Primary care nurse's role and educational preparedness in skin cancer screening and early detection: A scoping review.

AIM: To identify the available evidence regarding nursing roles in skin cancer screening and early detection and the reported education and training undertaken to do so. DESIGN: Scoping review, reported in accordance with PRISMA-ScR. DATA SOURCES: A database search of Medline, CINAHL, Scopus, Embase, Emcare and JBI was conducted in November 2021. A grey literature search was conducted in February 2022. Searches were updated in August 2023. REVIEW METHODS: The data were extracted and synthesized into themes related to nursing roles and education. RESULTS: Of the 2285 identified studies, 54 were included in the review. Nursing roles included screening and early detection, prevention and patient education or counselling. Except for specialized nurse practitioners, nurses working in primary clinical care mostly engage in skin cancer supportive/administrative roles rather than leading collaborators in screening and early detection. The education and training for nurses were identified around themes of didactic education, clinical experience, training in dermoscopy, performance and knowledge assessment and self-efficacy. CONCLUSION: The roles and responsibilities of nurses working in skin cancer screening and early detection are highly variable, as are the reported training and education programmes. Little research has been conducted to explore this nursing role or the educational requirements needed for proficiency. With appropriate best practice education, it is within most primary care nurses' scope of practice to obtain competence in delivering opportunistic skin cancer screening. IMPACT: While most nurse specialists in dermatology will be proficient in dermoscopy and skin cancer screening, nurses who work in general practice are often underutilized due to a lack of opportunity and a clear pathway to becoming proficient in dermoscopic skin cancer screening. Most nurses involved in skin cancer screening are employed in advanced roles, and only a few studies investigating educational interventions utilized dermoscopy among advanced nurses. With specific training, nurses can work within their full scope of practice and increase access to skin cancer screening and early detection. REPORTING METHOD: Adhered to JBI Guidance for Conducting Systematic Scoping Reviews. PROTOCOL REGISTRATION: Open Science Framework, https://doi.org/10.17605/OSF.IO/XUNE6 PATIENT OR PUBLIC CONTRIBUTION: N/A; a literature review.

Graphical User Interface Development for a Hospital-Based Predictive Risk Tool: Protocol for a Co-Design Study.

BACKGROUND: This co-design research method details the iterative process developed to identify health professional recommendations for the graphical user interface (GUI) of an artificial intelligence (AI)-enabled risk prediction tool. Driving the decision to include a co-design process is the belief that choices regarding the aesthetic and functionality of an intervention are best made by its intended users and that engaging these users in its design will promote the tool's adoption and use. OBJECTIVE: The aim of this research is to identify health professional design and uptake recommendations for the GUI of an AI-enabled predictive risk tool. METHODS: We will hold 3 research phases, each consisting of 2 workshops with health professionals, between mid-2023 and mid-2024. A total of 6 health professionals will be sought per workshop, resulting in a total enrollment of 36 health professionals at the conclusion of the research. A total of 7 workshop activities have been scheduled across the 3 workshops; these include context of use, notifiers, format, AI survey-Likert, prototype, AI survey-written, and testing. The first 6 of these activities will be repeated in each workshop to enable the iterative development and refinement of GUI. The last activity (testing) will be performed in the final workshop to examine health professionals' thoughts on the final GUI iteration. Qualitative and quantitative results data will be produced from tasks in each research activity. Qualitative data will be examined through inductive thematic analysis or deductive thematic analysis in accordance with the Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Sustainability (NASSS) framework; visual data will be examined in accordance with "framework of interactivity;" and quantitative data will be examined using descriptive statistics. RESULTS: Project registration with the Australia and New Zealand Clinical Trial Registry has been requested (#384098). Finalized design recommendations are expected in early to mid-2024, with a results manuscript to be submitted in mid-2024. This research method has human research ethics approval from the South Australian Department of Health and Wellbeing (#2022/HRE00131) as well as from the Human Research Ethics Committee of the University of South Australia (application ID#204143). CONCLUSIONS: Understanding whether an intervention is needed in a particular situation is just the start; designing an intervention so that it is used within that situation is paramount. This co-design process engages end users to create a GUI that includes the aesthetic and functional details they need in a manner that aligns with their existing work practices. Indeed, interventions that fail to do this may be disliked, and at worst, they may be dangerous. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47717.

Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review.

Background: There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims: This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods: A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results: We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion: Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.

Midwife led randomised controlled trials in Australia and New Zealand: A scoping review.

BACKGROUND: Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken. AIM: To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand. METHODS: This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021. FINDINGS: Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials. DISCUSSION: Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications. CONCLUSION: These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.

A scoping review of nurse-led randomised controlled trials.

BACKGROUND: Nurses comprise the largest portion of the healthcare workforce worldwide. However, nurse representation in the leadership of clinical research and research funding is largely unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established to provide a coordinated network, focussed on building research capacity in nursing and midwifery. To support this work, this scoping review of nurse-led randomised controlled trials was conducted to summarise research activity, as well as highlight future research directions, gaps and resources. Midwife-led trials will be reported elsewhere. AIM: To quantify number, type and quality of nurse-led randomised controlled trials registered between 2000-2021. DESIGN: A scoping review of RCTs. DATA SOURCES: Medline, Emcare and Scopus were searched from 2000 to August 2021. ANZCTR, NHMRC, MRFF and HRC (NZ) registries were searched from inception to July 2021. REVIEW METHODS: This review was informed by the JBI scoping review framework using the PRISMA-ScR. RESULTS: Our search yielded 188 nurse-led publications and 279 registered randomised controlled trials. Multiple trials had the same nurse leaders. There were more registrations than publications. Publications were predominantly of high methodological quality; however, there was a reliance on active controls and blinding was low. Trial registrations indicate that universities and hospital/healthcare organisations were the major sources of funding, while publications indicate that Governments and the National Health and Medical Research Council were the main funding bodies. CONCLUSION: A small number of high-quality, large-scale, nationally funded randomised controlled trials were identified, with a larger number of locally funded small trials. There was a disparity between the number of registered trials and those published. Additional infrastructure, funding and career frameworks are needed to enable nurses to design, conduct and publish clinical trials that inform the health system and improve health outcomes. RELEVANCE TO CLINICAL PRACTICE: Research initiated and led by nurses has the potential to improve the health and well-being of individuals and communities, and current nurse-led research is of high methodological quality; however, there were very few nurse-led RCTs, conducted by a small pool of nurse researchers. This gap highlights the need for support in the design, conduct and publishing of nurse-led RCTs. PATIENT OR PUBLIC CONTRIBUTION: This is a scoping review; therefore, patient or public contribution is not applicable.

The Australian and New Zealand nephrology nursing workforce: clinical pressure and organisational culture.

There has been increasing prevalence in the community of chronic kidney disease and an increased demand for nephrology trained nursing staff.We explored how nephrology trained nurses are impacted by daily caseload pressure, organisational support and workplace education.A co-designed 57-item questionnaire developed by the research team and clinical nephrology nurses hosted on Qualtrics™ was distributed to nephrology nurses in Australia and New Zealand.The 370 respondents described a strong professional identity as a nephrology nurse. 70% described pressure to work overtime and only 2% were adequately staffed. 40% felt at times that their patients clinical care was 'unsafe' and one-third described the erosion of work-based educational opportunities. However, team collegiality was high, a strength of the nursing profession.The nephrology nursing workforce will face important challenges over the next decade and there must be an organisational response to prevent continued staff shortages.

Relationships between job burnout, ethical climate and organizational citizenship behaviour among registered nurses: A cross-sectional study.

AIM: This study aimed to investigate the levels of nurses' organizational citizenship behaviour and the associations between job burnout and ethical climate with organizational citizenship behaviour. BACKGROUND: Organizational citizenship behaviour improves adverse outcomes led by nursing shortage. However, the associations between three dimensions of job burnout and organizational citizenship behaviour are inconsistent, and little is known about whether ethical climate is related to organizational citizenship behaviour in nurses. METHODS: In this cross-sectional study, 1157 nurses were selected using convenience sampling from April to October 2019. Self-report surveys assessed nurses' organizational citizenship behaviour, emotional exhaustion, depersonalization, personal accomplishment and perceptions of ethical climate. RESULTS: Mean organizational citizenship behaviour was high among nurses. The regression model showed that job burnout and ethical climate explained an additional 38.6% of the variance in organizational citizenship behaviour over and above sociodemographic factors, with 44.9% of the total variance. CONCLUSION: Nurses' organizational citizenship behaviour was at a relatively high level. Depersonalization was negatively associated with organizational citizenship behaviour while personal accomplishment and ethical climate were positively related to organizational citizenship behaviour. Therefore, nurse leaders are encouraged to take measures to help nurses reduce job burnout and create a favourable ethical climate for increasing nurses' organizational citizenship behaviour.

Development of a clinical pathway for behavioural and psychological symptoms of dementia care: A tool to improve resident outcomes.

OBJECTIVES: Clinical pathways are used to improve the quality of care, reduce variation and maximise health or treatment outcomes in selected populations. The aim of this study was to develop a draft clinical pathway based on the best practice evidence for use in the management of behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities (RACFs). METHODS: The pathway was developed using the best practice evidence from clinical practice guidelines, operational guides and a systematic literature review. A multidisciplinary team of health professionals and researchers worked in an iterative process to contextualise the proposed pathway to local needs and context, and improve its clarity and user-friendliness. The pathway was then re-assessed for accuracy and adherence to the evidence. RESULTS: The draft pathway outlines processes for BPSD prevention, watchful waiting for mild-to-moderate BPSD, and specific interventions for severe BPSD. Ongoing risk assessment is required throughout, and non-pharmacological options are first-line interventions. Person-centred care was found to be an important care component across all three phases. An instruction guide with colour-coded flow charts was developed to assist staff with determining the best care and treatment for each person living with dementia. Feasibility testing is underway. CONCLUSIONS: A draft clinical pathway based on clinical practice guidelines was developed to enhance the translation of evidence into practice for the management of BPSD, by nursing and clinical leaders in RACFs.

Outcome measures of palliative care programs and interventions implemented in nursing homes: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and map the outcomes reported from evaluations that measure the effectiveness and acceptability of palliative care programs and interventions in residential aged care facilities. INTRODUCTION: As the population ages, there is increasing attention on implementing new interventions and programs to improve palliative care in residential aged care facilities. However, there is no standard evaluation for intervention implementation. Mapping the outcome measures used in evaluations of diverse palliative care interventions in residential aged care facilities has not been explored recently. INCLUSION CRITERIA: This review will consider studies involving older adults (aged 50 years and above) in any country living and receiving care in residential aged care facilities. This review will exclude literature that focuses on other age groups, and people receiving palliative care in other care settings, such as hospitals, palliative care inpatient units, sheltered housing, cancer centers, own homes, and hospices. METHODS: This scoping review will follow the JBI methodology for scoping reviews. This scoping review will identify both published and unpublished (eg, gray literature) primary studies, as well as reviews. The databases to be searched for published studies will include MEDLINE, Emcare, ProQuest, Embase, PsycINFO, Web of Science, Scopus, and the Cochrane Library. The search will be limited to evidence published in English from 2008 to the present. Visual, tabular, and accompanying narrative summaries will be used to present the results.

Cross-cultural differences in nurse burnout and the relationship with patient safety: An East-West comparative study.

AIMS: To compare levels of nurse burnout across eastern and western cultures, as well as examine the influence of burnout on patient safety cross-culturally. DESIGN: Comparative cross-sectional study. METHODS: Survey data were collected from nurses between August and October 2017 in Australia (n = 730) and between April and October 2019 in China (n = 1107). Variables included burnout (emotional exhaustion, depersonalization, personal accomplishment), nurse leadership and support, staffing and resource adequacy, and perceived patient safety. Data were analysed separately for each jurisdiction using bootstrapped hierarchical regressions, which tested the relationships between burnout indicators and patient safety, controlling for support resources. RESULTS: Emotional exhaustion and depersonalization scores were significantly higher in the Australian sample compared with the Chinese sample. Australian participants reported significantly lower patient safety grades than Chinese participants and were less likely to agree that support resources were present in their current job. Separate regressions indicated that patient safety was significantly associated with staffing and resource adequacy, nurse leadership and support, and depersonalization among Australian participants (30% of variance explained in the final regression model), while staffing and resource adequacy, nurse leadership and support, personal accomplishment and emotional exhaustion predicted patient safety for Chinese participants (22% of variance explained in the final model). CONCLUSION: Australian nurses are at greater risk of burnout than Chinese nurses. Burnout dimensions are differentially associated with patient safety across cultures. Culturally relevant interventions may be more optimal than universal approaches for improving burnout and patient safety in nursing. IMPACT: This study increased understanding of cross-cultural differences in nurse burnout and the relationship with patient safety. Australian nurses were at greater risk of burnout than Chinese nurses. Emotional exhaustion, depersonalization and personal accomplishment influenced patient safety distinctively across the countries. These findings inform interventions designed to reduce nurse burnout and improve patient safety internationally.

Culturally safe, high-quality breast cancer screening for transgender people: A scoping review protocol.

AIM: To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people. DESIGN: The scoping review will follow the JBI methodological guidance for scoping reviews. METHODS: A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion. Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020. DISCUSSION: There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female. IMPACT: It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people.

Understanding implementability in clinical trials: a pragmatic review and concept map.

BACKGROUND: The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the 'implementability' of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability. METHODS: Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials; described factors that increased or decreased the capacity of trials to be implemented; and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019. RESULTS: Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map. CONCLUSIONS: The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia. TRIAL REGISTRATION: This review did not include health-related outcomes and was therefore not eligible for registration in the PROSPERO register.

A pilot study of population-based, patient-reported outcome collection in cancer survivors.

AIM: To determine feasibility and acceptability of completing PROs questionnaires at completion and 1 year after curative cancer treatment. METHODS: Patients assessed in a nurse-led end of treatment survivorship clinic, at a tertiary referral centre, recruited between October 2015 and July 2016 were mailed a survey at baseline and at 12-month follow-up. The survey included validated PRO questionnaires. A target response rate for feasibility, defined as the proportion of the eligible population approached that completed the survey, was set at 70%. Qualitative feedback regarding the survey was collected from participants. RESULTS: Of the 47 eligible patients approached, 34 (72.4%) agreed to participate with 29 (61.9%) completing the survey at baseline, and 21 (44.7%) at follow-up. Respondents lost to follow-up at 12 months had clinically meaningful lower scores on all QLQ-C30 functioning scales and 8 out of 9 symptom scales/items. Qualitative feedback from survey respondents indicated the content was relevant and acceptable. Participants expressed willingness to complete a similar survey approximately once per year and a higher preference for completing the survey in hard copy compared with online. CONCLUSIONS: Cancer survivors are willing to provide information on a range of PROs, but those with higher needs were the ones less likely to complete surveys. There is scope to improve the response rate and representativeness of the patient cohort captured. Future research should identify strategies to optimise recruitment when collecting PROs data from cancer survivors.

Recency of Practice and the Maintenance of Professional Competence for Nurses and Midwives: A Scoping Review Protocol.

Australian and international nursing regulators have specific requirements for continuing competence and the professional, safe practice of nurses and midwives. Requirements can dictate duration of practice, time away from/recency of practice, revalidation policies, and time between study program completion and practice commencement. Requirements vary between contexts and are periodically updated. To identify and examine Australian and international evidence for best regulatory practices relating to recency and the maintenance of professional competence among nurses and midwives, a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be undertaken. This protocol details the scope, inclusion criteria, and methodology that will guide the scoping review, which will inform an update to the Nursing and Midwifery Board of Australia's Registration Standard: Recency of Practice.

Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study.

BACKGROUND: Innovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined. OBJECTIVE: To implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity. METHODS: This action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout. RESULTS: Pilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020. CONCLUSIONS: Nursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15006.

Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context.

BACKGROUND: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario's Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. METHODS: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor's implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. RESULTS: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program's implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. CONCLUSIONS: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature.

Keratinocyte cancers in South Australia: incidence, geographical variability and service trends.

OBJECTIVES: To determine the incidence, multiplicity, geographical variability and service trends of keratinocyte cancers (KC) in South Australia (SA). METHODS: Medicare Australia data with a unique identifier were used to assess the number of people treated over years 2010-2014. A maximum of one KC service claim per year was used to determine incidence. Age-standardised rates were estimated as were KC service activity trends. RESULTS: There were 497,581 services to 204,183 SA residents for KC, solar keratoses, locally aggressive skin tumours or suspicious skin lesions. Of these, n=159,137 services were for KC (77,502 people). The five-year (2010-2014) age-standardised rate of KC in SA was 1,466.6 (95%CI 1,458.3-1,474.8) per 100,000. Forty per cent of people had more than one KC removed. Men accounted for more incident cases (59.2%). Age-specific rates showed least variability over time in the youngest age group (15-44 years). For 26 geographical areas, higher age-standardised ratios of KC were seen in coastal and agricultural areas. There was a 59% increase in services for KC from 2000 to 2015. CONCLUSIONS: Age-standardised rates for KC are relatively stable in SA, but regional variations are evident. Services for KC continue to rise. Implications for public health: This is the first systematic report of KC in SA. We demonstrate the utility of using validated Medicare data for assessing KC incidence and trends.

Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study.

BACKGROUND: Gout has an increasing global prevalence. Underutilization of urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing and poor medication adherence. The aims of this study were to determine the prevalence of self-reported gout and the key predictors of ULT use in those with gout in a representative population survey in South Australia. METHODS: Data were obtained from the Spring 2015 South Australian Health Omnibus Survey, a multilevel, systematic, survey in a representative population sample involving face-to-face interviews (n = 3005). This study analyzed responses from respondents aged ≥ 25 years (n = 2531) about self-reported gout, ULT use, sociodemographic factors, lifestyle factors, and comorbidities, using survey weighting. Univariate and subsequent adjusted logistic regression analyses on self-reported gout were performed. ULT use was divided into three categories (never use, prior use, and current use) and these data were analyzed using a multinomial logistic regression model. RESULTS: Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age of respondents with gout was 64 years (standard deviation 16) and 82% were male. As expected, older age, male gender, lower socioeconomic status (SES), and higher body mass index (BMI) were associated with gout, as were high alcohol consumption, current smoking, other forms of arthritis, and hypertension or hypercholesterolemia medication, after adjustment for sociodemographic variables. Two thirds of respondents with gout reported ULT use (36% current; 29% previous) with only 55% continuing treatment. Predictors of ULT use included male gender, low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with a higher BMI were more likely to remain on ULT. CONCLUSIONS: Despite gout being a common, potentially disabling joint disease, only 55% of respondents with gout in this study adhered to ULT. Identification of key predictors of ULT use will provide guidance on prescribing strategy in clinical practice and on the quality of gout care in the community.

An evaluation of social work services in a cancer accommodation facility for rural South Australians.

PURPOSE: The purpose of this investigation was to evaluate the social work service at an accommodation facility for people receiving cancer treatment away from home with a focus on distress, impact of support, and type of assistance received from the social work service. METHOD: Guests who stayed at the Cancer Council Lodge during June 2015 were mailed a questionnaire collecting information about level of distress upon arrival and departure, impact of support in several areas, and what the service assisted them with specifically. RESULTS: The sample comprised 149 guests. Social work contact (n = 19) was associated with greater reduction in distress between arrival and departure compared with no contact (n = 56). Contact with a social worker was associated with greater odds of agreeing or strongly agreeing that guests felt supported in 6 out of 10 areas assessed. These areas were managing the challenges related to cancer, approaching support services, asking questions of healthcare teams, accessing support services, coping with strong emotions, and understanding reactions of family and friends. The most common types of support received were emotional and informational support. CONCLUSIONS: This study describes some of benefits of providing social work services to people receiving cancer treatment away from home and has implications for provision of social work service resources in similar settings. Further research could investigate the impact of this service in similar settings using randomised controlled trials to better account for potential biases. Research in this area has potential to inform program development and policy.