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Psittacosis is a human systemic disease caused by infection with Chlamydia psittaci. Shortly after reports emerged of a global pandemic associated with contact with imported parrots, Australian researchers including Macfarlane Burnet and others demonstrated that C. psittaci was widespread in Australian parrots. Australian cases over the last two decades have revealed that environmental exposure and contact with infected horses are also risk factors in an increasingly complicated epidemiological picture for this zoonotic disease.

Objectives. The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra-Shoalhaven region of New South Wales, Australia. Methods. HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged 18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0-5.99% (lowest risk), 6.0-7.49% (intermediate risk) and 7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results. Data from 29 064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P < 0.001). Conclusion. In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness.

Objectives. The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra-Shoalhaven region of New South Wales, Australia. Methods. HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged 18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0-5.99% (lowest risk), 6.0-7.49% (intermediate risk) and 7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results. Data from 29 064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P < 0.001). Conclusion. In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness.

Background: More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people. Objective: The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors. Method: We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site. Results: The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame. Conclusion: Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration. Implications for Practice: Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

The number of people (including youth) in NSW prisons is at an historic high at more than 12000 prisoners. People have been incarcerated since 1788 in Australia. It also has one of the oldest penal health services. This project specifically looks at historical drivers for change in the delivery of health care for those in prison.

The number of people (including youth) in NSW prisons is at an historic high at more than 12000 prisoners. People have been incarcerated since 1788 in Australia. It also has one of the oldest penal health services. This project specifically looks at historical drivers for change in the delivery of health care for those in prison.

Occupational fatigue in anaesthetists is recognised as a patient safety risk. Better understanding of the issues surrounding their fatigue is needed. This study aimed to ascertain the sources and effects of occupational fatigue amongst anaesthetists in Australia and New Zealand. An anonymous online survey was sent to 979 anaesthetists. The response rate was 38.0%. Most participants reported regularly working over 40 hours per week; men reported five more hours per week than women. Stated contributors to fatigue included long work hours, mental strain at work, and personal and family demands. Fatigue-related behaviour was reported more by men (OR [odds ratio]=2.6) and less by respondents reporting eight or more hours of sleep before work (OR=0.6). Reporting at least one instance of less than five hours off between shifts was predictive of falling asleep while administering an anaesthetic (OR=1.6). More data are required to support practices and policies that promote more time off between work periods and increased time for sleep to reduce risk of fatigue.

Background: Rural clinical placement during medical training has been identified as important in addressing workforce mal-distribution in Australia. University of Wollongong (UOW) medical school is unique in Australia in that all students undertake a 12-month continuous longitudinal-integrated-clerkship (LIC) placement in rural or regional NSW, or in the non-capital city urban centre where the university main campus is located. This paper investigates whether origin is important in medical students' intentions and preferences for future practice. Methods: Between 2010 and 2015, rural clinical school (RCS) students from Australian medical school programmes, including UOW, completed the same survey. The responses from UOW students were compared to other students. The main outcome measures investigated were preference for location of future practice and training, and career preferences. These were investigated with respect to location of origin of students. Results: UOW students preferred regional city/large town locations for future practice compared to other RCS students. This finding strongly correlated with the non-capital city origin of UOW students. General practice/rural medicine was the career preference for one third of UOW students compared to one quarter of other students. Generalist specialist was the preference for almost half of other students. Skills development experiences and outcomes were similar in both groups. Conclusions: Many students who have experienced a LIC placement in a regional or rural setting during training prefer smaller regional cities, towns or rural locations for future practice. Augmenting the rural clinical experience by affirmative action in preferential selection of students of non-capital city origin can result in more medical graduates wanting to "by-pass" the big cities.

Purpose: The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers' expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery. Design/methodology/approach: A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses ("specials"), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken. Findings: There was a significant reduction in number of falls and number of patients allocated "specials" over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent. Originality/value: Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

While 'public health medicine' is a specialised field, most medical practitioners practice 'public health' to some extent, e.g., undertaking preventative screening tests or advising individuals about lifestyle interventions. While requirements to demonstrate capability in public health are common to medical education around the world, medical programs face a challenge to integrate public health education and promote health advocacy in an environment where the doctor: patient relationship is at the core of learning. Students who spend part of their medical education working within general practice or community settings have an opportunity to observe and identify issues of public health importance, and to see how they impact at both a personal and a population level. This paper aims to illustrate how a year-long research project can provide an opportunity for medical students to learn about public health issues and methods to investigate them. Analysis was undertaken of the research topics chosen by eight successive cohorts of medical students, representing 519 students, who successfully completed a research project. Over half of the student research projects (51.8%) directly related to Australian national health priority areas of dementia, obesity, arthritis and musculoskeletal conditions, asthma, diabetes, mental health, injury prevention and control, cardiovascular health and cancer control, and a further 28.5% of projects had a specific public health focus, within domains that include lifestyles and health, communicable disease, and healthy growth and development. Researching public health topics in the community setting represents a practical way to engage medical students in learning about public health, and can help to develop their potential to become 'clinician researchers', investigating and understanding issues relevant to their communities.

BACKGROUND: Children's formulations containing ibuprofen are frequently used to treat pain and fever. These medications, available over-the-counter, have the potential to cause adverse events if usage/safety information is not adhered to. This study aimed to investigate caregivers' knowledge about the safe use of a commonly purchased children's formulation containing ibuprofen. METHODS: A convenience sample of caregivers in Australia and New Zealand, who had purchased Nurofen® for Children, completed an online survey assessing their knowledge of product information and dosage instructions available on/in the product packaging. RESULTS: In total, 219 caregivers (mainly female 95%, mean age ± SD; 35 ± 6.82 years) completed the online survey. Responses suggest limitations in their knowledge about the active ingredients, contraindications and side effect profile associated with the product. Most respondents had a good understanding about the correct dosage to give children based on their weight and/or age, but many lacked a good understanding about the correct interval between doses and the maximum number of daily doses. CONCLUSIONS: These findings suggest that caregivers administering ibuprofen to children have gaps in their product knowledge. Strategies to help improve caregivers' knowledge about the safe administration of these products should be prioritised in an attempt to reduce the likelihood of children experiencing ibuprofen related adverse events. Improving caregiver knowledge to address these gaps is an important issue for all health care providers.

The value of history is, indeed, not scientific but moral … it prepares us to live more humanely in the present, and to meet rather than to foretell, the future - Carl Becker. Becker's quote reminds us of the importance of revealing and understanding historical practices in order to influence actions in the future. There are compelling reasons for uncovering this history, in particular to better inform government policy makers and health advocates, and to address the impacts of growing community expectations to 'make the punishment fit the crime'.

The value of history is, indeed, not scientific but moral … it prepares us to live more humanely in the present, and to meet rather than to foretell, the future - Carl Becker. Becker's quote reminds us of the importance of revealing and understanding historical practices in order to influence actions in the future. There are compelling reasons for uncovering this history, in particular to better inform government policy makers and health advocates, and to address the impacts of growing community expectations to 'make the punishment fit the crime'.

Evidence-based medical practice is best achieved by developing research understanding in medical practitioners. To this end, medical councils worldwide increasingly recognise the importance of medical schools graduating students with well-developed research skills and research capacity. To meet this need, the principles of programmatic assessment were implemented in designing a research and critical analysis curriculum and assessment program that aimed to enhance the research and critical analysis skills of medical students. The program was developed by mapping assessment tasks to a research capabilities framework that was in turn scaffolded to different levels of Miler's pyramid. The curriculum and assessments were integrated with the science, clinical, and professional aspects of the medical course. The progressive longitudinal development of research skills, with feedback and academic mentoring, culminated in the students' capacity to undertake an independent research project. Designing an assessment program for learning encouraged students to develop their research capacity by involving them in their learning.

Health care needs are changing due to the rapidly ageing population and the increasing number of patients with long term conditions and comorbidities.1 This has occurred at a time of continuing maldistribution of the medical workforce in Australia and increased specialisation and subspecialisation within the medical profession and the medical education system. As the next generation of doctors will need to serve an older population and those with more than one condition, a more useful focus would be "much less on narrow disease silos and . more on the breadth of possible permutations of co-morbidity". 1 Long periods of training and increasing subspecialism may also lead to difficulty in changing the scope of practice in times of surplus or reluctance to move to geographic areas with medical workforce shortages.2 For example, despite increasing numbers of medical graduates in Australia, there are existing shortages in generalist specialties, such as general practice, general medicine and psychiatry, and many rural communities still have reduced access to medical care compared with urban populations.2 Do current models and degree of specialisation encountered in medical training optimally prepare physicians to serve the needs of all patients?

Research skills are fundamental to the building of the evidence basis of professional practice, are at the core of lifelong professional learning and are the keys to discovery, innovation and knowledge transfer. Research competency is thus increasingly recognised as an important educational goal for graduates in many professions. This paper describes a flexible program, adaptable to any professional course of study that allows students to engage in meaningful, scholarly and authentic research. Students are supported to undertake a research activity that spans the research continuum from development of a research question through to dissemination of findings, and strategic points in-between.

Health care needs are changing due to the rapidly ageing population and the increasing number of patients with long term conditions and comorbidities.1 This has occurred at a time of continuing maldistribution of the medical workforce in Australia and increased specialisation and subspecialisation within the medical profession and the medical education system. As the next generation of doctors will need to serve an older population and those with more than one condition, a more useful focus would be "much less on narrow disease silos and . more on the breadth of possible permutations of co-morbidity". 1 Long periods of training and increasing subspecialism may also lead to difficulty in changing the scope of practice in times of surplus or reluctance to move to geographic areas with medical workforce shortages.2 For example, despite increasing numbers of medical graduates in Australia, there are existing shortages in generalist specialties, such as general practice, general medicine and psychiatry, and many rural communities still have reduced access to medical care compared with urban populations.2 Do current models and degree of specialisation encountered in medical training optimally prepare physicians to serve the needs of all patients?

The rise and rise of predatory publishers (Beall, 2016) suggests the unwary in the research world are still being conned. Yet, for emerging researchers, this rogue behaviour is only one of the threats encountered when playing the 'publication game'

Evidence-based medical practice is best achieved by developing research understanding in medical practitioners. To this end, medical councils worldwide increasingly recognise the importance of medical schools graduating students with well-developed research skills and research capacity. To meet this need, the principles of programmatic assessment were implemented in designing a research and critical analysis curriculum and assessment program that aimed to enhance the research and critical analysis skills of medical students. The program was developed by mapping assessment tasks to a research capabilities framework that was in turn scaffolded to different levels of Miler's pyramid. The curriculum and assessments were integrated with the science, clinical, and professional aspects of the medical course. The progressive longitudinal development of research skills, with feedback and academic mentoring, culminated in the students' capacity to undertake an independent research project. Designing an assessment program for learning encouraged students to develop their research capacity by involving them in their learning.

Background: This study aimed to assess and compare health literacy levels in a range of university-based health students. Methods: A survey containing the Health Literacy Questionnaire (HLQ) was administered to students enrolled in university-based medical, allied health or nursing degree programs. The HLQ scores and scale scores were compared across student groups. Results: In total, 374 students (24% response rate) with a median age of 25 years (range: 17-61 years), returned completed surveys. Three students who did not identify their degree programs were excluded from the final analysis which included 371 respondents; 242 graduate-entry medical students (65%), 67 allied health students (18%) and 62 nursing students (17%). Overall, the medical students had the highest score for seven of the nine HLQ scales; while the nursing students had the lowest score for all of the nine HLQ scales. Conclusion: These results show that health literacy profiles are different across student groups. In order to provide excellent patient-centred care, and to successfully look after their own health, a high level of health literacy is required by future health professionals. Health literacy training modules, tailored according to the different needs of the student groups, should therefore be included in university-based health professional degree programs.

Research skills are fundamental to the building of the evidence basis of professional practice, are at the core of lifelong professional learning and are the keys to discovery, innovation and knowledge transfer. Research competency is thus increasingly recognised as an important educational goal for graduates in many professions. This paper describes a flexible program, adaptable to any professional course of study that allows students to engage in meaningful, scholarly and authentic research. Students are supported to undertake a research activity that spans the research continuum from development of a research question through to dissemination of findings, and strategic points in-between.

Background: This study aimed to assess and compare health literacy levels in a range of university-based health students. Methods: A survey containing the Health Literacy Questionnaire (HLQ) was administered to students enrolled in university-based medical, allied health or nursing degree programs. The HLQ scores and scale scores were compared across student groups. Results: In total, 374 students (24% response rate) with a median age of 25 years (range: 17-61 years), returned completed surveys. Three students who did not identify their degree programs were excluded from the final analysis which included 371 respondents; 242 graduate-entry medical students (65%), 67 allied health students (18%) and 62 nursing students (17%). Overall, the medical students had the highest score for seven of the nine HLQ scales; while the nursing students had the lowest score for all of the nine HLQ scales. Conclusion: These results show that health literacy profiles are different across student groups. In order to provide excellent patient-centred care, and to successfully look after their own health, a high level of health literacy is required by future health professionals. Health literacy training modules, tailored according to the different needs of the student groups, should therefore be included in university-based health professional degree programs.

The rise and rise of predatory publishers (Beall, 2016) suggests the unwary in the research world are still being conned. Yet, for emerging researchers, this rogue behaviour is only one of the threats encountered when playing the 'publication game'

of a poster presentation at the 2016 National Medicines Symposium, 19-20 May, Canberra, Australia.

Objective: To investigate consumers' knowledge about commonly purchased over-the-counter (OTC) products containing ibuprofen. Methods: Customers buying two popular OTC ibuprofen-containing products (Nurofen or Nurofen Plus) were asked to complete a short survey assessing their knowledge about the products. Results: The survey was completed by 262 respondents, most of whom were older than 50 years of age; female; well-educated; with adequate functional health literacy. The majority correctly identified ibuprofen as an active ingredient and knew the correct intervals between doses. However, almost a third couldn't correctly identify the maximum daily dose and were unaware of some contraindications. Furthermore, fewer than half recognised potential side effects. Those who hadn't completed high school were significantly less likely to seek medical advice (when required) and significantly less likely to know when it was safe to take these products. Conclusions: The gaps in consumer knowledge, especially about the maximum daily dose, contraindications and potential side effects may be placing consumers at risk of experiencing ibuprofen-related adverse events. Implications for Public Health: Improving consumer knowledge to address these gaps in their understanding about the safe use of popular OTC ibuprofen-containing products is an important public health concern.

En route to the vaccination exhibition, it was easy to get distracted by the impressive variety of preserved specimens on display in one of London's most fascinating museums, the Hunterian. Jar upon jar of human and animal body parts as well as medical tools, skeletons, and other paraphernalia are enough to keep a visitor absorbed for hours. Happily, the Qvist gallery exhibition of Vaccination: Medicine and the Masses was equally captivating.

There is increased interest in longitudinal integrated clerkships (LICs) due to mounting evidence of positive outcomes for students, patients and supervising clinicians. Emphasizing continuity as the organizing principle of an LIC, this article reviews evidence and presents perspectives of LIC participants concerning continuity of care, supervision and curriculum, and continuity with peers and systems of care. It also offers advice on implementing or evaluating existing LIC programs.

of a poster presentation at the 2016 National Medicines Symposium, 19-20 May, Canberra, Australia.

There is increased interest in longitudinal integrated clerkships (LICs) due to mounting evidence of positive outcomes for students, patients and supervising clinicians. Emphasizing continuity as the organizing principle of an LIC, this article reviews evidence and presents perspectives of LIC participants concerning continuity of care, supervision and curriculum, and continuity with peers and systems of care. It also offers advice on implementing or evaluating existing LIC programs.

En route to the vaccination exhibition, it was easy to get distracted by the impressive variety of preserved specimens on display in one of London's most fascinating museums, the Hunterian. Jar upon jar of human and animal body parts as well as medical tools, skeletons, and other paraphernalia are enough to keep a visitor absorbed for hours. Happily, the Qvist gallery exhibition of Vaccination: Medicine and the Masses was equally captivating.

Objective: To investigate consumers' knowledge about commonly purchased over-the-counter (OTC) products containing ibuprofen. Methods: Customers buying two popular OTC ibuprofen-containing products (Nurofen or Nurofen Plus) were asked to complete a short survey assessing their knowledge about the products. Results: The survey was completed by 262 respondents, most of whom were older than 50 years of age; female; well-educated; with adequate functional health literacy. The majority correctly identified ibuprofen as an active ingredient and knew the correct intervals between doses. However, almost a third couldn't correctly identify the maximum daily dose and were unaware of some contraindications. Furthermore, fewer than half recognised potential side effects. Those who hadn't completed high school were significantly less likely to seek medical advice (when required) and significantly less likely to know when it was safe to take these products. Conclusions: The gaps in consumer knowledge, especially about the maximum daily dose, contraindications and potential side effects may be placing consumers at risk of experiencing ibuprofen-related adverse events. Implications for Public Health: Improving consumer knowledge to address these gaps in their understanding about the safe use of popular OTC ibuprofen-containing products is an important public health concern.

of a poster presentation at the 2015 PHC Research Conference, Adelaide, 29-31 July, 2015.

of a poster presentation at the 2015 PHC Research Conference, Adelaide, 29-31 July, 2015.

of a presentation at the AMEE 2015 conference, 4-9 September, Glasgow, United Kingdom.

Research is increasingly recognised as a key component of medical curricula, offering a range of benefits including development of skills in evidence-based medicine. The literature indicates that experienced academic supervision or mentoring is important in any research activity and positively influences research output. The aim of this project was to investigate the human research ethics experiences and knowledge of three groups: medical students, and university academic staff and clinicians eligible to supervise medical student research projects; at two Australian universities. Training in research ethics was low amongst academic staff and clinicians eligible to supervise medical student research. Only two-thirds of academic staff (67.9 %) and students (65.7 %) and less than half of clinicians surveyed (47.1 %; p = 0.014) indicated that specific patient consent was required for a doctor to include patient medical records within a research publication. There was limited awareness of requirements for participant information and consent forms amongst all groups. In the case of clinical trials, fewer clinicians (88.4 %) and students (83.3 %) than academics (100 %) indicated there was a requirement to obtain consent (p = 0.009). Awareness of the ethics committee focus on respect was low across all groups. This project has identified significant gaps in human research ethics understanding among medical students, and university academic staff and clinicians. The incorporation of research within medical curricula provides the impetus for medical schools and their institutions to ensure that academic staff and clinicians who are eligible and qualified to supervise students' research projects are appropriately trained in human research ethics.

Research is increasingly recognised as a key component of medical curricula, offering a range of benefits including development of skills in evidence-based medicine. The literature indicates that experienced academic supervision or mentoring is important in any research activity and positively influences research output. The aim of this project was to investigate the human research ethics experiences and knowledge of three groups: medical students, and university academic staff and clinicians eligible to supervise medical student research projects; at two Australian universities. Training in research ethics was low amongst academic staff and clinicians eligible to supervise medical student research. Only two-thirds of academic staff (67.9 %) and students (65.7 %) and less than half of clinicians surveyed (47.1 %; p = 0.014) indicated that specific patient consent was required for a doctor to include patient medical records within a research publication. There was limited awareness of requirements for participant information and consent forms amongst all groups. In the case of clinical trials, fewer clinicians (88.4 %) and students (83.3 %) than academics (100 %) indicated there was a requirement to obtain consent (p = 0.009). Awareness of the ethics committee focus on respect was low across all groups. This project has identified significant gaps in human research ethics understanding among medical students, and university academic staff and clinicians. The incorporation of research within medical curricula provides the impetus for medical schools and their institutions to ensure that academic staff and clinicians who are eligible and qualified to supervise students' research projects are appropriately trained in human research ethics.

of a presentation at the AMEE 2015 conference, 4-9 September, Glasgow, United Kingdom.

of a presentation at the HERDSA 2015 Conference, 6-9 July, Melbourne, Australia.

Background Many Australians with arthritis self-manage their pain with prescription and/or over-the-counter pain medications, containing paracetamol. If taken appropriately, these medications are relatively safe; however, if mismanaged through patients' inability to understand medication labels and instructions, these medications may cause adverse drug events and/or toxicities. Aim This study explored the prescription and over-the-counter pain medications most commonly used by people with arthritis and the ability of these patients to correctly identify paracetamol as an active ingredient in commonly available preparations. The study also investigated the functional health literacy of these patients and their inclination to borrow and/or share pain medications. Method Adult participants diagnosed with arthritis were invited to complete an anonymous survey which included questions about their prescription and over-the-counter pain medications; their medication borrowing and sharing behaviours; their functional health literacy; and their knowledge about preparations containing paracetamol as an active ingredient. Results Most of the 254 participants used analgesic agents containing paracetamol, as combination tablets (paracetamol 500 mg and codeine 30 mg) or paracetamol-only tablets (paracetamol 665 mg) to self-manage their pain. Respondents with low functional health literacy scores were significantly less likely to identify paracetamol as an active ingredient in both combination and paracetamol-only pharmaceutical products, and were more likely to guess or did not know how to identify that paracetamol was an active ingredient in these products. Almost 30% of the respondents indicated that they had and/or intended to borrow/share their over-the-counter pain medications whereas less than 10% suggested that they had and/or intended to borrow/share their prescription pain medication. Conclusion Australians with arthritis, especially those with low functional health lite

Objective The 'Essentials of Care' (EoC) program seeks to develop a shared vision amongst nurses within particular workplace teams. The purpose of this study was to describe the experiences of nurses during the process of exploring their values and developing these into a shared vision at both an individual level and as a team. Design A qualitative, focus group design was used to provide an accurate representation of the nurses experiences in reflecting on their values and developing these into individual ward/unit vision statements. Six focus groups were conducted by independent researchers. The focus group discussions were recorded and transcribed by an independent researcher. The transcription provided the data for thematic analysis. Setting This study was conducted in two tertiary hospitals from the same Local Health District in New South Wales, Australia. Subjects Forty-two nurses from fourteen hospital wards or units participated in the study. Seventeen were facilitators of the program and the remainder were nursing staff who had undertaken the program. Main outcome measures The authors independently interpreted the transcripts using inductive qualitative analysis, reaching consensus on emergent themes. Representative quotations were chosen for each theme. Results Six themes emerged which describe the experiences of nurses during the exploration of individual and team workplace values which were then developed into shared visions. The emergent themes were: shared values and commitment to patient care; empowerment and ownership for cultural change; real and observable outcomes; the meaning of the team; different active learning approaches equalling the same outcome; and culture change results in new perspectives. Conclusion This study supports the benefits of value-based programs. Exploring values led to new perspectives on clinical practice, both individually and collectively by the nursing teams.

of a poster presentation at the 2015 PHC Research Conference, Adelaide, 29-31 July, 2015.

Background Particularly when undertaken on a large scale, implementing innovation in higher education poses many challenges. Sustaining the innovation requires early adoption of a coherent implementation strategy. Using an example from clinical education, this article describes a process used to implement a large-scale innovation with the intent of achieving sustainability. Desire to improve the effectiveness of undergraduate medical education has led to growing support for a longitudinal integrated clerkship (LIC) model. This involves a move away from the traditional clerkship of 'block rotations' with frequent changes in disciplines, to a focus upon clerkships with longer duration and opportunity for students to build sustained relationships with supervisors, mentors, colleagues and patients. A growing number of medical schools have adopted the LIC model for a small percentage of their students. At a time when increasing medical school numbers and class sizes are leading to competition for clinical supervisors it is however a daunting challenge to provide a longitudinal clerkship for an entire medical school class. This challenge is presented to illustrate the strategy used to implement sustainable large scale innovation. What was done A strategy to implement and build a sustainable longitudinal integrated community-based clerkship experience for all students was derived from a framework arising from Roberto and Levesque's research in business. The framework's four core processes: chartering, learning, mobilising and realigning, provided guidance in preparing and rolling out the 'whole of class' innovation. Discussion Roberto and Levesque's framework proved useful for identifying the foundations of the implementation strategy, with special emphasis on the relationship building required to implement such an ambitious initiative. Although this was innovation in a new School it required change within the school, wider university and health community. Challenges encou

of an oral presentation at the ANZAHPE/AMEA 2015 Conference, 29-31 March, Newcastle, Australia.

Background Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. Materials and Methods The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. Results The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. Conclusion It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Introduction: Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community. Method: Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology. Results: Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability. Conclusions: There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.

Background: Telehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning. Objective: This protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project. Methods: Training sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees. Results: Results will be available when the trial has been completed in 2015. Conclusions: The protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments

Background Many Australians with arthritis self-manage their pain with prescription and/or over-the-counter pain medications, containing paracetamol. If taken appropriately, these medications are relatively safe; however, if mismanaged through patients' inability to understand medication labels and instructions, these medications may cause adverse drug events and/or toxicities. Aim This study explored the prescription and over-the-counter pain medications most commonly used by people with arthritis and the ability of these patients to correctly identify paracetamol as an active ingredient in commonly available preparations. The study also investigated the functional health literacy of these patients and their inclination to borrow and/or share pain medications. Method Adult participants diagnosed with arthritis were invited to complete an anonymous survey which included questions about their prescription and over-the-counter pain medications; their medication borrowing and sharing behaviours; their functional health literacy; and their knowledge about preparations containing paracetamol as an active ingredient. Results Most of the 254 participants used analgesic agents containing paracetamol, as combination tablets (paracetamol 500 mg and codeine 30 mg) or paracetamol-only tablets (paracetamol 665 mg) to self-manage their pain. Respondents with low functional health literacy scores were significantly less likely to identify paracetamol as an active ingredient in both combination and paracetamol-only pharmaceutical products, and were more likely to guess or did not know how to identify that paracetamol was an active ingredient in these products. Almost 30% of the respondents indicated that they had and/or intended to borrow/share their over-the-counter pain medications whereas less than 10% suggested that they had and/or intended to borrow/share their prescription pain medication. Conclusion Australians with arthritis, especially those with low functional health lite

Introduction: Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community. Method: Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology. Results: Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability. Conclusions: There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.

of a presentation at the AMEE 2015 conference, 4-9 September, Glasgow, United Kingdom.

of a presentation at the AMEE 2015 conference, 4-9 September, Glasgow, United Kingdom.