Virtual reality (VR) may be useful for reducing needle-based pain and distress. Our objective was to compare VR against standard care for children undergoing routine four-year-old immunisations. This was a randomised controlled superiority trial conducted in a single suburban general practice, comparing a VR sequence of an interactive marine adventure to standard care (parental comfort, distraction of child). Our primary outcome was self-rated pain scores (Faces Pain Scale - Revised and the poker chip tool). Secondary outcomes included observational ratings (visual analogue scales) of pain and distress from caregivers and an observing healthcare provider, andoverall enjoyment ofthe immunisation experience forthe parent and child. In all, 42 children received VR and 45 received standard care. There was no difference in the primary outcome, with median interquartile range self-rated pain scores of 2 (0-8) in the standard care group and 2 (0-6) in the VR group. Observer ratings of pain and distress, as well as ratings of overall enjoyment, favoured VR. There were nosignificant adverse events. VR was not superior to standard care for self-rated pain and distress in children aged four years receiving routine immunisations. However, parent and observer ratings ofpain and distress and overall ratings of enjoyment allfavoured VR.

The population of older (age ≥50 years) Aboriginal and Torres Strait Islander people is increasing, and the rate of dementia in this group is three to fivefold higher than in the general population. Ahigh prevalence of risk factors across the life course likely contributes to theserates. This paper highlights practical ways toapply best practice principles when addressing the detection of cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people and its management in the context of a person's family, carers andcommunity. Recognising culture, the collective nature of family and community decision making for a person, the ways to uphold respect for Elders and a trauma-informed approach are fundamental to the care ofolder Aboriginal and Torres Strait Islander people with cognitive impairment and dementia.

To reduce diagnostic delay for women with endometriosis-related symptoms, we need to understand general practitioners' (GPs) perspectives on the challenges they face in diagnosing and managing endometriosis. Qualitative interviews were conducted with nine Western Australian GPs to explore their knowledge, experiences andchallenges with the diagnosis and management of endometriosis. Three themes were identified as challenges: eliciting symptoms, with subthemes of multiple and complex symptoms, clinician experience and awareness, time constraints and screening opportunities; delivering patient-centred care, with subthemes of cultural factors and health literary, perceived gender biases and women's choices and priorities; and system and service, which included learning on the job, clearer diagnostic pathways, access to services and collaborative care models. GPs can be better supported in dealing with endometriosis through raising awareness and education; recognition ofendometriosis as a complex chronic condition; and the development of pragmatic guidelines, with increased access to local centres for excellent andcollaborative care.

Monochorionic twins have higher mortality rates than dichorionic twins. Selective intrauterine growth restriction (sIUGR) is a common complication found in monochorionic twins. We report such a case of type III sIUGR monochorionic twins. There was positive end-diastolic flow of umbilical arteries, which corresponded to type I sIUGR at 15 weeks. Then, the umbilical arteries showed persistently absent end-diastolic flow at 17 weeks which corresponded to type II sIUGR. Finally, the umbilical artery showed intermittent absent/reversed end-diastolic flow which corresponded to type III sIUGR. This case demonstrated a unique myriad of Doppler changes during the pregnancy, indicating its significance in being reported. The twins were delivered by caesarean section at 32 weeks and were developing well. Placental examination showed unequal placental sharing and the presence of an arterio-arterial anastomosis. These are characteristic findings of a type III sIUGR. Type III sIUGR may not be obvious at the initial examination but may only be obvious at later examinations.

BackgroundUp to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy. MethodsAn integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies. ResultsA comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers. LimitationsGeneralizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships. ConclusionsExpectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

Learner-generated digital media (LGDM) projects have been used extensively in secondary and higher education in the last decade. However, the methodology used to design, implement, and evaluate LGDM projects has been inconsistent. Challenges for teachers include planning the learning task; allocating marks and creating rubrics; providing feedback; and training students in the digital media principles needed to communicate effectively in the digital space. These are design rules around layout, colour theory, typography, images, and basic video principles which should be part of the curriculum. This chapter introduces some theoretical models to help pre-service teachers develop digital media literacies and systematically design, implement, and evaluate LGDM projects in the classroom. It also provides the tools to scaffold student learning via digital media content creation. The author discusses best practices for implementing digital media assignments, with an emphasis on STEM education.

Pelvic floor dysfunction causes high-level disease burden, with Aboriginal and Torres Strait Islander women less likely to have access to best management for these issues due to multiple sociocultural barriers. There is limited data on the impact of pelvic floor dysfunction in this specific population. To explore the impact of pelvic floor dysfunction on Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service, considering barriers and facilitators for care, and the services that are desired to address these conditions. This is a mixed methods project utilising the validated Pelvic Floor Impact Questionnaire 7 in combination with qualitative data from semi-structured interviews. Quantitative data were analysed using SPSS Version 24 and analysis included the use of means, SD and Fisher's exact test for comparison. Interview transcriptions were coded into initial themes using thematic analysis and a theoretical approach was used to capture common patterned responses. The majority of women reported urinary incontinence. Higher scores on the urinary impact questions were significantly associated with comorbid risk factors of chronic cough and obesity. Salient themes from interviews included help-seeking behaviours, embarrassment and normalisation of the condition. Women desired access to a pelvic floor physiotherapist, and preferred a female doctor and a consistent care provider. Pelvic floor disorders cause high disease burden for Aboriginal women across a broad age range with associated comorbid risk factors frequently occurring. This study suggests service improvement and care delivery strategies that may improve long-term outcomes for Aboriginal women with pelvic floor conditions.