A qualitative study of the role of Australian general practitioners in the surgical management of obesity.

General practitioners (GPs) are increasingly managing patients with class 2 and 3 obesity (body mass index [BMI] > 35 and 40 kg/m2 , respectively). Bariatric surgery is considered for patients with class 2 obesity and comorbidities or class 3 obesity where sustained weight loss using non-surgical interventions has not been achieved. In Australia, GPs facilitate access to surgery through referral processes, but the nature of GP involvement in bariatric pre- and post-surgery care is currently unclear. This qualitative study involved 10 in-depth interviews with GPs and 20 interviews with adults who had all undergone laparoscopic adjustable gastric banding (LAGB) for weight management in Tasmania, Australia. Interviews were transcribed and analysed thematically. Referrals for bariatric surgery commonly occurred at the patient's request or to manage comorbidity. Consistent with previous studies, for GPs, referral patterns were influenced by previous case experience and patients' financial considerations. Accessibility of surgery was also a consideration. Post-surgery, there was a lack of clarity about the role of GPs, with patients generally preferring the surgical team to manage the LAGB. In bariatric surgery, patient preference for surgery, access and comorbidity are key drivers for referral and post-surgical monitoring and support. Greater role clarity and enhanced collaboration between surgeons, GPs and patients following surgery is likely to enhance the experience and outcomes for patients.

Barriers to lifestyle risk factor assessment and management in hypertension: a qualitative study of Australian general practitioners.

Hypertension is a leading cause of mortality and disease burden worldwide, yet its management remains suboptimal. Identification and management of lifestyle risk factors should be a clinical priority in all patients because of the beneficial effects of lifestyle intervention on blood pressure. The objective of this qualitative focus group study was to identify barriers to lifestyle management in hypertension in Australian general practice. Purposeful sampling was used to select large group practices. Six focus groups (n=30) were audio recorded and transcribed. An iterative thematic analysis was conducted. Overall participants felt they had the required knowledge to provide broad lifestyle advice. However, cynicism dominated due to an overwhelming lack of success in practice. Patient reluctance and ambivalence were identified as major barriers but participants were willing to share the responsibility. Other barriers included time, reduced access to allied health and broader determinants of health. General practitioners need to be empowered to allow continuation of valuable lifestyle advice and counselling. The results emphasise the importance of ongoing lifestyle assessment and tailoring of management to the complex interplay of factors that impact on a patient's ability to adopt and maintain lifestyle change. System issues need to be addressed to provide better streamlined care.

Perceived impact on clinical practice and logistical issues in clinical management surveys of cancer: Australian experience.

BACKGROUND: In September 2004, 28 published and 17 ongoing clinical management surveys (CMS) of cancer in Australia were identified, describing the clinical management of representative series of cancer patients. The present study assessed the perceived influence of these on clinical practice and the logistical issues involved in conducting a CMS. METHODS AND MATERIALS: Questionnaire sent to a key clinical investigator in each survey. RESULTS: For the 28 published CMS, respondents (response rate 54%) reported that the CMS were influential in half or more of subsequent changes in the development or implementation of standard protocols, increasing specialist involvement in clinical trials, reducing variability in practice, and providing informed choice for patients. The surveys were regarded as influential in a third to half of noted changes in the use of evidence-based treatments, multidisciplinary care, and standardised collection of data. For CMS in progress, respondents (response rate 65%) reported on objectives and logistical issues, with the need for multiple ethical approvals emerging as a major issue. CONCLUSION: CMS of cancer have played a modest but important role in stimulating and supporting improvements in clinical care in Australia. Many Australian surveys have been large and population-based and with high response rates. The recent introduction of a requirement for patient consent by some (but not all) ethical committees greatly increases the difficulties and costs of such surveys.

A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma.

AIM: To compare 90 degrees , 180 degrees , and 360 degrees selective laser trabeculoplasty (SLT, 532 nm Nd:YAG laser) with latanoprost 0.005% for the control of intraocular pressure (IOP) in ocular hypertension (OHT) and open angle glaucoma (OAG). METHODS: A prospective, randomised clinical trial in the Department of Ophthalmology, St Thomas's Hospital, London, and Clayton Eye Centre, Wakefield, West Yorkshire. 167 patients (167 eyes) with either OHT or OAG were randomised to receive 90 degrees , 180 degrees , and 360 degrees SLT or latanoprost 0.005% at night and were evaluated at 1 hour, 1 day, 1 week and 1, 3, 6, and 12 months. RESULTS: The mean follow up was 10.3 months (range 1--12 months). Early, transient, complications such as postoperative ocular pain, uveitis, and 1 hour IOP spike occurred in a number of eyes after SLT, with pain being reported more frequently after 360 degrees than 90 degrees treatments (p>0.001). Success rates defined in terms of both a 20% or more and a 30% or more IOP reduction from baseline measurements with no additional antiglaucomatous interventions were better with latanoprost than 90 degrees (p<0.001) and 180 degrees SLT (p<0.02) treatments. Differences in success rates between latanoprost and 360 degrees SLT did not reach statistical significance (p<0.5). Success rates were greater with 180 degrees and 360 degrees compared to 90 degrees SLT (p<0.05). With 360 degrees SLT, 82% of eyes achieved a >20% IOP reduction and 59% a >30% reduction from baseline. Although success rates were better with 360 degrees than 180 degrees SLT treatments, differences did not reach statistical significance. There were no differences with regard to age, sex, race, pretreatment IOP, OHT versus OAG, laser power settings, and total laser energy delivered between eyes which responded, in terms of a >20% and a >30% IOP reduction, and those that did not respond with 180 degrees and 360 degrees SLT treatments. CONCLUSIONS: Success rates were higher with latanoprost 0.005% at night than with 90 degrees and 180 degrees SLT treatments. 90 degrees SLT is generally not effective. 360 degrees SLT appears to be an effective treatment with approximately 60% of eyes achieving an IOP reduction of 30% or more. Transient anterior uveitis with associated ocular discomfort is not unusual in the first few days after SLT. Late complications causing ocular morbidity after SLT were not encountered.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change.

BACKGROUND: Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination. OBJECTIVES: To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area. SELECTION CRITERIA: We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review. Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required. TYPES OF PARTICIPANTS: People of all ages. Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination). Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence. DATA COLLECTION AND ANALYSIS: We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented. MAIN RESULTS: No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisations. AUTHORS' CONCLUSIONS: We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

Interventions implemented through sporting organisations for increasing participation in sport.

BACKGROUND: There is now compelling scientific evidence that increased levels of physical activity can bring wide-ranging health benefits. These benefits can extend beyond physical health and include other positive impacts relating to mental health and personal development. The sport and recreation sector is viewed as a priority area for increasing rates of physical activity. Participation rates have been shown to be lower in females, decline with age, and are reduced in lower socio-economic and minority groups. It is important to determine the most effective interventions that sporting organisations can use to increase participation. OBJECTIVES: To review all controlled evaluation studies of interventions organised through sporting settings to increase participation. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, and a number of freely-available online health promotion and sports-related databases. The internet was used extensively to search for studies and locate information generated by sporting bodies throughout the world. SELECTION CRITERIA: Types of studies: Controlled evaluation studies. No minimum follow-up required. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review. TYPES OF PARTICIPANTS: People of all ages. Types of interventions: Any intervention designed to increase active and/ or non-active participation in sport. These could include: mass media campaigns; information or education sessions; management or organisational change strategies; policy changes, for example to improve the socio-cultural environment to encourage people of specific age, gender or ethnicity to participate; changes to traditional or existing programs, for example club or association-initiated rule modification programs; provision of activities beyond traditional or existing programs, for example 'Come and Try' initiatives (teaser or taster programs); skill improvement programs; volunteer encouragement programs. Types of outcome measures: Change in the number of (active and non-active) participants in organised sport, change in status from non-participating to non-active or active participation, change in status from non-active to active participation. DATA COLLECTION AND ANALYSIS: We assessed whether identified citations were controlled evaluation studies which investigated the use of interventions implemented in sporting settings to increase participation. Two reviewers independently inspected abstracts. We obtained full papers where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented. MAIN RESULTS: Despite a thorough review of the published and unpublished literature, we were unable to locate any rigorous studies which tested the effects of interventions organised through sporting organisations to increase participation in sport. AUTHORS' CONCLUSIONS: There is an absence of high quality evidence to support interventions designed and delivered by sporting organisations to increase participation in sport. Interventions funded and conducted in this area must be linked to a rigorous evaluation strategy in order to examine overall effectiveness, sociodemographic differentials in participation and cost-effectiveness of these strategies.

Eye injuries associated with 'war games'.

Eye injuries sustained by 4 patients who took part in 'war games' (in which young men shoot at each other with pistols powered by compressed carbon dioxide and firing latex rubber bullets filled with non-toxic paint) are described. In 3 cases the injuries were severe, including traumatic cataract, and 1 of these patients has a permanent macula scar with vision reduced to 6/36. Although eye protection is recommended, it was found that in the 'battle situation' combatants did not always follow regulations. Attention is drawn to the seriousness of disregarding the need for correct protective glasses.