Bibliografie tematiche / Western Sydney

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Letteratura scientifica selezionata sul tema "Western Sydney"

Autore: Grafiati
Pubblicato: 4 giugno 2021
Ultima modifica: 20 febbraio 2023

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Articoli di riviste sul tema "Western Sydney"

1

Smith, Wayne. "Listeriosis in western Sydney". New South Wales Public Health Bulletin 2, n. 12 (1991): 133. http://dx.doi.org/10.1071/nb91063.

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2

Beattie, Greg T. "Measles outbreak in western Sydney". Medical Journal of Australia 163, n. 3 (agosto 1995): 165–67. http://dx.doi.org/10.5694/j.1326-5377.1995.tb127985.x.

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3

McDonnell, Louise F., Louisa R. Jorm e Mahomed S. Patel. "Measles outbreak in western Sydney". Medical Journal of Australia 163, n. 3 (agosto 1995): 167. http://dx.doi.org/10.5694/j.1326-5377.1995.tb127986.x.

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4

F McDonnell, Louise, e Louisa R Jorm. "Measles epidemic in Western Sydney". New South Wales Public Health Bulletin 5, n. 6 (1994): 59. http://dx.doi.org/10.1071/nb94021.

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5

Bradford, Jennifer A., e Warwick B. Giles. "Teenage Pregnancy in Western Sydney". Australian and New Zealand Journal of Obstetrics and Gynaecology 29, n. 1 (febbraio 1989): 1–4. http://dx.doi.org/10.1111/j.1479-828x.1989.tb02865.x.

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Brotodihardjo, Agus E., Noel Tait, Martin D. Weltman, J. Miles Little e Geoffrey C. Farrell. "Hepatocellular carcinoma in western Sydney". Medical Journal of Australia 161, n. 7 (ottobre 1994): 433–35. http://dx.doi.org/10.5694/j.1326-5377.1994.tb127525.x.

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7

JOHNSON, GRAHAM M. "AIR POLLUTION AND WESTERN SYDNEY". Australian Planner 30, n. 2 (luglio 1992): 112–14. http://dx.doi.org/10.1080/07293682.1992.9657563.

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Blayney, Ben, e Wassim Wassef. "Western Sydney Recycled Water Initiative – Replacement Flows Project, Sydney, Australia". Proceedings of the Water Environment Federation 2011, n. 11 (1 gennaio 2011): 4758–72. http://dx.doi.org/10.2175/193864711802765255.

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HODGE, STEPHEN. "Disadvantage and ‘Otherness' in Western Sydney". Australian Geographical Studies 34, n. 1 (aprile 1996): 32–44. http://dx.doi.org/10.1111/j.1467-8470.1996.tb00101.x.

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Karimi, Neda, Joseph Descallar, Afaf Girgis e Patsy S. Soon. "Breast reconstruction in South Western Sydney". ANZ Journal of Surgery 90, n. 11 (5 ottobre 2020): 2340–45. http://dx.doi.org/10.1111/ans.16298.

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Tesi sul tema "Western Sydney"

1

Nesvaderani, Maryam. "Acute Pancreatitis in Western Sydney". Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21375.

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Abstract (sommario):
Background: Acute pancreatitis (AP) has a mortality of 30% in severe cases. Major causes worldwide are gallstones and alcohol misuse. The first aim was to characterise the aetiology, epidemiology and outcomes for patients with AP in Western Sydney (WS). The second aim was to explore pathogenesis of AP and identify potential biomarkers of severe AP using RNA sequencing. Methods: 1) A retrospective cohort analysis of 932 patients with AP presenting to 4 tertiary hospitals in WS was performed. Data from medical records was analysed using SPSS software 2) A RNA sequencing study was performed in a separate cohort of 84 patients with AP (mild=55, moderately severe=19, severe=10) from 2 tertiary hospitals in WS. RNA sequencing was performed on peripheral venous blood collected within 24h of presentation to hospital and data analysis conducted using DESeq2 and Ingenuity Pathway Analysis software. Results: The majority of patients had gallstone AP (40%). 11.1% had severe AP and mortality was 1%. Females were less likely to develop severe AP. There was a failure to comply with guidelines for early management of AP. RNA sequencing identified 1914 differentially expressed genes (DEG) in severe AP compared to moderately severe and mild AP. Lipocalin 2, IL10 and olfactomedin 4 are potential biomarkers for severe AP and pathways dysregulated in severe AP had immunological and mitochondrial functions. There were 1468 DEG between females and males with AP and pathways unique to females were involved in B cell function. There were no DEG between the different aetiological groups. Conclusion: The majority of patients have mild AP with a low risk of mortality. T cell suppression and mitochondrial dysfunction are important pathways in severe AP. We demonstrated clear differences in the pathophysiology of AP between genders, with women demonstrating up-regulation of B cell functions. The differences in clinical outcomes between genders in AP may be due to underlying immune system differences.
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2

Forrester, Linda, of Western Sydney Nepean University e Faculty of Humanities and Social Sciences. "Youth generated cultures in Western Sydney". THESIS_FHSS_XXX_Forrester_L.xml, 1993. http://handle.uws.edu.au:8081/1959.7/440.

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Abstract (sommario):
The study focuses on the types of cultural practice that are, in the main, generated by the young people themselves (hereafter referred to as youth generated cultures) who fall within the age group of 14-20 yrs of age. The research was undertaken in the Western Sydney region, which is the largest expanding population in Australia, and is regularly defined as a socio-economically disadvantaged region, therefore, an important factor within this study is the issue of class determinants. The paper explores the youth generated cultural practice of graffiti, skateboarding, street machining, and street dancing. These creative practices challenge traditional notions of culture and the arts, however the young people also employ strategies of an aesthetic nature in their creative process. Youth generated cultures are actively engaged in criticism through the use of instrumentalist aesthetics such as Monroe Beardsley describes. The thesis proposes that youth generated cultures have, in a united and structured manner, provided for themselves a framework of economic and pedagogical support that has afforded them a place within the cultural mainstream without the recognition or approval of mainstream cultural establishments. It is argued that these particular youth generated cultures are not rebellious or destructive subcultures, that they are creative in nature and have been established primarily to produce and display their creative cultures. Youth agency is essential to the character of these youth generated cultures and it is this agency that is under challenge from the cultural hegemony. The young people involved in youth generated cultures demand that any account of their cultural practice must also accept the agency of youth as fundamental to their cultural status.
Master of Arts (Hons) (Art History and Theory)
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3

Forrester, Linda. "Youth generated cultures in Western Sydney". Thesis, View thesis, 1993. http://handle.uws.edu.au:8081/1959.7/440.

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Abstract (sommario):
The study focuses on the types of cultural practice that are, in the main, generated by the young people themselves (hereafter referred to as youth generated cultures) who fall within the age group of 14-20 yrs of age. The research was undertaken in the Western Sydney region, which is the largest expanding population in Australia, and is regularly defined as a socio-economically disadvantaged region, therefore, an important factor within this study is the issue of class determinants. The paper explores the youth generated cultural practice of graffiti, skateboarding, street machining, and street dancing. These creative practices challenge traditional notions of culture and the arts, however the young people also employ strategies of an aesthetic nature in their creative process. Youth generated cultures are actively engaged in criticism through the use of instrumentalist aesthetics such as Monroe Beardsley describes. The thesis proposes that youth generated cultures have, in a united and structured manner, provided for themselves a framework of economic and pedagogical support that has afforded them a place within the cultural mainstream without the recognition or approval of mainstream cultural establishments. It is argued that these particular youth generated cultures are not rebellious or destructive subcultures, that they are creative in nature and have been established primarily to produce and display their creative cultures. Youth agency is essential to the character of these youth generated cultures and it is this agency that is under challenge from the cultural hegemony. The young people involved in youth generated cultures demand that any account of their cultural practice must also accept the agency of youth as fundamental to their cultural status.
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Forrester, Linda. "Youth generated cultures in Western Sydney /". View thesis, 1993. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030616.093033/index.html.

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Yamanouchi, Yuriko. "Searching for Aboriginal community in south western Sydney". Connect to full text, 2007. http://hdl.handle.net/2123/5485.

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Abstract (sommario):
Thesis (Ph. D.)--University of Sydney, 2008.
Title from title screen (viewed November 2, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Anthropology, Faculty of Arts. Degree awarded 2008; thesis submitted 2007. Includes bibliographical references. Also available in print form.
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Yamanouchi, Yuriko. "Searching for Aboriginal community in south western Sydney". Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/5485.

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Sharpe, Samantha A. "Regional dimensions of innovative activity in outer Western Sydney". View thesis, 2007. http://handle.uws.edu.au:8081/1959.7/36077.

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Abstract (sommario):
Thesis (Ph.D.)--University of Western Sydney, 2007.
A thesis submitted to the University of Western Sydney, College of Health and Science, Urban Research Centre, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references.
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Kelaita, Paul. "Suburban Queer: Infrastructure and Art in Greater Western Sydney". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18854.

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Abstract (sommario):
Since the 1990s, cultural geographers have used a variety of methodologies to track the physical migration of queers toward inner-city space and explored the wider cultural imaginaries that have grown up around this phenomenon. This thesis engages with recent theoretical accounts of metronormativity, or the idea that queer subjectivities are best served by urban environments. Invoking Scott Herring’s concept of ‘queer infrastructure’ and Karen Tongson’s account of queer exurban performance cultures in Greater Los Angeles, I consider engagements of intra-urban space in contemporary queer art by Sydney-based artists and collectives. This research departs from longstanding and recent Australian critiques of suburbia, which tend to frame the suburbs through either class homogeneity or ethnic multiculturalism, and demonstrates how queer-identified artists negotiate the apparent disconnection between the queer and the suburban in their art practices. Chapters one and two track the emergence and consolidation of queer urban studies as an interdisciplinary field. Chapter three provides a new reading of Sydney’s queer history via a focus on suburban rather than urban cultures. Chapter four looks at how queer exhibition practices in the western and south-western suburbs of Sydney articulate institutional, cultural, and social ecologies that bridge centre and periphery. The subsequent chapters each focus on one artwork: a performance staged in an outer-suburban shopping arcade that combines vogue, martial arts, and life-history narration; a video work that redeploys infrastructural tropes from a Bronski Beat music video in order to consider the queer trajectory from suburbs to city and back; and another video work that documents a six-hour drive around greater Sydney by a group of eight queer friends. Overall, this thesis illuminates how contemporary queer art practices in Greater Western Sydney reposition queerness as a central part of the suburbs and the suburbs as a central part of queer Sydney.
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Sharpe, Samantha A. "Regional dimensions of innovative activity in outer Western Sydney". Thesis, View thesis, 2007. http://handle.uws.edu.au:8081/1959.7/36077.

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Abstract (sommario):
The aim of this research is to understand the socio-economic development of a metropolitan region in Sydney through an analysis of regional innovative activity. South West Sydney, a major growth region within Sydney, includes the Local Government Areas (LGAs) of Liverpool, Campbelltown, Camden and Wollondilly. This region has absorbed 25% of Sydney’s population growth in the period from 1991-2001. Although South West Sydney has experienced rapid population growth, this has not been matched by associated employment growth. In some sectors such as business services employment growth has been minimal in the previous decade, this is particularly the case in Liverpool, the regional centre of South West Sydney. Population growth is estimated to continue at the current rate (in excess of 5% per annum) for at least the next fifteen years. In this environment, local government authorities in the region are seeking ways in which to develop the regional economy of South West Sydney and increase the amount of sustainable employment commensurably with current population and labour force increases. The role of innovative activity has a central place in economic development. This thesis uses a ‘systems of innovation’ (SI) approach to examine innovative activity in the South West Sydney region. SI understands innovation as a socially embedded process of transforming ideas and knowledge into novel products, processes and services through the processes of learning and searching. The approach recognises that innovative activity is determined by various actors (firms and institutions) and the interactivity between these actors and the cumulative base of knowledge in which they operate. The Regional Innovations Systems (RIS) framework develops from an acknowledgement that innovation is primarily a geographically bounded phenomenon. The RIS approach sees that specific local resources are important in determining and encouraging the innovative activities carried out by local firms and hence, the competitiveness of these areas. The RIS literature provides two fields of understanding of what constitutes a regional innovation system. The first takes the global examples of highly innovative regions such as Silicon Valley and Route 128 in the United States of America (Saxenian 1994), South West England (Cooke and Morgan 1998), Baden Wurttemberg in Germany (Cooke 2001; Braczyk, Cooke et al. 2004), Northern Italy (Piore and Sabel 1984) and in Australia, the North Ryde corridor (Searle and Pritchard 2005). These regions represent ‘ideal’ or ‘star’ RIS, with highly specialised and networked clusters of firms, many forms of supporting regional infrastructure, and high levels of interactivity. The second and emerging field understands RIS to be in existence in all regions and individual RIS are identified on a scale from weak to strong (Wiig and Wood 1995; Cooke and Morgan 1998; Cooke 2001). This second stream includes the analysis of regions seeking to encourage innovative activity by using the RIS approach to examine their local resources and connectedness. It seeks to determine how not only local resources but also their connectedness could be enhanced to increase firm competitiveness. The innovation systems represented in the ����ideal���� regions are largely a world away from what is available and what is necessary in the encouragement of RIS in most other regions. However, the conceptual framework for examining and interpreting RIS is derived from the analysis of these ‘ideal’ regions. This framework does not provide for measurement and effective interpretation of a range of activities that may be present in less exceptional regions. This research contributes to this endeavour by providing a method that allows for interpretation of a wider range of innovation activities through the analysis of knowledge intensive services activities (KISA). The focus on knowledge gathering, particularly through the KISA analysis, provides an examination of the relationship between innovation, learning and knowledge, much more so than more traditional measures of innovative activity e.g. patents and research and development (RandD) expenditure. KISA analysis is an emerging field of innovation research. KISA are closely linked to firm innovative activity (OECD 2006) and through an analysis of regional KISA usage, an understanding of innovation and knowledge activities within the region can be constructed. This analysis applies equally across various regions and provides an opportunity to guide regional economic development policy intervention at the local government level in South West Sydney.
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Hughes, D. "Teaching singing in Sydney government schools". View thesis, 2007. http://handle.uws.edu.au:8081/1959.7/36654.

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Abstract (sommario):
Thesis (Ph.D) -- University of Western Sydney, 2007.
A thesis submitted to the University of Western Sydney, College of Arts, School of Communication Arts, in fulfillment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references.
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Libri sul tema "Western Sydney"

1

Randolph, Bill. Who cares about Western Sydney? Penrith South DC, NSW: Urban Frontiers Program, University of Western Sydney, 2001.

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2

Karskens, Grace. Holroyd: A social history of Western Sydney. Kensington: New South Wales University Press, 1991.

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3

Robinson, Catherine. Accommodation in Crisis: Forgotten Women in Western Sydney. Broadway: UTS ePRESS, 2006.

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Out west: Perceptions of Sydney's western suburbs. St. Leonards, NSW, Australia: Allen & Unwin, 1993.

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Vinson, Tony. The great divide: Poverty and wealth in Western and outer South-Western Sydney : a report. [Wollongong, N.S.W: The Society], 1999.

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Hutchinson, Mark. A University of the People. Crows Nest, NSW, Australia: Allen & Unwin, 2013.

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Darke, Shane. Toxicological findings and circumstances of heroin-related deaths in South Western Sydney, 1995. [Sydney]: National Drug and Alcohol Research Centre, 1997.

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Bangsund, Dean A. Economic contribution of the sugarbeet industry to eastern Montana and western North Dakota. Fargo, North Dakota: North Dakota State University, Department of Agribusiness and Applied Economics, Agricultural Experiment Station, 2012.

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9

Brown, Richard P. C. Migrants and their remittances: Results of a household survey of Tongans and Western Samoans in Sydney. Sydney: Centre for South Pacific Studies, University of New South Wales, 1995.

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G, Betts A. V., e Blau S, a cura di. Ancient nomads of the Aralo-Caspian region: The Duana archaeological complex ; University of Sydney Central Asian Programme. Leuven: Peeters, 2007.

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Capitoli di libri sul tema "Western Sydney"

1

White, Arthur. "The natural history of western Botany Bay". In The Natural History of Sydney, 402–14. P.O. Box 20, Mosman NSW 2088, Australia: Royal Zoological Society of New South Wales, 2010. http://dx.doi.org/10.7882/fs.2010.031.

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Leary, Tanya, Alan Kwok, Khan Ben e Paul Ibbetson. "Yuppie bandicoots of inner western Sydney - in hiding or urban renewal?" In The Natural History of Sydney, 415–25. P.O. Box 20, Mosman NSW 2088, Australia: Royal Zoological Society of New South Wales, 2010. http://dx.doi.org/10.7882/fs.2010.032.

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Ferraro, Timothy John, e Shelley Burgin. "Amphibian decline: a case study in western Sydney". In Herpetology in Australia, 197–204. P.O. Box 20, Mosman NSW 2088, Australia: Royal Zoological Society of New South Wales, 1993. http://dx.doi.org/10.7882/rzsnsw.1993.030.

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Hawkins, Rhonda. "The Experience of University of Western Sydney, Australia". In Mergers and Alliances in Higher Education, 287–307. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-13135-1_14.

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5

Lunney, Daniel, Rob Close, Jessica V. Bryant, Mathew S. Crowther, Ian Shannon, Kylie Madden, Steven Ward e Daniel Lunney. "The koalas of Campbelltown, south-western Sydney: does their natural history foretell of an unnatural future?" In The Natural History of Sydney, 339–70. P.O. Box 20, Mosman NSW 2088, Australia: Royal Zoological Society of New South Wales, 2010. http://dx.doi.org/10.7882/fs.2010.029.

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Wotherspoon, Danny, Shelley Burgin, Shelley Burgin e Danny Wotherspoon. "Observations on the potential loss of threatened species in urbanising Western Sydney: death by a thousand cuts". In The Natural History of Sydney, 277–81. P.O. Box 20, Mosman NSW 2088, Australia: Royal Zoological Society of New South Wales, 2010. http://dx.doi.org/10.7882/fs.2010.023.

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Gannon, Susanne, Loshini Naidoo e Tonia Gray. "Educational Aspirations, Ethnicity and Mobility in Western Sydney High Schools". In Super Dimensions in Globalisation and Education, 225–40. Singapore: Springer Singapore, 2016. http://dx.doi.org/10.1007/978-981-10-0312-7_14.

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Silk, Christina. "Achieving Tree-Lined Streetscapes in Western Sydney: Intentions Versus Reality". In Routledge Handbook of Urban Landscape Research, 65–80. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003109563-7.

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Roggema, Rob, e Stewart Monti. "Nature Driven Planning for the FEW-Nexus in Western Sydney". In TransFEWmation: Towards Design-led Food-Energy-Water Systems for Future Urbanization, 59–94. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-61977-0_4.

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Moustakim, Mohamed, e Karin Mackay. "Transversal Resettlement Transitions: Young Refugees Navigating Resettlement in Greater Western Sydney". In Principles of Transversality in Globalization and Education, 131–47. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-13-0583-2_9.

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Atti di convegni sul tema "Western Sydney"

1

Zimmerman, Evan H., e Daniel J. Alonso. "Risk management of Moored Mobile Offshore Drilling Units in the Western Pacific Ocean". In OCEANS 2010 IEEE - Sydney. IEEE, 2010. http://dx.doi.org/10.1109/oceanssyd.2010.5603569.

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Isakson, Marcia J., e Nicholas P. Chotiros. "A finite element model of propagation on the Southern and Western Australian continental shelf". In OCEANS 2010 IEEE - Sydney. IEEE, 2010. http://dx.doi.org/10.1109/oceanssyd.2010.5603807.

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van der Sterren, M., G. R. Dennis, J. Chuck e A. Rahman. "Rainwater Tank Water Quality Testing in Western Sydney Australia". In World Environmental and Water Resources Congress 2010. Reston, VA: American Society of Civil Engineers, 2010. http://dx.doi.org/10.1061/41114(371)412.

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Hanzheng Duo e F. Bucca. "Demand side management programs in the Western Sydney areas". In CIRED Seminar 2008: SmartGrids for Distribution. IEE, 2008. http://dx.doi.org/10.1049/ic:20080426.

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van der Sterren, M., A. Rahman e S. Shrestha. "Investigation into Grated Drainage System: A Case Study in Western Sydney, Australia". In World Environmental and Water Resources Congress 2007. Reston, VA: American Society of Civil Engineers, 2007. http://dx.doi.org/10.1061/40927(243)571.

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van der Sterren, M., A. Rahman e G. Ryan. "Investigation of Water Quality and Quantity of Five Rainwater Tanks in Western Sydney Australia". In World Environmental and Water Resources Congress 2010. Reston, VA: American Society of Civil Engineers, 2010. http://dx.doi.org/10.1061/41114(371)400.

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Hughes, Y., C. Chung, I. Zablotska-Manos e D. Lewis. "P351 Clinical presentations of syphilis diagnosed at Western Sydney Sexual Health Centre, 2015–2019". In Abstracts for the STI & HIV World Congress, July 14–17 2021. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/sextrans-2021-sti.398.

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Lobo, S. R., P. Samaranayake e T. Laosirihongthong. "Comparative analysis of quality management capabilities of manufacturing industries in the Western Sydney region: Quality improvement perspective". In 2016 IEEE International Conference on Management of Innovation and Technology (ICMIT). IEEE, 2016. http://dx.doi.org/10.1109/icmit.2016.7605026.

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van der Sterren, M., S. Shrestha e A. Rahman. "A Risk Assessment of Ponding Using Grated Drainage System in Urban Areas of Western Sydney in Australia". In World Environmental and Water Resources Congress 2007. Reston, VA: American Society of Civil Engineers, 2007. http://dx.doi.org/10.1061/40927(243)569.

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10

Weir, F. M., e J. W. Watton. "Discrete Fracture Network Modelling for a Shallow Cover Road Tunnel System". In 3rd International Discrete Fracture Network Engineering Conference. ARMA, 2022. http://dx.doi.org/10.56952/arma-dfne-22-0004.

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Abstract (sommario):
Abstract The city of Sydney (Australia) is currently undergoing a major infrastructure construction boom, with numerous rail and road tunnels currently under construction. This paper presents DFN modelling undertaken as part of the tunnel design process for a major road tunnel system in western Sydney. The primary discontinuities controlling block formation are expected to be joints, bedding planes and seams / bedding plane shears, which were included in the DFN model. This paper presents the necessary input parameters for the modelling and derivation of these parameters, along with the model generation process. Multiple realizations of the model were generated, with a stability analysis carried out on each. Given the complicated geometry of the tunnels in the project two representative 100 m lengths of tunnel geometries were analyzed; a wide span cavern (striking 020°) and a mined tunnel (striking 125°). The stability analyses were used to develop the unstable block volume distribution and identify the maximum likely block volume for the crown and sidewalls of the cavern. In addition, the block results were filtered relative to the proposed pattern rock bolting to assist designers with considering shotcrete loads.
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Rapporti di organizzazioni sul tema "Western Sydney"

1

McIntyre, Phillip, Susan Kerrigan e Marion McCutcheon. Australian Cultural and Creative Activity: A Population and Hotspot Analysis: Marrickville. Queensland University of Technology, 2021. http://dx.doi.org/10.5204/rep.eprints.208593.

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Marrickville is located in the western heart of inner-city Sydney and is the beneficiary of the centrifugal process that has forced many creatives out of the inner city itself and further out into more affordable suburbs. This locality is built on the lands of the Eora nation. It is one of the most culturally diverse communities in the country but is slowly being gentrified creating tensions between its light industrial heart, its creative industry community and inner city developers. SME’s, co-working spaces and live music venues, are all in jeopardy as they occupy light-industrial warehouses which either have been re-zoned or are under threat of re-zoning. Its location underneath the flight path of major air traffic may indeed be a saving factor in its preservation as the creative industries operate across all major sectors here and the air traffic noise keeps land prices down. Despite these pressures the creative industries in Marrickville have experienced substantial growth since 2011, with the current CI intensity sitting at 9.2%. This is the only region in this study where the cultural production sector holds more than half the employment for specialists and support workers, when compared to creative services.
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Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong e Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, agosto 2022. http://dx.doi.org/10.57022/qpsm1481.

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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.
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