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One Size Doesn't Fit All: Clinician Perspectives on Using Health‐Related Quality of Life for Service Evaluation in Australian Community Health
No full textRationale:Health-related quality of life (HRQoL) offers a framework for assessing the impact of health conditions and treatments on a patient's overall well-being. It also holds the potential to evaluate the effectiveness of hospital and health services. However, this approach lacks evidence to fully support its widespread adoption. Aims and Objectives: To explore current HRQoL practices and clinician attitudes toward standardising HRQoL instruments for service evaluation across a diverse range of in-scope community health services. Methods: Semi-structured interviews were conducted with 20 senior clinicians from community health services. An interview guide was used, and interviews were recorded, transcribed, and analysed using content analysis to identify key themes and insights. Results: The average interview time was 20.1 min (SD = 4.6). While some HRQoL instruments were used, others had been discontinued due to limitations in relevance or effectiveness. Informal HRQoL assessments were commonly used alongside other instruments to gather broader insight into patient well-being. There was support for a holistic approach to service evaluation, emphasising comprehensive, contextually relevant assessments that are user-friendly and evidence-based. However, participants also raised several limitations to using HRQoL for service evaluation, such as the potential for misleading information, implementation difficulties, and risks to patient care. Participants identified 33 potential domains to be measured to demonstrate service success, with the most frequently cited being mental health, social connections, ability to perform daily activities, leisure pursuits, mobility and feeling supported. Conclusion: Findings underscore the need for balanced and meaningful assessment instruments that accurately capture the full scope of patient well-being for evaluation purposes. No single HRQoL assessment instrument is likely to address the needs of services providing care for patients with complex and varied conditions. It is essential to use assessment instruments tailored to individual patient cohorts, resonating with clinicians and patients. © 2025 John Wiley & Sons Ltd
Duloxetine-induced thrombocytopenia: a rare but serious haematological adverse event
No full textDuloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder, generalized anxiety disorder, fibromyalgia, and diabetic peripheral neuropathy [1]. The pharmacological action of duloxetine includes the inhibition of serotonin and norepinephrine reuptake at the synaptic cleft, thereby modulating pain and mood pathways [2]. While duloxetine is generally well-tolerated, there have been reports of adverse effects, including nausea, dry mouth, dizziness, and, less commonly, hematological abnormalities [3,4]
Effects of a Nurse-Avatar Guided Discharge Education Smartphone Application in People After Acute Coronary Syndrome: A Randomised Controlled Trial
No full textAim:To investigate the effects of an avatar-based discharge education application (app) on knowledge among inpatients admitted with acute coronary syndrome (ACS) compared to usual care alone.Method:Single centre randomised controlled trial of people hospitalised with ACS who were being discharged home and had a device capable of downloading the app. Intervention participants downloaded the ‘Six Steps to Cardiac Recovery’ app and were encouraged to complete six interactive educational modules covering heart disease diagnosis, treatment, risk factors, symptom management and secondary prevention. The primary outcome was heart disease knowledge (Coronary Artery Disease Education Questionnaire-II) at three months. Secondary outcomes were quality of life (QOL), cardiac rehabilitation (CR) attendance, app engagement and satisfaction.Results:Eighty-four participants, 86% male, mean age 60 years (SD 11) were randomised. At three months, the intervention group had increased knowledge and QOL but there were no significant between-group differences for the primary or secondary outcomes after adjusting for baseline values (Table). CR attendance was high; 74% of intervention participants and 64% of control participants attended (RR 1.2 (0.9, 1.5)). Using Google Analytics, participants spent 23 minutes (IQR 4–38) using the app. App satisfaction was high (89% found the app useful, 92% easy to use). Trialling app-based education in people following ACS who do not attend CR should be explored in future studies.Conclusion:In this trial, CR was well attended and using an avatar to deliver education via an app did not significantly improve outcomes, however patient satisfaction was high
Development of a patient decision aid in relation to imaging for rotator cuff tendinopathy: a mixed-methods study
No full textBackground: Unnecessary imaging for rotator cuff related shoulder pain is common and may be related to inadequate shared decision making. Objective: To develop and evaluate a patient decision aid (PDA) for people with rotator cuff-related shoulder pain to inform decision-making. Design: Mixed-methods study guided by the International Patient Decision Aids Standards. Methods: A multidisciplinary steering group guided this research. The PDA was developed iteratively, incorporating feedback from people with shoulder pain and health professionals through semi-structured interviews and acceptability questionnaires (1 = strongly disagree and 5 = strongly agree). Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. Results: Twenty health professionals and nineteen patients participated in interviews, while a separate cohort of 54 patients and 15 health professionals completed acceptability questionnaires. Most patients (74–98 %) rated the PDA as acceptable, though 37 % perceived it as biased against imaging. Health professionals (median agreement score 4/5) found the PDA useful but highlighted concerns about feasibility in time-constrained settings. Interview feedback emphasized clarity, contextualization of imaging findings, and alignment with clinical guidelines. When using the final version of the PDA in a clinical encounter, all five patients (100 %) reported that the information in the decision aid influenced their decision to have a scan, and four of the five health professionals (80 %) reported that they would use the decision aid in their practice. Conclusion: This decision aid appears to be an acceptable and useful tool for helping people with rotator cuff-related shoulder pain to make informed decisions about imaging. A randomized controlled trial evaluating whether this decision aid reduces people's intentions to have imaging and facilitate informed treatment choices is now needed
Hard Hats and Glass Ceilings: Women’s Experiences in the Construction Industry in Developed Western Nations
No full textContributing to the growing body of research, this systematic literature review (SLR) aims to investigate barriers faced by women in construction across developed Western nations, including Australia, New Zealand, North America, and the United Kingdom. While numerous studies have identified barriers such as gender discrimination, workplace culture, and career progression issues, these findings are often disconnected, leading to a lack of holistic understanding. This fragmentation results in inefficient policy efforts, wasted resources, missed opportunities to implement best practices, and limited comparative insights, all hindering the development of targeted, evidence-based solutions. To address these challenges, this study bridges a critical gap by conducting an SLR that consolidates and synthesizes existing research on the barriers that women face in construction across these developed nations. A systematic literature search found 63 journal articles that explore the barriers faced by women in Western countries. Four major barriers—workplace environment and culture, career development and opportunities, work–life balance and support, and policies and institutional factors with a number of subbarriers—emerged from the review. The findings of this research lay the foundation for organizations to inform their strategies for mitigating talent deficit and to assist governments in developing effective policies around women inclusion and retention in construction. The findings of this study present a comparative analysis of the barriers faced by women across different Western countries, revealing both common challenges and region-specific differences. This cross-regional comparison is a key contribution of our research, offering valuable insights into the unique and shared obstacles that hinder women’s participation in the construction industry
Effectiveness of a single emotional freedom techniques session on facilitating forgiveness and mental health: a randomized clinical trial
Get PDFInterpersonal transgressions can cause emotional distress and harm victims’ mental and physical health. This pre-registered clinical trial investigated the effectiveness of Emotional Freedom Techniques (EFT) in promoting forgiveness and mental health. A sample of 98 adults (91% female, aged 28–72) from Australia and the U.S. self-selected and were randomly allocated to an online EFT intervention or control task. Pre- and post-intervention measures assessed forgiveness, empathy, rumination, mood, and anxiety. Results revealed moderate improvements in most outcomes for the EFT group, suggesting its potential role in fostering forgiveness and psychological recovery. Findings suggest EFT may aid emotional reintegration, reduce stress, and enhance mental wellbeing after interpersonal offenses.</p
A cost-consequence analysis of a nudge intervention to improve hospital care of older people at the end of life: results from a stepped-wedge cluster randomised trial
No full textObjectivesThe ‘Intervention for Appropriate Care and Treatment’ (InterACT) was a nudge intervention to identify hospital patients at risk of imminent death or deterioration and communicate this information to treating clinical teams. The aim was to improve the quality of the care delivered. This paper reports an economic evaluation of the InterACT intervention.MethodsA stepped-wedge cluster randomised trial was conducted across three large tertiary hospitals in Australia between May 2020 and June 2021. We report the data as a cost-consequence analysis here. The cost of implementing the intervention was determined using prospectively collected staff time sheets, study documentation and field notes. Changes to hospital admission costs and health service outcomes between the trial’s intervention and control phases are also reported. Hospital admissions costs and other health service outcomes were obtained from hospital databases and patient chart reviews. ResultsThe mean intervention cost was 21,373 to 23 per at-risk admission. The intervention did not reduce the cost of ICU admission, length of stay, medical emergency calls or in-hospital deaths. Wide confidence intervals around at-risk admission cost differences (95% CI: –3,312) indicated there was large uncertainty.Conclusions This cost-consequence analysis found that the intervention was not effective in reducing the cost of non-beneficial treatment, which is consistent with the broader InterACT results. This simple nudge- intervention alone may not be sufficient to impact health service resource use and costs in the complex end-of-life setting. <br/
Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes
No full textIN RESPONSE: We thank Dr. Rosenfeld and colleagues and Dr. Birrell and associates for their interest in our commentary. We agree that healthy habits are important for public health. We question whether the best approach to improve lifestyle habits in the population is for clinicians to target one person with unhealthy habits at a time
Stroke characteristics are associated with sprint-paddling performance in female and male competitive surfers
No full textSpatiotemporal kinematics represent a novel domain within surfboard sprint-paddling. Investigating the interplay between stroke characteristics and sprint-paddling speed can inform the development of effective training strategies for both female and male surfers. 31 competitive Australian surfers ( n = 15 females, n = 16 males) performed two maximal 15-m sprint-paddling trials in a swimming pool. Split times (5-, 10-, and 15-m), stroke count, stroke rate, stroke length, and stroke phase distances (glide, pull, push, recovery) during acceleration and speed maintenance periods over the 15-m were measured. Regression analyses determined multiple spatiotemporal variables that strongly contributed to faster split times at all distances, including a sex interaction effect (r 2 = 0.749, 0.791, and 0.794 respectively). For all surfers, push distance during acceleration and pull distance during speed maintenance were indicative of faster split times. For male surfers, the pull distance during the full sprint-paddle effort was indicative of faster split times. No variables were indicative of faster times for female surfers. This indicated that the development of a technique which promotes longer propulsive distances (i.e. pull and push distance) and an additional investigation of the female surfer should be encouraged to further afford optimal sprint-paddling success in both sexes. </p
Enhancing Knowledge of Construction Safety: A Semantic Network Analysis Approach
No full textThe construction industry is recognized as high-risk due to frequent accidents and injuries, prompting extensive research and bibliometric analysis of construction safety. However, little attention has been given to the evolution and interconnections of key research topics in this field. This study applies semantic network analysis (SNA) to examine relationships and trends in construction safety research over the past 30 years. SNA enables quantitative exploration of topic interrelationships that is difficult to achieve with other approaches. Chronological network graphs are evaluated using the number of nodes, edges, density, average clustering coefficient, and average path length. Prominent topics are identified through degree, betweenness, and eigenvector centrality measures. The analysis combines a global overview of the main network, a chronological perspective, and local examination of clusters based on five macro keywords: accident, safety management, worker behavior, machine learning, and safety training. Results show a shift from traditional concerns with mortality and injuries to contemporary issues, such as safety climate, worker behavior, and technological innovations, including building information modeling, machine learning, and real-time monitoring. Topics with lower centrality scores are identified as under-researched. Overall, SNA offers a comprehensive view of the construction safety knowledge system, guiding researchers toward emerging topics and helping practitioners prioritize resources and design integrated safety risk strategies.</p