Mary MacKillop Institute for Health Research

Background: There is a high prevalence of depression in patients with heart failure (HF) that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS) in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling. Findings: We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H<0.40) and high reliability (Rho>0.8).

Background Past research has demonstrated that there is a high level of depression among older people, particularly for those with cognitive impairment and those in residential care. The current study was designed to determine the prevalence of depression among older people in hostels with cognitive impairment using a structured diagnostic interview. A further aim was to determine an appropriate screening instrument to detect depression within this population. It was also designed to evaluate the extent to which depression among these older people had previously been detected. Method Five commonly used depression scales were administered and compared to the results of the diagnostic interview.

Objective: This article investigates consumer perspectives on the treatment for depression among older people in residential facilities. Method: Aged care residents who were aware of being treated for depression in the past 6 months (24 women and 7 men, mean age = 83 years) participated in an interview that assessed their perspective on treatments. Results: Although more than half of the participants in the sample reported overall satisfaction with the medical treatments received for depression, qualitative data provided indications of unsatisfactory service delivery, including perceptions of low treatment efficacy, short consultation times, the failure to assess affective symptomatology, and negative responses to residents' disclosure of symptoms. Discussion: The findings are discussed in relation to previous research on consumer satisfaction with health services and issues that may be pertinent to the elderly depressed. Training for general practitioners providing treatment in aged care is indicated.

This paper reports the findings of a consumer-driven investigation conducted by the Centre for Clinical Nursing Research at Epworth Hospital in conjunction with the Endometriosis Association (Victoria, Australia) aimed at identifying the information and support needs of women experiencing endometriosis. Women's experiences of endometriosis and laparoscopy were examined. A questionnaire was designed to explore women's experiences of, and informational need for, the four categories of: diagnosis of endometriosis, endometriosis, laparoscopy and managing at home. A total of 465 women who had a positive diagnosis of endometriosis, including patients at the Epworth Endometriosis Centre and members of the Endometriosis Association, were included. The data were analysed in terms of frequency of responses and themes that arose from the research. Five main themes consistently emerged from the overall analysis of the questionnaire; these included: lack of communication, no-one listens, the emotional turmoil, expressions of gratitude to the Endometriosis Association and being young and helpless. Also identified was a lack of understanding of endometriosis and laparoscopy, on behalf of both the patient and the practitioner, which has led to communication of misinformation, extended physical pain and emotional distress. Based on these findings, recommendations were made for education strategies to be focused towards increasing awareness of endometriosis and for information to be disseminated using the preferred printed format and to be made available from gynaecologists, hospitals and schools. Through consumer participation, the information obtained in this study is of benefit to all women who come in contact with endometriosis by (a) validating women's experiences of endometriosis and (b) identifying women's needs in relation to the disease.

Most studies assessed the reliability and validity of the CDS: three studies assessed construct validity using factor analysis; six studies assessed the validity of the CDS with other measures of depression; and four studies assessed its diagnostic accuracy. However, some studies reported overlapping samples, which reduces confidence in their evaluation.

Cardiac rehabilitation (CR) is the sum of interventions required to ensure the best physical, psychological and social conditions so that patients with cardiac disease may assume their place in society and slow the progression of the disease. Exercise testing (ET) early after MI has been shown to result in earlier return to work than the nonperformance of ET. Research quality CR has resulted in lower cardiovascular mortality and lower recurrent hospitalisation and has been shown to be cost-effective. However, the content of cardiac rehabilitation programmes varies considerably. The only randomised trial of CR as usually performed in the 'real world' showed that CR had no impact on cardiac death rates or any other outcome. Only 20-50% of eligible patients attend CR programmes and attendance at CR has not improved in the last 20 years despite major attempts to increase participation in CR. Alternative methods for provision of CR have been sought. These include home-based CR, case management approaches, and nurse coordinated prevention programmes. Telephone based programmes, such as The COACH Program, have been introduced to coach patients and improve behavioural and biomedical risk factors. These have been shown to improve risk factors better than usual patient care and to reduce recurrences of cardiac events after discharge from hospital due to MI. Expansion of novel approaches such as The COACH Program may help to counteract the non-attendance at CR.

Background: Health care provider experiences of the carer have been researched, but little is written about how these can inform development of support programs. Objectives: This study aimed to (1) explore health care provider perceptions of stroke carer roles and support needs and (2) examine carer needs across the stroke care trajectory to assist with development of an Optimal Health Program (OHP) to support carers. This study is part of a staged program of research that will evaluate and refi ne the OHP. Methods: Four dual-moderated semi-structured focus groups of stroke health care providers across acute, subacute, and community rehabilitation services were conducted. Facilitators used a semistructured focus group schedule to guide discussion. Sessions were recorded, transcribed, and analyzed using thematic and content analysis. Results: Three key themes emerged: transition, information, and impact of stroke. A number of subthemes highlighted the distinct roles of health care providers and carers. Specifi c elements of the OHP were identifi ed as having the potential to advance support for carers across the stroke care trajectory. Discussion: Findings support the integration of an OHP for carers within existing stroke care services in Australian public hospital and community settings. Conclusion: This study suggests how health care provider experiences could inform a self-management OHP to assist carers in navigating stroke services and to address their health-related concerns.