ORCID Profile
0000-0001-7306-5591
Current Organisations
Southern Adelaide Local Health Network
,
University of Adelaide
,
Southern Adelaide Local Health Network Mental Health Services
,
Royal Australasian College of Physicians
,
Flinders University
,
Royal Australian and New Zealand College of Psychiatrists
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Publications
NewAccess for depression and anxiety: Adapting the UK Improving Access to Psychological Therapies Program across Australia
Publisher: SAGE Publications
Date: 10-07-2016
Abstract: NewAccess is a Low Intensity Cognitive Behaviour Therapy (LiCBT) early intervention pilot, for mild to moderate depression and anxiety. In November 2015 the Australian Government Review of Mental Health Programmes and Services specifically highlighted the program, stating, “Primary Health Networks will.…be encouraged and supported to work towards better utilisation of low intensity ‘coaching’ services for people with lesser needs, building on evaluations of programmes such as the NewAccess model of care, and the Improving Access to Psychological Therapies model of stepped care implemented in the United Kingdom.” NewAccess runs in three sites (Adelaide, Canberra and North Coast New South Wales) based on the successful UK Improving Access to Psychological Therapies (IAPT) model. NewAccess involves training in evidence-based interventions, regular clinical supervision and recording outcome measures every session. Key performance indicators include functional recovery,loss of diagnosis, return to employment and early intervention. Adaptation to Australia accommodated contextual issues such as geographical isolation and infrastructure of the healthcare system. Initial recovery rates and projected economic viability for NewAccess are very promising, supporting wider adoption of an IAPT model across Australia. In addition it has resulted in the emergence of a new Australian workforce in community mental health with the LiCBT ‘Coach’.
Divided we fall: clinicians and academic psychiatrists need to stand together
Publisher: SAGE Publications
Date: 12-07-2017
Abstract: Psychiatry faces urgent problems requiring united action. These problems affect academic psychiatrists in the universities, and clinicians in publicly funded mental health services. Academic units are isolated and endangered, finding it difficult to recruit. They could benefit from closer relationships with public mental health services, in terms of recruitment, shared teaching and clinical research. However, mental health services are preoccupied with their own problems, particularly in relation to acute clinical demand. How can we stand together to improve academic units and clinical psychiatry? Clinicians and academic psychiatrists can stand together on important matters, but it takes initiatives from local leaders to overcome the structural barriers between health services and the universities. An ex le is given of united action by clinicians and academic psychiatrists to address a crisis within a state mental health system. First, psychiatrists undertook independent health services research that compared the state system with those in other Australian and international jurisdictions. The comparative data was used to generate solutions, which were presented at every level from ministerial offices through to service managers. Finally, psychiatrists took up joint academic and clinical leadership roles in the university and the mental health system. This united research-led approach turned around the crisis in the state mental health system.
Teaching residents chronic disease management using the flinders model
Publisher: Springer Science and Business Media LLC
Date: 06-2006
Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.PSYCHRES.2018.02.028
Abstract: Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.
‘I’ll Just Pay the Rent Next Month’: an Exploratory Study Examining Facilitatory Cognitions Among EGM Problem Gamblers
Publisher: Springer Science and Business Media LLC
Date: 06-2019
Prospective study of dietary fat and the risk of age-related macular degeneration
Publisher: Elsevier BV
Date: 02-2001
Abstract: The relation between intakes of total fat and specific types of fat and age-related macular degeneration (AMD) remains unclear. Our objective was to examine prospectively the association between fat intake and AMD. We conducted a prospective follow-up study of participants in the Nurses' Health Study and the Health Professionals Follow-up Study. At baseline (1984 for women and 1986 for men), the study included 42743 women and 29746 men aged > or = 50 y with no diagnosis of AMD who were followed until 1996. Fat intake was assessed with a food-frequency questionnaire. We accrued 567 patients with AMD with a visual loss of 20/30 or worse. The pooled multivariate relative risk (RR) for the highest compared with the lowest quintile of total fat intake was 1.54 (95% CI: 1.17, 2.01 P for trend = 0.008). Linolenic acid was positively associated with risk of AMD (top versus bottom quintile of RR: 1.49 95% CI: 1.15, 1.94 P for trend = 0.0009). Docosahexaenoic acid had a modest inverse relation with AMD (top versus bottom quintile of RR: 0.70 95% CI: 0.52, 0.93 P for trend = 0.05), and >4 servings of fish/wk was associated with a 35% lower risk of AMD compared with < or = 3 servings/mo (RR: 0.65 95% CI: 0.46, 0.91 P for trend = 0.009). Total fat intake was positively associated with risk of AMD, which may have been due to intakes of in idual fatty acids, such as linolenic acid, rather than to total fat intakes per se. A high intake of fish may reduce the risk of AMD.
Health reform through coordinated care: SA HealthPlus
Publisher: BMJ
Date: 17-03-2005
A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions
Publisher: SAGE Publications
Date: 10-01-2013
Abstract: To evaluate the efficacy of the Flinders Program™ of chronic condition management on alcohol use, psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse. This 9-month wait-list, randomised controlled trial used the Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8 as the entry criterion. Intervention veterans received the Flinders Program plus usual care and controls received usual care. The primary outcome measure was AUDIT score at baseline, 3, 6 and 9 months. Secondary measures included quality of life, alcohol dependence (DSM-IV), anxiety and depression. All measures were repeated at variable trial end dates between 9 and 18 months in the intervention group. Randomisation resulted in 46 intervention and 31 control participants. Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up ( p = 0.039) in the intervention group compared to control group. The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months ( p = 0.027). There were no significant differences between groups for secondary measures. Within-group analyses showed that both groups significantly improved in AUDIT ( p 0.001), anxiety and depression ( p 0.01), anger ( p 0.001), and post-traumatic stress ( p 0.01). Improvements in AUDIT ( p 0.001) and alcohol dependence were maintained in the intervention group to 18 months. Use of the Flinders Program in addition to usual care resulted in reduced alcohol use, reduced alcohol dependence, and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems. The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support, case management and coordinated care for people with chronic conditions. This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia.
Self-management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.JOCA.2009.05.010
Abstract: To evaluate the efficacy of a self-management support program including a 6 week self-management course, in idualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery. Randomised controlled trial of 152 public hospital outpatients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery. Participants were randomised to a self-management program or to usual care. The primary outcome was change in the Health Education Intervention Questionnaire (HeiQ) from randomisation to 6 month follow-up. Quality of life and depressive symptoms were also measured. Changes in pain and function were assessed using the Western Ontario and McMaster Universities (WOMAC) Arthritis Index. At 6 month follow-up, health-directed behaviour was significantly greater in the intervention [mean 4.29, 95% confidence interval (CI) 3.99-4.58] than the control (mean 3.81, 95% CI 3.52-4.09 P=0.017). There was also a significant effect on skill and technique acquisition for the intervention (mean 4.37, 95% CI 4.19-4.55) in comparison to control (mean 4.11, 95% CI 3.93-4.29 P=0.036). There was no significant effect of the intervention on the remaining HeiQ subscales, WOMAC pain or disability, quality of life or depressive symptoms. The arthritis self-management program improved health-directed behaviours, skill acquisition and stiffness in patients on a joint replacement waiting list, although the observed effects were of modest size (Cohen's d between 0.36 and 0.42). There was no significant effect on pain, function or quality of life in the short term. Self-management programs can assist in maintaining health behaviours (particularly walking) in this patient group. Further research is needed to assess their impact on quality of life and over longer periods.
Self-detoxification by opiate addicts: A preliminary investigation
Publisher: Royal College of Psychiatrists
Date: 08-1991
Abstract: A study of 50 opiate addicts attending a London service for treatment of drug dependence found that 47 subjects had previously made at least one attempt at self-detoxification. These subjects reported 212 previous attempts. Although 30 subjects reported having managed to complete at least one attempt, the success rate per episode was low (24%). One of the most commonly reported methods, used by 28 subjects, involved an abrupt cessation of opiates (‘cold turkey’). Of the drugs used in their attempts at self-detoxification, benzodiazepines were reported by 24 subjects and opiates by 20. Practical strategies such as distraction and avoidance were also used. Self-help detoxification materials for opiate addicts might be useful.
A Practice-Focused Overview of Methods to Assess Obesity Before Arthroplasty
Publisher: Wiley
Date: 15-06-2015
DOI: 10.1002/MSC.1109
Changing practice to support self-management and recovery in mental illness: Application of an implementation model
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PY13103
Abstract: Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.
Gambling-related harm as reported by concerned significant others: a systematic review and meta-synthesis of empirical studies
Publisher: Informa UK Limited
Date: 27-09-2021
What are the components of effective chronic condition self-management education interventions for children with asthma, cystic fibrosis, and diabetes? A systematic review
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.PEC.2018.11.001
Abstract: To articulate the components of educational interventions that help children learn about managing their asthma, cystic fibrosis, or diabetes, relevant to their age/developmental status. A systematic review of chronic condition self-management (CCSM) educational interventions that included age/developmentally appropriate components, published before 27 January 2018, including evidence level and quality assessments. Teaching approaches were extracted and translated into practical components. Twenty education interventions were identified, published across 30 studies. Most studies (n = 20/30) were based on the theories of Piaget and Bandura. Similar teaching approaches were used across conditions, incorporating sequenced curriculum and a variety of active elements. Age/developmentally appropriate interventions resulted in improvements in the CCSM capabilities of children. Outcomes were improved when compared with usual care. For very young children, educational interventions were directed at parents/families. As children reached school age, interventions increasingly became child-focused, promoting autonomy. Integrated play and reinforcement were common. Adolescent interventions placed greater emphasis on communication, problem-solving, and role ision. Eight key components were identified: structured and sequenced curricula reinforcement active participation collaboration autonomy feedback multiple exposures and, problem-solving. Different components are relevant to specific life stages. Clinicians require age/developmentally appropriate practical education tools to provide effective paediatric health care.
Enlarged frontal P300 to stimulus change in panic disorder
Publisher: Elsevier BV
Date: 05-1996
DOI: 10.1016/0006-3223(95)00288-X
Abstract: This study investigated event-related potential (ERP) indices of information processing in sufferers of panic disorder (PD). ERPs were recorded from 14 PD patients and 15 controls during an auditory target detection task. The task required subjects to discriminate infrequent target tones (p = .14 2000 Hz) from frequent (p = .72 1000 Hz) and infrequent (p = .14 500 Hz) distractor tones. A frontal P300 (P3a) identified in the PD group was characteristic of activity that would be expected to novel, task-irrelevant stimuli and is consistent with junctional pathology involving the prefrontal-limbic pathways. This study provides psychophysiological evidence of an abnormality in PD of the brain's processing of physical changes in the stimulus field that occurs even under conditions of low stimulus load. It may assist in helping to understand the breakdown in information processing that occurs in PD under high load conditions such as crowds and supermarkets.
Experiences and Perceptions of Problem Gamblers on Cognitive and Exposure Therapies When Taking Part in a Randomised Controlled Trial: A Qualitative Study
Publisher: Springer Science and Business Media LLC
Date: 26-12-2016
DOI: 10.1007/S10899-015-9589-Z
Abstract: In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients' urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-s le of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants' comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge-cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of "rational thought" from their program of therapy and CT participants had "taken-over" their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out.
Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080330
Abstract: The Sharing Health Care SA chronic disease selfmanagement (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess selfmanagement skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led selfmanagement education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.
Problem Gambling and Intimate Partner Violence: A Systematic Review and Meta-Analysis
Publisher: SAGE Publications
Date: 03-12-2016
Abstract: This study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (8 for victimisation only, 4 for perpetration only and 2 for both victimisation and perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimization and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners.
Suicide ideation and behaviour in people with pathological gambling attending a treatment service
Publisher: Springer Science and Business Media LLC
Date: 07-2006
GPs and problem gambling: Can they help with identification and early intervention?
Publisher: Springer Science and Business Media LLC
Date: 24-04-2007
DOI: 10.1007/S10899-007-9062-8
Abstract: General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.
Problem gambling among female prisoners: lifetime prevalence, help-seeking behaviour and association with incarceration
Publisher: Informa UK Limited
Date: 04-07-2017
Paid and Unpaid Online Recruitment for Health Interventions in Young Adults
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JADOHEALTH.2016.07.020
Abstract: There is a growing need to identify new and innovative approaches to recruit representative s les of young adults in health intervention research. The current study used a data set of screening information from an online well-being intervention trial of young adults, to investigate cost-effectiveness of different recruitment strategies and whether the clinical and demographic characteristics of participants differed depending on paid or unpaid online recruitment sources. Data were collected from 334 18- to 25-year-old Australians. The study was advertised through a variety of paid and unpaid online recruitment channels (e.g., Google, Facebook, Twitter, YouTube, recruitment agency), with response rates to different recruitment channels tracked using unique Web links. Well-being of participants was measured using the Mental Health Continuum Short Form. Analyses consisted of independent t tests and χ Overall, unpaid recruitment channels had a considerably higher yield than paid recruitment channels. Of paid recruitment channels, a recruitment agency and paid Facebook advertisements attracted the largest number of in iduals. This study also found differences between paid and unpaid online recruitment channels with regard to the well-being and mood of participants. Although the success of online recruitment channels is likely subject to a complex interplay between the number of exposures, the targeted s le, the wording, and placement of the advertisement, as well as study characteristics, our study demonstrated that unpaid recruitment channels are more effective than paid channels and that paid and unpaid channels may result in s les with different characteristics.
Developmentally appropriate supported self-management for children and young people with chronic conditions: A consensus
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.PEC.2019.09.029
Abstract: To create a consensus list of self-management definitions, recommendations, and endpoints for children and young people (0-20 years) with chronic conditions. This study used a Delphi technique. Based on the number of relevant peer-reviewed publications, clinical academics were invited to participate in three survey rounds. Round one contained open-ended and multiple-choice questions eliciting general opinions on self-management. For round two, results were provided to the interdisciplinary expert panel as statements for rating their agreement using a 7-point Likert scale, with consensus predefined as moderately or extremely satisfied by >70% of participants. Statements not meeting consensus were re-presented in round three, with group feedback incorporated. Finalised statements informed creation of the 'Partners in Health: Self-Management Consensus List for Children and Young People'. Sixteen clinical academics participated: 12 completed round one 14 completed round two and 12 completed round three. Of 101 statements, 90 reached consensus, with statements separated into five developmentally appropriate groups. Statements covered broad self-management and self-management support domains including knowledge, involvement, monitoring/responding to symptoms, transition, impact, lifestyle, and support. Division of responsibility and autonomy were distinct themes. This research provides consensus-based guidance for clinicians providing paediatric self-management support.
Construct validity of the Dutch version of the 12-item partners in health scale: Measuring patient self-management behaviour and knowledge in patients with chronic obstructive pulmonary disease
Publisher: Public Library of Science (PLoS)
Date: 26-08-2016
Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PY13087
Abstract: Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.
Defining Vulnerable Patients with Heart Failure: Opportunistic Lessons from Covid-19
Publisher: Bentham Science Publishers Ltd.
Date: 07-2022
DOI: 10.2174/1573403X17666210928121625
Abstract: Congestive Heart Failure is a chronic disease that can be associated with poor outcomes. Some patients are more vulnerable, while others who are vulnerable appear absent or silent to health services. COVID-19 pandemic is a good opportunity to explore this important area. This review focuses on chronic disease, heart failure and those who require greater consideration.
Practice change in chronic conditions care: an appraisal of theories
Publisher: Springer Science and Business Media LLC
Date: 28-02-2017
Two-group randomised, parallel trial of cognitive and exposure therapies for problem gambling: A research protocol
Publisher: BMJ
Date: 06-2013
Sexual concerns of women diagnosed with breast cancer-related lymphedema
Publisher: Springer Science and Business Media LLC
Date: 27-03-2015
Chronic disease self-management in Aboriginal communities: Towards a sustainable program of care in rural communities
Publisher: CSIRO Publishing
Date: 2003
DOI: 10.1071/PY03043
Abstract: The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.
Understanding the business versus care paradox in gambling venues: A qualitative study of the perspectives from gamblers, venue staff and counsellors 17 Psychology and Cognitive Sciences 1701 Psychology Samantha Thomas and Maria Bellringer
Publisher: Springer Science and Business Media LLC
Date: 24-09-2018
Predictors of Problem Gambling Severity in Treatment Seeking Gamblers
Publisher: Springer Science and Business Media LLC
Date: 16-11-2011
Exploring Patterns of Change Processes over Distinct In-Treatment Phases of Cognitive and Exposure Therapies for Electronic Gaming Machine Problem Gamblers
Publisher: Cambridge University Press (CUP)
Date: 06-08-2018
DOI: 10.1017/BEC.2018.18
Abstract: Little is known about the change processes in gambling disorder-specific cognitive therapy (CT) and exposure therapy (ET). These therapies are underpinned by the cognitive approach (i.e., restructuring gambling cognitions) and the psychobiological approach (i.e., elimination of gambling urges) to treating problem gambling. Here, piecewise-linear modelling is used in a secondary analysis of randomised trial data for a CT group ( n = 44) versus an ET group ( n = 43) with the aim to open a discourse on how in iduals respond to CT and ET relative to theory. Measures were administered between therapy sessions (average = 6.2 per in idual) across 18 weeks for gambling urge (GUS) and gambling cognitions (GRCS). Results indicated the ET group had a stronger reduction in GUS ( p .01) in the first 4 weeks of treatment. Between 4–12 weeks, improvement in GUS ( p .01) and GRCS ( p = .02) was more rapid in the CT group. Both groups experienced comparable improvements from 12–18 weeks. These findings have implications for further treatment development, including a combined cognitive and exposure approach that is flexibly adapted to the patient. A larger trial is needed to formally establish change processes and identify differences in problem gambler subgroups. This would provide therapists capacity to offer each patient a clear direction and an expedited pathway to their preferred outcome.
Problem gambling and family violence: Prevalence and patterns in treatment-seekers
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.ADDBEH.2014.07.006
Abstract: The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment s le and to explore the relationship between problem gambling and family violence in other treatment-seeking s les. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling s le was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence s le was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) s les reported significantly higher rates of any family violence than the gambling s le, while the financial counselling s le (10.6%) reported significantly higher rates of problem gambling than the family violence s le. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.
Health workers' views of a program to facilitate physical health care in mental health settings: Implications for implementation and training
Publisher: SAGE Publications
Date: 21-08-2015
Abstract: Physical comorbidities shorten the lifespan of people with severe mental illness therefore mental health clinicians need to support service users in risk factor-related behaviour change. We investigated mental health care workers’ views of a physical health self-management support program in order to identify implementation requirements. Qualitative interviews were conducted with workers who had differing levels of experience with a self-management support program. Themes were identified using interpretive descriptive analysis and then matched against domains used in implementation models to draw implications for successful practice change. Three main themes emerged related to: (1) understandings of disease management within job roles (2) requirements for putting self-management support into practice and (3) challenges of coordination in disease management. Priority domains from implementation models were inner and outer health service settings. While staff training is required, practice change for care which takes account of both mental and physical health also requires changes in organisational frameworks.
How does routinely delivered cognitive–behavioural therapy for gambling disorder compare to “gold standard” clinical trial?
Publisher: Wiley
Date: 11-12-2018
DOI: 10.1002/CPP.2163
Abstract: Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive-behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post-treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with "pokies." However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts.
The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess
Publisher: Informa UK Limited
Date: 12-05-2020
Validation study of a Chinese version of Partners in Health in Hong Kong (C-PIH HK)
Publisher: Springer Science and Business Media LLC
Date: 23-05-2017
DOI: 10.1007/S11136-016-1315-5
Abstract: The Partners in Health (PIH) scale is a measure designed to assess the generic knowledge, attitudes, behaviors, and impacts of self-management. A cross-cultural adaptation of the PIH for use in Hong Kong was evaluated in this study. This paper reports the validity and reliability of the Chinese version of PIH (C-PIH[HK]). A 12-item PIH was translated using forward-backward translation technique and reviewed by in iduals with chronic diseases and health professionals. A total of 209 in iduals with chronic diseases completed the scale. The construct validity, internal consistency, and test-retest reliability were evaluated in two waves. The findings in Wave 1 (n = 73) provided acceptable psychometric properties of the C-PIH(HK) but supported the adaptation of question 5 to improve the cultural relevance, validity, and reliability of the scale. An adapted version of C-PIH(HK) was evaluated in Wave 2. The findings in Wave 2 (n = 136) demonstrated good construct validity and internal consistency of C-PIH(HK). A principal component analysis with Oblimin rotation yielded a 3-factor solution, and the Cronbach's alphas of the subscales ranged from 0.773 to 0.845. Participants were asked whether they perceived the self-management workshops they attended and education provided by health professionals as useful or not. The results showed that the C-PIH(HK) was able to discriminate those who agreed and those who disagreed related to the usefulness of in idual health education (p < 0.0001 in all subscales) and workshops (p < 0.001 in the knowledge subscale) as hypothesized. The test-retest reliability was high (ICC = 0.818). A culturally adapted version of PIH for use in Hong Kong was evaluated. The study supported good construct validity, discriminate validity, internal consistency, and test-retest reliability of the C-PIH(HK).
Chronic condition self-management support: Proposed competencies for medical students
Publisher: SAGE Publications
Date: 03-2009
Abstract: Objective: Governments and the medical profession are concerned that there continues to be less than optimal health outcomes despite escalating expenditure on health services from the effect of the ageing population with chronic illnesses. In this context, doctors will need to have knowledge and skills in effective chronic condition management (CCM) and chronic condition self-management (CCSM). Method: A national workshop of representatives of eight medical schools from the CCSM special interest group (SIG) of the Australian and New Zealand Association on Medical Education met in September 2004, to consider curriculum content in CCM and CCSM. Results: The workshop recommended that the Committee of Deans of Australian Medical Schools and the Commonwealth Department of Health and Ageing consider the identification and possible development of a specific curriculum for CCM and CCSM within the curricula of Australian Medical Schools. Discussion: Consideration needs to be given to the changing nature of medical practice and that as part of this doctors of the future will need skills in team participation, continuity of care, self-management support and patient-centered collaborative care planning. Doctors will also need skills to assist patients to better adhere to medical management, lifestyle behaviour change and risk factor reduction, if optimal health outcomes are to be achieved and costs are to be contained.
Exposure therapy for problem gambling via videoconferencing: A case report
Publisher: Springer Science and Business Media LLC
Date: 05-09-2008
DOI: 10.1007/S10899-007-9074-4
Abstract: This case report of a 31 year old woman who described her main problem as an uncontrollable urge to gamble on electronic gaming machines describes the application of exposure therapy (ET) by videoconferencing and the use of a clinical therapy assistant in the treatment of pathological gambling. The case study is used to demonstrate the effectiveness of this treatment with six sessions of therapy and 4 year follow up. The use of videoconferencing is discussed in relation to treatment effectiveness, ongoing follow up for the client and education and support for a community mental health nurse, therapy assistant, in a rural setting in South Australia. The implications of using this modality for the treatment of rural patients with problem gambling is discussed.
Chronic condition management models for cancer care and survivorship
Publisher: Springer Singapore
Date: 2016
Predictors of Relapse in Problem Gambling: A Prospective Cohort Study
Publisher: Springer Science and Business Media LLC
Date: 25-09-2015
DOI: 10.1007/S10899-013-9408-3
Abstract: To explore the variation of predictors of relapse in treatment and support seeking gamblers. A prospective cohort study with 158 treatment and support seeking problem gamblers in South Australia. Key measures were selected using a consensus process with international experts in problem gambling and related addictions. The outcome measures were Victorian Gambling Screen (VGS) and behaviours related to gambling. Potential predictors were gambling related cognitions and urge, emotional disturbance, social support, sensation seeking traits, and levels of work and social functioning. Mean age of participants was 44 years (SD = 12.92 years) and 85 (54 %) were male. Median time for participants enrollment in the study was 8.38 months (IQR = 2.57 months). Patterns of completed measures for points in time included 116 (73.4 %) with at least a 3 month follow-up. Using generalised mixed-effects regression models we found gambling related urge was significantly associated with relapse in problem gambling as measured by VGS (OR 1.29 95 % CI 1.12-1.49) and gambling behaviours (OR 1.16 95 % CI 1.06-1.27). Gambling related cognitions were also significantly associated with VGS (OR 1.06 95 % CI 1.01-1.12). There is consistent association between urge to gamble and relapse in problem gambling but estimates for other potential predictors may have been attenuated because of methodological limitations. This study also highlighted the challenges presented from a cohort study of treatment and support seeking problem gamblers.
Exploring the measurement structure of the Gambling Related Cognitions Scale (GRCS) in treatment-seekers: A Bayesian structural equation modelling approach
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.PSYCHRES.2016.02.002
Abstract: Knowledge of a problem gambler's underlying gambling related cognitions plays an important role in treatment planning. The Gambling Related Cognitions Scale (GRCS) is therefore frequently used in clinical settings for screening and evaluation of treatment outcomes. However, GRCS validation studies have generated conflicting results regarding its latent structure using traditional confirmatory factor analyses (CFA). This may partly be due to the rigid constraints imposed on cross-factor loadings with traditional CFA. The aim of this investigation was to determine whether a Bayesian structural equation modelling (BSEM) approach to examination of the GRCS factor structure would better replicate substantive theory and also inform model re-specifications. Participants were 454 treatment-seekers at first presentation to a gambling treatment centre between January 2012 and December 2014. Model fit indices were well below acceptable standards for CFA. In contrast, the BSEM model which included small informative priors for the residual covariance matrix in addition to cross-loadings produced excellent model fit for the original hypothesised factor structure. The results also informed re-specification of the CFA model which provided more reasonable model fit. These conclusions have implications that should be useful to both clinicians and researchers evaluating measurement models relating to gambling related cognitions in treatment-seekers.
Gambling problems among military personnel after deployment
Publisher: Elsevier BV
Date: 12-2020
Assessing Randomised Clinical Trials of Cognitive and Exposure Therapies for Gambling Disorders: A Systematic Review
Publisher: Cambridge University Press (CUP)
Date: 12-08-2020
DOI: 10.1017/BEC.2013.15
Abstract: Aims: Problem or pathological gambling is associated with significant disruption to the in idual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive ( n = 3), exposure ( n = 3) or both ( n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.
Patterns of Family and Intimate Partner Violence in Problem Gamblers
Publisher: Springer Science and Business Media LLC
Date: 26-03-2019
DOI: 10.1007/S10899-018-9768-9
Abstract: While the evidence about the statistical co-occurrence of family violence and problem gambling is growing, the mechanism by which the two behaviours are related is less clear. This study sought to clarify the dynamics of the problem behaviours, including the role of gender in victimisation and perpetration of violence in the family. Two-hundred-and-twelve treatment seeking problem gamblers (50.5% females) were recruited for interviews about past year FV and IPV experiences. The interviews included questions about the types of FV and IPV using the HITS tool (Sherin et al. in Fam Med Kans City 30:508-512, 1998). The questions addressed multiple family members, the temporal order of violence and gambling and the perceived associations between the two behaviours. The result show that well over half (60.8% 95 CI = 54.1-67.2) of the participants reported some form of violence in the past 12 months, with no gender differences in relation to perpetration and victimisation. Bidirectional violence (43.9% 95 CI = 37.4-50.6) was significantly more common than 'perpetration only' (11.3% 95 CI = 7.7-16.3) or 'victimisation only' (5.7% 95 CI = 3.3-9.6). Violence was mostly verbal, although considerable rates of physical violence also featured in the responses. 'Participants' own gambling preceded violence in a majority of the interviews but a small group of IPV victims reported that being a victim had led to their problematic gambling. These results can be used inform prevention, better treatment matching and capacity building in family violence and problem gambling services, where a significant focus should be on situational IPV.
The therapist experience of internet delivered CBT for problem gambling: Service integration considerations
Publisher: Elsevier BV
Date: 1970
Screening for hepatitis B and vaccination of injecting drug users in NHS drug treatment services
Publisher: Wiley
Date: 12-1990
DOI: 10.1111/J.1360-0443.1990.TB01656.X
Abstract: Hepatitis B vaccines are now available for people at high risk of infection. Injecting drug users are at particular risk. A UK national survey of statutory drug treatment facilities was conducted to assess what screening and vaccination procedures were offered to drug takers. Of the respondents 64% did not screen for hepatitis B and 71% did not offer vaccination to hepatitis B negative in iduals. However, 63% respondents said they would advise vaccination for injecting drug users who continued to share. Fifty-eight per cent thought that the partners of hepatitis B positive clients should be screened and 50% thought that vaccination of partners was advisable. A policy of screening and vaccination for hepatitis B is recommended.
Electroconvulsive Therapy: A Study of Attitudes and Attitude Change after Seeing an Educational Video
Publisher: SAGE Publications
Date: 12-1993
DOI: 10.3109/00048679309075824
Abstract: Despite the proven efficacy of Electroconvulsive Therapy [ECT], negative attitudes occur in some patients towards its use. However, research into attitudes of patients and public towards ECT, and the influence of the media on these attitudes, is limited and often contradictory. The aims of this study were: to develop a self-administered questionnaire to assess attitudes to assess the effect of an educational video on attitudes and to assess the effect of the media on attitudes. The questionnaire was administered to psychiatric and non-psychiatric patients of a Veterans’ hospital and to a group of general hospital patients. A video was shown to a randomly assigned group of the Veteran hospital psychiatric patients. Their attitudes were assessed before and after the video. An overall positive attitude towards ECT was demonstrated in all three groups. Showing a video to the Veteran psychiatric patients produced an improvement in some attitudes, but no reduction in fear. For the psychiatric patients, the effect of the media was negative.
Outcomes of telephone-delivered low-intensity cognitive behaviour therapy (LiCBT) to community dwelling Australians with a recent hospital admission due to depression or anxiety: MindStep™
Publisher: Springer Science and Business Media LLC
Date: 03-01-2019
GAMBLINGLESS: For LIFE study protocol: A pragmatic randomised trial of an online cognitive-behavioural programme for disordered gambling
Publisher: BMJ
Date: 02-2017
HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV
Publisher: Springer Science and Business Media LLC
Date: 05-03-2016
Effectiveness of problem gambling interventions in a service setting: A protocol for a pragmatic randomised controlled clinical trial
Publisher: BMJ
Date: 03-2017
Can low intensity cognitive behavioural therapy for non-cardiac chest pain presentations to an emergency department be efficacious? A pilot study
Publisher: Informa UK Limited
Date: 12-2019
DOI: 10.1111/AP.12424
Effects of affective and anxiety disorders on outcome in problem gamblers attending routine cognitive–behavioural treatment in South Australia
Publisher: Springer Science and Business Media LLC
Date: 05-2015
DOI: 10.1007/S10899-014-9465-2
Abstract: This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive-behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) 'harm to self' sub-scale with validated cut score 21+ (score range 0-60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of in iduals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56%) were males. At baseline, 353 (92.9%) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46%) had a very high probability of a 12-month affective or anxiety disorder, 103 (27%) in the high range and 102 (27%) in the low to moderate range. For the main analysis, in iduals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). In iduals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitive-behavioural therapy in the mid-term.
Measuring chronic condition self-management in an Australian community: factor structure of the revised Partners in Health (PIH) scale.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2017
DOI: 10.1007/S11136-016-1368-5
Abstract: To evaluate the factor structure of the revised Partners in Health (PIH) scale for measuring chronic condition self-management in a representative s le from the Australian community. A series of consultations between clinical groups underpinned the revision of the PIH. The factors in the revised instrument were proposed to be: knowledge of illness and treatment, patient-health professional partnership, recognition and management of symptoms and coping with chronic illness. Participants (N = 904) reporting having a chronic illness completed the revised 12-item scale. Two a priori models, the 4-factor and bi-factor models were then evaluated using Bayesian confirmatory factor analysis (BCFA). Final model selection was established on model complexity, posterior predictive p values and deviance information criterion. Both 4-factor and bi-factor BCFA models with small informative priors for cross-loadings provided an acceptable fit with the data. The 4-factor model was shown to provide a better and more parsimonious fit with the observed data in terms of substantive theory. McDonald's omega coefficients indicated that the reliability of subscale raw scores was mostly in the acceptable range. The findings showed that the PIH scale is a relevant and structurally valid instrument for measuring chronic condition self-management in an Australian community. The PIH scale may help health professionals to introduce the concept of self-management to their patients and provide assessment of areas of self-management. A limitation is the narrow range of validated PIH measurement properties to date. Further research is needed to evaluate other important properties such as test-retest reliability, responsiveness over time and content validity.
Parent‐delivered contingency management for a treatment‐refusing young adult with gaming disorder: Case report
Publisher: Wiley
Date: 2022
Abstract: Online video gaming is a popular activity among people of all ages. For some, however, gaming can become problematic. While evidence exists for the effectiveness of cognitive behavioural therapy for gaming disorder (GD), a major challenge is that adolescents and young adults, particularly males, are often reluctant to seek help and engage long term with a mental health practitioner. This report presents a case involving brief parent‐delivered contingency management for a 19‐year‐old male with GD who refused to engage with treatment services following a significant decline in functioning and a high‐lethality suicide attempt. This approach led to a substantial reduction in gaming time, as well as related gains in self‐care and independence. This case highlights the value and feasibility of developing a therapeutic alliance with a parent to manage excessive gaming behaviours among treatment‐refusing in iduals with GD. Practical challenges and associated lessons from managing this case are discussed. Brief parent‐delivered contingency management was implemented for a 19‐year‐old treatment‐refusing male with GD. This approach led to a substantial reduction in the young man's gaming time as well as related gains in areas of self‐care and independence at 6‐month follow‐up. This case highlights the value and feasibility of developing a therapeutic alliance with a parent to manage excessive gaming behaviours among treatment‐refusing in iduals with GD.
Does the Partners in Health scale allow meaningful comparisons of chronic condition self-management between men and women? Testing measurement invariance,伙伴健康评定量表是否允许对男性和女性慢性病自我管理进行有意义的比较?测试测量不变性
Publisher: Wiley
Date: 21-07-2019
DOI: 10.1111/JAN.14124
Abstract: To determine if the Partners in Health scale, pertinent to assessing patient chronic condition self-management, operates equivalently for men and women. There are distinct gender-based differences in self-management behaviours and health perceptions. This may introduce non-invariance in self-report measures. Testing of measurement invariance is a recommended practice in nursing science to ensure robust metrics. A representative cross-sectional population survey in South Australian. In 2014, 940 people responded to the South Australian Health Omnibus Survey, a battery of health-related questions. MI and estimation of heterogeneity was tested using Bayesian confirmatory factor analysis. Findings showed self-management constructs were interpreted equivalently between men and women. Observed population heterogeneity associated lower education levels with poorer illness and treatment knowledge, smokers with poorer treatment partnerships and mental health problems with lower coping capacity. Approximate measurement invariance was achieved between men and women for Partners in Health scale. There is a lack of well-validated generic instruments, including investigation into gender variability, for measuring chronic condition self-management behaviours. Lower education levels were found to connect with poorer knowledge of health condition and treatment. Mental health problems attenuated ability to cope with the effect of the condition. Findings can facilitate the development of better tailored interventions for self-management of patients' chronic condition/s.
Twelve evidence-based principles for implementing self-management support in primary care
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/S1553-7250(10)36084-3
Abstract: Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by erse providers, (7) self-management interventions delivered by erse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.
An ehealth intervention for patients in rural areas: Preliminary findings from a pilot feasibility study
Publisher: JMIR Publications Inc.
Date: 12-06-2014
DOI: 10.2196/RESPROT.2861
Managing chronic conditions care across primary care and hospital systems: Lessons from an Australian Hospital avoidance risk program using the flinders chronic condition management program
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH17099
Abstract: Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the in idual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help in iduals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical ch ions in the team) that work synergistically.
Gender by Preferred Gambling Activity in Treatment Seeking Problem Gamblers: A Comparison of Subgroup Characteristics and Treatment Outcomes
Publisher: Springer Science and Business Media LLC
Date: 25-04-2017
DOI: 10.1007/S10899-016-9614-X
Abstract: Problem gambling is a growing public health concern and treatment incompletion levels remain high. The study aims to support and extend previous studies in relation to the heterogeneity of the gambling population based on gender and gambling type, and the implications of subgroup differences on treatment outcomes. Additionally, the concept of drop-out is addressed in terms of categorical treatment measures. The empirical findings are examined in the context of the theoretical framework of the pathways model. Participants were recruited from the Statewide Gambling Therapy Service and stratified into subgroups based on gender and gambling mode preference [Electronic Gambling Machines (EGM) or track race betters]. Baseline predictors collected and analysed using multinomial logistical regression included demographic information as well as gambling variables, while treatment outcomes consisted of three therapist rated measures. Significant differences between the subgroups were found for age, marital and employment status, gambling duration, alcohol use and the Kessler 10 measure of psychological distress. Specifically, male track race gamblers were younger, married, employed, had a longer duration of gambling, higher alcohol use and lower psychological distress relative to EGM users. No difference was found in any of the treatment outcomes, however, consistent with previous studies, all subgroups had high treatment incompletion levels. The findings demonstrate the importance of screening, assessing and treating problem gamblers as a heterogeneous group with different underlying demographics and psychopathologies. It is also hoped future studies will continue to address treatment incompletion with a re-conceptualisation of the term drop-out.
Cognitive behaviour therapy for problem gamblers: A clinical outcomes evaluation
Publisher: Cambridge University Press (CUP)
Date: 25-03-2013
DOI: 10.1017/BEC.2013.2
Abstract: Cognitive-Behaviour Therapy (CBT) is considered the number one non-pharmacological treatment for a number of mental and psychological disorders (Tolin, 2010 Stuhlmiller & Tolchard, 2009). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent (Walker, 2005). This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.
Prevalence of Subclinical Papillary Thyroid Cancer by Age: Meta-analysis of Autopsy Studies
Publisher: The Endocrine Society
Date: 10-08-2022
Abstract: It is not known how underlying subclinical papillary thyroid cancer (PTC) differs by age. This meta-analysis of autopsy studies investigates how subclinical PTC prevalence changes over the lifetime. We searched PubMed, Embase, and Web of Science databases from inception to May 2021 for studies that reported the prevalence of PTC found at autopsy. Two investigators extracted the number of subclinical PTCs detected in selected age groups and extent of examination. A quality assessment tool was used to assess bias. Logistic regression models with random intercepts were used to pool the age-specific subclinical PTC prevalence estimates. Of 1773 studies screened, 16 studies with age-specific data met the inclusion criteria (n = 6286 autopsies). The pooled subclinical PTC prevalence was 12.9% (95% CI 7.8-16.8) in whole gland and 4.6% (2.5- 6.6) in partial gland examination. Age-specific prevalence estimates were ≤40 years, 11.5% (6.8-16.1) 41-60 years, 12.1% (7.6-16.5) 61-80 years, 12.7% (8-17.5) and 81+ years, 13.4% (7.9-18.9). Sex did not affect age-specific prevalence and there was no difference in prevalence between men and women in any age group. In the regression model, the OR of prevalence increasing by age group was 1.06 (0.92-1.2, P = .37). This meta-analysis shows the prevalence of subclinical PTC is stable across the lifespan. There is not a higher subclinical PTC prevalence in middle age, in contrast to higher observed incidence rates in this age group. These findings offer unique insights into the prevalence of subclinical PTC and its relationship to age.
Antidepressant deaths by overdose
Publisher: SAGE Publications
Date: 04-1996
DOI: 10.3109/00048679609076098
Abstract: Objective: To determine the prevalence of antidepressant deaths in South Australia, the relative frequency of each antidepressant used and demographic data of those who died. Method: This was a retrospective, case note study of all cases where death was caused by lethal levels of antidepressants in South Australia for the period from 1986 to 1990. The study occurred at the South Australian coroner's office. Subjects were selected from toxicology data, where serum or liver levels of one or more antidepressant were in the lethal range. Results: Seventy-one cases were identified and information was obtained on 68 of these cases from the coroner's files. Amitriptyline, Doxepin and Dothiepin accounted for the majority of antidepressant deaths. Women were 2.5 times more likely to use antidepressants to suicide than men. At least 63% had a known psychiatric illness and 45% had previously attempted suicide. Conclusions: The older tricyclic antidepressants are a significant cause of suicide. It is recommended that the newer antidepressants, which are as efficacious yet safer in overdose, be prescribed in preference to the older tricyclic antidepressants, as the first line of treatment in newly diagnosed depressed outpatients.
Privacy in the Digital Age: Implications for Clinical Practice
Publisher: American Psychological Association (APA)
Date: 09-2015
DOI: 10.1111/CPSP.12105
Cognitive behavioral therapy for problem gamblers
Publisher: Springer US
Date: 2008
Problem Gambling Among Australian Male Prisoners: Lifetime Prevalence, Help-Seeking, and Association With Incarceration and Aboriginality
Publisher: SAGE Publications
Date: 07-11-2018
Abstract: Prisoners represent a group containing the highest problem gambling (PG) rate found in any population. PG is of particular concern among Indigenous Australians. Little data exist concerning PG rates among Indigenous Australian prisoners. The present study aimed to address this gap in the literature by examining the lifetime prevalence of PG among male prisoners, whilst identifying prisoners of Aboriginal background. The EIGHT Gambling Screen (Early Intervention Gambling Health Test) was administered to 296 prisoners across three male prisons in South Australia. Previous help-seeking behaviour and forms of gambling were also examined. Sixty percent of prisoners indicated a lifetime prevalence of PG with 18% reporting they were incarcerated due to offending relating to their gambling problem. Indigenous Australian prisoners indicated a significantly higher prevalence of PG (75%) than non-Indigenous prisoners (57%) and reported less than half the rate of help-seeking. Given the high levels of PG and overall low rates of help-seeking among prisoners, prisons may provide an important opportunity to engage this high-risk population with effective treatment programs, in particular culturally appropriate targeted interventions for Australian Indigenous prisoners.
Chronic condition self-management: Is there a need for a specific curriculum for medical students?
Publisher: Wiley
Date: 08-2006
An Inpatient Treatment Program for People with Gambling Problems: Synopsis and Early Outcomes
Publisher: Springer Science and Business Media LLC
Date: 21-12-2018
The effectiveness of coordinated care for people with chronic respiratory disease
Publisher: AMPCo
Date: 11-2002
Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes
Publisher: SAGE Publications
Date: 10-05-2015
Abstract: In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking. This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7). Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6). The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program. The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES).
Self-Perceived Distress and Impairment in Problem Gamblers: A Study of Pre- to Post-treatment Measurement Invariance
Publisher: Springer Science and Business Media LLC
Date: 12-03-2016
DOI: 10.1007/S10899-016-9598-6
Abstract: Gambling help services typically evaluate treatment outcomes using self-reported responses and measurements. However, gamblers' conceptualisations and prioritisations with respect to these measurements may shift over time. Thus, changes in the self-reported responses may not always reflect true change in the in iduals. This study investigated for response shift in self-report measures of psychological distress and impairment in 293 help-seeking problem gamblers. We used confirmatory factor analysis to model data structures from pre-treatment to post-treatment. The findings indicated that a response shift had occurred. Two items became less important and one item became more important in measuring psychological distress. Measurement invariance was achieved for the complete set of items for impairment. These findings provide a more in-depth understanding of the nature of self-report outcomes in otherwise routinely collected data.
Obstructive sleep apnoea in adults: A common chronic condition in need of a comprehensive chronic condition management approach
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.SMRV.2012.09.004
Abstract: Obstructive sleep apnoea (OSA) is a common disorder that has all the characteristics of a chronic condition. As with other chronic conditions, OSA requires ongoing management of treatments and problems, such as residual symptoms, deficits and co-morbidities. Also, many OSA patients have modifiable lifestyle factors that contribute to their disease, which could be improved with intervention. As health systems are in the process of developing more comprehensive chronic care structures and supports, tools such as chronic condition management programs are available to enable OSA patients and their health care providers to further engage and collaborate in health management. This review explains why the OSA patient group requires a more comprehensive approach to disease management, describes the chronic care model as a platform for management of chronic conditions, and assesses the suitability of particular chronic disease management programs in relation to the needs of the OSA population. Implementation of an evidence-based health-professional-led chronic condition management program into OSA patient care is likely to provide a context in which health risks are properly acknowledged and addressed. Such programs present an important opportunity to enable more optimal health outcomes than is possible by device-focused management alone.
The mental health expert patient: Findings from a pilot study of a generic chronic condition self-management programme for people with mental illness
Publisher: SAGE Publications
Date: 2007
Abstract: Background: Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims: This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method: General practitioners and mental health case managers used a patient centred care model (the Flinders model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results: Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow-up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions: Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the in idual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector.
Developing a screening tool to recognise social determinants of health in Australian clinical settings
Publisher: The Sax Institute
Date: 12-2019
Abstract: Objective and importance of study: The importance of social determinants for in idual health recovery outcomes is well recognised in public health. However, no succinct social health screening (SHS) tool exists that has been developed with information from clinicians and patients. This proof-of-concept study asked health consumer advocates, patients and clinicians about their attitudes towards social determinants of health (SDH) and the usefulness of an SHS tool for collecting these data for use in clinical settings. We then developed a streamlined SHS tool to bring this knowledge to clinicians, and conducted a proof-of-concept trial to check its acceptability with patients and clinicians. This qualitative study had two stages. Stage 1 involved focus groups with health consumer advocates and interviews with clinicians about the draft SHS tool. Stage 2 involved refining the SHS tool and piloting it with 50 new patients in anxiety disorder and sleep disorder clinics, which often treat patients living in disadvantaged socio-economic conditions. The tool was evaluated by patients and clinicians. The data were analysed using framework analysis. All interviewees were positive about the benefits of addressing SDH in clinical practice to help reduce health inequities. We developed and refined an SHS tool that could be completed by patients ('self-complete'). The response to introducing an SHS tool in clinical settings was positive. Further piloting across erse clinical settings is required to determine efficacy. This tool promotes public health equity outcomes by improving clinician understanding of in idual social circumstances, and has the potential to provide useful epidemiological data on SDH.
AUStralian indigenous chronic disease optimisation study (AUSI-CDS) prospective observational cohort study to determine if an established chronic disease health care model can be used to deliver better heart failure care among remote indigenous Australians: Proof of concept-study rationale and protocol
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.HLC.2013.04.001
Abstract: The congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure. AUSI-CDS is a prospective, cohort, observational study to evaluate the efficacy of the standard "Flinders Program of Chronic Condition Management" for Indigenous patients with chronic heart failure. Eligible patients will be Indigenous, suffering from chronic heart failure, in the Northern Territory. The primary end-point is the satisfaction score based on the PACIC. The study will recruit 20 patients and is expected to last 12 months. The rationale and design of the AUSI-CDS using the Flinders Model is described.
Behavioural psychotherapy training for nurses in Australia: a trainee's view.
Publisher: Wiley
Date: 06-2002
DOI: 10.1046/J.1440-0979.2002.00238.X
Abstract: The training and outcomes for a mental health nurse, who completed a 6-month nurse behavioural psychotherapy course at Flinders Medical Centre (Bedford Park, South Australia) is described. Completion of this course enabled the nurse to work mainly with pathological gamblers as a trainee nurse behaviour therapist. Her experience demonstrates that with appropriate training and supervision, mental health nurses are able to increase their knowledge base in specialist areas and gain skills in therapies that will allow them to work autonomously with clients. A brief description of the training, outcome of patient case management and skills acquisition achieved through training is presented.
“When I’m not angry I am anxious”: The lived experiences of individuals in a relationship with a non-help-seeking problem gambler—A hermeneutic phenomenological study
Publisher: SAGE Publications
Date: 08-2019
Abstract: Although the negative effects of problem gambling (PG) are well-documented in respect of gamblers themselves, less research has focused on the experiences of their partners, particularly in situations where the gambler is not help-seeking. Data were drawn from 15 in-depth interviews of partners living with a non-help-seeking problem gambler. Through a hermeneutical-phenomenological analysis, nine central themes emerged: social activity, realization, role conflict, stigma, denial, health issues, disconnectedness, hypervigilance, and security. Findings indicated that living with a non-help-seeking PG partner was characterized by chronic worry, exhaustion, relationship conflict, and an overwhelming sense of isolation. Partners found it exceedingly difficult to reliably detect their partners’ gambling behavior, resulting in chronic hypervigilance, and were reluctant to seek help due to stigma. There is a need for programs that provide both guidance for partners to help protect their well-being and evidence-based strategies to help motivate non-help-seeking problem gamblers to acknowledge their problem and seek help.
E-Learning competency for practice nurses: An evaluation report
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY13033
Abstract: Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals’ is determined by several organisational, economic, pedagogical and in idual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses’ expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.
Nurse behavioural psychotherapy and pathological gambling: An Australian perspective
Publisher: Wiley
Date: 08-2017
DOI: 10.1046/J.1365-2850.2000.00273.X
Abstract: Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital (Marks et al. 1977). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) (Duggan et al. 1993). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed. Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.
Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults?
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.ADDBEH.2015.04.001
Abstract: Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies. We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N=454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity. Men (n=280, mean age=37.4years, SD=11.4) were significantly younger than women (n=174, mean age=48.7years, SD=12.9) (p<0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p<0.001 and p=0.004, respectively) whilst insignificant for women (p=0.164 and p=0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women. This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention.
The gambling urge scale: Reliability and validity in a clinical population
Publisher: Informa UK Limited
Date: 22-06-2013
Problem gambling, familial violence and alcohol misuse: exploring the triad for treatment-seekers
Publisher: Informa UK Limited
Date: 04-05-2015
The “Zone”: a Qualitative Exploratory Study of an Altered State of Awareness in Electronic Gaming Machine Problem Gambling
Publisher: Springer Science and Business Media LLC
Date: 19-09-2020
The acceptability and outcomes of a peer- and health-professional-led Stanford self-management program for Vietnam veterans with alcohol misuse and their partners.
Publisher: American Psychological Association (APA)
Date: 12-2013
DOI: 10.1037/PRJ0000031
Abstract: The purpose of this study was to determine the acceptability of peer- and health-professional-led self-management education using the Stanford Program with Australian veterans and their partners. The 6-week program taught problem-solving and decision-making skills to activate healthful behaviors, including action-planning and goal-setting. The evaluation included a participant and facilitator postprogram questionnaire group interview and alcohol, posttraumatic stress disorder, anxiety, depression, anger, relationship, and quality-of-life measures as part of a randomized controlled study. Participants included 25 male veterans with comorbid alcohol dependency, psychiatric and medical conditions, and 18 female partners (n = 43), 61.5% of who reported a chronic condition. The primary outcome was a self-reported improvement in self-management of their conditions in 69% of participants, with another 22.2% reporting that their confidence to self-manage had improved. There was an improvement in all measures at 9 months. The program resulted in improvements in lifestyle and confidence in self-management for Vietnam veterans, a cohort difficult to engage in healthy behaviors. Most participants were also accompanied by their partners. The program is a valuable resource for providing self-management education to veterans with alcohol dependency and various chronic conditions and needs to be considered in the suite of rehabilitation programs available to Defense Force personnel, veterans, and their partners.
Erratum: The effectiveness of coordinated care for people with chronic respiratory disease (Med J Aust (2002) 177 (481-485))
Publisher: AMPCo
Date: 2003
DOI: 10.5694/J.1326-5377.2003.TB05054.X
Abstract: To evaluate the effectiveness of coordinated care for chronic respiratory disease. Community-based geographical control study, in western (intervention) and northern (comparison) metropolitan Adelaide (SA). 377 adults (223 intervention 154 comparison) with chronic obstructive pulmonary disease, asthma or other chronic respiratory condition, July 1997 to December 1999. Coordinated care (includes care coordinator, care guidelines, service coordinator and care mentor). Hospital admissions (any, unplanned and respiratory), functionality (activities of daily living) and quality of life (SF-36 and Dartmouth COOP). At entry to the study, intervention and comparison subjects were dissimilar. The intervention group was 10 years older (P < 0.001), less likely to smoke (P = 0.014), had higher rates of hospitalisation in the previous 12 months (P < 0.001) and had worse self-reported quality of life (SF-36 physical component summary score [P < 0.001] and four of nine COOP domains [P = 0.002-0.013]). After adjustment for relevant baseline characteristics, coordinated care was not associated with any difference in hospitalisation, but was associated with some improvements in quality of life (SF-36 mental component summary score [P = 0.023] and three of nine COOP domains [P = 0.008-0.031]) compared with the comparison group. Coordinated care given to patients with chronic respiratory disease did not affect hospitalisation, but it was associated with an improvement in some quality-of-life measures.
Response to 'Does reducing safety behaviours improve treatment response in patients with social phobia?' (multiple letters) [3]
Publisher: SAGE Publications
Date: 10-2000
Chronic condition management and self-management in Aboriginal communities in South Australia: Outcomes of a longitudinal study
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH12165
Abstract: Objectives. This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. Methods. The study concentrated on three erse Aboriginal communities in South Australia the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for in idual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the in idual and group levels. Results. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. Conclusions. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. What is known about the topic? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. What does this paper add? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. What are the implications for practitioners? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.
Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital
Publisher: Royal College of Psychiatrists
Date: 06-1992
Abstract: Rapid tranquillisation – giving a psychotropic to control behavioural disturbances – is common in medical practice, yet few surveys describe its use in psychiatric populations. Over five months, 102 incidents, involving 60 patients, were retrospectively surveyed. Patients most often involved were young white men. The commonest diagnosis was affective disorder (manic phase) (39%) followed by schizophrenia (33%). Fifteen patients were involved in 57% of the incidents. The majority of incidents involved injury to people or damage to property. The most frequently used drugs were diazepam and haloperidol, alone or in combination. Droperidol, chlorpromazine, sodium amytal and paraldehyde were rarely used. Diazepam alone or in combination with haloperidol delivered intravenously was most rapidly effective and was associated with greatest staff satisfaction. Serious side-effects were rare.
Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review
Publisher: SAGE Publications
Date: 23-09-2020
Abstract: To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE ‘Guideline Quality Checklist’, and mapping of the supporting evidence. Fifteen guidelines were identified: asthma ( n=7) and type 1 diabetes mellitus ( n=7), CF ( n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration ( n=15), chronic condition self-management education ( n= 17), clinicians’ skills ( n= 4) personalized action plans ( n=3), problem-solving ( n=2) and the assessment of children’s chronic condition self-management needs ( n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool ( n=2), and adolescence ( n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines’ recommendations was poor only 14 out of 57 journals listed as evidence were concordant. Current guidelines articulate that developmentally appropriate chronic condition self-management is important however, more work needs to be done to translate the concept into practical clinical tools.
Self-Management in Lifestyle Medicine
Publisher: Elsevier
Date: 2017
Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18130
Abstract: Background Recruitment of people to randomised trials of online interventions presents particular challenges and opportunities. The aim of this study was to evaluate factors associated with the recruitment of people with HIV (PWHIV) and their doctors to the HealthMap trial, a cluster randomised trial of an online self-management program. Methods: Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. Results: Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3 95% confidence interval (CI) 3.0, 58.7 P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10 95% CI 0.04, 0.16 P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9 95% CI –2.55, 114.25 P = 0.06). Conclusion: Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.
Northern Territory Heart Failure Initiative -Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: Study design and rationale
Publisher: BMJ
Date: 2014
Control in chronic condition self-care management: How it occurs in the health worker-client relationship and implications for client empowerment
Publisher: Wiley
Date: 03-07-2014
DOI: 10.1111/JAN.12203
Abstract: To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment. It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker-client consultations. Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker-client consultations were observed/recorded in 2011. Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts. Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.
Self managing heart failure in remote Australia - translating concepts into clinical practice
Publisher: Bentham Science Publishers Ltd.
Date: 31-08-2016
DOI: 10.2174/1573403X12666160703183001
Abstract: Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are lified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
Behavioural psychotherapy training for nurses in Australia: A pilot program
Publisher: Wiley
Date: 06-2000
DOI: 10.1046/J.1440-0979.2000.00161.X
Abstract: This paper describes a pilot program that examined the feasibility of training for qualified mental health nurses in behavioural psychotherapy in response to the perceived need for improved client access to services. A 6-month course was conducted with four nurses from the in-patient mental health unit at Flinders Medical Centre, South Australia. They received a combination of workshop training and supervised practice by qualified and experienced nurse behavioural psychotherapists and were assessed throughout the period for clinical competency and level of knowledge in the subject. All four nurses completed the training satisfactorily. Each trainee treated four clients who presented with a range of anxiety disorders. The implications for further training of suitably qualified mental health professionals in the area are discussed.
Comorbidities and their management in women with breast cancer—an Australian survey of breast cancer survivors
Publisher: Springer Science and Business Media LLC
Date: 14-03-2023
DOI: 10.1007/S00520-023-07678-7
Abstract: Breast cancer survivors experience significant burden from comorbid chronic conditions, but little is known about how well these conditions are managed. We conducted a national survey of Australian breast cancer survivors to examine the burden of chronic conditions, their impact and care alignment with the principles of chronic condition management. A study-specific survey incorporated questions about chronic conditions using the Charlson Comorbidity Index (CCI), functional status using the Vulnerable Elders Survey (VES) and perceived quality of care for cancer and non-cancer conditions using the Patient Assessment of Care for Chronic Conditions Survey (PACIC). Members of Breast Cancer Network Australia (BCNA) were invited via email to complete the survey either online or through direct mail. The survey was sent to 2198 BCNA members and 177 responses were received (8.1%). Respondents were women aged 32–88 years (median 60.1 years). The majority were married (116 67.7%) and had private insurance (137 80.0%) and reported good to excellent health (119 73.5%). Other health conditions were reported by 157 (88.7%), the most common being chronic pain (27.1%) and fatigue (22.0%). When asked about management of comorbidities or cancer, less than 20% were routinely asked about management goals, helped to set goals or asked about health habits. In this population of survivors with good health status and high rates of private insurance, comorbidities were common and their management, as well as management of breast cancer, was poorly aligned with chronic condition management principles.
Implementing the flinders model of self-management support with aboriginal people who have diabetes: Findings from a pilot study
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/PY08009
Abstract: A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.
Providing the right support, in the right format, at the right time
Publisher: Mark Allen Group
Date: 11-2014
DOI: 10.12968/IJTR.2009.16.11.44944
Abstract: This book is a very interesting collection of essays that will help any rehabilitation professional who wishes to consider the needs of patients with intellectual disability. Health professionals have increasing numbers of boxes to tick, and this includes the need to address the public and patient involvement agenda, and also the particular and often unmet or neglected needs of a section of society embraced within the category ‘learning disability’ or ‘intellectual disability’. Professionals in health, rehabilitation, social services and other sections of society working with those with intellectual disability will all be helped by this collection, to tick such boxes. Topics covered by the 15 fairly short chapters include, service user involvement in higher education, employment, leisure, primary care, mental health issues, housing and policy. The authors come from a variety of agencies around the UK, and are from a predominantly specialist nursing background. Those from other backgrounds should not be put off by this, as their experience, expertise and commitment to valuing the lives of this patient group has much value beyond that small branch of nursing.
The Victorian Gambling Screen: Reliability and Validation in a Clinical Population
Publisher: Springer Science and Business Media LLC
Date: 25-12-2010
DOI: 10.1007/S10899-009-9172-6
Abstract: There is a need to establish reliability and the various forms of validity in all measures in order to feel confident in the use of such tools across a wide ersity of settings. The aim of this study is to describe the reliability and validity of the Victorian Gambling Screen (VGS) and in particular one of the sub-scales (Harm to Self-HS) in a specialist problem gambling treatment service in Adelaide, Australia. Sixty-seven consecutive gamblers were assessed using a previously validated clinical interview and the VGS (Ben-Tovim et al., The Victorian Gambling Screen: project report. Victorian Research Panel, Melbourne, 2001). The internal consistency of the combined VGS scales had a Cronbach's alpha of .85 with the HS scale .89. There was satisfactory evidence of convergent validity which included moderate correlations with another measure of gambling-the South Oaks Gambling Screen. There were also moderate correlations with other measures of psychopathology. Finally, how the VGS may best be used in clinical settings is discussed.
The systematic development of a complex intervention: HealthMap, an online self-management support program for people with HIV
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Efficacy of the Flinders chronic condition management program in obese patients with hip or knee osteoarthritis: A study rationale and protocol
Publisher: OMICS Publishing Group
Date: 2016
A Pilot Group Cognitive Behavioural Therapy Program for Problem Gamblers in a Rural Australian Setting
Publisher: Springer Science and Business Media LLC
Date: 14-06-2012
The IAPT@Flinders Service: Adapting the Improving Access to Psychological Therapies model to the emergency department setting in Australia
Publisher: SAGE Publications
Date: 02-04-2014
Abstract: To describe the implementation of an Improving Access to Psychological Therapies (IAPT) service at Flinders Medical Centre emergency department (IAPT@Flinders). IAPT, a population-based model of guided self-help for anxiety and depression delivered mainly by phone, was rolled-out nationally in the UK in 2010. There is a growing body of evidence demonstrating its clinical effectiveness and efficiency that can improve treatment adherence, reduce stigma, remove appointment attendance barriers and improve access for hard-to-reach populations. IAPT@Flinders was the test site for the first IAPT in Australia and also the first IAPT service that was integrated with an emergency department (ED). IAPT@Flinders offers rapid access, low-intensity cognitive behavioural therapy, social prescribing and signposting to clients with adjustment disorders, anxiety and/or depressive symptoms. Successful implementation within an Australian crisis setting has demonstrated that many IAPT structures and protocols are applicable to ED settings and the model can be implemented with fidelity. Adaption required consideration of positioning of the service within the Australian mental health framework staff qualifications the referral pathways and exclusion criteria. It is recommended additional test sites and larger scale trials are conducted to provide further evidence of the applicability of large-scale adoption of the UK IAPT model into Australian ED settings.
Implementing a Self-Management Intervention for People with a Chronic Compensable Musculoskeletal Injury in a Workers Compensation Context: A Process Evaluation
Publisher: Springer Science and Business Media LLC
Date: 11-11-2015
DOI: 10.1007/S10926-014-9551-4
Abstract: Determining factors critical for an intervention's success, specifically for whom and under what circumstances, is necessary if interventions are to be effectively targeted and efficiently implemented. This paper describes a process evaluation undertaken to assess the implementation of a novel self-management (SM) intervention developed for those with a chronic compensable work-related musculoskeletal disorder seeking to return to work. The process evaluation, assessing the 'Self-Management for Return to Work' intervention, examined data from program leader evaluations, telephone interviews with stakeholders (injured worker participants, vocational rehabilitation consultant program leaders and compensation insurance regulators), post-intervention focus group session feedback, attendance lists and researcher notes. The evaluation identified several challenges and barriers associated with conducting research within the VR environment and with the characteristics of those targeted i.e., injured workers with a chronic compensable condition. These issues were primary contributing factors to the modifications to the randomised controlled trial methodology and the trial's premature cessation. Despite the difficulties encountered, high stakeholder acceptability suggests that the concept and theory underlying the targeted SM intervention were not flawed, though there is room for further tailoring to both the program method and its timing. The results of this process evaluation provide a useful platform for others considering the implementation of interventions within the vocational rehabilitation context or with in iduals with chronic, compensated injuries.
Pharmaceutical heroin and ‘chasing the dragon’From Malcolm Battersby, Michael Farrell & John Strong
Publisher: Wiley
Date: 1990
Large reductions in depression and anxiety via low-intensity cognitive behavioural therapy delivered by novice coach
Publisher: SAGE Publications
Date: 12-01-2016
A response to intractability — a way forward
Publisher: SAGE Publications
Date: 03-2005
Small steps: Physical health promotion for people living with mental illness
Publisher: Computers, Materials and Continua (Tech Science Press)
Date: 12-03-2015
Chronic condition self-management support for aboriginal people: Adapting tools and training
Publisher: Wiley
Date: 22-04-2018
DOI: 10.1111/AJR.12413
Abstract: Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts. The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program. Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed. A total of 825 health professionals across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability. The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally.
An integrative assessment of brain and body function 'at rest' in panic disorder: A combined quantitative EEG/autonomic function study
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.IJPSYCHO.2010.10.002
Abstract: We conducted a quantitative electroencephalographic (QEEG) and autonomic assessment of panic disorder (PD). The study s les comprised 52 in iduals meeting DSM-IV criteria for PD (with or without agoraphobia) and 104 age-, gender-, and handedness-matched controls. EEG data were acquired from 16 scalp sites during resting eyes-open (REO) and eyes-closed (REC) conditions, and spectral power was assessed within 4 frequency bands: theta, alpha-1, alpha-2, and beta. The main findings were an overall reduction of spectral power in PD, compared to controls (Group main effect, p=.011), which was most apparent during REC (Group Condition interaction, p=.014), and within the alpha-1 frequency band (8-11 Hz Group Band interaction, p=.014). Alpha-1 desynchronization occurs in response to increases in non-specific information processing, and aspects of attention such as alertness. Other findings were region-specific alterations of spectral power at frontal and temporal scalp sites, including a frontal alpha-1 asymmetry (R<L power) during REC in patients, but not controls. Findings for concomitantly-recorded autonomic measures included elevated heart rate, lower heart rate variability, and reduced rate of decrement of skin conductance level in patients, compared to controls. Finally, analyses examining the within-subjects relationship of central and peripheral function measures showed a differential pattern in patients and controls. Possible causes of these disturbances of brain and body function 'at rest', such as patients' ongoing automatic and strategic engagement with multiple disorder-related threat cues, including somatic variability and the testing environment, are discussed.
Cognitive versus exposure therapy for problem gambling: Randomised controlled trial
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.BRAT.2015.04.008
Abstract: Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial. To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service. Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up. Of eighty-seven participants who were randomised and started intervention (CT = 44 ET = 43), 51 (59%) completed intervention (CT = 30 ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference -0.18, 95% CI: -4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI: -4.46-7.39). Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them in idually and combined to enhance retention rates and reduce drop-out.
Treatment outcomes and predictors of drop out for problem gamblers in South Australia: A cohort study
Publisher: SAGE Publications
Date: 10-2010
DOI: 10.3109/00048674.2010.493502
Abstract: Objectives: Recent prevalence studies in Australia, the USA and Canada have estimated 1-2% of the adult population meet the diagnostic criteria for problem or pathological gambling. The Statewide Gambling Therapy Service (SGTS) provides treatment for problem gamblers in key metropolitan and rural regions in South Australia. The aims of this study were two-fold: to analyse the short and mid-term outcomes following treatment provided by SGTS and to identify factors associated with treatment drop-out. Method: A cohort of treatment seeking problem gamblers was recruited through SGTS in 2008. Repeated outcome measures included problem gambling screening, gambling related cognitions and urge. Treatment drop-out was defined as participants attending three or less treatment sessions, whilst potential predictors of drop-out included perceived social support, anxiety and sensation-seeking traits. Results: Of 127 problem gamblers who participated in the study, 69 (54%) were males with a mean age of 43.09 years (SD = 12.65 years) and with 65 (52%) reporting a duration of problem gambling greater than 5 years. Follow up time for 50% of participants was greater than 8.9 months and, overall, 41 (32%) participants were classified as treatment drop-outs. Results indicated significant improvement over time on all outcome measures except alcohol use for both treatment completers and drop-outs, although to a lesser extent for the treatment drop-out group. A significant predictor of treatment drop-out was sensation-seeking traits. Conclusion: These results will inform future treatment planning and service delivery, and guide research into problem gambling including aspects of treatment drop-out.
A group method for learning about psychiatric research
Publisher: SAGE Publications
Date: 09-1987
DOI: 10.3109/00048678709160936
Abstract: Psychiatric trainees in their final year of training met fortnightly with an experienced psychiatric researcher. A group format was used to facilitate the development of skills employed in psychiatric research. Various exercises, including conducting a research project during the group sessions, were undertaken. This report highlights certain issues that may inhibit clinicians from undertaking research projects. It is presented from both the group leader's and the participants' perspectives.
Care Plans in Community Mental Health: an Audit Focusing on People with Recent Hospital Admissions
Publisher: Springer Science and Business Media LLC
Date: 03-03-2017
A risk worth taking
Publisher: SAGE Publications
Date: 12-2006
Much Ado About Nothing? The Role of Land-Based Gambling Venue Employees in Facilitating Problem Gambling Harm Reduction and Help-Seeking
Publisher: Springer Science and Business Media LLC
Date: 21-06-2023
DOI: 10.1007/S10899-023-10226-X
Abstract: Over the past decade, greater emphasis has been placed on the role of the land-based gambling industry to respond to problem gambling behaviour in their venues. Despite this, there is a lack of clear information advising best practice responses by gambling venue employees. This article reviews strategies, practices, and policies employed by land-based gambling venues concerning their employees’ role in preventing gambling-related harm and responding to problem gambling behaviours. A systematic search strategy was applied to source peer-reviewed literature which identified 49 articles. The synthesised results were arranged and presented across five categories: (1) the identification of gamblers with potential problems in the venue (2) gambling venue staff responses to gamblers with potential problems (3) gamblers’ perspectives around venue responsibilities and interactions with gamblers with potential problems (4) corporate social responsibility programs and the identification of gamblers with problems in the venue and (5) gambling venue staff needs. The results suggest that most activity performed by venue staff concerning their response to problem gambling is limited to observing and documenting risky behaviours and then discussing this internally with other venue staff. Action which moves beyond this, such as approaching and interacting with identified gamblers of concern, rarely occurs. The results of this review suggest that a focus on the identification and intervention specifically with identified gamblers of concern is a particularly unhelpful aspect of the role of venue staff. The results also indicate that a re-thinking of the role frontline staff play in addressing problem gambling is necessary.
The internal consistency and construct validity of the Partners in Health scale: Validation of a patient rated chronic condition self-management measure
Publisher: Springer Science and Business Media LLC
Date: 05-2010
DOI: 10.1007/S11136-010-9661-1
Abstract: The purpose of this study was to test the internal consistency and construct validity of the revised 12-item self-rated Partners in Health (PIH) scale used to assess patients' chronic condition self-management knowledge and behaviours. Baseline PIH data were collected for a total of 294 patients with a range of co-morbid chronic conditions including diabetes, cardiovascular disease and arthritis. Scale data for the initial s le of 176 patients were analysed for internal consistency and construct validity using Reliability Analysis and Factor Analysis. Construct validity was tested in a separate s le of 118 patients using confirmatory factor analysis and a structural equation model. Good internal consistency was indicated with a Cronbach's alpha coefficient of 0.82 in the initial s le. Factor analysis for this s le revealed four key factors (knowledge, coping, management of condition and adherence to treatment) across the twelve items of the scale. These four key factors were then confirmed by applying the exploratory structural equation model to the separate s le. The PIH scale exhibits construct validity and internal consistency. It therefore is both a generic self-rated clinical tool for assessing self-management in a range of chronic conditions as well as an outcome measure to compare populations and change in patient self-management knowledge and behaviour over time. The four domains of self-management provide a valid measure of patient competency in relation to the self-management of their chronic condition(s).
Working effectively with patients with comorbid mental illness and substance abuse: A case study using a structured motivational behavioural approach
Publisher: BMJ
Date: 20-03-2009
'Getting your life back on track after stroke': A Phase II multi-centered, single-blind, randomized, controlled trial of the Stroke Self-Management Program vs. the Stanford Chronic Condition Self-Management Program or standard care in stroke survivors
Publisher: SAGE Publications
Date: 04-2009
DOI: 10.1111/J.1747-4949.2009.00261.X
Abstract: Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial. Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements. Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either standard care, standard care plus a six week generic chronic condition self-management group education program, or, standard care plus an eight week stroke specific self-management education group program. Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months. The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events. Secondary outcomes include: positive and active engagement in life measured by the Health Education Impact Questionnaire, improvements in quality of life measured by the Assessment of Quality of Life instrument, improvements in mood measured by the Irritability, Depression and Anxiety Scale, health resource utilization measured by a participant held diary and safety. The results of this study will determine whether a definitive Phase III efficacy trial is justified.
General practitioners' collaboration with service coordinators: What makes it work? Lessons from the SA HealthPlus Coordinated Care Trial
Publisher: CSIRO Publishing
Date: 2002
DOI: 10.1071/PY02007
Abstract: In the past, a number of factors have been identified that discourage collaboration between GPs and other health professionals in providing care to patients with chronic illness. These include financing arrangements, lack of time and lack of knowledge of the role of other professions. This paper uses data from the independent evaluation of the SA HealthPlus Coordinated Care Trial to examine the factors that encourage and inhibit collaboration between general practitioners (GPs) and Service Coordinators (a role introduced by the trial and carried out by nurses and allied health professionals). Both quantitative and qualitative methods were used to evaluate the role of the GP and the Service Coordinator in the trial. These data were analysed to determine what factors encouraged and inhibited collaboration. Results indicated that effective communications, knowledge of and respect for each other's roles and responsibilities, and a clearly perceived benefit from collaboration were the most important predictors of successful collaboration for both parties. These results also suggest strategies for increasing the likelihood of collaboration between GPs and others such as the location of the Service Coordinator in the practice and ways of dealing with GP workloads and communication needs. These findings are relevant to recent policy initiatives including the MBS Enhanced Primary Care item numbers, the employment of practice nurses, and allied health staff via Divisions of General Practice.
The changing attitudes of health professionals and consumers towards a coordinated care trial--SA HealthPlus.
Publisher: CSIRO Publishing
Date: 2001
DOI: 10.1071/AH010172A
Abstract: The national coordinated care trials have been a vehicle for health reform in Australia, driven by escalating healthcare costs and projections of an ageing population. The first round of trials conducted between 1997 and 1999 set thetrials a challenge to reduce financial and system barriers to enable health professionals in all sectors and consumers todevelop service delivery models which would give better outcomes for patients within existing resources. As part of achange management strategy, the developers of the SA HealthPlus trial assessed the attitudes of health professionalsand consumers involved in designing the projects which made up the larger trial, prior to trial development and twelvemonths later. This paper reports on the results of the survey and how initial enthusiasm gave way to appropriateanxiety as the complexities of creating a new system of care from reactive to prospective patient centred care planning,became a reality. The survey enabled trial developers to show evidence of acceptability for the new model of care andidentify areas of concern and appropriate strategies for the project teams. This type of survey and the issues identifiedmay be of benefit to the second round coordinated care trials and health regions aiming to initiate coordinated careprograms.
... or not?
Publisher: Royal College of Psychiatrists
Date: 07-1989
Abstract: Cellular transplantation has been employed for several years to deliver donor cardiomyocytes to normal and injured hearts. Recent reports of a variety of stem cells with apparent cardiomyogenic potential have raised the possibility of cell transplantation-based therapeutic interventions for heart disease. Here we review the preclinical studies demonstrating that intracardiac transplantation of skeletal myoblasts, cardiomyocytes and cardiomyogenic stem cells is feasible. In addition, recent clinical studies of skeletal myoblast and adult stem cell transplantation for heart disease are discussed.
Bipolar disorder supplement needed broader perspective
Publisher: AMPCo
Date: 03-2011
Concurrent validity of the Partners in Health scale against general self-rated health in chronic conditions: A short report
Publisher: SAGE Publications
Date: 24-11-2019
Abstract: The Partners in Health scale is a structurally valid measure of chronic condition self-management behaviours. This report describes a study that further evaluated construct validity of Partners in Health scale by assessing its relationship with a single-item measure of general self-rated health. The concurrent validity of the scale was demonstrated by a statistically significant association with general self-rated health in a population representative s le of people with chronic conditions.
‘Horse trading’: prescribing injectable opiates to opiate addicts. A descriptive study
Publisher: Wiley
Date: 1992
DOI: 10.1080/09595239200185061
Abstract: The clinical audit of 40 opiate-dependent in iduals who were prescribed injectable drugs (heroin or methadone) between June 1987 and June 1989 is described. These subjects were characterized by the chronicity of their injecting and dependent opiate use, and by their refusal to comply with a treatment programme involving oral-only prescribing. The key aim was to attract entrenched injectors into contact with treatment services and to promote movement away from injecting drug use and reduce HIV risk behaviour. On review 35 of the original 40 were either still receiving an injectable prescription or injecting illicit drugs. Despite this 14 (35%) were rated as making positive life changes. Nine (22.5%) had been admitted to the in-patient unit and became drug free during their stay. The stability of the lives of eight (20%) had deteriorated. The benefits and drawbacks of this form of intervention are discussed with comparison to the other studies of injectable drug prescribing.
A case study of trichotillomania with social phobia: Treatment and 4-year follow-up using cognitive-behaviour therapy
Publisher: Cambridge University Press (CUP)
Date: 11-2007
Abstract: This article describes a case study that demonstrates an innovative combination of predominantly behavioural techniques in the treatment of trichotillomania (TTM) preceded by social phobia. Outcomes are reported to 4-year follow-up. A master's qualified cognitive–behavioural nurse therapist administered the course of treatment over 1 year and followed the client for 4 years. A combination of exposure and response prevention, habit reversal and serial photography for TTM urges, exposure for social phobia, cognitive restructuring and problem solving were utilised. These treatments were provided sequentially and concurrently. Pre and posttreatment and repeated outcome measures were applied in three domains. The client received a total of 23 treatment sessions over 1 year and follow-up over 4 years. During treatment, discharge and follow-up improved outcomes in TTM and social phobia were achieved and maintained at 4 years. Benefits accrued beyond the presenting conditions to have a major positive impact on the client's life. Theoretical implications for the classification of TTM are discussed.
'Imagine if I gave up smoking ...': a qualitative exploration of Aboriginal participants' perspectives of a self-management pilot training intervention
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY14104
Abstract: This paper reports on a pilot qualitative study investigating Aboriginal participants’ perspectives of the Flinders Living Well Smoke Free (LWSF) ‘training intervention’. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care-planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation, the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study, 10 Aboriginal clients who had been volunteers in the mock care-planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal community controlled health services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care-planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program.
Do Males and Females Conceptualise Work and Social Impairment Differently Following Treatment for Different Mental Health Problems?
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.APNU.2017.11.016
Abstract: The Work and Social Adjustment Scale (WSAS) is used by psychiatric nurses for screening and evaluating patients' treatment outcomes for a variety of mental health problems. This study investigated longitudinal and gender measurement invariance of WSAS using structural equation modeling within a help-seeking problem gambling s le (n=445), and an intervention program for depression and anxiety s le (n=444). The concept of functional impairment was defined by all WSAS items in males and females at pre- and post-treatment assessments. These findings confirm that the WSAS is a robust and efficacious instrument for evaluating treatment outcomes in two differing populations.
The influence of depression and other co-occurring conditions on treatment outcomes for problem gamblers: A cohort study
Publisher: AMPCo
Date: 08-2011
DOI: 10.5694/J.1326-5377.2011.TB03267.X
Abstract: To examine the influence of co-occurring conditions on gambling treatment outcomes. Prospective cohort study of problem gamblers. Participants were recruited from consecutive referrals to a gambling therapy service in 2008. Inclusion criteria were: (i) assessed as a problem gambler based on a screening interview including DSM-IV criteria for pathological gambling, and (ii) suitable for admission to a treatment program. Cognitive-behavioural therapy was based on graded exposure-to-gambling urge. One-to-one treatment was conducted with 1-hour sessions weekly for up to 12 weeks. Problem gambling screening and co-occurring conditions including depression, anxiety and alcohol use. Of 127 problem gamblers, 69 were males (54%), mean age was 43.09 years, and 65 (51%) reported a duration of problem gambling greater than 5 years. Median time for participants' enrolment in the study was 8.9 months. Results from mixed effects logistic regression analysis indicated that in iduals with higher depression levels had a greater likelihood (13% increase in odds [95% CI, 1%-25%]) of problem gambling during treatment and at follow-up. Addressing depression may be associated with improved treatment outcomes in problem gambling conversely, treatment of problem gambling improves affective instability. We therefore recommend a dual approach that treats both depression and problem gambling.
Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders?-Protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 10-06-2010
Abstract: Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation. The research plan contains mixed methodology consisting of a single blind randomised controlled trial, an economic evaluation and qualitative research. Participants (n = 366) are volunteers with compensated musculoskeletal disorders of 3 months to 3 years in duration who were working at the time of the injury/onset of the chronic disorder. The trial tests the effectiveness of usual vocational rehabilitation plus the Chronic Disease Self-Management Program (CDSMP) to which two additional and newly-developed modules have been added, against vocational rehabilitation alone (control) The modules added to the CDSMP focus on how to navigate through compensation systems and manage the return to work process, and aim to be relevant to those in a vocational rehabilitation setting. The primary outcome of this study is readiness for return to work which will be evaluated using the Readiness for Return-to-Work scale. Secondary outcomes include return to work status, health efficacy (heiQ™ questionnaire) and general health status (SF-12v2 ® Health Survey). Measures will be taken at baseline, immediately post-intervention and at 6- and 12- months post-intervention by an independent assessor. An economic evaluation will compare the costs and outcomes between the intervention and control groups in terms of cost-effectiveness and a partial cost-benefit or cost analysis. The impact of the intervention will also be evaluated qualitatively, in terms of its acceptability to stakeholders. This article describes the protocol for a single blind randomised controlled trial with a one year follow-up. The results will provide evidence for the addition or not of self-management training within vocational rehabilitation for chronic compensated musculoskeletal disorders. Australia and New Zealand Clinical Trials Registry ACTRN12609000843257
The South Oaks Gambling Screen: A review with reference to Australian use
Publisher: Springer Science and Business Media LLC
Date: 2002
Abstract: The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legaliZed gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.
Improving cardiovascular health and quality of life in people with severe mental illness: study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 11-07-2018
Event-related potential and autonomic signs of maladaptive information processing during an auditory oddball task in panic disorder
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.IJPSYCHO.2009.07.001
Abstract: Various empirical data suggest that in iduals with Panic Disorder (PD) fail to appropriately assign significance to sensory stimuli within the internal and external milieu, including those stimuli which are patently threat-neutral. The failure to appropriately discriminate 'signal' stimuli from among 'noise' signals [Gordon, E., Liddell, B.J., Brown, K.J., Bryant, R., Clark, C.R., Das, P., et al. 2007. Integrating objective gene-brain-behavior markers of psychiatric disorders. J. Integr. Neurosci. 6, 1-34.] results in disturbances of information processing and attentional deployment, which manifests across multiple levels of functioning (e.g., brain, behaviour, autonomic). The present event-related potential (ERP) study, therefore, investigated attentive information processing in PD, using a standard two-tone auditory oddball paradigm, to assess patients' response to infrequent 'target' tones (i.e., signals) and frequent 'non-target' tones (i.e., noise). Simultaneously-recorded autonomic data provided converging measures of the concomitants of disordered information processing. PD patients (n=50) showed increased N1 litude to frequent non-target tones and reduced P3 litude to infrequent targets, compared to matched controls (n=98). There were no between-group differences for N1 targets, N2 or P2. Patients additionally showed increased heart rate, fewer spontaneous skin conductance responses (trend) to significant stimuli, and reduced P3 latency compared to controls, although the latter result was accounted for by patients who frequently experienced depersonalization and/or derealisation during panic. Patients showed several disturbances of attentive information processing in a simple auditory discrimination task: Increased N1 to repeated stimuli suggests impaired stimulus filtering, whereas reduced P3 litude and latency represent the under-allocation of neural resources for infrequent, goal-relevant stimuli, and their increased speed of processing, respectively. These disturbances likely contribute to patients' aversive outcomes in stimulus-rich environments.
Implementing guideline based heart failure care in the Northern territory: challenges and solutions
Publisher: Elsevier BV
Date: 05-2014
Related Organisations
Southern Adelaide Local Health Network Mental Health Services
Location: Australia
Royal Australian And New Zealand College Of Psychiatrists
Location: Australia
Related Funding Activities
No related grants have been discovered for Malcolm Battersby.