Australian Approach Research Articles

The Australian Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) hospital study: effect of a collaborative medication review on the number of current regular medicines for older hospital inpatients.

Potentially harmful polypharmacy is a growing public health concern. This article aims to evaluate the effectiveness of a structured Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) framework. We recruited patients at metropolitan hospitals for a randomised controlled trial with 12 months of follow-up. The intervention included a comprehensive medicines history, multidisciplinary meeting and medicines review prior to discharge, with engagement with the participants' general practitioner extending after discharge. The primary outcome was the change in the number of regular medicines used at 12 months from baseline. A cost consequence was performed to estimate costs per participant during the study period. There were 98 participants enrolled in the study. The number of regular medicines was significantly reduced from baseline in both groups (-1.7 ± 4.3, t = 2.38, P = 0.02 in the control group vs -2.7 ± 3.6, t = 4.48, P = 0.0001 in the intervention group), although there was no statistical difference detected between the two groups (1.0 (SE 0.9), t = 1.03, P = 0.31). The intervention was estimated to cost AU$644.17 and was associated with cost savings of AU$552.53 per participant in sustained reduced medicines cost. Health outcomes and healthcare costs were similar in both groups. Medicines were significantly reduced in both groups, with a trend to a larger reduction in medicines at 12 months in the intervention group. The intervention cost was approximately offset by sustained reduced medicines cost, although these results should be regarded cautiously because of the absence of significance in the differences in outcomes between groups.

“You're on your own, kid”: A critical analysis of Australian universities' international student mental health strategies

AbstractMental ill‐health is a serious and growing problem among university students in Australia. Within this cohort, international students are particularly vulnerable. International students in Australia have fewer social rights than domestic students and are at elevated risk of social isolation, exploitation in employment, precarious housing, financial insecurity, and racism and discrimination. When mental health challenges arise, international students are also less likely than their domestic counterparts to access support services. Against the backdrop of this escalating problem, this article presents a critical analysis of Australian universities' policy approaches to international student mental health. We ask: (a) How many universities have such policies publicly available, and (b) how do these policies understand and seek to address the problem of international student distress? Drawing on a documentary analysis of publicly available university mental health strategies, we find that—in the comparatively rare cases where such documents exist—international students' mental ill‐health is generally framed in these documents as an individual concern, placing the onus on individual students to develop “resilience” and/or seek out help. Leveraging theoretical insights concerning the collective production of (mental) health and illness, we caution that this individualisation of student distress naturalises and depoliticises the logics of financial exploitation and neglect that contribute to many international students' mental health problems to begin with.

Nurses and Voluntary Assisted Dying: How the Australian Capital Territory's Law Could Change the Australian Regulatory Landscape.

On June 5, 2024, the Australian Capital Territory passed a law to permit voluntary assisted dying ("VAD"). The Australian Capital Territory became the first Australian jurisdiction to permit nurse practitioners to assess eligibility for VAD. Given evidence of access barriers to VAD in Australia, including difficulty finding a doctor willing to assist, the Australian Capital Territory's approach should prompt consideration of whether the role of nurses in VAD should be expanded in other Australian jurisdictions. Drawing on lessons from Canada, which currently permits nurse practitioners to assess patient eligibility, we argue that the time has come for Australian jurisdictions to expand the role of nurses in VAD systems. This would be an important step in ensuring access to VAD for patients in practice. Attention, however, must also be paid to ensuring adequate remuneration of nurses (and doctors) if this goal of promoting access is to be achieved in practice.

A shift from contractarianism to ‘characterisation’: Assessing the ideal Australian approach for determining fiduciary duties in a commercial context

In the wake of excessive judicial reliance on a contractarian approach to the assessment of fiduciary duties in commercial contexts, both judicial and academic concern has been voiced as to whether such an approach is the most appropriate to ensure fair dealing. What's more, the emergence of novel commercial relationships facilitated by changing values in business and exponential leaps in the capabilities and use of technology warrant a reassessment of whether contractarianism is fit for the purpose of ushering in appropriate legal analysis so that such new developments can be appropriately facilitated. This article argues that contractarianism is not fit for that purpose and that the ‘characterisation’ of the relationship between parties is a superior and more equitable approach to determining the extent of fiduciary duties in commercial contexts.

The Australian Traumatic Brain Injury Initiative: Single Data Dictionary to Predict Outcome for People With Moderate-Severe Traumatic Brain Injury.

In this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI.

The AUstralian multidomain Approach to Reduce dementia Risk by prOtecting brain health With lifestyle intervention study (AU-ARROW): A study protocol for a single-blind, multi-site, randomized controlled trial.

The Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World-Wide FINGERS (WW-FINGERS). As part of WW-FINGERS, the Australian AU-ARROW study mirrors aspects of FINGER, as well as US-POINTER. AU-ARROW is a randomized, single-blind, multisite, 2-year clinical trial (n = 600; aged 55-79). The multimodal lifestyle intervention group will engage in aerobic exercise, resistance training and stretching, dietary advice to encourage MIND diet adherence, BrainHQ cognitive training, and medical monitoring and health education. The Health Education and Coaching group will receive occasional health education sessions. The primary outcome measure is the change in a global composite cognitive score. Extra value will emanate from blood biomarker analysis, positron emission tomography (PET) imaging, brain magnetic resonance imaging (MRI), and retinal biomarker tests. The finalized AU-ARROW protocol is expected to allow development of an evidence-based innovative treatment plan to reduce cognitive decline and dementia risk, and effective transfer of research outcomes into Australian health policy. Study protocol for a single-blind, randomized controlled trial, the AU-ARROW Study.The AU-ARROW Study is a member of the World-Wide FINGERS (WW-FINGERS) initiative.AU-ARROW's primary outcome measure is change in a global composite cognitive score.Extra significance from amyloid PET imaging, brain MRI, and retinal biomarker tests.Leading to development of an innovative treatment plan to reduce cognitive decline.

The inclusion of children in divorce mediation: A continental ‘non‐directive’ approach

AbstractThis article undertakes an interdisciplinary examination of child‐inclusive mediation (CIM) in divorce and separation mediation, particularly its implementation in the Czech Republic through the Mediation and Education Centre in Brno (MEDUC). It aims to offer a comparative analysis of MEDUC's unique non‐directive mediation model, which involves children's active participation in mediation processes, in contrast to the original Australian model of Child‐Inclusive Mediation and Counseling (CIMC). This paper uses a structured theoretical methodology combining comparative and conceptual analysis. Specifically, the comparative approach contrasts Australian and Czech practices and reveals key differences and similarities in legal frameworks, philosophical theories, and the roles of mediators and child specialists. Meanwhile, the conceptual analysis draws on an extensive literature review to explore the theoretical underpinnings of Australian and Czech family mediation approaches. The study identifies considerable flexibility in adapting CIP models in different legal and cultural settings. Although Australian practices heavily influence MEDUC, it has adapted these principles to fit its legal and cultural context. The article highlights the potential of combining human rights and therapeutic approaches, augmented by developmental psychology and international child rights standards, to create a more nuanced and child‐sensitive mediation practice. The article highlights the value of a multidisciplinary, adaptive approach to practice involving children in family mediation. It suggests that integrating psychological and legal‐philosophical theories can lead to a robust model that can be adapted to different cultural and legal settings. It advocates for future research to empirically evaluate the effectiveness and sustainability of these adapted models and explore how cultural perceptions of childhood and family roles may influence the success of CIP.

(Re)positioning Indigenous games in HPE: turning to criticality

ABSTRACT In 2011, the Australian national curriculum called for the inclusion of Indigenous histories, cultures and perspectives/knowledges, prompting Health and Physical Education (HPE) teachers in schools and academics within higher education have experimented with and reported upon different purposes and ways of teaching Indigenous Games. However, Australian schools remain sites of epistemic injustice, where the privileging of Western knowledges marginalises alternative voices and knowledge systems, maintaining disciplinary terra nullius [terra nullius means ‘empty land’ – it was a legal fiction, overturned by the High Court of Australia in 1992, used by British settler-colonisers to justify the invasion of Australia. In this context, we mean that Physical Education in Australia still assumes erroneously that Western knowledges are the only available knowledges]. Worryingly, experimentation with Indigenous games, by predominantly white educators with minimal understanding of Indigenous histories and cultures, has resulted in confusion and apprehension over their purpose and place in the curriculum, leading toward either omission or cultural appropriation, rather than deep, critical engagement with Indigenous Knowledges. Centring on the publication and implementation of Yulunga: Traditional Indigenous Games [Edwards, K., & Meston, T. (2009). Yulunga: Traditional indigenous games. Ausport. http://www.ausport.gov.au/participating/indigenous/resources/games_and_activities/full_resource], we reappraise the Australian approach toward Indigenous games, suggesting this work has occurred over three distinct time periods or ‘waves’. Conceptualising this work with the heuristic of ‘three waves’ provides a useful contribution to the field, revealing a lack of substantive progress in including Indigenous knowledges and perspectives in HPE. We argue HPE educators and researchers are complicit in the marginalisation and/or omission of Indigenous knowledges and perspectives and must shift current practice toward a ‘fourth wave’ of implementing Indigenous games with criticality. We call for a revisiting of Martin Nakata’s [(2002). Indigenous knowledge and the cultural interface: Underlying issues at the intersection of knowledge and information systems. IFLA Journal, 28(5-6), 281–291. https://do.org/10.1177/034003520202800513; Nakata, M. (2007). The cultural interface. Australian Journal of Indigenous Education, 36, 1–7. Nakata, M. (2011). Pathways for Indigenous education in the Australian curriculum framework. The Australian Journal of Indigenous Education, 40(1), 1–8. https://do.org/10.1375/ajie.40.1] theory of the Cultural Interface – a theory of critique of knowledge systems. Nakata [(2002). Indigenous knowledge and the cultural interface: Underlying issues at the intersection of knowledge and information systems. IFLA Journal, 28(5-6), 281–291. https://do.org/10.1177/034003520202800513] cautioned that Indigenous knowledges and perspectives cannot be simply dropped into contested knowledge domains. Now more than ever, knowledge of critical frameworks like Nakata’s are required to disrupt the entrenched white disciplinary praxis of Australian HPE.

‘Our friends the Chinese’: Australian advisers and images of China in the world wars

Across the two world wars two Australian former journalists – George Morrison (1862–1920) and Harold Timperley (1898–1954) – produced propaganda for the Chinese government. In doing so, they employed discourses of vulnerability and anxiety over Australia’s position in Asia. Previous arguments that Morrison or Timperley represent an Australian approach to Asia have not taken into account their biographies and their positions within the Chinese government. In this article, I argue that Morrison and Timperley’s depictions of Asia were heavily influenced both by their individual experiences and by developments in how successive Chinese governments made use of foreign journalists to communicate to the west.

Baseline diet quality of participants in AU‐ARROW trial based on adherence to the MIND diet recommendations

AbstractBackgroundThe Mediterranean‐Dietary Approaches to Stop Hypertension (MIND) diet is rich in leafy green vegetables, legumes, berries, wholegrains, fish, nuts, and olive oil and low in red and processed meats and discretionary foods (high in saturated fat, added sugar and added salt). Following a MIND diet is associated with a reduction in risk of cognitive decline and dementia. The lifestyle intervention known as the AUstralian multidomain Approach to Reduce dementia Risk by prOtecting brain health With lifestyle intervention study (AU‐ARROW) is undergoing recruitment of participants. Here we report on the dietary quality of participants to date, based on their adherence to the MIND diet.MethodA self‐administered MIND diet questionnaire was completed by participants in the online REDCap platform as part of the screening surveys to determine participant eligibility into the AU‐ARROW trial. Eligible participants were required to have a ‘poor diet’, which was a MIND diet score of ≤9 out of a maximum MIND diet score of 14. Comparative statistical analyses were conducted to determine the differences in dietary quality between eligible and ineligible participants.ResultFrom the 39 participants who were screened to date, 16 participants were ineligible, and 23 were eligible. Ineligible participants had a higher total MIND diet score (mean = 10.5(SD = 0.6)) compared with eligible participants (mean = 7.5(SD = 1.8)). For ineligible participants, there was greater proportion adhering to MIND diet recommendations for fish, nuts, and poultry. No eligible participants adhered to MIND diet recommendations for leafy green vegetables, berries, and wholegrains. There was general compliance to recommendations for red meat and butter intake among both groups, but a smaller proportion of eligible participants adhered to the MIND diet recommendations for fried foods, sweets, and cheese, compared to ineligible participants.ConclusionOverall, improvements to the diet quality of both eligible and ineligible participants are required. Particularly for participants eligible to the AU‐ARROW trial, a focus on improving adherence to core food group recommendations are required not only for cognitive health but also for general health and prevention of other chronic diseases. Education and counselling from dietitians are critical for supporting participants in dietary behaviour change.

The ABC of history education: a comparison of Australian, British and Canadian approaches to teaching national and First Nations histories

PurposeThis essay engages with scholarship on history as a discipline, curriculum documents and academic and public commentary on the teaching of history in Australian, British and Canadian secondary contexts to better understand the influence of the tension between political pressure and disciplinary practice that drives the history wars in settler-colonial nations, how this plays out in secondary history classrooms and the ramifications this may have on students' democratic dispositions.Design/methodology/approachThis article aims to compare secondary history curricula and pedagogies in Australia, Britain and Canada to better articulate and conceptualise the influence of the “history wars” over the teaching of national histories upon the intended and enacted curriculum and how this contributes to the formation of democratic dispositions within students. A conceptual model, drawing on the curriculum assessment of Porter (2006) and Gross and Terra's definition of “difficult pasts” has been developed and used as the basis for this comparison. This model highlights the competing influences of political pressure upon curriculum creation and disciplinary change shaping pedagogy, and the impact these forces may have upon students' experience.FindingsThe debate around what content students learn, and why, is fraught because it is a conversation about what each nation values and how they construct their own national identity(ies). This is particularly timely when the democratic self-identification of many nations is being challenged. The seditious conspiracy to storm the US Capitol on 6 January 2021, Orban's “illiberal democracy” in Hungary and the neo-Nazis in Melbourne, Australia are examples of the rise of anti-democratic sentiment globally. Thus, new consideration of how we teach national histories and the impact this has on the formation of democratic dispositions and skills is pressing.Originality/valueThe new articulation of a conceptual model for the impact of the history wars on education is an innovative synthesis of wide-ranging research on: the impacts of neoliberalism and cultural restorationism upon the development of intended curriculum; discipline-informed inquiry pedagogies used to enact the curriculum; and the teaching of national narratives as a political act. This comprehensive comparison of the ways in which history education in settler-colonial nations has developed over time provides new insight into the common elements of national history education, and the role this education can play in developing democratic dispositions.

A provisional evaluation of Australia's medical cannabis program

In 2016, the Australian Government legislated to allow cannabis to be prescribed to patients as an unapproved medicine under the special access provisions of the Therapeutic Goods Act. This paper compares the Australian regulatory approach with other national approaches, outlines the main provisions of the Special Access Scheme for medical cannabis, describes how the program has evolved since 2017, includes an analysis of adverse events reported to the Therapeutic Goods Administration, and discusses the barriers that remain for patients who wish to access medical cannabis. It assesses how well the Australian program has addressed the challenges of providing patients with easier access to medical cannabis while ensuring that high-quality products are used safely and effectively under medical guidance.

Making the case for policy interventions in disaster governance and management in Australia to better support internally displaced people

PurposePolicy is key for effective displacement governance in times of crises and in response and recovery. Therefore, this study assessed if Australian climate, disaster and emergency management policies provide effective mechanisms for governing displacement crises and areas where current approaches could be improved.Design/methodology/approachThis study assessed 18 national and state-level disaster, emergency and climate change management frameworks to determine if best practice displacement governance themes were reflected in policy documents. Deductive thematic analysis was undertaken using Braun and Clarke’s six-phase method.FindingsIssues of displacement are reflected in policies analysed in this study. However, current policy frameworks need to be equipped to comprehensively address the housing requirements of displaced people or provide long-term initiatives. Approaches are focused on crisis management rather than pre-emptively planning for displacement response and recovery. Therefore, Australia has not exercised national responsibility for displaced people appropriately.Research limitations/implicationsDisaster displacement is an under-researched area of Australian scholarship and disaster management policy and practice. Therefore, this paper has practical implications in so far as it draws attention to the issue of displacement in Australia. A limitation of this paper is that it only analysed policy frameworks specific to disasters. While broader engagement was outside the scope of this study, this limitation provides opportunities for further research from disciplinary perspectives of public housing and homelessness to examine displacement policy challenges in these fields. Furthermore, this study is limited to a theoretical inquiry into this topic through a desktop review of policy documents. While this is a necessary first step, empirical studies are required to determine accurate displacement rates, drivers and people’s experience of being displaced.Practical implicationsThis research aims to inform policy by presenting recommendations for policy interventions for disaster displacement governance. Therefore, this research has practical implications as policy and disaster risk reduction (DRR) professionals can draw from the findings of this research when planning and initiating disaster response for displaced persons.Social implicationsThis research draws attention to an area of disaster management practice and policy that has not been adequately accounted for. Highlighting gaps in current policy can assist in developing targeted strategies and solutions for internally displaced people, which protect their rights and meet their needs.Originality/valueDisplacement is a growing climate change issue. This research aims to help address this problem by drawing attention to areas where Australian disaster management approaches fail to account for displaced populations. Therefore, this research has practical implications for addressing future issues of disaster injustice that may arise if displacement continues, unacknowledged in disaster management.

Beyond the binary: Sex and gender diversity in population projections

For many people, their gender is the same as their sex recorded at birth. For some, gender and sex recorded at birth may not align, or they may not fall exclusively into the binary categories of male or female. There is growing recognition of the need to have quality estimates and projections of the population in a context beyond binary sex and gender. However, there is currently little demographic literature on this topic and production of such data is limited. In this paper, we use the demographic equation as a framework to describe the implications of considering sex and gender diversity in the production of population projections. In doing so, we consider implications for base population estimates, births, deaths and migration. We also consider implications of acknowledging gender as a concept that can change over time. We outline existing Australian and international approaches to data collection and address implications for the formation of projection assumptions. We conclude by outlining possible future directions for forming population projections that consider sex and gender beyond the binary.

Punching above their weight or falling flat? Flagship policy modernisation initiatives in Australia, Britain, Canada, and New Zealand

AbstractConcerns of a decline in public service policy capacity coupled with evolving policy advisory systems have seen public services seek to reform their policy capacity and practices. This article examines the flagship policy modernisation initiatives launched by the Australian, Canadian, British, and New Zealand governments. Comparative analysis reveals a shared emphasis on overarching objectives, but important differences in their design, how they are embedded within the public service, and their comprehensiveness. The New Zealand and British initiatives are found to be the most comprehensive and stable, while the Canadian and Australian approaches suffer from repeated reinvention exercises and resource and leadership precarity. An examination of these initiatives also provides new insights into understanding the trade‐offs and tensions around how these initiatives aim to address public service policymaking and effective advisory system participation.Points for practitioners The public service's role within advisory systems is evolving and needs to be carefully reconsidered. Senior officials need to get serious about effectively scoping reform initiatives and being clearer about the trade‐offs associated with broad or more targeted approaches. Initiatives are drastically under‐resourced even in the best of scenarios. Governments and senior officials need to step up and invest in sustainable and well‐institutionalised initiatives. Practitioners will need to be creative about how and where they can access tools and approaches to improve their policymaking in cases where governments continue to under‐resource policy modernisation.

Open Justice, Closed Courts and the Constitution

Open justice is an essential feature of the judiciary, in Australia and elsewhere. The principle has constitutional salience, as an element of judicial power in Chapter III of the Constitution. Yet open justice is not absolute. In recent years, the tension between open justice and national security has been a matter of public controversy in Australia, as a result of the Bernard Collaery, Witness K and Witness J prosecutions, which have all been shrouded in secrecy. Reconciling open justice with the confidentiality required to protect national security is a common challenge for many jurisdictions. This Article compares the Australian approach with the United Kingdom and Canada. It argues that Australian law and practice in relation to protecting open justice in the national security context is underdeveloped. Drawing on the British and Canadian experience, the Article proposes methods to better balance these competing interests in Australia, in a manner which would reflect emerging constitutional principles.

Australian Red Cross psychosocial approach to disaster preparedness

Emergency and disaster preparedness is often centred on preparing the physical environment. Moving the emphasis from the physical to the personal, people can be physically and mentally better prepared to face and recover from these events. This paper examines the approach by Australian Red Cross to improve psychosocial preparedness. It outlines how theories of psychosocial support, adaptive capacity and behaviour change are operationalised as well as the evaluation methods used to assess effectiveness.

Próba porównania niektórych elementów instytucji przyczynienia się poszkodowanego w deliktowej odpowiedzialności za szkody na osobie w prawie polskim i w systemie common law / Attempt at a Comparative Analysis of Certain Elements of Contributory Negligence of the Injured in Tortious Liability for Personal Injury Under the Polish Law and in the Common Law System

The article provides a comparative analysis of the approaches related to contributory negligence of the injured causing the occurrence or aggravation of the injury in the Polish law and in the common law system. The article discusses the development of this institution, differences and similarities with special emphasis on the latter as peculiar to the systems that evolved from such distant sources as well as rules according to which the occurrence and degree of contribution is established. The basis for deliberations is the legislation of England and Wales under which this institution developed, from a chronological perspective, for the first time. However, certain American, Canadian and Australian approaches have also been discussed against this background. The article addresses important issues, though rarely debated in the Polish legal literature, and constitutes an important source of knowledge for legal scholars providing professional insights and prompting both axiological and purely practical deliberations. em Key words: tortious liability, personal injury, comparative negligence, contributory negligence, the common law system

Elements of Country: a First Nations-first approach to chemistry

AbstractCollectively, we have chosen to explore an Australian First Nations-first approach to understanding the chemical elements. We believe that engagement with cultural heritage, ongoing cultures, and the knowledges ofthis place—the lands on which we work, live, and study—will lead to new ways of understanding the elements and change the way we practice chemistry. The “First Nations first” phrase and approach comes from understanding the unique place that Aboriginal and Torres Strait Islander peoples have in the Australian context. In this paper we explore how a First Nations-first approach could take place in Sydney on Aboriginal lands. This approach is led by Aboriginal people, engages with culture, and is produced with local knowledge holders. So far, the work has entailed two years of meeting, conversing, and sharing space to determine appropriate ways of working together, interrogating the complexities of the ideas, and to refining our approach to the work. To appreciate the significant shift that a First Nations-first approach represents for chemistry, we consider the legacy of the Periodic Table. We share some reflections on how Indigenous knowledges can contribute to an expanded chemistry curriculum through the recognition of productive cultural tension.

Is Australia a Model for the UK? A Critical Assessment of Parallels of Cruelty in Refugee Externalization Policies

Abstract For several years, Australia has been regarded by some politicians and observers in Europe as a model for hard-line policies towards refugees. At the same time, Australia’s implementation of refugee externalization measures has been subject to considerable scholarly attention and critique. Although the Australian approach has featured prominently in political debates in several European states, this article analyses the implications of a possible adoption of the Australian offshore detention approach for refugee policy-making in the UK, and the consequences this will have for the integrity of the international refugee protection regime. The article considers how states might influence each other’s policies—both directly and indirectly—by focusing on a case study of offshore detention and processing with regard to Australia’s influence on—and similarity to—the UK, to the extent that we observe policy parallels, as the article brings to light substantial policy convergence of detrimental practice of these two countries.