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Biomedical subjects

C Veitch

Publications and source records attributed to C Veitch.

At least 19 recordsLinked to original sources
PubMed2007

A retrospective review of place of death of palliative care patients in regional north Queensland.

BACKGROUND: Palliative care strives to offer patients and their families choice in the location of their management and final terminal care. The place of death has been shown to be related to various patient, carer and health service factors. AIM: This study explores place of death of palliative care patients in regional north Queensland, and investigates which patient, disease, and other factors impact on place of death. METHODS: All patients under the care of the specialist Palliative Care Service (PCS) at The Townsville Hospital, who died in 2004, were identified. Medical charts for these patients were analysed for various demographic data, disease-related information and place of death. RESULTS: Some 270 patients were analysed. A total of 162 were male, median age was 72 years, and 146 (54%) were married. Home death rate was 19% (54 patients), with 64% (173) of patients dying in hospital. Factors significantly associated with home death included younger age, married, a diagnosis of colorectal carcinoma, and the involvement of community nurses. There was a trend towards male patients being more likely to die at home. Logistic regression analysis indicated that younger age and community nurse involvement were significantly associated with home death. DISCUSSION: The results of this study are in keeping with available, largely urban-based literature, with respect to predictive factors of home death. Further prospective study, with an emphasis on choice regarding place of care and GP involvement with palliative care patients, is warranted.

Age Factors↗
PubMed2006

Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings.

INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.

Community Health Planning↗
PubMed2006

A descriptive study comparing health attitudes of urban and rural oncology patients.

INTRODUCTION: Rural patients have poor outcomes in cancer management. Previous studies have shown different health beliefs and values in rural populations with high levels of stoicism and fatalism, leading to later presentation and diagnosis, with subsequent poorer prognosis and survival. This study explores the relationship between urban or rural background and health attitudes of newly diagnosed oncology patients, attending one oncology unit in north Queensland, during a 5 month period. This study is a forerunner to a planned larger project to explore the research question: do oncology patients from rural backgrounds differ in their health attitudes and hope levels compared with those from urban backgrounds? The aim of this study was to determine the utility of the selected validated instruments, newly diagnosed patients' willingness and ability to complete the composite survey instrument, and to identify likely issues for inclusion and/or greater focus in the larger project. As pilot studies are also used to develop or refine research questions and hypotheses, this article also considers some research questions for the planned large scale study. METHODS: Self-administered questionnaire survey of 47 patients newly referred to the Medical Oncology Department in The Townsville Cancer Centre. Scales used were: the EORTC QLQ-C30 to assess symptom burden and quality of life; the Duke UNS Functional Social Support Questionnaire to assess social support; the Herth Hope Index to assess hope; and the Multi-Dimensional Health Locus of Control to assess health beliefs. Data were collated and transformed according to the various scales' scoring manuals. Rurality was ascertained using the RRMA classification and patient self-assessment. Uni-variate analyses were conducted as small numbers precluded multi-variate analysis. Non-parametric Mann-Whitney U and Kruskal-Wallis tests were used where data were skewed, or categorical. Monte-Carlo estimations of p-values were generated. RESULTS: In all, 28 of 47 patients classified as rural, 27 were suitable for curative treatment, and 31 were male. Median age was 56 years. Some respondents (17%) identified as 'rural', although they had an urban residence, and vice versa. Health attitude scores were not affected by global health scores or by intent of treatment (palliative/curative). Males scored significantly higher for belief in chance. Rural patients scored significantly higher for internal belief and belief in chance. No statistically significant differences were evident between rural/urban patients by gender, nor social support scores. Hope levels were generally high with no significant difference between urban and rural patients, regardless of treatment intent. DISCUSSION: The study does reveal differences in health attitudes between urban and rural populations; however, there are several confounding factors which may contribute to this, especially gender. In this study women were under-represented. People with fatalistic beliefs (high belief in chance) tend to have poor initiative in health matters which may cause delay in seeking treatment, or poor compliance with treatment. Analysis is limited by small numbers of patients. This study is a pilot to a larger project to investigate health attitudes and decisions by oncology patients in northern Queensland. The questionnaire was well received by patients, but the need for a dedicated recruitment person was evident. There is a need to determine how patients identify in terms of rurality over and above their actual place of residence.

Adult↗
PubMed2006

Cloning and sequence analysis of pituitary prolactin cDNA from the northern brown bandicoot (Isoodon macrourus).

The nucleotide sequence for pituitary prolactin cDNA from the marsupial bandicoot (Isoodon macrourus) was determined by reverse transcription-polymerase chain reaction and 5'/3' rapid amplification of cDNA ends. The deduced amino acid sequence showed high sequence identity with brushtail possum prolactin (95%) and all of the expected structural features of a quadruped prolactin. A prolactin gene tree was constructed and rates of evolution calculated for bandicoot, possum, opossum and several mammalian and non-mammalian prolactins. Bootstrap analysis provided strong support for marsupials as a sister group with eutherian mammals and weak support for opossum and bandicoot as an independent grouping from the brushtail possum. The rates of molecular evolution for marsupial prolactins were comparable to the slow rate seen in the majority of quadruped prolactins that have been sequenced.

Amino Acid Sequence↗
PubMed2004

Community involvement in medical practitioner recruitment and retention: reflections on experience.

The provision of health services to rural and remote communities has been the source of much concern and debate in recent times. One aspect of this is the universal problem of insufficient medical practitioners in rural areas and the associated issues of recruitment and retention. Rural communities can play an important role in the recruitment and retention of health professionals, particularly in terms of aiding the integration of health professionals and their families into the community. Community 'involvement' is not community 'development' in the usual sense of that term. Community involvement is about engaging and facilitating active community participation and leadership in the process at hand. This article reflects on experience gained through working with rural and remote communities in Queensland, Australia, with the key purpose of facilitating active community involvement in the recruitment and retention of medical practitioners. This article raises and discusses a number of issues arising from these experiences, with particular focus on barriers and opportunities to community involvement, and working with other agencies. Communities and agencies that attempt to increase rural community involvement in health service planning, provision, recruitment and retention should consider the following. For communities: Involvement must be real--active participation; Expectations need to be achievable (short and long term); Outcomes should be sustainable; Resources and capacity should remain in the community. For agencies: Avoid creating unrealistic community expectations; Be aware of time and resource requirements and constraints; Be consistent, forthright and honest in all dealings with communities; Keep communities informed of pending policy changes; See the process through to whatever conclusion.

Journal Article↗
PubMed2002

Exploring indicators of experiential place integration in a sample of Queensland rural practitioners: a research note.

INTRODUCTION: Until recently, the focus on the universal problem of insufficient medical practitioners in rural areas had been on training and recruitment. Many of the rural workforce strategies in Australia targeted selection of medical students, medical curricula, postgraduate training and retraining experienced urban graduates. To date, there is little consistent evidence that the rural workforce situation in Australia is improving. The decision to remain in rural practice appears to be a dynamic equilibrium of positive and negative factors, and issues such as overwork and poor adaptation to role changes easily upset this equilibrium. AIM: To perform a scoping exploratory post facto review of interview data with a view to establishing the potential for a dedicated prospective study of rural GP retention. METHODS: Theoretical construct of 'dimensions of integration' was used in a post facto review of in-depth interview transcripts of 17 medical practitioners who had left rural practice. The construct posited integration as an active developmental process based on three 'principles'--security, freedom and identity--which together form the basis of practitioner retention. A series of 'dimensions' (n = 27) exists within each of these principles. RESULTS: Many of the 27 dimensions were found to be absent, particularly for practitioners who left before they originally intended. In some cases, apparently well-established practitioners (in terms of numbers of dimensions present) left because of some external 'pulling factor'. Dimensions related to practitioner security were generally most often missing. CONCLUSION: The potential for a dedicated prospective study was established.

Journal Article↗
PubMed2002

Role of PGF2alpha and oxytocin in parturition in the brushtail possum (Trichosurus vulpecula).

Maturation of the fetal pituitary and adrenal glands allows the secretion of cortisol, which in turn leads to an increase in prostaglandin and mesotocin production. The production of prostaglandin and mesotocin results in an increase in uterine contractions and initiates birth in marsupials. The major metabolite of PGF(2alpha), 13,14-dihydro-15-keto-prostaglandin F(2alpha) (PGFM), has been found in the plasma of the possum at the time of birth and administration of PGF(2alpha) to female possums induced the adoption of the birth position. Evidence that mesotocin is an integral hormone of birth in the tammar wallaby indicates that both PGF(2alpha) and mesotocin or oxytocin are required for marsupial birth. The presence of PGF(2alpha) receptors in the uterus and corpus luteum of the possum, and the in vitro uterine responsiveness to PGF(2alpha) or oxytocin, were examined. PGF(2alpha) receptors were not observed in possum uteri and the inability of PGF(2alpha) to cause contractions indicates that PGF(2alpha) is not involved directly in contraction of the uterus at parturition. The presence of oxytocin and mesotocin receptors in the uterus of possoms and the ability of oxytocin to induce uterine contraction in vitro supports the view that mesotocin is required for expulsion of the young from the uterus. Low numbers of PGF(2alpha) receptors were found in the possum corpus luteum at birth, indicating an involvement of PGF(2alpha) in regression of the corpus luteum.

Animals↗
PubMed2001

General practice research. Problems and solutions in participant recruitment and retention.

BACKGROUND: Increasing interest in general practice research, especially postal surveys, has been met with decreasing response rates. Prospective, longitudinal surveys pose additional concerns for general practice researchers, one of the major problems being sample attrition after project commencement. OBJECTIVE: This article draws on the authors' experiences from seven studies conducted by them to identify useful strategies for researchers who need to recruit general practitioners and/or their patients, with particular reference to retaining participants across time. A list of issues, lessons learned and possible strategies was developed which, although not exhaustive, probably reflects those commonly encountered in many general practice studies. DISCUSSION: The issues identified here are not necessarily new, but it is useful to revisit such issues and to review and reiterate methods and processes, as even experienced researchers encounter problems from time to time. Studies involving prolonged participation especially, require diligent consideration of likely recruitment/retention problems.

Australia↗
PubMed2000

General practitioners leaving rural practice in Western Victoria.

The West Vic Division of General Practice, working with the Department of General Practice, The University of Queensland conducted a qualitative study of GPs who had left western Victoria over the previous 10 years to examine issues relating to the decision to leave rural practice. This study was conducted as part of a project to explore the role of rural Divisions in assisting with general practitioner recruitment and retention. The study supported the conclusions of a similar study in North Queensland and proposed a model that regards rural retention as an interplay of influences both positive and negative with acute trigger factors that can precipitate the decision to leave. Conflict and dissatisfaction with aspects of rural GP hospital work appeared to be a relatively frequent trigger factor that is immediately amenable to intervention from Divisions of general practice and through improvement in negotiation and conflict resolution skills for rural general practitioners.

Conflict, Psychological↗
PubMed2000

Interpractitioner communication: telephone consultations between rural general practitioners and specialists.

The results of a study that sought to investigate the utility of and satisfaction with telephone consultations from the perspective of general practitioners and specialists are reported. Semi-structured interviews with rural general practitioners and specialists were used to elicit information about their most recent telephone consultations. The telephone was found to be an important means of communication for rural practitioners, primarily in terms of organising referrals. General practitioners tended to called specialists who they knew and appeared to have fairly well-formed networks of specialists who they called for most of their concerns. Trust is an important element of interpractitioner communication as it increases understanding and confidence in the reliability of the information exchanged. Good working relationships ensure that rural general practitioners have an accessible source of acceptable specialist support.

Attitude of Health Personnel↗
PubMed1999

Community participation in the recruitment and retention of rural doctors: methodological and logistical considerations.

Two Queensland rural communities with histories of poor general practitioner (GP) recruitment and retention participated in a process aimed at developing broadly based community action plans to recruit and retain GPs. Despite their very different physical and social characteristics, the two communities developed many similar objectives and strategies, which had the possibility of being implemented more widely. The community participation process can be both time- and cost-effective if consideration is given to a variety of methodological and logistical issues. The process is a means by which communities, Divisions of General Practice, government, academic institutions and others can work together to recruit and retain medical practitioners.

Community Participation↗
PubMed1999

Consumers' after hours health care decisions. Comparison between those who did and those who did not seek care in an Australian provincial city.

OBJECTIVE: To compare the demographic and illness characteristics of people who sought after hours care with those who did not, to identify differences that might be exploited in patient education regarding 'appropriate' use of after hours care. METHOD: Structured telephone interview survey of randomly selected householders in Townsville. RESULTS: An 88% response rate was achieved (1227/1402). A total of 10.8% (133/1227) of respondents had sought after hours care for themselves in the 3 months before interview. A further 10.9% (134/1227) had decided against seeking care during that period. The two groups were demographically similar, except in terms of health care training and perceived travel time to after hours care. Self reported conditions varied only for ICPC general, musculoskeletal and skin chapters. Symptom related issues were most important in the decision to seek care, while self care procedures were the most common reason for not seeking care, followed by access related issues. CONCLUSIONS: The decision to seek care is an individual process that cannot be reliably predicted by demographic characteristics. Broad scale community education programs aimed at reducing 'inappropriate' use of after hours services would need to find a balance between increasing knowledge for self care of minor conditions and emphasising the importance of being alert to signs and symptoms of life threatening conditions.

Adolescent↗
PubMed1996

Fostering multidisciplinary research and approaches to rural health issues: the concept of an International Summer Institute.

The challenge of how best to provide equitable, accessible and affordable health care in rural and remote settings is an international concern. It has been acknowledged that a multidisciplinary approach to current rural health issues involving social scientists and health practitioners may be crucial in developing appropriate responses. One initiative designed to facilitate multidisciplinary research and greater collaboration between researchers and practitioners was an International Summer Institute sponsored by the Social Science and Humanities Research Council of Canada. This article outlines an Australian perspective on the rationale for, background to, and structure of this initiative, and evaluates it as one option for promoting multidisciplinary approaches to rural health research.

Allied Health Personnel↗
PubMed1996

Application of primary health care standards to a developing community health group: a rural case history.

The development of community health groups in rural settings involving private general practitioners and other health care workers has been relatively rare. This case history examines the activities of such a group and the views of its participants over a 12-month period. It considers whether the principles of primary care and the relevant Community Health Accreditation and Standards Program criteria can be applied in such a setting. The centre was able to meet most of the primary care criteria; however, some other important elements that could be helpful to further developments emerged in the research process. These included the sensitivity of a rural community to an individual case or patient focus in a case conference setting and the high level of acceptance of population or healthy-community goals. Other key issues included the strength (in terms of advocacy for health service provision) of an intersectoral group in a rural setting. Positive benefits were perceived to accrue from the increased professional and intersectoral communication. The role of the private general practitioner was focal, but the participants did not believe this necessarily had to be a leadership role. The initiation of such a conference and its leadership could be undertaken by any interested and appropriately skilled member. Organisation, administration, continuity and cost are important practical issues which need to be examined in early stages of development and taken into account in evaluation.

Accreditation↗
PubMed1992

Socioeconomic status and mortality revisited: an extension of the Brisbane area analysis.

Using the methodology of an earlier study of socioeconomic mortality gradients, we partitioned Brisbane City into five strata of equal size on the basis of suburb scores derived from aggregate socioeconomic census data. Numbers of deaths by stratum, age, sex and cause were obtained from mortality files. For almost all causes, mortality gradients had not changed between 1976-1979 and 1980-1987. A new category, medically-preventable death under age 65, had lower rates in higher-ranking suburbs. Potential years of life lost (PYLL) per unit of population, age-standardised, were also computed by stratum and cause. External causes of death were the main contributors to PYLL among men, with a strong socioeconomic gradient, while neoplasms were most important among women, with little evidence of a social class effect. It is estimated that, in urban Australia, the annual number of additional deaths under age 65 due to socioeconomic circumstances is over 2000 for males and over 1000 for females. This study provides a baseline against which the programs of health advancement initiated in the mid-1980s may be evaluated, or conversely, the effects of societal changes assessed.

Adolescent↗
PubMed1990

Procedural skills for general practice. The results of a Queensland survey.

The acquisition of procedural skills for general practice, appears to be somewhat haphazard. A list of 139 procedural skills of possible use to a GP was compiled. A survey of sixth year medical students, faculty and hospital teaching staff, and GPs in Queensland was undertaken to evaluate the perceived importance of these skills. The list has been modified to 47 'essential' and 22 'essential or desirable' skills, and could form the basis for more directed learning in the area of procedural skills.

Attitude of Health Personnel↗