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Abstract Background Complementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study. Methods A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics. Results Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books. Conclusions Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.

Abstract Background Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. Methods We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway; (2) derive draft criteria; (3) pilot test the criteria; and (4) modify criteria to maximise agreement between review authors. Results Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model', 'care map', 'multidisciplinary care', evidence-based care' and 'guideline'. Conclusions The criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway.

Abstract Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion Improved compliance with thrombolytic guidelines via clinical pathways will increase acute myocardial infarction survival rates in rural hospitals and thereby help to reduce rural-urban mortality inequalities. Such knowledge translation has the potential to be adapted for a range of clinical problems in a wide array of settings. Trial registration Australia New Zealand Clinical Trials Registry code ACTRN12608000209392.

A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of 'supply', is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just 'supply'. The pipeline metaphor is disrupted with concerns about a range of other 'gaps' – gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline. [ABSTRACT FROM AUTHOR]

WHO WOULD you rather be led by: an engaging nurse or a heroic one? Is it better to be led by a charismatic visionary who is faster than a speeding [...]

Purpose – Factors for successful workplace health promotion (WHP) are well described in the literature, but often sourced from evaluations of wellness programmes. Less well understood are the features of an organisation that contribute to employee health which are not part of a health promotion programme. The purpose of this paper is to inform policy on best practice principles and provide real life examples of health promotion in regional Victorian workplaces. Design/methodology/approach – Individual case studies were conducted on three organisations, each with a health and wellbeing programme in place. In total, 42 employers and employees participated in a face to face interview. Interviews were transcribed verbatim and the qualitative data were thematically coded. Findings – Employers and senior management had a greater focus on occupational health and safety than employees, who felt that mental/emotional health and happiness were the areas most benefited by a health promoting workplace. An organisational culture which supported the psychosocial needs of the employees emerged as a significant factor in employee's overall wellbeing. Respectful personal relationships, flexible work, supportive management and good communication were some of the key factors identified as creating a health promoting working environment. Practical implications – Currently in Australia, the main focus of WHP programmes is physical health. Government workplace health policy and funding must expand to include psychosocial factors. Employers will require assistance to understand the benefits to their business of creating environments which support employee's mental and emotional health. Originality/value – This study took a qualitative approach to an area dominated by quantitative biomedical programme evaluations. It revealed new information about what employees really feel is impacting their health at work. [ABSTRACT FROM AUTHOR]

Indigenous people globally remain resilient yet vulnerable to the threats of HIV. Although Australian Aboriginal and Torres Strait Islander peoples experience the worst health status of any identifiable group in Australia, with a standardized morbidity rate three times that of non-Indigenous Australians, the Australian response to HIV has resulted in relatively low and stable rates of HIV infection among Australia's Indigenous peoples. This paper examines the reasons for the success of HIV prevention efforts. These include early recognition by Indigenous peoples of the potential effect that HIV could have on their communities; the supply of health hardware (needle and syringe programs and condoms); the development and implementation of culturally-appropriate health promotion messages such as the internationally-recognized Condoman campaign; the inclusion of dedicated Aboriginal and Torres Strait Islander Sexual Health Workers in communities; and an inclusive policy and partnership approach. Furthermore, the efforts of peak Aboriginal health organizations including NACCHO and its member services and Indigenous programs in peak mainstream organizations like AFAO and its member organizations, have all contributed to prevention success. Efforts need to be maintained however to ensure an escalated epidemic does not occur, particularly among heterosexual people, especially women, and people who inject drugs. New ideas are required as we enter a new era of HIV prevention within the context of the new paradigm of treatment as prevention, and getting to zero new infections. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the influences on accessibility of compounded progesterone therapy for Australian women. Study design: A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the ‘Perspectives on Progesterone’ questionnaire. Main outcome measures: Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups. Results: Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged. The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines. Conclusion: Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it. [Copyright &y& Elsevier]

This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs. The authors searched the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED, and Global Health. Twenty-seven studies considering a total of 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications (odds ratio 0.58: 95% CI [0.36, 0.94] and improved documentation (odds ratio 11.95: 95% CI [4.72, 30.30]) associated with clinical pathways. Considerable variation in study design and settings prevented statistical pooling of results for length of stay (LOS) and hospital costs. The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation. [ABSTRACT FROM AUTHOR]

The commentary provided by Vanhaecht et al. from the European Pathways Association (EPA) questions whether conclusions derived from the review of effects of clinical pathways in hospitals are appropriate. They provide some methodological discussion that indicates a poor appreciation of the detailed content of the review as published in the Cochrane Library and a lack of understanding of the methodological requirements for complex interventions of the Cochrane Effective Practice and Organisation of Care (EPOC) group. In addition, Vanhaecht et al. misrepresent some important points from the review relating to the intervention reviewed. The critical commentary offered by Vanhaecht et al. is a misrepresentation of the process and content of the review and suggests they have not taken the time and effort to thoroughly read and understand this comprehensive review. [ABSTRACT FROM AUTHOR]

Critical theorists from Walter Benjamin to Arthur Kroker and Debra Lupton have commented on how end-of-century or end-of-millennium social anxieties manifest in crises of social or subjective integrity including widespread social panic responses to perceived threats to such integrity. During the last 2 decades we have seen such a response to a range of public health issues, including obesity, drug use in sport, binge drinking, rural mental health, and the sexual health of social minorities. In this series of autoethnographic reflections, based in the framework of analytic autoethnography established by Leon Anderson (2006), 1 examine the impact of these panic discourses on the experience of living with a chronic disease. Particularly I examine the medicalization of HIV-infected bodies, the surveillance and governance of HIV-positive bodies, and the systematic distortions to self-care that result from the internalization of tropes of toxic or panic bodies. I also explore the possibilities for an emancipatory resistance to these tropes, and the place of hope and public health citizenship in the subjectivities of the chronically ill. [ABSTRACT FROM AUTHOR]

Canada–France–Hawaii Telescope Legacy Survey optical photometry has been used to study the galaxy luminosity functions (LFs) of 14 X-ray selected clusters from the XMM Large Scale Survey (XMM–LSS) survey. These are mostly groups and poor clusters, with masses ( M500) in the range 0.6 to and redshifts . Hence, these are some of the highest redshift X-ray selected groups to have been studied. Lower and upper colour cuts were used to determine cluster members. We derive individual LFs for all clusters as well as redshift-stacked and temperature-stacked LFs in three filters, and , down to . All LFs were fitted by Schechter functions which constrained the faint-end slope, α, but did not always fit well to the bright end. Derived values of α ranged from −1.03 to as steep as −2.1. We find no evidence for upturns at faint magnitudes. Evolution in α was apparent in all bands: it becomes shallower with increasing redshift; for example, in the band it flattened from −1.75 at low redshift to −1.22 in the redshift range . Eight of our systems lie at , and we combine these to generate a galaxy LF in three colours for X-ray selected groups and poor clusters at redshift 0.3. We find that at is steeper (−1.67) in the green band than it is (−1.30) in the red band. This colour trend disappears at low redshift, which we attribute to reddening of faint blue galaxies from to 0. We also calculated the total optical luminosity and found it to correlate strongly with X-ray luminosity , and also with ICM temperature , consistent with expectations for self-similar clusters with constant mass-to-light ratio. We did not find any convincing correlation of Schechter parameters with mean cluster temperature. [ABSTRACT FROM AUTHOR]

Background: People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design: The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion: Improved compliance with thrombolytic guidelines via clinical pathways will increase acute myocardial infarction survival rates in rural hospitals and thereby help to reduce rural-urban mortality inequalities. Such knowledge translation has the potential to be adapted for a range of clinical problems in a wide array of settings. Trial registration: Australia New Zealand Clinical Trials Registry code ACTRN12608000209392. [ABSTRACT FROM AUTHOR]

We present a joint weak lensing and X-ray analysis of 4 deg2 from the CFHTLS and XMM-LSS surveys. Our weak lensing analysis is the first analysis of a real survey using shapelets, a new generation weak lensing analysis method. We create projected mass maps of the images, and extract six weak-lensing-detected clusters of galaxies. We show that their counts can be used to constrain the power-spectrum normalization for . We show that despite the large scatter generally observed in the mass–temperature relation derived from lensing masses, tight constraints on both its slope and normalization M* can be obtained with a moderate number of sources provided that the covered mass range is large enough. Adding clusters given by Bardeau et al. to our sample, we measure . Although they are dominated by shot noise and sample variance, our measurements are consistent with currently favoured values, and set the stage for future surveys. We thus investigate the dependence of those estimates on survey size, depth and integration time, for joint weak lensing and X-ray surveys. We show that deep surveys should be dedicated to the study of the physics of clusters and groups of galaxies. For a given exposure time, wide surveys provide a larger number of detected clusters and are therefore preferred for the measurement of cosmological parameters, such as σ8 and M*. We show that a wide survey of a few hundred square degrees is needed to improve upon current measurements of these parameters. More ambitious surveys covering 7000 deg2 will provide the 1 per cent accuracy in the estimation of the power-spectrum and the relation normalizations. [ABSTRACT FROM AUTHOR]

We present an analysis of three strong, intervening Mg II absorption systems towards the optical afterglow of gamma-ray burst (GRB) 060418. From high-resolution Ultraviolet and Visual Echelle Spectrograph (UVES) spectra we measure metal column densities and find that the highest redshift absorber exhibits a large amount of dust depletion compared with damped Lyman absorbers (DLAs) seen in quasi-stellar object (QSO) spectra. The intervening absorber is also unusual in exhibiting a clear 2175-Å bump, the first time this feature has been definitively detected in a GRB spectrum. The GRB afterglow spectrum is best fitted with a two-component extinction curve: a Small Magellanic Cloud (SMC) extinction law at (the redshift of the host) with and a Galactic extinction curve at with . We also present a moderately deep New Technology Telescope (NTT) R-band image of the GRB 060418 field and spectroscopy of four galaxies within 1 arcmin. None of these objects has a redshift that matches any of the intervening absorbers, and we conclude that the galaxies responsible for the two intervening Mg ii absorbers at have luminosities . [ABSTRACT FROM AUTHOR]

This paper reports on ethnographic research on the culture-specific barriers that masculinity poses to preventing HIV transmission in the sexual lives of Pitjantjatjara men. The investigation had three objectives: investigating how the Pitjantjatjara people model the physical and social development of adult male bodies; describing the nature, range and cultural dynamics of sexual practice among Pitjantjatjara men; and delineating health and infection risks posed by sexual practice. The study used classical ethnographic approaches to investigate the deployment of men's bodies within systems of cultural production and reproduction, and post-Foucauldian analysis to examine culture-specific technologies of the self. Data were collected using participant observation, key informant interviews, and sexual life history interviews. Key findings are that the Pitjantjatjara deploy the capacities for reproduction and pleasure of men's bodies in culturally specific ways, and that men are trained in culturally approved uses of these capacities in ways that are resistant to change. The introduction of safe sex technologies in this context requires close attention to the specific content and methods by which men's self understandings are developed. [ABSTRACT FROM AUTHOR]

This paper describes findings from fieldwork conducted among Pitjantjatjara tribespeople of Central Australia between 1989 and 1997. The study examined the impact of a distinctive gender system and practices of masculinity, particularly sexual and ritual practices, on the risk of contracting sexually transmissible infections and other blood-borne diseases. The research was designed as an ethnography of masculinity, conducted via participant observation, life history interviews, ritual analysis, and critical reflection on the work of early ethnographers. The paper presents selected field data, examined in the light of early twentieth century anthropological description of Pitjantjatjara sexuality. It identifies a systematic deflection of male same-sex attraction away from possible resolution through sexual practices between men. Key components of this deflection are the ritual construction of a culturally distinctive masculinity, the inextricable linkage between masculinity rites and the system for arranging marriages, and the cultural coding of the penis during ritual. The paper concludes that although men may feel erotic attraction for each other, the gender and kinship systems of the Pitjantjatjara conspire to limit completely the possibilities for the physical, sexual expression of this attraction. The findings reported here add to our understanding of the cultural basis of heteronormativity. [ABSTRACT FROM AUTHOR]

Homelessness is a significant issue in Australia, particularly for Aboriginal and Torres Strait Islander people, who are disproportionally affected compared to non-Indigenous Australians. In this article, we present new findings into the barriers and enablers of housing stability for Aboriginal and Torres Strait Islander people in the Brisbane and Logan areas of Queensland. The aim of the study was to document workers perceptions of barriers and enablers faced by Aboriginal and Torres Strait Islander people in Queensland when seeking to access housing. We drew on extensive interview data with front-line staff from an Aboriginal Community-Controlled Health Organisation (ACCHO) and in doing so identified five key themes: Bureaucratic Barriers and Inaccessibility of Services; Experiences of Discrimination; Impact of Family Dynamics on Housing Stability; Geographic Location; Comprehensive Support Needs. We demonstrated that consistent with the scholarly literature the interplay of systemic, structural, and cultural factors continues to impact housing stability. These findings suggest more work is required if governments are to address housing stability for Aboriginal and Torres Strait Islander individuals and families.IMPLICATIONSPresenting original data from social workers at an Aboriginal Community-Controlled Health Organisation (ACCHO) contributes to available understandings.In addressing housing challenges, cultural connection and competency are of vital importance.Voices from social workers can provide guidance for policymakers aiming to address homelessness for Aboriginal and Torres Strait Islander people.Presenting original data from social workers at an Aboriginal Community-Controlled Health Organisation (ACCHO) contributes to available understandings.In addressing housing challenges, cultural connection and competency are of vital importance.Voices from social workers can provide guidance for policymakers aiming to address homelessness for Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Presents a study on the aspects of dying for Pitjantjatjara Aboriginal people in Central Australia. Preference of dying in Pitjantjatjara's home country; Provision of palliative care through matrilineal kin structures; Correlation of Pitjantjatjara's way of dying in their cultural way of living.

Background: Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. Methods: We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway; (2) derive draft criteria; (3) pilot test the criteria; and (4) modify criteria to maximise agreement between review authors. Results: Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model', 'care map', 'multidisciplinary care', evidence-based care' and 'guideline'. Conclusions: The criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway. [ABSTRACT FROM AUTHOR]