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Editorial: Medical overuse and underuse in healthcare systems
No full textThe healthcare landscape is rapidly evolving with advances in medical technology, pharmaceuticals, and diagnostic tools (1). While these innovations have markedly improved patient outcomes and saved countless lives, they have also led to a concerning issue: medical overuse. Medical overuse refers to services that are more harmful than beneficial, do not enhance the quality and quantity of life, impose excessive costs on patients and the healthcare system, and are of low quality. If patients were fully informed, they would likely not request these services (2). This phenomenon, characterized by unnecessary or excessive medical interventions, poses significant risks to both individual patients and the broader healthcare system, in addition to imposing substantial costs (3). Addressing this growing concern requires education, policy reform, and systemic change
The Effects of Parent-Child Interaction Therapy on Parent Feeding Practices and Children's Problematic Mealtime Behaviors
No full textMany children are fussy or demanding about food, and managing these behaviors can be difficult and distressing for parents. Yet, no previous study had examined whether Parent-Child Interaction Therapy (PCIT), an interactive parenting support program that coaches caregivers while they interact with their young children, improves problematic mealtime behaviors and food-related parenting practices. In this study, 178 parents in Australia (Mage = 35.1 years, SD = 7.5 years; 93% female) of young children (Mage = 4.5 years, SD = 1.3, 76% male) completed up to two baseline surveys (prior to a waitlist, pre-PCIT) and a third survey after PCIT. The surveys included measures of their parenting practices in general and related to feeding and mealtimes, beliefs about eating, and children’s mealtime behavior (e.g., food avoidance, mealtime aggression) and general externalizing symptoms. Using paired t-tests, no changes were found during baseline (pre-waitlist to pre-PCIT), but from pre- to post-PCIT, medium to large improvements were found in parent mealtime demandingness and responsiveness, aversion to mealtime, child eating behaviors, general parenting practices, and child externalizing behavior. However, positive mealtime environment did not improve and improvements in general parenting and behavior were larger than for eating-related parenting and child behavior. The findings suggest that PCIT can be effective for reducing most problematic mealtime behaviors and can improve multiple parental feeding practices
Criminal Due Process and Chapter III of the Australian Constitution (Second Edition)
No full textThis book considers the potential of Chapter III of the Australian Constitution to protect fundamental criminal due process rights such as the presumption of innocence, right to silence, the right to confront accusers, and the right to fair and proportionate sentencing. These features might be regarded as fundamental characteristics of judicial process in the criminal sphere, such that significant departures from them might intefere with the institutional integrity of a court. This may trigger unconstitutionality, given how the High Court has found that significant features of judicial process are in effect protected by Chapter III of the Australian Constitution, and its promise of judicial independence
Navigating complexity: a conceptual framework for simulation interventions
No full textBackground: Healthcare systems are inherently complex, shaped by dynamic interactions and interdependencies rather than rigid structures. Simulation-based training interventions must embrace this complexity. Complex Adaptive Systems and Resilient Healthcare provide complementary theoretical frameworks for understanding how healthcare systems can respond to internal and external needs while maintaining adaptability and functionality. Incorporating concepts from Complex Adaptive Systems and Resilient Healthcare into simulation-based interventions increases the likelihood of their success within contemporary healthcare systems. A focus on adaptability, continuous learning, and system-wide resilience is necessary for healthcare improvement, and simulation interventions can help develop and reinforce these capabilities. In this article, we argue that simulation must be reimagined to reflect the realities of complex healthcare systems and propose a conceptual framework to support this shift.Main body: We propose a three-component conceptual framework for simulation practitioners seeking to design and deliver interventions that embrace complexity: (1) Problem identification, (2) simulation design, and (3) evaluation strategies. The three components function across organizational levels, supporting a dynamic and adaptive approach to addressing healthcare system challenges. By integrating Complex Adaptive Systems and Resilient Healthcare principles, simulation-based interventions can foster a complexity-aware mindset, enabling healthcare professionals and organizations to anticipate, respond to, and recover from challenges more effectively. To illustrate this framework, we introduce three vignettes demonstrating how simulation-based interventions may benefit at different levels within healthcare systems. The vignettes illustrate how challenges at the institutional, departmental, and individual levels can be identified and addressed effectively by simulation-based interventions.Conclusion: Simulation interventions can strengthen healthcare systems by supporting organizational learning and embedding principles from complexity science and resilience thinking. This requires reimagining simulation not as isolated training events but as complex interventions that operate across levels and respond to dynamic system needs. By adopting this systems-based approach, simulation practitioners, healthcare leaders, and policymakers can better align simulation with real-world conditions - bridging theory and practice while fostering more adaptive and resilient care
Measuring the quality of leisure facilities for older residents in urban communities based on the GA-PP cloud model
No full textPresently, China has entered the leisure era, and leisure has become an increasingly important aspect of life for the elderly. To improve the quality of leisure services for the elderly, this study evaluates the service supply quality of community home care leisure facilities, using Wuxi City as a case study. Moreover, effective improvement suggestions are proposed to address problems in the supply of community care leisure facilities and to promote the development of community-based elderly leisure services. An innovative assessment method is proposed to evaluate the supply quality of elderly leisure facilities, based on the projection pursuit method and the MBCT-SR (Multi-Step Backward Cloud Transformation Algorithm Based on Sampling with Replacement) multidimensional cloud model. This method analyzes the supply and use of community elderly leisure facilities from the perspective of the diverse needs of the elderly and comprehensively evaluates the supply quality of elderly leisure service facilities based on those needs. The results show that the quality level of elderly leisure facility provision in the community is mainly at a medium to good level, with the overall evaluation leaning more towards the good level. This provides new insights into the evaluation and improvement of elderly leisure service quality.</p
The Role of Low Earth Orbit Satellites in Facilitating Internet Connectivity in the Asia-Pacific Region during Disaster Times: a Study in Regulatory Obstacles and Opportunities
No full textRandomised controlled trial of standard outpatient cardiac rehabilitation versus personalised cardiac rehabilitation for secondary prevention for all in need (SPAN) after type 1 myocardial infarction
Get PDFIntroduction:Cardiac rehabilitation after type 1 myocardial infarction (type 1 MI) is an effective but underutilised method of preventing new cardiac events. This study aims to determine whether a programme of personalised cardiac rehabilitation achieves better completion rates compared with a routine outpatient rehabilitation model post-type 1 MI. A secondary aim is to determine any differences in rates of major adverse cardiovascular events at 12 months. Methods and analysis:Secondary prevention for all in need (SPAN) is a prospective multisite single-blind comparative effectiveness randomised trial of personalised versus standard outpatient rehabilitation. Five hundred and thirty-two patients with a recent type 1 MI diagnosis will be randomised to either a personalised model of rehabilitation which includes flexibility in the components of rehabilitation and the time and location of contacts, or the standard outpatient model. Exclusion criteria include conditions associated with higher clinical risk to the participant, which introduce confounding to the study or interfere with a participant's ability to comply. The primary study endpoint is the proportion of patients who complete the assigned rehabilitation model. Completion of rehabilitation is defined as participation in ≥80% of all scheduled sessions, in either treatment arm. Assuming a power of 90% and an overall type 1 error of 5%, we expect that 50% of those randomised to usual care will meet the primary endpoint compared with 65% of those on personalised rehabilitation. To detect this difference of 15%, we require a sample size of 478 participants (239 per arm). Accounting for a conservative attrition rate of 10%, the total sample size required is 532. Ethics and dissemination:The trial received ethical approval from the Southern Adelaide Clinical Human Research Ethics Committee (ref. 2022/HRE00071) in September 2022, with an opt-out approach
Linear Focal Elastosis: What We Know From Epidemiological Studies
Get PDFLinear focal elastosis (LFE), characterised by horizontal streaks on the lower back, is a dermatological condition with unclear etiopathogenesis and limited epidemiological data. This study synthesises case reports to elucidate demographic patterns, clinical manifestations, and potential associations. A literature search across PubMed, Embase, Ovid and ResearchGate identified 37 relevant articles, yielding 80 cases after excluding duplicates and irrelevant articles. In analysis, the male-to-female ratio for LFE was 5:1, with a mean age of 39 years. Cases were more common among adolescents and older adults (age ≥ 60), with the majority occurring in pubertal adolescents. No racial predilection was observed. The lower back was the most frequently affected site, with rare cases involving other body parts. Some cases were associated with growth spurts or strenuous exercise, although the etiopathogenesis remains speculative. LFE may be underreported due to its asymptomatic nature and resemblance to other skin conditions, particularly striae distensae. Further research is required to clarify its pathogenesis and explore potential treatment options
Rehabilitating Soldiers for Load Carriage Tasks: An International Perspective
Get PDFSoldiers are likely to suffer an injury and require rehabilitation at some stage of their career. Load carriage, whilst a fundamental requirement, is also a source of injury risk. To optimize the rehabilitation of soldiers and prepare them for a full return to operational duty, load carriage requirements need to be considered throughout their rehabilitation pathway. In addition, injury risks associated with load carriage need to be considered to inform mitigation of reinjury. During the initial injury treatment stage, loss of key fitness elements associated with load carriage performance, being aerobic fitness and relative strength, need to be minimized. Any losses of these same elements of fitness then need to be considered in the overall reconditioning stage. Finally, with injury being a predictor of future load carriage injury, the conditioning stage must move beyond general occupational conditioning to include load carriage-specific conditioning to make the soldier physically resilient against future injury and confident of their capability. By synthesizing evidence from the latest research in load carriage, this narrative review provides pragmatic considerations and guidelines for optimizing soldier load carriage capability following injury
Injuries in Specialist Police Officers: A Scoping Review
No full textBackground: Within Law Enforcement Organizations, specialist police officers perform dangerous tasks beyond those of general duties police officers. These tasks are often performed in complex austere environments while officers wear or carry heavy loads and place officers at a high risk of injury. The aims of this scoping review were to identify, collect, and synthesize the available evidence on injuries sustained by specialist police, and to compare these injuries with those of other law enforcement officers and wider Special Forces populations. Methods: Four academic databases were searched using key search terms. Duplicates of identified records were removed, with those remaining screened against eligibility criteria. A rearward and forward snowballing approach of citations was used to identify other relevant records. Key findings were then summarized in table format. Results: From an initial 3,266 identified records, 2 studies (1 cross-sectional, 1 retrospective cohort) met the eligibility criteria. The most common injury sites varied between the studies and only one study reported injury incidence, that being 1,347 per 1,000 person-years. Conclusion: Musculoskeletal injuries occur frequently in the specialist police population and may bear some similarities to those among general duties police officers and Military Special Forces. However, there is a limited amount of evidence elucidating the injury profile of this population.