INTRODUCTION: Low muscle mass and low muscle attenuation (radiodensity), reflecting increased muscle adiposity, are prevalent muscle abnormalities in people with lung cancer receiving curative intent chemoradiation therapy (CRT) or radiation therapy (RT). Currently, there is a limited understanding of the magnitude, determinants and clinical significance of these muscle abnormalities in the lung cancer CRT/RT population. The primary objective of this study is to identify the predictors of muscle abnormalities (low muscle mass and muscle attenuation) and their depletion over time in people with lung cancer receiving CRT/RT. Secondary objectives are to assess the magnitude of change in these parameters and their association with health-related quality of life, treatment completion, toxicities and survival. METHODS AND ANALYSIS: Patients diagnosed with lung cancer and planned for treatment with CRT/RT are invited to participate in this prospective observational study, with a target of 120 participants. The impact and predictors of muscle abnormalities (assessed via CT at the third lumbar vertebra) prior to and 2 months post CRT/RT on the severity of treatment toxicities, treatment completion and survival will be assessed by examining the following variables: demographic and clinical factors, weight loss, malnutrition, muscle strength, physical performance, energy and protein intake, physical activity and sedentary time, risk of sarcopenia (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls history (SARC-F) score alone and with calf-circumference) and systemic inflammation. A sample of purposively selected participants with muscle abnormalities will be invited to take part in semistructured interviews to understand their ability to cope with treatment and explore preference for treatment strategies focused on nutrition and exercise. ETHICS AND DISSEMINATION: The PREDICT study received ethics approval from the Human Research Ethics Committee at Peter MacCallum Cancer Centre (HREC/53147/PMCC-2019) and Deakin University (2019-320). Findings will be disseminated through peer review publications and conference presentations.

BACKGROUND: Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. METHODS: This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. RESULTS: Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. CONCLUSIONS: Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. TRIAL REGISTRATION: ANZCTR 12613000664741 ; 19/06/2013.

OBJECTIVES: Diagnosing chronic heart failure (CHF) in general practice is challenging. Our aim was to investigate how general practitioners (GPs) diagnose CHF in real-world patients. DESIGN: Think-aloud study. METHODS: Fourteen GPs were asked to reason about four real-world CHF cases from their own practices. The cases were selected through a clinical audit. This was followed by an interview to get a deeper insight in their reasoning. The Qualitative Analysis Guide of Leuven was used as a guide in data analysis. RESULTS: We developed a conceptual diagnostic model based on three important reasoning steps. First, GPs assessed the likelihood of CHF based on the presence or absence of HF signs and symptoms. However, this approach had serious limitations since GPs experienced many barriers in their clinical assessment, especially in comorbid elderly. Second, if CHF was considered based on step 1, the main influencing factor to take further diagnostic steps was the GPs' perception of the added value of a validated CHF diagnosis in that specific case. Third, the choice and implications of these further diagnostic steps (N-terminal pro B-type natriuretic peptide, ECG and/or cardiac ultrasound) were influenced by the GPs' knowledge about these tests and the quality of the cardiologists' reports. CONCLUSION: This think-aloud study identified the factors that influenced the diagnostic reasoning about CHF in general practice. As a consequence, targets to improve this diagnostic reasoning were withheld: a paradigm shift towards an earlier and more comprehensive risk assessment with, among others, access to natriuretic peptide testing and convincing GPs of the added value of a validated HF diagnosis.

OBJECTIVE: The present study aimed to translate and cross-culturally adapt the Physical Function in ICU Test-scored (PFIT-s) and the De Morton Mobility Index (DEMMI) to Brazilian Portuguese. METHODS: This study consisted of the translation, synthesis, and back-translation of the original versions of the PFIT-s and DEMMI, including revision by the Translation Group and pretesting of the translated version, assessed by an Expert Committee. The Brazilian versions of these instruments were applied to 60 cooperative patients with at least 48 h of mechanical ventilation at ICU discharge. The interrater reliability of both scales was tested using the Intraclass Correlation Coefficient (ICC). RESULTS: The authors of both original scales have approved the cross-culturally validated versions. Translation and back-translation attained consensus, and no item was changed. Both scales showed good interrater reliability (ICC>0.80) and internal consistency (α>0.80). CONCLUSION: The versions of the PFIT-s and DEMMI adapted to Brazilian Portuguese proved to be easy to understand and apply clinically in the ICU environment.

BACKGROUND: Cardiologists play a key role in multidisciplinary care by guiding heart failure (HF) management in the hospital and in the community. Regional implementation of multidisciplinary health care interventions depends on how they perceive collaboration with other health care disciplines, yet research on this topic is limited. This study aimed to explore the views and opinions of cardiologists on multidisciplinary collaboration in HF care. METHODS: We conducted a qualitative study based on face-to-face semi-structured interviews with 11 Belgian cardiologists between September 2019 and February 2020. We used the Qualitative Analysis Guide of Leuven (QUAGOL) method as guidance for data analysis until data saturation was reached. RESULTS: Cardiologists consider the general practitioner (GP) and HF nurse as the most important partners in HF management. Cardiologists identified four problems in current multidisciplinary collaboration: the communication of a HF diagnosis to the patient, advanced care planning, titration of HF medication by the GP and electronic data exchange and communication. Three themes emerged as ideas for improvement of HF care: 1) expansion of the role of the HF nurse, 2) implementation of a structured, patient-centered, and flexible model of disease management program and 3) integrated data approaches. CONCLUSION: Cardiologists value close cooperation with GPs in HF management. They advocate an expanded future role for the HF nurse, increased eHealth, and structured disease management to optimize current HF care.

Introduction: Many patients continue to receive suboptimal services, inappropriate, unsafe, and costly care. Underutilization of research by health professionals is a common problem in the primary care setting. Although many theoretical frameworks can be used to help address such evidence-practice gaps, health care professionals may not be aware of the benefits of frameworks or of the most appropriate ones for their context and thus, may be faced with the challenge of selecting and using the most relevant one. Aim: The aim of this article was to describe the process used to adapt a knowledge translation framework to meet the local needs of health professionals working in one large primary care setting. Methods: The authors developed a 5-step approach for guideline implementation. This approach was informed by prior research and the authors' experiences in supporting multidisciplinary teams of health care professionals during the implementation of evidence-based clinical guidelines into primary care practices. To ensure that the 5-step approach was practical and suitable for the context of guideline implementation by multidisciplinary teams in primary health care, the implementation team adapted the "knowledge-to-action" framework using a multistep process. Results: The implementation approach consisted of the following 5 steps: identification, context analysis, development of implementation plan, evaluation, and sustainability. All 5 steps were described alongside details about a national low back pain project. Discussion: This article describes a collaborative, grassroots process that addressed an identified need in one complex context by adapting a knowledge translation framework to meet the local needs of health professionals working in primary care settings. Existing implementation frameworks may be too complex or abstract for use in busy clinical contexts. The 5-step approach presented in this paper resulted in practical steps that are more readily understood by health care professionals and staff on "the ground."

INTRODUCTION: Although medical students are increasingly exposed to clinical experiences as part of their training, these often occur parallel with, rather than connected to, their classroom-based learning experiences. Additionally, students seem to struggle with spontaneously making the connection between these spheres of their training themselves. Therefore, this systematic review synthesized the existing evidence about educational interventions that aim to enhance the connection between learning in the classroom and its application in the workplace. METHODS: Electronic databases (AMED, CINAHL, EMBASE, ERIC, Medline, RDRB, PsycINFO and WoS) were screened for quantitative and qualitative studies investigating educational interventions that referenced a connection between the classroom and workplace-based experiences within undergraduate, graduate or postgraduate medical education. RESULTS: Three types of interventions were identified: classroom to workplace interventions, workplace to classroom interventions, and interventions involving multiple connections between the two settings. Most interventions involved a tool (e. g. video, flow chart) or a specific process (e. g. linking patient cases with classroom-based learning content, reflecting on differences between what was learned and how it works in practice) which aimed to enhance the connection between the two settings. DISCUSSION: Small-scale interventions can bring classroom learning and workplace practice into closer alignment. Such interventions appear to be the necessary accompaniments to curricular structures, helping bridge the gap between classroom learning and workplace experience. This paper documents examples that may serve to assist medical educators in connecting the classroom and the workplace.

BACKGROUND: This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs). METHODS: A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations. RESULTS: We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence). CONCLUSIONS: The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.

BACKGROUND: The COVID-19 pandemic has profoundly affected assessment practices in medical education necessitating distancing from the traditional classroom. However, safeguarding academic integrity is of particular importance for high-stakes medical exams. We utilised remote proctoring to administer safely and reliably a proficiency-test for admission to the Advanced Master of General Practice (AMGP). We compared exam results of the remote proctored exam group to those of the on-site proctored exam group. METHODS: A cross-sectional design was adopted with candidates applying for admission to the AMGP. We developed and applied a proctoring software operating on three levels to register suspicious events: recording actions, analysing behaviour, and live supervision. We performed a Mann-Whitney U test to compare exam results from the remote proctored to the on-site proctored group. To get more insight into candidates' perceptions about proctoring, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed. RESULTS: In total, 472 (79%) candidates took the proficiency-test using the proctoring software, while 121 (20%) were on-site with live supervision. The results indicated that the proctoring type does not influence exam results. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates' appreciation of proctoring and as emotional distress because of proctoring. Four themes were identified in the thematic analysis providing more insight on candidates' emotional well-being. CONCLUSIONS: A comparison of exam results revealed that remote proctoring could be a viable solution for administering high-stakes medical exams. With regards to candidates' educational experience, remote proctoring was met with mixed feelings. Potential privacy issues and increased test anxiety should be taken into consideration when choosing a proctoring protocol. Future research should explore generalizability of these results utilising other proctoring systems in medical education and in other educational settings.

AIMS: The primary aim of this study was to establish how many neonatal nurseries in Australia and New Zealand had a neurodevelopmental allied health team, to ascertain the disciplines involved, their qualifications and experience. The secondary aim was to evaluate which standardised neurobehavioural/neurological assessments were currently being implemented, and the existing practice in relation to their use. METHODS: A descriptive cross-sectional survey, sampling 179 eligible public and private hospital neonatal intensive care units (NICUs) and special care nurseries (SCNs) throughout Australia and New Zealand, was purpose-developed and administered electronically from the 5th April to 23rd July 2013. RESULTS: A total of 117 units (65%) overall, and 26 of 26 (100%) NICUs responded to the survey. NICUs had more neurodevelopmental allied health staff than SCNs, with physiotherapists and speech pathologists the most common disciplines. Physiotherapists were more likely to administer standardised neurobehavioural/neurological assessments in NICUs, while medical staff were more likely to do so in SCNs. A wide variety of standardised neurobehavioural/neurological assessment tools were used, with Prechtl's General Movements Assessment the most common in the NICUs (50%) and the Hammersmith Neonatal Neurological Examination the most common in the special care units (25%). Standardised neurobehavioural assessments were not administered in 22% of SCNs. CONCLUSIONS: Although neurodevelopmental allied health teams and standardised neurobehavioural/neurological assessments are valued by many, there was little consistency across Australian and New Zealand neonatal nurseries.

Physical activity (PA) levels are low in patients with lung cancer. Emerging evidence supports the use of interventions to increase PA in this population. We aimed to (1) identify and synthesize outcome measures which assess PA levels in patients with lung cancer and (2) to evaluate, synthesize and compare the psychometric properties of these measures. A systematic review of articles from searches was conducted of five electronic databases and personal records. Eligible studies were those which assessed PA using either performance-based or patient-reported measures. For aim 2, studies identified in aim 1 reporting on at least one psychometric property (validity, reliability, responsiveness or measurement error) were included. Two independent reviewers assessed eligibility and risk of bias with the COnsensus-based Standards for the selection of health status Measurement INstruments. Thirty-four studies using 21 different measures of PA were identified. Seventeen studies used performance-based measures. The Godin Leisure Time Exercise Questionnaire (GLTEQ) was the most frequently used patient-reported measure. Psychometric properties were reported for 13 of these measures and most frequently for movement sensors. Two studies reported on properties of the GLTEQ. Quality ratings for risk of bias were low. There is significant heterogeneity amongst studies regarding method of PA measurement along the lung cancer continuum. Greater consensus could be achieved by using a consensus approach such as a Delphi process. Future studies should include assessment of psychometric properties of the measurement tool being used. Currently, it is recommended where feasible, both performance-based and patient-reported measurements of PA should be undertaken.

AIMS: This study evaluated the construct validity of the Australian Pelvic Floor Questionnaire against two alternative measures of the severity of bladder and bowel symptoms. METHODS: This was an exploratory analysis of data from two prospective studies. Patients who had undergone surgery for colorectal cancer were analysed. Bladder and bowel symptoms were measured using three validated questionnaires: the Australian Pelvic Floor Questionnaire, the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence and the International Consultation on Incontinence Questionnaire-Bowel Module post-cancer treatment. RESULTS: The study sample consisted of 44 participants, including 25 men and 19 women. The Australian Pelvic Floor Questionnaire bladder and bowel domain scores demonstrated moderate positive correlations with the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence (r = 0.74, P < 0.01) and the International Consultation on Incontinence Questionnaire-Bowel Module (r = 0.69-0.78, P < 0.01). Similar results were obtained in each gender subgroup. CONCLUSIONS: This study suggested that the Australian Pelvic Floor Questionnaire may be a valid measurement tool for use in colorectal cancer populations in clinical trials and practice. Future research using larger cohorts is warranted.

This paper is a review of a successful mental health programs for young black people who have experienced some complex issues such mental health, racism and discrimination, family problems and bullying in schools. The article provides a brief overview of the ways and programs that may be usefully in supporting young people with mental health and wellbeing issues from the South Sudanese Australian community. A combination of desktop research and consultation with young people was employed to collect data. There was conversation meeting with 19 young people which conducted by a youth worker and one counsellor where young people were open to raise some mental health and wellbeing related issues that are affecting them, but there are no safe programs to support them. The review of successful mental health and wellbeing programs came out from the discussion based on the mental health and wellbeing issues raised by young people. The aim is to find out the existing mental health and wellbeing programs internationally that can be replicated as support programs for South Sudanese –Australian young people in Melbourne.

Settlement of people from refugee backgrounds has been largely discussed in Australia because of critical social issues affecting the integration of newly emerged community such as the South Sudanese community. This research paper has taken one-step back to at looks the benefits of employment in settlement context of refugees using the case study of the South Sudanese community in Melbourne, Australia. The aim of this research was to provide an understanding of the benefits of employment on different forms of capitals that can assist refugees to overcome settlement challenges. These five capitals or benefits are economic capital, social capital, the cultural and psychological capital. This research was conducted through in-depth interviews with 20 participants from the South Sudanese community in Melbourne, Australia with refugee backgrounds. Participants were given taken the time to tell their settlement experiences, the level of participation in employment and benefits of employment to them and their families with duration range between 45 minutes to 60 minutes. Major findings confirmed that participation of refugees in employment assists them to access important benefits of economic capital, social capital, cultural and psychological capital, which they can accumulate through employment.

Social work as a profession is a growing area in many Indigenous community groups around the world. Students who choose to study social work have some strong voices and commitments to serve vulnerable families, individuals and community groups that are facing some social, health and political issues. Building resilience resources and skills for social work students who are studying social work course is part of the social work roles. In real life, social issues and health issues challenged many people in different levels which caused emotional challenges, feeling of uncertain and helpless. Therefore, teaching resilience skills to social work students is very important in order for students to be well-prepared and managed complex issues of their clients in the field of social work such as emotional reaction of clients and work pressures. This paper is a literature review of resilience that used Ubuntu concept from African Indigenous perspective in humanity and community. The paper first provided introduction of Ubuntu philosophy to reader. Second, the paper provided background of the research problem, which is the need of resilience skills in social work teaching. Finally, the paper summarised resilience skills that are suitable to social work practitioners, social work students and social work lecturers in their field of practice to support their clients and themselves while dealing with complex and emotional issues in the fields.

Social workers play a significant role in supporting vulnerable families and individuals during difficult time. Social work as a profession is a frontline occupation that is forced to deal with the complex and difficult issues of coronavirus disease 2019 (COVID-19). Lockdown, self-isolation, the loss of loved ones, the loss of work, and dealing with family issues and children while working at home are emotionally challenging for many. This virus has raised high levels of anxiety, fear, confusion, frustration, hopeless and uncertainty feelings among many people internationally. Many people were isolated from their families and friends as well as from community. Governments in many countries brought in health measures to control the spread of coronavirus. These measures included quarantine, lockdown, social distancing/physical distancing, isolation, travel restrictions, masks, ventilators, respirators, personal protective clothing (PPE), online/remote services, containment, mitigation, sanitisers, flattening the curve, inflammatory syndrome and herbal/organic treatments. In addition to the loss of social connection, the loss of livelihoods and income are psychologically torturing. There were many lives lost because of coronavirus around the world how many. The impacts of coronavirus have been felt across the health, economic, social, and mental health sectors. Social workers were viewed first people to support people while they were going through difficulties. The situation analysis of emergency lockdown in Melbourne, Victoria, Australia demonstrated role of social workers in supporting vulnerable individuals and families during difficult time. The study shows serious impact of lockdown such as mental health, social and economic consequences on people. The impact of COVID-19 lockdown was clearly observed in relation to mental health, social and economic impacts on people. Many residents were psychological impacted and found themselves in tears, frustration, enraged, powerless, hopeless with lack of support. This analysis argues that social workers should be prepared and supported with enough resources to support people during emergency situations. Therefore, the role of social workers and community development workers is very critical in supporting and preparing vulnerable community groups, individuals, and families to cope with emergency events when they emerge. The case example of the COVID-19 emergency lockdown is the lockdown of high-rise towers in the city of Melbourne in Australia. Many people have been seeking support from social workers for emotional support as they are enraged and frustrated by the lockdown.

Introduction Health outcomes and life expectancy of Indigenous people throughout the world are far poorer than non-Indigenous populations. Emerging evidence from research shows that many social issues which impact on Indigenous peoples globally is linked to trauma over generations. This review explores literature about Indigenous people from around the world to seek interventions which have been successful in healing intergenerational trauma. Method To identify interventions that have been successful in healing intergenerational trauma amongst Indigenous populations globally, a systematic search strategy was conducted using keywords and synonyms related to the topic. Peer reviewed academic literature was sourced from four different databases i.e. Ebscohost, PubMed, CINAHL and Medline. Results There were 89 citations, 55 were identified as relevant, after duplicate copies were removed. Of these 55 papers, 23 met inclusion/exclusion criteria. Two additional papers from a reference lists were included and a total of 25 papers were analysed. A comprehensive critical appraisal of the literature was undertaken using three different appraisal tools. This review found that interventions which were successful in healing intergenerational trauma amongst Indigenous populations incorporated traditional cultural practices within their healing method(s). Discussion There was strong evidence that strengthening and reclaiming cultural identity enhances mental health disorders commonly experienced throughout Indigenous populations. Often non-Indigenous clinicians, although well intentioned, fail to address the needs of Indigenous people because they lack the understanding and awareness of Indigenous people’s culture. This review highlights benefits of blending Indigenous and Western approaches into healing intergenerational trauma and the concept of ‘Two-Eyed Seeing’. This concept acknowledges that each of our worlds has its strengths and if we respectfully and methodically accept these strengths, they can work together and effectively to bring about healing. Conclusion Healing from intergenerational trauma is not a straightforward process. Incorporating traditional healing methods assists in the development of cultural identity, which was found to be extremely important in the healing process. To address trauma effectively, clinicians need to acknowledge the historical impact from public policies by having a real understanding of our history.

This paper presents qualitative research findings in relation to the systemic racism and racial vilification issues facing people from the South Sudanese community in Melbourne, Australia. The paper is drawn from a PhD study at Victoria University in which 20 participants were interviewed about settlement issues facing their community. Racism and discrimination is one of the themes that emerged as a problem facing people from the South Sudanese community, including in the employment sector and in schools, because of negative media reporting on this community. This racism and racial verification has been identified in research context as unfair in which some of these research argues for how members of the South Sudanese and recent African communities have become part of a broader system of racism and racialisation in Australia (Ang & Stratton 2001; Baak 2016; Due 2008; Majavu 2017; Walton et al. 2016). The impact of racial vilification has been largely felt by African community groups in public places such as schools, shopping centres, and bus and train stations. The comments made by politicians such as Peter Dutton have promoted hatred and encouraged a great deal of racism toward the South Sudanese community and other African groups, such as the Somalian community. There is no doubt that Australia is a fair-go country, but it has an interesting record about racism and discrimination toward minor groups such as African communities and the Aboriginal community. Racial vilification can be a damaging issue for young people and for minority community groups if there are no policies in places to protect them from such vilification (Baak, 2018).

Participation in sport provides different forms of capital for all, but particularly for those with refugee backgrounds who are facing settlement issues. Such people are caught in a challenging situation of dealing with settlement issues such as homesickness, cultural shock, lack of a background of social activities and networks, lack of employment, racism and discrimination. As a result of these settlement challenges and other social issues, a large number of young people become disengaged. Therefore, the aim of this study is to explore a social benefit of participation in sport for the South Sudanese people from refugee backgrounds who are settling in Melbourne, Australia. For people with social isolation and other social issues, participation in sport can be a tool that assists those young people by providing physical benefits, a social network (thus breaking social isolation) and sometimes a form of income as a result of being noticed as a good player. Participating in sport can thus be a rewarding experience, particularly for young people, in overcoming settlement challenges. This research was conducted through an in-depth interview of 20 participants from the South Sudanese community. Major findings confirmed that social benefits of sport in relation to network, physical capital, psychological capital, cultural capital, economic capital

This book describes the common challenges which many refugees faced when resettled in country that is different to their own country. &quot;This book has touched my heart as it is discussed critical challenges of settlement&quot;. John Smith.

Migration and Marginalisation of Refugees: The Settlement Experiences of South Sudanese-AustraliansAuthor: Dr William Abur, PhDMigration and resettlement is a process that involved an individual or a family moving to

Social work has a critical role in supporting families, young people and others with complex needs, such as the elderly and those with disabilities. This chapter discusses critical social work from the perspective of Indigenous social workers who have experienced some forms of institutional marginlisation and also worked with marginalised community groups, using cultural knowledge to address a number of institutional injustice issues and practices. Social workers working with Indigenous community groups constantly experience and witness the challenges faced by those communities, including isolation within educational institutions. Social work as a profession is a growing area in Indigenous community groups because of social justice problems and historical marginalisation through colonial practices. Writing as a social work lecturer within an Indigenous educational institute, I recognise that social work has a significant role to play in Indigenous communities. It can empower people to speak up and speak the truth, supporting people through journeys of pain and healing, as well as acknowledging their experiences and cultural knowledge by validating those experiences. While walking alongside students and their families, social work lecturers bring their knowledge and their own experiences to enhance social work courses at university.

The majority of South Sudanese-Australians arrived in Australia, and other host countries outside Africa, after spending a greater part of their lives in refugee camps or conflict-affected areas. In addition, refugees are often not able to return to their home countries because the causes of their departure (wars, insecurity, hunger) continue to apply in their country of origin. The purpose of this paper is to examine some of the mental health and wellbeing issues some South Sudanese-Australians experience as a result of settlement difficulties and their earlier experience of conflict. The study looks at experiences of resettlement and settlement difficulties, and, more importantly, mental health and wellbeing issues in the wake of the aforesaid challenges. The data was collected from a qualitative method which comprised a series of semi-structured, one-on-one interviews with a total of 20 South Sudanese-Australians living in Melbourne. There were 11 males and nine females, with ages ranging from 18 to 64 years, who volunteered to participate in this study. Findings indicated that, as with many other people from refugee backgrounds, South Sudanese-Australians face a range of settlement-related challenges, and a host of post-resettlement adaptation experiences such as limited change of gender roles, language proficiency, unemployment, host society unacceptance or intolerance, constrained recreational opportunities, lack of community connectedness and overall mental health and general wellbeing issues. Experiencing conflict can be traumatic and refuge in neighbouring countries that are socio-culturally different can be challenging. In conclusion, these issues can not only be troublesome on a day-to-day basis, but also adversely affect the long-term mental health and wellbeing of refugees.

Endometriosis-associated pain and the mechanisms responsible for its initiation and persistence are complex and difficult to treat. Endometriosis-associated pain is experienced as dysmenorrhea, cyclical pain related to organ function including dysuria, dyschezia and dyspareunia, and persistent pelvic pain. Pain symptomatology correlates poorly with the extent of macroscopic disease. In addition to the local effects of disease, endometriosis-associated pain develops as a product of peripheral sensitization, central sensitization and cross sensitization. Endometriosis-associated pain is further contributed to by comorbid pain conditions, such as bladder pain syndrome, irritable bowel syndrome, abdomino-pelvic myalgia and vulvodynia. This article will review endometriosis-associated pain, its mechanisms, and its comorbid pain syndromes with a view to aiding the clinician in navigating the literature and terminology of pain and pain syndromes. Limitations of our current understanding of endometriosis-associated pain will be acknowledged. Where possible, commonalities in pain mechanisms between endometriosis-associated pain and comorbid pain syndromes will be highlighted.

AIMS: To conduct a concept analysis of clinical practice contexts (work environments) in health care. BACKGROUND: Context is increasingly recognized as important to the development, delivery, and understanding of implementation strategies; however, conceptual clarity about what comprises context is lacking. DESIGN: Modified Walker and Avant concept analysis comprised of five steps: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of its defining attributes; and (5) definition of its empirical referents. METHODS: A wide range of databases were systematically searched from inception to August 2014. Empirical articles were included if a definition and/or attributes of context were reported. Theoretical articles were included if they reported a model, theory, or framework of context or where context was a component. Double independent screening and data extraction were conducted. Analysis was iterative, involving organizing and reorganizing until a framework of domains, attributes. and features of context emerged. RESULT: We identified 15,972 references, of which 70 satisfied our inclusion criteria. In total, 201 unique features of context were identified, of these 89 were shared (reported in two or more studies). The 89 shared features were grouped into 21 attributes of context which were further categorized into six domains of context. CONCLUSION: This study resulted in a framework of domains, attributes and features of context. These attributes and features, if assessed and used to tailor implementation activities, hold promise for improved research implementation in clinical practice.

BACKGROUND: To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an "afferent" and "efferent" limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust-level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. AIM: To identify how deteriorating patient policy documents provide "actionable" behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. DESIGN: A structured content analysis of a national guideline and local policies using a behaviour specification framework. METHODS: Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. RESULTS: There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). CONCLUSION: Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. RELEVANCE TO CLINICAL PRACTICE: Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time-sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enact expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, unrecorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into "belief statements". Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalized) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques/mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, "sub-optimal care" of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e. targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research.

AIMS: To systematically review the evidence for the effect of pelvic organ prolapse (POP) and/or continence surgery on pelvic floor muscle (PFM) morphometry and function in women, and to investigate whether a relationship exists between PFM measures and clinician-reported objective pelvic floor outcomes postoperatively. METHODS: Six electronic databases were searched until March 2018. Studies were included if they examined the effect of POP and/or continence surgery on the PFM in women, and reported pre- and postoperative data. Methodological quality was assessed using a modified Downs and Black checklist. Three meta-analyses were planned based on postoperative follow-up time. RESULTS: Twenty-one studies met the inclusion criteria. Varied surgical interventions and 33 different PFM measures were represented. The methodological quality of included studies varied considerably. The 0 to 6 weeks postoperative meta-analysis showed no statistically significant change in PFM function (SMD = 0.04; 95% confidence interval [CI] = -0.26 to 0.33). This was consistent at 3 and 6 or more months (SMD = 1.13; 0.35 95% CI = -0.34 to 2.60, - 0.42 to 1.12 respectively). None of the included studies investigated the relationship between PFM measures and clinician-reported objective outcomes postoperatively. CONCLUSIONS: This review did not show a clear effect of POP and/or continence surgery on PFM morphometry or function in women and was unable to show a relationship with outcomes such as objective prolapse score and urodynamic findings. This could be because surgery does not measurably impact on the PFM or due to the poor quality and heterogeneity of studies. Future well-designed research is needed to specifically investigate change in the PFM following surgery.

BACKGROUND: Patients who survive critical illness frequently develop muscle weakness that can impact on quality of life; nutrition is potentially a modifiable risk factor. The present study aimed to explore the associations between cumulative energy deficits (using indirect calorimetry and estimated requirements), nutritional and functional outcomes. METHODS: A prospective single-centre observational study of 60 intensive care unit (ICU) patients, who were mechanically ventilated for at least 48 h, was conducted. Cumulative energy deficit was determined from artificial nutrition delivery compared to targets. Measurements included: (i) at recruitment and ICU discharge, weight, fat-free mass (bioimpedance spectroscopy) and malnutrition (Subjective Global Assessment score B/C); (ii) at awakening and ICU discharge, physical function (Physical Function in Intensive Care Test-scored) and muscle strength (Medical Research Council sum-score (MRC-SS). ICU-acquired weakness was defined as a MRC-SS score of less than 48/60. RESULTS: The median (interquartile range) cumulative energy deficit compared to the estimated targets up to ICU day 12 was 3648 (2514-5650) kcal. Adjusting for body mass index, age and severity of illness, cumulative energy deficit (per 1000 kcal) was independently associated with greater odds of ICU-acquired weakness [odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.4-3.3, P = 0.001] and malnutrition (OR = 1.9, 95% CI = 1.1-3.2, P = 0.02). In similar multivariable linear models, cumulative energy deficit was associated with reductions in fat-free mass (-1.3 kg; 95% CI = -2.4 to -0.2, P = 0.02) and physical function scores (-0.6 points; 95% CI = -0.9 to -0.3, P = 0.001). CONCLUSIONS: Cumulative energy deficit from artificial nutrition support was associated with reduced functional outcomes and greater loss of fat-free mass in ventilated ICU patients.

OBJECTIVE: To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications. DESIGN: Cross-sectional survey. SETTING: Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings. PARTICIPANTS: Sample of 288 (n = 288) allied health professionals from the disciplines of physiotherapy, occupational therapy, speech pathology, social work, dietetics/nutrition, and other. MAIN OUTCOME MEASURE: Cross-sectional survey including 12 questions measuring respondents' confidence to conduct a range of EBP activities. RESULTS: Allied health professionals begin to lose confidence related to EBP activities within the first 5 years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with postgraduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time. CONCLUSIONS: Allied health professionals' confidence to perform EBP activities degrades over time, particularly for those individuals with no postgraduate qualifications. Registration and accreditation bodies along with allied health professional employers should explore potential strategies to preserve and enhance EBP skills, confidence, and behaviours.

OBJECTIVE: To explore patient experiences of, and preferences for, physical activity after a lung cancer diagnosis. METHODS: This was a qualitative study involving seven patients who had been treated for lung cancer within the previous 2 years. Participants attended a focus group interview. Conventional content analysis methodology was used to analyse the text by two independent researchers. RESULTS: Eight major themes emerged from the data. These were as follows: the influence of past lifestyle and chronic disease; the perceived benefits of physical activity; using physical activity to facilitate return to activities of daily living; the impact of symptoms, capacity and motivation; family and peer support; access to services; health professionals; and enjoyment of different types of physical activity. Patients suggested several factors that could improve their healthcare experience. These include access to exercise professionals particularly after cancer treatment; access to information about physical activity in different formats; supervision from health professionals and peer support; and use of behaviour change strategies to achieve sustainable increases in physical activity. CONCLUSION: Our results should be considered in the improvement of lung cancer care pathways as we strive to implement physical activity services into routine clinical care.