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E-prescription : views and acceptance of general practitioners and pharmacists in Greater Sydney
No full textBackground. Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists’ experience with, and facilitators and barriers to, the use of e-prescription. Methods. This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results. Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of ‘perceived usefulness’; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of ‘perceived ease of use’. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of ‘instant prescription’ and lost opportunities for best-practice care, HCPs’ perceptions of inadequate govern- mental governance, and ongoing costs) were ‘other issues with e-prescription’, and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were ‘suggestions to improve’. Conclusion. There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post- COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription
Fit for purpose? : the suitability of oral health outcome measures to inform policy
No full textMeasuring outcomes for oral health is frequently undertaken using the decayed, missing, and filled teeth (DMFT) index. DMFT measures dental caries experience. As a condition-specific outcome, it is not relatable to consumers, nor does it capture the impact of dental caries on quality of life or outcomes that matter most to consumers. Efficient resource allocation should include patient values. It is crucial to use measurement instruments that record consumer values or preferences for oral health and oral diseases. These measures are often called patient-reported outcome measures and/or patient-reported experience measures. Outcome measures relevant to patients are recommended to influence and inform policy decision-making for oral health. Knowledge Transfer Statement: Oral health research and program evaluation should consider alternative outcome measures for population oral health other than the DMFT index
Comparison of interpolation techniques for prolonged exposure estimation : a case study on seven years of daily nitrogen oxide in Greater Sydney
No full textContinuous exposure to air pollutants over a long period of time adversely affects population health. Addressing this issue may help in reducing the disease burden. Thus, it is crucial to understand the spatial and spatiotemporal variation in this prolonged exposure to ambient air pollutants to make informed decisions. The objective of this study is to evaluate the performance of most commonly used spatial interpolation techniques in sparsely located real-world sensor data for the purpose of estimating the prolonged exposure to air pollutants. The secondary data obtained from NSW Air Quality Monitoring Network (AQMN) sites within Greater Sydney during 1st January 2011 - 31st December 2017 by considering the daily concentrations of Nitrogen Oxide (NO) were used for this study. Nearest Neighbour (NN) interpolation, Inverse Distance Weighted (IDW) interpolation without search radius and with search radius (10 km, 15 km, 20 km, 25 km, 30 km, 35 km, 40 km, 45 km and 50 km) were used to estimate the daily concentrations at unknown locations. The performance of these interpolation techniques was assessed based on leave location-out cross-validation (LLO-CV) using Root Mean Square Error (RMSE), Index of Agreement (d) and Coefficient of Determination (R2). Results revealed that, IDW with search radius of 25 km and power value of one performed better for the given dataset. IDW outperformed NN interpolation technique. These findings may help policy makers to come up with strategies for disease management, control and mitigation
Prevalence and associated factors of thyroid nodules among 52,003 Chinese 'healthy' individuals in Beijing : a retrospective cross-sectional study
No full textIntroduction: The prevalence of thyroid nodules has been increasing, and there are few research data on the risk factors of thyroid nodules in the Chinese population. In this study, we aimed to determine the prevalence and risk factors of thyroid nodules by retrospectively investigating the physical examination records of a cohort of “healthy” individuals in Beijing, China. Methods: This was a retrospective cross-sectional study. The database of a Medical Examination Centre (MEC) was searched. Physical examination data, blood test data, and ultrasound examination data, etc., from 2015 to 2017 were accessed. Only those that recorded a thyroid ultrasound were included. Chi-square test and t-test were used to compare clinical features of individuals’ age, gender, body mass index, blood pressure, blood glucose, blood lipids, uric acid, and presence of fatty liver. Risk factors for thyroid nodules were determined using multivariate logistic regression. Results: A total of 52,003 records, which included 19,901 cases with thyroid nodules, were examined. The overall prevalence rate was 38.3% (19,901/52,003): 30.2% (6,726/22,305) and 44.4% (13,175/29,698) in men and women, respectively. Of 52,003 cases, only 35,420 cases had records of all nodule-related metabolic abnormalities and were selected for cross-sectional determination of related risk factors of thyroid nodules. In male, relationships were found between thyroid nodules and increased age (p < 0.001), impaired fasting glucose (p = 0.044), diabetes (p = 0.047), decreased HDL-C (p = 0.018) and prostatic hyperplasia (p < 0.001). And in female, relationships were found between thyroid nodules and increased age (p < 0.001) and decreased HDL-C (p < 0.001). Conclusion: Thyroid nodules are common in China. This study found that thyroid nodules are associated with several metabolic indicators or metabolic diseases, although the mechanism is unclear. Further research is needed
Rise of wood-based catalytic electrodes for large-scale hydrogen production
No full textLarge-scale utilization of hydrogen energy is considered as the key to resolve the problem of ever-increasing environmental pollution and energy shortage in today's world. As such, using renewable energy and renewable materials for hydrogen production by water electrolysis has become a research hotspot in the field of hydrogen energy in recent years. Wood, as the most widely sourced and renewable biomass material, has a rich pore structure, numerous hydroxyl groups, excellent mechanical properties, corrosion resistance and modifiable properties. These merits enable wood as a potential candidate for the substrate of self-supporting catalytic electrodes in water electrolysis. However, there is currently a lack of a comprehensive summary of the working mechanism and essential properties of wood-based catalysts for water electrolysis. Here, we provide an overview of the current status, design, construction, and characterization of wood-based catalytic electrodes, including strategies for pretreatment and loading of active sites. Furthermore, we discuss the potential of wood-based catalytic electrodes for large-scale water electrolysis at high current density and propose solutions for industrial-scale implementation. We also explore the future development and challenges of wood-based catalysts in the field of water electrolysis
Idiopathic slow transit constipation : pathophysiology, diagnosis, and management
No full textSlow transit constipation (STC) has an estimated prevalence of 2–4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others
Buds and bugs : a fascinating tale of gut microbiota and cannabis in the fight against cancer
No full textEmerging research has revealed a complex bidirectional interaction between the gut micro- biome and cannabis. Preclinical studies have demonstrated that the gut microbiota can significantly influence the pharmacological effects of cannabinoids. One notable finding is the ability of the gut microbiota to metabolise cannabinoids, including ∆9-tetrahydrocannabinol (THC). This metabolic transformation can alter the potency and duration of cannabinoid effects, potentially impacting their efficacy in cancer treatment. Additionally, the capacity of gut microbiota to activate cannabinoid receptors through the production of secondary bile acids underscores its role in directly influencing the pharmacological activity of cannabinoids. While the literature reveals promising avenues for leveraging the gut microbiome–cannabis axis in cancer therapy, several critical considerations must be accounted for. Firstly, the variability in gut microbiota composition among individuals presents a challenge in developing universal treatment strategies. The diversity in gut microbiota may lead to variations in cannabinoid metabolism and treatment responses, emphasising the need for person- alised medicine approaches. The growing interest in understanding how the gut microbiome and cannabis may impact cancer has created a demand for up-to-date, comprehensive reviews to inform researchers and healthcare practitioners. This review provides a timely and invaluable resource by synthesizing the most recent research findings and spotlighting emerging trends. A thorough examination of the literature on the interplay between the gut microbiome and cannabis, specifically focusing on their potential implications for cancer, is presented in this review to devise innovative and effective therapeutic strategies for managing cancer
Clinical practice guidelines in prehospital pain management for paramedics : a systematic review protocol
No full textObjectives: The purpose of this review is to examine prehospital pain management clinical practice guidelines (CPGs) to identify recommendations that can be adopted or adapted into paramedic clinical practice. An additional aim is to consider the methodological quality of these CPGs and the recommendations within them. Introduction: Quality, evidence-based CPGs support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, the evaluation of pain management CPGs, their quality, and whether their recommendations can be adopted or adapted into practice is required to increase understanding in this area. Inclusion criteria: We will include CPGs for pain management intended for prehospital services in civilian communities. CPGs in English published from 2017, and containing clear recommendations addressing pain of any cause will be considered for inclusion. Methods: This review will combine methodologies, including the PICAR framework (population, intervention, comparison, attributes of eligible CPGs, recommendations characteristics) by Johnston et al., and JBI umbrella and scoping review methodology. The search strategy will include 12 databases, including PubMed, Embase, and specific CPG databases (eg, GIN library). Additionally, Google Scholar and Google will be searched, and prehospital organizations without regular publications will be contacted. The AGREE II and AGREE-REX tools will be used to assess the methodological rigor and clinical credibility of the CPGs. The characteristics of both CPGs and the recommendations will be extracted and discussed in the review
Football for Good: Evaluation of the 'Festival 23', During and After the FIFA Women's World Cup Australia/New Zealand 2023
Get PDFFestival23 was a Football for Good (F4G) project aligned with the FIFA 2023 Women's World Cup in Australia and New Zealand. It was designed to produce a lasting social legacy of enhanced social capital, social inclusion, leadership, and resilience in Football for Good emerging women leaders across the globe. Football 23 brought together Youth Leaders Delegates (YLD) from across the global Common Goal membership of community organisations. Festival23 was run in parallel to the Women's World Cup quarter finals, from August 6 to August 14, 2023. This report provides the findings of the evaluation of Festival23 co-led by UNSW Sydney and Western Sydney University academics. Festival23 welcomed 69 women aged 18-30 from organisations globally that use football for social and educational purposes. They came from over 45 different countries, the majority being from the Asia-Pacific region, including 13 from the festival's host countries (Australia & New Zealand). In addition, eight managers from the Oceania Football Confederation (OFC) were present to guide 8 young leaders from this region. Festival23 activities were centred around advancing four United Nations Global Goals: gender equity, climate action, employability & all abilities inclusion. The Young Leader Programme focused on empowering and building the skills of the 69 young women delegates and supporting them as emerging leaders in football. Opportunities for YLD to directly engage with youth in Australia included community sports days (gala days) in nine local communities across Sydney and a fair-play football tournament for members of the community who may not have had an opportunity to engage in the festivities surrounding the Women's World Cup. The evaluation aimed to investigate and understand the perspectives and experiences of the YLD, staff and festival organisers participating in and leading the 'Festival23' 'Football for good' activities and the impact on the YLD knowledge, attitudes, and skills. The research questions were: 1. What are the main impacts of the festival on the YLD in the short and longer term with a focus on: • Cross-cultural connections and collaborations • Leadership skills and confidence • Learnings about social enterprise, gender equality, climate change and inclusion 2. What are the learnings about the Festival23 organization and implementation which can inform future festivals? 3. In what ways are the participants leveraging the learnings from Festival23 when back in their communities? The study was a mixed methods design including pre/post survey measures, with qualitative data collected in open text survey responses, via postings on Slack, an online communications application (Slack) and through opportunistic video interviews throughout the festival. Focus groups were also held with Festival23 organisers and staff to understand their perspectives on the organisation, implementation, and impact of the festival. The survey instrument collected quantitative and qualitative self-reported perceptions of YLD's including their attitudes to interacting with people from other cultures and of their beliefs in themselves as leaders prior, to immediately after and three weeks post the festival
Surgical and radiology trainees' proficiency in reading mammograms : the importance of education for cancer localisation
No full textMedical imaging with mammography plays a very important role in screening and diagnosis of breast cancer, Australia’s most common female cancer. The visualisation of cancers on mammograms often forms a diagnosis and guidance for radiologists and breast surgeons, and education platforms that provide real cases in a simulated testing environment have been shown to improve observer performance for radiologists. This study reports on the performance of surgical and radiology trainees in locating breast cancers. An enriched test set of 20 mammography cases (6 cancer and 14 cancer free) was created, and 18 surgical trainees and 32 radiology trainees reviewed the cases via the Breast Screen Reader Assessment Strategy (BREAST) platform and marked any lesions identifiable. Further analysis of performance with high- and low-density cases was undertaken, and standard metrics including sensitivity and specificity. Radiology trainees performed significantly better than surgical trainees in terms of specificity (0.72 vs. 0.35; P < 0.01). No significant differences were observed between the surgical and radiology trainees in sensitivity or lesion sensitivity. Mixed results were obtained with participants regarding breast density, with higher density cases generally having lower performance. The higher specificity of the radiology trainees compared to the surgical trainees likely represents less exposure to negative mammography cases. The use of high-fidelity simulated self-test environments like BREAST is able to benchmark, understand and build strategies for improving cancer education in a safe environment, including identifying challenging scenarios like breast density for enhanced training