Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol.

INTRODUCTION: Negative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive-behavioural therapy results in a modest reduction in negative symptoms. Behavioural activation may be an effective alternative treatment for negative symptoms.The study aims to examine the feasibility and acceptability of implementing a behavioural activation trial delivered in three community mental health services in South Australia to support adult consumers experiencing negative symptoms of schizophrenia. METHOD AND ANALYSIS: This randomised controlled study will recruit a total of 60 consumers aged 18 years or above with mild-moderate negative symptoms of schizophrenia. The consumers will be randomly allocated to receive behavioural activation plus usual mental healthcare or usual mental healthcare alone. The intervention group will receive twelve 30 min sessions of behavioural activation, which will be delivered twice weekly over 6 weeks. In addition, we aim to recruit nine mental health workers from the three rural mental health services who will complete a 10-week online training programme in behavioural activation. Changes in negative symptoms of schizophrenia and depressive symptoms will be assessed at three time points: (a) at baseline, at 6 weeks and 3 month follow-ups. Changes in health-related quality of life (Short Form F36; secondary outcome) will be assessed at two time points: (a) at baseline and (b) immediately at postintervention after 6 weeks. At the end of the trial, interviews will be conducted with purposively selected mental health workers and consumers. Descriptive statistics and thematic analysis will be used to assess feasibility and acceptability. ETHICS AND DISSEMINATION: The findings from our feasibility study will inform the design of a fully powered randomised controlled trial to test the effectiveness of behavioural activation as a treatment for negative symptoms in schizophrenia. The study protocol was approved by the Central Adelaide Local Health Network Human Research Ethics Committee. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER: ACTRN12623000348651p.

Decentralised clinical trials in rural Australia: Opportunities and challenges.

AIMS: To present opportunities and a model to redress the under-representation of rural communities and people in Australian clinical trials. CONTEXT: Clinical trials are essential for building and understanding the health evidence base. The lack of representation of rural people in clinical trials is evident in other countries. Examining the Australian New Zealand Clinical Trial Registry (ANZCTR) suggests this is also the case in Australia. APPROACH: We propose an approach that empowers rurally based academics and clinicians to co-design clinical trials and increase rural Australians' participation in clinical trials to address this inequality of access. A case study of a decentralised, co-designed clinical trial is presented to support this approach. CONCLUSION: Decentralising clinical trials could improve access to clinical trials, strengthen the social capital of rural communities and help address the health inequalities that exist between rural and metropolitan communities.

Who cares about Aboriginal Aged Care? Evidence of home care support needs and use in rural South Australia.

OBJECTIVE: To assess awareness, needs and use of Australian Government-funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. DESIGN: Mixed-method study. SETTING: Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). PARTICIPANTS: Fifty Aboriginal peoples aged 50-89 years (68% females) interviewed between August 2020 and October 2021. MAIN OUTCOME MEASURES: Participant awareness, needs and unmet needs. RESULTS: 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2-6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. CONCLUSION: Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision-making.

Evaluation of research capacity and culture of hospital pharmacists and pharmacy technicians in a state-wide Australian public health service: A cross-sectional survey.

BACKGROUND: Integrating research with clinical practice is essential for evidence-based practice and continuous improvement in health care. Little is known about the research capacity and culture of the Australian hospital pharmacy workforce, particularly in rural areas and for pharmacy assistants/technicians. OBJECTIVE: This paper aims to characterise the research capacity and culture of a state-wide public-hospital pharmacy service at organisation, team and individual levels, and to explore variables which influence research confidence and success. METHOD: An online, anonymous, cross-sectional survey using the validated Research Capacity in Context tool was emailed to all pharmacists, pharmacy assistants/technicians and non-clinical staff employed by a statewide pharmacy service in South Australia. Respondent characteristics and organisation, team and individual scores of research skill/success were summarised using descriptive statistics. T-tests compared results for pharmacists and pharmacy assistants/technicians and metropolitan-based and non-metropolitan-based staff. Regression analyses explored predictors of pharmacists individual research skill/success scores. RESULTS: A response rate of 43.4% (n = 278/641, 19 sites) was obtained. Respondents were primarily pharmacists (68%) and pharmacy assistants/technicians (28%); 91% were practicing in a metropolitan setting. 47% reported no research experience. Highest scores for research skill/success were observed at the organisational level (mean score 6.0/10) vs. team (mean score 5.6/10) and individual levels (mean score 5.1/10). Within each level specific items that scored poorly were identified. Individual research skills/success scores were higher in pharmacists vs. pharmacy assistants/technicians (mean score 5.2/10 vs. 4.2/10, p < 0.01), and were not different between staff in metropolitan vs. non-metropolitan settings (mean scores 5.2 vs. 5.0, p = 0.77). For pharmacists, undertaking undergraduate or internship research projects or postgraduate research training were associated with higher individual scores of research skills and success. DISCUSSION/CONCLUSION: This research extends understanding of hospital pharmacy research capacity and culture, describes research skills and success in hospital pharmacy technicians/assistants for the first time and highlights low-scoring areas; these could be targeted to improve research capacity and culture at an individual, team and organisational levels.

Perceptions of barriers to addressing pharmaceutical stockout in timor-leste.

Background: Since 2005, stockout of pharmaceuticals has been a constant issue at all health services in Timor-Leste (TL). Aim: This study identifies factors that contribute to the ongoing pharmaceutical stockout as perceived by various stakeholders. Methods: A mixed-method approach was implemented, including face-to-face interviews with 46 Timorese health professionals involved in the pharmaceutical supply chain, along with documentational review and analysis. The field study was conducted in four locations (Dili, Liquiça, Aileu, and Ermera) from July to October 2018. This paper draws on qualitative accounts of participants' perceptions, which were investigated through an interview schedule in the Tetum language, with transcripts translated into English for analysis. Results: The responses gathered were consistent among various groups of employees. Perceptions of stakeholder views on factors contributing to pharmaceutical stockout were identified. These included issues such as poor coordination, failure to adhere to policy guidelines, significant difficulties, and lack of knowledge with inventory management, quantification, forecasting, and budgetary constraints. A weak logistic management information system and a lack of capacity in inventory management resulted in a lack of reliable data. Other factors, such as political intervention, work ethics and lack of basic infrastructure, such as internet connectivity, were also reported by participants. Conclusion: The findings highlighted that there are multiple factors contributing to the ongoing pharmaceutical stockout. This may be addressed by implementing more culturally appropriate education and training on forecasting methods.

Design and delivery of an innovative speech pathology service-learning program for primary school children in Far West NSW, Australia.

BACKGROUND: Children growing up in Australian rural communities have more communication impairments than their urban counterparts. Communication impairments, if left unresolved in school starters, lead to long-term learning and behavioural problems. Rural communities are disadvantaged by a scarcity of health professionals. METHODS: Supervised speech pathology students on rural clinical placement provided speech, language and communication screening, assessment and therapy to children starting kindergarten in Broken Hill, New South Wales, Australia. The students collected service outcome data for children in the program. RESULTS: Analysis of the outcome data demonstrated improvements in communication impairments for approximately one-quarter of the children. CONCLUSION: The service-learning program used in this study is designed to facilitate implementation in other locations. The model resulted in some improvement in communication impairments. It has the potential to revolutionise undergraduate student learning placements, as well as address the chronic health professional shortage in rural Australia.

Treatment of scabies using a tea tree oil-based gel formulation in Australian Aboriginal children: protocol for a randomised controlled trial.

INTRODUCTION: In remote Aboriginal communities in Australia, scabies affects 7 out of 10 children before their first birthday. This is more than six times the rate seen in the rest of the developed world. Scabies infestation is frequently complicated by bacterial infection, leading to the development of skin sores and other more serious consequences, such as septicaemia and chronic heart and kidney diseases. Tea tree oil (TTO) has been used as an antimicrobial agent for several decades with proven clinical efficacy. Preclinical investigations have demonstrated superior scabicidal properties of TTO compared with widely used scabicidal agents, such as permethrin 5% cream and ivermectin. However, current data are insufficient to warrant a broad recommendation for its use for the management of scabies because previous studies were small or limited to in vitro observations. METHODS AND ANALYSIS: A pragmatic first trial will examine the clinical efficacy of a simple and low-cost TTO treatment against paediatric scabies and the prevention of associated secondary bacterial infections, with 1:1 randomisation of 200 participants (Aboriginal children, aged 5-16 years and living in remote Australia) into active control (permethrin 5% cream) and treatment (5% TTO gel) groups. The primary outcome for the study is clinical cure (complete resolution). Secondary outcome measures will include relief of symptoms, recurrence rate, adverse effects, adherence to treatment regimen and patient acceptability. ETHICS AND DISSEMINATION: The project has received approvals from the University of Canberra Human Research Ethics Committee (HREC 16-133), Wurli-Wurlinjang Health Service Indigenous subcommittee and the Aboriginal Medical Services Alliance Northern Territory reference group. The results of this study will be published in core scientific publications, with extensive knowledge exchange activities with non-academic audiences throughout the duration of the project. TRIAL REGISTRATION: ACTRN12617000902392; Pre-results.

Therapeutic Potential of Tea Tree Oil for Scabies.

Globally, scabies affects more than 130 million people at any time. In the developed world, outbreaks in health institutions and vulnerable communities result in a significant economic burden. A review of the literature demonstrates the emergence of resistance toward classical scabicidal treatments and the lack of effectiveness of currently available scabicides in reducing the inflammatory skin reactions and pyodermal progression that occurs in predisposed patient cohorts. Tea tree oil (TTO) has demonstrated promising acaricidal effects against scabies mites in vitro and has also been successfully used as an adjuvant topical medication for the treatment of crusted scabies, including cases that did not respond to standard treatments. Emerging acaricide resistance threatens the future usefulness of currently used gold standard treatments (oral ivermectin and topical permethrin) for scabies. The imminent development of new chemical entities is doubtful. The cumulative acaricidal, antibacterial, antipruritic, anti-inflammatory, and wound healing effects of TTO may have the potential to successfully reduce the burden of scabies infection and the associated bacterial complications. This review summarizes current knowledge on the use of TTO for the treatment of scabies. On the strength of existing data for TTO, larger scale, randomized controlled clinical trials are warranted.