SYNOPSIS A 52‐year‐old black female for 19 years had severe intermittent unilateral headaches that demonstrated the “clustering 12 phenomenon. She was initially diagnosed as having episodic cluster headache. Response to lithium carbonate, ergotamine and courses of corticosteroids was, however, only partial. In December 1989 the headache pattern changed and she developed severe unilateral hemicranial headache that was continuous and non‐remitting. This responded immediately and persistently to oral indomethacin. A diagnosis of hemicraniacontinua (HC) was made. The initial intermittent headache syndrome appears to have been the pre‐continuous stage of hemicrania continua, and not episodic cluster headache as previously supposed. The pre‐continuous phase of hemicrania continua may thus masquerade as episodic cluster headache by reason of its intermittency and “clustering”. In this case, the intermittent stage was protracted. This stage may, conceivably, even be a permanent one. To our knowledge, this is the first report of hemicrania continua in a black African.
Background The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. Aim To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. Design A prospective, Australian, multicentre, randomized controlled trial. Setting Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. Subjects 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Intervention Exposure to the ICARUSS model of integrated care or usual care. Primary outcome The composite of stroke, MI or death from any vascular cause, whichever occurs first. Secondary outcomes Risk factor management in the community, depression, quality of life, disability and dementia. Statistical power With 1000 patients followed up for a median of one-year, with a recurrence rate of 7–10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points Conclusion The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.
Summary Academic-practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data-driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic-practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as "research focused practitioners."
A curiosity has therefore arisen over time relating to the availability of, and access to, clinical supervision within Australian Youth Cancer Services and how healthcare professionals perceive the role of supervision in supporting the delivery of quality youth cancer care. This chapter reports on the qualitative component of a larger mixed-methods study that aimed to address this question. Youth Friendly Care has evolved from recognition of the unique impacts experienced by young people facing ill health and the challenges faced by professionals in caring for them. Clinical supervision, also referred to as 'supervision', is considered a vital part of modern, effective healthcare practice and is embedded in many healthcare systems and professions. The chapter explores the availability of, and access to, clinical supervision for healthcare professionals working in Australian Youth Cancer Services and their perceptions of the role of supervision in supporting the delivery of quality youth cancer care.
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