Development of a risk prediction model for Barrett's esophagus in an Australian population

Esophageal adenocarcinoma has poor 5-year survival rates. Increased survival might be achieved with earlier treatment, but requires earlier identification of the precursor, Barrett's esophagus. Population screening is not cost effective, this may be improved by targeted screening directed at individuals more likely to have Barrett's esophagus. To develop a risk prediction tool for Barrett's esophagus, this study compared individuals with Barrett's esophagus against population controls. Participants completed a questionnaire comprising 35 questions addressing medical history, symptom history, lifestyle factors, anthropomorphic measures, and demographic details. Statistical analysis addressed differences between cases and controls, and entailed initial variable selection, checking of model assumptions, and establishing calibration and discrimination. The area under the curve (AUC) was used to assess overall accuracy. One hundred and twenty individuals with Barrett's esophagus and 235 population controls completed the questionnaire. Significant differences were identified for age, gender, reflux history, family reflux history, history of hypertension, alcoholic drinks per week, and body mass index. These were used to develop a risk prediction model. The AUC was 0.82 (95% CI 0.78-0.87). Good calibration between predicted and observed risk was noted (Hosmer-Lemeshow test P = 0.67). At the point minimizing false positives and false negatives, the model achieved a sensitivity of 84.96% and a specificity of 66%. A well-calibrated risk prediction model with good discrimination has been developed to identify patients with Barrett's esophagus. The model needs to be externally validated before consideration for clinical practice.

Seeking an Explanation for the Poor Uptake of In-Hospital AED Programs

The automated external defibrillator (AED) has been adopted by emergency service personnel as a first-line intervention in the management of out-of-hospital cardiac arrest (OHCA). AED leads to more successful Advanced Cardiac Life Support; consequently, national resuscitation organisations worldwide have recommended that nurses and doctors also integrate AEDs as a component of their basic life-support response to cardiac arrest. Despite these recommendations, the implementation of AED programs within hospitals has been generally sporadic and isolated. A continuation of this situation will most likely disturb and perplex nurses and patients, as they are key stakeholders with respect to upholding recommended BLS practices. In the absence of any explanation from change agents within hospitals, this paper seeks, by way of a pilot study and a review of the literature, to identify the extent of the problem and identify factors contributing to the relatively slow uptake of this device. We argue that nurses and other first responders to in-hospital cardiac arrest (CA) have much to gain, in the context of Occupational Health Safety and Welfare (OHS and W), from ready access to AEDs. Cost factors are also considered, with initial cost of AED purchase likely to be a major concern for managers of hospital budgets. The issues we discuss in this paper clearly support the need for further research to (a) explain the nature of public hospital resistance to AEDs and (b) to consider whether AEDs will provide practical advantages to public hospitals from an occupational, social and economic perspective.

Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners

BACKGROUND

Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention.

DESIGN

In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population.

RESULTS

This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.

Australian men's long term experiences following prostatectomy: a qualitative descriptive study

The experiences of men in the immediate postoperative period following surgery for primary prostate cancer are well reported in the literature. Recognition of the unresolved morbidity encountered by men in the medium term suggests that a more complete understanding of how men cope in the long term is needed. Health professionals are deserving of a more complete literature for the purpose of providing holistic care for this group of men, providing informed advocacy and better support for men living with the diagnosis of prostate cancer. Emerging literature reveals that men's knowledge of the long term problems associated with prostatectomy was inadequate at the time they consented to treatment; the likely outcomes at all phases of recovery should be taken into account when deciding on choice of treatment or no treatment. This qualitative study aims to describe men's long term recovery following prostatectomy for the purpose identifying the effects of unresolved post surgical morbidity. The content analysis of focus group interviews revealed that incontinence and impotence were a major source of emotional tension affecting the men's social interactions and sense of self-worth. The men expressed great regret over the lack of information accessible to them for evaluating the risk and nature of long term problems. The thick description provided in this study identifies the need for empathetic assessment of men with ongoing post surgical issues and alerts the reader to the inadequacies of information provided prior to consent to prostatectomy.

Exploring the complexities of prostate cancer screening with a view to supporting informed consent

Men request to be screened for prostate cancer because they believe they are exhibiting responsible health promotion behaviour and there are definite benefits from the early detection of the disease. This belief about the benefits is in contrast to several national guidelines recommending that screening for prostate cancer not be done. Despite the guidelines men continue to request to be screened and doctors continue to supply screening tests to asymptomatic males. The lack of an appropriate screening test has been a key factor in supporting recommendations not to screen. However, recent studies show improved accuracy in the use of serum prostate specific antigens (PSA) as a screening tool. This implies that a revision of the guidelines might soon be appropriate. It is important that nurses and other health professionals are kept abreast of developments in prostate screening to assist men with their screening options to ensure their fully informed consent.

Transmission of health knowledge and health practices from men to boys among Aboriginal communities and non-Indigenous Australians: searching for evidence

Although men's health literature has developed rapidly over the last decade and covers a plethora of issues, almost no attention has been paid to understanding the transmission of health knowledge from men to boys in Australian society. This paper identifies a paucity of literature on the topic and offers explanations for this phenomenon. To raise awareness among health professionals of the need to explore the topic, the authors outline literature pertaining to men's role within the family and gender specfic cultural practices. This information is combined with the authors' personal experiences with Indigenous and non-Indigenous Australian men to provide a background to this emerging issue.

The complexities of interviewing Italo-Australian men about sensitive health issues

The increase in the incidence of prostate cancer in Australia has been followed by an increase in prostate cancer awareness among Australian adults. However, men's level of knowledge on the subject has never been systematically assessed (Laws et al, 2000). It was postulated by Laws et al., (2000) that many men from Non English Speaking Cultures (NESC) experience language and cultural difficulties that would ultimately impinge on their ability to access information about prostate problems. In exploring 'The knowledge and attitudes of Italo-Australian men toward prostate cancer' the researchers became aware that the majority of interviewees (n=20) were reluctant to divulge information on all aspects of the topic (Drummond et al., 2001). This report highlights the importance of using a reflexive phase within the research process as a means of identifying factors that can, in part, explain the paucity of data and act a basis for developing strategies to overcome the problem. The research subsequently evolved to incorporate a secondary research question. 'Why were the men at interview so reluctant to speak of general health problems and health problems related to prostatic dysfunction?' A focus group comprised of Italo-Australian men was used to explore gender and culturalfactors, perceived by the researchers as, restricting theflow of information. Several barriers thought to be limiting the release of information were confirmed. We conclude that our findings will have implications for other researchers wanting to maximise their chances of accessing information rich datafrom the experiences of men from NESCs.

A Content Analysis of Contemporary Men's Health Books Marketed to the Health Professional

The concept of "men's health" per se has followed on from the development of substantial social theories that coherently supported the women's health movement and women's health policy. Subsequently, literature on women's health took a variety of forms and has had time to meet the growing needs of that market. While men's health literature is a burgeoning area the needs and derivations of the market are yet to be fully understood. This review of three men's health books intended for health professionals and easily located in Australian bookshops or on-line marketing, shows that there are numerous gaps in content that are likely to frustrate the health professional who is wanting salient knowledge and appropriate guidelines on social and health practice. We argue that the reason for the mismatch between what is supplied and what is demanded by the health professional can, to a great extent, be attributed to two important factors. That is, the domination of the biomedical model as a means of structuring and presenting information and a rhetorical approach that attempts to extrapolate theories about masculinity to men's health issues. We further suggest that a more vibrant rhetoric is about to take place with the emergence of a more critical appraisal of where the men's movement is heading.

A proactive approach to assessing men for eating disorders

Assessment guidelines for nurses on the subject of eating disorders (EDs) focus primarily on evaluating the severity and progress of the problem for females who have already received a formal ED diagnosis. We argue that, because there is scant research into men with eating disorders and men strive to conceal this health problem, nurses should be equipped with information that will support earlier detection of EDs among men and boys before they manifest as a serious health problem. We advocate the use of epidemiological data to identify groups of men most at risk and the use of qualitative interview data as a means of grounding the nurse on the issues these men face when seeking to modify their body image.

Knowledge of and Attitudes towards Prostate Cancer among Italo-Australian Men

Information surrounding the treatment of prostate cancer is not clearly defined by medical science. Consequently, health professionals are divided with respect to the most appropriate method of screening and detection. The assumption that if health professionals are not clear, what are the perceptions of Australian males in terms of prostate cancer detection and treatment options? Further, what does it mean to men from non-Australian cultures with language and cultural barriers impacting on choices and decisions relating to health? (Laws et al., 2000). This paper provides insight into the lives of 20 Italo-Australian men. It attempts to draw on their perceptions and understandings of prostate cancer and prostate cancer awareness from their unique perspectives. It will highlight some of the significant issues with respect to being an Italian born man living in Australia and how this impacts on health issues, and specifically prostate cancer awareness. The intention of this paper is to provide in-depth qualitative data to emphasise Italo-Australian men?s health perspectives and experiences.

On What Basis do Australian Men Make Informed Decisions about Diagnostic and Treatment Options for Prostate Cancer?

Men rely on general practitioners (GPs), other medical and nursing staff to provide them with information on prostate cancer and urinary symptoms. This paper identifies several problems encountered by Australian men in gaining information necessary for making an informed decision with respect to the detection and treatment of prostate cancer. An examination of disparities between national guidelines for screening and screening practices of GPs reveals that complex medical issues exist in relation to the supply of screening tests. Similar complexities exist for Australian men trying to make an informed decision about prostate cancer treatments. In particular, there is very little evidence to show that any treatment option or combination of treatments has better outcomes. Thus, it is unlikely that Australian men, even those who are assertive and information literate, make fully informed decisions when consenting to screening procedures and treatment for prostate cancer. Men with limited use of English and poor literacy skills, such as older migrants are further disadvantaged in terms of gaining information, and are likely to remain largely uninformed on even the basic issues relating to prostatic symptoms and prostate cancer. The task facing nurses is to research the needs of men and their communities as a basis for the development of accessible information resources. This approach will provide evidence in support of holistic nursing practice as well as increasing the likelihood that men's consent to prostate screening and treatment constitutes an informed decision.