Digital Commons Network^™

Carers' Preferences For The Delivery Of Therapy Services For People With Disability In Rural Australia: Evidence From A Discrete Choice Experiment, G Gallego, A Dew, M Lincoln, K Bulkeley, J Brentnall, C Vietch

Medical Papers and Journal Articles

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics.

Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living …

Relaxation Techniques For Pain Management In Labour, C. Smith, K. Levett, C. Collins, H. Dahlen, M. Suganuma

Medical Papers and Journal Articles

Background: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011.

Objectives: To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour.

Search methods: We searched Cochrane Pregnancy and Childbirth’s Trials Register (9 May 2017), the Cochrane Central Register of Controlled Trials …

Massage, Reflexology And Other Manual Methods For Pain Management In Labour, C. Smith, K. Levett, C. Collins, H. Dahlen, C. Ee, M. Suganuma

Medical Papers and Journal Articles

Background

Many women would like to avoid pharmacological or invasive methods of pain management in labour, and thismay contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012.

Objectives

To assess the effect, safety and acceptability of massage, reflexology and other manual methods to manage pain in labour.

Search methods

For this update, we searched Cochrane Pregnancy and Childbirth’s Trials Register (30 June 2017), the Cochrane Central Register of …

Impact Of Aging On The Auditory System And Related Cognitive Functions: A Narrative Review, Dona M.P Jayakody, Peter L. Friedland, Ralph N. Martins, Hamid R. Sohrabi

Medical Papers and Journal Articles

Age-related hearing loss (ARHL), presbycusis, is a chronic health condition that affects approximately one-third of the world’s population. The peripheral and central hearing alterations associated with age-related hearing loss have a profound impact on perception of verbal and non-verbal auditory stimuli. The high prevalence of hearing loss in the older adults corresponds to the increased frequency of dementia in this population. Therefore, researchers have focused their attention on age-related central effects that occur independent of the peripheral hearing loss as well as central effects of peripheral hearing loss and its association with cognitive decline and dementia. Here we review the …

Actinomyces Cavernous Sinus Infection: A Case And Systematic Literature Review, Michal Lubomski, James Dalgliesh, Kenneth Lee, Omprakash Damodaran, Genevieve Mckew, Stephen Reddel

Medical Papers and Journal Articles

A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis then Tolosa-Hunt syndrome and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (18F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces-like colonies. Actinomyces cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a …

How Is Chaplaincy Marginalised-By Our Faith Communities And By Our Institutions And Can We Change It?, Jeffrey Cohen

Medical Papers and Journal Articles

This paper reviews the issues confronting chaplaincy/spiritual care in the 21st century. It looks at how faith communities are changing their view of chaplaincy as well how institutions respond. The paper looks at two qualitative studies and what can be learned from them in confronting the questions raised at the beginning. It concludes with the question of how the evidence base can be expanded to make chaplaincy/spiritual care more relevant over the next few years.

Effect Of Adjunctive Ranitidine For Antipsychotic-Induced Weight Gain: A Systematic Review Of Randomized Placebo-Controlled Trials, Xiaojing Gu, Rui Chen, Chen-Hui Sun, Wei Zheng, Xin-Hu Yang, Shi-Bin Wang, Gabor S. Ungvari, Chee Ng, Andrei Golenkov, Grace Lok, Lu Li, Ines Chow, Fei Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

This study was a meta-analysis of randomized controlled trials (RCTs) of ranitidine as an adjunct for antipsychotic-induced weight gain in patients with schizophrenia. RCTs reporting weight gain or metabolic side effects in patients with schizophrenia were included. Case reports/series, nonrandomized or observational studies, reviews, and meta-analyses were excluded. The primary outcome measures were body mass index (BMI) (kg/m2) and body weight (kg). Four RCTs with five study arms were identified and analyzed. Compared with the control group, adjunctive ranitidine was associated with marginally significant reductions in BMI and body weight. After removing an outlier study for BMI, the effect of …

Pain Medicine Content, Teaching And Assessment In Medical School Curricula In Australia And New Zealand, Elspeth E. Shipton, Frank Bate, Raymond Garrick, Carole Steketee, Eric J. Visser

Medical Papers and Journal Articles

Background: The objective of pain medicine education is to provide medical students with opportunities to develop their knowledge, skills and professional attitudes that will lead to their becoming safe, capable, and compassionate medical practitioners who are able to meet the healthcare needs of persons in pain. This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

Method: All 23 medical schools in Australia and New Zealand in 2016 were included in this study. A structured curriculum audit tool was used to obtain information on pain medicine curricula including …

Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study, Yan Liang, Yang-Kun Chen, Vincent C. Mok, De-Feng Wang, Gabor S. Ungvari, Winnie C. Chu, Hee-Ju Kang, Wai-Kwong Tang

Medical Papers and Journal Articles

Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS.

Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of _7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed …

Mobile Phone Dependence, Social Support And Impulsivity In Chinese University Students, Songli Mei, Jingxin Chai, Shi-Bin Wang, Chee H. Ng, Gabor S. Ungvari, Yu-Tao Xiang

Medical Papers and Journal Articles

This study examined the frequency of mobile phone dependence in Chinese university students and explored its association with social support and impulsivity. Altogether, 909 university students were consecutively recruited from a large university in China. Mobile phone use, mobile phone dependence, impulsivity, and social support were measured with standardized instruments. The frequency of possible mobile phone use and mobile phone dependence was 78.3% and 7.4%, respectively. Multinomial logistic regression analyses revealed that compared with no mobile phone dependence, possible mobile phone dependence was significantly associated with being male (p = 0.04, OR = 0.7, 95% CI: 0.4–0.98), excessive mobile phone …

Nonstandard Lumbar Region In Predicting Fracture Risk, Dima Alajlouni, Dana Bliuc, Thach Tran, Nicholas Pocock, Tuan Nguyen, John A. Eisman, Jacqueline Center

Medical Papers and Journal Articles

Background: Femoral neck BMD is the most commonly used skeletal site to estimate fracture risk. The role of lumbar spine BMD in fracture risk prediction is less clear due to osteophytes that spuriously increase LS BMD, particularly at lower levels. The aim of this study was to compare fracture predictive ability of upper L1-L2 BMD compared to standard L2-L4 BMD and assess whether the addition of either lumbar spine site could improve fracture prediction over FN BMD.

Methodology: A prospective cohort of 3016 women and men 60+ years from the Dubbo Osteoporosis Epidemiology Study followed for occurrence of minimal trauma …

Long-Term Impact Of Childhood Hepatitis B Vaccination Programs On Prevalence Among Aboriginal And Non-Aboriginal Women Giving Birth In Western Australia, Joanne Reekie, John M. Kaldor, Donna B. Mak, James Ward, Basil Donovan, Jane S. Hocking, David Preen, Bette Liu

Medical Papers and Journal Articles

Background/Aims: To evaluate the long-term effect of infant and childhood hepatitis B (HBV) vaccination programs among birthing women in Western Australia.

Methods: A cohort of Western Australian women born from 1974 to 1995 was created using Birth Registrations and Electoral Roll records. They were linked to a perinatal register and notifiable diseases register to identify women having respectively their first births between 2000 and 2012 and diagnoses of HBV infections. HBV prevalence was estimated in Aboriginal and non-Aboriginal women, and according to maternal birth year cohorts.

Results: Of 66,073 women, 155 (0.23%) had a linked non-acute HBV notification. HBV prevalence …

Indigenous Youth Peer-Led Health Promotion In Canada, New Zealand, Australia, And The United States: A Systematic Review Of The Approaches, Study Designs, And Effectiveness, Daniel Vujcich, Jessica Thomas, Katy Crawford, James Ward

Medical Papers and Journal Articles

Background: Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness.

Methods: A systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers.

Results: Twenty-four studies were identified for inclusion, based on 20 …

Standard Setting In Australian Medical Schools, Helena Ward, Neville Chiavaroli, James Fraser, Kylie Mansfield, Darren Starmer, Laura Surmon, Martin Veysey, Deborah O'Mara

Medical Papers and Journal Articles

Background: Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC).

Methods: A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 …

The Voice Study: Valuing Opinions, Individual Communication And Experience: Building The Evidence Base For Undertaking Patient-Centred Family Meetings In Palliative Care - A Mixed Methods Study, Philippa J. Cahill, Christine R. Sanderson, Elizabeth A. Lobb, Jane L. Phillips

Medical Papers and Journal Articles

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives.

Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be …

A Process For Developing Standards To Promote Quality In General Practice, Julie Khoury, Catherine Krejany, Ronald Versteeg, Michaela Lodewyckx, Simone Pike, Michael Civil, Moyez Jiwa

Medical Papers and Journal Articles

Background: Since 1991, the Royal Australian College of General Practitioners (RACGP) Standards for general practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017.

Objective: The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally.

Method: A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by …

Does Implementation Matter If Comprehension Is Lacking? A Qualitative Investigation Into Perceptions Of Advance Care Planning In People With Cancer, Anna Ugalde, Clare O'Callaghan, Clem Byard, Samantha Brean, Jenelle Mackay, Anna Boltong, Sondra Davoren, Deborah Lawson, Phillip Parente, N Michael, Patricia Livingstone

Medical Papers and Journal Articles

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes.

Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney …

Comorbidities Only Account For A Small Proportion Of Excess Mortality After Fracture: A Record Linkage Study Of Individual Fracture Types, Chen Weiwen, Judy Simpson, Lynette March, Fiona Blyth, Dana Bliuc, Thach Tran, Tuan Nguyen, John A. Eisman, Jacqueline Center

Medical Papers and Journal Articles

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality.

Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality.

Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable …

Inferior Vena Cava Filters (Ivcfs): A Review Of Uses And Application To International Guidelines At A Single Australian Center; Implications Of Venous Thromboembolism Associated With Malignancy, Philip Craven, Ciara Daly, Randall Oates, Nisha Sikotra, Tim Clay, Eli Gabbay

Medical Papers and Journal Articles

Venous thromboembolism (VTE) is a potentially lethal event. Anticoagulation is the cornerstone of treatment. Inferior vena cava filters (IVCFs) may be used in circumstances when anticoagulation is contraindicated or as an adjunct to anticoagulation. IVCF use is not without controversy due to concerns over their safety profile, differences in guidelines from international societies, and a limited randomized control trial evidence. We retrospectively undertook a review of IVCF use over a three-year period (2014–2016) at our center, which has a large oncology service but no trauma unit. There were 44 patients with successful IVCF insertion and one patient with an unsuccessful …

Developing A Mental Health Eclinic To Improve Access To And Quality Of Mental Health Care For Young People: Using Participatory Design As Research Methodologies, Laura Ospina-Pinillos, Tracey A. Davenport, Cristina S. Ricci, Alyssa C. Milton, Elizabeth M. Scott, Ian B. Hickie

Medical Papers and Journal Articles

Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising.

Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years …

Reduced Mortality And Subsequent Fracture Risk Associated With Oral Bisphosphonate Recommendation In A Fracture Liaison Service Setting: A Prospective Cohort Study, Tineke A. Van Geel, Dana Bliuc, Piet P. Geusens, Jacqueline R. Center, Geert-Jan Dinant, Thach Tran, Joop P. Van Den Bergh, Alastair R. Mclellan, John A. Eisman

Medical Papers and Journal Articles

Objective: Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.

Materials and methods: In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between …

The Prevalence Of Autism Spectrum Disorders In China: A Comprehensive Meta-Analysis, Fei Wang, Li Lu, Shi-Bin Wang, Ling Zhang, Chee H. Ng, Gabor S. Ungvari, Xiao-Lan Cao, Jian-Ping Lu, Cai-Lan Hou, Fu-Jun Jia, Yu-Tao Xiang

Medical Papers and Journal Articles

There are conflicting prevalence estimates of autism spectrum disorders (ASDs) in mainland China (China thereafter). This study is a comprehensive meta-analysis of the pooled prevalence of ASDs in the general population in China. Study investigators independently conducted a systematic literature search of the following databases: PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure, Chinese biomedical literature service system, and Wan Fang. Studies reporting prevalence of ASDs and autism in Chinese population were identified and analysed using the Comprehensive Meta-Analysis program with the random effects model. Forty-four studies were included in the meta-analysis comprising 2,337,321 subjects of whom 46.66 % were females. …

Physician-Assisted Suicide And Euthanasia: Emerging Issues From A Global Perspective, Charles L. Sprung, Margaret Somerville, Lukas Radbruch, Nathalie Steiner Collet, Gunnar Duttge, Jefferson P. Piva, Massimo Antonelli, Daniel P. Sulmasy, Willem Lemmens, E Wesley Ely

Medical Papers and Journal Articles

Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn’t be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients …

Looking Both Ways: A Review Of Methods For Assessing Research Impacts On Policy And The Policy Utilisation Of Research, Robyn S. Newson, Lesley A. King, Lucie Rychetnik, Andrew J. Milat, Adrian E. Bauman

Medical Papers and Journal Articles

Background: Measuring the policy and practice impacts of research is becoming increasingly important. Policy impacts can be measured from two directions – tracing forward from research and tracing backwards from a policy outcome. In this review, we compare these approaches and document the characteristics of studies assessing research impacts on policy and the policy utilisation of research.

Methods: Keyword searches of electronic databases were conducted in December 2016. Included studies were published between 1995 and 2016 in English and reported methods and findings of studies measuring policy impacts of specified health research, or research use in relation to a specified …

Does Citation Matter? Research Citation In Policy Documents As An Indicator Of Research Impact – An Australian Obesity Policy Case-Study, Robyn Newson, Lucie Rychetnik, Lesley King, Andrew Milat, Adrian Bauman

Medical Papers and Journal Articles

Background: Citation of research in policy documents has been suggested as an indicator of the potential longer-term impacts of research. We investigated the use of research citations in childhood obesity prevention policy documents from New South Wales (NSW), Australia, considering the feasibility and value of using research citation as a proxy measure of research impact.

Methods: We examined childhood obesity policy documents produced between 2000 and 2015, extracting childhood obesity-related references and coding these according to reference type, geographical origin and type of research. A content analysis of the policy documents examined where and how research was cited in the …

Exploring Tutor Perceptions And Current Practices In Facilitating Diagnostic Reasoning In Preclinical Medical Students: Implications For Tutor Professional Development Needs, Jane E. Keir, Shannon L. Saad, Lorna Davin

Medical Papers and Journal Articles

Introduction: This study explores tutors’ experience of teaching diagnostic reasoning (DR) – a key component of clinical reasoning – to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students.

Methods: A qualitative, interpretive study was undertaken with 14 preclinical problem-based learning tutors who participated in semi-structured interviews. A thematic analysis was conducted to identify key factors that influence students’ learning of diagnostic reasoning.

Results: Tutor dispositions towards facilitating learning of DR were variable in this study. Explicit strategies to teach DR were thought to exert positive influences on the development of …

A Profiling Analysis Of Contributions Of Cigarette Smoking, Dietary Calcium Intakes, And Physical Activity To Fragility Fracture In The Elderly, Thuy T. Pham, Diep N. Nguyen, Eryk Dutkiewicz, Jacqueline R. Center, John A. Eisman, Tuan V. Nguyen

Medical Papers and Journal Articles

Fragility fracture and bone mineral density (BMD) are influenced by common and modifiable lifestyle factors. In this study, we sought to define the contribution of lifestyle factors to fracture risk by using a profiling approach. The study involved 1683 women and 1010 men (50+ years old, followed up for up to 20 years). The incidence of new fractures was ascertained by X-ray reports. A “lifestyle risk score” (LRS) was derived as the weighted sum of effects of dietary calcium intake, physical activity index, and cigarette smoking. Each individual had a unique LRS, with higher scores being associated with a healthier …

Perceptions Of Shared Care Among Survivors Of Colorectal Cancer From Non-English-Speaking And English-Speaking Backgrounds: A Qualitative Study, Lawrence Tan, Gisselle Gallego, Thi T.C Nguyen, Les Bokey, Jennifer Reath

Medical Papers and Journal Articles

Background: Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners.

Methods: This was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally …

Prevalence Of Insomnia Symptoms And Their Associated Factors In Patients Treated In Outpatient Clinics Of Four General Hospitals In Guangzhou, China, Wei Zheng, Xin-Ni Luo, Hai-Yan Li, Xiao-Yin Ke, Qing Dai, Chan-Juan Zhang, Chee H. Ng, Gabor S. Ungvari, Yu-Tao Ziang, Yu-Ping Ning

Medical Papers and Journal Articles

Background: Data on the prevalence of insomnia symptoms in medical outpatient clinics in China are lacking. This study examined the prevalence of insomnia symptoms and their socio-demographic correlates in patients treated at medical outpatient clinics affiliated with four general hospitals in Guangzhou, a large metropolis in southern China.

Method: A total of 4399 patients were consecutively invited to participate in the study. Data on insomnia and its socio-demographic correlates were collected with standardized questionnaires.

Results: The prevalence of any type of insomnia symptoms was 22.1% (95% confidence interval (CI): 20.9–23.3%); the prevalence of difficulty initiating sleep was 14.3%, difficulty maintaining …

Healing Conversations: Developing A Practical Framework For Clinical Communication Between Aboriginal Communities And Healthcare Practitioners, Andrea Mckivett, David Paul, Nicky Hudson

Medical Papers and Journal Articles

In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner’s own cultural identity and will be guided by collective Aboriginal world-views in …