Associations between physicians' personal preferences for end-of-life decisions and their own clinical practice: PROPEL survey study in Europe, North America, and Australia.

Background: Physicians have significant influence on end-of-life decisions. Therefore, it is important to understand the connection between physicians' personal end-of-life care preferences and clinical practice, and whether there is congruence between what they prefer for themselves and for patients.

Aim: Study to what extent physicians believe their personal end-of-life preferences impact their clinical practice and to what extent physicians' personal treatment option preferences differ from what they prefer for their patients.

Assisted dying: participation barriers and facilitators - qualitative interview study of doctors' perceptions.

Objectives: As more countries legalise assisted dying, it is of increasing significance for policy-makers and the medical profession. Doctors are needed for patients to access this choice; however, there is currently limited participation. Few studies identify what factors, if any, facilitate participation in assisted dying and how the inter-relationship of multiple factors may also influence participation.

Models of care for voluntary assisted dying: a qualitative study of Queensland's approach in its first year of operation.

Objective Voluntary assisted dying (VAD) began in Queensland in January 2023 but little is known about its practical operation. This research examined models of care for providing VAD in Queensland. Methods Semi-structured interviews were conducted with 24 participants involved with VAD delivery across Queensland's 16 Health and Hospital Services (HHSs).

Antibiotics damage the colonic mucus barrier in a microbiota-independent manner.

Antibiotic use is a risk factor for development of inflammatory bowel diseases (IBDs). IBDs are characterized by a damaged mucus layer, which does not separate the intestinal epithelium from the microbiota. Here, we hypothesized that antibiotics affect the integrity of the mucus barrier, which allows bacterial penetrance and predisposes to intestinal inflammation.

A history of repeated antibiotic usage leads to microbiota-dependent mucus defects.

Recent evidence indicates that repeated antibiotic usage lowers microbial diversity and ultimately changes the gut microbiota community. However, the physiological effects of repeated - but not recent - antibiotic usage on microbiota-mediated mucosal barrier function are largely unknown. By selecting human individuals from the deeply phenotyped Estonian Microbiome Cohort (EstMB), we here utilized human-to-mouse fecal microbiota transplantation to explore long-term impacts of repeated antibiotic use on intestinal mucus function.

Elevated type-17 cytokines are present in axial spondyloarthritis stool.

Axial spondyloarthritis (axSpA) is characterized by type-17 immune-driven joint inflammation, and intestinal inflammation is present in around 70% of patients. In this study, we asked whether axSpA stool contained Th17-associated cytokines and whether this related to systemic Th17 activation. We measured stool cytokine and calprotectin levels by ELISA and found that patients with axSpA have increased stool IL-17A, IL-23, GM-CSF, and calprotectin.

The gut commensal Blautia maintains colonic mucus function under low-fiber consumption through secretion of short-chain fatty acids.

Beneficial gut bacteria are indispensable for developing colonic mucus and fully establishing its protective function against intestinal microorganisms. Low-fiber diet consumption alters the gut bacterial configuration and disturbs this microbe-mucus interaction, but the specific bacteria and microbial metabolites responsible for maintaining mucus function remain poorly understood. By using human-to-mouse microbiota transplantation and ex vivo analysis of colonic mucus function, we here show as a proof-of-concept that individuals who increase their daily dietary fiber intake can improve the capacity of their gut microbiota to prevent diet-mediated mucus defects.

'Can a relative override a patient's Advance Care Directive?': end-of-life legal worries of general practitioners and nurses working in aged care.

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting.

Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken.

Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question.

Online modules to improve health professionals' end-of-life law knowledge and confidence: a pre-post survey study.

Background: Health professionals and medical students have knowledge gaps about the law that governs end-of-life decision-making. There is a lack of dedicated training on end-of-life law and corresponding research on the impact of this type of training.

Objective: To examine the impact of online training modules on key concepts of end-of-life law on Australian health professionals' legal knowledge and their self-reported confidence in applying the law in practice.

Legal issues in end-of-life care for speech-language pathologists and social workers: A scoping review.

Purpose: End-of-life law governs end-of-life decision-making in clinical practice. There has been little analysis of the specific legal issues relevant to allied health professionals working in end-of-life care.

Method: A scoping review was undertaken to identify and examine the extent, range, and nature of literature on the legal issues relevant to end-of-life practice for Australian speech-language pathologists and social workers, including current gaps.

Autophagy controls mucus secretion from intestinal goblet cells by alleviating ER stress.

Colonic goblet cells are specialized epithelial cells that secrete mucus to physically separate the host and its microbiota, thus preventing bacterial invasion and inflammation. How goblet cells control the amount of mucus they secrete is unclear. We found that constitutive activation of autophagy in mice via Beclin 1 enables the production of a thicker and less penetrable mucus layer by reducing endoplasmic reticulum (ER) stress.

Assisted Deaths Prior to the Voluntary Assisted Dying Act 2017 (Vic): Would Patients Have Met the Eligibility Criteria to Request Voluntary Assisted Dying?

Unlawful assisted dying practices have been reported in Australia for decades. Voluntary assisted dying (VAD) is now lawful in Victoria and Western Australia in limited circumstances and will soon be lawful in a further four Australian States. This article examines nine cases involving unlawful assisted dying practices in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) in 2019.

A cross-sectional study of the first two years of mandatory training for doctors participating in voluntary assisted dying.

Objectives: Voluntary assisted dying (VAD) was legalized in Victoria, Australia, in June 2019. Victoria was the first jurisdiction in the world to require doctors to undertake training before providing VAD. This study examines data from doctors who completed the mandatory training in the first 2 years of the VAD system's operation (up to 30 June 2021).

Operationalizing legal rights in end-of- life decision-making: A qualitative study.

Background: For a patient's legal right to make end-of-life treatment decisions to be respected, health care practitioners, patients and their substitute decision-makers must know what rights exist and how to assert them (or support others to assert them). Yet very little is known about what enhances or obstructs the operationalization of legal rights from the perspective of patients, family members and substitute decision-makers.

Aim: To explore barriers and facilitators to the operationalization of rights in end-of-life decision-making from the perspectives of terminally-ill patients and family members and substitute decision-makers of terminally ill patients in Australia.

Role of Law in End-of-Life Decision-Making: Perspectives of Patients, Substitute Decision-Makers and Families.

The law regulating medical end-of-life decisions aims to support patients to receive high-quality health care. It does so through ensuring treatment received reflects the person's wishes and values and protecting health professionals who provide adequate pain and symptom relief even if that treatment may coincidentally hasten death. However, good decision-making is predicated by those involved, including patients themselves and those supporting patients, being familiar with the law and the role it plays in the decision-making process.

Intentional hastening of death through medication: a case series analysis of Victorian deaths prior to the Voluntary Assisted Dying Act 2017.

Background: Voluntary assisted dying is lawful in Victoria in limited circumstances and commences in Western Australia in mid-2021. There is evidence that in rare cases, unlawful assisted dying practices occur in Australia.

Aims: To determine whether assisted dying practices occurred in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) ('VAD Act'), and to examine features of any identified cases.

Limitations in health professionals' knowledge of end-of-life law: a cross-sectional survey.

Background: Insufficient knowledge about end-of-life law can impede the provision of safe and high-quality end-of-life care. Accurate legal knowledge across health professions is critical in palliative and end-of-life settings given the reliance on multidisciplinary care. Most research has focused on doctors, finding significant knowledge gaps.

Prevalence of advance care directives in the community: a telephone survey of three Australian States.

Background: The community prevalence of advance care directives (ACD) is low despite known benefits of advance care planning for patients, families and health professionals.

Aim: To determine the community prevalence of instructional and appointing ACD in New South Wales, Victoria and Queensland and factors associated with completion of these documents.

Methods: A telephone survey of adults living in New South Wales, Victoria and Queensland (n = 1175) about completion of instructional ACD (making their own decisions about future healthcare) and appointing ACD (appointing another to decide).

Community knowledge of law at the end of life: availability and accessibility of web-based resources.

Objective The aim of the present study was to identify online resources community members may access to inform themselves about their legal duties and rights in end-of-life decision making. Methods Resource mapping identified online resources that members of the public in New South Wales, Victoria and Queensland are likely to identify, and assessed the ease or difficulty in locating them. Resources were then critically analysed for accessibility of language and format using the Patient Education Materials Assessment Tool (PEMAT).

Personal and Contextual Factors Affecting the Functional Ability of Children and Adolescents with Chronic Pain: A Systematic Review.

Objective: Chronic pain can significantly impair functioning of children and adolescents; however, evidence suggests that current psychological approaches have limited effect on functioning post treatment. The objective of this review is to present the current evidence for the personal and contextual factors that affect functioning and disability of children and adolescents with chronic pain, to support the evolution of new treatments.

Method: Key word searches were conducted in PsycINFO, MEDLINE via Ovid, CINAHL, and PubMed from 1995 to October 2014.

Contribution of speech and language difficulties to health-related quality-of-life in Australian children: A longitudinal analysis.

Purpose: The trajectory of health-related quality-of-life (HRQoL) for children aged 4-9 years and its relationship with speech and language difficulties (SaLD) was examined using data from the Longitudinal Study of Australian Children (LSAC).

Method: Generalized linear latent and mixed modelling was used to analyse data from three waves of the LSAC across four HRQoL domains (physical, emotional, social and school functioning). Four domains of HRQoL, measured using the Paediatric Quality-of-Life Inventory (PedsQL™), were examined to find the contribution of SaLD while accounting for child-specific factors (e.

Mapping allied health evidence-based practice: providing a basis for organisational realignment.

Objective: Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectance, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting.

Methods: All AH staff from the two Brisbane (Qld) tertiary paedritic hospitals were invited to participate in the survey.

Fostering and Inspiring Research Engagement (FIRE): program logic of a research incubator scheme for allied health students.

The purpose of this study was to present the application of a logic model in depicting the underlying theory of an undergraduate research scheme for occupational therapy, physiotherapy, and speech pathology university students in Queensland, Australia. Data gathered from key written documents on the goals and intended operation of the research incubator scheme were used to create a draft (unverified) logic model. The major components of the logic model were inputs and resources, activities/outputs, and outcomes (immediate/learning, intermediate/action, and longer term/impacts).

Early intervention services of children with physical disabilities: complexity of child and family needs.

Background/aim: To gain insight into the special issues confronting parents when accessing early intervention for children with physical disabilities where child and/or family characteristics indicate complex needs within the unique Australian context.

Methods: Qualitative interviews with families receiving early intervention for their children with physical disabilities (N=10). Families with complex circumstances such as having children with high support needs, those from culturally and linguistically diverse backgrounds, and single-parent families were recruited to the study.

Health-related quality-of-life of children with speech and language difficulties: a review of the literature.

A review of the literature has been undertaken to examine health-related quality-of-life (HRQoL) of children and adolescents with speech and language difficulties (SaLD), with a particular focus on evidence regarding the domains of HRQoL most affected by SaLD. Twelve electronic databases were searched for articles on this topic published from 1966 to January 2011. Seven studies suitable for inclusion were identified.