Citizen science as a vehicle to address multiple policy objectives: Case studies from Australia.

ISSUE ADDRESSED: Despite increasing interest in citizen science as an approach to engage members of the public in research and decision making about health and wellbeing, there is a lack of practical evidence to guide policy and practice organisations to utilise these approaches. In this study we investigated how and why citizen science came to be incorporated into the work of two policy organisations. METHODS: We offer two in-depth case studies of Australian government organisations which have utilised citizen science in environmental and healthy ageing policy. Interviews with organisational informants and relevant documents were analysed inductively to explore how citizen science came to be adopted, legitimised and supported. RESULTS: Citizen science was utilised to address multiple organisational objectives, including increasing community participation in science; enhancing individuals' wellbeing, learning, and skills, and generating data to support research and policy in a relatively cost-effective manner. In both cases, grant funding was a mechanism to support citizen science, with project delivery facilitated through academic-policy partnerships and led by external academic or community partners. CONCLUSION: Although citizen science is relatively new in policy and practice settings, this study underscores the value of these approaches in realising co-benefits for organisations, academics, and community members. The support and advocacy of senior managers as 'champions', and a willingness to invest in trialling new approaches to address policy problems are necessary ingredients to foster acceptance and legitimacy of citizen science. SO WHAT?: Citizen science initiatives can be strategically utilised by health promotion organisations to enact priorities related to genuine community involvement, support research and innovation and facilitate collaboration and partnerships between academic, policy and community stakeholders.

Average thickness of the bones of the human neurocranium: development of reference measurements to assist with blunt force trauma interpretations.

The accurate interpretation of a blunt force head injury relies on an understanding of the case circumstances (extrinsic variables) and anatomical details of the individual (intrinsic variables). Whilst it is often possible to account for many of these variables, the intrinsic variable of neurocranial thickness is difficult to account for as data for what constitutes 'normal' thickness is limited. The aim of this study was to investigate the effects of age, sex and ancestry on neurocranial thickness, and develop reference ranges for average neurocranial thickness in the context of those biological variables. Thickness (mm) was measured at 20 points across the frontal, left and right parietals, left and right temporals and occipital bones. Measurements were taken from post-mortem computed tomography scans of 604 individuals. Inferential statistics assessed how age, sex and ancestry affected thickness and descriptive statistics established thickness means. Mean thickness ranged from 2.11 mm (temporal squama) to 19.19 mm (petrous portion). Significant differences were noted in thickness of the frontal and temporal bones when age was considered, all bones when sex was considered and the, right parietal, left and right temporal and occipital bones when ancestry was considered. Furthermore, significant interactions in thickness were seen between age and sex in the frontal bone, ancestry and age in the temporal bone, ancestry and sex in the temporal bone, and age, sex and ancestry in the occipital bone. Given the assorted influence of the biological variables, reference measurement ranges for average thickness incorporated these variables. Such reference measurements allow forensic practitioners to identify when a neurocranial bone is of normal, or abnormal, thickness.

The case for citizen science in public health policy and practice: a mixed methods study of policymaker and practitioner perspectives and experiences.

BACKGROUND: Citizen science (CS) is increasingly being utilised to involve the public in public health research, but little is known about whether and how CS can address the needs of policy and practice stakeholders in health promotion and chronic disease prevention. METHODS: Using a mixed methods approach we conducted an online survey (n = 83) and semi-structured interviews (n = 21) with policy and practice stakeholders across Australia to explore how CS approaches are perceived and applied in chronic disease prevention, how CS aligns with existing approaches to community engagement, and how the uptake of CS can be supported within policy and practice settings. RESULTS: Most participants had heard of CS, and while few had experience of using CS, there was widespread support for this approach, with many seeing it as complementary to other community engagement approaches. CS was seen as providing: (a) a robust framework for engagement; (b) access to rich data; (c) opportunities for more meaningful engagement; and (d) a mutually beneficial approach for stakeholders and community members. However, stakeholders identified a need to weigh benefits against potential risks and challenges including competing organisational priorities, resourcing and expertise, data quality and rigour, governance, and engagement. CONCLUSIONS: To expand the use of CS, stakeholders identified the need for increased awareness, acceptance, and capacity for CS within public health organisations, greater access to supporting tools and technology, and evidence on processes, feasibility and impacts to enhance the visibility and legitimacy of CS approaches.

Harnessing citizen science in health promotion: perspectives of policy and practice stakeholders in Australia.

Citizen science is rapidly gaining momentum as a means of involving members of the public in research and decision-making in disease prevention and health promotion. However, citizen science projects have predominantly been led by academic researchers and there is limited understanding of how to support the application of citizen science approaches in policy and practice settings. This study aimed to understand the perceptions, motivations and early experiences of applying citizen science approaches in policy and practice settings. Semi-structured interviews were conducted with policy and practice stakeholders who were leading citizen science projects (project partners, n = 7), and their implementation partners (project implementers, n = 11). Participants viewed citizen science as an opportunity to access hard-to-reach data and to enhance engagement with community members to support policy and practice change. Barriers and facilitators of citizen science in policy and practice settings included navigating collaborative relationships, team capacity and resources available to deliver projects, recruitment and engagement of citizen scientists and ethical considerations in the design and implementation of citizen science projects. Findings support the feasibility and wider application of citizen science approaches in health promotion and are being used to inform the development of tools and resources to build capacity in these approaches in policy and practice settings.

Local government's roles in community health and wellbeing in Australia: Insights from Tasmania.

ISSUE ADDRESSED: Local governments are well-placed to respond to communities' health and wellbeing needs. However, in the Australian state of Tasmania, the sector's roles in that respect are unclear. METHODS: We interviewed 10 municipal personnel in Tasmania to understand their views on local governments' community health and wellbeing functions. RESULTS: Participants had an integrative understanding of community health and wellbeing and recognised that collective effort from all tiers of government, community members, and other place-based stakeholders would improve outcomes. They identified several roles local governments have to support and drive such improvements, including in relation to diverse place-specific determinants of health and wellbeing. Capacity and capability to fulfil what is needed varied, with rural and remote councils generally less able than urban counterparts to respond consistently or comprehensively to community members' complex needs. However, in the presence of clear expectations and parameters, and appropriate support from other tiers of government, participants were eager for their councils to do more to improve their communities' health and wellbeing, including via a mandate in legislation. CONCLUSION: Local governments have the potential to do more to improve health and wellbeing outcomes in Tasmania, and the greatest gains could be made by addressing spatial inequalities faced by the sector. That insight is extensible to other comparable jurisdictions. SO WHAT?: We argue the need both for a shared societal goal of equitable wellbeing supported by all tiers of government and for actions proportionate to the needs of council areas.

Using citizen science to empower older adults to improve a food security initiative in Australia.

Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities.

Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia.

ISSUE ADDRESSED: Returning to work is a major barrier to continued breastfeeding. While many large organisations in Australia have policies to support breastfeeding and expressing at work, it is not known how these are implemented in practice, what support is available in smaller workplaces or to what extent workplace support meets the needs of breastfeeding mothers. METHODS: This pilot study trialled a citizen science approach where members of the public provided photographs and descriptions of breastfeeding facilities and support within their workplaces. The study was promoted through community networks and social media, and data were submitted via an online survey. Data were analysed inductively to identify key themes. RESULTS: Thirty-seven participants provided data on breastfeeding support in their workplace. Three key themes were identified: physical features and facilities; workplace culture; and organisational and occupational characteristics. There was considerable variation in workplace support and around half of the participants indicated that they had to use communal, poorly equipped and/or unhygienic spaces to breastfeed or express at work. CONCLUSION: While some employers have taken important steps towards supporting mothers to combine breastfeeding and work, there is room for improvement. Through this pilot study, we have demonstrated the feasibility and value of using a citizen science approach to obtain data from a range of workplaces along with perceptions of workplace characteristics that support or hinder breastfeeding and expressing at work. SO WHAT?: Citizen science is a useful approach to capturing data on workplace support for breastfeeding and could be scaled up to enable ongoing monitoring. The findings raise important issues around the interpretation and implementation of current legislation to support mothers in the workplace.

Human identification: a review of methods employed within an Australian coronial death investigation system.

Whilst many identification methods have been widely described and discussed in the literature, and considered in disaster and humanitarian contexts, there has been limited reporting and evaluation of the identification methods used in domestic medico-legal death investigation contexts. The aim of this study was to evaluate the identification methods utilised at the Victorian Institute of Forensic Medicine (VIFM), which forms part of a coronial medico-legal death investigation system. The method of identification and time taken to complete the identification were reviewed for all cases admitted to the VIFM over a five-year period from 1 July 2015 to 30 June 2020. The majority, 91%, of individuals admitted to the VIFM were visually identified. The remaining 9% of cases required identification by primary methods (i.e. fingerprints, DNA or dental) or, when those methods were not possible, by secondary methods (i.e. circumstantial). Visual identifications were the timeliest, taking an average of 1.5 days, whilst primary identification methods required an average of 5 days to complete. The triaging of identification methods, dependent on the case context, body preservation, availability of ante-mortem data, legal requirements and admissibility of the method, are determined by identification coordinators within the Human Identification Service (HIS) to ensure the most appropriate and timely method is employed. This review of human identification methods provides the foundation for future analyses to compare workflow processes and improve identification methods utilised in domestic medico-legal contexts.

30+ years of media analysis of relevance to chronic disease: a scoping review.

BACKGROUND: Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area. METHODS: We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies. RESULTS: Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work. CONCLUSIONS: The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

Knowledge mobilisation in practice: an evaluation of the Australian Prevention Partnership Centre.

BACKGROUND: Cross-sector collaborative partnerships are a vital strategy in efforts to strengthen research-informed policy and practice and may be particularly effective at addressing the complex problems associated with chronic disease prevention. However, there is still a limited understanding of how such partnerships are implemented in practice and how their implementation contributes to outcomes. This paper explores the operationalisation and outcomes of knowledge mobilisation strategies within the Australian Prevention Partnership Centre - a research collaboration between policy-makers, practitioners and researchers. METHODS: The Centre's programme model identifies six knowledge mobilisation strategies that are hypothesised to be essential for achieving its objectives. Using a mixed methods approach combining stakeholder interviews, surveys, participant feedback forms and routine process data over a 5-year period, we describe the structures, resources and activities used to operationalise these strategies and explore if and how they have contributed to proximal outcomes. RESULTS: Results showed that Centre-produced research, resources, tools and methods were impacting policy formation and funding. Policy-makers reported using new practical methodologies that were helping them to design, implement, evaluate and obtain funding for scaled-up policies and programmes, and co-creating compelling prevention narratives. Some strategies were better implemented and more impactful than others in supporting these outcomes, with variation in who they worked for. The activities used to effect engagement, capacity-building and partnership formation were mostly generating positive results, but co-production could be enhanced by greater shared decision-making. Considerably more work is needed to successfully operationalise knowledge integration and adaptive learning. CONCLUSIONS: Describing how collaborative cross-sector research partnerships are operationalised in practice, and with what effects, can provide important insights into practical strategies for establishing and growing such partnerships and for maximising their contributions to policy. Findings suggest that the Centre has many strengths but could benefit from more inclusive and transparent governance and internal processes that facilitate dialogue about roles, expectations and co-production practices.

What can we learn from interventions that aim to increase policy-makers' capacity to use research? A realist scoping review.

BACKGROUND: Health policy-making can benefit from more effective use of research. In many policy settings there is scope to increase capacity for using research individually and organisationally, but little is known about what strategies work best in which circumstances. This review addresses the question: What causal mechanisms can best explain the observed outcomes of interventions that aim to increase policy-makers' capacity to use research in their work? METHODS: Articles were identified from three available reviews and two databases (PAIS and WoS; 1999-2016). Using a realist approach, articles were reviewed for information about contexts, outcomes (including process effects) and possible causal mechanisms. Strategy + Context + Mechanism = Outcomes (SCMO) configurations were developed, drawing on theory and findings from other studies to develop tentative hypotheses that might be applicable across a range of intervention sites. RESULTS: We found 22 studies that spanned 18 countries. There were two dominant design strategies (needs-based tailoring and multi-component design) and 18 intervention strategies targeting four domains of capacity, namely access to research, skills improvement, systems improvement and interaction. Many potential mechanisms were identified as well as some enduring contextual characteristics that all interventions should consider. The evidence was variable, but the SCMO analysis suggested that tailored interactive workshops supported by goal-focused mentoring, and genuine collaboration, seem particularly promising. Systems supports and platforms for cross-sector collaboration are likely to play crucial roles. Gaps in the literature are discussed. CONCLUSION: This exploratory review tentatively posits causal mechanisms that might explain how intervention strategies work in different contexts to build capacity for using research in policy-making.

Knowledge mobilisation for chronic disease prevention: the case of the Australian Prevention Partnership Centre.

BACKGROUND: Cross-sectoral, multidisciplinary partnership research is considered one of the most effective means of facilitating research-informed policy and practice, particularly for addressing complex problems such as chronic disease. Successful research partnerships tend to be underpinned by a range of features that enable knowledge mobilisation (KMb), seeking to connect academic researchers with decision-makers and practitioners to improve the nature, quality and use of research. This paper contributes to the growing discourse on partnership approaches by illustrating how knowledge mobilisation strategies are operationalised within the Australian Prevention Partnership Centre (the Centre), a national collaboration of academics, policy-makers and practitioners established to develop systems approaches for the prevention of lifestyle-related chronic diseases. METHODS: We undertook interviews with key academics, policy, and practice partners and funding representatives at the mid-point of the Centre's initial 5-year funding cycle. We aimed to explore how the Centre is functioning in practice, to develop a conceptual model of KMb within the Centre for use in further evaluation, and to identify ways of strengthening our approach to partnership research. Inductive and deductive thematic analysis was used to identify the key mechanisms underpinning the Centre's KMb approach. RESULTS: Six key mechanisms appeared to facilitate KMb within our Centre, namely Engagement, Partnerships, Co-production, Capacity and Skills, Knowledge Integration, and Adaptive Learning and Improvement. We developed a conceptual model that articulated these mechanisms in relation to the structures and processes that support them, as well as the Centre's goals. Findings also informed adaptations designed to strengthen the Centre. CONCLUSIONS: Findings provide insights into the practical realities of operationalising KMb strategies within a research partnership. Overall, the centre is perceived to be progressing towards its KMb goals, but challenges include stakeholders from different settings understanding each other's contexts and working together effectively, and ensuring knowledge generated across different projects within the Centre is integrated into a more comprehensive understanding of chronic disease prevention policy and practice. Our conceptual model is now informing ongoing developmental evaluation activities within the Centre, where it is being tested and refined.

Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment.

AIMS AND OBJECTIVES: To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals. BACKGROUND: Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real-world, environment. DESIGN: Cross-sectional study. METHODS: A sample of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n = 141) and nurse survey (n = 154). Analysis was comparative with regression models constructed for the different ward types. RESULTS: Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added. CONCLUSION: Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful. RELEVANCE TO CLINICAL PRACTICE: Ward-level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.

Fatal falls involving stairs: an anthropological analysis of skeletal trauma.

The skeletal blunt force trauma resulting from fatal falls involving stairs is complex. There are countless ways an individual may fall when stairs are involved, and thus a variety of ways the skeleton may fracture. Therefore anecdotally, it may be said that there is no specific skeletal trauma characteristic of this fall type. In order to scientifically investigate this anecdotal understanding, this study provides a detailed investigation of the skeletal fracture patterns and morphologies resulting from fatal falls involving stairs. Skeletal trauma was analyzed using the full-body postmortem computed tomography scans of 57 individuals who died from a fall involving stairs. Trauma was examined in the context of the variables that potentially influence how an individual falls (i.e. sex, age, body mass index, number of stairs involved, psychoactive drugs, pre-existing conditions, landing surface and manner of the fall) using logistic regression. Skeletal trauma primarily occurred in the axial skeleton. An analysis of fracture patterns showed the cranial base was less likely to fracture in younger individuals and the cervical vertebrae were more likely to fracture in falls that involved more than half a flight of stairs. A total of 56 fracture morphologies were identified. Of these, diastatic fractures were less likely to occur in older individuals. Findings indicate that there are skeletal fracture patterns and morphologies characteristic of a fatal fall involving stairs.

Nurse-Performed Endoscopy: Implications for the Nursing Profession in Australia.

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country's health system model.

Regulated and unregulated nurses in the acute hospital setting: Tasks performed, delayed or not completed.

AIMS: Investigate the number and type of tasks performed, delayed or not completed by regulated and unregulated (assistant) nurses. BACKGROUND: Assistants in Nursing change the work environment of the nurses with whom they work. As the number of Assistants in Nursing working on acute units grows, it is important to understand how their presence influences nursing care. DESIGN: Descriptive analysis of survey data from 62 acute nursing units across three Australian states between 2008-2010. METHODS: All staff providing nursing care to patients were asked to complete a survey that included demographics, the number of tasks delayed/incomplete and the completion of six specific tasks. Nonparametric tests compared Assistants in Nursing (n = 25) to regulated nurses (n = 1630), and regulated nurses on units with no Assistants in Nursing (n = 1356) to those on units with up to 5% assistants (n = 76) and over 5% assistants (n = 198). RESULTS: More regulated nurses on units with zero, or up to 5% Assistants in Nursing, completed tasks usually associated with assistants' scope of practice, relative to those on units with over 5% Assistants in Nursing. Statistically significant differences were found between the units in delays responding to the patient bell and in the planning of nursing care. CONCLUSION: This study suggests that Assistants in Nursing have an impact on the nature and timeliness of care provided in acute hospital units, that is relative to the proportion of staffing they comprise, to the effectiveness of integration and to the clarity of their scope of practice and associated delegation. RELEVANCE TO CLINICAL PRACTICE: With increasing employment of Assistants in Nursing in acute hospital settings comes the requirement to optimise their use. This needs to include a well-articulated scope of practice, clear delegation of tasks and effective integration with the rest of the care team.

Changes to nurses' practice environment over time.

AIMS: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. BACKGROUND: Positive nurse practice environments have been linked to nurse retention and care quality outcomes. METHODS: The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. RESULTS: On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. CONCLUSIONS: The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. IMPLICATION FOR NURSING MANAGEMENT: Managers need to apply existing evidence to improve nurse practice environments and manage instability.

Beyond fun runs and fruit bowls: an evaluation of the meso-level processes that shaped the Australian Healthy Workers Initiative.

Issue addressed The Australian National Partnership Agreement on Preventive Health (NPAPH) charged states and territories with the development and implementation of the Healthy Workers Initiative (HWI) to improve workplace health promotion. Most evaluation efforts focus on the setting (micro) level. In the present study the HWI at the meso-level (state program development) was examined to understand how jurisdictions navigated theoretical, practical, and political priorities to develop their programs, and the programmatic choices that support or hinder perceived success. Methods Interviews with HWI program coordinators and managers across seven Australian jurisdictions explored decision-making processes related to developing and implementing the HWI and the impact of defunding. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Despite taking a variety of approaches to the HWI, jurisdictions had common goals, namely achieving sustainability and capacity for meaningful change. These goals transcended the performance indicators set out by the NPAPH, which were considered unachievable in the given timeframe. Four ways jurisdictions sought to achieve their goals were identified, these were: 1) taking an embedded approach to workplace health promotion; 2) ensuring relevance of the HWI to businesses; 3) engaging in collaborative partnerships with agencies responsible for implementation; and 4) cultivating evolution of the HWI. Conclusions This meso-level evaluation has provided valuable insights into how health promotion program coordinators translate broad, national-level initiatives into state-specific programs and how they define program success. The study findings also highlight how broader, contextual factors, such as jurisdiction size, political imperatives and funding decisions impact on the implementation and success of a national health promotion initiative. So what? When evaluating the translation of complex initiatives, a meso-level analysis can reveal valuable principles for informing program effectiveness and sustainability. It can also identify alignment between macro- and meso-level goals and where macro-level specifications may hinder or assist those goals.

Externalizing the private experience of pain: a role for co-speech gestures in pain communication?

Despite the importance of effective pain communication, talking about pain represents a major challenge for patients and clinicians because pain is a private and subjective experience. Focusing primarily on acute pain, this article considers the limitations of current methods of obtaining information about the sensory characteristics of pain and suggests that spontaneously produced "co-speech hand gestures" may constitute an important source of information here. Although this is a relatively new area of research, we present recent empirical evidence that reveals that co-speech gestures contain important information about pain that can both add to and clarify speech. Following this, we discuss how these findings might eventually lead to a greater understanding of the sensory characteristics of pain, and to improvements in treatment and support for pain sufferers. We hope that this article will stimulate further research and discussion of this previously overlooked dimension of pain communication.

Antibiotic prescribing in primary care: The need for interprofessional collaboration.

Patients with self-limiting respiratory tract infections (RTIs) are frequently seen in general practice. Although antibiotics are ineffective for these conditions, they are often prescribed by general practitioners (GPs), and perceived patient expectations for an antibiotic plays an important role in the decision to prescribe one. Superfluous use of antibiotics contributes to antimicrobial resistance. High numbers of nurse prescribers work alongside GPs and these prescribers see education and self-management advice as central to the care of these patients. Multi-faceted interventions, designed to reduce antibiotic prescribing, only exist for GPs. Such interventions should foster interprofessional collaboration and, as such, consider the needs and experiences of the different prescribers, and the views of patients. This paper outlines a research study in which a questionnaire will be distributed to patients who consult with a nurse prescriber to see whether their expectations influence their satisfaction with the consultation outcome. Findings will guide the development of an interprofessional intervention designed to promote collaborative practice and appropriate and responsible antibiotic prescribing in primary care.