RESUMEN
Despite the "best of intentions", Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non-Aboriginal Australians. We examined 2150 original research articles published over the 12-year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases. The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%). This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. We anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health.
Asunto(s)
Enfermedades Transmisibles , Servicios de Salud del Indígena , Australia , Humanos , Pueblos Indígenas , Intención , Nativos de Hawái y Otras Islas del PacíficoRESUMEN
PURPOSE: Recognition and responses of the health system to healthcare errors are key areas for improvement in oncology. Despite their role in direct patient care, nurses' perceptions of errors have rarely been explored. The aim of this study was to determine oncology nurses' direct experience of healthcare errors in the previous six months; the circumstances surrounding the error; and ensuing actions by the healthcare system. METHODS: Cross-sectional survey of nurses who were members of an oncology nursing society and/or registered or enrolled nurses employed in an oncology setting. Participants indicated whether they had direct experience (i.e. direct involvement or witnessing) of error(s) in the previous six months. Those who experienced an error indicated their perceptions of the: cause; location and phase of care; how the error was identified, who was responsible, level of harm and action(s) taken. RESULTS: 67% (n = 65/97) of nurses who completed the survey had direct experience with at least one error in the previous six months. According to these nurses, most occurred during treatment (n = 48, 74%), happened in outpatient clinics (n = 28, 43%) and were related to chemotherapy (n = 15, 23%). Nurses perceived errors were primarily caused by nurses (n = 36, 55%) and doctors (n = 27, 42%); and 54% (n = 35) were deemed 'near-miss'. Nurses perceived errors were recorded (n = 40, 62%), explained to patients (n = 33, 51%) and an apology provided (n = 32, 49%). CONCLUSION: Two-thirds of oncology nurses in this study had direct experience with an error in the previous six months. Nurses perceived response to errors as inconsistent with open disclosure standards. Strategies to improve accuracy of measures of error and response of the health system, including adherence to open disclosure processes, are required.
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Actitud del Personal de Salud , Errores Médicos/psicología , Errores Médicos/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Anxiety and depression can be heightened among individuals living with chronic diseases. Identifying these individuals is necessary for ensuring they are provided with adequate support. Traditional tools such as clinical interviews or symptom checklists are not always feasible to implement in practice. Robust single-item questions may be a useful alternative. This study aimed to measure agreement, sensitivity, specificity, positive predictive value and negative predictive value of a single-item question about anxiety and depression compared to the widely used Hospital Anxiety and Depression Scale (HADS). A cross-sectional survey of 2,811 people with cancer attending 19 treatment centres in Australia. Patients were approached in the waiting room prior to an outpatient clinic appointment and invited to complete a pen and paper survey. Participants completed the HADS as well as 2 single-items asking if they have felt anxious or depressed in the last week. The single-items for anxiety and depression each demonstrated moderate levels of sensitivity (0.78 for anxiety; 0.63 for depression) and specificity (0.75 for anxiety; 0.84 for depression) against the relevant HADS subscale. Positive predictive values were moderate (0.53 for anxiety and 0.52 for depression) while negative predictive values were high for both single-item questions (0.90 for anxiety and 0.89 for depression). The single-item measures of anxiety and depression may be useful to rule out individuals who do not require further psychological assessment or intervention for anxiety and depression. Further research is needed to explore whether these findings generalise to other chronic diseases.
Asunto(s)
Ansiedad/diagnóstico , Depresión/diagnóstico , Neoplasias/psicología , Cuestionario de Salud del Paciente , Autoinforme , Adulto , Anciano , Ansiedad/psicología , Australia , Enfermedad Crónica/psicología , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Adulto JovenRESUMEN
BACKGROUND: Supporting people after bereavement is a priority area for many health services. Investment in bereavement care must be supported by a rigorous evidence-base. AIM: To examine the (1) relative proportion of descriptive, measurement and intervention research in grief counselling and (2) quality and effectiveness of intervention studies. DESIGN: Systematic review of studies published in the area of grief counselling. DATA SOURCES: MEDLINE, Embase, Cochrane Library and PsycINFO databases were searched for studies published between 2000 and 2013. Eligible papers were categorised into descriptive, measurement, review, commentaries and intervention studies. Intervention studies were assessed against the Cochrane Effective Practice and Organisation of Care methodological criteria, and papers meeting criteria were assessed for quality. The impact of interventions on grief, psychological morbidity and quality of life was examined. RESULTS: A total of 126 data-based papers, including 47 descriptive, 3 measurement and 76 grief counselling intervention studies were included. Only 59% (n = 45) of intervention studies met Effective Practice and Organisation of Care design criteria. Overall, study quality was poor, with the majority of interventions showing a risk of bias in several key areas. The three studies that met all criteria showed mixed effectiveness. CONCLUSION: Grief counselling interventions require a strong rationale for design, and a systematic approach to development and evaluation. Descriptive research efforts should inform this process, focusing on homogeneity in sample, identification of risk factors for complicated grief and the impact of extraneous factors on intervention effects. Interventions should include comparisons to usual care, as well as replication to confirm positive findings.