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Exploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia
Get PDF© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP–Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the
quality of care that GPs provide, which is dependent on GPs’ capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs’ attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD
How do nurses keep children safe from abuse and neglect, and does it make a difference? A scoping review
Get PDFCopyright © 2018 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/Objectives: To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice.
Design: This scoping review was guided by Arksey and O'Malley's framework for scoping reviews. Data Sources: Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching.
Results: Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect.
Conclusions: This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness
Fluoride and phosphate release from carbonate-rich fluorapatite during managed aquifer recharge
Get PDFManaged aquifer recharge (MAR) is increasingly used as a water management tool to enhance water availability and to improve water quality. Until now, however, the risk of fluoride release during MAR with low ionic strength injectate has not been recognised or examined. In this study we analyse and report the mobilisation of fluoride (up to 58 µM) and filterable reactive phosphorus (FRP) (up to 55 µM) during a field groundwater replenishment experiment in which highly treated, deionised wastewater (average TDS 33 mg/L) was injected into a siliciclastic Cretaceous aquifer. In the field experiment, maximum concentrations, which coincided with a rise in pH, exceeded background groundwater concentrations by an average factor of 3.6 for fluoride and 24 for FRP. The combined results from the field experiment, a detailed mineralogical characterisation and geochemical modelling suggested carbonate-rich fluorapatite (CFA: Ca10(PO4)5(CO3,F)F2) to be the most likely source of fluoride and phosphate release. An anoxic batch experiment with powdered CFA-rich nodules sourced from the target aquifer and aqueous solutions of successively decreasing ionic strength closely replicated the field-observed fluoride and phosphate behaviour. Based on the laboratory experiment and geochemical modelling, we hypothesise that the release of fluoride and phosphate results from the incongruent dissolution of CFA and the simultaneous formation of a depleted layer that has hydrated di-basic calcium phosphate (CaHPO4·nH2O) composition at the CFA-water interface. Disequilibrium caused by calcium removal following breakthrough of the deionised injectate triggered the release of fluoride and phosphate. Given the increasing use of highly treated, deionised water for MAR and the ubiquitous presence of CFA and fluorapatite (Ca10(PO4)6F2) in aquifer settings worldwide, the risk of fluoride and phosphate release needs to be considered in the MAR design process.We gratefully acknowledge the financial support for DS through a Robert and Maude Gledden scholarship through the University of Western Australia and topup scholarships by the National Centre for Groundwater Research and Training (NCGRT) and CSIRO Land and Water
Media Smart-Targeted: Diagnostic outcomes from a two-country pragmatic online eating disorder risk reduction trial for young adults
Get PDFThis article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving'.
Copyright 2018 Wiley Periodicals, Inc.
This author accepted manuscript is made available following 6 month embargo from date of publication (January 2018) in accordance with the publisher’s copyright policyBackground: Diagnostic outcomes in eating disorder (ED) risk reduction trials are important but rarely reported. Methods: An online pragmatic randomized-controlled trial was conducted with young-adult women in Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received tips for positive body image. Eating Disorder Examination–Questionnaire (EDE-Q) scores from baseline and 12-month follow-up were used to investigate two outcomes: ED onset in those who were asymptomatic at baseline (prevention effects); and, ED remission in those who met diagnosis at baseline (treatment effects). Results: MS-T participants were 66% less likely than controls to develop an ED by 12-month follow-up (non-significant). MS-T participants who met ED criteria at baseline were 75% less likely than controls to still meet diagnostic criteria at follow-up. This effect was significant and remained so for both those who did and who did not access external face-to-face ED treatment during the trial. Conclusions: Whilst further investigations are necessary, MS-T has fully automated procedures, low implementation costs, the potential to be delivered at-scale to assist those assist those where face-to-face services are limited or not available (e.g., remote areas)
Costs of potentially inappropriate medication use in residential aged care facilities
Get PDF© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground
The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.
Methods
Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.
Results
Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.
Conclusions
The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.
Visuospatial asymmetries do not modulate the cheerleader effect
Get PDFOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.The cheerleader effect occurs when the same individual appears to be more attractive when seen in a group, compared to alone. As observers over-attend to visual information presented in the left visual field, we investigated whether the spatial arrangement of the faces in a group would influence the magnitude of the cheerleader effect. In Experiment 1, target faces were presented twice in the centre of the display: once alone, and once in a group. Group images featured two distractor faces, which were presented in either the left or the right visual field, or on either side of the target. The location of the distractor faces did not modulate the size of the cheerleader effect, which was observed in each group configuration. In Experiment 2, we manipulated the location of the target faces, which were presented at the far left, far right, or centre of the group. Faces were again significantly more attractive in each group configuration, and the spatial location of the target face did not influence the size of the cheerleader effect. Together, our results show that the cheerleader effect is a robust phenomenon, which is not influenced by the spatial arrangement of the faces in the group
Contaminated fingers: a potential cause of Chlamydia trachomatis-positive urine specimens
Get PDFThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives The detection of an STI agent in a urogenital tract (UGT) specimen from a young child is regarded as being indicative of sexual abuse. However, the probabilities of contamination events that could conceivably lead to STI positive specimens in the absence of sexual contact are unclear. The objective was to estimate the potential for fingers that have come in contact with Chlamydia trachomatis-positive urine to detectably contaminate C. trachomatis-negative urine.
Methods The study design was based on self-experimentation. Dilutions of C. trachomatis elementary bodies (EBs) were prepared. A participant contacted an EB dilution then a urine surrogate specimen. The experiment was performed by three participants using three C. trachomatis isolates, of genotype E, F and B. Two surrogate urine contact methods were used to mimic contamination of a carer assisting with a child’s urine collection. All EB dilutions and urine surrogate specimens were subjected to C. trachomatis assay and quantification in a real-time PCR-based diagnostic system.
Results The amplimer crossing point (Cq) for EB dilutions was 10.0±1.6 less than for corresponding finger contacted urine specimens, which corresponds to ~10 µL of EB suspension transferred. This was largely independent of participant identity, C. trachomatis strain or EB dilution. Hand decontamination led to large reductions in EBs transferred, but transfer remained consistently detectable. Recent Cq data from C. trachomatis-positive clinical urine specimens were collated, and 20% clearly contained sufficient C. trachomatis to detectably contaminate another specimen by finger-mediated transfer, as in this experiment.
Conclusions This study directly demonstrated the potential for urine contaminated fingers to convert a C. trachomatis-negative urine specimen to C. trachomatis positive as a result of contact. Accordingly, procedures for urine specimen collection, particularly from children, need to be designed to prevent contamination
Physical water scarcity metrics for monitoring progress towards SDG target 6.4: An evaluation of indicator 6.4.2 “Level of water stress”
Get PDFThis is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Target 6.4 of the recently adopted Sustainable Development Goals (SDGs) deals with the reduction of water scarcity. To monitor progress towards this target, two indicators are used: Indicator 6.4.1 measuring water use efficiency and 6.4.2 measuring the level of water stress (WS). This paper aims to identify whether the currently proposed indicator 6.4.2 considers the different elements that need to be accounted for in a WS indicator. WS indicators compare water use with water availability. We identify seven essential elements: 1) both gross and net water abstraction (or withdrawal) provide important information to understand WS; 2) WS indicators need to incorporate environmental flow requirements (EFR); 3) temporal and 4) spatial disaggregation is required in a WS assessment; 5) both renewable surface water and groundwater resources, including their interaction, need to be accounted for as renewable water availability; 6) alternative available water resources need to be accounted for as well, like fossil groundwater and desalinated water; 7) WS indicators need to account for water storage in reservoirs, water recycling and managed aquifer recharge. Indicator 6.4.2 considers many of these elements, but there is need for improvement. It is recommended that WS is measured based on net abstraction as well, in addition to currently only measuring WS based on gross abstraction. It does incorporate EFR. Temporal and spatial disaggregation is indeed defined as a goal in more advanced monitoring levels, in which it is also called for a differentiation between surface and groundwater resources. However, regarding element 6 and 7 there are some shortcomings for which we provide recommendations. In addition, indicator 6.4.2 is only one indicator, which monitors blue WS, but does not give information on green or green-blue water scarcity or on water quality. Within the SDG indicator framework, some of these topics are covered with other indicators
Quality of life in older adults following a hip fracture: an empirical comparison of the ICECAP-O and the EQ-5D-3 L instruments
Get PDFOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
The purpose of this study was to empirically compare the performance of two generic preference based quality of life instruments, EQ-5D-3 L (with a health and physical function focus) and ICECAP-O (with a wellbeing and capability focus), in a population of older Australians following hip fracture.
Methods
Older adults or their family member proxies (in cases of severe cognitive impairment) following surgery to repair a fractured hip were invited to take part in this cross sectional study. Inclusion criteria included an age of 60 years or older, confirmed falls-related hip fracture and those receiving current palliative care or consented to other research studies were excluded. 87 participants completed the ICECAP-O and EQ-5D-3 L instruments between one and three weeks post-surgery.
Results
For the hip fracture population, the mean ICECAP-O score was 0.639 (SD 0.206, n = 82) and the mean EQ-5D-3 L utility score was 0.545 (SD 0.251, n = 87). There was a statistically significant positive correlation between the ICECAP-O and EQ-5D-3 L scores (r = 0.529, p = < 0.001).
Conclusions
Study findings indicate significant impairments in quality of life post hip fracture. In multiple regression analyses, age and health-related QoL (measured by the EQ-5D) were significant determinants of ICECAP-O scores, while proxy respondent status, age, and capability-related QoL (measured by the ICECAP-O) were significant determinants of EQ-5D scores. Approaches to measuring and valuing quality of life in this sample, should consider the target domains of the intervention in their choice of instrument. Studies aiming to measure the impact of interventions targeting broader domains of wellbeing and QoL should consider including a broader measure of QoL in conjunction with a HRQoL measure.Rachel Milte was supported by a Flinders University Research Scholarship
and an Australian Postgraduate Award
Phylogenomic history of enigmatic pygmy perches: implications for biogeography, taxonomy and conservation
Get PDFPublished by the Royal Society under the terms of the Creative Commons
Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted
use, provided the original author and source are credited.Pygmy perches (Percichthyidae) are a group of poorly
dispersing freshwater fishes that have a puzzling
biogeographic disjunction across southern Australia. Current
understanding of pygmy perch phylogenetic relationships
suggests past east–west migrations across a vast expanse
of now arid habitat in central southern Australia, a region
lacking contemporary rivers. Pygmy perches also represent a
threatened group with confusing taxonomy and potentially
cryptic species diversity. Here, we present the first study
of the evolutionary history of pygmy perches based on
genome-wide information. Data from 13 991 ddRAD loci
and a concatenated sequence of 1 075 734 bp were generated
for all currently described and potentially cryptic species.
Phylogenetic relationships, biogeographic history and cryptic
diversification were inferred using a framework that combines
phylogenomics, species delimitation and estimation of
divergence times. The genome-wide phylogeny clarified
the biogeographic history of pygmy perches, demonstrating
multiple east–west events of divergence within the group
across the Australian continent. These results also resolved
discordance between nuclear and mitochondrial data from
a previous study. In addition, we propose three cryptic species within a southwestern species complex. The finding of potentially new species demonstrates
that pygmy perches may be even more susceptible to ecological and demographic threats than
previously thought. Our results have substantial implications for improving conservation legislation
of pygmy perch lineages, especially in southwestern Western Australia.This project was funded by an Australian Research Council Future Fellowship (FT130101068 to
L.B.B.)