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• There is high variability in assessment practices for non-progressive dysarthria. • Informal measures of assessment are most commonly used. • A greater focus on impairment and intelligibility measures exists. This aim of this study was to identify assessment practices for non-progressive dysarthria used by Australian speech-language pathologists (SLPs) and to describe these practices within the framework of the World Health Organization's International Classification of Functioning Disability, and Health (ICF). A 23-item online survey was distributed to Australian SLPs, with 56 responses suitable for data analysis. The majority of SLPs prescribed 'high importance' to the assessment of impairment to speech function (96%, n = 54), activity limitations (91%, n = 51) and participation in society (91%, n = 51) in non-progressive dysarthria. However, reported assessment selection for non-progressive dysarthria focused largely on impairment and intelligibility, with assessments addressing participation restrictions being under-utilised. There was also a preference for informal assessment tools across all ICF domains. Over half (69%, n = 37) indicated that current assessment tools for non-progressive dysarthria generally do not meet their needs, with key issues being time-factors and inadequate sensitivity. There was variability in the use of outcome measures for non-progressive dysarthria, with workplace setting, time constraints and a perceived lack of relevance being the most commonly reported barriers to implementation. [ABSTRACT FROM AUTHOR]

Aim There has been a rise in the use of psychotropic medication in young people, despite limited risk-benefit profile of psychotropic medication for this population. Given their side effect profile, the use of psychotropic medications should occur with caution. This study investigated psychotropic prescribing pattern in a public youth community mental health service and gives an estimate of general level of psychotropic medication use in this setting. Methods A retrospective file review was undertaken of all young people aged 12–17 who received care from the service in 2016 (N = 189) for a range of mental health problems, excluding psychosis. Files were reviewed for demographical information (age, gender), diagnosis/presenting issues, prescribed medications, indications of medications, and prescriber type (e.g. psychiatrist, general practitioners (GPs), paediatrician). The data was analysed descriptively. Results Over 60% (60.8%, n = 115) of young people were prescribed psychotropic medications. Over half of the entire sample were on antidepressants (51.32%, n = 97), nearly a quarter (n = 46, 24%) on antipsychotics, 6% on ADHD medications (6.35%, n = 12), and a fifth (19.58%, n = 37) on polypharmacy. Antidepressants and antipsychotics were mostly used off-label, prescribed by public psychiatric staff. Quetiapine was the most prescribed antipsychotic predominantly for insomnia. Fluoxetine and fluvoxamine were the most prescribed antidepressants predominantly for anxiety disorders. Girls are more likely to be prescribed psychotropic medications than boys, specifically antipsychotic medication. Conclusions A high proportion of young people were prescribed psychotropic medication, including antipsychotic medication, mostly for the treatment of anxiety and depressive disorders. There is little evidence around how psychotropic medication is used in youth mental health settings, and this study contributes to this gap. [ABSTRACT FROM AUTHOR]

Background Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. Objective We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. Methods A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. Results The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37–0.93) and hospitalizations (HR 0.67, 95% CI 0.46–0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80–2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47–0.96). Conclusions The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting. [ABSTRACT FROM AUTHOR]

Online counselling services for a range of health conditions have proliferated in recent years. However, there is ambiguity and tension around their role and function. It is often unclear whether online counselling services are intended to provide only a brief intervention, the provision of information or referral, or constitute an alternative to face-to-face treatment. In line with recent analyses of alcohol and other drug (AOD) policy and interventions that draw on a critical social science perspective, we take an evidence-making intervention approach to examine how online counselling in the AOD field is made in policy and through processes of local implementation. In this article, we analyse how online AOD counselling interventions and knowledges are enacted in Australia's AOD policy, and compare these enactments with an analysis of information about Australia's national online AOD counselling service, Counselling Online, and transcripts of counselling sessions with clients of Counselling Online. We suggest that while the policy enacts online counselling as a brief intervention targeting AOD use, and as an avenue to facilitate referral to face-to-face treatment services, in its implementation in practice online counselling is enacted in more varied ways. These include online counselling as attempting to attend to AOD use and interconnected psychosocial concerns, as a potential form of treatment in its own right, and as supplementing face-to-face AOD treatment services. Rather than viewing online counselling as a singular and stable intervention object, we suggest that multiple 'online counsellings' emerge in practice through local implementation practices and knowledges. We argue that the frictions that arise between policy and practice enactments need to be considered by policy makers, funders, clinicians and researchers as they affect how the concerns of those targeted by the intervention are attended to. [ABSTRACT FROM AUTHOR]

• Potentially suboptimal prescribing affected almost all residents (302 out of 303 residents). • Most residents (92%) were exposed to polypharmacy and were prescribed an average of 10.3 ± 4.5 regular medicines daily. • At least one instance of potential under-prescribing was identified in 86% of residents. • At least one instance of high-risk prescribing was identified in 81% of residents. • Most participants (85%) had highly complex regimens. To describe medicines regimens used by older people living in residential aged care facilities (RACFs). This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: The Coping Strategies Inventory-Short Form (CSI-SF) measures four coping strategies based on 16 items: 4 items each indicating problem- vs. emotion-focused engagement or disengagement. Here we provide the first assessment of reliability and construct validity of the CSI-SF among hemodialysis patients across 13 countries.Methods: The CSI-SF was completed by patients in 9 languages in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-11). Cronbach's alpha was used to assess internal consistency. Exploratory and confirmatory factor analyses were applied to assess the factor structure of the CSI-SF by country and language. CSI-SF data were analyzed from 7201 patients (60% male; median age 62.5 [range 18-96] years).Results: Good internal consistency (α=0.56-0.80) was seen for three scales in English (US, UK, Canada, Australia, New Zealand), German, and Swedish versions. The fourth scale was internally consistent if two items were dropped. In these countries, both exploratory and confirmatory factor analyses indicated a factor structure consistent with the four CSI-SF scales. Other language versions showed a factor structure inconsistent with these four scales.Conclusion: The slightly modified English, German, and Swedish versions of the CSI-SF are reliable and valid instruments for measuring coping strategies in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Abstract: The present study considered factors influencing teachers'' reporting of child sexual abuse (CSA). Conducted in three Australian jurisdictions with different reporting laws and policies, the study focused on teachers'' actual past and anticipated future reporting of CSA. A sample of 470 teachers within randomly selected rural and urban schools was surveyed, to identify training and experience; knowledge of reporting legislation and policy; attitudes; and reporting practices. Factors influencing actual past reporting and anticipated future reporting were identified using logistic regression modelling. This is the first study to simultaneously examine the effect of important influences in reporting practice using both retrospective and prospective approaches across jurisdictions with different reporting laws. Teachers who have actually reported CSA in the past are more likely have higher levels of policy knowledge, and hold more positive attitudes towards reporting CSA along three specific dimensions: commitment to the reporting role; confidence in the system''s effective response to their reporting; and they are more likely to be able to override their concerns about the consequences of their reporting. Teachers indicating intention to report hypothetical scenarios are more likely to hold reasonable grounds for suspecting CSA, to recognise that significant harm has been caused to the child, to know that their school policy requires a report, and to be able to override their concerns about the consequences of their reporting. [Copyright &y& Elsevier]

To investigate administration of pro re nata (PRN) medications and nurse-initiated medications (NIMs) in Australian aged care services over a 12-month period. Twelve-month longitudinal audit of medication administrations. Three hundred ninety-two residents of 10 aged care services in regional Victoria, Australia. Records of PRN and NIM administration were extracted from electronic and hard copy medication charts. Descriptive statistics were used to calculate medication administration per person-month. Poisson regression was used to estimate predictors of PRN administration. Over a median follow-up of 12 months (interquartile range 10–12 months), 93% of residents were administered a PRN medication and 41% of residents an NIM on 21,147 and 552 occasions, respectively. The mean number of any PRN administration was 5.85 per person-month. The most frequently administered PRN medications per person-month were opioids 1.54, laxatives 0.96, benzodiazepines 0.72, antipsychotics 0.48, paracetamol 0.46, and topical preparations 0.42. Three-quarters of residents prescribed a PRN opioid or PRN benzodiazepine and two-thirds of residents prescribed a PRN antipsychotic had the medication administered on 1 or more occasions over the follow-up. Most residents were administered PRN medications. Administration was in line with Australian regulations and institutional protocols. However, the high frequency of PRN analgesic, laxative, and psychotropic medication administration highlights the need for regular clinical review to ensure ongoing safe and appropriate use. [ABSTRACT FROM AUTHOR]

It is now well recognised that, in many areas of medicine, substantial gaps in clinical care exist despite robust clinical trial data and the careful assimilation of this information into clinical practice guidelines. Those at greatest risk are patients presenting with multiple co-morbidities, and those with advanced age in whom the issues of complexity and limited time available for careful assessment, potentially lead to sub-optimal clinical practice and outcomes. Greater efforts are needed to move the acquired knowledge across the “last mile”, that is from clinical guidelines and best practice to nationwide routine practice. This article will discuss some of issues faced in operationalising “clinical effectiveness” in cardiovascular care in Australia. [Copyright &y& Elsevier]