Lorraine Sheppard

Breast Cancer and Sexuality

Abstract:  Breast cancer affects a woman’s body image and feelings of sexuality. Little is known about the perceptions of spouses to the sensitive topics of sexuality and body image. A qualitative inquiry was undertaken using in‐depth interviews. A diagnosis of breast cancer brought some relationships closer. Mastectomy by disturbing body image did obliterate sexual relationships for a significant period of time. Women often felt (wrongly) that their partner would be repulsed by changes. More support in relation to sexuality and body image could improve relationships by identifying and clarifying perceptions, and therefore the quality of life.

A review of critical appraisal tools show they lack rigor: Alternative tool structure is proposed

OBJECTIVES To evaluate critical appraisal tools (CATs) that have been through a peer-reviewed development process with the aim of analyzing well-designed, documented, and researched CATs that could be used to develop a comprehensive CAT. STUDY DESIGN AND SETTING A critical review of the development of CATs was undertaken. RESULTS Of the 44 CATs reviewed, 25 (57%) were applicable to more than one research design, 11 (25%) to true experimental studies, and the remaining 8 (18%) to individual research designs. Comprehensive explanation of how a CAT was developed and guidelines to use the CAT were available in five (11%) instances. There was no validation process reported in 11 CATs (25%) and 33 CATs (77%) had not been reliability tested. The questions and statements that made up each CAT were coded into 8 categories and 22 items such that each item was distinct from every other. CONCLUSIONS CATs are being developed while ignoring basic research techniques, the evidence available for design, and comprehensive validation and reliability testing. The basic structure for a comprehensive CAT is suggested that requires further study to verify its overall usefulness. Meanwhile, users of CATs should be careful about which CAT they use and how they use it.

The role of teamwork and communication in the emergency department: A systematic review

The aim of this study was to develop a systematic review using international research to describe the role of teamwork and communication in the emergency department, and its relevance to physiotherapy practice in the emergency department. Searches were conducted of CINAHL, Academic Search Premier, Scopus, Cochrane, PEDro, Medline, Embase, Amed and PubMed. Selection criteria included full-text English language research papers related to teamwork and/or communication based directly in the emergency department, involvement of any profession in the emergency department, publication in peer-reviewed journals, and related to adult emergency services. Studies were appraised using a validated critical appraisal tool. Fourteen eligible studies, all of mid-range quality, were identified. They demonstrated high levels of staff satisfaction with teamwork training interventions and positive staff attitudes towards the importance of teamwork and communication. There is moderate evidence that the introduction of multidisciplinary teams to the ED may be successful in reducing access block, and physiotherapists may play a role in this. The need for teamwork and communication in the ED is paramount, and their roles are closely linked, with the common significant purposes of improving patient safety, reducing clinical errors, and reducing waiting times.

Sustainable undergraduate education and professional competency

The primary purpose of Schools of Physiotherapy, and their tradition, is to develop in their students the cognitive and practical breadth required to function as competent practitioners immediately on graduation, with the capacity to continue to learn and develop. As schools within universities, they also seek to provide students with broad educational experiences, assisting them to develop generic skills such as independent learning, teamwork, responsibility towards other people, problem solving abilities and the like.

Combining Case Study Research and Systems Theory as a Heuristic Model

The combined use of case study and systems theory is not often seen in the literature. The use of both approaches enables the specifics of the case to consider the influence of broader systems and external environments, offering in-depth exploration as well as comparative analysis between cases in the context of the system. Health care has obvious systems operating that may have developed from organizational hierarchies, funding mechanisms, or traditional service delivery of health care. Systems theory is ideally suited to examine health care and health promotion sites, such as hospitals or universities. Sites can use the principles of systems theory to explore innovation, change, and complexity of service delivery in the context of a case study approach. This article discusses how the combination of the two can act as a heuristic model, offering its application to emergency department physiotherapy as an example, to further bolster the evidence base for using such a methodology.

A general critical appraisal tool: an evaluation of construct validity.

BACKGROUND Many critical appraisal tools (CATs) exist for which there is little or no information on development of the CAT, evaluation of validity, or testing reliability. The proposed CAT was developed based on a number of other CATs, general research methods theory, and reporting guidelines but requires further study to determine its effectiveness. OBJECTIVES To establish a scoring system and to evaluate the construct validity of the proposed critical appraisal tool before undertaking reliability testing. METHODS Data obtained from this exploratory study along with information on the design of the proposed CAT were combined to evaluate construct validity using the Standards for educational and psychological testing which consist of five types of evidence: test content, response process, internal structure, relations to other variables, and consequences of testing. To obtain data for internal structure and relations to other variables, the proposed CAT was analysed against five alternative CATs. A random sample of 10 papers from six different research designs across the range of health related research were selected, giving a total sample size of 60 papers. RESULTS In all research designs, the proposed CAT had significant (p<0.05, two-tailed) weak to moderate positive correlations (Kendalls τ 0.33-0.55) with the alternative CATs, except in the Preamble category. There were significant moderate to strong positive correlations in the quasi-experimental (τ 0.70-1.00), descriptive/exploratory/observational (τ 0.72-1.00), qualitative (τ 0.74-0.81), and systematic review (τ 0.62-0.82) designs and to a lesser extent in the true experimental (τ 0.68-0.70) design. There were no significant correlations in the single system research designs. CONCLUSIONS Based on the results obtained, the theory on which the proposed CAT was designed, and the objective of the proposed CAT there was enough evidence to show that inferences made from scores obtained from the proposed CAT should be sound.

Comparison of the effects of using the Crowe Critical Appraisal Tool versus informal appraisal in assessing health research: a randomised trial

In systematic reviews, evidence-based practice and journal clubs critical appraisal tools are used to rate research papers. However, little evidence exists on whether the critical appraisal tool, subject matter knowledge or research design knowledge affect the appraisal of research papers. A match paired randomised trial was conducted in August/September 2010 in the Faculty of Medicine, Health and Molecular Science, James Cook University, Australia. Ten participants in total were randomly assigned to two groups using either an informal appraisal of research (IA group) or the Crowe Critical Appraisal Tool (CCAT group), a general critical appraisal tool. Participant independently appraised five research papers, where each paper had a different research design. The scores allocated to the papers by each group were analysed. The intraclass correlation coefficient for absolute agreement was 0.76 for the informal appraisal group and 0.88 for the Crowe Critical Appraisal Tool group. The G study showed that in the informal appraisal group 24% of variance in scores was attributable to either the rater or paper × rater interactions, whereas this was 12% in the Crowe Critical Appraisal Tool group. Analysis of covariance showed that there were statistically significant results in the informal appraisal group for subject matter knowledge (F(1,18) = 7.03, P < 0.05 1 tailed, partial η² = 0.28) and rater (F(4,18) = 4.57, P < 0.05 1 tailed, partial η² = 0.50). Kendalls tau correlation coefficient also showed a significant weak positive relationship (τ = 0.38, P = 0.03) between total score and subject matter knowledge for the informal appraisal group. The Crowe Critical Appraisal Tool was more reliable than an informal appraisal of the research papers. In the informal appraisal group, there were significant effects for rater and subject matter knowledge, whereas the Crowe Critical Appraisal Tool almost eliminated the rater effect, and no subject matter knowledge effect was apparent. There was no research design knowledge effect in either group. The Crowe Critical Appraisal Tool provided much better score reliability and should help readers with different levels and types of knowledge to reach similar conclusions about a research paper.

Public perception of physiotherapy: implications for marketing

A national telephone survey which randomly selected 510 members of the general public was undertaken in early 1992. The aim was to ascertain the publics perception of physiotherapy. The results of the survey revealed that physiotherapists were best known for their treatment of musculoskeletal conditions. There was very little awareness that physiotherapists provided specialist care for women and children. Location of the physiotherapist appeared to be an important factor, giving physiotherapists the potential to capitalise on tailoring service provision to their particular locality. Another important feature of physiotherapy service that was identified was the need for client centred care. Medical practitioners were found to be very important for referral and communication about physiotherapy. However it appears the public is unaware of the full range of physiotherapy services, which suggests that there is a need for appropriately focused marketing campaigns.

Lost in translation? How patients perceive the extended scope of physiotherapy in the emergency department

OBJECTIVES To investigate the perceptions of emergency department physiotherapy practice by emergency patients in metropolitan and regional Australia with a view to probing how consumers interpret the place of physiotherapy in such an acute, non-traditional setting. DESIGN A qualitative investigation using a descriptive open-ended questionnaire technique was administered to emergency patients in order to thematically analyse their perceptions of emergency physiotherapy practice. SETTING Case 1 was a metropolitan emergency department in Melbourne, Australia. Case 2 was a regional emergency department in North Queensland, Australia. PARTICIPANTS A purposeful, convenience sample of 80 emergency department patients (n=40, Case 1; n=40, Case 2) responded to the open-ended questionnaire. ANALYSIS Data were thematically analysed using NVivo software and manual analysis, facilitating constant case comparison, and were reflected upon continually within an interpretivist framework. RESULTS Participants at both emergency departments had a general, but limited, awareness of the role of physiotherapy. Among multiple themes identified were six key domains which participants could recognise as being both the role of general physiotherapy and also relevant to the emergency setting. These were sports injury management, musculoskeletal care, rehabilitation and mobility, pain management, respiratory care and management of elderly patients. Discussions also involved those areas that were specific to general physiotherapy practice or emergency department care but which did not overlap. CONCLUSIONS Participants in this study demonstrated a general, but limited, awareness of the scope of physiotherapy practice. There was strong identification of musculoskeletal-based interventions, with less familiarity with the potential role of physiotherapy in cardiorespiratory and rehabilitative management. Further research is needed on consumer awareness of the broader, less traditional roles of physiotherapy to increase acceptance and familiarity of its extended scope.

Examining primary and secondary school canteens and their place within the school system: a South Australian study

In Australia, school canteens are an integral part of the school environment and an ideal site to encourage healthy eating. However, when the canteen is not supported within the school system, healthy menus may be difficult to implement. The aim of this study was to investigate school canteens and their place within the school system in primary and secondary schools in South Australia. Using a systems approach, 14 schools and their canteens located throughout metropolitan and rural South Australia are discussed. A range of qualitative interviews was conducted with school principals (n = 14), canteen managers (n = 14), parents (n = 50), teachers (n = 10) and focus group interviews were held with students (n = 450). This study showed that although school canteens were located on school grounds and should be supported as an integral part of the school system, in many cases they were not. A range of influences such as: maintaining profit, reduced volunteer support and student choice negatively impacted what was sold on the canteen menu. This study indicated that offering a sustainable healthy school canteen menu largely depended on the support and resources provided to the canteen by the school system in which it belonged.