Rural Clinical School - Research Publications
Permanent URI for this collection
Search Results
1 - 10 of 349
-
ItemSexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection(CSIRO PUBLISHING, 2020)UNLABELLED: Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS: A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.
-
ItemPatient-delivered partner therapy for chlamydia in Australia: can it become part of routine care?(CSIRO Publishing, 2020-08-03)Background: Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. Methods: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs’ understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. Results: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor–partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. Conclusion: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.
-
ItemBeing in two minds: Staff's perspectives of paperwork in group homes for people with intellectual disabilities(WILEY-BLACKWELL, 2016-07-01)Aim: Paperwork is an important technology in group homes for people with intellectual disabilities. This study explored frontline staffs’ perceptions of paperwork in two Australian group homes. Method: Researchers used a constructivist grounded theory methodology. Data were collected from nine group home staff (1 supervisor and 8 support workers) using semi-structured interviews and observations. Open and focussed coding was used to identify participants’ perception of paperwork. Results: Participants described being in two minds about paperwork; considering it a useful yet problematic technology in group homes. They described paperwork as having particular characteristics and used these to evaluate the usefulness of different pieces. Conclusions: Frontline group home staff actively evaluate paperwork technologies in their workplace. Understanding staff perceptions of paperwork might better enable it to be better designed or help better equip staff with meaningful technologies to provide good resident support, rather than paperwork detracting staff from their core work of providing support to residents.
-
ItemNo Preview AvailableStaff perspectives on paperwork in group homes for people with intellectual disability(Routledge, 2019-08-20)This book gathers together recent international research in intellectual disability (ID), examining the diverse modes of existence that characterise living with intellectual disabilities in the 21st century.
-
ItemSocial interaction and social inclusion in international rural health research(Springer International Publishing, 2022-05-14)There are particular attributes of rural communities that shape inclusion and exclusion in these settings. Social inclusion, or the opportunity for participation and access, together with its opposite, social exclusion, are central issues in rural contexts due to lower levels of income, education, and health outcomes as well as less access to health services. Adapting Wilkinson's interactional perspective of rural communities, this chapter focuses on how social interactions, or the ways local people talk, undertake activities and organize their daily lives, play a central role in understanding inclusion and exclusion within rural communities. This perspective underpins three case studies of inclusion research, one investigating the inclusion of socially and culturally diverse consumers in local health services in regional Australia, one working with a rural Australian health service to increase inclusion for local consumers, and a traditional healing approach to men's sexual health in rural Bangladesh. Key lessons from these case studies include the importance of developing genuine relationships and partnerships, working with local systems and "ways of doing things," progressing change slowly, and adopting pluralistic approaches to inclusion. Successful inclusion research was found to involve effective engagement, working with local networks, conducting long-term projects, and employing local researchers. The case studies highlight the need for more inclusive practices in rural health which can be assisted by research that challenges exclusionary interactions in rural communities.
-
ItemDiabetes in ischaemic stroke in a regional Australian hospital: uncharted territory.(Wiley, 2022-04)BACKGROUND: Stroke and diabetes mellitus (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. AIMS: We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including subanalyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). METHODS: We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre-morbid DM status, indicators of glycaemic control and renal impairment were recorded. RESULTS: DM was present in 28.5% of IS and TIA patients, including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (estimated glomerular filtration rate of <30). The majority of IS were partial anterior circulation stroke (53.4%) and cardioembolism was the commonest mechanism (43.5%). We found no significant association between DM and a specific stroke location or mechanism. CONCLUSIONS: Almost one-third of IS/TIA patients had DM, with a significant proportion showing poor glycaemic control. The DM prevalence in our cohort was comparable with reported rates from other developed countries. Although we found no association between DM and a particular stroke type or mechanism, it is likely a reflection of our cohort size. Our study demonstrated that DM, as a significant risk factor in IS, warrants early detection and better management strategies.
-
ItemImpact of COVID-19 on rural and remote student placements in Australia: A national study(WILEY, 2022-04)OBJECTIVE: To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN: A mixed-method design comprising an online survey and semi-structured interviews. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION: A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES: Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS: While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS: The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.
-
ItemBacteriophage-encoded lethal membrane disruptors: Advances in understanding and potential applications.(Frontiers Media SA, 2022)Holins and spanins are bacteriophage-encoded membrane proteins that control bacterial cell lysis in the final stage of the bacteriophage reproductive cycle. Due to their efficient mechanisms for lethal membrane disruption, these proteins are gaining interest in many fields, including the medical, food, biotechnological, and pharmaceutical fields. However, investigating these lethal proteins is challenging due to their toxicity in bacterial expression systems and the resultant low protein yields have hindered their analysis compared to other cell lytic proteins. Therefore, the structural and dynamic properties of holins and spanins in their native environment are not well-understood. In this article we describe recent advances in the classification, purification, and analysis of holin and spanin proteins, which are beginning to overcome the technical barriers to understanding these lethal membrane disrupting proteins, and through this, unlock many potential biotechnological applications.
-
ItemCorrigendum: Both caffeine and Capsicum annuum fruit powder lower blood glucose levels and increase brown adipose tissue temperature in healthy adult males.(Frontiers Media SA, 2022)[This corrects the article DOI: 10.3389/fphys.2022.870154.].
-
ItemA prospective cohort study on cam morphology and its role in progression of osteoarthritis.(Wiley, 2022-05)BACKGROUND: Cam morphology contributes to the development of hip osteoarthritis (OA) but is less studied in the general population. This study describes its associations with clinical and imaging features of hip OA. METHODS: Anteroposterior hip radiographs of 1019 participants from the Tasmanian Older Adult Cohort (TASOAC) were scored at baseline for α angle (cam morphology) in both hips. Using the Altman's atlas, radiographic hip OA (ROA) was assessed at baseline. Hip pain and right hip structural changes were assessed on a subset of 245 magnetic resonance images (MRI) at 5 years. Joint registry data for total hip replacement (THR) was acquired 14 years from baseline. RESULTS: Of 1906 images, cam morphology was assessed in 1016 right and 890 left hips. Cross-sectionally, cam morphology modestly associated with age (prevalence ratio [PR]: 1.02 P = .03) and body mass index (BMI) (PR: 1.03-1.07, P = .03) and strongly related to male gender (PR: 2.96, P < .001). Radiographically, cam morphology was prevalent in those with decreased joint space (PR: 1.30 P = .03) and osteophytes (PR: 1.47, P = .03). Longitudinally, participants with right cam and high BMI had more hip pain (PR: 17.9, P = .02). At the end of 5 years of follow-up these participants were also more likely to have structural changes such as bone marrow lesions (BMLs) (PR: 1.90 P = .04), cartilage defects (PR: 1.26, P = .04) and effusion-synovitis at multiple sites (PR: 1.25 P = .02). Cam morphology at baseline in either hip predicted up to threefold risk of THR (PR: 3.19, P = .003) at the end of 14 years. CONCLUSION: At baseline, cam morphology was linked with age, higher weight, male gender, early signs of radiographic OA such as joint space narrowing (JSN) and osteophytes (OST). At follow-up, cam predicted development of hip BMLs, hip effusion-synovitis, cartilage damage and THR. These findings suggest that cam morphology plays a significant role in early OA and can be a precursor or contribute to hip OA in later life.