FACULTY OF HEALTH SCIENCES AND MEDICINE
 BOND UNIVERSITY
Prof Mieke Van Driel
Director, PHCRED
P: 07 5595 4405
E: mvandrie@bond.edu.au
This year Professor Mieke van Driel has joined us as Director of the Bond University PHCRED Program.
She has recently also been appointed Associate Dean of Research of the Faculty of Health Sciences and Medicine.
With her experience in Evidence Based Practice we are looking forward to making a substantial contribution in this area.
Presently we are conducting workshops on Evidence Based Practice, journal clubs and systematic literature reviews for a motivated group of participants across various disciplines in primary care.
We have engaged a new research fellow and research assistants to facilitate progress of ongoing projects. It is a pleasure to work together as a team.
Prof Van Driel trained as a general practitioner in The Netherlands. She worked in primary health care assistance projects for Médecins Sans Frontières in Asia and Africa.
With a Master's degree in Public Health from the London School of Hygiene and Tropical Medicine, she embarked on an academic career at the University of Ghent, Belgium in 1998.
Teaching and appraising evidence she noticed how poorly it was applied and used in patient care. This provided inspiration for a PhD thesis on the implementation of evidence in clinical care, exploring the medical, contextual and policy related aspects of scientific evidence.
Mieke has published several scientific publications on the implementation of evidence in clinical practice and supervised numerous systematic reviews to support recommendations for appropriate use and reimbursement of medicines in Belgium. She is a founding editor of the Belgian journal for evidence-based medicine and author of a glossary of epidemiological and statistical terminology that is widely used in Belgium, The Netherlands and France.
 PHCRED QUEENSLAND
Denise Schultz
Statewide Coordinator
P: 07 3346 4905
E: d.schultz@uq.edu.au
Proserpine has chronic disease managed
Last month the PHCRED Queensland team presented a series of workshops on Program Planning and Evaluation for health practitioners working in Mackay, Proserpine and Moranbah.
Queensland Health's clinical nurse Sandy McBean attended the last workshop at Proserpine Hospital and was delighted with the support offered by PHCRED.
Following the workshop she dropped the State Coordinator a quick note which said “I just wanted to let you know how much I appreciated the visit you and your team payed to Proserpine Hospital. I don't know how to put this without sounding dramatic but I believe you and your colleagues saved me from myself!”
 Sandy has been busy planning the development and implementation of a Chronic Disease Management Clinic as part of the state-wide rollout of the Healthy Lifestyles Strategy for Chronic Disease 2005-2015.
Following the workshop she felt that she was now able to better articulate and describe the projects she has planned. In fact, in her letter she said she had spent the weekend developing her project plans. “During my work on these plans I have been appalled by how much I have failed to plan and how much has been sitting in my head - I don't know how I thought I was going to translate it all into action - now I can, and more importantly I can explain it and report it!”
“On a positive note, I am thrilled by how much I am 'on track' with the project and how the plan now makes sense,” she said. Sandy is now confidently pursuing her plans with the support of her colleagues in the District.
This is just one example of the appreciation people in rural and remote areas have for the PHCRED Roadshow activities which have provided information and support to Queensland Health and primary health care staff in regional areas for the past four years.
Plans to host Roadshow workshops in the Darling Downs region have been scheduled for November 2008.
SCHOOL OF MEDICINE
GRIFFITH UNIVERSITY
Xanthe Golenko
Research Administrator PHCRED
P: 07 3382 1337
E: x.golenko@griffith.edu.au
Successful Outcome for Chronic Obstructive Pulmonary Disease (COPD) Research
Carolyn Ehrlich from Griffith University was recently awarded first class honours for her Masters of Advanced Practice thesis.
 Her research investigates the way patients with COPD access information and utilise that information to manage their condition on a daily basis.
Findings from her research will assist health professionals to understand this process in order to improve health-related outcomes and avoid risk-taking behaviours in patients with COPD.
The idea for the project came through Carolyn's work with Queensland Health on a Place-Based Initiative (PBI); a holistic approach to health planning and delivery designed to promote and protect health and prevent and manage chronic disease. She found that people with COPD rely extensively on how they are feeling to determine how to look after themselves. They gather information from a wide variety of external sources including healthcare professionals, media, relatives, or as a member of a support group and they then evaluate all the information they receive based on what they know and believe about themselves.
Carolyn's research identified four inter-related themes that people with COPD use in self-management; personal intelligence, trial and error with or without risk taking, comparison and the ‘critical event'.
While, to the patient, the processing and use of information is structured, it can result in health-related behaviour being unpredictable and appearing illogical to an external observer.
Carolyn's dedication and commitment, together with the combined support provided by Queensland Health, the Griffith Primary Health Care Research Evaluation and Development (PHCRED) program, Griffith University School of Nursing and Midwifery and the Griffith Abilities Research Program has produced high quality research that will benefit patients with COPD.
GENERAL PRACTICE AND RURAL MEDICINE
JAMES COOK UNIVERSITY
Robyn Preston
PHCRED Coordinator
P: 07 4796 3383
E: robyn.preston@jcu.edu.au
The North Queensland Practice Based Research Network
Busy clinicians often have many reasons why they find it difficult to find time for research activities. In addition, some conditions or presentations are rare, and thus to gather sufficient participants several practices or practitioners may need to be targeted.
There is a growing movement towards the establishment of research networks, or groups of practitioners or practices with a similar interest in primary health care research who combine their efforts in terms of conducting small research projects.
It is well recognised that Practice Based Research Networks (PBRN) assist in developing research and bridging the links between academics and practitioners.
The North Queensland Practice Based Research Network (NQPBRN) was launched at the North Queensland Sub-faculty conference of the Royal Australian College of General Practitioners (RACGP) on 14 September in Townsville.
The network was ‘trialled' in 2007-8, with eight practices in Townsville, Cairns and Mackay participating in the study GP Management of Acute Otitis Externa in North Queensland. Practice nurses, local leadership and ongoing communication with practices, including the timely dissemination of results were identified as the keys to a successful project.
After this project, interviews and stakeholder meetings determined that general practitioners and practice nurses do want to develop a formal PBRN, but without losing the momentum of locally driven and relevant research. Three streams of research interest were identified: skin conditions including skin cancer and wound management, sexual health and evaluation of enhanced primary health care items. Research ideas were workshopped at the RACGP conference and the network is preparing to start new multi-site projects in one or more of the interest topics.
Participating practices will receive funding for practice nurse time invested in the project, as well as training and support.
We are excited about developing research that is close to practice and relevant for North Queensland and invite all GPs and PNs to join the NQPBRN.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein
PHCRED Coordinator
P: 02 9556 7200
E: raechelle@gp.med.usyd.edu.au
Our three RDP Fellows have been proactive in applying for grants this year.
Dr Penny Abbott and Dr Melinda Prince recently learned that their applications for the RACGP Rex Walpole Travelling Fellowship and PWH Grieve Memorial Award were successful.
The Rex Walpole Fellowship is to support a plan of travel, and Penny will use it to travel to the Wonca Europe Conference in Basel in 2009, where she plans to present her research.
The PWH Grieve Memorial Award is to support a plan of study in medical education, and Melinda will use the funds to attend two courses in qualitative research run by the Australian Consortium for Social and Political Research Inc (ACSPRI). The outcome of other funding applied for is pending.
The Youth Health Research Interest Group (YHRIG), which our PHCRED Program helps to support, presented a Workshop at this year's GP & PHC Research Conference. Health for all young people: research practice and policy implications was co-facilitated by Dr Carol Kefford and Dr Lena Sanci and organized with the assistance of another of our RDP Fellows, Ms Sam Stott.
A number of local young people assisted at the Workshop. The Workshop considered how the removal of barriers to accessing primary health care makes a difference for young people and how primary health care can address the multi-faceted health needs of adolescents.
As part of the Workshop, participants helped to write the Hobart Declaration for Health for all young Australians, to highlight the 30 year anniversary of Alma-Ata. A copy of the Hobart Declaration is now on-line at <www.phcris.org.au/phplib/filedownload.php?file=/conference/2008/media/declaration_of_hobart.pdf>.
Further information about YHRIG is available from:
Dr Carol Kefford
E: ckefford@med.usyd.edu.au
DEPARTMENT OF GENERAL PRACTICE
 MONASH UNIVERSITY
Kerry Hampton
MPhil (Research) Candidate
P: 03 9830 5280
E: kerryhampton@iprimus.com.au
A Survey Study of Fertility-Awareness amongst Women at Entry to an Assisted Reproductive Technology (ART) Service
Infertility is a significant health issue affecting up to one in six couples of childbearing age at some time in their reproductive lives.
A survey of fertility-awareness amongst infertile women at entry to a New Zealand tertiary level assisted reproductive technology (ART) facility found that the majority (76%) had insufficient fertility-awareness to maximise their chances of a natural conception.
Fertility-awareness amongst infertile women has not been studied in Australia before so we decided to conduct a self-administered questionnaire to explore the fertility-awareness knowledge, attitudes and practices amongst women seeking fertility assistance at two Melbourne ART services.
Two hundred and eighty-two women were invited to complete a self-administered questionnaire to establish a consecutive cohort.
The questionnaire was designed to collect demographic data, level of fertility-awareness, level of utilisation of the fertile period and attitudes towards fertility-awareness in the context of attempting pregnancy naturally.
Responses from the 204 (72%) women showed that 80% had been attempting pregnancy for one year or more, 87% had actively tried to improve their fertility-awareness from one or more sources, and 68% believed they had timed sex mainly during the fertile time of their menstrual cycles. Only 12% demonstrated a high level of fertility-awareness combined with a high level of utilisation of their fertile time.
The findings in this study will be used to raise awareness amongst women and their primary health care providers of the nature and extent of women's fertility-awareness and for the potential for integrating fertility-awareness education into pre-conception care and the primary health care of infertile couples.
DEPARTMENT OF RURAL AND INDIGENEOUS HEALTH
MONASH UNIVERSITY
Jowey Lim
PHCRED Coordinator
P: 04 2254 5488
E: jowey.lim@med.monash.edu.au
 New research skills to benefit health professionals
Heath professionals, nurses, doctors and paramedics recently completed a short course at Latrobe Regional Hospital (LRH) in Gippsland, Victoria, which could help them improve health care research.
The 10 hour short course Research Methods for Health Care Professionals presented by Monash University Department of Rural and Indigenous Health (MUDRIH), and supported by the Primary Health Care Research, Evaluation and Development (PHCRED) program, provided introductory information on conducting health care research. It covered designing research projects and collecting and analysing data as well as covering ethical issues in research.
The aim of the short course is to provide health care professionals with an overview of the issues involved in conducting research. It also encourages them to think about furthering their career through undertaking research based postgraduate studies, or becoming involved with research projects that may be developed through their workplace. The course attracted Health professionals from the Latrobe Valley, East Gippsland and Melbourne and was heralded as a success by many of its participants.
Course participant, paramedic and Victorian University lecturer Kim Savige praised the course's ability to point her in the right direction in regards to research.
The PHCRED program, which is funded by the Department of Health and Ageing, provided text books for viewing and refreshments for participants.
SCHOOL OF RURAL HEALTH
THE UNIVERSITY OF MELBOURNE
Dr Elaine Tan
Lecturer in Pharmacy, PHCRED Coordinator
P: 03 5823 4538
E: elainet@unimelb.edu.au
In 2008, seven PHCRED funded researchers commenced their PHCRED projects at the School of Rural Health, The University of Melbourne in Shepparton. Following are their profiles:
Eboni Stachlewski graduated from the University of Melbourne in 2006 and is working as a sole physiotherapist in hospital, community health and nursing home environments in rural Victoria. Eboni's interest in chronic pain management and her passion for rural health led her to apply for a PHCRED fellowship researching GP management of low back pain in rural and regional communities.
Jenny Buerckner graduated from La Trobe University in 2002. She is working as an occupational therapist with Yarrawonga Community Health Centre. Jenny's research interest is in cognitive behavioural therapy (CBT) and physical exercise and investigating their combined effects on depression. Her PHCRED project evaluates a CBT and exercise program conducted in Yarrawonga for people with depression.
Lea Klippel has a background in nursing, social welfare and social work. Lea is interested in rural and remote practice, and how health professionals maintain their networks, professional support and work life balance. Her PHCRED project explores this area of interest via a national social work focussed questionnaire.
Meredith Bowden is a psychologist and health promotion coordinator in the Primary Care Health Services at Alexandra District Hospital. Meredith's interests are in the promotion of mental health and wellbeing, and the prevention of depression and anxiety. Her PHCRED project investigates the relationship between family ritual at life transition points and subjective wellbeing and/or depression and anxiety.
Lea Fitzgerald graduated from Charles Sturt University in 1999. She is an occupational therapist working with Alexandra and Yea Hospitals in the Murrindindi Shire. Lea's passion to undertake research in her local community led her to apply for a PHCRED fellowship investigating the role service organisations, recreational and leisure groups have in meeting older men's needs in a small rural community.
Sharon Laver has a nursing and education background. Sharon's research interests are in organisational development, and leadership and professional practice. Her PHCRED project examines the effect of community leadership in disaster recovery for a small rural community.
Cathy Hill has a base training in general nursing, with post-graduate certificates and extensive experience in diverse areas of nursing practice spanning 35 years. Cathy has specialised in aged care in a rural area for the last 12 years. Her PHCRED project seeks to identify issues that may be confronting to ‘baby boomers' ageing in a rural environment.
DEPARTMENT OF GENERAL PRACTICE
THE UNIVERSITY OF MELBOURNE
Melinda Soós
Practice-Based Research Network Coordinator
P: 03 8344 3392
E: msoos@unimelb.edu.au
 Introducing our Practice-Based Research Network VicReN Member Dr Hubert van Doorn
Dr Hubert van Doorn, VicReN Foundation Member, is a dedicated and considered general practitioner of 22 years, based in the inner north of Melbourne. He has a strong commitment to improving general practice and has recently undertaken research in the area of mood disorders following completion of a PHCRED RDP Fellowship in 2007.
He says that the RDP Fellowship “gave me the time to study and think about primary care research. It highlighted the processes involved in actually doing the work and gave me the time to think more deeply in the area of my interest. My final project ended up being an audit of patients with depression in our practice. What struck me about the final data was the uncanny correlation with national data such as the BEACH study, confirming the ubiquity of mood disorders such as anxiety and depression.”
The PHCRED RDP Fellowship cemented his interest in research and such was his drive and interest that he agreed to become a Foundation Member of the Victorian Primary Care Practice-Based Research Network (VicReN), a PHCRED initiative, with four other GPs. He explains the role of VicReN in general practice: “[It] in effect creates the equivalent of an academic meeting place for GPs. We have no immediate place such as a hospital to meet, exchange ideas and challenge each other. Just as important is the opportunity to open up what is really happening in primary care and work towards making it as good as it can get.”
Currently, Dr van Doorn's main focus is to provide a high level of service to his patients and we are delighted at his contributions to the network.
RESEARCH DEVELOPMENT PROGRAM, PHCRED
UNIVERSITY DEPARTMENT OF RURAL HEALTH, UNIVERSITY OF TASMANIA
Theresa Doherty
PHCRED Statewide Coordinator
P: 03 6226 4803
E: bdoherty@utas.edu.au
Jennifer Hargrave
Breastfeeding outcomes of the cohort of Late Preterm Infants (infants born between 34-37 completed weeks of gestation.
This study describes the population demographics of a cohort of Late Preterm Infants (LPIs) (N=152), their initiation of breastfeeding at birth and breastfeeding outcomes at discharge from the Royal Hobart Hospital (RHH), Tasmania . The LPI population constitute the 83% of all preterm births at the RHH, this is consistent with international population health estimates (AIHW, 2005; Raju, 2006).
This study constitutes an important step in mapping the breastfeeding outcomes for the LPI; equally, in the search for determinates of child health outcomes and the effect of breastfeeding and the use of human milk in the preterm population. The public health and primary health care impact of the demographic characteristics and outcomes of this population and overall mortality and morbidity is unknown and requires further study. It is anticipated that the results of this study will be published for peer review and a prospective follow up study will be conducted of the cohort.
AIHW. (2005). Australian's mothers and babies 2003, (Government report). Sydney: National Perinatal Statistics Unit, AIHW
Raju, TN. (2006). Epidemiology of late preterm (near-term) births. Clin Perinatol , 33(4), 751-763; abstract vii.
Sally Bennett
Psychosocial needs of families with a child diagnosed with profound hearing loss: A systematic literature review
Tasmania is currently establishing a Universal Newborn Hearing Screening (UNBHS) program. The team consists of an audiologist, screeners and a social worker. Sally is the social worker on the team. UNBHS programs have been established in Britain for over a decade and more recently on the mainland of Australia. Most of the literature emphasises the need for family support after a diagnosis. It also emphasises the benefits of early diagnosis to maximise the child's potential for communicating aurally. Sally is hoping that this literature will help to consolidate the literature and provide the new service with some guiding principles so that it can best work with families.
GREATER GREEN TRIANGLE UNIVERSITY DEPARTMENT OF RURAL HEALTH
FLINDERS AND DEAKIN UNIVERSITIES
Andrea Hernan
Research Assistant, RDP position
P: 03 5563 3505
E: andrea.hernan@greaterhealth.org
 Life! Taking Action on Diabetes is a prevention program that focuses on lifestyle modification through behaviour change to reduce the risk of progression to type 2 diabetes mellitus (T2DM) among those at high risk.
This program is funded by Diabetes Australia Victoria and the Department of Human Services.
The Greater Green Triangle University Department of Rural Health (GGT UDRH) is investigating the applicability of this program for people who are culturally and linguistically diverse (CALD) from the general population. CALD populations are defined as people born overseas in countries where English is not the main language spoken or people born in Australia whose main or preferred language spoken is not English. This definition may not always allow for the complexities involved in identifying specific CALD communities, therefore we consider the definition of CALD populations to be beyond the constructs of language. Eg. South Asians who speak English at home but eat traditionally.
We undertook a literature search of the current published evidence on T2DM prevention, management or education programs in CALD populations both nationally and internationally. From this review we found that programs contained unique CALD elements such as1:
- integrating specific cultural values, practices and beliefs
- using focus groups, interactive group sessions and story telling
- encouraging family support and involvement
- using bilingual health workers, facilitators, educators, and cultural peers to deliver programs
- using life coaches for individualised assistance and
- using pictorial or flashcards, video formats and easy to understand written or translated material.
Overall the level of evidence available about prevention of diabetes in CALD populations is poor and no relevant evaluated work of this kind has been undertaken in Australia. Additionally, there is insufficient data to accurately identify the prevalence of T2DM in CALD populations in Australia, and to identify those populations who are at high risk for the disease.
Reference
1 Thurston C, Davis-Lameloise N, Boak R, Reddy P, Dunbar J. Developing Diabetes Prevention Programs for CALD groups: what the literature tells us. GP & PHC Conference: Health for All? Hobart, 2008.
DISCIPLINE OF GENERAL PRACTICE & UNIVERSITY DEPARTMENT OF RURAL HEALTH
UNIVERSITY OF NEWCASTLE
Dr Terry Joyce
Research Academic
P: 02 4968 6731
E: terry.joyce@newcastle.edu.au
Dr Rod Cooper
Research Academic
P: 02 67678465
E: Rodney.cooper@hnehealth.nsw.gov.au
On 31 July a group of enthusiastic early-career researchers and PHCRED staff met at Maddies, a cosy Function Centre at Bolwarra in the peaceful Hunter Valley for the Annual Writing Retreat.
 The event was co-hosted by the University of Newcastle PHCRED Programs from the Discipline of General Practice and the University Department of Rural Health.
Twelve of the 29 attendees travelled up to six hours to attend the writing retreat. The purpose of the retreat was to provide protected time for writing, access to mentors for writing and tips on writing in order to better resource would-be writers with skills and confidence.
We were fortunate again to have Dr Ann Gregory (Deputy Editor of the MJA) provide an inspirational talk on the writing process. As a key person in the editing process, Ann encouraged us to submit articles for publication and suggested that we resubmit articles even if they were previously rejected. Ann's ‘feet on the ground' approach enabled our understanding of the editing process and the commitment editors have to publishing quality work. A panel discussion followed with researchers sharing their tips on getting their research published. Panel members included Ann Gregory, Helen Tolhurst and Bev Sibthorpe.
Ann stayed for most of the day talking to people individually providing advice and guidance on writing or getting research results published. The retreat was a stimulating and thought provoking. I would expect that on the drive home, most of the attendees were formulating their next paper which of course, would be accepted for publication without changes!
Our Annual Writing Retreat continues to be an important mechanism for building the research capacity within the Hunter-New England regional PHC community. Our tops tips for getting published were good research, good editing and persistence!
UNIVERSITY DEPARTMENT OF RURAL HEALTH NORTHERN NSW
THE UNIVERSITY OF NEWCASTLE
Elesa Crowley
RCBI funded Primary Health Care researcher
P: 02 6767 8467
E: elesa.crowley@hnehealth.nsw.gov.au
Research update: The effect of cow's milk protein on paediatric constipation
Chronic functional constipation (CFC) is a common problem in children. Usual management includes laxatives, high fibre/fluid diet, toilet training and faecal disimpactation. These treatments are not always effective and when laxatives are withdrawn the constipation often resumes.
This poses problems for primary health care practitioners GPs, dietitians and nurses. Removal of cow's milk protein (CMP) from the diet results in symptom resolution for some children who are unresponsive to usual treatments for CFC.
A randomised clinical trial substituting soy milk for cow's milk in children suffering from CFC was conducted in the Hunter New England region of NSW. The aim of this pilot study was to conduct immunological and biochemical investigation into the underlying biological mechanism for CFC.
Fourteen children, (1-12 years) with CFC were recruited to a crossover, control trial. Subjects were assigned to two pathways - cow's milk or soy milk for a two week exclusive use trial period with all other CMP sources excluded. These pathways were switched following a two week ‘washout' period free of all milk and soy protein. Blood, urine and faeces samples were collected at baseline, and after completion of each pathway.
Subjects kept a ‘constipation diary' with resolution of constipation taken as eight or more bowel movements during a two week intervention.
Results revealed abnormalities in biochemical and immunological tests in the 13 subjects who completed the trial. Eight subjects completed constipation diaries with five subjects showing resolution of their constipation on soy milk versus cow's milk. This preliminary research suggests that previously constipated children responded well to the substitution of cow's milk with soy milk.
Further research is required to clarify biochemical and immunological mechanisms and bowel changes.
|
