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Cross Cultural Understanding for 2HM 2FM students at NHTV Breda University - Duration: 45:44.
hi I'm Joseph Roevens of the NHTV Breda University of Applied Sciences in the
Netherlands and I'm a professor of organizational behavior especially for
students in hospitality management and this will be a cross-cultural lecture,
and we start with another worldview. Now when you look at this map of the world
most of you may find this odd because most of you are used to having this map
the other way around and the reason is that the people who
made this map or made the first maps were from Western Europe I think it was
either the Netherlands or or Britain but they made the map and they put
themselves in the center of the world just like most nations put themselves in
the center of the world and I think part of the cross-cultural challenges come
come from that fact. Now what I will show you first is that there are three
perspectives to look at different cultures and one perspective is quite
famous that's the one we call the "They- perspective". is when
we look at another culture as them. You know, the Japanese, or the French, and us
the Dutch, the Germans, the Americans, then you have a perspective called the "We
perspective" is where you actually make an effort to
live like the locals. I can give you an example I've been a student in the US in
France in Bologna and now I am working in the Netherlands even when I come from
Belgium so from a different culture but each time when I've been in a
culture I have decided to join the local festivities the local foods a lot of the
local behavior and then you enter the we perspective now the richness
of the we perspective is that you start to see new things things you
didn't see before for example in the Netherlands people have a tendency to be
more direct or upfront than people in Belgium it's changing but that's what's
going on now what did I learn from the Dutch for example that when I was
sitting in a meeting and I was being quiet local people consider this almost
uninterested they would prefer me to come up with suggestions they would also
prefer me to say what my truth was for example if I disagreed with something I
could just openly disagree with it rather than the standard Belgian way
where you try not to disagree but go around it so I learned this more direct
approach and what was interesting is I could import this approach also in my
relationships with my Belgian friends and relatives I had to do it
maybe more well more subtly but I could import directness and the only way I
could have learned directness is by doing it by living it with the culture
just like for example when I was a student in the United States I learned
that it was okay to fail it was okay to try out new and weird and different
things and if it didn't work out people didn't find it a big problem they said
great you tried it it was very different from my culture at least 1980s Flanders
or Belgium where if sudden something didn't work out it seems to be almost
like it like a blame now I realize I am giving some
stereotypical comments they may have changed but the point is see if you can
go into the WE perspective rather than the THEY perspective. Also the THEY
perspective is very bizarre because if I say something like the French what do I
mean which picture do I have in my head do I have this kind of silly picture of
a man wearing a Barrett and holding his baguette under him and drinking wine?
Is that my image or do I have an image of a young hard-working female
executive in Paris or do I have an image of a farmer in the South of France and
even that you know what it's always about specific people and the danger
with the THEY perspective is that you start to live in this illusion
of a whole group being something they are like this or they are like that
which of course scientifically makes absolutely no sense. There's a THEY
perspective which most of us do, the we perspective, and then finally self
reflexivity and I would say that perspective is similar to the we
perspective a little bit different but it basically says when you enter a
different culture you have the chance to evaluate your own culture you can go
back home and say wait a minute in my country shops are closed on a
Sunday and you can ask yourself is that useful and the answer may be yes you may
say yes I'm glad that there is a day of inactivity
in my country so that you can sort of ease down and be quiet or you could tell
yourself well it's odd that we closed on Sunday because it's a religious day for
the Christian community it's not so for the Jewish community or non-religious
communities so you could say we should just keep things open
so self reflexivity is the skill of taking the wealth of another culture and
thinking what that means for you now this is for my students I will
give you a link on the video of HSBC Bank and also on the peace corpse
and there they talk about things that you should and should not do in another
culture for example in certain cultures it's impolite to give something to
someone with your left hand you should always use your right hand. Now those are
things you should know or you can at least read about in in guide books
about a culture. Now I've talked a lot about culture but I haven't defined it
really now you could say that it's a set of basic assumptions that offer shared
solutions to universal issues that have evolved over time and they're handed
down from one generation to the next now simply put the human experience is quite
similar for everyone in the world whether you're born in Syria, in Belgium,
in Japan, all of us have dreams and goals all of us want family relations want a
job, want peace and harmony, those are all things we want as humans, but we deal
with it differently so a specific issue, a universal issue could be
food. Well for some people food means, for example, Spain, it's something that you
do between 2:00 and 4:00 in the afternoon and it involves a cooked meal
with maybe rice, olives and some meats and drinks with it. And in another
culture for example the Netherlands lunch may mean something that you do
between 12:00 and 1:30 and that involves a sandwich with cheese for example
another issue could be relationships in certain cultures it is or it is only
acceptable to have a marriage between people of different sexes but there are
cultures where it's fine for a marriage between a man and a man or a woman or
and a woman so it is again a shared solution of a specific group to a
universal issue. How do we deal with those universal issues, and most of you
may remember Abraham Maslow's hierarchy of human needs and I go into that in
another lecture, but I just want to point out that all those needs
are human needs. There is no one on earth who does not have those needs when
you're human the way we fill it out, the way for example we deal with esteem
needs may be very different in Pakistan than it is for example in the
Netherlands, where an esteem need could be that you get an individual award and
feel extremely proud of an individual award
whereas in Pakistan you may only feel proud when the award was for a group.
If it was individual you may even feel a bit embarrassed towards the other
people so we all have esteem needs but how we fill them out may be different
just like all the other needs and um I'm not sure if you've seen the movie I am I
was born in 1968 so in the 90s I was mesmerised by a movie called The Matrix
and I really invite you to go there and the essence of the matrix is that
human beings live in some sort of artificial womb and inside that we have
these connections to our brain and they're a virtual world is created it
happened to be New York City in the 1919 80s well culture is this virtual world
culture is not something that is it that is inherited it's not something that is
genetic we don't start talking a specific language and behaving a
specific way because we happen to be born in Amsterdam rather than in Kyoto
or in Buenos Aires no it's something that you learn and we forget that it's
just that it's something that you learned and that you might as well may
as well unlearn and by the way it's also not the truth it's not because our
culture worships a specific God in a specific way that that's normal or
regular or correct it's just what we happen to do now I
make a little jump but here's a wonderful model in how you can analyze a
culture and this can be a national culture but it can also be a corporate
culture and I call the model you know it's like deep-sea diving so if you look
at the culture you have certain things that are visible and visible are
artifacts and behavior then there are things that are invisible and invisible
is often the beliefs the values the things that people find important like
we go to church oh sorry we go to the synagogue on Saturday and we say
specific prayers in Hebrew that is something that we do underneath that are
they assumptions about the world about why
you do that kind of stuff and in the next clip I'll explain that more briefly
so let's start with the visible parts of a of a culture so these are the
artifacts or the behavior and this could be things like architecture greeting
rituals business protocol business protocol can be do you go do you give
each other a handshake or a hug or you bow to each other it can be the degree
of formality or familiarity with which you treat people it can be specific
dress codes to indicate let's say more important people where specific suits
and you can see that quite clearly in the Christian churches where the Pope
wears more stuff than a cardinal at least most of the Pope's mean maybe not
this one and more than then just regular regular pastors contacts what's the
physical and psychological space and then also do we have written verses
verbal contracts and here's a short example from the hotel or hospitality
industry this is the Westin Palace Madrid and as you can see it's quite an
impressive building most of us when we look at this building we think this is
going to be very expensive this is probably a 4-star or sorry a five-star
property which it is it has luxury guests Will Smith was there a few
summers ago by the way and when you watch this building it tells you many
different things like you're probably realizing that you need quite some money
to be able to get a room in that building you probably imagine that
you'll be served formally and when you enter
this hotel you will see that the concierge and other staff members have
very beautiful uniforms someone opens the door for you it's it's very formal
very almost all school beautiful decent things and that creates a specific
culture a specific atmosphere and that's very different from this some of you may
remember the Big Brother house it used to be a game show in the mid 90s where
people were put together in a house and they had to do different tasks and then
the audience was watching this and was then voting who could stay in the house
and who had to go and and after a while it started to take on almost ridiculous
aspects in that people were really being very unpleasant to each other and all
these all these kinds of things now the Big Brother house is also a specific
culture it tell told you what you could do what you couldn't do what was
accepted what was not accepted so again that's a visible aspect of of culture
now here we have other visible aspects of culture but they need a bit of
explanation every culture has specific heroes symbols myths stories rituals and
language now of course this is stereotypical and one of the good ways
to see what important heroes and symbols are for a culture is to watch TV and
first of all watch some typical films of a specific country now again it's a
stereotype and I know there's differences but let's take the typical
American movie typical American movie is boy or girl has a dream then this dream
is shattered you know something very bad happens and the boy or the girl is very
angry but says no problem I'm gonna fix this I'm gonna solve this so they're
busy fixing it and they have a lot of difficulties but along the way they
probably meet another nice boy or girl in the beginning they fight but then
they become friends and fall in love and at the end of the movie of course the
boy or the girl wins and not only do they win but they also have a
relationship with this other person most likely they end up in a big beautiful
house with money and a big car and everything is fine that is the typical
American dream of course again there are other types of
movie in America but that's sort of typical hero you know go through
difficulties and end up somewhere and it always involves also material success
it's kind of hard for an American hero to end up you know just like successful
but poor not it's different with other cultures now again it's a stereotype but
I've seen some American adaptations of French movies one typical French movie
is Cuza Kuzon which became cousins or loudini the call which I kind of forgot
how how that was translated into American or in English but one essential
difference with French movies is that in French movies very often the
protagonists are not so good-looking are not always so bright they may be much
more average people and life seems to also be challenging but there seems to
be less of this how can I say it grander challenges that somehow America needs to
have you know a French hero we combats one person that's enough in
American movies have to be like 10 and robots and tanks and everything no just
one and in the end of a French movie very often there can also be a happy
ending and the person is then very content living in its small apartment
somewhere in in non major city and that's also happiness it doesn't have to
be this exaggeration or at least the French would call it the exaggeration so
each culture again has its own myths symbols and heroes just like every
corporation or organization another way to see this is advertising take some
time and check advertising from Germany from Australia from the US from wherever
and you will find patterns of what people find important and this by the
way something that Austrian artist Gottfried helm wine pointed out to me is
that if you look at American advertising it very often has to do with solving
problems by taking medicine or eating food you feel bad
take a pill you feel depressed have a hamburger so much about food and and you
know and medicine he then had to look at Austrian commercials and German
commercials and there it very often had to do with clean many more commercials
about soaps and products that made everything clean and doctors telling you
how to brush your teeth well and so the focus in that culture light more on
cleanliness now I spent a year in in Italy and when I watched Italian
advertising I had a sense it was very clown esque very loud exaggerated and
also I have to admit very often involving either men or
that were very lightly dressed so it seems to be a focus of a culture good
let's let's move on and um yes you have the visible aspects but they also have
invisible ones and those are beliefs what do people believe is right now
here's a picture I think it's 1971 The Hague the Netherlands and that was the
way that people who were in the late 20s were supposed to be dressed in those
days not everyone but the majority was dressed like this and it was fine
nowadays youth is dressed differently now people are more used to the tight
jeans and and I see people in their 30s with big beards which I still find a bit
odd but it's not art it's just a belief that that's the way we now do things and
it also shows our values in those days this showed values of a freedom of
togetherness of social contact and it was a direct response to the much better
dressed people of the 1950's with their suits but it was a response to say hey
you know relax we're social work together we're not so elitist and so
again assumptions are what people mean and this is what really drives behavior
now these assumptions are often difficult for us as outsiders to to
detect and for insiders it's hard to explain because that's why we do things
I sometimes tell my students that the reason that a culture does something
almost always has to do with because the that's a successful way of doing things
let me be concrete why do the Dutch and the Scandinavians why do they dare to
say what they really think why do they dare to say negative criticism one of
the reasons they dare to say this is because over hundreds and maybe
thousands of years they have learned this behavior and this behavior was safe
it was probably very safe for a Dutch merchant in the 16th century to bluntly
speak his mind to another merchant without being thrown into jail or
tortured or whatever and therefore he learned or she learned that that was
appropriate they could continue this and in other cultures like Belgium for
example which is by the way I'm mouse here in a studio in Breda it's only a
15-minute drive from the Belgian border but Belgians don't necessarily have this
tendency to be so upfront now when I look at the history of Belgium I see a
lot of I'm losing the word but we were conquered by many nations by the
Spaniards the French the Germans I think the Austrians and the Dutch so
we had to learn to shut up and do what the others told us or we would end up in
jail or be tortured so we learned the art of doing our own thing but not
telling others so again why do people do what they do is because probably that
was the safest smartest behavior that's the way people deal with things but we
often forget that so we cannot necessarily explain it and that's why a
lot of our culture is an internalized worldview my grandmother she's 94 1
sorry 93 is still convinced that the main reason for economic difficulty
is that women have jobs she says in the good old days meaning you know right
after the war women stayed home and took care of kids men worth jobs and she
didn't thinks there was no unemployment then which by the way it wasn't true but
she she has that view and I've already for 20 years given up trying to explain
to her that that's not the case because it's a view of the world that she has
and she cherished it very dearly and she's not even willing to go look at
facts they're good now we looked at the model of Schneider mbar so before you
know the diver and how it's connected to to culture and assumptions I'm now going
to walk you through some assumptions of culture and I borrowed from several
authors hofstader trompin ARS Shai dreamer so and others and I
purposely decided not to stick to one model the reason I did so is because I
want you to make your own selection I don't necessarily think that Hoff stated
Trump announced who ever are the rightest approach to looking at culture
it is an approach it is one view also colored by their own culture and but
anyways here they go so vision on human activity
now some cultures you could say are more achievement than ascription oriented and
there's always different shades so don't think about this too much in black and
white terms but you could say that in certain cultures it is more important
what you have done then who you are
the difference is let's take 200 years ago many people wanted to be part of the
aristocracy and they tried to get into the favor of the king so that the king
would say from now on you're a baron or an earl or a Duke and they thought great
I've made it in life I became a baron that's a scription that's wanting to
belong to a specific group of people whereas nowadays people would say
doesn't matter whether you're born aristocrat or whatever it's what you do
what you with your own talents are able to achieve and here's an example of one
of our students she well she was Student of the Year but also she received an
award by the Jumeirah Carleton hotels of being the best employee of the month
so that shows individual achievement important for her important for the
hotel and for us and it's very different from this one it's a bit of a cartoon
saying that you know you're why somebody King well just because he or she happens
to be born in a specific way without having done anything and but in certain
culture that that's enough you know okay another one is what we call power
distance and power distance is what you could call is how easy is it for you to
gain access to someone who is higher up than you I'm already using culturally
coloured words for example if your boss lives on the top floor of a hundred
storey building and he has a huge desk and he has three secretaries and it's
extremely difficult for you you know just a regular clerk to talk to him most
I'm into him then you are living in a high power distance culture Eve on the
other hand you are working in a flexible office space you take your laptop and
let's say you're you know 15 years ago you're at Apple and you log in with your
computer with your Apple and help by the way Steve Jobs sits right next to you
and he's doing his work and he looks at you and he says oh you know Joseph I'm
gonna get some some coffee would you like something and I say sure Steve
bring me a cappuccino now he's the owner of the company I'm one of the
programmers but it's very easy for me to talk to him directly that would be a
sign of a low power distance culture and it's important it's important for
students when you go to a different culture to find out what seems to be
appropriate here is there a lot of hierarchy or not
I personally tell my students when they write me an email don't call me by my
first name don't say dear Joseph I mean it I don't
get hurt by this but I just want them to be in the habit of saying they're mr.
Rubens or their professor because the majority of cultures in this world are
still high power distance if you go to the Middle East if you go to Latin
America even Germany right next door you address your boss by his last name not
by the first name except if she or he tells you you know you can you can call
me by my first name so that's has to do with power distance
I'm not going to go into it more but often that's related to hierarchy who
talks to to whom and another short example of what what power distance
power distance means
here's a brief this isn't an office space for it where I work so here you
have three people that are different in hierarchy they're all from a different
scale we call it pay scale and in hierarchy scale but they very openly
communicate with each other the next one um some of you may have already had some
insight into douglas mcgregor's Theory X and Theory Y there's also a
theory Zed but I'm not discussing it here
basically what McGregor says people can have two views on life if you're in
Theory X you basically believe that humans are lazy and if you don't control
them if you don't tell them what to do they'll basically be doing nothing
Theory Y is a different approach there the view is humans are eager they want
to learn they want to be challenged so let's find ways to make this flourish
more and by the way you see this very clearly in the business world
Theory X organizations have a lot of hierarchy control structures punching
the clock in the morning you know were you there at 851 or at 853 very
important different from a theory why organization or basically your bosses or
the owners of the company say these are the products we need delivered and let
me help you in achieving those goals but I'm not going to control you because I
know you're a mature human being and are going to do the right thing so here's an
example of our school a bit of publicity here the NH TV Britta University of
Applied Sciences and this is a group of hotel management and facility management
students graduating on a change management project and very openly
discussing things with each other and this picture was taken I think it was
about seven years ago and all of them now all of them are doing quite well
it's also in an international group there was a lady from Columbia and also
a man from Germany the rests two others are from the Netherlands now okay that
was Theory X and Theory Y but task oriented and relationship oriented it's
interesting to notice that when I came to work in the Netherlands almost at
every situation when I came for a job interview or yet doing a task with
somebody when it was a new person on average the person spent less than five
minutes asking me personal questions for example and the questions would be how
was the drive did you easily find this place would you like a cup of coffee and
that's it they didn't ask me you know are you married house live in Belgium
what do you think about our building and the decorations and the history of our
nation's no less than five minutes relationship and then directly we want
you to do this and this and this for us can you do it and after half an hour you
know we've arranged our task and the meeting is over and we go and do
something else those are task oriented cultures
relationship oriented cultures are different for example typically when you
want to start business relations with Chinese with the Chinese you spend a lot
of time in the beginning getting to know each other and by the way every summer I
spend about 10 days with Chinese Russian polish and Germans too
in Germany in Bremerhaven and with my Chinese students I spent a lot of social
time they treat me beers and they want to know why I teach in a specific way
and why I speak French and how's life in Belgium and how's the food and this is
all part of the fact that for them for their culture it's important to know who
is this person is this someone we like is this someone we can trust is this
someone we want to be with and once that is established then it's fine to go and
talk about tasks but not before so again it's very important for task oriented
people when you go to a relationship oriented culture please learn to spend
at least a few hours or find out how many hours or days you need to do non
task oriented stuff to be accepted by those people and of course the reverse
also holds
another way of defining cultures and I'm going over it quickly so I really invite
you to read specifically about the culture in the country you're you're
going to difference between a tough and a tender culture and the basic ideas
well in tough or sometimes math they also call it masculine cultures it's all
about work it's all about achievement and the cliche could be in a tough
culture you live in order to work and in a tender culture you work in order to
live so those are some essential differences and um yes I want to I want
to leave it at that and maybe here's a typical one you what's what's this
what's his name again this this chef I don't mind doesn't doesn't matter but
anyways I remember him screaming and using the f-word a lot in kitchens and
making everybody nervous I didn't I didn't like the program but that was
very tough oriented I kind of prefer tender cultures where people say hey
let's sit together cook a bit if it doesn't work we'll try it again you know
just take it easy dolce vita enjoy enjoy life then there
is a difference between you could call in the way you relate to other people
what is called universal or particular typical example in our school if someone
cheats on the exam it doesn't matter who he or she is I mean this person can be
the king or the you know the Prince of the Netherlands so to speak but if he
cheats on the exam he gets a fail and may even be excluded from school the
rules apply to everybody but there are some cultures or
regions in the world where people say wait a minute there's a very different
rules for us than for other people and it can be religion it can be if you're
part of our religion you have a lot of freedom if you a member of the other
religions you have to pay more taxes or there are certain things you cannot do
it can be in mrs. Lee apartheid regimes whether it was in the
in South Africa or in America where you say hey if you happen to be Caucasian
white there's all these things you can do if you're not there's other rules
that apply to you now the world is tending to go to more universalism but
there are still many cultures where particularism is is playing um doing
versus being culture now I find this a difficult one to explain basically
because I'm a member of a doing culture you could say most of Western Europe is
a core cultures where people say let's do something let's take action sure you
can think about making a decision but if you say I'm gonna think five months
about something most people would say mmm you're just scared of taking
initiative but there are cultures the more being cultures where life seems to
be less pressing where people find it okay to think a lot more about what they
think should be done or where life almost seems to be moving slower now
both of these cultures have advantages and disadvantages for example and I'll
I'll be very personal Belgium is partly a doing culture now
if I look back over the last 15 years that I've been living in the city of
Antwerp or outside the city of Antwerp I've seen
people continuously reshaping our roads and it's always the same story
we are reshaping the road because we want traffic to be more efficient we are
reshaping the tram lines because we want traffic to be more efficient but the
reality is for the last 10 15 years there's always been traffic jams and
traffic difficulties because somebody feels we need to do something to make it
go more efficiently maybe we should stop doing that and then traffic can just run
which eventually it does that is what some being cultures do some being
cultures say well we used to travel in our city without a bridge and it worked
rather fine so whether we should have or not have a bridge is something we should
really really very deeply think about before we take an initiative because if
we make the wrong decision we have to change it all the time and I think
that's one of the essential difficulties of the doing culture of course a being
culture can then be a culture where you're so stuck into the way we always
done something that you almost become your almost thing that any innovation is
necessarily something something bad now good
this was introduction to cross-cultural understanding especially for second year
university students I hope you enjoyed it and for those at NH TV these are our
tutors working with you please come and find us and we'll be very happy to to
help you
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easy kolam designs for beginners | rangoli designs with dots | easy muggulu designs with dots - Duration: 2:59.
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GOT7 "7 for 7" Dance Practice Behind - Duration: 9:41.
Start!
Lie down! You know what to do. Get down.
I'll take it really slow. Get some sleep.
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For more infomation >> St. Joseph football prepares for undefeated Lompoc - Duration: 1:06. -------------------------------------------
Best evidence to best practice implementing an innovative model of care for nutrition management - Duration: 15:58.
I'd like to thank NHMRC and Cancer Institute New South Wales for the
funding of this fellowship. And someone asked me a little while ago, can you put
a summary slide of your fellowship in a single slide? So I turned to
infographics, for the challenge. And this is the first half of the story and I'll
show you the other half at the end. But we do know there's a significant
proportion of patients with head and neck cancer that are malnourished and it does
impact on outcomes. We also know in terms of research translation, there's a very
long lag time in terms of changing clinical practice. And in our centre, we
had about 20 percent of our patients actually receiving nutrition care according to
best practice standards. So some years ago, we had a Cancer Institute funded
project to actually undertake the knowledge synthesis and dissemination
through developing clinical guidelines that we were publishing on a wiki
platform, thanks to our friends at Cancer Council. So we had a large repository of
information there telling us what the best available evidence was, but I also
knew that this wasn't happening in my own centre. So the natural
progression to implementation was where it took me next. So I've been very
fortunate to work with a fantastic team of experts in translational research,
implementation science as well as those who are actually clinical leads within
the head and neck oncology MDT, but they also serve a dual role of having
being opinion leaders within the organisation. It was actually very
important in terms of that executive sponsorship to drive your project
through. So what we wanted to know is what consumers and clinicians thought
about their nutrition care and how we could optimise it before, during and
after treatment. We also wanted to explore the barriers and enablers to
implementing best practice care and what were the most effective implementation
strategies at the individual team and system levels. So what we're aiming to do
is to implement our best practice model of care for nutrition management of
these patients and, obviously, to ultimately reduce the detrimental effect
of malnutrition. The target groups were patients and caregivers and also our
multidisciplinary team. Now, the primary outcomes of this project are the process
measures because if you realise that we're not actually reproving the
clinical guidelines, we're actually measuring adherence
to them. So while the clinical outcomes are of interest, we're not necessarily
out to detect significant differences. But we also want to explore the system
level impact in terms of hospital admissions and length of stay and
related costs to those. The other-- the other outcome measure that's also
important to look at is fidelity, so how closely did we deliver the
implementation strategies that we said we were going to? So it's a mixed-methods
pre and post study design incorporating qualitative and quantitative research
methods to look at outcomes of interest in a pre-implementation
cohort, implement the new model of care and then measure in a post-
implementation cohort. So this is our baseline scorecard in targeting the
recommendations through-- for patients having curative intent radiation therapy.
Are we using malnutrition screening tools that are validated? Are we using
nutrition assessment tools that are validated in oncology populations and
are we also giving patients access to dietetic care before treatment, weekly
during treatment and six weeks-- fortnightly reviews at six
weeks following treatment? So you can see in our baseline scorecard, we've got no
green ticks. So having developed guidelines, it's a punishing process so
I'm sure you want to see them all in practice. Very simple snapshot of 30
patient and caregiver and clinician interviews to have a look at what some
of the barriers and enablers were across individual, team and system levels. One of
the very clear messages that our patients and family members told us was that
they really wanted to meet the dietitian sooner, because you know there's a lot
that's involved in nutrition management and supporting these people through
highly toxic and complex treatments and not the least of which is some of the
management of managing tube feeding et cetera at home. So the other thing that was also
interesting is some of the team dynamics and we would have a very great
cohesive head and neck multidisciplinary team but the core business of that
meeting is talking about treatment decisions. So what was interesting to me
was to find that the medical-- the non-medical clinicians in the room felt
nutrition care was important but that there wasn't an opportunity to say
anything and that they thought that perhaps anyone else in the room didn't
think it was equally important. And for the medical clinicians in the
room, they said, "Well, we thought nutrition care is important but nobody ever says
anything." So what the challenge was, was trying to find a way to give everyone in
the room a voice. So in terms of implementation strategies. we looked at
engaging with local opinion leaders. Of course, we involved the staff in
designing and delivering the model of care, involved audit and feedback and we
also integrated information technology strategies to improve the workflow. So in
terms of fidelity, we delivered a supportive care-led pre-treatment clinic
as one of the key implementation strategies. We had 33 of 34 eligible
patients offered an appointment - 100 percent of those accepted and
100 percent attended. The one patient that was missed was also the one patient
that was not on our weekly head and neck oncology MDT list. So without that
piece of information, we didn't know that they were required to be seen. The other
key implementation strategy was a nutrition care dashboard, so we have a
weekly list of every patient that's on treatment and where they're up to. We
actually integrated nutrition care clinical outcome measures into that
weekly list and that also provided impetus for the dietitians to conduct
the nutrition assessments at the timelines that they were required to, but
it also provided an opportunity to have a bit of a script to talk to when it was
opportunity to discuss how patients were progressing. So I'm actually in the
middle of the sort of post-implementation analysis at the moment, so
I can share some of the preliminary results with you. And we have two cohorts
of 98 in the baseline and 34 patients in the post-implementation group. We do know
that they are different, we have to do some further analysis - we certainly had a
higher proportion of patients with oro-pharyngeal cancers in the post-treatment
group and a higher proportion of patients with stage 3 and 4 disease in
the post-treatment group as well. We also had more patients who were moderately or
severely malnourished in the post-treatment group, so while we haven't made a
difference in BMI and percentage weight loss on treatment - remembering I
wasn't powered to do that, it wasn't necessarily the point of it - we've also
got actually a group of sicker patients. So the fact it's not significant--
significantly different, I think will be interesting to explore a bit further.
When it comes to the actual process measures, when we were-- patients being seen by a dietician
prior to treatment, that occurred 20 percent of the time
prior to the new model of care and that's essentially because we didn't
have a dedicated service for those patients. That 20 percent that we're
seeing were essentially because they were admitted to hospital because
they're in such a poor condition. And certainly, we had a significant
improvement in delivering pre-treatment assessment to 97 percent of
patients. Weekly contact on treatment improved moderately and I suspect that
is also due to the improved capacity, that the complex new consults have been
removed from that clinic and freeing up a little bit more capacity. The post-
implementation fortnightly for six weeks is a little bit of a challenging area, we
haven't had a specific implementation strategy to address it but I think it
represents an opportunity for us to do some more innovative work around that in
the future. The other term-- in terms of looking at were we adhering to
malnutrition screening and nutrition assessment guidelines? The
malnutrition screening - I would like to take a clean victory for that but it was
actually our nursing staff who perhaps have more awareness of nutrition within
the unit have actually initiated a nursing intake that included the
malnutrition screening tool. That's also been a significant improvement in
general awareness. Were the dietitians using the gold standard of nutrition
assessment in this patient group? Is the scored patient generated a subjective
global assessment? It's important because it does have a patient-reported
component. We historically did that well at baseline but you almost never saw it
again. So what this has actually been able to
do is to, you know, engage with the team of dietitians and work with them to
become more confident in using the tool that is a little bit complex when you
first start getting used to it. I did have some pushback from management
initially about, you know, how can you expect people to keep doing-- repeating
these measures. But my pushback is if you're not doing a nutrition assessment
when you're doing a nutrition assessment, I'm not sure what you're actually
spending your time assessing. And having a repeated measure and being able
to put it in front of the the multidisciplinary team, it adds a lot of
weight if you have things that you would like to say. The other thing, in terms of
the pre-treatment clinic, it allowed us to identify patients were at risk of
certain conditions where the early
identification of malnutrition or refeeding syndrome, patients that may
have declined gastrostomy tubes when clinically it would have been indicated.
But probably one of the other important things is around financial hardship. We
know a lot about financial toxicities in this patient group but the additional
costs for nutritional supplements and feeding tube consumables can come at a
time when people really don't need it. So we have a hardship fund program at Lifehouse
and that fortunately, we can refer patients that - where some of the costs, it
will-- actually all of the costs of - those have covered for a six-week period
initially. In terms of system impact, I didn't have a significant increase in
terms of the amount of dietetics resources, but if you can look at the
unplanned admission dietetics resources in the top right hand corner, if we can
manage these patients as outpatients, we use a lot less dietetics resources. It
nearly doubles once they become inpatients because clearly they've
deteriorated to the point they need much more intensive input. So in terms of the
proportion of unplanned admissions from 46% at baseline to a 38% post-
implementation, I mean it's not a necessarily a large number but in a real
world setting, it's worth doing some economic investigations on that to see
what that might mean in the real world. So I've been working with the health
economist, the lovely Richard De Abreu Lourenco - some of you may know from UTS. I
know from the baseline data that the average cost of these admissions was
around $35,000 per admission. I'm just going through getting the the admission
costing data for the post-implementation group, but if we look at the study period
and a projected annualised figures for the potential savings of unplanned
admissions, it was around 3.92 over a year. And I had said at the start of this,
if we could save nearly 4 admissions a year, we'd potentially pay for an
allied health clinician. In dollar terms, that's $138,000
potentially saved and that would certainly cover the costs of
an allied health clinician for the year. So the other thing that we did was look
at some focus groups and at the post-implementation, we had 12 of the
multidisciplinary team participate in those groups. I'll just give you a bit of
an overview of some of the key themes that came through. That it really improved
work processes and time management was probably not a huge surprise for some of
the people that were involved but what I wasn't expecting was for one of the
oncologists to say, "Look, I make a lousy dietician
but I'll cost more to do it." So the other important thing there is to realise in a
value-based healthcare equation, if everybody gets to operate at the top of
their license, you're inherently injecting value into the system. Other
things in terms of care coordination and communication, they came across as having
that clinical information within the MDTs lists were actually really
important. I think one of the key design features was the color coding of the
malnutrition and weight-- critical weight loss categories and that certainly
seemed to be something that was used as a visual support to tool very frequently.
And in terms of prepared for care, while the medical staff felt that they had
more time to discuss other things with their patients, they also knew that once
someone was deteriorating, they had a-- they did see it coming versus it being a
little bit more of a surprise to them. And other allied health clinicians felt
that, you know, they've had a chance to digest a huge amount of information - by
the time they get to me, they're ready for the next piece of information. So in
terms of a journey to the nutrition care dashboard, we held some workshops in
training people in using different types of tools. This was piloted with nothing
more sophisticated than an Excel spreadsheet and, as many of you know with
EMRs, we have an untidy dog's breakfast of three separate EMRs. And they're also
free text historically, which is, of course, the nail in the coffin to sort of
quality research and audit. So we developed a suite of dietician-specific
clinical documents in the medical record and now towards automation of that
nutrition care dashboard means it's pulling clinical information entered at
the point of care and that can come from the source systems. So I think that's
something that we're doing a little bit more work on in the future.
So our post implementation scorecard is looking a lot better, we've gotten
quite a few more green ticks. Always room for improvement, but overall, I think
we're looking at the feasibility of: can we get closer adherence to clinical
practice guidelines with modifying a model of care? I think we've certainly
indicated that that is feasible and in the last couple of minutes, this is a
little sub-study that came out of the opportunity to do the trip fellowship in
training, doing computer tomography analysis to look at sarcopenia and
there's very large data sets coming out of Canada showing us that patients that
have low skeletal muscle index, low muscle attenuation and greater than
8 percent involuntary weight loss have much higher risk of poor outcome
and that's independent of BMI. And I think it's a really important thing when
we talk about cancer care in the modern era - which is an era of overweight and
obesity - that we're not necessarily looking at the capacity-- the
metabolic capacity of the people we're treating. So on this slide on the top row,
you've got 3 patients that actually have a BMI from the top left of morbidly
obese to the top right to severely underweight, but they actually had the
same skeletal muscle index. So what do we do that's weight based in cancer care?
Pretty much everything, so I think this is a real area of interest that I'll
be doing some more work in, so happy to talk to you more about that at lunchtime
or visit my poster number 10 and feel free to vote for it. And the bottom line
there, we've got three patients conversely that have the same BMI and
their skeletal muscle index varies almost twofold.
So I think it's an interesting-- this is an example of a patient that had-- he was a
57 year old male that had chemo-radiotherapy for a base of tongue tumor.
He was actually at baseline, and if we look at the fact that he
was technically in the overweight category, it tends to mask what's
actually happening underneath so it reinforces the
importance of that clinical nutrition assessment. What I did find obviously
with this is actually the baseline cohort that had pre and post CT scans
before and 12 weeks after finishing treatment. All significantly different,
not surprising but it was significantly associated
with all cause mortality and unplanned admissions. So the single slide snapshot
at the end, really I think I've kind of covered it all previously. We've
certainly made some change in clinical practice and human behavior which are
some of the hardest things to do in a busy and complex healthcare system and I
think I will leave it there. And thank you very much for your time.
-------------------------------------------
Lessons learned in improving access to colonoscopy for the National Bowel Cancer Screening Program - Duration: 12:22.
And we'd identified several, in fact, many significant deficiencies in our care
process. A couple of the lowlights of this-- of this review: it was taking us
nearly five months between first contact with the health service to start
treatment of colorectal cancer for our average colorectal cancer patient. It was
taking over three months - a hundred days - for a patient who was referred from
general practice with the bowel cancer screening program positive stool test to
get their colonoscopy. And within these dreadful access times, there were even
wider variations because there was no consistency of triage for being seen in
a clinic, there was no consistency of triage category for actually having a
procedure done and there was no relationship at all between the triage
category decided for either clinic or for a procedure and what was actually
being delivered when the patient was turning up for either the clinic or
procedure. So we started a project which has run through the last five years and
is continuing today and our main aim at the beginning was to improve the time to
scope for a positive patient-- of a stool test positive patient. And for this work,
we got a Cancer Institute project grant in 2013 and it started with an enormous
amount of preparatory work that took the best part of a year by
Donna to organise a new way of delivering our colonoscopy service for
these patients. That preparation was critical. It was critical because you
have to take with you all of the people in the system - from the people who
receive the referrals in the-- in the referral management office in the
hospital to the secretaries working for the clinicians to the clinicians to the
people who are organising and booking the scopes in the administration part of
the theatre complexes and to the theatre staff themselves: the anesthetist and
everybody else involved in the process. We were doing this across three
hospitals in Newcastle because our endoscopy service is delivered on three
different sites in Newcastle. You have to prepare people, you have to explain the
reason for changes, you have to go through the practicalities of the
changes and the new methods of working and you have to solve the problems that
come up and those are always problems that you never-- never
anticipated or never expected it would be a problem. We were aiming to
streamline the booking for colonoscopy. We were not aiming to provide an open
access service where a GP could just request a colonoscopy and it would be
done. We still needed to maintain a gatekeeper triaging process to make sure
that the colonoscopies we were doing were appropriate and were safe. We wanted
to rationalise this to consistent standards and maintain those consistent
standards and the bedrock of that new service was a telephone triage
and booking service replacing the initial outpatient appointment with--
between a specialist and the patient. The old pathway, it was taking an average of
two months - 60 days - for a referral from the GP to be seen by a specialist, either
in their rooms or in the hospital clinics.
It was then taking nearly 40 days - another five to six weeks - between being
seen in the clinic or rooms that's been getting their scopes to make the average
of a hundred days. Under our new pathway, after the first year or so we'd settled
down to having an average of about six days from referral to being dealt with
on the phone and then for about seven weeks - we'd get them seen between six
and seven weeks to get them seen and actually have the scope done, making a
running average in recent times of about 55 days for the pathway - a
significant improvement on the 100 days before. Part of our issue was in
managing this and not achieving our target, which we would optimistically
hope to achieve the guideline target of 30 days from referral to scope. This is due to
increased demand on the service and part of that demand has come from
increasing external pressure, an increasing need for these scopes to be
done. Over the time that we've been doing this project, the bowel cancer screening
program was extended from only offering screen tests to people aged 50, 55 and 65
in 2013. By the end of next year, everybody from every two years from age
50 to 74 - the bulk of the increase in those screening frequencies
occurred in 2015 and 2016. We've also seen a steady increase in
participation rates in the bowel cancer screening program itself and there's a
significant number of FOBT tests that are done that are instigated in the
community by GPs or by other organisations. So we've seen an increase
in participation and we've seen an increase in the total number of scopes--
tests being done and so we're steadily seeing an increase in the
number of positive tests. And we saw, for example, an increase in over 10 percent
between 2015 and 2016. This is a graph which shows - the red and blue lines are
2015 and 2016 - numbers of scopes-- the number scopes by age group. So you can
see in the middle of the graph here, the age group covered by the bowel
cancer screening program - between 50 and 74. And you can see the bulk of the
increase was in the upper age groups in that-- in that area. In fact, pretty well
all of the increase in our scopes in 2015 to 2016 appears to have come from
increased testing through the bowel cancer screening program. We've also
extended the indications for using this service. One of the project grants we got
from Cancer Institute in New South Wales was to extend from the screening
program to symptomatic patients and that grant ran from the
middle of last year to the middle of this year. From September last year,
medically fit patients over the age of 45 had been referred to clinic with
rectal bleeding as their main symptom were booked direct to scope, they didn't have
to be come to be seen in the clinic. This has increased our
internal demand from service development in Newcastle. This graph shows the
increase in the referrals per month from way back at the beginning of the project
in its pilot phase in December - between December 2013 and the
middle of 2014 - when we were at dealing with 15 to 20 patients a month. So over
the last year where we've been dealing with - on most months - more than 100
patients a month through the booking service. How have we done? Well, the most
important metric is the time from referrals to scope. It was a hundred days
between-- before the direct access service was introduced. This is a slightly odd
graph, in some respects. It's an average of the last 30 patients and the time that
they've taken moving through the last year or so of our service. So by
the middle of this year, the last 30 patients were taking on average 42 days
to get through the system. We're slowly - very slowly - but steadily
bringing down our access time from around 100 days at the start of
this project to now with much increased demand on the service to about 40 to 42
days. So I said at the beginning that I was going to tell you where we started,
what I think has worked, I'm going to tell you what I think has not worked and some of
the reasons why we think they haven't worked.
What's definitely not worked is the process for our medically less fit
patients and we've also struggled to keep up with capacity in providing
enough endoscopy opportunities-- enough endoscopy slots, if you like, to meet this
demand for the service. This is the graph of the last
30 people's average days to scope, for the patients who we were able to
successfully book on the phone through the direct access service. That averages
around 65 to 70 percent of all of the people referred to the service. About a third -
between a quarter and a third - and a slightly increasing proportion in the
last few years as our age group has got slightly older and not medically fit
enough for us to be able to book with the strict triage criteria we
put for our nurse-led service. You can see for the people who are fit, we've
averaged around 40 days for most of the last year. This is the same graph but for
the people who were not fit to be booked on the phone, so people had to be
diverted to go through clinic. And you can see at the beginning
of last year or middle of last year, we were averaging about 150 days to get these
people seen and get them to scope. And for most of the middle part of the last
year, we were around averaging around 120 days. We've got the average down to about
100 days now. That's still better but it's still pretty awful, it's not
good enough that these people who are, in many ways, more
vulnerable patients are waiting longer. We looked hard in the middle half this
year about why and we found that part of the reasons is slow access to the
clinics that these people had to be sent to. If they were sent to one of the
colorectal surgeons - myself or my four colleagues - we were seeing them in
about 50 days. Likewise, my general surgical colleagues were seeing them in about
50 days, gastroenterologists were seeing them in about 80 days and then it was a
fairly constant period to get them to a scope unless they needed other medical
intervention first. We've responded to that by better control and monitoring.
Put simply, if we ask for a clinic appointment, we used to assume that it
was going to happen. We've now realised that you can't assume
anything even in a fairly tightly-controlled system and you have
to chase them down and make sure that Mrs. Brown really does have an
appointment for the next Tuesday week rather than yes it will be done. And the
delivery of the clinic service by the clinicians is, to say the least, a
bit variable. It's still the case that there are an awful lot of low value
follow-up appointments being seen using that clinic time, which could be better
used for higher value health care. The other issue that we faced is capacity.
We have 30-plus endoscopists in three public hospitals in Newcastle providing
the service. In the first few years of our service, we added one or two patients
per list as we-- in turn between the endoscopists to
try and get these scopes done. A couple of our endoscopists refused to take part,
but most agreed to go along with that. As our numbers rose towards 100
patients per month, this caused issues with perception - that these scopes were
displacing routine scopes. Those are-- those that are booked for 90 or 365 day
priority. Now some of those patients are in surveillance because
they've had high-risk polyps or they've had a cancer in the past. They're
actually very important patients because they are the people who
get the highest yield of actual pathology when you scope them - and so
they're at risk. And if we're displacing those, we're actually not doing the
community, as a whole, a particularly good service. We responded to that in the
middle of this year by creating three dedicated lists just for direct access
scopes. We now have three of these each four
weeks where we can do 8, 9 or 10 scopes - depending on the anesthetist - and that's
helped us meet our capacity. But it's really only helped us keep up with
demand rather than create an improvement in our access. So what are we doing now
because we can't leave things alone? We're looking at waitlist management.
We're looking seriously for the first time at what we're doing and why we're
doing it. We did a pilot project last summer where we reviewed the waiting
list of two of our endoscopists. At least 10% of the scopes that were on those
waiting lists were completely unnecessary by any recognisable
guidelines or clinical indications, but 5% of scopes were seriously overdue. So
we were doing badly in both directions. Other evidence that we've done through
student projects and other audits and suchlike suggested that
between 25 and 40 percent of the scopes that we do might be completely
unnecessary. So our intent is to develop better waiting-- better waitlist
management process, which creates capacity for the timely scopes from
whichever cause - whether it's the bowel cancer screening program, symptomatic or
surveillance. That means we can get those things done as we need them. Even if we
manage to create 10% of extra capacity by moving things out that don't need to
be done to moving things in which do need to be done, in our service, that's
over 500 colonoscopies a year. Thank you for listening.
-------------------------------------------
Games for Kids Baby Learn Colors with Subway Surfers Vs Minions Rush Kids Video iGame Kids Cartoons - Duration: 9:06.
Games for Kids Baby Learn Colors with Subway Surfers Vs Minions Rush Kids Video iGame Kids Cartoons
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Dolphins vs Ravens Live Stream: How to Watch Online for Free | SML News - Duration: 4:32.
Dolphins vs Ravens Live Stream: How to Watch Online for Free
Both still very much alive in their respective divisional title battles, the Miami Dolphins and Baltimore Ravens meet for a Week 8 "Thursday Night Football" matchup at M&T Bank Stadium.
Kickoff is scheduled for 8:25 p.m.
ET and will be broadcast on CBS.
If you don't have cable or can't get to a TV, here's how to watch a live stream on your computer, tablet or streaming device:.
Amazon Prime: If you have Amazon Prime or want to start a free 30-day trial of Amazon Prime, you can watch the game via Amazon Prime Video.
You can watch on your computer via your browser, or on your tablet or streaming device via the Amazon Video app.
CBS All Access: If you don't have Amazon Prime and aren't interested in starting a free trial, you can also watch the game via CBS All Access, a cable-free streaming service that lets you watch a live stream of your local CBS channel.
They offer a free seven-day trial.
Preview.
So far in 2017, "Thursday Night Football" has been kind to those who like entertaining football.
The Chiefs and Patriots began the season with 69 combined points.
Two weeks later, the Rams and 49ers surprised everyone with a 41-39 instant classic.
The Pats and Bucs didn't have a lot of points but ultimately had an exciting finish.
The Eagles vs.
Panthers was another that came down to the final seconds, and last week's 31-30 Raiders victory over the Chiefs was just about as good as it gets.
Well, hopefully you didn't used to it.
Because this one, at least on paper, has the makings of an ugly, low-scoring, punt fest.
The Dolphins are 31st in the NFL in scoring offense, 32nd in yards per play, 29th in Football Outsiders' offensive efficiency rankings and are now without Jay Cutler, which may or may not be addition by subtraction.
The Ravens rank 23rd, 30th and 26th in those same stats, and still have Joe Flacco, who has a QB rating better than DeShone Kizer and no one else.
One interesting aspect to watch will be Miami's rushing offense vs.
Baltimore's rushing defense.
A classic case of stoppable force vs movable object, the Dolphins rank 31st in yards per carry, while the Ravens are just 23rd in yards per carry allowed.
Whether or not the Dolphins are able to get Jay Ajayi going on the ground will go a long way in determining who has the edge in this one.
The oddsmakers favor Baltimore by three points, so don't be surprised if this is yet another Thursday night game that comes down to the final possession.
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Learn Color Farm Animals Cartoon Superhero Dance For Kids Color Dinosaur Horse Cow Videos For Kids - Duration: 12:10.
Learn Color Farm Animals Cartoon Superhero Dance For Kids Color Dinosaur Horse Cow Videos For Kids
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JUST GO-BEFORE 5: For How Long Do You Go Abroad - Duration: 4:40.
For more infomation >> JUST GO-BEFORE 5: For How Long Do You Go Abroad - Duration: 4:40. -------------------------------------------
Search Is On For Inmate Who Walked Away From Folsom State Prison - Duration: 1:48.
For more infomation >> Search Is On For Inmate Who Walked Away From Folsom State Prison - Duration: 1:48. -------------------------------------------
Radiotherapy patterns of care for stage I and II non small cell lung cancer in Sydney, Australia - Duration: 11:29.
Good afternoon, everyone. My name is Andrew Nguyen, I'm a fourth year medical student
at the University of New South Wales and today I'll be talking about how
non-small-cell lung cancer is treated in Sydney. So lung cancer remains the most
common and most lethal cancer in the world. Patients with stage one and two
non-small-cell lung cancer have localised tumors that are potentially
curable. Radiotherapy is an alternative for surgery for these patients who are
medically inoperable or refuse surgery. However, there is variation seen in the
use of curative radiotherapy, with some patients receiving palliative
radiotherapy or no treatment. Curative treatment rates for stage 1 and 2 non-
small-cell lung cancer vary internationally between about a half to three-quarters,
and for inoperable patients, the curative radiotherapy rate varies between one-third and
a half. The reasons behind this variation are known and may be due to patient or
clinician factors. Stereotactic ablative body radiotherapy - or SABR - is a newer
method of delivering precise high-dose radiation in a limited number of
fractions. However, eligibility for this treatment
depends on tumor size and location. The primary aims of this-- of this study were
to document radiotherapy patterns of care for early stage non-small-cell lung
cancer in Sydney and to evaluate reasons for palliative rather than curative
treatment. A secondary aim was to identify the proportion of patients who
would be suitable for SABR treatment.
Electronic oncology databases at three institutions were queried to retrieve
data on patients with stage one or two non-small-cell lung cancer
who were seen at a radiation oncology clinic between 2008 and 2014 and who did
not receive surgery. The three institutions, Liverpool
MacArthur Cancer Therapy Centre, Prince of Wales Cancer Therapy Centre and St.
George Cancer Care Centre are all public facilities located
in Sydney. Data collected included patient demographics, tumor treatment and
outcome details. The simplified comorbidity score is a score that adds
up weighted comorbidities and was determined using past medical records.
Curative radiotherapy was defined by a minimum of 50 Grays for conventional
and 48 Grays for the SABR.
Suitability for SABR was defined as peripheral tumors less than five
centimetres in patients with T1-2N0M0 disease. Analysis was performed
using SPSS statistics. Univariate and multivariate analysis were used to
determine factors associated with curative radiotherapy. Now to the results.
There are 312 patients included in the analysis. The median
age was 77 years and 64% were male. Differences were noted between the
institution populations, including tumor histology, ECOG performance status,
simplified comorbidity score and pulmonary comorbidity. Gender, age distribution,
stage were similar. Now, treatment was curative radiotherapy in 57 percent, palliative
radiotherapy in 19 percent and no radiotherapy in 24 percent of
patients. Variation was seen in the use of curative radiotherapy between
institutions ranging from 43 percent at Liverpool MacArthur to 81 percent at
St. George. There was variation in the method of delivery of curative
radiotherapy. The SABR to non-SABR ratio is a ratio of SABR to
conventional radiotherapy use. The overall ratio was 0.33. The use of SABR
was lowest at St. George and highest at Prince of Wales.
We compared patterns of care between two separate time periods. We picked 2012
because this was the year when widespread SABR use began at these
institutions. Use of curative radiotherapy increased from 51 percent during
2008 to 2011 to 64 percent from 2012 to 2014, with the corresponding decrease in the
use of palliative radiotherapy by about half. The proportion of patients
receiving no treatment was identical. The main reasons for receiving palliative or
no treatment was chronic obstructive pulmonary disease or poor pulmonary
function. Patient preference was comprised 11 percent of reasons and other
reasons included logistical factors, such as the patient being unable to lie flat,
disease progression and physician preference. We also analysed factors
associated with curative radiotherapy use on both univariate and multivariate
analysis: the method of diagnosis, simplified comorbidity score, ECOG
performance status, FEV1 percentage, institution and time period were all
significantly associated. In the subgroup of patients with T1-2N0M0 non-
small-cell lung cancer, those suitable for SABR based on tumor size and
location include 32 percent who receive palliative radiotherapy and
approximately half who received no treatment as well as conventional
radiotherapy. About a third of patients who received no treatment and one-fifth of those
who underwent palliative radiotherapy were also technically-- sorry, clinically
SABR, so clinically suitable for SABR as defined as having an ECOG
performance status between 0 and 2. Now, my apologies in advance for this next
slide. There are only three published
Australian studies that documented patterns of care in early stage
non-small-cell lung cancer. Our results fit in at a 57 percent curative treatment rate,
among 56 percent, 33 percent - which is the one just cut out below - and 73 percent at the
bottom. Boxer et al reported the highest curative rate, but this was in a
highly selected population whose management was only discussed at MDT. The
lowest included stage three patients and ours looked at patients who did not
receive surgery. Overall the literature-- literature does show a variation in
the Australian treatment patterns. To our knowledge, this is the first radiotherapy
palliative care study for inoperable stage one and two patients in Australia and
outside North America. Use of curative radiotherapy for these patients varied
between countries: one third in Canada and half in the US and in ours. The
Canadian study by Smith et al was before the introduction of SABR, which
may explain its lower rate. Despite guidelines recommending curative
radiotherapy for these patients, only one third to half of these patients received this
treatment, although Smith et al suggested that this is likely due to
patient factors, such as poor performance status, older age and poor general
condition. We found that institutional factors also play a role. Like in ours,
variation between institutions was also reported invalid or unstudied. According to
the authors of this study, institutional variation could be due to a downstream
effect in variations of surgical practice and in preference-sensitive
care. The practice of surgeons from different institutions could lead to
differences in the type of patients left for consideration of surgery, in terms of
comorbidities, lung function and age. Variation in the use of surgery has been
reported between institution types, however we tried to take this into account
in our multivariate analysis. Management for early-stage non-small-cell lung
cancer is complex, often requiring discussion of MDT. Patients are given
many legitimate treatment options that-- which offer significant benefits and
trade-offs. Many patients commonly delegate decision-making to clinicians
and this therefore may lead may lead to variations in treatment through
recommendations based on subjective opinion. In our study, treating
institution was significantly associated with the use of curative radiotherapy
after controlling for other factors, suggesting evidence of clinician bias.
This is also the first study to evaluate the suitability of patients for SABR.
The implementation of SABR has resulted in an increased proportion of patients
receiving curative radiotherapy. The shorter fractionation schemes are more
convenient for the elderly population with comorbidities. Since the
introduction of SABR, curative radiotherapy use has increased. We found
that a third of those who received no treatment and a fifth of those who
receive palliative radiotherapy were both clinically and technically suitable
for SABR. Increased utilisation of this method in suitable patients has the
potential to improve survival in non-small-cell lung cancer. Introduction
of SABR did change radiotherapy practice but it did not increase
radiotherapy use in patients who did not receive any treatment. The reasons for
this are unknown, although patient preference was a more important factor
in this group. The limitations of this study include its retrospective nature,
the fact that all three institutions were from public metropolitan hospitals
and the self-reporting of comorbidity scores. In conclusion, the use of curative
radiotherapy varied between cancer institutions.
Patient factors were the predominant reason for palliative treatment.
Treating institution was also important. A significant proportion of patients who
were treated with palliative intent were suitable for SABR treatment. Thank you
everyone for your attention, I would like to now open it up for questions.
-------------------------------------------
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Keto Full Day of Eating Vlog 01: Keto Eating For TALL people! - Duration: 6:33.
I'm gonna do a full day of eating vlog, starting now. Hey guys. How are you?
Welcome to A.D. Keto! This is the channel where we talk about all things ketogenic
diet. We talk about keto foods, talk a little bit of keto science, and we do some keto
recipes. If this is your first time here, please consider subscribing, and do click
that bell icon, so you get notifications when I post new content. So today, I'm
gonna do the first of what I hope to be several Full Day of Eating Vlogs. When I
first started keto, I really enjoyed watching vlogs. That kind of gave me a
clue as to what I should be eating. I'm a taller guy; I'm about 6'3". When I started,
I was about 272. I didn't really know what I should be eating, so I'm hoping that
this vlog can help you out if you're just starting, and are kind of in the
same ballpark I was -- a bigger fella. You know, maybe I'll do these every couple of
weeks, maybe every month or so, just to show you what I'm eating.
So calories, when you're first starting keto, are not really something to focus
on. They're something to keep your eye on, but not something to obsess over. If I were just
maintaining, I would probably be at about 2,000 calories a day -- between 2,000 and
2,100 calories per day. I've been on keto since January, I've been at a pretty
significant deficit, calorie-wise -- most days around eighteen to nineteen hundred.
So that's what I'm gonna do today. I'm gonna do a food vlog that just shows
kind of what I would eat when I was just starting out -- breakfast, lunch, and dinner --
trying to keep it at around 1,800 calories. But again, calories shouldn't
really be the focus. You really want to focus, especially when you're starting
out, on your macros -- specifically protein. Hitting that protein goal, keeping your
carbs under 20 grams, and then eating fat until you're full.
So this is the first of those vlogs, so let's get to breakfast! All right, guys -- so
what I normally would eat for breakfast for the first week that I was on keto
was either eggs and bacon, or eggs and sausage, and I would throw an avocado
into the mix, into my frying pan -- throw an avocado in there, put my eggs on top of
it, scramble it all up. Add my sausages -- delicious.
So that's what we're gonna do today for breakfast, and I normally start with some
coconut oil. About a tablespoon of coconut oil, and then I do my sausages in
it. And I've got to cover these sausages up, because they tend to splatter.
These are Jones Dairy Farm Sausages. Per serving -- and I had two servings -- zero
carbs, seven grams of protein, and 16 grams of fat. So for this breakfast, those
sausages are gonna supply me with 32 grams of fat, zero carbs, and 14 protein. Yay!
So before I put my eggs in, hello, light! Before I put my eggs in, I'm gonna
actually fry up this avocado, and then I'm gonna dump my eggs on top of it.
That's a nice one!
Sorry I'm burying you, sausages. Sea-salt! All right, but my breakfast
would not be complete without my keto coffee:
A tablespoon of coconut oil, tablespoon of Truvia, tablespoon of Kerrygold butter, a
couple of tablespoons of heavy whipping cream, and Green Mountain Caramel
Vanilla Ceam.
And if I'm feeling super distinguished, I will pour it into a coffee cup. So here it is
guys! This is my... This was my go-to breakfast when I was starting keto:
Sausages, eggs, avocado, keto coffee. Can't go wrong. Here are the macros. I'll flash
them, put them kind of right here. And I'll keep track as I go through the day.
So I'll see you at lunch time! Hey guys, I am on my lunch break, and sitting in my
car. I actually have a meeting today -- my wife and I have a meeting to attend. And
I brought with me for lunch a Quest Bar. My favorite flavor,
Cookies & Cream. But have a protip / hack that I like to do with all of my
Quest Bars. I'm gonna leave this on my dashboard for about 45 minutes to an
hour, let it warm up, and when I come back to the car, hopefully it'll taste like
a fresh-out-of-the-oven Oreo cookie. So see in about an hour!
All right, I'm gonna take a look at my Quest Bar now. It doesn't seem like it's too
too melty, but some days, like I've done this a few times, and...Whoa, hang on there,
phone! Warmed up quest bar for lunch.
It's dinner time, and Caroline and I are going to Five Guys.
Okay, so we've made it out of Five Guys. I had a double bacon cheeseburger with
jalapenos and peppers and onions and grilled green peppers. I will flash the
macros right up here. It was good! Again, if you're just starting out, you should try
not to worry too much about calories, and focus more on getting the right macros.
So hit the protein, keep the carbs under 20 grams, and then eat fat to satiety.
So that'll just about do it! I hope this was valuable to you in some way. If you
liked this video, please give it a thumbs up, and please subscribe! It'll really
help me grow the channel. So I hope you have a fantastic day, and I'll see you
next time!
Soph, what are you doing? You should not be on the table.
-------------------------------------------
Message 2 quit M2quit for smoking cessation a pilot trial - Duration: 15:14.
All righty. So thanks everyone for coming this afternoon, it's great to see so many
great presentations. So today in terms of an outline, in terms of background, I'll
be talking about some of the engagement with current services, how we need to
increase reach and coverage of those services to try and get more engagement
from smokers and in particular, our most vulnerable, socially-disadvantaged
smokers or low-SES - low socioeconomic status - smokers. So I'll work quickly through
a systematic review that colleague Veronica Boland had led at NDARC and
then some of the formative qualitative research that we've done to give us an
understanding of what low-SES smokers actually want in terms of program needs
via text messaging. So the first study will look at the-- examine the quit
support and factors associated with treatment engagement and alternative
treatment options at the moment for low-SES smokers and then the second
qualitative study will look and ask-- we specifically asked low-SES smokers what
exactly they wanted help with and needed in terms of how to overcome some of the
current obstacles for current treatment services and using a different modality
that they'd prefer which was text messaging. And then I'll quickly run
through the study protocol and next steps. So as one of the slides was earlier
with mental health, this is very similar - just more broadly for low-SES smokers.
You can see that the lowest SEIFA quintile - that's an area level of
disadvantage indicator - has a much markedly higher rate of smoking compared
to those that are more privileged in our society. And we haven't done a very good
job over time in closing that gap, unfortunately, we need to do a lot more
work on that. So the current reach of cessation support needs to increase. This
is universal, it's not just a problem that we face here in Australia. For
instance in the US, approximately 2 percent of US smokers
use Quitlines despite the constant push from the Center for Disease Control to
lift it to 6 percent. Some of our data that we've looked at with NDSHS - so
that's our national survey for drug and alcohol - have found about 3.2 percent of
Australian smokers engaged with the Quitline and a recent RCT we completed -
1047 low-SES smokers that were enrolled in a program where we
offered nicotine replacement therapy and Quitline support - only 31 percent of
those had said that they'd spoke to the Quitline previously and then the mean
age of participants in that trial were 46 years. So we need to really
re-evaluate and think about where we move forward in terms of cost effective
methods with high reach but also have high acceptability among our user groups.
So cessation interventions, we really need to work on trying to increase
cessation for low-SES smokers. Unfortunately at the moment, treatment
approaches are failing to reduce smoking rates at the same rate as those of more
privileged counterparts. So their studies in the US that look at Quitline use
6000 and a chosen marked lower rate of cessation when engagement occurs with
low-SES or disadvantaged groups. That's also been found in the UK's world, for
big RCTs, even when pharmacological treatments are used as well as a
behavioral support where there's a marked difference in terms of outcomes
for our most disadvantaged groups. So we really need to work on trying to
increase our research output with individualised behavioral programs but
also really need to re-evaluate how we complement our tax increases with
additional tobacco control interventions focused on cessation - with the price of
cigarettes soon to hit 40 dollars a packet - so we really need to think about
how we're going to help this group to achieve cessation.
So related to that as well, we need to re-examine our current strategies. So
Australia is not on track to reach our COAG benchmarks for cessation and it's
been noted in the mid-point review of the National Tobacco Strategy that
there's a high priority for Commonwealth state and territory governments to
jointly invest in the merits of alternative modes of Quitline service
delivery and coordination and also think about how we come about with more
targeted strategies to reach the most disadvantaged Australian smokers. And
also it's been recognised for quite some time now that the WHO Tobacco-Free
Initiative has really been pushing towards more mobile health based
interventions for smoking, which for a general population level for smokers,
they've found are high reach. cost-effective, scalable and a
sustainable platform for tobacco control interventions as well as for other
health risk behaviors. So this is just a a quick overview in terms of Veronica's
work that she did at NDARC. So we found only looking at low-SES and
disadvantaged groups, we found 13 studies that had evaluated a technology-based
platform of cessation delivery and only one of those had used text messaging and
that was a New Zealand Maori smoking trial in the late 2000s. So since then,
there's no movement in terms of developing personalised or tailored
approaches to try and help low-SES or disadvantaged smokers quit using text
messaging in particular. So for our first qualitative study, so as part of the
wider RCT where we recruited 1047, we invited smokers in the Sydney
metropolitan area to be involved in some focus groups that were conducted at
NDARC. The aims of the study were to explore low-SES smokers' and ex-smokers'
recent quit experiences with available quit support and factors that impacted
their treatment engagement, as well as trying to gain feedback about
the acceptability and feasibility of alternative approaches to smoking
cessation. So as part of that, we had 5 ex-smokers and 19 smokers that were all low-
SES, defined as having a government pension or allowance. We'd use thematic
analysis, deductive from the interview guide and supplemented inductively.
Initial codes were generated based on the interview guide headings and
patterns observed in the data and then we coded that into groups and then
overarching themes. Sub-themes are identified within themes and key
concepts within those sub-themes. So related to the results, so guilt, shame
and stigmatisation of smoking were expressed and prevented treatment-
seeking behaviours. So there's a few quotes here - I won't read them all
out but the first one there, they said, "I just didn't like it - speaking to Quitline -
because it made me feel guilty...it made me feel guilty so I hated it." That
was an ex-smoker. And then also smokers expressed a positive smoker identity
which functioned as a barrier to cessation. So smoking had become such an
ingrained behavior and lifestyle choice that was hard to see the other side.
So, "I see myself as a smoker and I just figure that's me, you know." So that's a
smoker, and then also-- there's another quote there actually, "There's the whole
other thing of it being a part of your identity for so long. this is your...this
is just part of your personality or something." Related to tech support and
smartphone apps, they were considered more favourable to alternative current
telephone counseling services. So there's a few quotes, so one at the bottom there,
"If I was getting a text message when I was feeling vulnerable, it could probably
turn me away," - that's from smoking, not seeking
treatment. But then there was also-- so further high support for alternative
support options, it overcomes stigmatisation and feelings of judgment.
So as one smoker said, "Knowing the progress you've made as opposed to being
constantly reminded that you're a smoker." And they also come around to the idea
that, via mobile platforms, that it can actually be tailored and interactive
in terms of the support options. So they really look towards wanting support
related to health benefits, there's also the the money saved from quitting as well
during the quit attempt. The second qualitative study, so this was to examine
treatment service experience and how a text message program could be developed
to improve treatment success and also to identify user preference for design and
content of the proposed text message program. So for this, we recruited 13 low-
SES smokers, so they were from the Sydney metropolitan area but we did a letterbox
drop in the local area to recruit low-SES smokers rather than the previous
cohort where we had a really strong treatment-seeking focus, they were
enrolled in an RCT. The same analyses was used as the qualitative study 1 approach.
For the results, so the barriers from qualitative study 1 were often
repeated but smokers really looked towards-- what they wanted was a SMS
program. It requires messages that overcome the obstacles presented by: normalisation
of smoking in their peer groups and community, social network and higher
exposure to smoking and also the lack of non-smoker role models for support and
guidance was lacking. And they also cited that there was a need for the
program to be seen as a source of positive encouragement and reassurance.
So during the qualitative analyses, we found that-- also the participants were
saying that to develop a tailored text message program, it's really important to
consider the quit cycle and how this or the needs of smokers change as they
transition through the cycle - so from pre quit through to preventing relapse
at the end. And they really wanted to get support and guidance at each stage to
strengthen their non-smoking identity and normalise non smoking behaviors.
So this is a little bit of a complex slide, but it did come out a lot better
than I was thinking given the small font. But I can work you through that. So in
the middle there, you've got the quit cycle - so from pre quit, decision to quit,
managing cravings and preventing relapse. In the blue there, that's some of the
feedback that we'd got from low-SES smokers in terms of some of the themes
that we'd received. We also did-- completed an expert advisory
group as well but I haven't had time to include that as well in the actual
presentation today. But during the pre quit phase, they really wanted help to
establish self belief and build confidence. They generally look towards
tapering smoking rather than abrupt cessation during the early phase and
they really wanted assistance in terms of trying to raise consciousness of
smoking and its role in their lives given that it's so ingrained and
so habitual, you know, trying to substitute and do other things and then
challenge existing beliefs. During the decision to quit, they wanted
assistance about setting expectations and knowing what they can expect
along the path. Related to managing cravings, they wanted assistance with
resisting temptations and cravings, distractions and substitutes and making
sure they get that assistance when they most need it. And they also talked a lot
about making sure that there was positive affirmation and acknowledgement
of the rewards and changes and efforts that they were making and also
congratulating them along the way, even on some of the smaller achievements. One
of the key things that did come out related to some of the reward-based
principles, was an idea about, you know, having a piggy bank there - about the
money saved along the way. And then finally related to preventing relapse,
they really wanted support in terms of-- so there's sort of some of the quotes.
"Just because you trip, doesn't mean you fall." And, "If you have a bad day,
recognizing that each day changes." So during the pre quit phase, here's some
of the quotes about - as I've touched upon before with raising consciousness-
about, you know, the role that smoking-- These are some of the quotes that the
participants had and then also about the decision to quit and making sure that
clear-- about setting expectations of what to expect as well as the positive
affirmation is really important throughout the whole cycle. For managing
cravings - as I sort of touched upon before with the larger diagram - they
really wanted support with substitutes and distractions and with preventing
relapse in particular, they wanted assistance with day to day coping. You know, not
every day is the same - some days are good, some days aren't so good. So just because
you trip doesn't mean you have to stay down.
So finally - I'm running a little bit short of time, I think - but with the text program,
this is where we're at so far. I mean, it needs a little bit more finer analyses but
really with program logistics and functionality, they really were looking
for something that was personalised, tailored and customisable and
interactive. And the style of messages had to be practical, in the moment,
supportive and reward-focused and the format really had to make sure it was
quite simple in its approach. So in terms of where we're at now with next
steps, so in the next few weeks we'll be consolidating these findings and
starting to-- we've already started to develop some preliminary text messaging
and the pilot will occur in the next few weeks. So it's been a lot of qualitative
work and formative work, but I think it's important to engage with the community
and ask what they want and it's clear that we've got a clearer understanding now,
that's for sure. And finally, just big acknowledgments to
the NDARC team and the investigators. NDARC's
supported by UNSW and a big thank you to the Cancer Institute for funding my
fellowship. That's it, thanks.
-------------------------------------------
Preliminary findings from an evaluation of the barriers for carers... - Duration: 12:28.
Thank you. I'd like to start by acknowledging the traditional owners of
this land - the Gadigal people of the Eora nation - and I'd also like to pay my
respects to the elders past, present and future. I work in Sydney Local Health
District as a tobacco treatment specialist, I've been doing this work for
about ten years now. I'm also the project lead on a project called "Focusing on the
Carer," and I think Joanna Freeman, who I work with, is also here. Joanna, where are
you? She's a project officer on this project
as well. So I'm here today to talk about this project that we're working on -
it's still underway - and to present the preliminary findings. Okay, so... the aims of
this project are to enhance the capacity of carers to provide quit smoking support
to mental health consumers. There are four stages to this project. The first
stage, which I'll talk about today, is the carers survey, where we're looking at
carers knowledge and attitudes to providing quit smoking support and also
what are some of the barriers and what their education and resource development
needs are. From that, we're developing resources which are printed and online
resources that will be uploaded on websites by the end of this year and
we're working in partnership with One Door Mental Health, which was
formerly the Schizophrenia Fellowship. The Schizophrenia Fellowship runs the
carer assist program which-- where they run groups for carers and as part of this
project, we're going to develop an education program that will be run
through the carer assist program. And finally, early next year we'll run a
train-the-trainer program for the facilitators of the carers groups so
that we can upskill them in providing quit-smoking groups. The project's funded
through the Cancer Institute of New South Wales and it's due for completion
in July 2018 and it has ethics approval.
As I mentioned, we're partnering with One Door Mental Health but along the way,
thanks very much to Joanna, we've established other partnerships with Mental
Health South East Sydney, Mental Health Carers New South Wales, Carers New South
Wales, Flourish and Headspace. So who are carers? Carers are someone who's
actively caring for a person with mental illness. They may be a family member, a
friend or someone who has a significant role in the person's life. They may not
be living with the person, the caring role may vary over time according
to the needs of the carer or the consumer - and by consumer, we're talking
about somebody who's living with a mental illness. Why engage carers? Well
we've worked in our roles, we've worked with mental health consumers for many
years and we've also had many carers coming into sessions and we've
identified that sometimes carers have misinformation about quit smoking and
that can get in the way of consumers quitting. But also, research shows that
carer involvement improves consumer participation in treatment, it also
improves psychological treatment outcomes and medication adherence. So
engaging carers in the quit smoking process can help consumers to use quit
smoking medications more effectively. It can also help them in terms of managing
triggers and can keep them going with the quit smoking attempt. Carers are also
important in reducing relapse rates because they are there at the time and
can identify that the person is going to relapse and early identification of that.
State and national mental health policies also recommend carer
involvement in treatment programs and health services should provide carers
with information and education about treatment interventions. So we've been
doing that under more ad hoc basis, but now we're trying to put our systems in
place to engage carers more in the treatment process because most smoking
for mental health consumers happens at home, and so if they're trying to quit
smoking, a carer can play a really important role in helping them stay on
track. In terms of the smoking rates across a general population in Australia,
there are around 12.8 percent, but for people with mental illness they
range from 35 to 73 percent. For drug and alcohol clients -
I'm based in drug and alcohol - rates are up to about 98 percent. The range depends on the
severity of mental illness, so the more severe the mental illness the higher the
smoking rates. So for people with schizophrenia, they're in the highest
group for smoking. So in terms of smoking and mental illness, compared to the
general population, smokers with mental illness tend to smoke more heavily and are
more nicotine dependent and unfortunately die approximately 25
years earlier than non-smokers - and this is because of their smoking. They're also
less likely to be offered professional quit smoking support and this is largely
because health professionals sometimes assume that they're not ready or they're
not interested or it's too hard for them to quit smoking. I've heard so many
times over the years, health professionals saying that that's all
they've got, that's all they've got. But actually the research shows that
mental health consumers are as ready as anyone else to quit smoking but they
might find it more challenging mainly because of the mental health issues that
they're experiencing. But there's also an impact of consumer smoking on carers and
I think that they're often forgotten in this. People who-- we know that people who
are exposed to secondhand smoke have higher lung cancer risks, almost the same
heart disease risks as smokers and because the smoking rates are much
higher with mental health consumers, that puts carers and other family members at
increased risk. We also know that because mental health consumers will smoke more
heavily, they experience stronger withdrawal symptoms and that can be
increased agitation and tension and that can place increased stress on carers.
There's also now the financial burden. I had a client yesterday who told me he
spent-- he's spending $35 a packet-- on a packet of cigarettes.
He's on the Disability Support pension, which is just over $400 a week, and he's
spending more than half of his pension on smoking so that also
places increased financial pressure on carers. What we know about quitting with
mental illness - it can be more challenging because of the heavy smoking
and chronic stress and because many mental health consumers have fewer
social supports and some have cognitive impairments. But the main barriers that we
see in the clinic are fears by consumers and carers about quitting, that it will make
mental health worse. I've worked with thousands - thousands, I think - of consumers
around quitting over the years and I liken it a lot to going skydiving and
before somebody goes skydiving, there's often a lot of fear and trepidation
about doing that. Now that's true with quitting smoking. I see a lot of fear,
particularly. We know that anxiety increases the day before somebody quits
but we also know that support helps and carers are in a really great position to
provide that support. The good news is people with mental illness can and do
quit successfully, they may have their medication-- anti-psychotic medication
reduced when they quit and we know that their mental health improves. In the
old days, they used to tell people not-- who had a mental illness not to stop
smoking because they thought that it increased mental health issues but we
now know that it improves mental health. They have reduced stress, anxiety and
depression and improved mood and quality of life. So, the carers survey. We wanted
to-- we're looking at evaluating carers knowledge and attitudes around quit
smoking, we wanted to find out how many carers compared to consumers smoked
because we couldn't find any data on this, we're also looking at what support
services they access and what their resource and education needs are. We've
used an online and paper-based survey and we've disseminated this through One
Door Mental Health, Sydney LHD and the other services. This is an ongoing survey,
it started in January and will run through to May. And I'll present today
the findings so far. So far-- actually, this says 94 but Joanna,
how many have we had now? Is it 98? So it's increased since I've submitted this. Most
of the carers who have responded are over the age of 50, most of them are born in
Australia and speak English at home, most of them are living with others. When we
looked at-- when we've asked about smoking rates - and this is carer self-reported
smoking rates and carers reporting on consumers smoking rates - what you can see
from this slide is that the majority of consumers are smoking. So I have 80
percent compared to a much lower rate among carers and there's more carers who
are ex or never smokers. What carers reported about the main triggers for
consumers to smoke - there's probably no surprises here: stress, boredom and
being around other smokers. Anxiety and substance use were also triggers as well.
Most carers reported that consumers at a high level of nicotine dependence, 77
percent were smoking within 30 minutes of waking and 58 percent reported
smoking 20 or more cigarettes a day. Of the consumers who smoked, the carers
reported that 44 percent were smoking inside the home, so strategies to reduce
smoking inside the home, they've had probably had some effect but there are
still high smoking rates inside the home which need to be addressed.
62 percent indicated that they were not planning on giving up. Many of them had
used quit smoking medications and mainly it was nicotine replacement therapy. And
most was-- many sought support through a GP. We asked carers about their views
around quitting. Many carers thought that quitting was too hard for consumers, many
have misconceptions that smoking reduced stress for consumers - we know that actually increases stress -
that smoking improved mental health symptoms - we know
that it actually makes mental health worse, that quitting may harm mental
health recovery. So our approach through developing our resources is to address
those misconceptions. Most carers were interested in providing some more
support but were concerned that quitting would increase stress on them. Many
wanted to improve their knowledge and skills and they-- these were the key
topics that they wanted covered in education. And the development of the
resource, how to use quitting medications, do's and dont's of providing support,
there were other things as well but these were the main topics. I'll just
flick through from there. So where are we at? Well we've developed a brochure
which is nearly finished and it should be up on the Schizophrenia Fellow-- One
Door Mental Health website and Sydney LHD website by the end of the year. We're
also working on a video that will go with that resource and they will be
uploaded to the websites as well. These will also be available to other services
if you're interested and we're working on the development of the group education
program and we'll run the train-the-trainer program next year. So if you are
a carer or you know your service provides support to carers, we are still
gathering data and collecting surveys. We'd like to invite you to complete the
survey, Jo and I are here this afternoon if you want to give us your contact
details or if you would like a copy of the resources once we complete the
project. Thank you.
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