ORCID Profile
0000-0001-5650-4791
Current Organisation
Deakin University
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Publisher: BMJ
Date: 09-2005
Publisher: Cambridge University Press (CUP)
Date: 31-05-2017
DOI: 10.1017/S147895151700044X
Abstract: Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver (2) equitable, enabling access to components of palliative care for a group with significant needs (3) accessible and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as “usual” care by patients and clinicians alike (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care and (d) transition to usual palliative care services is facilitated as the patient nears death. Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2010
Abstract: The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY). The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense ® ). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data. To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention. Australian New Zealand Clinical Trial Registry ACTRN12609000705280
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.MIDW.2017.04.006
Abstract: To determine the feasibility and acceptability and measure the effects of a mindfulness intervention compared to a pregnancy support program on stress, depressive symptoms and awareness of present moment experience. A pilot randomised trial using mixed methods. Forty-eight women attending a maternity service were randomly allocated to a mindfulness-based or pregnancy support program. Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Mindfulness Attention Awareness Scale, and Birth Outcomes. Women's perceptions of the impact of the programs were examined via summative evaluation, interviews, diaries and facilitator field notes. Nine women in the mindfulness program and 11 in the pregnancy support program completed post-program measures. There were no statistically significant differences between groups. Of practical significance, was an improvement in measures for both groups with a greater improvement in awareness of present moment experience for the intervention group. The intervention group reported learning how to manage stressors, fear, anxiety, and to regulate their attention to be more present. The control group reported learning how to calm down when stressed which increased their confidence. Intervention group themes were: releasing stress, becoming aware, accepting, having options and choices, connecting and being compassionate. Control group themes were:managing stress, increasing confidence, connecting, focussing, being accepted, preparing. The feasibility and acceptability of the intervention was confirmed. Programs decreased women's self-reported stress in different ways. Women in the mindfulness program accepted themselves and their experiences as they arose and passed in the present moment, while those in the control group gained acceptance primarily from external sources such as peers. Mindfulness programs can foster an internalised locus of self-acceptance which may result in woman becoming less dependent on others for their wellbeing. Adequately powered RCTs, with an active control, long-term follow up and economic evaluation are recommended.
Publisher: Hindawi Limited
Date: 19-06-2014
DOI: 10.1111/JCPT.12185
Abstract: About half of all patients taking antihypertensives discontinue treatment by 12 months. There is potential for substantial health gains at both in idual and population levels through improved treatment adherence. The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure (BP) control. prospective, non-blinded, cluster-randomized, controlled trial. adults with primary hypertension who obtained antihypertensives in the previous 6 months. Patients with poor refill adherence were preferentially identified with the help of a purpose-built software application. package comprising BP monitor training on BP self-monitoring motivational interviewing medication use review prescription refill reminders. six months. change in proportion self-reporting medication adherence. Secondary outcome: BP changes. Participants (n = 395 intervention - 207 control - 188) had a mean age of 66.7 years 51.1% were males. The proportion of adherent participants increased in both groups but was not significantly different between groups [57·2% to 63·6% (control) vs. 60·0% to 73·5% (intervention), P = 0·23]. The mean reduction in systolic BP was significantly greater in the intervention group (10·0 mmHg vs. 4·6 mmHg P = 0·05). The proportion of patients who were non-adherent at baseline and adherent at 6 months was 22·6% (95%CI 5·1-40·0%) higher in the intervention group (61·8% vs. 39·2%, P = 0·007). Among participants with baseline BP above target, reduction of systolic BP was significantly greater in the intervention group [by 7·2 mmHg (95%CI 1·6-12·8 mmHg) (P = 0·01)]. Among participants non-adherent at baseline and above target BP, the proportion reporting adherence at 6 months was significantly greater in the intervention group [56·8% vs. 35·9%, P = 0·039). This community pharmacist intervention resulted in improved adherence to antihypertensive medication and reduced systolic BP.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.WOMBI.2015.08.006
Abstract: Perinatal stress is associated with adverse maternal and infant outcomes. Mindfulness training may offer a safe and acceptable strategy to support perinatal mental health. To critically appraise and synthesise the best available evidence regarding the effectiveness of mindfulness training during pregnancy to support perinatal mental health. The search for relevant studies was conducted in six electronic databases and in the grey literature. Eligible studies were assessed for methodological quality according to standardised critical appraisal instruments. Data were extracted and recorded on a pre-designed form and then entered into Review Manager. Nine studies were included in the data synthesis. It was not appropriate to combine the study results because of the variation in methodologies and the interventions tested. Statistically significant improvements were found in small studies of women undertaking mindfulness awareness training in one study for stress (mean difference (MD) -5.28, 95% confidence intervals (CI) -10.4 to -0.42, n=22), two for depression (for ex le MD -5.48, 95% CI -8.96 to -2.0, n=46) and four for anxiety (for ex le, MD -6.50, 95% CI -10.95 to -2.05, n=32). However the findings of this review are limited by significant methodological issues within the current research studies. There is insufficient evidence from high quality research on which to base recommendations about the effectiveness of mindfulness to promote perinatal mental health. The limited positive findings support the design and conduct of adequately powered, longitudinal randomised controlled trials, with active controls.
Publisher: BMJ
Date: 05-2005
Publisher: Informa UK Limited
Date: 12-2012
DOI: 10.5172/CONU.2012.43.1.56
Abstract: Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues.
Publisher: Wiley
Date: 2003
DOI: 10.1002/SMI.964
Publisher: Wiley
Date: 08-09-2015
DOI: 10.1111/INM.12162
Abstract: Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience s le of midwives (n = 95) and MCHN (n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.
Publisher: Mark Allen Group
Date: 02-12-2016
DOI: 10.12968/IJPN.2016.22.12.581
Abstract: Nurse practitioners (NP) are relatively new in Australia with national registration achieved in 2010. Most NP-related literature is about establishing models and scope of practice. This paper reports on the establishment and 12–month evaluation of an NP model of care, between inpatient and community palliative care services, developed to coordinate client care between hospital and home. To enhance patient outcomes, in hospital or home to enhance professional relationships between services and facilitate effective discharges and admissions between services. Both services worked together to develop an evaluation framework, based on agreed key performance indicators. The NP model contributed to earlier discharges from hospital and fewer hospital admissions for those being cared for at home. There are developing opportunities to strengthen professional relationships through clinical and educational collaboration. The model has benefited both patient care and clinical cooperation between services.
Publisher: BMJ
Date: 08-2005
Publisher: Informa UK Limited
Date: 08-02-2010
DOI: 10.1080/08952840903488831
Abstract: The aim of this study was to measure a range of psychological factors identified as important in the literature (resilience, psychological distress, feelings of hopelessness, personal and interpersonal control) among community-dwelling elderly women (N = 31) who had suicidal intentions or attempted suicide. The target group was matched to a control group on age within 5 years. The target group reported lower resilience, personal and interpersonal control but higher psychological distress and feelings of hopelessness compared to the control group. Women who had suicidal ideation or attempts in the last 12 months reported higher personal and interpersonal control. This suggests that although suicide among older women is strongly linked to psychological factors, it warrants further investigation.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.MIDW.2014.07.002
Abstract: to identify the perceptions of midwives and doctors at Monash Women's regarding their educational preparation and practices used for perineal management during the second stage of labour. anonymous cross-sectional semi-structured questionnaire ('The survey'). the three maternity hospitals that form Monash Women's Maternity Services, Monash Health, Victoria, Australia. midwives and doctors attending births at one or more of the three Monash Women's maternity hospitals. a semi-structured questionnaire was developed, drawing on key concepts from experts and peer-reviewed literature. surveys were returned by 17 doctors and 69 midwives (37% response rate, from the 230 surveys sent). Midwives and doctors described a number of techniques they would use to reduce the risk of perineal trauma, for ex le, hands on the fetal head erineum (11.8% of doctors, 61% of midwives), the use of warm compresses (45% of midwives) and maternal education and guidance with pushing (49.3% of midwives). When presented with a series of specific obstetric situations, respondents indicated that they would variably practice hands on the perineum during second stage labour, hands off and episiotomy. The majority of respondents indicated that they agreed or strongly agreed that an episiotomy should sometimes be performed (midwives 97%, doctors 100%). All the doctors had training in diagnosing severe perineal trauma involving anal sphincter injury (ASI), with 77% noting that they felt very confident with this. By contrast, 71% of the midwives reported that they had received training in diagnosing ASI and only 16% of these reported that they were very confident in this diagnosis. All doctors were trained in perineal repair, compared with 65% of midwives. Doctors were more likely to indicate that they were very confident in perineal repair (88%) than the midwives (44%). Most respondents were not familiar with the rates of perineal trauma either within their workplace or across Australia. Midwives and doctors indicated that they would use the hands on or hands off approach or episiotomy depending on the specific clinical scenario and described a range of techniques that they would use in their overall approach to minimising perineal trauma during birth. Midwives were more likely than doctors to indicate their lack of training and/or confidence in conducting perineal repair and diagnosing ASI. many midwives indicated that they had not received training in diagnosing ASI, perineal repair and midwives' and doctors' knowledge of the prevalence of perineal outcomes was poor. Given the importance of these skills to women cared for by midwives and doctors, the findings may be used to inform the development of quality improvement activities, including training programs and opportunities for gaining experience and expertise with perineal management. The use of episiotomy and hands on/hands off the perineum in the survey scenarios provides reassurance that doctors and midwives take a number of factors into account in their clinical practice, rather than a preference for one or more interventions over others.
Publisher: Wiley
Date: 30-10-2014
DOI: 10.1111/IJN.12228
Abstract: A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.
Publisher: Informa UK Limited
Date: 12-02-2009
DOI: 10.1080/08952840802633669
Abstract: Inactivity has been identified as a major contributor to the burden of disease in older women. Study aims were: (a) to assess the personal, social, and environmental facilitators and impediments to physical activity in older women from ethnic communities and (b) to determine the factors associated with physical activity participation. Older women (aged 60-84 years) were recruited from the local Italian (n = 20), Vietnamese (n = 26) and Anglo-Celtic (n = 26) communities. A survey questionnaire was administered in the participants' preferred language. The most common barriers were: "I am not in good health," "I am self-conscious about my looks," "I am too tired," "I don't have time," and "The weather is bad." When comparing the ethnic groups, the Vietnamese women reported fewer barriers than the Italian women (2.6 vs. 5.9). While the Vietnamese women were much more likely to report being "self-conscious about my looks," the Italian women more commonly reported poor health, being too tired, and not liking exercise as barriers. Overall, those living alone were more likely to be active and those who reported fear of injury, less active. Recognizing ethnospecific differences in the prevalence of barriers may be important when devising strategies to increase activity levels of older women.
Publisher: BMJ
Date: 07-2005
Publisher: Wiley
Date: 18-06-2013
DOI: 10.1111/IJN.12125
Abstract: This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.
Publisher: Wiley
Date: 14-04-2014
DOI: 10.1111/AJAG.12156
Abstract: To evaluate an aged care program in developing self-efficacy of newly graduated registered nurses. An evaluation of the program was conducted using a mixed methods approach. Twenty-four nurses completed the pre- and post-survey of aged care nursing self efficacy and attended one of three focus groups held to gain in-depth understanding of their insight into the program. There was an increase in nurses' self-efficacy post-program. The increased self-efficacy and new knowledge gained enhanced nurses' confidence and enabled them to critically appraise their workplace practices. The improved confidence resulting from increased self-efficacy and new knowledge gained from the aged care program enabled nurses to critically appraise the practices in their workplace, demonstrating the program's effectiveness. Aged care service providers should support continuing education for aged care nurses to ensure sustainability of a competent workforce to manage the increasing aged care population.
Publisher: Wiley
Date: 07-01-2008
DOI: 10.1111/J.1440-1584.2007.00933.X
Abstract: The health and wellbeing of urban and rural Anglo- and Italian-Australian residents was compared using five domains which are deemed to influence the outcome 'ageing well'. The five domains included physical and functional status, social supports, material resources, activity and leisure, and mental efficacy. A cross-sectional survey carried out in a two-stage data collection process included a brief telephone interview and face-to-face interview using semistructured schedules with several psychometric measures. Eastern and Western Melbourne and Mildura, Victoria, Australia. Health and wellbeing of urban and rural community-dwelling Anglo- and Italian-Australian men and women aged 50-89 years. Urban and rural community-dwelling Anglo- and Italian-Australian men and women aged 50-89 years. There were 364 urban Anglo-Australians, 149 rural Anglo-Australians, 190 urban Italian-Australians, and 77 rural Italian-Australians. Urban Anglo-Australian residents reported significantly higher general and emotional health but also reported significantly higher stress levels than their rural counterparts. The rural Italian-Australian residents reported higher resilience and personal control but poorer general and emotional health than the urban residents. If health disparities between urban and rural residents are to be successfully addressed, the link between place of residence, health status and wellbeing must be explored.
Publisher: BMJ
Date: 2005
Publisher: BMJ
Date: 09-2005
Publisher: Maney Publishing
Date: 03-03-2016
Publisher: Wiley
Date: 03-2006
DOI: 10.1111/J.1440-1754.2006.00813.X
Abstract: To determine whether using a respiratory function monitor alters clinicians' choice of ventilator settings, tidal volumes or blood gases in the first 48 h of ventilation. Clinicians were trained to use a respiratory function monitor to optimize neonatal ventilation. Thirty-five infants, weighing < 2 kg, treated with the Infant Star ventilator were randomized to have a respiratory function monitor display visible or concealed. All reasons for altering ventilator settings were noted. Data on ventilator parameters and clinical care were collected hourly. The primary outcome was the mean peak pressure used during the first 48 h. There were no statistically significant differences in peak pressures, tidal volumes or arterial carbon dioxide levels between the two groups. Using the Florian respiratory function monitor in the first 48 h of ventilation with the Infant Star ventilator did not alter the choice of ventilator settings, tidal or minute volumes or arterial blood gases. Possible explanations for this result include lack of power due to the small numbers recruited and bias due to the unblinded nature of the trial.
Publisher: BMJ
Date: 08-08-2007
Abstract: During volume guarantee (VG) ventilation the peak inflating pressure (PIP) for each ventilator inflation is adjusted to ensure the expired tidal volume (V Te ) is close to the set V Te . Differences in the PIP between inflations triggered by the infant’s inspirations and untriggered inflations are seen. To investigate the effects of triggered and untriggered inflations on PIP and V Te . Neonates were ventilated with the Dräger Babylog 8000 using assist control (synchronous intermittent positive pressure ventilation) and VG modes. Continuous recordings of ventilator pressures and tidal volumes were made at 200 Hz for 10 minutes. In 10 infants, 6540 inflations were analysed, of which 4052 (62%) were triggered. Triggered inflations had a significantly lower mean (SD) PIP than untriggered inflations: 12.9 (4.9) vs 17.0 (3.3) cm H 2 O, (p .001). Despite this, there was no significant difference in the V Te of each type of inflation (103% and 101% of the set V Te , respectively). When a triggered inflation was immediately preceded or followed by an untriggered inflation the PIP changed by about 5 cm H 2 O. Between adjacent inflations of the same type, the change in PIP was less than 3 cm H 2 O: for triggered inflations it was 0.11 (1.50) cm H 2 O and for untriggered inflations 0.06 (1.53) cm H 2 O. During VG ventilation with the Dräger Babylog 8000 the PIP was 4 cm H 2 O lower during triggered inflations than untriggered inflations, although the expired tidal volumes were similar.
Publisher: Wiley
Date: 05-2015
Publisher: Wiley
Date: 07-10-2014
No related grants have been discovered for Rosalind Lau.