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Background and Objective: It is critical to evaluate cancer survivors’ preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. Methods: Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. Results: Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors’ preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. Conclusions: Attributes identified can be used in future DCE studies to elicit cancer survivors’ preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.

BACKGROUND: Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. METHODS: Data collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos. RESULTS: GPs' attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs. CONCLUSION: This study demonstrates

Evidence of the health and wellbeing benefits of Tai Chi and Qigong (TQ) have emerged in the past two decades, but TQ is underutilized in modern health care in Western countries due to lack of promotion and the availability of professionally qualified TQ instructors. To date, there are no government regulations for TQ instructors or for training institutions in China and Western countries, even though TQ is considered to be a part of Traditional Chinese medicine that has the potential to manage many chronic diseases. Based on an integrative health care approach, the accreditation standard guideline initiative for TQ instructors and training institutions was developed in collaboration with health professionals, integrative medicine academics, Tai Chi and Qigong master instructors and consumers including public safety officers from several countries, such as Australia, Canada, China, Germany, Italy, Korea, Sweden and USA. In this paper, the rationale for organizing the Medical Tai Chi and Qigong Association (MTQA) is discussed and the accreditation standard guideline for TQ instructors and training institutions developed by the committee members of MTQA is presented. The MTQA acknowledges that the proposed guidelines are broad, so that the diversity of TQ instructors and training institutions can be integrated with recognition that these guidelines can be developed with further refinement. Additionally, these guidelines face challenges in understanding the complexity of TQ associated with different principles, philosophies and schools of thought. Nonetheless, these guidelines represent a necessary first step as primary resource to serve and guide health care professionals and consumers, as well as the TQ community.

Evidence of the health and wellbeing benefits of Tai Chi and Qigong (TQ) have emerged in the past two decades, but TQ is underutilized in modern health care in Western countries due to lack of promotion and the availability of professionally qualified TQ instructors. To date, there are no government regulations for TQ instructors or for training institutions in China and Western countries, even though TQ is considered to be a part of Traditional Chinese medicine that has the potential to manage many chronic diseases. Based on an integrative health care approach, the accreditation standard guideline initiative for TQ instructors and training institutions was developed in collaboration with health professionals, integrative medicine academics, Tai Chi and Qigong master instructors and consumers including public safety officers from several countries, such as Australia, Canada, China, Germany, Italy, Korea, Sweden and USA. In this paper, the rationale for organizing the Medical Tai Chi and Qigong Association (MTQA) is discussed and the accreditation standard guideline for TQ instructors and training institutions developed by the committee members of MTQA is presented. The MTQA acknowledges that the proposed guidelines are broad, so that the diversity of TQ instructors and training institutions can be integrated with recognition that these guidelines can be developed with further refinement. Additionally, these guidelines face challenges in understanding the complexity of TQ associated with different principles, philosophies and schools of thought. Nonetheless, these guidelines represent a necessary first step as primary resource to serve and guide health care professionals and consumers, as well as the TQ community.

This chapter is an accompaniment to the previous chapter (Chapter 10), where the steps involved in answering a clinical question about patients' experiences and concerns were explained. To further help you learn how to assess the quality (critically appraise) the evidence for this type of question, this chapter contains worked examples of questions about patients' experiences and concerns. The Critical Appraisal Skills Program(CASP) qualitative checklist1 for assessing the quality of qualitative research has been used as a guide in...

Menopausal hot flushes affect up to 90% of women and pose a significant health and financial burden. Many women are reluctant to use hormone replacement therapy, an effective treatment, because of fear of serious adverse events. Acupuncture is a safe treatment with conflicting evidence for efficacy as a hot flush treatment. The aim of this thesis was to assess the efficacy of acupuncture for menopausal hot flushes. The principal study was a fully powered randomised sham-controlled trial which enrolled women aged over 40 in the late menopausal transition or postmenopause with a moderate hot flush burden, and who met criteria for the Chinese medicine diagnosis of Kidney Yin deficiency. Women were randomised to receive eight weeks of either Chinese medicine needle acupuncture or non-insertive sham acupuncture. The primary outcome was hot flush score at the end of treatment. Secondary outcomes included quality-of-life, anxiety, depression, and adverse events. Women were followed up at 4 and 8 weeks (end of treatment) and at 3 and 6 months post end of treatment. Analysis was by intention-to-treat using mixed effects modelling. 327 women were randomised to real (n=163) or sham acupuncture (n=164). There was no evidence for a between-group difference in hot flush scores at end-of-treatment (mean difference 0·33; 95% CI -1·87 to 2·52; p=0·77) or for secondary outcomes, and no serious adverse events. Both groups improved by an average of 40% from baseline for hot flush score. There was a small, clinically irrelevant difference for hot flush severity at end of treatment. Limitations of the study are that participants were predominantly Caucasian and none had breast cancer or surgical menopause, conditions which predispose to more severe hot flushes. In conclusion, an eight week course of Chinese medicine acupuncture was not superior to non-insertive sham needling for menopausal hot flushes. Women may have improved because of natural resolution of symptoms, frequent therapist

BACKGROUND: Randomised controlled trials (RCTs) are considered the “gold standard” when evaluating the effectiveness of therapeutic interventions, because of their ability to minimise bias. Bias refers to any process that leads to a conclusion that is systematically different from the truth, and four key features of RCTs that serve to minimise bias have been identified. These are discussed using the case of acupuncture, a popular and safe complementary therapy, for treating hot flushes or vasomotor symptoms (VMS), which are common and bothersome during menopause. The methodological shortcomings of existing RCTs on this topic are discussed. AIM: To determine the feasibility of a rigorous randomised-controlled study evaluating the efficacy of needle acupuncture compared to non-penetrating sham control for treatment of VMS, in Melbourne, Australia. METHOD: A randomised sham-controlled pilot study was conducted. Various recruitment strategies, including online strategies, were implemented to recruit 27 acupuncture-naïve women having more than seven hot flushes a day and who were diagnosed with Kidney Yin deficiency, a Traditional Chinese Medicine diagnosis. Women were randomised into intervention or control groups and received ten treatments over eight weeks. The intervention group received needling at four acupuncture points while the control group received needling with a non-penetrating (blunt) needle (“the Park Sham Device”) at four non-acupuncture points. The main outcome measures were recruitment, enrolment and dropout rates; adequacy of blinding; adverse events; and qualitative assessment of trial procedures by participants. Changes in hot flushes were measured by a seven-day hot flush diary administered at baseline, four weeks, six weeks, end of treatment and three month follow-up. Quality of life (QOL) using the Menopause-Specific Quality of Life Questionnaire (MENQOL) was administered at the same times. Between-group differences for hot flush and QOL measures