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The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

See related Editorial See cover image, Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community‐based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community‐based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re‐certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community‐based healthcare settings.

Using waste paper as fuel for domestic heating is a beneficial recycling option for small island developing states where there are lacks of resources for energy and waste treatment. However, there are concerns about the impact of air pollutants emitted from the burning of the self-made paper briquettes as household air pollution is recognised as the greatest environmental risk for human. In this study, combustion tests were carried out for paper briquettes made in one Pacific island and three commercial fuels in Australia including wood briquettes, kindling firewood and coal briquettes in order to: 1) characterise the emissions of three criteria air pollutants including particulate matters, CO and NOx including their emission factors (EF) from the tested fuels; and 2) compare the EFs among the tested fuels and with others reported in the literature. The results showed that waste paper briquettes burned quickly and generated high temperature but the heat value is relatively low. Paper briquettes and coal briquettes produced higher CO concentration than the others while paper briquettes generated the highest NOx level. Only PM2.5 concentration emitted from paper briquettes was similar to kindling firewood and lower than wood briquettes. Burning of paper briquettes and wood briquettes produced particulate matter with large average count median diameter (72 and 68 nm) than coal briquette and kindling firewood (45 and 51 nm). The EFs for CO, NOx and PM2.5 of paper briquettes were within the range of EFs reported in this study as well as in the literature. Overall, the results suggested that using paper briquettes as fuel for domestic heating will not likely to generate higher level of three major air pollutants compared to other traditional fuels.

Objective The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P

Large volumes of engineered wood products (EWPs) and paper are routinely placed in landfills in Australia, where they are assumed to decay. However, the extent of decay for EWPs is not well-known. This study reports carbon loss from EWPs and paper buried in landfills in Sydney, Brisbane and Cairns in Australia, located in temperate, subtropical and tropical climates, respectively. The influence of pulp type (mechanical and chemical) and landfill type (municipal solid waste - MSW and construction and demolition - CD) on decay levels were investigated. Carbon loss for EWPs ranged from 0.6 to 9.0%; though there is some uncertainty in these values due to limitations associated with sourcing appropriate controls. Carbon loss for paper products ranged from 0 to 58.9%. Papers produced from predominantly mechanical pulps generally had lower levels of decay than those produced via chemical or partly chemical processes. Typically, decay levels for paper products were highest for the tropical Cairns landfill, suggesting that climate may be a significant factor to be considered when estimating emissions from paper in landfills. For EWPs, regardless of the landfill type and climate, carbon losses were low, confirming results from previous laboratory studies. Lower carbon losses were observed for EWP and paper excavated from the Sydney CD landfill, compared with the Sydney MSW landfill, confirming the hypothesis that conditions in CD landfills are less favourable for decay. These results have implications for greenhouse gas inventory estimations, as carbon losses for EWPs were lower than the commonly assumed values of 23% (US EPA) and 50% (Intergovernmental Panel on Climate Change). For paper types, we suggest that separate decay factors should be used for papers dominated by mechanical pulp and those produced from mostly chemical pulps, and also for papers buried in tropical or more temperate climates.

In September 1847, David John Thomas read a paper on etherisation at a monthly meeting of the Port Phillip Medical Association. Thomas’ paper is the earliest known presentation of a paper on etherisation in the Australian colonies. Almost half of Thomas’ 27-page manuscript was published in October 1847 in the Australian Medical Journal. The original manuscript was acquired at an unknown date by the Medical Society of Victoria. Although a full transcript of the manuscript was published in 1933, the original manuscript of Dr Thomas remained unknown to anaesthesia historians and is now held by the Medical History Museum, University of Melbourne.

This paper examines the personal and professional experiences of the five arts leaders who co-wrote the foundation document for Australia’s first national curriculum in the Arts. Their personal and professional backgrounds, which were explored during in depth interviews, drove the complex collaborative process that informed the first iteration of the Australian Curriculum: The Arts. Though each couched their responses in the context of their background and arts discipline, they shared an awareness of the important role of the Arts in providing the analytical tools for children and young people to identify and subsequently challenge social injustice. The findings, which are presented as a group narrative using a Narrative Inquiry approach, reveal how the five arts leaders’ individual lived experience, disciplinary experience and expertise, and commitment to collaborative leadership informed their approach. It was one driven by their shared belief that all Australian students, regardless of their background, are entitled to a quality arts education. Refereed/Peer-reviewed

Background Antenatal education prepares women for childbirth and can be delivered face-to-face, in hard-copy and electronically. Smartphones allow access to online learning and internet searching is common among pregnant women. It is unclear which mode of health information delivery women prefer. Aim This study aimed to investigate how women at one Local Health District (LHD) preferred to receive health information during pregnancy and the early postnatal period. Methods We developed a survey to gather data on women’s preferences for educational information. Women who were discharged from one LHD, in NSW Australia, were invited, in 2019, to participate in a simple 14 question survey, either online or in hard copy format. Findings In total, 685 women completed the survey which represented a 40% response rate over a period of two months. The survey revealed women commonly used smart phones, or other devices, to source information. Despite this, most women preferred to receive antenatal education via non-electronic methods. Of note many participants felt underprepared for the post-birth period. The method of survey completion, whether hardcopy or online, aligned with individuals’ preferences for information delivery. Conclusion Non-electronic methods of education delivery were the preferred method for most women, and this was consistent across all educational, cultural and socioeconomic levels. Women sought information online, or through apps, but these options did not always meet their knowledge needs, especially regarding the postnatal period. We recommend that hospitals continue to provide information in a variety of modes, as exclusively electronic methods may marginalise groups of women.

Work‐related asthma (WRA) is one of the most common occupational respiratory conditions, and includes asthma specifically caused by occupational exposures (OA) and asthma that is worsened by conditions at work (WEA). WRA should be considered in all adults with asthma, but especially those with new‐onset or difficult to control asthma. Improvement in asthma symptoms when away from work is suggestive of WRA. Clinical history alone is insufficient to diagnose WRA; therefore, objective investigations are required to confirm the presence of asthma and the association of asthma with work activities. Management of WRA requires pharmacotherapy similar to that of non‐WRA, however, also needs to take into account control of the causative workplace exposure. Ongoing exposure will likely lead to decline in lung function and worsening asthma control. WRA is a preventable condition but this does rely on increased awareness of WRA and thorough identification and control of all potential occupational respiratory hazards.

Social insects are highly diverse in their social structures, aside from the consistent presence of reproductive castes. Among social insects, the Australian paper wasp Ropalidia plebeiana constructs extremely dense colony aggregations consisting of hundreds of colonies within a few square meters; however, little is known about the aggregation structures. We genetically analyzed the colony and population structure of R. plebeiana, and concomitant variations in colony sex ratios. In spring, the foundress (candidate queen) group started their colonies on a single old comb from the previous season, subsequently dividing these old combs via relatedness-based comb-cutting. Female philopatry, a prerequisite condition of Local Resource Competition (LRC), was confirmed. The colony sex ratio of reproductive individuals (male and female offspring for the next generation) became slightly male-biased in larger colonies, as predicted under LRC. However, the number of foundresses was positively associated with the number of reproductive individuals, suggesting that Local Resource Enhancement (LRE) also operates. Although the population structure appears to meet the prerequisites of LRC, the sex ratio appears to be modulated by factors other than LRC. Rather, through LRE, the availability of female helpers at the founding stage is likely to mitigate the sex ratios predicted under LRC.

Objective: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. Design: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes. Setting: A community rehabilitation programme within a large metropolitan health service. Subjects: Patients with stroke with upper limb deficits, referred for outpatient rehabilitation. Interventions: Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks. Main measures: The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction. Results: A total of 62 participants were allocated to the intervention ( n = 30) and control groups ( n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI −12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI −0.1 to 0.1). There were no between-group differences in how participants found instructions ( p = 0.452), whether they remembered to do their exercises ( p = 0.485), or whether they enjoyed doing their exercises ( p = 0.864). Conclusions: The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke. This trial design was registered prospectively with the Australian and New Zealand Clinical Trials Register, ID: ACTRN 12613000786796. http://www.anzctr.org.au/trialSearch.aspx

This is a brief summary of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) evidence-based guideline for the management of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG). The full guideline and executive summary including auditable outcomes are freely available on the SOMANZ website [https://www.somanz.org/guidelines.asp]. The guideline includes a proposed SOMANZ definition of NVP and HG and evidence-based practical advice regarding the investigation and management of NVP, HG and associated conditions including thyroid dysfunction. A practical algorithm for assessment and management as well as an individual patient management plan and self-assessment tools are included.

One hundred thousand years ago, give or take, the forebears of some of Australia’s First Nations—by some accounts as few as 150 people—left Africa on an immense journey. After some 2,000 generations, the passage through new and unfamiliar territories of these first modern human beings terminated in a supercontinent that included Australia, Papua, and Tasmania. By some estimates, no more than 150 people—the same number that had originally left Africa—made the final sea crossing that separates Indonesia and Australia. Research on such ancient migrations emphasises population growth, the ‘selfish gene,’ and the territorial imperative, as key drivers of mobility. This working paper speculates that the numinous was the equal to any other factor in migration, which is why this vast trek is called an inspired journey or the very first pilgrimage.

Objectives:Computerised neuropsychological assessments (CNAs) are proposed as an alternative method of assessing cognition to traditional pencil-and-paper assessment (PnPA), which are considered the “gold standard” for diagnosing dementia. However, limited research has been conducted with culturally and linguistically diverse (CALD) individuals. This study investigated the suitability of PnPAs and CNAs for measuring cognitive performance in a heterogenous sample of older, Australian CALD English-speakers compared to a native English-speaking background (ESB) sample.Methods:Participants were 1037 community-dwelling individuals aged 70–90 years without a dementia diagnosis from the Sydney Memory and Ageing Study (873 ESB, 164 CALD). Differences in the level and pattern of cognitive performance in the CALD group were compared to the ESB group on a newly developed CNA and a comprehensive PnPA in English, controlling for covariates. Multiple hierarchical regression was used to identify the extent to which linguistic and acculturation variables explained performance variance.Results:CALD participants’ performance was consistently poorer than ESB participants on both PnPA and CNA, and more so on PnPA than CNA, controlling for socio-demographic and health factors. Linguistic and acculturation variables together explained approximately 20% and 25% of CALD performance on PnPA and CNA respectively, above demographics and self-reported computer use.Conclusions:Performances of CALD and ESB groups differed more on PnPAs than CNAs, but caution is needed in concluding that CNAs are more culturally-appropriate for assessing cognitive decline in older CALD individuals. Our findings extend current literature by confirming the influence of linguistic and acculturation variables on cognitive assessment outcomes for older CALD Australians.

Rationale : Saliva as a sample matrix is rapidly gaining interest for disease diagnosis and point-of-care assays because it is easy to collect (non-invasive) and contains many health-related biomarkers. However, saliva poses particular problems relative to more common urine and blood matrices, which includes low analyte concentrations, lack of understanding of biomolecule transportation and inherent viscosity variability in human samples. While several studies have sought to improve assay sensitivity, few have addressed sample viscosity specifically. The goal of this study is to minimize the effect of sample viscosity on paper-based analytical devices (PADs) for the measurement of pH and nitrite in human saliva. Methods : PADs were used to measure salivary pH from 5.0 to 10.0 with a universal indicator consisting of chlorophenol red, phenol red and phenolphthalein. Nitrite determination was performed using the Griess reaction. Artificial saliva with viscosity values between 1.54 and 5.10 mPa∙s was tested on the proposed PAD. To ensure the proposed PADs can be tailored for use in-field analysis, the devices were shipped to Australia and tested with human specimens. Results : Initial experiments showed that viscosity had a significant impact on the calibration curve for nitrite; however, a more consistent curve could be generated when buffer was added after the sample, irrespective of sample viscosity. The linear range for nitrite detection was 0.1 to 2.4 mg/dL using the improved method. The nitrite measurement in artificial saliva also showed a good correlation with the standard spectrophotometry method (p=0.8484, paired sample t-test, n=20). Measured pH values from samples with varying viscosities correlated well with the results from our pH meter. Conclusions : The inherent variation of salivary viscosity that impacts nitrite and pH results can be addressed using a simple washing step on the PAD without the need for complex procedures.

The development of technology such as intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image-guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.

Children have not been severely affected by SARS‐CoV‐2‐related illness but are vulnerable to the economic and social deprivation arising from the pandemic. This document describes unique risks and burdens for children and their care givers during the COVID‐19 pandemic. The principles for the allocation of health‐care resources apply to the whole population; however, there are particular paediatric considerations. The experience internationally is that paediatric intensive care resources are being utilised to support adult services during the emergency. Ethical tensions also arise from decisions about usual service restriction as a strategy for controlling the pandemic. This guidance provides a framework for health services and authorities to ensure paediatric concerns are considered during the development of COVID‐19 related guidelines and decision‐support tools, when resources may be constrained by the emergency response. It was developed by a working group of paediatric clinical ethicists, and intensive care and other specialty clinicians. This document is an extension to the other general documents available. It is intended to be read by clinicians and executive of paediatric and general hospitals, and by health‐related government departments.

Objective Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. Methods This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. Results One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25–40 years) and pack weight of 11 ± 1.8 kg (range, 8–16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. Conclusions Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

IntroductionLung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The Australia and New Zealand Lung Cancer Registry (ANZLCR) will be developed as a Clinical Quality Registry to monitor the safety, quality and effectiveness of lung cancer care in Australia and New Zealand.Methods and analysisPatient participants will include all adults >18 years of age with a new diagnosis of non-small-cell lung cancer (NSCLC), SCLC, thymoma or mesothelioma. The ANZLCR will register confirmed diagnoses using opt-out consent. Data will address key patient, disease, management processes and outcomes reported as clinical quality indicators. Electronic data collection facilitated by local data collectors and local, state and federal data linkage will enhance completeness and accuracy. Data will be stored and maintained in a secure web-based data platform overseen by registry management. Central governance with binational representation from consumers, patients and carers, governance, administration, health department, health policy bodies, university research and healthcare workers will provide project oversight.Ethics and disseminationThe ANZLCR has received national ethics approval under the National Mutual Acceptance scheme. Data will be routinely reported to participating sites describing performance against measures of agreed best practice and nationally to stakeholders including federal, state and territory departments of health. Local, regional and (bi)national benchmarks, augmented with online dashboard indicator reporting will enable local targeting of quality improvement efforts.

Australia released the newest edition of its Defense White Paper, describing Canberra’s current and emerging national security priorities, on February 25, 2016. This continues a tradition of issuing defense white papers since 1976. This work will examine and analyze the contents of this document as well as previous Australian defense white papers, scholarly literature, and political statements assessing their geopolitical significance. It will also examine public input into Australian defense white papers and the emerging role of social media in this public involvement. It concludes by evaluating whether Australia has the political will and economic resources necessary to fulfill its geopolitical and national security aspirations.

BACKGROUND It is unknown whether questionnaires measuring psychosocial constructs related to low back pain (LBP) that were originally designed for adults are suitable for adolescents, and if paper and web-versions have similar measurement properties. OBJECTIVES To examine selected psychometric properties for the paper- and web-based Back-Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ-phys) among adults and adolescents in two diverse countries and to determine whether differences existed between countries and pain groups. METHODS A sample of 156 adults (Hong Kong, n= 75; Australia, n= 81) and 96 adolescents (Hong Kong, n= 61; Australia, n= 35) participated in this cross-sectional study. RESULTS Main effects for country and administration mode were observed in adult BBQ scores, where Australian adults reported significantly higher BBQ scores than Hong Kong adults (mean difference (MD); 95% CI: 2.85; 0.96-4.74) and significantly higher scores were recorded on the web mode compared to the paper mode (MD 0.74; 0.10-1.38). Similarly, Hong Kong adults and adolescents reported higher FABQ-phys scores than Australian adults and adolescents (MD; 95% CI: 3.40; 1.37-5.43 and 4.88; 0.53-9.23, respectively). Internal consistency values were mostly acceptable (α ≥ 0.7). CONCLUSION Differences exist between cultures for LBP-related beliefs. The BBQ and FABQ-phys have acceptable measurement properties in both administration modes.

Introduction Increasingly, over the past decade, there has been a global shift in healthcare away from fixed "fee for service" payment mechanisms towards value-based reimbursement models rewarding safety and quality patient outcomes. Curbing the burgeoning costs of healthcare while incentivising higher quality and safer patient care are key drivers of this approach. At face value, this is clearly a worthwhile endeavour. However, there is a lack of conclusive evidence to support the effectiveness of such schemes where they have been introduced internationally. For this reason, Australia has largely been an observer of the shift in payment modalities that are occurring in other countries such as the United States and the United Kingdom. Method This paper presents an overview of current Australian practice in pricing for safety and quality in Healthcare. Recommendations are provided to help infection control professionals prepare for the upcoming introduction of funding reforms aimed at reducing complications acquired in Australian public hospitals. Conclusion The implications for infection control professionals are wide-ranging. This will be a period of significant adjustment for the public health system in Australia.

This paper outlines a research protocol to be undertaken with people with disability from Syrian and Iraqi refugee backgrounds settling in Australia. Since 2012, the numbers of people with disability arriving from these countries has increased with limited understanding about the impact of their refugee journeys on their settlement. The aim of this small-scale exploratory study is to learn about the journeys made by people with disability from Syrian and Iraqi refugee backgrounds from their countries of origin, through transit countries, to Australia in order to understand the impact of these journeys on inclusion and participation in Australian society. This participatory action research study employs a bilingual co-researcher with disability from a Syrian background to conduct life history interviews with up to five participants. Participants will recount their journeys with a focus on the impact of their disability on this experience. The study design is informed by BenEzer and Zetter’s 2014 seminal paper on the importance of the refugee journey to settlement. This study has the potential to foreground the voices and experiences of people with disability from refugee backgrounds who are often absent, silenced or excluded in research and, in so doing, hopefully impact Australian refugee policy.

Background The need for new graduate nurses to have the capabilities to function effectively in increasingly complex, dynamic and diverse health care settings has energised debate about the need for four year nursing degrees. Questions What types of four year bachelor degrees are evident globally and what are the key arguments and evidence suggesting a need for four year nursing degrees in Australia? Methods A scoping of contemporary literature is conducted to identify and discuss the key trends, concerns and evidence that informs the current debate on the appropriate duration of nursing degrees. Findings A unique combination of emerging health care challenges and shifting health care priorities are fuelling the call to reconsider the duration of nursing degrees in Australia. Discussion Future nurses will need the capabilities to work effectively across organisational and geographical boundaries, work as partners with a well-informed public, engage with advancing technologies and work autonomously and collaboratively as equals in inter-professional teams. Conclusion The need for nurse education to produce nurse graduates with key capability for the future, gives credence to a call for a four year nursing degree in Australia.

Non

Stable isotope analysis of a novel combination of carbon and nitrogen pools traced inputs and processing of primary-treated (PE) and secondary-treated effluent (SE) from a paper and pulp mill (PPM) in a temperate Australian estuary. Distinct carbon stable isotope ratios of dissolved organic carbon (DOC) near the PPM outfall indicated large PE and reduced SE inputs of DOC. DOC was remineralized to dissolved inorganic carbon regardless of season, but rates were lower in winter. PE discharge in winter elevated DOC concentrations along much of the estuary. Distinct stable isotope ratios confirmed particulate organic matter (POM) input from PE and SE to the water column and into the sediment. This was relatively localized, indicating rapid POM settlement regardless of season. SE discharge increased nutrient inputs and enhanced algal productivity, particularly in summer when chlorophyll-a concentrations were elevated throughout the estuary. SE discharge reduced pCO(2) from levels associated with PE discharge. However, the estuary remained heterotrophic as subsequent respiration or decomposition of algal material offset reductions in PPM organic matter input. The influence of the PPM was apparent throughout the estuary, demonstrating the ability of anthropogenic inputs, and changes to these, to affect ecosystem functioning.

Background The most-cited papers help to better understand important characteristics of this specific science field. Objective To analyse the 100 most-cited papers in the field of Paediatric Dentistry. Design A search of the most-cited papers in Paediatric Dentistry journals was performed using journals included in the category of 'Dentistry, Oral Surgery & Medicine' in the Thompson Reuters Web of Science citation indexing database up to December 2018. Two researchers performed the data extraction, which included: number of citations, title, authors, country, year, journals, study design, and thematic area. Results The number of citations of each paper included in the top 100 most-cited ranged from 42 to 182 (mean: 64.51). Seven papers were cited more than 100 times. Most of the papers were published in the International Journal of Paediatric Dentistry (36%), between 2006 and 2015 (55%), with a cross-sectional design (39%). Twenty-six authors participated in two or more papers. The countries with the highest number of most-cited papers were the United States (25%), Australia (11%), and Brazil (9%). Cariology was the most studied thematic area. Conclusion The evaluation of the top 100 most-cited papers in Paediatric Dentistry journals allowed for a better understanding of the world scenario regarding this research field.

There is an obvious mismatch between the high reported rates of use of traditional and complementary medicines (TCM) by Australian cancer patients and cancer survivors and the low numbers of Australian cancer services integrating TCM. An estimated 65% of Australian cancer patients use at least one form of TCM. Over half use TCM in conjunction with conventional cancer therapy. Yet, less than 20% of Australian hospital cancer care facilities provide access to TCM. This compares to around 70% of UK cancer care facilities offering at least one TCM therapy. Barriers to developing integrative oncology services include determining an appropriate service model and revenue structure; concerns with ethical and legal issues such as regulations and credentialing; and inadequate high-quality scientific evidence demonstrating safety and effectiveness, including concerns about the possibility of adversely affecting chemotherapy or radiotherapy treatment. This paper aims to provide general guidance and practical strategies for those seeking to develop integrative oncology services in Australian cancer care facilities.

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

The COVID-19 pandemic has impacted the management of non-communicable diseases in health systems around the world. This study aimed to understand the impact of COVID-19 on diabetes medicines dispensed in Australia. Publicly available data from Australia’s government subsidised medicines program (Pharmaceutical Benefits Scheme), detailing prescriptions by month dispensed to patients, drug item code and patient category, was obtained from January 2016 to November 2020. This study focused on medicines used in diabetes care (Anatomical Therapeutical Chemical code level 2 = A10). Number of prescriptions dispensed were plotted by month at a total level, by insulins and non-insulins, and by patient category (general, concessional). Total number of prescriptions dispensed between January and November of each year were compared. A peak in prescriptions dispensed in March 2020 was identified, an increase of 35% on March 2019, compared to average growth of 7.2% in previous years. Prescriptions dispensed subsequently fell in April and May 2020 to levels below the corresponding months in 2019. These trends were observed across insulins, non-insulins, general and concessional patient categories. The peak and subsequent dip in demand have resulted in a small unexpected overall increase for the period January to November 2020, compared to declining growth for the same months in prior years. The observed change in consumer behaviour prompted by COVID-19 and the resulting public health measures is important to understand in order to improve management of medicines supply during potential future waves of COVID-19 and other pandemics.

IntroductionPeople of Ashkenazi Jewish (AJ) ancestry are more likely than unselected populations to have a BRCA1/2 pathogenic variant, which cause a significantly increased risk of breast, ovarian and prostate cancer. Three specific BRCA1/2 pathogenic variants, referred to as BRCA-Jewish founder mutations (B-JFM), account for >90% of BRCA1/2 pathogenic variants in people of AJ ancestry. Current practice of identifying eligible individuals for BRCA testing based on personal and/or family history has been shown to miss at least 50% of people who have one of these variants. Here we describe the protocol of the JeneScreen study—a study established to develop and evaluate two different population-based B-JFM screening programmes, offered to people of Jewish ancestry in Sydney and Melbourne, Australia.Methods and analysisTo rmeasure the acceptability of population-based B-JFM screening in Australia, two screening programmes using different methodologies have been developed. The Sydney JeneScreen programme provides information and obtains informed consent by way of an online tool. The Melbourne JeneScreen programme does this by way of community sessions attended in person. Participants complete questionnaires to measure clinical and psychosocial outcomes at baseline, and for those who have testing, 2 weeks postresult. Participants who decline testing are sent a questionnaire regarding reasons for declining. Participants with a B-JFM are sent questionnaires 12-month and 24-month post-testing. The questionnaires incorporate validated scales, which measure anxiety, decisional conflict and regret, and test-related distress and positive experiences, and other items specifically developed or adapted for the study. These measures will be assessed for each programme and the two population-based B-JFM screening methods will be compared.Ethics and disseminationInstitutional Human Research Ethics Committee approval was obtained from the South Eastern Area Health Service Human Research Ethics Committee: HREC Ref 16/125.Following the analysis of the study results, the findings will be disseminated widely through conferences and publications, and directly to participants in writing.

Background: Historical socio-political processes have produced gross inequity of health resource for Aboriginal Australians and New Zealand Māori. Objectives: This paper argues that socio-political factors resulting from the entrenchment of colonialism have produced significant personal and structural barriers to the utilisation of healthcare services and directly impact the health status of these two vulnerable groups. Design: Discussion Paper. Conclusions: Understanding the actual barriers preventing the utilisation of healthcare facilities, as perceived by Indigenous people, is essential in reducing the gross disparity between Indigenous and non-Indigenous morbidity and mortality in Australia and New Zealand.

Purpose To describe nursing assessment documentation practices in aged care organizations and to evaluate the quality of electronic versus paper-based documentation of nursing assessment. Methods This was a retrospective nursing documentation audit study. Study samples were 2299 paper-based and 6997 electronic resident assessment forms contained in 159 paper-based and 249 electronic resident nursing records, respectively, from three aged care organizations. The practice of nursing assessment documentation in participating aged care homes was described. Three attributes of quality of nursing assessment documentation were evaluated: format and structure, process, and content by seven measures: quantity, completeness, timeliness comprehensiveness, frequencies of documentation specific to care domains and data items, and whether assessment forms were signed and dated. Results Varying practice in documentation of nursing assessment was found among different aged care organizations and homes. Electronic resident records contained higher numbers and more comprehensive resident assessment forms than paper-based records. The frequency of documentation was higher in electronic than in paper-based records in relation to most care domains. There was no difference between the two types of documentation systems on other aspects of nursing assessment documentation (overall completeness and timeliness, variation of frequencies among different care domains, and item completion in personal hygiene assessment forms). Conclusions Electronic nursing documentation systems could improve the quality of documentation structure and format, process and content in the aspects of quantity, comprehensiveness and signing and dating of assessment forms. Further studies are needed to understand the factors leading to the variations of practice and the limitations of nursing assessment documentation and to evaluate documentation quality from a clinical perspective.

IntroductionGynaecological cancers collectively account for almost 10% of cancer diagnoses made in Australian women. The extent of variation in gynaecological cancer survival rates and treatment outcomes across Australia is not well documented. The purpose of the clinical quality registry described in this paper is to systematically monitor and improve quality of care provided to these women, and facilitate clinical process improvements to ensure better patient outcomes and greater adherence to best practice care. The registry infrastructure has been developed in conjunction alongside the inaugural ovarian, tubal and peritoneal (OTP) module, allowing for concurrent piloting of the methodology and one module. Additional tumour modules will be developed in time to cover the other gynaecological tumour types.Method and analysisThe National Gynae-Oncology Registry (NGOR) aims to capture clinical data on all newly diagnosed cancers of the uterus, ovary, fallopian tubes, peritoneum, cervix, vulva and vagina in Australia with a view to using these data to support improved clinical care and increased adherence to ‘best practice’. Data are sourced from existing clinical databases maintained by clinicians and/or hospital gynaecological cancer units. A pilot phase incorporating only OTP cancers has recently been conducted to assess the feasibility of the registry methodology and assess the support of a quality initiative of this nature among clinicians and other key stakeholders.Ethics and disseminationThe NGOR has received National Mutual Acceptance (NMA) ethics approval from Monash Health Human Research Ethics Committee (HREC), NMA HREC Reference Number: HREC/17/MonH/198. We also have approval from Mercy Health HREC and University of Tasmania HREC. Data will be routinely reported back to participating sites illustrating their performance against measures of agreed best practice. It is through this feedback system that the registry will support changes to quality of care and improved patient outcomes.

To describe the paper-based and electronic formats of resident admission forms used in several aged care facilities in Australia and to compare the extent to which resident admission information was documented in paper-based and the electronic health records.Retrospective auditing and comparison of the documentation quality of paper-based and electronic resident admission forms were conducted. A checklist of admission data was qualitatively derived from different formats of the admission forms collected. Three measures were used to assess the quality of documentation of the admission forms, including completeness rate, comprehensiveness rate and frequency of documented data element. The associations between the number of items and their completeness and comprehensiveness rates were estimated at a general level and at each information category level.Various paper-based and electronic formats of admission forms were collected, reflecting varying practice among the participant facilities. The overall completeness and comprehensiveness rates of the admission forms were poor, but were higher in the electronic health records than in the paper-based records (60% versus 56% and 40% versus 29% respectively, p0.01). There were differences in the overall completeness and comprehensiveness rates between the different formats of admission forms (p0.01). At each information category level, varying degrees of difference in the completeness and comprehensiveness rates were found between different form formats and between the paper-based and the electronic records. A negative association between the completeness rate and the number of items in a form was found at each information category level (p0.01), i.e., more data items designed in a form, the less likely that the items would be completely filled. However, the associations between the comprehensiveness rates and the number of items were highly positive at both overall and individual information category levels (p0.01), suggesting more items designed in a form, more information would be captured.Better quality of documentation in resident admission forms was identified in the electronic documentation systems than in previous paper-based systems, but still needs to be further improved in practice. The quality of documentation of resident admission data should be further analysed in relation to its specific content.

Intakes of dietary fibre in Australia are lower than recommended. An understanding of food choices associated with fibre intake can help to inform locally relevant dietary interventions that aim to increase its consumption. This study aimed to profile the relationship between dietary choices and fibre intake of Australians. Using Day 1 data from the 2011&ndash, 2012 National Nutrition and Physical Activity Survey (n = 12,153, &ge, 2 years), dietary fibre intake was classified by quartiles for children (2&ndash, 18 years) and adults (&ge, 19 years). Intakes of the Australian Dietary Guidelines (ADG) food groups were calculated, as well as the major, sub-major, and minor food groups from the Australian Food Composition Database. Each of these food groups provide a progressively greater level of detail. Associations with ADG food groups and major food groups were determined, and the leading sub-major and minor food group sources of fibre for low (Quartile 1) and high (Quartile 4) fibre consumers were profiled. Energy-adjusted intakes of wholegrain and/or high fibre but not refined grain (cereal) foods, vegetables, and fruit were positively associated, and discretionary foods negatively associated, with quartile of fibre intake (p &lt, 0.001). The top three sub-major food group sources of fibre were regular breads, cereal mixed dishes, and ready-to-eat breakfast cereals in high fibre consumers and regular breads, cereal mixed dishes, and potatoes in low fibre consumers. White breads was the leading minor food group contributor in low fibre consumers, and apples and lower sugar wheat based breakfast cereal were the leading fibre contributors in high fibre consumers in children and adults, respectively. Higher intakes of wholegrain, fruits, and vegetables, and a lower discretionary intake were associated with higher fibre intake. Encouraging these foods as part of any public health intervention is likely to be effective for increasing dietary fibre intakes.

This is the first in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE). The SHARE Program is an investigation of concepts, opportunities, methods and implications for evidence-based investment and disinvestment in health technologies and clinical practices in a local healthcare setting. The papers in this series are targeted at clinicians, managers, policy makers, health service researchers and implementation scientists working in this context. This paper presents an overview of the organisation-wide, systematic, integrated, evidence-based approach taken by one Australian healthcare network and provides an introduction and guide to the suite of papers reporting the experiences and outcomes.

Background. Answering clinical questions arising from patient care can improve that care and offers an opportunity for adult learning. It is also a vital component in practising evidence-based medicine. GPs' sources of in-consultation information can be human or non-human (either hard copy or electronic). Objectives. To establish the prevalence and associations of GP trainees' in-consultation information-seeking, and to establish the prevalence of use of different sources of information (human, hard copy and electronic) and the associations of choosing particular sources. Methods. A cross-sectional analysis of data (2010-13) from an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was whether the trainee sought in-consultation information for a problem/diagnosis. Secondary outcomes were whether information-seeking was from a human (GP, other specialist or other health professional) or from a non-human source (electronic or hard copy), and whether a non-human source was electronic or hard copy. Results. Six hundred forty-five trainees (response rate 94.3%) contributed data for 84 723 consultations including 131 583 problems/diagnoses. In-consultation information was sought for 15.4% (95% confidence interval = 15.3-15.6) of problems/diagnoses. Sources were: GP in 6.9% of problems/diagnoses, other specialists 0.9%, other health professionals 0.6%, electronic sources 6.5% and hard-copy sources 1.5%. Associations of information-seeking included younger patient age, trainee full-time status and earlier training stage, longer consultation duration, referring the patient, organizing follow-up and generating learning goals. Associations of choosing human information sources (over non-human sources) were similar, but also included the trainee's training organization. Associations of electronic rather than hard-copy information-seeking included the trainee being younger, the training organization and information-seeking for management rather than diagnosis. Conclusion. Trainee information-seeking is mainly from GP colleagues and electronic sources. Human information-sources are preferentially sought for more complex problems, even by these early-career GPs who have trained in the 'internet era'.

Background Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy. Aim This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach. Findings Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care. Conclusion Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.

Summary The radiologist is likely to be the first medical practitioner on the scene for contrast reactions, anaphylaxis and other common medical emergencies that occur in radiology departments and stand-alone practices. Until 2007, the Royal Australian and New Zealand College of Radiologists (RANZCR) did not provide resuscitation training as a CPD service for fellows, and the need for such a service has not been gauged. In 2007, the authors ran the first RANZCR large-group resuscitation refresher training workshop at the Melbourne 2007 annual scientific meeting. The workshop maximized audience participation and knowledge transfer in a constrained time, disseminated guidelines, and collected feedback on the need for further resuscitation training for radiologists. Of the 100 feedback forms, 82 were returned. All the 82 responses wanted the workshop repeated at future annual scientific meetings, and 71 wanted RANZCR to provide hands-on refresher training. Sixty-six responders indicated when they had their most recent resuscitation training: six in the past 12 months, 25 in the past 3 years and 35 longer than 3 years. Sixty-nine responded on availability of resuscitation training at their workplace: 33 indicated ‘Yes’ and 36 ‘No’. There is a definite need to provide resuscitation training for radiologists in Australia. At the end of this article, we reproduce the currently applicable guidelines as a service to our readers.

The Australian health care system is responsible for delivering health services to an increasingly diverse health population. Nurses are in a position to positively influence health-related outcomes by actively addressing the differences individuals bring to their health care experiences. By focusing diversity on health inequities, nurses can play an important role in identifying those at risk of poorer health. This paper discusses diversity in the health population through health inequities and proposes directions for nursing practice. These suggested directions include application of a definition of diversity that include health determinants; targeting specific groups with programmes and services designed to reduce health inequalities; engaging in political action to promote effective policy development; preparing nurses at an undergraduate and graduate level to build capacity for addressing diversity and health inequities; and identifying effective interventions through research studies that address inequities in the health population.

Título, resumen, palabras clave en español e ingles Resumen basado en el de la publicación Se revisan los temas relacionados con la cantidad de la iluminación; las propiedades espectrales específicas de iluminación; y las propiedades de reflectancia de la página que se está leyendo y se comparan los niveles de alfabetización y aritmética en los estudiantes del s. XXI con las tendencias de lectura a largo plazo, todo ello con un enfoque específico de Australia. Se examina la hipótesis de que los cambios relativamente recientes a las condiciones de lectura en las escuelas de Primaria han impactado en un subgrupo significativo de estudiantes con sensibilidades visuales que pueden causar dificultades de lectura. En particular, el papel latente que el déficit de procesamiento visual común denominado Meares-Irlen Syndrome (MIS), también conocido como Visual Stress (VS), puede jugar un papel fundamental en el rendimiento de los estudiantes, examinando la posibilidad de que el aumento de la iluminación fluorescente y materiales de lectura más brillantes pueden ser perjudiciales para el aprendizaje de los estudiantes en general. ESP

Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41–186.9) and route (OR 8.65, 95%CI: 3.46–21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77–1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20–4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.

The ability to perform bedside thoracic ultrasound is increasingly recognized as an essential skill for thoracic clinicians, extending the clinical examination and aiding diagnostic and therapeutic procedures. Thoracic ultrasound reduces complications and increases success rates when used prior to thoracentesis or intercostal chest tube insertion. It is increasingly difficult to defend performing these procedures without real or near-real time image guidance. To assist thoracic physicians and others achieve and demonstrate thoracic ultrasound competence, the Interventional Pulmonology Special Interest Group (IP-SIG) of the Thoracic Society of Australia and New Zealand (TSANZ) has developed a new pathway with four components: (i) completion of an approved thoracic ultrasound theory and hands-on teaching course. (ii) A log of at least 40 relevant scans. (iii) Two formative assessments (following 5-10 scans and again after 20 scans) using the Ultrasound-Guided Thoracentesis Skills and Tasks Assessment Tool (UG-STAT). (iv) A barrier assessment (UG-STAT, pass score of 90%) by an accredited assessor not directly involved in the candidate's training. Upon completion of these requirements a candidate may apply to the TSANZ for recognition of competence. This pathway is intended to provide a regional standard for thoracic ultrasound training.

Fibre-optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists.

Analysis of Australian nursing research output is becoming more important as academic institutions move into implementing quality programs of research output. Notable in determining research quality is the publication of research papers in journals with a high ranking within the Institute for Scientific Information (ISI) or Excellence in Research for Australia (ERA). This paper reports an analysis of Australian nurse researcher output in journals highly ranked by the ISI and ERA. Research abstracts were analysed for topic, sources of data, location of research and methodological paradigm. A total of 530 articles from five Australian and from five USA and UK journals were analysed. There was an increase in output from the period of prior analyses in 2000. Practice issues are the most common topic followed closely by nurse education. While most studies used nurses as sources of data there were more studies in which consumers of nursing care were the point of inquiry. Both qualitative and quantitative methods were utilised. Given the importance of rationalising nursing practice and adding new knowledge to evidence based care, it is imperative for the nursing profession to disseminate research findings. Failure to do this may result in poor return in investment outcomes for the future of nursing in Australia and internationally.