Academic literature on the topic 'Personal injuries Australia Trial practice'

The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients’ choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses’ skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

This paper reports on selected findings from a novel randomised controlled trial (RCT) conducted in mental health settings in Queensland, Australia. Several national and state reports recently revealed the sub-optimal state of Australian mental health service provision which have direct implications for mental health nursing, including the privately experienced cost of working and coping in these settings. Clinical supervision (CS), a structured staff support arrangement, has shown promise as a positive contribution to the clinical practice development agenda and is now found reflected in health policy themes elsewhere in the world. However, CS is underdeveloped in Australia and the empirical evidence base for the informed implementation of CS, per se, has remained elusive. Within the overall context of a RCT design, therefore, and supplemented by other data collection methods, this large and generously funded study attempted to make an incremental contribution to better understanding this demanding substantive domain. Whilst the substantive insights and theoretical propositions reported here were derived from, and may be limited by, a sub-specialty of nursing and a single geographic location, they were earthed in the personal self-reported experience of those directly involved with a clinical practice innovation. They may resonate with counterparts beyond mental health nursing and Queensland, Australia, respectively, therefore, and may assist in both conceptualising and operationalising CS research, education, management, policy and clinical practice development decision making in the future.

Higher-order driving skills (HO-DS) are deficient in young drivers who are over-represented in road crash fatalities and serious injuries. Teaching HO-DS has strong theoretical support in reducing crash risk. This study contributes to the dearth of literature regarding on-road driver training that can develop these skills. Higher-order driving instruction (HO-DI) is explored in formal on-road driving lessons (in Queensland, Australia) via naturalistic observation. Fifteen instructors and 96 learner drivers aged 16–19 years were recruited, with 110 lessons observed. An HO-DI coding taxonomy informed by the Goals for Driver Education ( 24) was used for content analysis using an a priori approach, comprising eight HO-DI codes: driving plan (formerly driving route), vehicle control and maneuvering, mastery of traffic situations, surveillance, situational risk (formerly environmental variables), personal risk (formerly knowledge of risk), car function (formerly car knowledge), and distraction. Thirty-nine sub-themes were identified within the codes allowing a deeper understanding of instruction, including missed (unseen) and untaken (seen but not actioned) HO-DI opportunities. The findings inform recommendations for the development of best practice HO-DI. This study has implications for the driver training industry with potential for reducing the crash risk of young novice drivers.

Musculoskeletal injuries (MSI) remain a concerning cause of racehorse morbidity and mortality with important ethical and welfare consequences. Previous research examining risk factors for MSI report inconsistent findings. Age is thought to affect MSI risk, but, to date, there have been no prospective studies comparing MSI in two-year-old versus older horses. This study aimed to: (1) determine the incidence of MSI for two-year-old and older horses, and whether this was affected by training track, season, or rainfall, and (2) determine the types of MSI affecting two-year-old and older horses, and whether horses trialled or raced after injury. A prospective survey was conducted with data collected through personal structured weekly interviews with participating trainers over a 13-month period. Data were analysed using Poisson regression. The incidence of MSI in the current study was low (0.6%). The incidence of MSI in two-year-old horses was higher than older horses (p < 0.001). Types of MSI varied between two-year-old and older horses (p < 0.001) and affected whether horses subsequently trailed or raced from 11 to 23 months after injury (p < 0.001). A larger proportion of two-year-old horses had dorsal metacarpal disease and traumatic lacerations. A smaller proportion of two-year-old horses had suspensory ligament desmitis, superficial digital flexor tendonitis, proximal sesamoid bone fractures, and fetlock joint injuries than older horses. Training track and rainfall did not affect MSI. The season affected MSI in two-year-old horses (p < 0.001) but not older horses. The major limitation was that trainers in this study were metropolitan (city) and our findings may not be generalisable to racehorses in regional (country) areas. Another significant limitation was the assumption that MSI was the reason for failure to trial or race after injury. In conclusion, the incidence of MSI was low in the current study and the types and the risk factors for MSI are different for two-year-old and older horses.

IntroductionThere is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model.Method and analysisThis is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial.Ethics and disseminationAlfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies.Trial registration numberNCT04217330.

Objective. To compare the uptake of peer review among interns in mandatory and voluntary peer-review programs. Population. All first and second year graduates (n = 105) in two Australian hospitals. Main outcome measures. Completion of peer review, and reported responses by doctors to peer review. Results. Eight of sixty interns undertaking the mandated program completed all steps. In the voluntary program, none of 45 interns did so. Resistance to peer review occurred at all stages of the trial, from the initial briefing sessions to the provision of peer-review reports. Discussion. Hospital internship is a critical period for the development of professional identity among doctors. We hypothesise that resistance to peer review among novice doctors reflects a complex tension between the processes underpinning the development of a group professional identity in hospital, and a managerial drive for personal reflection and accountability. Peer review may be found threatening by interns because it appears to run counter to collegiality or ‘team culture’. In this study, resistance to peer review represented a low-cost strategy in which the interns’ will could be asserted against management. Conclusion. To enhance uptake, peer review should be structured as key to clinical development, and modelled as a professional behaviour by higher-status colleagues. What is known about this topic? In non-clinical settings, peer review can lead to improvements in performance. Studies in the US and Canada have demonstrated that junior doctors in hospital have low rates of uptake of peer review. What does this paper add? In Australia, junior doctors had low rates of engagement with both mandatory and voluntary peer review. Peer review may be resisted because it threatens to undermine the collegiate atmosphere among hospital peers. What are the implications for practice? Peer review should be modelled as professional behaviour by higher-status colleagues, especially registrars and consultants, and presented as central to improvement in clinical skills.

Purpose A six-month randomized controlled trial was conducted to examine the impact of a home-based nutrition and exercise intervention on functional capacity to prevent falls among rural seniors. The paper aims to discuss this issue. Design/methodology/approach Men and women (n=134), aged 60 and older were assigned to one of four groups: exercise, nutrition, exercise-nutrition, and control. Participants in the exercise and exercise-nutrition groups performed a home-based exercise program (Home Support Exercise Program), and the nutrition and exercise-nutrition groups received a liquid nutritional supplement (Ensure®) for six months. Participants were assessed at baseline and six months on functional mobility, balance, flexibility and endurance. Findings There were significant group differences over time for functional reach and the Timed Up and Go test, with significant differences existing between exercise and nutrition-exercise, and exercise and nutrition groups respectively. Overall, the exercise group out-performed the other groups in terms of functional capacity and psychological well-being. Research implications Improvement of functional health among rural seniors is achievable through the delivery of a home-based intervention focusing on exercise and nutrition. Practical implications The study also shows that the effective delivery of an intervention to successfully address a fundamental and persistent problem is possible using existing resources; however, it requires a commitment of focus and energy over considerable time. Social implications The approach and findings helps seniors to age in place in a rural context. It shows feasibility of delivering a practical intervention in the rural setting through the health care infrastructure of home care. Originality/value Apart from the rural context, the study was innovative at many levels. Specifically, this intervention addressed a significant health issue (functional capacity, falls and injuries), involved frail rural seniors (often hard to reach through community-based programs), provided a feasible intervention (multiple component exercise program), used existing infrastructure (e.g. home care), and espoused community development principles (active involvement of community partners, researchers, and trainees). As well, the study had built-in mechanisms for monitoring and support through the involvement of home service workers who received training. This approach created a strong research to practice connection (another innovation) and was critical for the credibility of the investigation, as well as the sustainability of the intervention. Another innovation was the inclusion of a population health perspective as the study framework. From the population health perspective, this research addressed several determinants of health in rural and urban areas that include: physical environment (intervention within people’s home and rural context), social environment and social support networks (through existing infrastructures of home support workers), health services (availability of health promotion strategy delivered through the health care system) and personal health practices and coping skills (exercise).

Abstract Introduction Serious infection is common in patients with multiple myeloma (MM), and associated with major morbidity and mortality. Immunoglobulin (Ig) replacement is frequently used to reduce frequency and severity of infections, however evidence is based on small trials conducted &gt;20 years ago. Ig utilisation and associated costs in this patient cohort are rising worldwide. In Australia (Aus), Ig for secondary hypogammaglobulinaemia is funded if total IgG is below lower limit of reference range with a history of recurrent or severe bacterial infection, or in severe hypogammaglobulinaemia (IgG &lt; 4 g/L excluding paraprotein). In New Zealand (NZ), patients generally require a history of recurrent infections and trial of oral antibiotics before commencing Ig. This study aims to outline Ig use in the "real-world" MM setting, identify variation in and predictors of use, and describe association of Ig with survival outcomes. Methods Retrospective review of patients registered on the MRDR, a prospective registry established in 2012, currently open at &gt;60 sites across Aus/NZ. Patients with a diagnosis of MM or plasma cell leukaemia with verifiable data regarding Ig use were included in this analysis. Ig use was confirmed using medical/laboratory records, national Aus Ig dispensing tool or the NZ Blood Service portal. Quality of survival outcomes and cause of death data was augmented via linkage with national death registries. Baseline patient/disease characteristics, therapy and survival outcomes were compared between patients who received any Ig within 24 months of MM diagnosis and non-recipients using chi-square tests for categorical variables and rank sum tests for continuous variables. Variation in Ig use across sites were compared. Kaplan-Meier survival analysis was used to estimate time to Ig and duration of use. A time-dependent Cox analysis was used to compare survival for patients whilst on and off Ig therapy. All statistical analysis was completed on STATA/IC statistical software v16.1 (College Station, TX, USA). Results As of July 2021, &gt;4600 patients with plasma cell dyscrasias are registered on the MRDR. Of these, 2025 patients from 13 sites (12 Aus across five states/territories and one NZ) with verifiable data on Ig were included. 242 (12.0%) received Ig during follow-up, with a median time from MM diagnosis to Ig use of 14.2 months, median duration of Ig use of 54.9 months, and median patient follow-up time of 23 months (Figure 1). At 24 months following MM diagnosis, 14.9% (160 of 1075 patients reaching 24-month follow up) received Ig, and a further 7.6% (82 patients) received Ig later, after 24 months. Administration of Ig within 24 months post-MM diagnosis varied widely across Aus states and territories (2.7%-29.6%), and was 2.0% from one NZ site. Patients administered Ig within 24 months post-MM diagnosis had lower baseline IgG (3.7 vs. 5.6 g/L, p&lt;0.001), IgA (0.3 vs. 0.5 g/L, p=0.027), IgM (0.20 vs. 0.21 g/L, p=0.019) and total serum Ig levels (28.0 vs 56.0 g/L, p&lt;0.001), were more likely to have abnormal Fluorescence in situ hybridization (FISH) results (83.5% vs. 62.7%, p&lt;0.001) and receive immunomodulatory drugs (IMiDs) (28% vs. 12.3%, p&lt;0.001) or anti-CD38 therapy (4.5% vs. 1.2%, p=0.004) first-line compared with patients not administered Ig (Tables 1, 2). Ig use was not associated with an overall survival benefit (HR=0.79, 0.50-1.24, p=0.3). At time of last follow-up, there were 577 deaths (28.5%). Available data on cause of death was available for 175 deaths (30.3%). Of these, 65 deaths (37.1%) had infection listed as primary/secondary cause of death (COD). 64 of 65 infection-related deaths occurred in non-Ig recipients. In patients who received Ig (at any time), 12.5% had infection as primary/secondary COD, compared to 38.5% in non-recipients (p=0.14). Conclusion This Aus/NZ analysis found that 14.9% of MM patients received Ig by 24 months post-MM diagnosis with wide variation in practice. Ig use was associated with lower baseline Ig levels (all subtypes), abnormal FISH and first-line IMiD/anti-CD38 therapy. In this "real-world" cohort, Ig use was not associated with survival, highlighting the need for well-designed contemporary studies to inform evidence-based patient selection, especially with increasing use of Ig and targeted anti-myeloma therapies, and a high burden of infection-related mortality. Figure 1 Figure 1. Disclosures Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Harrison: Haemalogix: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche/Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene/ Juno/ BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Eusa: Consultancy, Honoraria, Speakers Bureau; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; GSK: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Terumo BCT: Consultancy, Honoraria. Mollee: Janssen, Pfizer: Research Funding; Amgen, BMS, Janssen, Caelum, EUSA, Pfizer, SkylineDx, Takeda: Membership on an entity's Board of Directors or advisory committees, Other: No personal fees received. Quach: GlaxoSmithKline: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Antengene: Consultancy, Membership on an entity's Board of Directors or advisory committees; CSL: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen/Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Spencer: Celgene: Honoraria, Research Funding, Speakers Bureau; Janssen: Honoraria, Research Funding, Speakers Bureau; Amgen: Honoraria, Research Funding; Bristol Myers Squibb: Research Funding; Takeda: Honoraria, Research Funding, Speakers Bureau; STA: Honoraria. Wood: Amgen, Celgene, Gilead, Janssen, Novartis, Sanofi, Takeda: Research Funding; Abbvie, Amgen, Antengene, Bristol-Myers Squibb, Celgene, Gilead, GSK, Janssen, Novartis, Sanofi, and Takeda.: Other: The Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) has received funding from Abbvie, Amgen, Antengene, Bristol-Myers Squibb, Celgene, Gilead, GSK, Janssen, Novartis, Sanofi, and Takeda. . McQuilten: Amgen, Celgene, Gilead, Janssen, Novartis, Sanofi, Takeda: Research Funding; Abbvie, Amgen, Antengene, Bristol-Myers Squibb, Celgene, Gilead, GSK, Janssen, Novartis, Sanofi, and Takeda.: Other: The Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) has received funding from Abbvie, Amgen, Antengene, Bristol-Myers Squibb, Celgene, Gilead, GSK, Janssen, Novartis, Sanofi, and Takeda. .

The following article is in response to a research project that took the form of a road trip from Perth to Lombadina re-enacting the journey undertaken by the characters in the play Bran Nue Dae by playwright Jimmy Chi and Broome band Kuckles. This project was facilitated by the assistance of a Creative and Research Publication Grant from the Faculty of Communications and Creative Industries, Edith Cowan University, Western Australia. The project was carried out by researchers Kara Jacob and Margaret Hair. One thing is plainly clear. Aboriginal art expresses the possibility of human intimacy with landscapes. This is the key to its power: it makes available a rich tradition of human ethics and relationships with place and other species to a worldwide audience. For the settler Australian audience, caught ambiguously between old and new lands, their appreciation of this art embodies at least a striving for the kind of citizenship that republicans wanted: to belong to this place rather than to another (Marcia Langton in Watson 191). Marcia Langton is talking here about painting. My question is whether this “kind of citizenship” can also be accessed through appreciation of indigenous theatre, and specifically through the play Bran Nue Dae, by playwright Jimmy Chi and Broome band Kuckles, a play closely linked to the Western Australian landscape through its appropriation of the road trip genre. The physical journey taken by the characters metaphorically takes them also through the contact history of black and white Australians in Western Australia. Significantly, the non-indigenous characters experience the redemptive power of “human intimacy with landscapes” through travelling to the traditional country of their road trip companions. The road trip genre typically places its characters on a quest for knowledge. American poet Gary Snyder says that the two sources of human knowledge are symbols and sense-impressions (vii). Bran Nue Dae abounds with symbols, from the priest’s cassock and mitre to Roebourne prison; however, the sense impressions, which are so strong in the performance of the play, are missing from the written text, apart from ironic comments on the weather. In my efforts to understand Bran Nue Dae, I undertook the road trip from Perth to the Kimberley myself in order to discover those missing sense-impressions, as they form part of the “back story” of the play. In the play there is a void between the time the characters leave Perth and reach first Roebourne, where they are locked up, and then Roebuck Plains, not far from Broome, yet in the “real world” they would have travelled more than two thousand kilometres. What would they have seen and experienced on this journey? I took note of Krim Benterrak, Paddy Roe and Stephen Muecke’s Reading the Country, a cross-cultural and cross-textual study on Roebuck Plains, near Broome. Muecke talks about “stories being contingent upon place … Aboriginal storytellers have a similar policy. If one is not prepared to take the trouble to go to the place, then its story can only be given as a short version” (72). In preparing for the trip, I collected tourist brochures and maps. The use of maps, seemingly essential on any road trip as guides to “having a look at” country (Muecke ibid.), was instantly problematic in itself, in that maps represent country as colonised space. In Saltwater People, Nonie Sharp discusses the “distinction between mapping and personal journeying”: Maps and mapping describe space in a way that depersonalises it. Mapping removes the footprints of named creatures – animal, human, ancestral – who belong to this place or that place. A map can be anywhere. ‘Itineraries’, however, are actions and movements within a named and footprinted land (Sharp 199-200). The country journeyed through in Bran Nue Dae, which privileges indigenous experience, could be designated as the potentially dangerous liminal space between the “map” and the “itinerary”. This “space between” resonates with untold stories, with invisibilities. One of the most telling discoveries on the research trip was the thoroughness with which indigenous people have been made to disappear from the “mapped” zones through various colonial policies. It was very evident that indigenous people are still relegated to the fringes of town, as in Onslow and Port Hedland, in housing situations closely resembling the old missions and reserves. Although my travelling companion and I made an effort in every place we visited to pay our respects by at least finding out the language group of the traditional owners, it became clear that a major challenge in travelling through post-colonial space is in avoiding becoming complicit in the disappearance of indigenous people. We wanted our focus to be “on the people whose bodies, territories, beliefs and values have been travelled though” (Tuhiwai Smith 78) but our experience was that finding even written guides into the “footprinted land” is not easy when few tourist pamphlets acknowledge the traditional owners of the country. Even when “local Aboriginal” words are quoted, as in the CALM brochure for Nambung National Park (i.e., the Pinnacles), the actual language or language group is not mentioned. In many interpretive brochures and facilities, traditional owners are represented as absent, as victims or as prisoners. The fate of the “original inhabitants of the Greenough Flats”, the Yabbaroo people, is alluded to in the Greenough River Nature Walk Trail Guide, under the title, “A short history of Greenough River from the Rivermouth to Westbank Road”: The Gregory brothers, exploring for pastoral land in 1848, peacefully met with a large group of Aborigines camped beside a freshwater spring in a dense Melaleuca thicket. They named the spring Bootenal, from the Nyungar word Boolungal, meaning pelican. Gregory’s glowing reports of good grazing prompted pastoralists to move their flocks to Greenough, and by 1852 William Criddle was watering cattle for the Cattle Company at the Bootenal Spring. The Aborigines soon resented this intrusion and in 1854, large numbers with many from surrounding tribes, gathered in the relative safety of the Bootenal thicket. Making forays at night, they killed cattle and sheep and attacked homesteads. The pastoralists retaliated by forming a posse at Glengarry under the command of the Resident Magistrate. On the night of the 4th/5th July they rode to Bootenal and drove the Aborigines from the thicket. No arrests were made and no official report given of casualties. Aboriginal resistance in the area was finished. The fact that the extract actually describes a massacre while purporting to be a “history of Greenough River” subverts the notion that the land can ever really be “depersonalised”. At the very heart of the difference lie different ways of being human: in Aboriginal classical tradition the person dwells within a personified landscape which is alive, named, inscribed by spiritual and human agents. It is a ‘Thou’ not an ‘It’, and I and Thou belong together (Sharp 199-200). Peter Read’s book Belonging: Australians, Place and Aboriginal Ownership contains a section titled “The Past Embedded in the Landscape” in which Read discusses whether the land holds the memory of events enacted upon it, so forming a tangible link between the dispossessed and the possessors. While discussing Judith Wright’s poem Bora Ring, Read states: “The unlaid violence of dispossession lingers at the sites of evil or old magic”, bringing to mind Wright’s notion of Australia as “a haunted country” (14). It is not surprising that the “unlaid violence of dispossession lingers” at the sites of old prisons and lock-ups, since it is built into the very architecture. The visitor pamphlet states that the 1890s design by George Temple Poole of the third Roebourne gaol, further up the great Northern Highway from Greenough and beautifully constructed from stone, “represents a way in which the state ideology of control of a remote and potentially dangerous population could be expressed in buildings”. The current Roebourne prison, still holding a majority of Aboriginal inmates, does away with any pretence of architectural elegance but expresses the same state ideology with its fence topped with razor wire. Without a guide like Bran Nue Dae’s Uncle Tadpole to keep us “off the track”, non-indigenous visitors to these old gaols, now largely museums, may be quickly led by the interpretation into the “mapped zone” – the narrative of imperialist expansion. However, we can follow Paul Carter’s injunction to “deepen grooves” and start with John Pat’s story at the Roebourne police lock-up, or the story of any indigenous inmate of the present Roebuck prison, spiralling back a century to the first Roebuck prison in settler John Withnell’s woolshed (Weightman 4). Then we gain a sense of the contact experience of the local indigenous peoples. John Withnell and his wife Emma are represented as particularly resourceful by the interpretation at the old Roebourne gaol (now Roebourne Visitors Centre and Museum). The museum has a replica of a whalebone armchair that John Withnell built for his wife with vertebrae as the seat and other bones as the back and armrests. The family also invented the canvas waterbag. The interpretation fails to mention that the same John Withnell beat an Aboriginal woman named Talarong so severely for refusing to care for sheep at Withnell’s Hillside Station that “she retreated into the bush and died of her injuries two days later”. No charges were brought against Withnell because, according to the Acting Government Resident, of the “great provocation” by Talarong in the incident (Hunt 99-100). Such omissions and silences in the official record force indigenous people into a parallel “invisible country” and leave us stranded on the highways of the “mapped zone”, bereft of our rights and responsibilities to connect either to the country or to its traditional owners. Roebourne, and its coastal port Cossack, stand on the hauntingly beautiful country of the Ngarluma and seaside Yapurarra peoples. Settlers first arrived in the 1860s and Aboriginal people began to be officially imprisoned soon after, primarily as a result of their resistance to being “blackbirded” and exploited as labour for the pearling and pastoral industries. Prisoners were chained by the neck, day and night, and forced to build roads and tramlines, ostensibly a “civilising” practice. As the history pamphlet for The Old Roebourne Gaol reads: “It was widely believed that the Roebourne Gaol was where the ‘benefit’ of white civilisation could be shown to the ‘savage’ Aboriginal” (Weightman 2). The “back story” I discovered on this research trip was one of disappearance – indigenous people being made to disappear from their countries, from non-indigenous view and from the written record. The symbols I surprisingly most engaged with and which most affected me were the gaols and prisons which the imperialists used as tools of their trade in disappearance. The sense impressions I experienced – extreme beauty, isolation, heat and sandflies – reinforced the complexity of Western Australian contact history. I began to see the central achievement of Bran Nue Dae as being the return of indigenous people to country and to story. This return, so beautifully realised in when the characters finally reach Lombadina and a state of acceptance, is critical to healing the country and to the attainment of an equitable “kind of citizenship” that denotes belonging for all. References Aboriginal Tourism Australia. Welcome to Country: Respecting Indigenous Culture for Travellers in Australia. 2004. Benterrak, Krim, Stephen Muecke, and Paddy Roe. Reading the Country. Perth: Fremantle Arts Centre Press, 1984. Carter, Paul. The Lie of the Land. London: Faber & Faber, 1996. Dalton, Peter. “Broome: A Multiracial Community. A Study of Social and Cultural Relationships in a Town in the West Kimberleys, Western Australia”. 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Citation reference for this article MLA Style Hair, Margaret. "Invisible Country." M/C Journal 8.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0512/09-hair.php>. APA Style Hair, M. (Dec. 2005) "Invisible Country," M/C Journal, 8(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0512/09-hair.php>.

Objectives: Australian general practitioners (GPs) are pivotal in mental health care. The REFOCUS-PULSAR (Principles Unite Local Services Assisting Recovery) primary care study aimed to improve personal recovery outcomes in adults with mental health problems consulting GPs.Design: Modified from an intended stepped-wedge cluster study, an exploratory (pre- and post-intervention) design employed cross-sectional surveys of patients consulting GPs.Setting: Eighteen primary care sites (clusters) in Victoria, Australia in 2013–2017.Participants: From 30 GPs recruited, 23 participated (76%), with 235 patient surveys returned from adults aged &lt;75 years receiving mental health care.Intervention: A co-delivered face-to-face training intervention for GPs in recovery-oriented practice (ROP), with personal recovery a key focus, used multimedia, mnemonics, and targeted interview schedules to encourage ROP—with availability of support sessions for 1 year.Outcome Measures: Primary: the Questionnaire about the Process of Recovery full-scale score (outcome). Secondary: INSPIRE (experience), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and Kessler Psychological Distress Scale (K10) (outcomes). Other: General-practice-Users Perceived-need Inventory (experience).Results: Small positive significant effects indicated primary-outcome post-intervention improvements [t-test (233) = −2.23, p = 0.01], also improvement in two secondary outcomes (WEMWBS t(233) = −2.12, p = 0.02 and K10 t(233) = 2.44, p = 0.01). More patients post-intervention reported “no need” for further help from their GP; but in those reporting needs, there was greater unmet need for counseling.Conclusions: ROP implementation, internationally influential in specialist mental health care, here is explored in primary care where it has had less attention. These exploratory findings suggest better patient outcomes followed introducing GPs to ROP in routine practice conditions. Higher unmet need for counseling post-intervention reported by patients might be a sign of limited supply despite ROP facilitating better identification of needs. Challenges in project implementation means that these findings carry risks of bias and flag the importance establishing research infrastructure in primary care.Clinical Trial Registration:www.clinicaltrials.gov/, The Australian and New Zealand Clinical Trial Registry Identifier: ACTRN12614001312639.