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Public health orders were introduced in many countries, including Australia, during the COVID-19 pandemic to reduce the spread of the virus. However, for many people this led to an exacerbation of mental health symptoms, particularly those living with severe or persistent mental illness (SPMI). Additionally, the conduct of clinical research was severely impacted during the pandemic, with many difficulties encountered in the conduct of clinical trials. This paper describes the COVID-related impacts experienced during the implementation of a randomised controlled trial (RCT) testing the effectiveness of a community pharmacist-led support service for people living with SPMI in Australia (the PharMIbridge RCT), and the strategies used to successfully implement the RCT. Australian public health orders led to interstate border closures, stay-at-home orders and work-from-home requirements, resulting in necessary changes to allow for the continuation of the RCT including; changes to trial regions, transferring some training materials online while delaying face-to-face (F2F) training components, delays in pharmacy and consumer recruitment, encouraging telehealth service delivery and extensions to timelines with existing funding. Having a solution-focussed and flexible approach, while still ensuring critical trial protocol elements were adhered to, such as providing opportunities for F2F skills-based training for pharmacists, as well as F2F site visits from researchers and mentors to support trial implementation, resulted in high pharmacy and consumer participant retention through to trial conclusion. Future planning for RCTs should consider possible pandemic-related risks and rapid responses from approval bodies to ensure researchers can be agile and adapt to ensure successful trial completion. [ABSTRACT FROM AUTHOR]

Coastal Natural Resources Management (NRM) is a distinct sector in Australia with a focus on biodiversity conservation. It is a sector worthy of scrutiny because coastal and marine environments are arguably more complex and dynamic than their terrestrial counterparts thus creating more diverse challenges for managers. Land tenure at the coast in Australia also sets these environments apart and has direct implications for NRM governance, including reliance on a volunteer workforce. Numerous politically driven federal policy and funding cycles have shaped what has become Australia's current NRM system. It is argued that over time the coastal sector has become increasingly marginalised through these cycles. Here we concentrate on the devolved governance framework established in the mid-2000s as the federal government's 'regional delivery' model. While NRM policy has since re-centralised and shifted focus, regions and their administration have endured and are significant entities but have received little recent attention. This paper presents a brief history of NRM in Australia including the emergence of state NRM architecture and an update of the status of coastal NRM regions. We use a sample of ten NRM regions selected based on coastline length to land area ratios and affluence attributes. The prominence of coasts is considered through three pillars essential to the NRM system: Boards of Management; strategic planning, and support for the volunteer community. While a regional NRM framework is in place, the prominence of coastal and marine environments is questionable in relation to Boards of Management expertise. This has implications for strategic planning. The interrogation of plans suggests that overall, the focus of stakeholders is not primarily on conservation of coastal assets and the past levels of support for coastal volunteers is a but shadow of previous programs. A set of national guidelines or principles to integrate coastal and marine priorities in NRM planning cycles offer one mechanism to amend this situation along with a reinvigoration of a community support program. • 34 coastal regions form an important part of Australia's current NRM system. • Coastal NRM in Australia has become increasingly marginalised through policy cycles. • Coastal expertise is underrepresented on NRM boards of management. • Strategic NRM plans lack focus on conservation of coastal assets. • Support for coastal volunteers by NRM bodies is much reduced than previous systems. [ABSTRACT FROM AUTHOR]

Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers. We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice. We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers. We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia. We recruited general practitioners (15) and practice nurses (20). We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains. Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes. We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care. [ABSTRACT FROM AUTHOR]