Evaluation of a novel ELISA test using synthetic mycolic acid antigens for serodiagnosis of non-tuberculous mycobacterial (NTM) infections.

The diagnosis of non-tuberculous mycobacteria (NTM) is a particular challenge in people with cystic fibrosis. Current standard diagnostic approaches rely on serial sputum culture, which is resource demanding, dependent on patient expectoration and may be compromised by excessive decontamination, conventional bacterial overgrowth and masking by concomitant oral and nebulised antibiotics. An alternative rapid, reliable and inexpensive diagnostic method is therefore urgently needed. Serum of patients with Mycobacterium abscessus infection and chronic suppurative lung disease without NTM infection was tested against an array of novel synthetic mycolic acids, identical or similar to natural components of mycobacterial cell walls, and glycopeptidolipid (GPL)-core antigen, which has previously been investigated in Mycobacterium avium pulmonary infection. Diagnostic accuracy of individual antigens and combination of various antigens were calculated. An ELISA using individual trehalose dimycolates and GPL-core antigen was able to effectively distinguish serum from infected and non-infected individuals with a specificity of 88% and a sensitivity of up to 88%, which increased to 88% sensitivity and 93% specificity by combining several antigens in the test. These results suggest synthetic mycolic acid antigens, used individually or in combination with GPL-core antigen could be successfully used to distinguish patients with M. abscessus infection from disease controls.

Outcomes of post-prostatectomy radiotherapy at a Regional Cancer Centre.

INTRODUCTION: To investigate the efficacy and toxicity of radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer at Radiation Oncology Centres, Toowoomba. METHODS: The electronic medical records of 130 consecutive patients with histologically proven prostate adenocarcinoma who underwent post-prostatectomy RT between January 2008 and December 2014 were analysed. Primary endpoint was Biochemical Recurrence (BCR) after RT. BCR was defined by PSA > 0.2 ng/mL and BCR endpoints were analysed using Kaplan-Meier methods. The impact of RT technique and the rates of acute and late toxicities are also reported. Toxicities were graded according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: Median follow-up time after RT (regardless of technique) was 28 months. BCR occurred in 32 of the 126 patients (25%) whose prostate specific antigen (PSA) levels have been monitored post-RT. At 24 and 36 months, 85% and 75% of patients were BCR-free, respectively. Patients with a pre-RT PSA above 0.2 ng/mL had a higher probability of recurrence than patients with values below 0.2 ng/mL (P = 0.03). RT technique, pelvic nodal irradiation, androgen deprivation therapy, T staging or surgical margin did not significantly impact BCR results. No patient experienced acute toxicities greater than grade 2. Grade 1 or 2 late gastrointestinal (GI) toxicity occurred in 11% and 1 patient experienced a grade 3 event. 12% of patients developed grade 1 or 2 late genitourinary (GU) toxicity, with evidence of grade 3 severity in only 1 patient. Evidence of a trend in reduction in late GI toxicity with the use of intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) was apparent but not with late GU toxicity. CONCLUSION: At our regional centre, early RT (PSA < 0.2 ng/mL) was associated with significant improvement in BCR-free survival. Rates of toxicity mirror those of landmark trials which suggest no detriment for our regional prostate cancer patients. The use of IMRT/VMAT techniques was associated with a trend towards reduced rates of GI toxicity.

Maintaining prostate contouring consistency following an educational intervention.

INTRODUCTION: The aim of this study was to assess variation in prostate contouring 12 months following a structured interactive educational intervention (EI) and to test the hypothesis that EIs positively impact on prostate contouring accuracy and consistency long term. METHODS: A common set of computed tomography (CT) and magnetic resonance imaging (MRI) data sets were used to assess prostate contouring consistency before, immediately after and 12 months following an EI. No further EIs were provided after the initial EI. Contour variation was assessed using the volume ratio (VR), defined as the ratio of the encompassing volume to common volume. RESULTS: Of the original five radiation oncologists (ROs) at baseline, four completed all assessments, and one was unavailable at 12 months follow-up. At 12 months, mean VR deteriorated by 3.2% on CT and 1.9% on MRI compared to immediately post EI. Overall, compared to the pre-EI baseline VR, an improvement of 11.4% and 10.8% was demonstrated on CT and MRI, respectively. CONCLUSION: Good retention of applied knowledge 12 months following an EI on prostate contouring was demonstrated. This study advocates for EIs to be included as part of continuing medical education to reduce contour variation among ROs and improve knowledge retention long term.

Outcomes of nodal metastatic cutaneous squamous cell carcinoma of the head and neck treated in a regional center.

BACKGROUND: Given its metastatic potential and high incidence, cutaneous squamous cell carcinoma of the head and neck (SCCHN) has significant morbidity and mortality. METHODS: We conducted a retrospective review of prospectively collected data for 113 consecutive patients with nodal metastatic cutaneous SCCHN treated surgically with curative intent in a regional center. Survival curves were generated by the Kaplan-Meier method. RESULTS: Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 80%, 83%, and 75%, respectively. Twenty-six patients (23%) relapsed, with 92% of relapses occurring within 2 years of surgery. Immunosuppression (p = .008) and N classification (p = .043) predicted decreased DFS on univariate analysis. On multivariate analysis, only immunosuppression independently predicted DFS (p = .034). CONCLUSION: This study validates the current N classification system, supports the adverse effect of immunosuppression, and suggests that intense follow-up for 2 years postsurgery is warranted. Survival at this regional center is comparable to that achieved at metropolitan tertiary cancer centers.

Assessing the Efficiency and Consistency of Daily Image-guided Radiation Therapy in a Modern Radiotherapy Centre.

BACKGROUND: Patients at Radiation Oncology Queensland Toowoomba are treated using the assistance of daily image-guided radiation therapy (IGRT). Each patient's daily setup is exposed to a number of variables. This study investigates the effect that these variables have on the total time taken to analyse field placement and the total time taken for treatment, as well accessing setup error across a variety of treatment types. METHODS: This is a retrospective study of 80 patients across a variety of treatment sites where daily IGRT was undertaken using kilovoltage and megavoltage orthogonal images. Variables investigated include the treatment type, the imaging modality used, and the setup error of each session. Statistical analysis was then performed on the data. RESULTS: Patients being treated in the thoracic region had the greatest random setup error. The mean matching times were also longer for chest patients (197 seconds), whereas there were minimal differences in times regarding modality. Treatment times were longest for head and neck variables (399-405 seconds). CONCLUSIONS: Pretreatment daily IGRT is beneficial to all patients and can be performed efficiently. Pelvic variables were the strongest performer, with fiducial markers providing the most consistent and rapid match times. Chest variables were the worst performer specifically regarding random setup error and match times indicating future work required on chest stabilization.

Influence of Individualized Stabilization on the Consistency of Supraclavicular Fossa Positioning in Breast Radiation Therapy: A Retrospective Study.

INTRODUCTION: The accurate stabilization of breast patients who are also undergoing supraclavicular fossa treatment is essential and can be challenging. Discrepancy in setup error for these patients often lies with the position of the clavicle in relationship with other anatomic structures. This study was performed to assess how individualized stabilization can improve patient's stability and reproducibility. METHODS: Thirty patients stabilized with an individualized vacfix located on a Civco wing board (Civco Medical Solutions, Kalona, IA) were compared with 30 patients stabilized in the traditional manner on a Civco breast board (Civco Medical Solutions). Each of these patients underwent daily imaging using the Varian Clinac iX On-board Imaging System (Varian Medical Systems, Palo Alto, CA), and image mismatch data for each session were collected. Additionally, the relationship between the clavicle and vertebrae was assessed for each stabilization solution on a daily basis. Statistical analysis of this data was then performed using a mixed effects approach to take account of data grouping by patient specifically for the displacement error in each direction. RESULTS: The use of an individualized vacfix decreased the overall systematic and random setup errors and displayed a reduction in the standard deviation of setup error. Patients positioned using breast board stabilization with the clavicle as the match method were exposed in the longitudinal direction to a systematic error of a 95% confidence interval (CI) of 2.6-4.5 mm and a random error of a 95% CI of 2.7-3.2 mm. This was significantly reduced for vacfix stabilization with a systematic error of a 95% CI of 1.2-2.3 mm and a random error of a 95% CI of 1.8-2.3 mm. These data amount to a reduction of the systematic error by 40% (P = .02) and a random error by 25% (P = .003) when using the vacfix method compared with the breast board. The data displaying the relationship between the clavicle and other anatomy within the treatment volume appear to be more consistent with the individualized vacfix approach. CONCLUSIONS: Reproducible and consistent stabilization for the breast/supraclavicular fossa technique is vital in terms of ensuring accurate patient position. Analysis of the setup error for clavicle and spinous process matching strongly indicates a reduction in both the systematic and random setup error achieved by the vacfix. This illustrates the increased stability and reproducibility of patient positioning when an individualized vacfix is used.

Incremental changes verses a technological quantum leap: the additional value of intensity-modulated radiotherapy beyond image-guided radiotherapy for prostate irradiation.

INTRODUCTION: Both intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) have been shown to independently reduce late rectal toxicity for men with prostate cancer (PC) treated with radiotherapy. We explore whether IMRT offers further reductions in late rectal toxicity for men already being managed with IGRT and compare this with more gradual changes over time. METHODS: Between 2007 and 2009, 103 patients with PC were treated with three-dimensional conformal radiotherapy (3D-CRT n = 52) or IMRT (n = 51) with doses of 74­78 Gy at 2 Gy per fraction. All men had daily IGRT using intra-prostatic gold fiducials. The primary endpoint was incidence of grade ≥2 late rectal toxicity as graded by the Radiation Therapy Oncology Group scale. RESULTS: The relative risk of late grade ≥2 rectal toxicity in patients treated with IMRT was 68% less than seen with image-guided 3D-CRT at 36 months post-treatment (7% versus 22%; hazard ratio = 0.32, P = 0.03). IMRT remained a significant protective factor in a multivariate analysis. A discriminant analysis showed that the relative volume of rectal wall exposed to doses over 50 Gy was most strongly associated with late rectal toxicity. Controlling for duration of follow-up, a later year of treatment was the strongest clinical predictor of late rectal toxicity in multivariate modelling (P = 0.03). CONCLUSION: For men with PC managed to doses of 74­78 Gy with IGRT, IMRT leads to reduced rectal toxicity compared with 3D-CRT. Incremental improvements in treatment delivery over time also appear to have an independently strong beneficial effect.

Field Placement Correction Using MV IGRT. Is Postintervention Imaging Necessary?

PURPOSE: Online image-guided radiation therapy (IGRT) is used for all radical pelvic patients at Radiation Oncology Queensland. One linear accelerator is equipped with megavoltage electronic portal imaging. Daily imaging on this linear accelerator introduces a dose burden that must be accounted for in the planning process. This dose burden is further complicated by postintervention images taken to verify field placement corrections. Analysis of setup errors and number and management of isocenter shifts was also used to identify an appropriate dose burden to be applied. METHOD: The IGRT data of 50 radical pelvic patients were retrospectively collected and analysed, and the number of isocenter moves made was assessed. Statistical analysis of systematic and random errors, both preintervention and postintervention, was undertaken. Inclusive in this analysis was the number of times postintervention images revealed an error in manually entered isocenter shifts. The imaging dose used was also investigated. RESULTS: Online IGRT was able to reduce the setup error to <2 mm for all orthogonal planes. Postintervention imaging was shown to be necessary to assess field placement, because manual errors in field placement were found to occur. The generic dose burden in use was found to be excessive. CONCLUSION: Daily IGRT is now considered an essential tool in modern radiation therapy. Postintervention imaging is required to ensure correct isocenter placement on linear accelerators where the process is manual. The current estimate of the worst-case scenario dose burden may be reduced to either incorporate a "population" dose or a more realistic absolute maximum dose. Any removal of a quality assurance process such as this requires evidence, consultation, and careful consideration.

Complementary and alternative medicine use in radiotherapy: what are patients using?

OBJECTIVES: Complementary and alternative medicine (CAM) use by patients could interact in unpredictable ways with conventional therapies. This trial was designed to study the prevalence, types, and clinical implications of CAM use in patients with cancer who are receiving radiotherapy. DESIGN: A validated questionnaire was given to consenting outpatients in this ethics-approved study. Questions specified types of CAM used, clinician knowledge, reason for use, perceived effectiveness, safety, and cost. RESULTS: Of the 101 assessable questionnaires, 38 patients (38%) of the total patient group used CAM, with vitamins (53%), antioxidants (29%), spiritual/meditation practices (29%), and herbs (18%) being the most commonly used. The intention of CAM use was to improve quality of life in 69% of patients and for either hope of cure or to assist other forms of treatment in 26%. The majority of patients (58%) were using CAM prior to their diagnosis of cancer, with 40% starting at diagnosis or during conventional treatment. Patients spent up to $300/month on CAM use. Patients using CAM were significantly more likely to also receive chemotherapy versus non-CAM users (45% versus 24%, p=0.045). Significantly fewer CAM users expected cure from conventional therapy, compared to non-CAM users (50% versus 75%, p=0.016). More CAM users expected conventional therapy to prolong life (58% versus 32%, p<0.001). Only 40% discussed CAM use with their oncologists. CONCLUSIONS: CAM is commonly used by patients with cancer. CAMs, particularly antioxidants, are being taken which could negate the underlying free-radical tumorcidal effects of radiotherapy. Oncologists need to have greater awareness of this use and of its potential adverse consequences.

Prostate contouring variation: can it be fixed?

PURPOSE: To assess whether an education program on CT and MRI prostate anatomy would reduce inter- and intraobserver prostate contouring variation among experienced radiation oncologists. METHODS AND MATERIALS: Three patient CT and MRI datasets were selected. Five radiation oncologists contoured the prostate for each patient on CT first, then MRI, and again between 2 and 4 weeks later. Three education sessions were then conducted. The same contouring process was then repeated with the same datasets and oncologists. The observer variation was assessed according to changes in the ratio of the encompassing volume to intersecting volume (volume ratio [VR]), across sets of target volumes. RESULTS: For interobserver variation, there was a 15% reduction in mean VR with CT, from 2.74 to 2.33, and a 40% reduction in mean VR with MRI, from 2.38 to 1.41 after education. A similar trend was found for intraobserver variation, with a mean VR reduction for CT and MRI of 9% (from 1.51 to 1.38) and 16% (from 1.37 to 1.15), respectively. CONCLUSION: A well-structured education program has reduced both inter- and intraobserver prostate contouring variations. The impact was greater on MRI than on CT. With the ongoing incorporation of new technologies into routine practice, education programs for target contouring should be incorporated as part of the continuing medical education of radiation oncologists.

Dosimetric effect of external beam planning preceding combined high-dose-rate brachytherapy of the prostate.

PURPOSE: The sequencing of external beam radiotherapy (EBRT) and a high-dose-rate brachytherapy (HDRB) boost is often interchangeable in clinical practice. When given before EBRT, HDRB could induce volume alterations in the prostate, which may have significant implications for EBRT dosimetry. We aimed to assess the influence of HDRB on prostate volume and, hence, prostate dosing via subsequent EBRT. METHODS AND MATERIALS: Fifteen men had both pre- and post-HDRB CT performed followed by EBRT. After deidentification, the clinical target volume (CTV) was defined on each CT by a single-blinded observer. Volumes were compared for the pre- and post-HDRB scans in each patient. Radiotherapy planning was performed using the prebrachytherapy volumes aiming for the planning target volume (PTV) to be covered by 43.7Gy. After soft-tissue coregistration, this plan was also applied to the postbrachytherapy volumes. RESULTS: Median volume increase was 35.4% for the CTV after HDRB. No patient experienced a decrease in CTV volume (range, 0-79% volume increase; p-value<0.001). Median volume increase was 26.1% for the PTVs, with no volume decrease observed (range, 8-56%; p<0.001). PTV proportion achieving dose target (V43.7Gy) decreased by median of 7% (range, 0-21.5%; p=0.004). The minimum dose to the PTV (D(100)%) decreased by a median of 6Gy (range, 0.5-16Gy; p<0.001). CONCLUSIONS: Insertion of HDRB catheters exerts substantial acute volumetric distortion on the prostate. EBRT planning performed on the basis of pre-HDRB imaging only inherently risks underdosing tumor. Planning adjustments based on repeat CT, or dedicated post-HDBT planning, is warranted for men managed with HDRB before EBRT.

Successful implementation of image-guided radiation therapy quality assurance in the Trans Tasman Radiation Oncology Group 08.01 PROFIT Study.

PURPOSE: The quality assurance (QA) of image-guided radiation therapy (IGRT) within clinical trials is in its infancy, but its importance will continue to grow as IGRT becomes the standard of care. The purpose of this study was to demonstrate the feasibility of IGRT QA as part of the credentialing process for a clinical trial. METHODS AND MATERIALS: As part of the accreditation process for a randomized trial in prostate cancer hypofraction, IGRT benchmarking across multiple sites was incorporated. Each participating site underwent IGRT credentialing via a site visit. In all centers, intraprostatic fiducials were used. A real-time assessment of analysis of IGRT was performed using Varian's Offline Review image analysis package. Two-dimensional (2D) kV and MV electronic portal imaging prostate patient datasets were used, consisting of 39 treatment verification images for 2D/2D comparison with the digitally reconstructed radiograph derived from the planning scan. The influence of differing sites, image modality, and observer experience on IGRT was then assessed. RESULTS: Statistical analysis of the mean mismatch errors showed that IGRT analysis was performed uniformly regardless of institution, therapist seniority, or imaging modality across the three orthogonal planes. CONCLUSIONS: The IGRT component of clinical trials that include sophisticated planning and treatment protocols must undergo stringent QA. The IGRT technique of intraprostatic fiducials has been shown in the context of this trial to be undertaken in a uniform manner across Australia. Extending this concept to many sites with different equipment and IGRT experience will require a robust remote credentialing process.

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004.

AIM: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses Union (QNU). BACKGROUND: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. METHODS: A self-reporting, postal survey was undertaken by the QNU members from the major employment sectors of aged care, public acute and community health and private acute and community health. RESULTS: Only 60% of nurses had been with their current employer more than 5 years. In contrast 90% had been in nursing for 5 years or more and most (80%) expected to remain in nursing for at least another 5 years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. CONCLUSION: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an ageing nursing population.

Aged care nursing in Queensland - the nurses' view.

AIMS AND OBJECTIVES: Through comparison of two studies undertaken three years apart the opinions of nurses working in aged care facilities in Queensland were determined. Results will support policy planning for the Queensland Nurses Union. BACKGROUND: An ageing population in Australia is placing increased demands on residential aged care facilities. In Queensland, the national situation is exacerbated by an influx of retirees from other states and territories. The ongoing problem of shortages of nurses in the workforce may be addressed by gaining further insight into the nurses' own views of their conditions and experiences. METHODS: One thousand nurses working in public and privately owned residential aged care facilities were surveyed by postal questionnaire in 2004. Results were compared with data collected in an identical study in 2001. RESULTS: Respondents offered their opinions on working hours and conditions, professional development and experiences in nursing. The predominately female aged care nursing workforce is ageing. Reported workplace violence has increased substantially since 2001. Some improvements are reported in staff numbers, skill mix and workplace policies. Nurses expressed very serious concerns about pay, workload, stress, physical and emotional demands and staff morale. CONCLUSION: Working conditions for nurses in the residential aged care sector in Queensland must be addressed to retain the current nurses and to encourage new nurses to replace those that retire. RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide information not only for the Queensland Nurses Union but also policy makers and nurse managers both nationally and internationally on areas that need to be addressed to maintain the required workforce within the aged care sector.

Extrinsic and intrinsic work values: their impact on job satisfaction in nursing.

AIMS: The aim of this study was to identify the intrinsic and extrinsic work values that were perceived by the members of the Queensland Nurses Union (QNU) in Queensland, Australia, to influence job satisfaction. BACKGROUND: The current shortage of nurses in Australia has been the focus of many recent studies and national inquiries. This shortage is experienced internationally in both developed and developing nations. Few studies, however, have examined the results of surveys from the model of intrinsic and extrinsic work values and their impact on job satisfaction. METHODS: Following a pilot study, a questionnaire was posted to 2800 assistants-in-nursing, enrolled and Registered Nurses in October 2001, who were members of the QNU. The sampling of nurses was undertaken from three sectors - public, private and aged care and therefore the results are reported separately for these three sectors. A total of 1477 nurses responded to the survey, equating to a total overall response rate of 53%. It should be noted that the study was limited to members of the QNU, and therefore does not represent nurses who are not members of the Union. RESULTS: The results show that intrinsic and extrinsic work values do impact upon job satisfaction and therefore intention to leave employment. The results also indicate that work stress was high and morale was low and decreasing. CONCLUSIONS: The findings of this study give some indication of what should be included in a nursing workforce planning strategy, the need for which in Australia is 'fundamental and urgent' (Senate Community Affairs References Committee 2002, p. xiii). The findings of this study also suggest that a 'one size fits all' solution across sectors will not work.

Workforce issues in nursing in Queensland: 2001 and 2004.

AIM AND OBJECTIVES: The aim of the study was to identify the factors having an impact upon nursing work and to use the results to inform strategic planning of the Queensland Nurses Union. BACKGROUND: In 2001 and 2004, a study was undertaken to gather data on the level of satisfaction of nurses with their working life. This paper reports the 2004 results on workload, skill mix, remuneration and morale. Where applicable, the results are compared with 2001 data. METHODS: A questionnaire was mailed to 3000 Assistants-in-Nursing, Enrolled and Registered Nurses in October 2004. All participants were members of the Queensland Nurses Union. The results are reported in three sectors - public, private and aged care. A total of 1349 nurses responded to the survey, a response rate of 45%. RESULTS: Nurses in the 2004 study believed: their workload was heavy; their skills and experience poorly rewarded; work stress was high; morale was perceived to be poor and, similar to 2001, deteriorating; the skill mix was often inadequate; and the majority of nurses were unable to complete their work in the time available. Nursing morale was found to be associated with autonomy, workplace equipment, workplace safety, teamwork, work stress, the physical demand of nursing work, workload, rewards for skills and experience, career prospects, status of nursing and remuneration. CONCLUSIONS: Overall the findings of the study are consistent with those determined by the 2001 survey. RELEVANCE TO CLINICAL PRACTICE: The findings of this study indicate the importance of factors such as workplace autonomy, teamwork, the levels of workplace stress, workload and remuneration on nursing morale. The data also indicate that workplace safety and workplace morale are linked. These findings provide information for policy makers and nurse managers on areas that need to be addressed to retain nurses within aged care, acute hospital and community nursing.

Workplace violence in Queensland, Australia: the results of a comparative study.

This paper presents the results on workplace violence from a larger study undertaken in 2004. Comparison is made with the results of a similar study undertaken in 2001. The study involved the random sampling of 3,000 nurses from the Queensland Nurses' Union's membership in the public (acute hospital and community nursing), private (acute hospital and domiciliary nursing) and aged care (both public and private aged care facilities) sectors. The self-reported results suggest an increase in workplace violence in all three sectors. Although there are differences in the sources of workplace violence across the sectors, the major causes of workplace violence are: clients/patients, visitors/relatives, other nurses, nursing management and medical practitioners. Associations were also found between workplace violence and gender, the designation of the nurse, hours of employment, the age of the nurse, morale and perceptions of workplace safety. Although the majority of nurses reported that policies were in place for the management of workplace violence, these policies were not always adequate.

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses.

AIMS AND OBJECTIVES: The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. BACKGROUND: Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. DESIGN: During 2001-02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross-sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses' medication practices. METHOD: All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non-proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. RESULTS: The data indicated that there was a difference between endorsed and unendorsed registered nurses' medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side-effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. CONCLUSION: It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. RELEVANCE TO CLINICAL PRACTICE: It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.

Nursing workloads: the results of a study of Queensland Nurses.

This paper reports the findings of a survey undertaken in Queensland, Australia in October 2001. The participants were registered and enrolled nurses and assistants in nursing who were members of the industrial body - the Queensland Nursing Union (QNU), and who were in paid employment in nursing in Queensland. Participants were selected by random sampling from each of the three major employment groups - the aged care, public and private acute sectors. Of the 2800 invited participants, 1477 responded resulting in an overall response rate of 53%. The findings indicate that over 50% of nurses in the aged-care sector, 32% of nurses in the public and 30% of nurses in the private acute sector experience difficulties in meeting patient needs because of insufficient staffing levels. The nurses in this study also believed that there was poor skills-mix, mostly caused by lack of funding, too few experienced staff or too many inexperienced staff. Many nurses in this study expressed their anger and frustration about their inability to complete their work to their professional satisfaction in the paid time available. Further, many nurses also expressed the view that because of this inability they were planning to leave the nursing profession. These findings are consistent with other research into the nursing workforce both within Australia and internationally.

Adequacy of support for new graduates during their transition into the workplace: a Queensland, Australia study.

In 2001, a study into issues of concern to assistant-in-nursing, registered and enrolled nurse members of the Queensland Nurses Union was undertaken. Approximately equal numbers of nurses from each of the aged care, acute private and acute public sectors were surveyed. Overall, 1477 nurses responded, representing a response rate of 53%. This article focuses on one aspect of the study-the perceived adequacy of support offered to new nursing graduates as they exit university and begin their transition into the workplace. In particular, responses from nurses are compared with professional level or current role designation, age, time spent in the workplace and health sector. Considerable divergence of opinion among the respondents, particularly across designation, age and years of experience, was found within the three sectors. For example, in the public and private employment sectors, older and more experienced nurses were more likely to perceive the support for new nurses as adequate compared to younger and less experienced nurses. Additionally, in the acute private sector, the more senior the nurse the more likely the perception that there was adequate preparation for new graduates entering the workforce.