Setting up the Prostate Cancer Outcomes Registry of New Zealand: reflecting and influencing clinical practice.

AIM: To describe the establishment of a national prostate cancer clinical quality registry (PCOR-NZ) within the New Zealand healthcare system and discuss the challenges encountered and achievements obtained during its development. Additionally, to provide a descriptive snapshot of the patients enrolled thus far. METHODS: A review of the processes underpinning the start-up and maintenance of the registry was undertaken. We also extracted data from PCOR-NZ in April 2021 to report on patients diagnosed between 2016 and 2019 that had at least 12 months of follow-up. RESULTS: Following ethical approval in 2015, a steering committee made up of clinicians, public health specialists and patient representatives was constituted, and site recruitment commenced. Men aged ≥18 years with a diagnosis of incident prostate cancer from participating sites are eligible for enrolment in PCOR-NZ. The registry functions with an opt-out consent model and captures diagnosis, treatment and short-term outcomes, with a particular focus on quality-of-life measures. As of January 2021, 100% of public hospitals and 36% of private urology clinics in New Zealand are actively participating in the registry. 5,858 men, including 411 who identified as Maori (7.0%), were diagnosed between 2016 and 2019 and enrolled in the registry. Population coverage is currently estimated to be almost 70%. Opt-out is estimated to be 2.8%. CONCLUSIONS: PCOR-NZ is providing quality diagnostic, treatment and outcome data for promoting enhancements in the care of men with prostate cancer. The registry resources are therefore valuable for informing and supporting quality improvement resourcing of this common cancer.

Age, gender, social contacts, and psychological distress: findings from the 45 and up study.

OBJECTIVE: The study examined the relationships between social contact types and psychological distress among mid-older adults. METHOD: Self-completed data from 236,490 Australian adults aged 45+ years. RESULTS: There was a consistent relationship between increased frequency in phone contacts, social visits, and social group contacts and reduced risk of psychological distress adjusted for demographic and health factors. However, stratified analyses by age showed, with one exception, that no significant associations were found between social group contact frequency and risk of psychological distress for those aged 85 years and older. Furthermore, significant interaction terms revealed that women experience a steeper reduction in risk than men at age 65 to 74 years and 75 to 84 years compared with those aged 45 to 64 years. DISCUSSION: Social contacts have age and gender differential effects on psychological distress of mid-older Australian adults. Interventions addressing social interaction need to be sensitive to gender and age differences.

An evaluation of portable sleeping spaces for babies following the Christchurch earthquake of February 2011.

AIM: To describe how recipients of portable sleeping spaces (PSSs) for babies received and used these devices, offered as emergency baby beds in earthquake-ravaged Christchurch, New Zealand, 2011. METHOD: The PSS package responded to increased risk to babies from disrupted living and sleeping conditions in families. 'Door-to-door' distribution offered easy access to those in need. A subgroup of recipients gave feedback via a survey. RESULTS: From 642 families who received PSSs between March and August, 139 were invited to complete a survey on usage and 100 (72%) responded. Risks identified were 'earthquake related' (82%), bed-sharing (41%), smoking in pregnancy (26%) and prematurity or low birthweight (11%). PSSs were used for same-bed co-sleeping by 87%. They were used even though most families (96%) also had a cot or bassinet. Features most appreciated were 'having baby close' (90%), 'peace of mind' (88%) and portability (74%). CONCLUSION: PSSs were acceptable to parents and used as instructed. Enabling physical protection of babies when same-bed co-sleeping, they gave peace of mind to parents. PSSs could be considered in ordinary times for protecting babies from sudden infant death.

A systematic review of the effectiveness of occupational health and safety training.

OBJECTIVES: Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS: Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on training's effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (iIi) behaviors, and (iv) health using the US Centers for Disease Control and Prevention's Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS: Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS: The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected, based on research evidence.

The epidemiology of motor neuron disease in Northern Ireland using capture-recapture methodology.

Capture-recapture analysis allows an investigator to estimate the number of unobserved cases in an epidemiological survey, although it has not been employed widely in published research to date. This study examines the usefulness of capture-recapture analysis in measuring the incidence and prevalence of motor neuron disease (MND) in Northern Ireland (NI). Cases were ascertained from the NI MND register to measure incidence and prevalence. The authors then employed capture-recapture analysis to estimate the number of missing cases. Less than one case was estimated to be missing from the prevalence study, providing a completeness of ascertainment of 99%. Prevalence was 3.3 per 100,000 population adjusted to the European standard population and was unchanged when adjusted for missing cases. Incidence was 1.4 per 100,000 person-years adjusted to the European standard population. Due to the lack of overlapping sources it was inferred that there were no missing cases and completeness of ascertainment was estimated at 100%. In conclusion, capture-recapture analysis is relatively simple to perform and provides an objective measure of case ascertainment in epidemiological studies. The authors feel that future investigators should consider employing capture-recapture methods, where possible, to validate their estimations of disease frequency in MND.

Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial.

OBJECTIVE: To assess which of three triage strategies for women with borderline abnormal cervical smear results in the best psychosocial outcomes. DESIGN: Pragmatic, non-blinded, multicentre, randomised controlled trial. SETTING: 18 family planning clinics across Australia, covering both urban and rural areas, between January 2004 and October 2006. PARTICIPANTS: Women aged 16-70 years (n=314) who attended routine cervical screening and received a borderline cervical smear. INTERVENTIONS: Patients were randomly assigned to human papillomavirus (HPV) DNA testing (n=104), a repeat smear test at six months (n=106), or the patient's informed choice of either test supported by a decision aid (n=104). Psychosocial outcomes were assessed at multiple time points over 12 months by postal questionnaire. MAIN OUTCOME MEASURES: We assessed health related quality of life (SF36 mental health subscale), cognitive effects (such as perceived risk of cervical cancer, intrusive thoughts), affective outcomes (general anxiety [state-trait anxiety inventory]), specific anxiety about an abnormal smear (cervical screening questionnaire), and behavioural outcomes (sexual health behaviour and visits to the doctor) over 12 months of follow-up. RESULTS: At two weeks, some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group (SF36 vitality subscale: t=-1.63, df=131, P=0.10; intrusive thoughts chi(2)=8.14, df=1, P<0.01). Over 12 months, distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group (t=-2.89, df=135, P<0.01). Intrusive thoughts were highest in patients allocated to HPV testing (25%, compared with 13% in the informed choice group; difference=12%, 95% CI -1.1% to 25.1%). Women in the HPV DNA group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing. CONCLUSIONS: Although the psychosocial effect was initially worse for women allocated to HPV triage, over the full year of follow-up this intervention was better for women's psychosocial health than repeat smear testing. Offering informed choice could have a small advantage for cognitive outcomes, but in view of the additional effort and logistical complexity that this intervention requires, HPV testing alone can be justified for most women. TRIAL REGISTRATION: actr.org.au Identifier: 12605000111673.

HPV testing versus repeat Pap testing for the management of a minor abnormal Pap smear: evaluation of a decision aid to support informed choice.

OBJECTIVE: To examine women's informed preference for the management of a mildly abnormal Pap smear and the impact of a decision aid. METHODS: Women (n=106) were given a choice of management supported by a decision aid and surveyed before, and after decision making to evaluate predictors of choice and decision aid impact. RESULTS: HPV triage was preferred by most women (65%) although a substantial minority selected repeat Pap testing (35%). Women who chose HPV triage were more likely to have had children, have had a previous abnormal Pap smear and were more distressed than women who chose a repeat Pap test. In total, 68% of women made an informed choice. Rapid timing of follow-up was important for women choosing HPV testing. The lower chance of colposcopy and greater opportunity for regression, were rated as important by women choosing Pap testing. Decisional conflict was lower among women who chose HPV triage. No other differences in short-term psychological outcomes were found. CONCLUSION: The decision aid supported informed choice among the majority of women. Women tailored their choice to their practical, health and psychological needs. PRACTICE IMPLICATIONS: Offering women an informed choice for a mildly abnormal Pap smear may enable women to select the management that best suits their circumstances.

The professional development of nursing through different aspects of the caring practices of nurses: nursing the patient person in a geriatric assessment unit.

The caring component of nursing practice has become an increasingly visible activity of nursing. Consequently, a growing amount of research has explored the role caring plays in nurse practice. Research often explores the activities of caring or its moral agenda, rather than motivation. This study broadens the discussion about nurses and caring practice by examining nurses approaches to different aspects of the caring practices of nurses for the aged in a Geriatric Assessment Unit (GAU). Data collection involved semi-structured interviews and participant observation within the GAU. Four categories of themes emerged as different aspects of the caring practices of nurses. Three fit within the professional development of nursing: physical caring, negotiative caring and relational caring. A fourth, motivated caring, however, provides an additional aspect of caring located within and beyond professional development.

Knowledge and decision-making for labour analgesia of Australian primiparous women.

OBJECTIVE: to assess and investigate knowledge of labour pain management options and decision-making among primiparous women. DESIGN: a semi-structured guide was used in focus groups to gather pregnant women's knowledge concerning labour analgesia. Attitudes to labour and pain relief, knowledge of pain relief, trustworthiness of knowledge sources, and plans and expectations for labour pain relief were investigated. SETTING: a major tertiary obstetric hospital in metropolitan Sydney, Australia. PARTICIPANTS: twenty five primiparous women, who were 25 weeks or more gestation, and planning a vaginal birth. FINDINGS: although women considered themselves knowledgeable, they were unable to describe labour analgesic risks or benefits. There was a large discrepancy between perception and actual knowledge. The main source of knowledge was anecdotal information. Late in pregnancy was considered the ideal time to be given information about labour analgesia. Women described their labour pain relief plans as flexible in relation to their labour circumstances; however, most women wanted to take an active role in decision-making. KEY CONCLUSIONS: the large discrepancy between perceived knowledge and actual knowledge of the likely consequences of labour analgesia suggests that women rely too heavily on anecdotal information. IMPLICATIONS FOR PRACTICE: clinicians should be aware that some women overestimate their knowledge and understanding of analgesic options, which is often based on anecdotal information. Standardised labour analgesia information at an appropriate time in their pregnancy may benefit some women and assist health-care providers and women to practice shared decision-making.

Use of functional capacity evaluations in workplaces and the compensation system: a report on workers' and report users' perceptions.

Until recently, little was documented about how functional capacity evaluations (FCEs) are used by employers and workers' compensation organizations. Such information was one focus of a comprehensive research study on FCEs carried out in southern Ontario, Canada, which involved representatives from the full range of groups involved in FCEs: referral sources, assessors, return-to-work specialists, third party payers and injured workers [1]. This paper shares findings from a cohort of injured workers undergoing FCEs, and explored how their FCE results were perceived and utilized by those receiving the reports. Based on study findings, we provide recommendations as to how FCEs should be requested, undertaken, reported and particularly applied to reduce work disability among injured workers.

Functional assessment of injured workers: a profile of assessor practices.

BACKGROUND: Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. PURPOSE: Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. METHOD: Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. RESULTS: Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. PRACTICE IMPLICATIONS: Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.