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Background Aim Methods Results Conclusion Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high‐quality physicians are needed.To assess the outcomes of 2 novel flexible training positions in Rheumatology.The clinical department, trainees and senior administration designed flexible, part‐time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part‐time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs.Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work−life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral.Flexible training positions can enhance clinical departments while enabling high‐quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings. [ABSTRACT FROM AUTHOR]

Abstract: The effects of seawater disinfection with continuous ozonation or with daily formalin treatment during flow-through culture, on the survival, growth, bacteriology and histology of eastern rock lobster, Jasus (Sagmariasus) verreauxi, phyllosoma were determined. Survival from hatch to Instar II was highest and bacterial abundance was least in low ozonated seawater (containing 5ppb ionised bromine, Br). By contrast, at high ozonation (45ppb Br) and medium ozonation (15ppb Br), 77% and 69% of larvae, respectively, suffered deformities at the moult to Instar II and starved to death. Histological examination of phyllosoma showed no differences in cuticular epithelium thickness but the digestive gland tissue of moribund deformed phyllosoma had significantly thinner tubule epithelium, the lumen was dilated, B-cells were more abundant and there was greater separation between the cuticular epithelium and distal tip of digestive gland tubules. In unozonated (Control) water, 66% of larvae died during Instar II probably resulting from a possible Vibrio infection. In a second experiment, survival to Instar III was highest at low ozonation or no ozonation without addition of formalin (0ppm). Bacterial numbers were lowest in low ozonation with 0ppm formalin treatments, compared to daily treatment with formalin at 10ppm or above. A concentration of 250ppm formalin killed all larvae by Instar III. In a final experiment, larval survival between Instar III to VI in low ozonated seawater was approximately 80% at formalin levels of 0 to 80ppm, whereas all larvae treated with 160ppm formalin died shortly after Instar V. Disinfection improved survival by minimising bacterial disease for the culture of phyllosoma to Instar VI without interrupting growth and development. The present study established that the optimum treatment for the culture of phyllosoma to Instar VI appeared to be low ozonation (5ppb Br) with 10ppm formalin. [Copyright &y& Elsevier]

Intimate partner cyberstalking, a form of intimate partner stalking, is stalking behaviour perpetrated via technology. Experiencing intimate partner cyberstalking is associated with significant negative outcomes including depression, anxiety, sleep disturbances, and social isolation. In the current study, we aimed to (1) establish intimate partner cyberstalking as a controlling relationship behaviour and (2) explore the utility of gender and dimensions of the Dark Tetrad traits (i.e., narcissism, Machiavellianism, psychopathy, and sadism) to predict intimate partner cyberstalking. Participants (N = 405; 69.6% women) completed an online questionnaire measuring personality, online behaviour, and controlling relationship behaviours. Controlling relationship behaviours was a significant predictor of intimate partner cyberstalking. Further, gender (women), vulnerable narcissism, direct sadism (verbal and physical), and secondary psychopathy were significant, positive predictors of intimate partner cyberstalking. Importantly, significant gender differences appeared regarding predictors; vulnerable narcissism and direct verbal sadism were significant predictors for women, and only secondary psychopathy was a significant predictor for men. Results are discussed in terms of implications and gender differences in motivations for perpetrating this controlling relationship behaviour. [ABSTRACT FROM AUTHOR]

Phaeochromocytomas and paragangliomas are rare catecholamine-producing neuroendocrine tumours which can potentially cause catastrophic crises with high morbidity and mortality. This best practice article considers the causes and presentation of such tumours, screening and diagnostic tests, management of these patients and consideration of family members at risk., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Gender is a critical determinant of mental health and well-being. Women are at greater risk of mental illness due to gender-based violence, economic disadvantage, and low social status. Women experience higher levels of acute and chronic stress and are twice as likely to be diagnosed with anxiety disorder. Anxiety disorder is a serious public health problem affecting 1:3 people worldwide, and according to WHO's International Classification of Diseases (ICD-10), a key symptom of anxiety is excessive worry. Few studies, however, have explored worry as a precursor to anxiety, and fewer have explored worry in relation to gender. This critical feminist study aimed to explore this phenomenon and identify the impact of worry on women and their mental health and well-being. Methods: Forty-five women living in Melbourne, Australia, participated in this qualitative study. They attended a 1-h semi-structured interview with the researcher to define and discuss worry and identify any impact or effect worry or worrying has had on their life as women. Results: The findings revealed that women worry about children, money, work, study, and violence against women. Conclusions: This study builds on the existing knowledge of the mental health and well-being of women, supports early intervention strategies to prevent anxiety disorder and long-term health risks; and meets the core objectives of the National Women's Health Strategy 2020-2030 to 'Improve the health and wellbeing of all women and girls in Australia'.

Background: Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high-quality physicians are needed., Aim: To assess the outcomes of 2 novel flexible training positions in Rheumatology., Methods: The clinical department, trainees and senior administration designed flexible, part-time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part-time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs., Results: Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work-life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral., Conclusion: Flexible training positions can enhance clinical departments while enabling high-quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings., (© 2021 Royal Australasian College of Physicians.)

Background: Natural history studies in neuromuscular disorders are vital to understand the disease evolution and to find sensitive outcome measures. We performed a longitudinal assessment of quantitative magnetic resonance imaging (MRI) and phosphorus magnetic resonance spectroscopy ( 31 P MRS) outcome measures and evaluated their relationship with function in lower limb skeletal muscle of dysferlinopathy patients., Methods: Quantitative MRI/ 31 P MRS data were obtained at 3 T in two different sites in 54 patients and 12 controls, at baseline, and three annual follow-up visits. Fat fraction (FF), contractile cross-sectional area (cCSA), and muscle water T 2 in both global leg and thigh segments and individual muscles and 31 P MRS indices in the anterior leg compartment were assessed. Analysis included comparisons between patients and controls, assessments of annual changes using a linear mixed model, standardized response means (SRM), and correlations between MRI and 31 P MRS markers and functional markers., Results: Posterior muscles in thigh and leg showed the highest FF values. FF at baseline was highly heterogeneous across patients. In ambulant patients, median annual increases in global thigh and leg segment FF values were 4.1% and 3.0%, respectively (P < 0.001). After 3 years, global thigh and leg FF increases were 9.6% and 8.4%, respectively (P < 0.001). SRM values for global thigh FF were over 0.8 for all years. Vastus lateralis muscle showed the highest SRM values across all time points. cCSA decreased significantly after 3 years with median values of 11.0% and 12.8% in global thigh and global leg, respectively (P < 0.001). Water T 2 values in ambulant patients were significantly increased, as compared with control values (P < 0.001). The highest water T 2 values were found in the anterior part of thigh and leg. Almost all 31 P MRS indices were significantly different in patients as compared with controls (P < 0.006), except for pH w , and remained, similar as to water T 2 , abnormal for the whole study duration. Global thigh water T 2 at baseline was significantly correlated to the change in FF after 3 years (ρ = 0.52, P < 0.001). There was also a significant relationship between the change in functional score and change in FF after 3 years in ambulant patients (ρ = -0.55, P = 0.010)., Conclusions: This multi-centre study has shown that quantitative MRI/ 31 P MRS measurements in a heterogeneous group of dysferlinopathy patients can measure significant changes over the course of 3 years. These data can be used as reference values in view of future clinical trials in dysferlinopathy or comparisons with quantitative MRI/S data obtained in other limb-girdle muscular dystrophy subtypes., (© 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Aim: A treat-to-target strategy is recommended for management of psoriatic arthritis (PsA), although there is lack of agreement regarding the best measure of disease activity to target. Physician assessments included in traditional indices can be complex and time consuming to complete and cannot be readily conducted by telehealth. This study compares the routine assessment of patient index data 3 (RAPID3), an efficient tool comprising patient self-assessment, with traditional clinician-led composite measures in the PsA clinic setting., Methods: Data were collected prospectively from July 2016 to March 2020 in 2 dedicated PsA clinics in Sydney, Australia. A receiver operating characteristic (ROC) curve was created for comparison of RAPID3 score with composite scores minimal disease activity (MDA), very low disease activity (VLDA) and disease activity in psoriatic arthritis (DAPSA) in low disease activity or remission., Results: Ninety-three patients had simultaneous collection of RAPID3 and MDA measures. Mean (SD) age was 49.9 (13.5) years, 50.5% were male and 23 (24.7%) had erosive disease at baseline. RAPID3 scores ≤3.2 and ≤2.7 (range 0-30) had high sensitivity and specificity for VLDA and DAPSA remission respectively, with ROC curve area under the curve (95% CI) of 0.94 (0.91-0.97) and 0.96 (0.93-0.99)., Conclusion: RAPID3 has good agreement with physician-led composite scores of MDA, VLDA and DAPSA, and provides a viable alternative to composite scores. This is particularly helpful in settings that do not allow for clinical examination, for example telehealth., (© 2022 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Aim: This study is a narrative inquiry that aims to better understand the experience of nurses implementing a Person-Centred Care (PCC) bundle onto an acute care ward in a large hospital in Melbourne, Australia., Background: The PCC includes five key focus areas aimed at streamlining nursing practice 1) Nursing assessment and care planning, 2) bedside handover, 3) patient safety rounding, 4) patient whiteboards, and 5) safety huddles. The PCC bundle outlines a nursing care process that is interactional with the patient, focused on information sharing, safety and respect., Method: A narrative inquiry was used to explore the nurse's experiences implementing the PCC. Surveys and focus groups were used to collect data and thematic analysis was used to identify any key themes., Results: The three themes were; Passing the baton; Keeping the cogs moving when time poor; and Deep interpersonal relating-The sum of us., (Copyright © 2020. Published by Elsevier Inc.)

The purpose of this pilot study was to explore how best to prepare and support nursing undergraduate students learning in a community/primary care setting through a Student Managed Initiatives in Lifestyle Education (SMILE) project. Further to this our intention was to evaluate the ways in which students were able to apply nursing theory to the practice of identifying and responding to the health needs of vulnerable people. Using a collaborative approach and a qualitative method, this pilot study used focus group discussions to explore both the experiences of community participants and undergraduate nursing students. This project found that students were able to draw on theoretical understandings and their simulated learning experiences to support their learning in a complex, non-clinical practice setting. It also illustrates the way in which community centres and other naturalistic environments where individuals and groups meet, can provide spontaneous and rewarding opportunities for nursing students to develop and apply health promoting knowledge and skills. Shaping nursing curricula with this in mind, creates the potential for nurses to make a significant contribution to improved health outcomes for vulnerable and/or marginalised people., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier Ltd.)