. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate.


CONCLUSIONS
Information about the benefits and limitations of consumer-driven mental health services in rural and remote Australia is in short supply. Increasing the available information about the contribution these services make may result in services being legitimised, understood, and resourced within mental health systems thus making the services sustainable. The benefits of consumer-driven services are that they provide flexibility and adaptation, an ability to capture the energy and passion of rural communities to improve the wellbeing of community members, and they overcome the power differential that exists between professionals and 'patients' or 'clients'.
12906963
Unique issues in research and evaluation in rural and remote locations: is there a place for specific research training?
BACKGROUND
There is increased interest in building research capacity in rural health research in Australia and internationally. In Australia, the Primary Health Care Research Evaluation and Development program funded by the Australian Government has supported this move. Overall this program aims to build the quantum of primary healthcare research to underpin clinical practice, health systems improvement, and policy. In order to achieve this objective, one strand of the program aims to build research capacity among practitioners. In implementing this program in rural and remote areas of the west of South Australia, the Spencer Gulf Rural Health School has identified methodological and research design issues faced by practitioners who are researching in their communities. These issues include problems encountered in living and researching in the same location and accessing small-scale statistical information. We were interested to know whether there was interest in a formal course (Rural Research and Evaluation) that would address these issues and provide information about community-based research designs.


METHODS
A cross-sectional anonymous survey was designed and sent to 141 organisations in the health, human service, and local government sectors in regional South Australia. Respondents were asked to evaluate the demand and interest for a new course--Rural Research and Evaluation. The term 'rural' was used to refer to both rural and remote locations. Information was sought on the respondent's role in the organisation, current level of research participation, views about the proposed course content, and factors that the respondent thought would facilitate or inhibit their participation. The majority of questions were close-ended.


RESULTS
Sixty surveys were returned giving a 42.5% response rate. Data were analysed using descriptive statistics. A high level of research and evaluation activity was reported with 80% of respondents undertaking research or evaluation as part of their professional role. There was also agreement that all the proposed topics were important to be included in a course. Each of the topics was ranked at four or five on a five-point scale by at least 58% of respondents. The topic 'understanding evaluation methodologies' was ranked at four or five by 85% of respondents, making it the most highly ranked topic. There was also consensus about the features respondents thought would make the course attractive for them to study. Over half (62%) of the respondents ranked having lecturers with a broad rural research background at five, very important, on a five-point scale. Almost half (48%) of the respondents ranked online delivery at five, a very important factor in making the course attractive to study.


CONCLUSIONS
Those interested in research and evaluation may have been more likely to return the survey and there may have been respondent bias in this regard. Therefore the results must be interpreted with caution. However, the level of agreement with the proposed course topics may suggest that these reflect important issues in undertaking research and evaluation in rural and remote locations. If this is the case there is value in discussion about how these issues are dealt with in different contexts in order to overcome some of the barriers to effective research.
6962773
Heritability of Wisconsin Card Sorting Test (WCST) and Stroop Color-Word Test performance in normal individuals: implications for the search for endophenotypes.
A surge in the search for endophenotypes for psychiatric disorders has occurred in the past several years. An important criterion of an endophenotype is that it is heritable. Two of the most widely used executive cognitive functioning measures are the Wisconsin Card Sorting Test (WCST) and the Stroop Color-Word Test. Each has been considered as a possible endophenotype. However, research on the heritability of each of these measures is sparse, and in the case of the WCST, mixed. As part of a pilot twin study examining cognitive functioning and personality in adults, the WCST and the Stroop were administered to 80 monozygotic and 29 dizygotic twin pairs screened for absence of neurological disease and head injury. Results replicated and extended previous findings for moderate heritability of Stroop performance. However, the WCST showed little evidence of genetic influence, suggesting that it might not meet one of the criteria for an endophenotype.
205326823
Practitioner assessments of 'good enough' parenting: factorial survey.
AIM
The aim of this study was to measure health visitors' professional judgements on 'good enough' parenting and identify what factors and combinations of these are important when making such judgements.


BACKGROUND
The relationship between parenting and child health is unclear. Whilst agreement exists that 'good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define 'good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements.


DESIGN
Factorial survey methods were employed using vignette techniques.


METHODS
Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario.


ANALYSIS
Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported.


RESULTS
The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing.


CONCLUSIONS
Most professionals can articulate what makes a 'good' parent, equally they may have strong views regarding what constitutes 'poor' parenting. The difficulty is in determining when parenting is 'good enough' to provide a child with a nurturing environment.


RELEVANCE TO CLINICAL PRACTICE
This study suggests that practitioners move their thresholds of what is 'good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children.
24733801
Salutogenesis as a framework for child protection: literature review.
AIM
The aim of this paper is to demonstrate the usefulness of salutogenesis in work relating to child protection.


METHODS
A systematic review to explore the links between parenting, social factors and failure to thrive was carried out using 17 CD ROM and online databases using keywords in appropriate medical subject headings (MeSH terms) and Boolean operators refined for the studies. The salutogenic framework was then used as a way of clarifying what benefit particular research findings may have in identifying and using factors which can be associated with protection, safety and well being of children. Cross-referencing the evidence from the systematic review against Antonovsky's generalized resistance resources created a salutogenic matrix.


FINDINGS
Four factors in the systematic review were found crucially important: parent factors; parenting factors; child factors; and social factors. However, it is probable that these are useful within all child protection research and the evidence gathered in particular cases (here failure to thrive) could be plotted against each factor. Application of a salutogenic framework to the results was further illuminating and has utility for both systematic review methodology and other child protection explorations. The matrix created a warp and weft effect that identified gaps in current evidence and practice and was able to disentangle some of the complexities inherent within failure to thrive situations. By beginning to shed understanding on such processes, the concept of salutogenesis added further depth and rigour to the analysis.


CONCLUSIONS
The concept of salutogenesis is widely used in some areas of nursing practice and research, and can also be regarded as a theoretical tool that has potential in child care and protection research, development and practice. The paper also illustrates the importance of a sound theoretical framework in ensuring depth and rigour in analyses of literature review findings.
12250389
Letter: Evidence for non-repetitive subunits in the genome of Rous sarcoma virus.
3459683
Quality improvements in resident mobility care: using person- and relationship-centered frameworks.
PURPOSE OF THE STUDY
Research is needed to demonstrate the application of person- and relationship-centered care to nursing home practice. This article aimed to find a suitable person/relationship-centered framework to assist with mobility care practice improvements in nursing homes.


DESIGN AND METHOD
The authors discuss the task of mobility care, the nature of person- and relationship-centered care, and the significance of such approaches to mobility care. The Senses Framework (Nolan, Davies, Ryan, & Keady, 2008) is employed to develop mobility care practice improvement objectives.


RESULTS
The objectives are used to evaluate outcomes from 2 hypothetical scenarios to illustrate the possible value of the Senses Framework.


IMPLICATIONS
The Senses Framework facilitated development of objectives for mobility care practice improvement that considers the needs of all stakeholders.