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Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

Indigenous primary health care (PHC) services have been identified as exemplary models of comprehensive PHC; however, many practitioners in these services struggle to deliver effective health promotion. In particular, practitioners have limited capacity and resources to evaluate health promotion activities. Best practice health promotion is important to help address the lifestyle and wider factors that impact on the health of people and communities. In this paper, we report on the acceptability and feasibility of an innovative approach for evaluating the design of health promotion activities in four Indigenous PHC services in the Northern Territory. The approach draws on a popular continuous quality improvement technique known as audit and feedback (A&F), in which information related to best practice is gathered through the use of a standardised audit tool and fed back to practitioners. The A&F approach has been used successfully to improve clinical service delivery in Indigenous PHC; however, the technique has had limited use in health promotion. The present study found that facilitated participatory processes were important for the collection of locally relevant information and for contributing to improving PHC practitioners' knowledge and understanding of best practice health promotion. [ABSTRACT FROM AUTHOR]

Aim To examine processes of aged-care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care. Method A qualitative study involving 11 semistructured interviews with aged-care assessors and two focus groups with Aboriginal community members. Results This paper reports four major themes concerning how needs assessments relate to realities of service delivery: cultural perspectives on aged care, context of service delivery, equity and access to services, and program (mis)alignments. Conclusion Disparities exist between assessment recommendations and service availability, with a potential mismatch between Aboriginal understandings of needs, interpretations by individual assessment staff and program guidelines. Incorporating a conceptual framework, such as the International Classification of Functioning, Disability and Health, into service guidelines to ensure structured consideration of a person's holistic needs may assist, as will building the capacity of communities to provide the level and type of services required. [ABSTRACT FROM AUTHOR]

Background This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. Design, setting, participants Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. Main outcome measures Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. Results Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. Conclusion Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision. [ABSTRACT FROM AUTHOR]

Alcohol is the leading cause of healthy years lost. There is significant variation in alcohol consumption patterns and harms in Australia, with those residing in the Northern Territory (NT), particularly First Nations Australians, experiencing higher alcohol-attributable harms than other Australians. Community leadership in the planning and implementation of health, including alcohol, policy is important to health outcomes for First Nations Australians. Self-determination, a cornerstone of the structural and social determinants of health, is necessary in the development of alcohol-related policy. However, there is a paucity of published literature regarding Indigenous Peoples self-determination in alcohol policy development. This study aims to identify the extent to which First Nations Australians experience self-determination in relation to current alcohol policy in Alice Springs/Mbantua (Northern Territory, Australia). Semi-structured qualitative yarns with First Nations Australian community members (n = 21) were undertaken. A framework of elements needed for self-determination in health and alcohol policy were applied to interview transcripts to assess the degree of self-determination in current alcohol policy in Alice Springs/Mbantua. Of the 36 elements, 33% were not mentioned in the interviews at all, 20% were mentioned as being present, and 75% were absent. This analysis identified issues of policy implementation, need for First Nations Australian leadership, and representation. Alcohol policy for First Nations Australians in the NT is nuanced and complicated. A conscious approach is needed to recognise and implement the right to self-determination, which must be led and defined by First Nations Australians. First Nations Australians' experiences of current alcohol policy in Central Australia: evidence of self-determination? [ABSTRACT FROM AUTHOR]

Background: Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods: The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results: The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse's personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions: It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace. [ABSTRACT FROM AUTHOR]

Objective Indigenous Australians have poorer health outcomes compared to the non-Indigenous population. Malnutrition, and subsequently iron-deficiency anaemia, impairs childhood development. The aim of this study was to identify the prevalence of anaemia in school-aged children of an Australian Indigenous community and evaluate the effectiveness of treatment. Design A retrospective cohort study. Setting A Northern Territory Indigenous community. Participants Two hundred and one school-age students (5-15 years old) undergoing annual school screening. Main outcome measures Presence of anaemia. Anaemic and non-anaemic students were compared to determine any differences in age, gender, BMI and past history of anaemia. The response to treatment was analysed using initial and repeat haemoglobin results. Results Altogether, 201 students were screened with 105 (52%) classified as anaemic. No significant association was found between anaemic students and age, gender, BMI or prior history of anaemia. After treatment, the mean rise in haemoglobin was 13% (95% CI 11-15) at the 4-week interval. Age ( P = 0.17), gender ( P = 0.53) and weight ( P = 0.14) were not significantly associated with treatment efficacy. Only 11 students (17%) were still anaemic after treatment. Discussion Anaemia in Indigenous Australian school-aged children is a major public health issue. The prevalence of anaemia in this population is 52% and many times higher than that of the general Australian population. As per current guidelines, the recommended treatment is effective in over 80% at the 4-week interval. Community wide interventions are required to combat this alarming issue. [ABSTRACT FROM AUTHOR]

Objective. To compare general and oral health perceptions between Indigenous and non-Indigenous Australians and to quantify Indigenous Australian health-related frames of reference. Methods. A mixed-methods approach was used. The quantitative component comprised data from four convenience studies of Indigenous oral health and one national oral health survey stratified by Indigenous status. Qualitative data with questions pertaining to frames of reference were collected from 19 Indigenous Australian interviews. Results. Among the Indigenous studies, deficits in perceptions of excellent, very good, or good general health and excellent, very good, or good oral health ranged from 10.5% to 43.8%. Among the non-Indigenous population, the deficit was 5%. Frames of reference appeared to underpin a biomedical conceptual outlook. Conclusion. The deficit in perceived oral health compared with general health was far greater among Indigenous Australians. The frame of reference underpinning Indigenous Australian's perceptions of health reflect those of the general Australian population. [ABSTRACT FROM AUTHOR]

Background: Hospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context.Methods: This randomised control trial compares a tailored, multidimensional transitional care package to usual care. The objective is to evaluate the efficacy of the transitional care package for Indigenous and non-Indigenous Australian patients with chronic diseases at risk of recurrent readmission with the aim of reducing readmission rates and improving transition to primary care in a remote setting. Patients will be recruited from medical and surgical admissions to Alice Springs Hospital and will be followed for 12 months. The primary outcome measure will be number of admissions to hospital with secondary outcomes including number of emergency department presentations, number of ICU admissions, days alive and out of hospital, time to primary care review post discharge and cost-effectiveness.Discussion: Successful transition from hospital to home is important for patients with complex chronic diseases. Evidence suggests that a coordinated transitional care plan can result in a reduction in length of hospital stay and readmission rates for adults with complex medical needs. This will be the first study to evaluate a tailored multidimensional transitional care intervention to prevent readmission in Indigenous and non-Indigenous Australian residents of remote Australia who are frequently admitted to hospital. If demonstrated to be effective it will have implications for the care and management of Indigenous Australians throughout regional and remote Australia and in other remote, culturally and linguistically diverse populations and settings.Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12615000808549 - Retrospectively registered on 4/8/15. [ABSTRACT FROM AUTHOR]

Background: Despite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia.Methods: Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6- and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner's Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed.Discussion: Remoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions.Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404 was retrospectively registered on 22/03/2016. [ABSTRACT FROM AUTHOR]

Background: In the Northern Territory (NT) there is a lack of respite services available to palliative care patients and their families. Indigenous people in the NT suffer substantially higher rates of poorly controlled chronic disease and premature mortality associated with poor heath than the Australian population as a whole. The need for a flexible, community based, culturally appropriate respite service in Alice Springs was identified and, after the service had been operating for 10 months, a qualitative evaluation was conducted to investigate the experiences of people involved in the use and operation of the service. Methods: Semi-structured interviews were conducted with patients, carers, referrers, and stakeholders. A total of 20 people were interviewed. Interpretative Phenomenological Analysis was used inductively to analyse the transcripts. Two case studies are also described which illustrate in greater detail the impact the respite service has had on people's lives. Results: From the semi-structured interviews, two superordinate themes along with a number of sub themes were developed. The two superordinate themes described both "The Big Picture" considerations as well as the pragmatics of "Making the Service Work". The sub themes highlighted issues such as being stuck at home and the relief that respite provided. The case studies poignantly illustrate the difference the respite service made to the quality of life of two patients. Discussion: The findings clearly indicate an improvement in quality of life for respite patients and their carers. The respite service enabled improved care coordination of chronic and complex patients as well as improved medication compliance and symptom management. As a result of this evaluation a number of recommendations to continue and improve the service are provided. [ABSTRACT FROM AUTHOR]

Objective To evaluate health practitioners' confidence and knowledge of alcohol screening, brief intervention and referral after training in a culturally adapted intervention on alcohol misuse and well-being issues for trauma patients. Design Mixed methods, involving semi-structured interviews at baseline and a post-workshop questionnaire. Setting Targeted acute care within a remote area major tertiary referral hospital. Participants Ten key informants and 69 questionnaire respondents from relevant community services and hospital-based health care professionals. Intervention Screening and brief intervention training workshops and resources for 59 hospital staff. Main outcome measures Self-reported staff knowledge of alcohol screening, brief intervention and referral, and satisfaction with workshop content and format. Results After training, 44% of participants reported being motivated to implement alcohol screening and intervention. Satisfaction with training was high, and most participants reported that their knowledge of screening and brief intervention was improved. Conclusion Targeted educational interventions can improve the knowledge and confidence of inpatient staff who manage patients at high risk of alcohol use disorder. Further research is needed to determine the duration of the effect and influence on practice behaviour. Ongoing integrated training, linked with systemic support and established quality improvement processes, is required to facilitate sustained change and widespread dissemination. [ABSTRACT FROM AUTHOR]

Background: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. Methods: In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Results: Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. Discussion: The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs. (BIRTH 42:4 December 2015) [ABSTRACT FROM AUTHOR]

Objective We investigated patient perceptions of a virtual preoperative anaesthesia evaluation clinic linking Royal Darwin Hospital to Katherine Hospital. Design Descriptive study, cross-sectional survey. Setting Regional and rural areas of Northern Territory, Australia. Participants Sample includes 27 respondents, five Indigenous, 18 non- Indigenous and four unknown. Interventions Introduction of a preoperative anaesthesia evaluation clinic. Main outcome measures We designed a 10-item, 5-point Likert scale questionnaire assessing patient perceptions in four domains: (i) technical quality; (ii) perceived efficacy; (iii) affective patient experience; and (iv) patient preference. Qualitative responses are also reported. Results Twenty-seven out of 35 patients (77%) completed the questionnaire. Ninety-eight per cent were in positive agreement on technical quality with a mean score of 1.35 ( SD: 0.53); Ninety-five per cent on perceived efficacy, 1.35 ( SD: 0.65); Eighty-four per cent in negative agreement on affective patient experience (negative perception item), 4.19 ( SD: 1.07); Eighty-one per cent in negative agreement on patient preference (negative perception item), 4.23 ( SD: 1.14). There were no significant differences in the answers between Indigenous (five patients) and non- Indigenous patients (18 patients). Conclusion Our study confirms the acceptability of telemedicine in the remote assessment of preoperative patients in the Northern Territory, with positive perceptions in all four domains. [ABSTRACT FROM AUTHOR]

Contemporary diets of Aboriginal people living in remote Australia are characterised by processed foods high in fat and sugar. Within the 'new' food system, evidence suggests many Aboriginal people understand food in their own terms but lack access to consumer information about store-purchased foods, and parents feel inadequate as role models. In a remote Australian Aboriginal community, purposive sampling identified adults who participated in semistructured interviews guided by food-based themes relating to the contemporary food system, parental guidance of children's food choice and channels through which people learn. Interpretive content analysis was used to identify salient themes. In discussions, people identified more closely with dietary qualities or patterns than nutrients, and valued a balanced, fresh diet that made them feel 'light'. People possessed basic knowledge of 'good' store foods, and wanted to increase familiarity and experience with foods in packets and cans through practical and social skills, especially cooking. Education about contemporary foods was obtained from key family role models and outside the home through community-based organisations, including school, rather than pamphlets and flip charts. Freedom of choice was a deeply held value; carers who challenged children's autonomy used strategic distraction, or sought healthier alternatives that did not wholly deny the child. Culturally safe approaches to information sharing and capacity building that contribute to the health and wellbeing of communities requires collaboration and shared responsibility between policy makers, primary healthcare agencies, wider community-based organisations and families. [ABSTRACT FROM AUTHOR]

Objective During a paediatric emergency, it is often impractical to weigh a child. Many resuscitative measures require a child's weight; therefore, estimation is often used. Different methods are available to do this, usually based on a child's age or length. The accuracy of these methods has not been validated in Aboriginal and Torres Strait Islander children from remote communities. The objective of this study was to determine how well these paediatric emergency weight estimation methods predict weight for this group of children. Method A retrospective descriptive study using the measured weights and heights of Aboriginal and Torres Strait Islander children from remote locations across the Northern Territory ( NT) was used. The weight estimation methods chosen to evaluate were the APLS, ' Best Guess', Luscombe and Nelson's formulae, Argall's modification, the Broselow® and Sandell® tapes, and the World Health Organization standard reference growth charts. Adjusted R-squared values for each method are reported, and agreement was measured in terms of mean percentage error ( MPE). Results A total of 2102 children were included. The length-based methods performed the best. The Broselow Tape had the highest adjusted R-squared value at 0.8886 in all age groups. The APLS, Luscombe and Argall's methods were the worst performing methods. The Broselow® Tape was also the best performing in terms of accuracy and precision, with an MPE of −0.35% (95% CI −0.82-0.1). Conclusion Our data support the use of the Broselow® Tape as the recommended method when estimating weight in an emergency for remote Aboriginal and Torres Strait Islander children in the NT for the 0-5 year age group. [ABSTRACT FROM AUTHOR]

Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies.Methods/design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal post-partum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance.Discussion: This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring. [ABSTRACT FROM AUTHOR]

Background One of the most commonly cited rationales for inclusive education is to enable the development of quality relationships with typically developing peers. Relatively few researchers have examined the features of the range of relationships that children with developmental disability form in inclusive school settings. Method Interviews were conducted with 25 children with developmental disability, aged 5 and 12 years, their 3 closest peers, and parents and teachers to examine 6 types of relationships. Results Behaviours associated with general friendship and acquaintance were the most commonly reported. Few dyads reported high rates of behaviour associated with special treatment, helping, ignoring, or intimate best friend relationships. Conclusions The relationships of the majority of dyads were characterised by friendship or acceptance, but evidence of more intimate relationships was limited. An important direction for future research is the examination of ways to encourage more intimate relationships. [ABSTRACT FROM AUTHOR]

Objective Little is known about Australian Aboriginal world views related to child rearing and child development. The aim of this qualitative study was to provide an opportunity for remote Aboriginal families in Central Australia to share what they felt was important for non- Aboriginal people, working in the same setting, to know about their parenting methods. Design, setting and participants A descriptive study was carried out in a remote Central Australian community by an Aboriginal and non- Aboriginal researcher, working in partnership, combining ethnographic and participatory approaches. Eight families with children under five were primary participants. Data were collected through participant observation and informal conversational interviews. Findings Three main interlinked themes were identified through this research: 'fitting in' (integration of children into community life), 'growing up' (children's development) and 'staying strong' (children's autonomy within a communal social structure). In this community, the development of independence and self-reliance within a closely nurturing environment are paramount. Children are taught responsibilities and obligations through interaction in community life from birth. Children's growth and development is not linked to chronological time scales. Rather, children are encouraged and praised for their social and emotional maturity as well as physical development, regardless of the age at which milestones are achieved. Conclusions This descriptive study provided an opportunity for Aboriginal people in one remote community to share their perspectives about child rearing and child development. It provides some insights into positive child-rearing practices and perspectives which can assist non- Aboriginal service providers to work more effectively with Aboriginal families. [ABSTRACT FROM AUTHOR]

Accurate data on the health of refugees in primary care is vital to inform clinical practice, monitor disease prevalence, influence policy and promote coordination. We undertook a retrospective clinical audit of newly arrived refugees attending the Darwin refugee primary health service in its first 12 months of operation. Data were collected from the clinic files of refugee patients who attended for their initial health assessment from 1 July 2009 to 30 June 2010 and were analysed descriptively. Among 187 refugees who attended in 2009-2010, ~60% were from Asia and 42% were female. The most common diagnoses confirmed by testing were vitamin D deficiency (23%), hepatitis B carrier status (22%), tuberculosis infection (18%), schistosomiasis (17%) and anaemia (17%). The most common documented health conditions recorded by the GPs were vitamin D deficiency or insufficiency (66%), followed by schistosomiasis (24%) and dental disease (23%). This clinical audit adds to a limited evidence base suggesting a high prevalence of infectious disease, nutrient deficiency and dental disease among refugees arriving to Australia. GPs involved in the care of refugees must be aware of the epidemiology of disease in this group, as some diseases are rare among the general Australian population. Our results also highlight the ongoing need for advocacy to address service constraints such as limited public dental access for this population. [ABSTRACT FROM AUTHOR]

This study addresses the question of what clinical supervision or CS means. Twelve supervisees and their clinical supervisors were asked the question: ‘what does CS mean to you?’ Inspired by Clarkson and Aviram's phenomenological study, the aim of this research was to compare and contrast the perspectives of clinical supervisors and their supervisees. The responses to this question from the supervisors' and supervisees' perspectives highlight differences and similarities in the way the term CS is understood and what ‘good’ CS is like from each group's viewpoint. The results reveal congruence in some areas of understanding, but also difference in the terms used to express the priorities of each group. For clinical supervisors ensuring ‘safe practice’ with clients was seen as the primary goal of contact with supervisees. For supervisees, ‘trust’, ‘support’ and having a ‘safe place’ to discuss problems was discussed as the priorities. The implications of these findings for social work practice are suggested. [ABSTRACT FROM AUTHOR]

Background: In a number of countries, frameworks have been developed to improve self-management support (SMS) in order to reduce the impact of chronic disease. The frameworks potentially provide direction for system-wide change in the provision of SMS by healthcare systems. Although policy formulation sets a foundation for health service reform, little is currently known about the processes which underpin SMS framework development as well as the respective implementation and evaluation plans.Methods: The aim of this study was to conduct a cross-country comparative document analysis of frameworks on SMS for chronic diseases in member countries of the Organisation for Economic Cooperation and Development. SMS frameworks were sourced through a systematic grey literature search and compared through document analysis using the Health Policy Triangle framework focusing on policy context, contents, actors involved and processes of development, implementation and evaluation.Results: Eight framework documents published from 2008 to 2017 were included for analysis from: Scotland, Wales, Ireland, Manitoba, Queensland, Western Australia, Tasmania and the Northern Territory. The number of chronic diseases identified for SMS varied across the frameworks. A notable gap was a lack of focus on multimorbidity. Common courses of action across countries included the provision of self-management programmes for individuals with chronic disease and education to health professionals, though different approaches were proposed. The 'actors' involved in policy formulation were inconsistent across countries and it was only clear from two frameworks that individuals with chronic disease were directly involved. Half of the frameworks had SMS implementation plans with timelines. Although all frameworks referred to the need for evaluation of SMS implementation, few provided a detailed plan.Conclusions: Differences across frameworks may have implications for their success including: the extent to which people with chronic disease are involved in policy making; the courses of action taken to enhance SMS; and planned implementation processes including governance and infrastructure. Further research is needed to examine how differences in frameworks have affected implementation and to identify the critical success factors in SMS policy implementation. [ABSTRACT FROM AUTHOR]