710 results
Search Results
2. Leveraging existing data to improve antimicrobial resistance-related mortality estimates for Australia.
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Wozniak, Teresa M., Nguyen, Anthony, Good, Norm, and Coombs, Geoffrey W.
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MORTALITY prevention , *MORTALITY , *RISK assessment , *DRUG resistance in microorganisms , *GLOBAL burden of disease ,MORTALITY risk factors - Abstract
Antimicrobial resistance (AMR) is a global pandemic, however, estimating its burden is a complex process. As a result, many countries rely on global estimates to infer burden within their own setting. With a growing number of recent publications quantifying AMR burden in Australia, and an expansion of surveillance programs, enumerating AMR mortality for Australia is feasible. We aimed to leverage existing published data to assess methodological factors contributing to the considerable variation in AMR-related mortality and provide two reliable estimates of AMR mortality in Australia. This is a necessary step towards generating meaningful measures of AMR burden in Australia. What is known about the topic? Antimicrobial resistance is a significant global health threat, but estimating the burden of disease is complicated by data challenges. What does this paper add? This paper highlights progress in estimating the number of people dying from antimicrobial resistance in Australia and highlights the importance of rigorous antimicrobial resistance mortality estimates in Australia to assess burden of disease. What are the implications for practitioners? Practitioners should use only rigorous estimates of burden of disease to inform actions on reducing the threat of antimicrobial resistance. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Application of the Australian Bureau of Statistics Socio-Economic Indexes for Areas in cardiovascular disease research: a scoping review identifying implications for research.
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Beks, Hannah, Walsh, Sandra M., Wood, Sarah, Clayden, Suzanne, Alston, Laura, Coffee, Neil T., and Versace, Vincent L.
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MEDICAL information storage & retrieval systems , *CARDIOVASCULAR diseases , *CINAHL database , *SYSTEMATIC reviews , *MEDLINE , *MEDICAL research , *LITERATURE reviews , *MEDICAL records , *ACQUISITION of data , *QUALITY assurance , *SOCIAL classes , *PSYCHOLOGY information storage & retrieval systems - Abstract
Objective: To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods: The Joanna Briggs Institute's scoping review methodology was used. Results: The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions: The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research. What is known about the topic? A socio-economic status (SES) gradient is well established for cardiovascular disease (CVD). Research has generally applied two approaches to classifying SES: at an individual level using income, education or occupation data, and at an area level using a range of existing socio-economic information, including the Australian Bureau of Statistics (ABS) Socio-Economic Indexes for Areas (SEIFA). What does this paper add? This review examined how SEIFA has been applied to measure SES in Australian peer-reviewed CVD research and to identify any variations in research practice. What are the implications for practitioners? It is recommended that researchers provide a clear explanation in the methods section of research papers as to which SEIFA version and index was applied, how it was applied, at what spatial unit, and whether the spatial unit was an ABS or non-ABS unit. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Common leaf spot of lucerne and the dawn of mycology and plant pathology in Australia.
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Ryley, Malcolm J.
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LEAF spots , *PLANT diseases , *MYCOLOGY , *FUNGI classification , *AUSTRALIANS , *MYCOSPHAERELLA , *SUBURBS - Abstract
As the number of livestock increased in the years following English colonisation of Australia in 1788, the need for nutritious fodder, including lucerne (Medicago sativa), grew. One of the first diseases found on lucerne was a leaf spot which was collected in 1879 by George Bancroft, a physician and naturalist, in a suburb of Brisbane. The Queensland Government Botanist Frederick Manson Bailey sent a specimen to the prominent English mycologists Miles Joseph Berkeley and Christopher Edmund Broome who in 1883 formally described and named the fungus Sphaerella destructiva. That fungus is now known as Pseudopeziza medicaginis , the causal agent of common leaf spot of lucerne. It was one of over 300 fungi that were included in a 1880 paper co-written by the Reverend Julian Tenison-Woods and Frederick Bailey. At that time almost all of these fungi which had been collected in Australia were identified by overseas mycologists, particularly Berkeley and Broome. It can be argued that their 1880 paper was the first significant one published in Australia which focussed on fungi. Just a decade or so later Australian scientists, in particular Daniel McAlpine, were describing new fungal taxa on their own. Among the fungi recorded in a paper published in the 1880 Proceedings of the Linnaean Society of New South Wales was Sphaerella destructiva , now Pseudopeziza medicaginis , the cause of common leaf spot of lucerne. The paper, co-authored by the naturalist Reverend Julian Tenison-Woods and the Queensland Government Botanist Frederick Manson Bailey was the first known comprehensive list of Australian fungi published by Australian residents. It is a milestone in the evolution of mycology and plant pathology studies in Australia. Photograph by H. H. Baily. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?
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Hawley, Glenda, Hepworth, Julie, Jackson, Claire, and Wilkinson, Shelley A.
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CONTENT analysis , *FOCUS groups , *INTEGRATED health care delivery , *INTERVIEWING , *MATERNAL health services , *MEDICAL records , *QUALITATIVE research , *ELECTRONIC health records - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2017
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6. A pilot model of care to achieve next-day discharge in patients undergoing hip and knee arthroplasty in an Australian public hospital setting.
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Delahunt, Marisa, McGaw, Rebekah, and Hardidge, Andrew
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PUBLIC hospitals , *PATIENT compliance , *MEDICAL protocols , *HUMAN services programs , *PILOT projects , *DISCHARGE planning , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *ENHANCED recovery after surgery protocol , *LONGITUDINAL method , *TOTAL knee replacement , *CONVALESCENCE , *LENGTH of stay in hospitals , *QUALITY assurance , *MEDICAL screening , *DATA analysis software , *PERIOPERATIVE care , *PATIENTS' attitudes - Abstract
Objectives: Internationally, hip or knee arthroplasty (TJA) with a 1-day hospital length of stay (LOS) is common and demonstrates improved patient and health service outcomes. This study aimed to develop and pilot an enhanced recovery program (ERP) for patients undergoing TJA to achieve a next-day discharge in an Australian public hospital setting. Methods: A project lead and six perioperative clinical craft group leads developed an ERP protocol based on enhanced recovery after surgery (ERAS) principles. Strict patient eligibility criteria were developed. Quality improvement methodology was used to implement the ERP. A patient navigator was put in place as a single contact point for patients. Results: A total of 825 patients were screened for the ERP and 47 patients completed the protocol. The mean ± standard deviation (s.d.) of the LOS was 34.7 (± 7.2) h with 41 patients (87%) achieving next-day discharge, the remaining six (13%) discharged on Day 2. Compliance with ERAS was high (96%) with mobilisation within 12 h occurring on 87% of occasions. There were no adverse events. Patient experience was positive. Conclusion: Next-day discharge was achieved with a selected cohort of patients with no adverse events and positive patient experience, using a multidisciplinary approach and an improvement framework. Broadening inclusion criteria will make ERP available to more patients. What is known about the topic? Next-day discharge following hip or knee arthroplasty in Australian public hospital settings is uncommon and little has been published reflecting enhanced recovery principles in this local context. What does this paper add? This paper describes the development and piloting of an enhanced recovery program using a novel approach to achieve next-day discharge following hip and knee replacement. What are the implications for practitioners? Other health services may leverage this approach to design and implement an enhanced recovery program to reduce hospital length of stay and improve patient and health service outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Private health insurance incentives and passive adverse selection: is Lifetime Health Cover responsible for the excess ageing of Australia's hospital cover risk pool?
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Ryan, Jonathon Bruce
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INSURANCE , *HEALTH insurance reimbursement , *VALUE-based healthcare , *HEALTH policy , *PRIVATE sector , *HOSPITALS , *AGE distribution , *DESCRIPTIVE statistics , *AGING , *RESEARCH methodology , *MEDICAL care costs - Abstract
Objective: Lifetime Health Cover (LHC) was introduced in mid-2000 to increase participation in private health insurance that includes hospital cover (PHI-HC) and improve the risk profile of PHI-HC participants. It initially achieved both objectives, but since 2001 the PHI-HC population has aged faster than the general population. The aim of this study was to determine if the excess ageing of the PHI-HC risk pool has been due to passive age-based adverse selection, an inherent risk of LHC. This study has potential implications for the retention of LHC. Methods: A descriptive population-level analysis of publicly available administrative datasets was performed. Data relating to PHI-HC were obtained from the Australian Prudential Regulatory Authority. National population data were obtained from the Australian Bureau of Statistics. Trends in demography, PHI-HC participation rates and LHC loading payments were analysed. Results: By 2021, age-based adverse selection had returned to the pre-LHC level. Based on the available data, this was due to passive age-based adverse selection not active age-based adverse selection. Specifically, it reflected the combination of an avoidable unintended consequence of the introduction of LHC (the over-representation, in 2001, of individuals aged 45–59) and one of LHC's intended effects (incentivisation of insured individuals to retain PHI-HC). Conclusions: This study supports the retention of LHC. Nonetheless, it highlights the risk of passive age-based adverse selection created by incentivising insured individuals to retain PHI-HC in the presence of distortions in the age distribution of the PHI-HC risk pool. Early targeted interventions are required when such distortions arise. What is known about the topic? Since the introduction of Lifetime Health Cover (LHC) in mid-2000, the participation rate for private health insurance that includes hospital cover (PHI-HC) has remained relatively stable, but the PHI-HC population has aged faster than the general population. What does this paper add? This paper makes a novel distinction between 'active' and 'passive' age-based adverse selection to explain LHC's role in the excess ageing of the PHI-HC risk pool. What are the implications for practitioners? Governments need to be vigilant for the emergence of distortions in the age distribution of the PHI-HC risk pool and respond with targeted interventions to normalise the age distribution, or risk problematic passive age-based adverse selection. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia.
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Walsan, Ramya, Mitchell, Rebecca J., Braithwaite, Jeffrey, Westbrook, Johanna, Hibbert, Peter, Mumford, Virginia, and Harrison, Reema
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HEALTH services accessibility , *SURGICAL robots , *USER charges , *HUMAN services programs , *RESEARCH funding , *RADICAL prostatectomy , *HEALTH policy , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *STATE governments , *LONGITUDINAL method , *MEDICAL records , *ACQUISITION of data , *HEALTH equity , *CONFIDENCE intervals , *MEDICAL care costs , *GOVERNMENT regulation , *OPERATING rooms , *ECONOMICS - Abstract
Objectives: Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods: A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results: Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions: Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs. What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Poor policy and inadequate regulation of medical technology is driving low-value care in Australia's private health system.
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David, Rachel
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MEDICAL technology , *GOVERNMENT policy , *PATIENT safety , *MEDICAL care , *COST analysis , *VALUE-based healthcare , *PRIVATE sector , *QUALITY control , *CONFLICT of interests , *QUALITY assurance , *NEURAL stimulation , *RULES , *MEDICAL care costs , *EQUIPMENT & supplies , *SPINAL cord - Abstract
Millions of Australians use the private health system every year. They should receive safe, high-quality, value-based care. However, poor policy and inadequate regulation of medical technology is driving low-value care at great expense to consumers and the broader health system. Key drivers include the Prescribed List of Medical Devices and Human Tissue, gaps in quality and safety controls for devices being used, and marketing and conflicts of interest. All of these should be addressed to reduce low-value care in Australia's private health system, so consumers are protected from harm and limited health budgets are used effectively. What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia's private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Taking a value based commissioning approach to non-clinical and clinical support services.
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Kinsman, Trinette, Reid, Samantha, and Arnott, Hayley
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DIGITAL technology , *PUBLIC hospitals , *DIAGNOSTIC imaging , *MEDICAL care , *VALUE-based healthcare , *PATIENT care , *FOOD service , *EVALUATION of medical care , *ORTHOPEDICS , *SOCIAL support , *WOUND care , *PATIENT participation - Abstract
Value based healthcare beyond the clinical domain is the focus of this case study. We share NSW Health's experiences in achieving value through a focus on outcomes in non-clinical and clinical support services using examples that demonstrate key aspects across the commissioning cycle. These include: the importance of stakeholder engagement in the planning phase to later success; the critical role of non-clinical services in patient experience; the opportunity to facilitate value by introducing new approaches in business areas such as procurement; and the role of clinical supports such as digital enablement to facilitate outcome-focussed clinical models. Applying a value lens to non-clinical services can increase the potential benefits to patients, clinicians and the system. What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]
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- 2024
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11. From the desert it came: evolution of the Australian paper daisy genus Leucochrysum (Asteraceae, Gnaphalieae).
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Schmidt-Lebuhn, Alexander N. and Smith, Kiarrah J.
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ASTERACEAE , *PLANTS , *DESERT plants , *PLANT evolution , *PLANT phylogeny , *PHYTOGEOGRAPHY - Abstract
Present patterns of diversity in the Australian flora have been shaped by increasing seasonality since the Eocene, and by pronounced aridification in the past 3 million years. Arid-zone plants are commonly hypothesised to be the products of radiations of ancestrally temperate or coastal lineages, as in the case of the everlasting paper daisy tribe Gnaphalieae (Asteraceae). However, these inferences are often based on higher-level phylogenies, whereas evolutionary processes in the Australian Gnaphalieae have rarely been studied at the species level. Here, we reconstructed the phylogeny and biogeographic history of the small, but ecologically diverse, paper daisy genus Leucochrysum, to examine recent habitat shifts and character changes, at the same time exploring the feasibility of using amplicon sequencing of low-copy nuclear gene regions to resolve phylogenetic relationships in Australian Gnaphalieae. On the balance of evidence, outgroup comparison and ancestral-area reconstruction support an ancestral range in the arid zone with subsequent diversification towards the south-east, demonstrating a complex evolutionary history with a re-colonisation of temperate areas. Low amplification success rates suggest that methods other than amplicon sequencing of currently available primers will be more promising for molecular phylogenetic work at a larger scale. [ABSTRACT FROM AUTHOR]
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- 2016
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12. Mental health reform: where are we in 2024?
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Hickie, Ian and Rosenberg, Sebastian
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POLICY sciences , *MENTAL health , *HEALTH policy , *GOVERNMENT agencies , *HEALTH care reform , *ELECTIONS , *FEDERAL government , *VOTING , *BUDGET , *PRACTICAL politics - Abstract
What is known about the topic? Little is known about the state of mental health reform in Australia. This article describes the struggle to develop the systems of accountability necessary to assess national progress. What does this paper add? We provide some historical context regarding mental health reform and consider recent efforts in particular, before then describing current key opportunities. What are the implications for practitioners? Many people working in mental health are struggling to deliver quality services to Australians. This paper considers the broad policy issues which have led to this situation. This is useful for practitioners who can then better respond and participate in processes of systemic reform. Opportunities to engage now in key policy formulation are identified in the article. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Australian surgeon attitudes and experiences towards completing a higher degree by research.
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Sena Board, Mariana, McBride, Kate E., Solomon, Michael J., Aitken, Sarah J., Rickard, Matthew J. F. X., Collins, Jean-Mah, and Steffens, Daniel
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CROSS-sectional method , *PUBLIC hospitals , *PILOT projects , *SURGEONS , *JUDGMENT sampling , *DESCRIPTIVE statistics , *WAGES , *SURVEYS , *HOSPITAL medical staff , *MOTIVATION (Psychology) , *ATTITUDES of medical personnel , *MEDICAL research , *POSTDOCTORAL programs , *ACADEMIC achievement , *PUBLISHING , *DATA analysis software , *COMPARATIVE studies , *PSYCHOSOCIAL factors , *VOCATIONAL guidance , *TIME - Abstract
Objective: In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods: A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P < 0.05 considered significant. Results: Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n = 18) and consultants (N = 25; P = 0.968). A HDR was associated with more publications (P < 0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P = 0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions: These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research. What is known about the topic? The value of research is well-recognised as a crucial part of the surgical training pathway. Despite this, minimal contemporary evidence exists which explores the impact of higher degrees by research (HDR) on academic career pathways in the Australian context. What does this paper add? Contemporary evidence was obtained to understand why Australian surgeons undertake HDRs and how their completion impacts the surgical career pathway. What are the implications for practitioners? By understanding the role of HDRs in the surgical landscape, practitioners can ensure beneficial support for future academic surgeons is in place. [ABSTRACT FROM AUTHOR]
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- 2024
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14. A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic.
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Cheung, Winston, Naganathan, Vasi, Myburgh, John, Saxena, Manoj K., Fiona, Blyth, Seppelt, Ian, Parr, Michael, Hooker, Claire, Kerridge, Ian, Nguyen, Nhi, Kelly, Sean, Skowronski, George, Hammond, Naomi, Attokaran, Antony, Chalmers, Debbie, Gandhi, Kalpesh, Kol, Mark, McGuinness, Shay, Nair, Priya, and Nayyar, Vineet
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AT-risk people , *STATISTICAL sampling , *HEALTH policy , *QUESTIONNAIRES , *PUBLIC opinion , *DESCRIPTIVE statistics , *CHI-squared test , *SURVEYS , *CHRONIC diseases , *INTENSIVE care units , *FRONTLINE personnel , *DISASTERS , *SURVIVAL analysis (Biometry) , *PUBLIC health , *CONFIDENCE intervals , *DATA analysis software , *COVID-19 pandemic , *COMORBIDITY , *MEDICAL triage , *CRITICAL care medicine - Abstract
Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]
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- 2024
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15. Maintaining the health of people with and without COVID-19 during isolation: a case study.
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Scales, Caoimhe, Tsai, Ling-Ling, Whitney, Sarah, Shaw, Miranda, Vrklevski, Lil, Carey, Sharon, Hutchings, Owen, Spencer, Lissa, and Alison, Jennifer
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DIETETICS , *HEALTH status indicators , *PATIENTS , *T-test (Statistics) , *EXERCISE , *HOSPITAL admission & discharge , *PILOT projects , *STATISTICAL sampling , *FATIGUE (Physiology) , *ANXIETY , *PSYCHOLOGICAL adaptation , *QUARANTINE , *LONGITUDINAL method , *SURVEYS , *PRE-tests & post-tests , *HEALTH promotion , *HOTELS , *CASE studies , *COMPARATIVE studies , *DATA analysis software , *COVID-19 , *NUTRITION , *PATIENTS' attitudes , *MENTAL depression , *NUTRITION education - Abstract
This case study evaluated the effects of a health package (HP) of a light intensity individualised exercise program and advice on anxiety management and nutrition, on the physical and mental health of people with or without COVID-19, who were quarantined in hotels used as Special Health Accommodation and admitted to the Royal Prince Alfred Virtual Hospital, Sydney during the COVID-19 pandemic. After initial screening and consenting, participants completed three surveys: Depression, Anxiety, Stress Scale; Brief Fatigue Inventory; and the European Quality of Life 5-Dimensions 5-Levels, and were provided with the HP for the duration of their quarantine. The three surveys and a participant reported experience measure were completed prior to discharge. The HP for people in quarantine demonstrated stability of health outcomes and reduction in fatigue. Most participants reported that the HP helped them cope with isolation. Provision of a HP during quarantine could be useful to support physical and mental health. What is known about the topic? Quarantine during the COVID-19 pandemic could negatively impact physical and mental health. What does this paper add? A health package of light intensity exercise, advice on anxiety management and nutritional information demonstrated maintenance of physical and mental health and reduced fatigue in people with and without mild COVID-19 in hotel quarantine. What are the implications for practitioners? Practitioners should consider providing a health package of exercise, anxiety management and nutritional information to help people in quarantine to cope with the physical and mental isolation. Adequate staffing is required to enable implementation. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Experiences of occupational therapy students undertaking an Aboriginal and Torres Strait Islander health module: embedding cultural responsiveness in professional curricula.
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Mackenzie, Lynette, Gwynn, Josephine, and Gilroy, John
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OCCUPATIONAL therapy education , *ACCREDITATION , *HEALTH status indicators , *QUALITATIVE research , *CULTURE , *INTERVIEWING , *DESCRIPTIVE statistics , *CONFIDENCE , *EMOTIONS , *THEMATIC analysis , *RACISM , *OCCUPATIONAL therapy students , *RESEARCH methodology , *LEARNING strategies , *STUDENT attitudes , *SELF-consciousness (Awareness) , *INDIGENOUS Australians , *PROFESSIONAL competence - Abstract
Objective: Along with other Australian health professionals, occupational therapy students need to understand Aboriginal and Torres Strait Islander culture and health issues to develop their capacity to work effectively with this community and meet accreditation standards. The study aimed to explore the learning experiences of occupational therapy students during a module focused on Aboriginal and Torres Strait Islander peoples' health issues and approaches. Methods: A qualitative descriptive method was used. Individual interviews were audiotaped, transcribed and analysed thematically following the module. Participants were asked about their prior experience with Aboriginal and Torres Strait Islander peoples, feelings about undertaking the module, difficulties and highlights of the module, and how the module contributed to their learning. Results: In all, 18 students participated in interviews. Interview themes were (1) student context of learning about Aboriginal and Torres Strait Islander peoples' heath and culture, (2) experiencing the module with others and (3) student learning gains following the module. Conclusion: Students developed in their self-awareness and understanding of Aboriginal and Torres Strait Islander peoples' issues of relevance to occupational therapy. Further research is needed to evaluate educational activities with occupational therapy and other health professional students across Australia, and ongoing culturally responsiveness training for health professionals (post-registration). What is known about the topic? Health professional students need to develop their knowledge and skills in working with Aboriginal and Torres Strait Islander peoples to be culturally responsive and meet their health needs effectively. What does this paper add? This study is the first to describe the responses of occupational therapy students to a module on Aboriginal and Torres Strait Islander health and wellbeing. Students were challenged about any biases that could affect their capacity to be culturally responsive. What are the implications for practitioners? Both practitioners and students need to be culturally responsive to provide culturally safe services to Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes – an Australian multi-institutional radiation oncology survey.
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Magon, Honor, Smith, Justin, Besson, Jacqueline, Hau, Eric, Taylor, Suzanne, Ruben, Jeremy, Jones, Diana, Mabb, Kira, Feldman, Jamie, Gholam Rezaei, Leily, and Lee, Yoo Young
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WORK , *OCCUPATIONAL adaptation , *PSYCHOLOGICAL burnout , *WORK-life balance , *PATIENT care , *DESCRIPTIVE statistics , *WORKING hours , *TELEMEDICINE , *JOB satisfaction , *MEDICAL radiology , *ATTITUDES of medical personnel , *RESEARCH , *JOB stress , *ONCOLOGISTS , *MEDICAL needs assessment , *DATA analysis software , *COVID-19 pandemic , *EMERGENCY management , *WELL-being , *EXPERIENTIAL learning - Abstract
Objective: To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results: Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion: These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians. What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements. [ABSTRACT FROM AUTHOR]
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- 2024
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18. New record of the giant freshwater whipray from the Lesser Sunda region, Indonesia.
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Oktaviyani, Selvia and Fahmi
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FRESH water , *STRAITS , *SPECIES , *GILLS , *PHOTOGRAPHS - Abstract
Context: The taxonomic nomenclature of species can change with the discovery of a distinct species. Such nomenclatural changes occurred for the giant freshwater whipray with the discovery of a similar species in the Indo-Australian region in 2008. Aims: This paper reports a finding of the giant freshwater whipray in the Lesser Sunda region as the first confirmed record from the area. Methods: The specimen was identified as the giant freshwater whipray based on its morphological features. Morphometric measurements were taken directly in the field and also based on the scale provided in the photographs. Key results: The female specimen was recorded from the Alas Strait, West Nusa Tenggara Province, Indonesia on 20 July 2020. It was identified as Urogymnus cf. dalyensis due to its similar morphological characteristics with U. dalyensis from northern Australia but it had a shorter preoral snout and greater distance between the left and right fifth gill slits. Conclusions: The occurrence of this species in the Lesser Sunda region may confuse U. dalyensis with the close relative from south-east Asia, U. polylepis. Implications: This record may provide a link between the two species, either as a population structure of the same species or showing a clear separation between the two as distinct species. This study reports the first confirmed occurrence of a giant freshwater whipray in the Lesser Sunda region of Indonesia. The finding may confuse the species validity between Urogymnus dalyensis and its south-east Asian relative, U. polylepis. This observation suggests a possible population structure or the revelation of distinct species within the giant freshwater whipray complex, necessitating further investigations. [ABSTRACT FROM AUTHOR]
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- 2024
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19. The discovery of tomato spotted wilt virus.
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Geering, Andrew D. W.
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TOMATO spotted wilt virus disease , *ETIOLOGY of diseases , *AGRICULTURAL research , *INDUSTRIAL research , *ZIKA Virus Epidemic, 2015-2016 , *WORKS councils - Abstract
The discovery of tomato spotted wilt virus (TSWV) was an important finding in Australian science, involving a self-educated field naturalist and a small team of plant pathologists who had to work in relative academic isolation and with inadequate glasshouse facilities. After its discovery in Melbourne in 1915, TSWV rapidly spread throughout Australia and by 1929, it posed an existential threat to the tomato industry. To address this problem, a joint project between the Waite Agricultural Research Institute and the Council for Scientific and Industrial Research was initiated in 1926. This collaboration, led by University of Adelaide plant pathologist Geoffrey Samuel, was initially turbulent but ultimately highly productive. Within an eight-year period, significant advances were made in understanding the aetiology of the disease, particularly by establishing that it was caused by a thrips-transmitted virus. Aspects of the epidemiology and control of the virus were also elucidated such as investigating alternative hosts of the virus. This research was made possible through substantial improvements in mechanical inoculation techniques. Tomato spotted wilt virus (TSWV) is one of the most economically important viruses in the world. Before it became a global problem, it devastated tomato crops in Australia. This paper describes how TSWV was identified and biologically characterised by Australian scientists at a time when few techniques existed to detect the virus. It is a remarkable story of human endeavour by a small team of people working in academic isolation. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.
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Elliott, Rohan A., Cik Yin Lee, and Hussainy, Safeera Y.
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DRUG dosage , *DRUG delivery systems , *ELDER care , *AUDITING , *PHARMACY databases , *MEDICAL protocols , *MEDICATION errors , *PROBABILITY theory , *RESEARCH funding , *THERAPEUTICS , *RESIDENTIAL care , *CROSS-sectional method , *RETROSPECTIVE studies , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Objectives: The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods: A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results: Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Fortyseven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion: Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. [ABSTRACT FROM AUTHOR]
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- 2016
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21. Identification and nutritional management of malnutrition and frailty in the community: the process used to develop an Australian and New Zealand guide.
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Rattray, Megan and Roberts, Shelley
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MALNUTRITION diagnosis , *MALNUTRITION treatment , *CONSENSUS (Social sciences) , *PATIENT aftercare , *OCCUPATIONAL roles , *FRAIL elderly , *NUTRITIONAL assessment , *TRANSITIONAL care , *MEDICAL personnel , *MEDICAL screening , *GERIATRIC assessment , *MEDICAL protocols , *DIET therapy , *ATTITUDES toward illness , *DOCUMENTATION , *TREATMENT effectiveness , *INDEPENDENT living , *ACCESS to information , *HEALTH care teams , *EXPERTISE , *MEDICAL referrals , *MALNUTRITION , *PHYSICIAN practice patterns , *DECISION making in clinical medicine , *DISEASE management , *DISCHARGE planning , *GOAL (Psychology) , *DISEASE risk factors , *OLD age - Abstract
Malnutrition and frailty affect up to one-third of community-dwelling older adults in Australia and New Zealand (ANZ), burdening individuals, health systems and the economy. As these conditions are often under-recognised and untreated in the community, there is an urgent need for healthcare professionals (HCPs) from all disciplines to be able to identify and manage malnutrition and frailty in this setting. This paper describes the systematic and iterative process by which a practical guide for identifying and managing malnutrition and frailty in the community, tailored to the ANZ context, was developed. The development of the guide was underpinned by the Knowledge-to-Action Framework and included the following research activities: (1) a comprehensive literature review; (2) a survey of ANZ dietitians' current practices and perceptions around malnutrition and frailty; (3) interviews with ANZ dietitians; and (4) a multidisciplinary expert panel. This resulted in the development of a guide tailored to the ANZ context that provides recommendations around how to identify and manage malnutrition and frailty in the community. It is now freely available online and can be used by all HCPs across several settings. The approach used to develop this guide might be applicable to other conditions or settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. Malnutrition and frailty are common in Australian and New Zealand communities, burdening individuals, health systems and the economy. This paper describes the process by which an evidence-informed guide for identifying and managing these conditions in the community was developed. The guide is now freely available online and can be used by all healthcare professionals across several settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. [ABSTRACT FROM AUTHOR]
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- 2024
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22. E-prescription: views and acceptance of general practitioners and pharmacists in Greater Sydney.
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Lau, Phyllis, Tran, Minh Thuan, Kim, Ricky Yong, Alrefae, Alsayed Hashem, Ryu, Sangwoo, and Teh, Jim Chyuan
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- *
MEDICAL quality control , *ATTITUDES of medical personnel , *RESEARCH methodology , *DIGITAL health , *INTERVIEWING , *QUALITATIVE research , *MEDICAL prescriptions , *THEMATIC analysis , *STAY-at-home orders , *PATIENT care , *COVID-19 pandemic , *TELEMEDICINE - Abstract
Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. Methods: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. Conclusion: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription. It is inevitable that electronic prescriptions will one day supersede paper prescriptions, but there is resistance to their implementation at the practitioner and patient levels. This paper explored GPs and pharmacists' experience and views, and found that while e-prescription improves the quality of patient care, there are several challenges to its effective use. Findings may inform the future promotion of e-prescription, particularly post-COVID-19 pandemic, and guide future research in exploring consumer perspectives. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Capacity building for mental health services: methodology and lessons learned from the Partners in Recovery initiative.
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Shelby-James, Tania, Rattray, Megan, Raymond, Garry, and Reed, Richard
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MEETINGS , *CONVALESCENCE , *RESEARCH methodology , *INTERVIEWING , *MENTORING , *ORGANIZATIONAL change , *SURVEYS , *LABOR supply , *INTERPROFESSIONAL relations , *TELECONFERENCING , *WEBINARS , *SCALE analysis (Psychology) , *DESCRIPTIVE statistics , *CONTENT analysis , *DIFFUSION of innovations , *HEALTH promotion - Abstract
Background: The Partners in Recovery (PIR) program was implemented by the Australian Government Department of Health. Its overriding aim was to improve the coordination of services for people with severe and persistent mental illness, and who have complex needs that are not being met. The PIR capacity-building project (CBP) was funded to provide capacity building activities to the nationwide network of consortia that were set up in 2013 to deliver PIR over a 3-year period. The purpose of this paper is to describe the design and findings from an evaluation of the PIR CBP. Methods: The evaluation involved collecting feedback from consenting PIR staff via an online survey and follow-up semi-structured interviews. CBP activities included: state and national meetings; a web portal; teleconferences; webinars; a support facilitator mentor program; and tailored support from the CBP team. Results: The CBP made a positive contribution to the implementation and delivery of PIR. Staff highly valued activities that employed face-to-face interaction or provided informative knowledge exchange, and were appreciative of CBP staff being responsive and adaptable to their needs. Conclusions: From this evaluation, we recommend the following: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). This information is informing the mental health workforce capacity building activities that our team is currently undertaking. Capacity-building programs are necessary for advancing new public health initiatives, yet there remains limited evidence to inform best practices for delivering these in the context of mental health. This paper describes the design and findings of a capacity-building program developed to enhance the knowledge and skills of community-based mental health providers. From this evaluation, we recommend the following to ensure effective capacity-building programs: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). [ABSTRACT FROM AUTHOR]
- Published
- 2024
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24. A biography of professor Jenny Davis: a scientist with a passion for freshwater ecology.
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Kennedy, Patricia L.
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FRESHWATER ecology , *BIOGRAPHY (Literary form) , *WATER table , *ARID regions , *FRESHWATER organisms , *SONS - Abstract
Jenny Davis was among the first small, but significant tranche of women field biologists in the Pacific Region. She was born in Tasmania and developed a fascination with freshwater systems at an early age. Despite the paucity of female role models, freshwater ecology evolved into her research career track at the University of Tasmania where she completed her Honours degree (Zoology; 1976) and PhD (Freshwater Ecology; 1981). Jenny started her first academic position as a Tutor at Murdoch University in 1985. She successfully moved through the academic hierarchy where women continue to be under-represented in the senior ranks. She recently (2021) retired from her administrative and teaching responsibilities at Charles Darwin University (CDU) and approaching 70, is currently a Professor of Freshwater Ecology at CDU. An over-arching theme of her research is to understand the factors influencing the persistence of groundwater and surface water ecosystems. She has worked on the impacts of multiple stressors on springs, wetlands and arid zone waterbodies. She serves as a compelling role model for young scientists struggling to have a satisfying work-life balance. Jenny single-parented a son while conducting field work, teaching, publishing, serving as an academic administrator and being a prolific and successful grant writer. Jenny was also an exceptional mentor to a diverse group of students and post-docs, many of whom have thriving careers in academia, government and industry across Australia. This paper is a biography of a woman who with talent and persistence successfully broke gender barriers in Australian freshwater ecology and academia. Jenny Davis was among the first small, but significant tranche of female field biologists in the Pacific Region. Jenny is one of the few women to be promoted to the academic rank of Professor in Australian sciences. Her current research involves answering two questions: (1) how much water does the environment need; and (2) how important are isolated aquatic waterbodies for the conservation of Australia's freshwater biota? This paper is a brief biography of Jenny. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Big talk, little action: the enduring narrative of primary care reform.
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Jackson AM, Claire
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HEALTH insurance reimbursement , *PRIMARY health care , *MEDICARE , *FEE for service (Medical fees) , *WAGES , *HEALTH care reform , *ENDOWMENT of research , *INTEGRATED health care delivery , *LABOR supply - Abstract
What is known about the topic ? Governments acknowledge that current health arrangements are unsustainable, and a better resourced, integrated, and connected primary care system is central to the future. What does this paper add ? This paper calls out the most significant barriers to implementing the required national reform and poses potential solutions in addressing them. What are the implications for practitioners ? Without action, we will see increased system cost, and decreased service access and quality for Australian communities. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Lessons from the 'legitimate' misuse of Medicare Benefits Schedule Item 45503.
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Ryan, Jonathon Bruce
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NATIONAL health services , *MEDICAL care use , *CORPORATE culture , *HEALTH insurance reimbursement , *MEDICARE , *HEALTH policy , *ETHICS , *ECONOMICS - Abstract
This Perspective begins with a case study that raises two important questions: who is responsible for the existence of non-compliant Medicare billing, and who is responsible for eliminating it? In the discussion that follows, I argue, first, that the problem has been created by individual clinicians and by Medicare itself (i.e. the organisational structure that administers Medicare). Second, and more importantly, I argue that the ethical obligation to eliminate the problem extends more broadly to include both the government and the medical profession. What is known about the topic? The scale of non-compliant Medicare billing is contested. What does this paper add? This Perspective frames non-compliant Medicare billing (and denial of its existence) as a ubiquitous cultural problem. What are the implications for practitioners? Strategies aimed at reducing non-compliant Medicare billing need to target the normative behaviour of societal actors as well as individual practitioners. [ABSTRACT FROM AUTHOR]
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- 2024
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27. What are the cost and resource implications of voluntary assisted dying and euthanasia?
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Hudson, Peter, Marco, David, De Abreu Lourenco, Richard, and Philip, Jennifer
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ASSISTED suicide laws , *ASSISTED suicide , *PALLIATIVE treatment , *HEALTH policy , *EUTHANASIA , *GOVERNMENT aid , *LITERATURE reviews , *MEDICAL care costs , *HEALTH care teams - Abstract
Objectives: Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating in many settings worldwide for a considerable time, the specific costs associated with VAD seem unclear. The aim of this study was therefore to outline the common resource implications associated with VAD. Methods: A rapid literature review and grey literature search were undertaken. Results: We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and a future research agenda. Conclusions: There is a lack of publicly available information related to the costs associated with implementing VAD. Given that this is a significant change in policy and many multidisciplinary practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resources can be allocated. What is known about the topic? Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating internationally for a considerable time, there have been calls for more data to understand the resources required to implement VAD. What does this paper add? We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and outline a research agenda. What are the implications for practitioners? Given that a significant number of practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resource allocation can be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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28. Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review.
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Considine, Julie, Dempster, Jenny, Wong, Nga Man Wendy, Kiprillis, Noelleen, and Boyd, Leanne
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CORPORATE culture , *MANAGEMENT styles , *EMOTION regulation , *LEADERS , *HUMAN beings , *CINAHL database , *EMOTIONAL intelligence , *LEADERSHIP , *HOSPITALS , *WORK experience (Employment) , *ORGANIZATIONAL structure , *SYSTEMATIC reviews , *MEDLINE , *LITERATURE reviews , *PSYCHOSOCIAL factors , *CRITICAL care medicine , *PSYCHOLOGY information storage & retrieval systems , *EDUCATIONAL attainment , *MANAGEMENT , *SELF-perception - Abstract
Objective: Transformational leadership benefits both patients and staff. The objective of this scoping review was to explore personal and organisational attributes that support transformational leadership in acute health care. Methods: A scoping review was undertaken using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medline Complete, PsycInfo and Emerald Insight databases. Search terms were related to transformational leadership and acute care hospitals. Results: A total of 18 studies were included: 14 reported personal attributes and 8 reported organisational attributes supporting transformational leadership. The most common personal attributes were manager educational preparation (n = 5), years of management experience (n = 4), age (n = 3) and emotional intelligence (n = 3). The most common organisational attributes reported were larger organisational size (n = 2) and culture (n = 2). Personal (manager) attributes were synthesised into the following categories: demographics, role characteristics, leadership preparation and traits. Organisational attributes were categorised as manager support, organisational characteristics and organisational processes. Conclusions: Despite the beneficial outcomes of transformational leadership for patients, staff and organisations, the personal and organisational attributes supporting transformation leadership are not well understood. What is known about the topic? Transformational leadership has clear benefits for patients, staff and organisations. What does this paper add? The personal and organisational attributes supporting transformation leadership are not well understood. What are the implications for practitioners? Transformational leadership was unrelated to gender or years of experience but was strongly associated with manager educational preparation and emotional intelligence. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Highlighting efficiency and redundancy in the Royal Australian College of General Practice standards for accreditation.
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McNaughton, David, Mara, Paul, and Jones, Michael
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ACCREDITATION , *CLINICAL medicine , *FAMILY medicine , *MEDICAL quality control , *PATIENT safety , *EMPIRICAL research , *HEALTH policy , *KEY performance indicators (Management) , *DESCRIPTIVE statistics , *DATA analysis software , *QUALITY assurance - Abstract
Objectives: Accreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020. Methods: Data encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion. Results: A total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a). Conclusion: Our results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level. What is known about the topic? Minimal empirical evaluation of the 5th edition standards for accreditation have occurred since their implementation. What does this paper add? Our findings suggest that more than half of the indicators currently do not adequately distinguish practices at the site assessment. What are the implications for practitioners? These findings may suggest that a review of individual indicators and the standards structure is required. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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30. Familiarity, confidence and preference of artificial intelligence feedback and prompts by Australian breast cancer screening readers.
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Trieu, Phuong Dung, Barron, Melissa L., Jiang, Zhengqiang, Tavakoli Taba, Seyedamir, Gandomkar, Ziba, and Lewis, Sarah J.
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BREAST tumor diagnosis , *SCALE analysis (Psychology) , *RESEARCH funding , *DATA analysis , *EARLY detection of cancer , *ARTIFICIAL intelligence , *QUESTIONNAIRES , *CONFIDENCE , *DESCRIPTIVE statistics , *CHI-squared test , *SURVEYS , *MAMMOGRAMS , *ATTITUDES of medical personnel , *CLINICAL competence , *STATISTICS , *RADIOLOGISTS , *DATA analysis software , *COMPARATIVE studies , *PSYCHOSOCIAL factors - Abstract
Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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31. Partnering with consumers and practising clinicians to establish research priorities for public hospital maternity services.
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Cole, Roni, Kearney, Lauren, Jenkinson, Bec, Kettle, Imogen, Ng, Beng, Callaway, Leonie, and Nugent, Rachael
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PUBLIC hospitals , *MEDICAL care research , *CONSENSUS (Social sciences) , *MATERNAL health services , *DELIVERY (Obstetrics) , *VAGINA , *QUESTIONNAIRES , *LGBTQ+ people , *SURVEYS , *PATIENT-centered care , *PRIORITY (Philosophy) , *CONCEPTUAL structures , *PATIENT participation , *CULTURAL pluralism , *PATIENTS' attitudes ,RESEARCH evaluation - Abstract
Objective: An innovative approach by two Queensland health services was taken to establish a shared maternity services' research agenda by partnering with consumers and clinicians. The objective was to set the top five research priorities to ensure that the future direction of maternity research was relevant to end-user and organisational needs. Methods: A modified James Lind Alliance (JLA) methodology was applied between August 2022 and February 2023 across two south-east Queensland Health Services which included five participating maternity units and involved partnership with consumers, healthcare professionals and clinician researchers. The reporting guideline for priority setting of health research (REPRISE) was followed. Results: There were 192 respondents to the initial harvesting survey, generating 461 research suggestions. These were aggregated into 122 unique questions and further summarised into a list of 44 research questions. The 157 eligible interim prioritisation survey respondents short-listed 27 questions ready for ranking at a final consensus workshop. The top five question themes were: (1) maternity care experience, engagement and outcomes of priority populations; (2) increasing spontaneous vaginal birth; (3) experiences and perceptions of woman/person-centred care; (4) best practice care during the 'fourth' trimester; and (5) antibiotic use during labour and birth. Conclusion: Applying an adapted JLA framework can successfully shape and establish a research agenda within Australian health services, through partnership with consumers and practicing clinicians. This is a transparent process that strengthens the legitimacy and credibility of research agendas, and it can form a replicable framework for other settings. What is known about the topic? Establishment of research agendas often neglects the participation of research end-users, consumers and practising clinicians, consequently limiting relevance and translation. What does this paper add? Prioritised specific maternity research questions were jointly generated by consumers and front-line clinicians to highlight areas of focus for research funding and support. What are the implications for practitioners? By partnering with consumers and practising clinicians health service research priorities can be established to optimise patient outcomes and ensure future research is both translational and relevant. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
32. Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.
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Pearson, Odette, Othman, Shwikar, Colmer, Kate, Ishaque, Sana, Mejia, Gloria, Crossing, Sarah, Jesudason, David, Wittert, Gary, Zimmet, Paul, Zoungas, Sophia, Wischer, Natalie, Morey, Kim, Giles, Jane, Jones, Sara, Brown, Alex, and Kumar, Saravana
- Subjects
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CHRONIC disease treatment , *MEDICAL information storage & retrieval systems , *RESEARCH funding , *PRIMARY health care , *HUMAN beings , *CINAHL database , *EVALUATION of medical care , *DESCRIPTIVE statistics , *PROFESSIONS , *SYSTEMATIC reviews , *MEDLINE , *LITERATURE reviews , *ONLINE information services , *DATA analysis software , *INDIGENOUS Australians - Abstract
Background: To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods: Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results: Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions: Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability. Limited studies have sought to implement and evaluate novel workforce approaches to reducing differential diabetes-related outcomes in the Aboriginal and Torres Strait Islander peoples populations. This review described the characteristics of the chronic disease management training programs and their effectiveness for Aboriginal Health Workers and Practitioners. Most included studies reported satisfaction with the training content, whereas some reported improved knowledge, confidence, and clinical and non-clinical skills of the participants. However, few studies reported knowledge transfer into clinical practice and client-related outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Identifying high-value tactical livestock decisions on a mixed enterprise farm in a variable environment.
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Young, Michael, Young, John, Kingwell, Ross S., and Vercoe, Philip E.
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AGRICULTURE , *DRY farming , *SUSTAINABLE agriculture , *SUSTAINABILITY , *ROTATIONAL grazing - Abstract
Context: Australia is renowned for its climate variation, featuring years with drought and years with floods, which result in significant production and profit variability. Accordingly, to maximise profitability, dryland farming systems need to be dynamically managed in response to unfolding weather conditions. Aims: The aim of this study is to identify and quantify optimal tactical livestock management for different weather-years. Methods: This study employed a whole-farm optimisation model to analyse a representative mixed enterprise farm located in the Great Southern region of Western Australia. Using this model, we investigated the economic significance of five key livestock management tactics. These included timing of sheep sales, pasture-area adjustments, rotational grazing, crop grazing and sheep nutrition adjustments. Key results: The results showed that, on the modelled dryland mixed-enterprise farm in the Great Southern region of Western Australia, short-term adjustments to the overall farm strategy in response to unfolding weather conditions increased expected profit by approximately 16%. Each tactic boosted profit by between A$7704 and A$53,171. However, we outline several complexities that farmers must consider when implementing tactics. Conclusions: The financial gains from short-term tactical management highlighted their importance and farmers' need to develop and apply those skills. The tactical skills promote business resilience and adaptability in the face of climate uncertainties. Implications: The study highlighted the economic value of dynamic livestock management in response to climate variations, offering farmers in the Great Southern region the means to underpin profitable and sustainable farm practices. Under Australia's renowned climate variation, it is profitable for farmer to implement short-term tactical management adjustments in response to the unfolding weather conditions. This paper has identified and quantified optimal tactical livestock management for different weather-years for a mixed-farming system in the Great Southern region of Western Australia. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia.
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Harrison, Stephanie L., Lang, Catherine, Eshetie, Tesfahun C., Crotty, Maria, Whitehead, Craig, Evans, Keith, Corlis, Megan, Wesselingh, Steve, Caughey, Gillian E., and Inacio, Maria C.
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HEALTH services accessibility , *ELDER care , *HOME care services , *PATIENTS , *RESEARCH funding , *LONG-term health care , *HOSPITAL care , *HOSPITAL admission & discharge , *HOSPITAL emergency services , *RETROSPECTIVE studies , *POPULATION geography , *DESCRIPTIVE statistics , *LONGITUDINAL method , *MEDICAL care for older people , *LENGTH of stay in hospitals , *CONFIDENCE intervals , *DATA analysis software , *RESIDENTIAL care , *DISEASE incidence - Abstract
Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]
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- 2024
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35. Designing and implementing a bundle of care for patients with early-stage breast cancer: lessons from a pilot program.
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Zissiadis, Yvonne, Ballal, Helen, Forsyth, Nicola, Ives, Angela, Jackson, Lee, Montgomery, Anna, Wise, Sarah, Yeow, Wen Chan, and Saunders, Christobel
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HUMAN services programs , *RESEARCH funding , *BREAST tumors , *VALUE-based healthcare , *PILOT projects , *PRIVATE sector , *CANCER patients , *EVALUATION of medical care , *FINANCIAL management , *QUALITY assurance , *HEALTH care industry , *MEDICAL care costs - Abstract
We present a case study on the design and implementation of a value-based bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. Value-based healthcare is an essential change to how we deliver healthcare, shifting the focus from paying for individual services provided to a focus on the health outcomes gained over a full cycle of care. The Australian health system has unintentionally created barriers to value-based cancer care through fragmented care pathways and complex funding arrangements where patients can unexpectedly encounter high out-of-pocket costs. A team of clinicians, service providers, health systems and funding experts, private health insurers and consumers have collaborated to design and pilot a complete bundled package of care for breast cancer patients which aims to address these challenges. With 40 patients recruited to date, early evaluation results show positive patient experience of 'joined-up' care and financial transparency. This case study provides a high-level overview of the approach taken to design and implement the Breast Cancer Bundle and the lessons learned for its expansion in both public and private settings. What is known about this topic? Enabling value-based healthcare is essential to improve healthcare, focusing on outcomes gained over a full cycle of care. Patients diagnosed with cancer frequently report care to be disjointed and the cause of financial stress, thus can particularly benefit from value-based care models. What does this paper add? This case study describes the design and implementation of a bundled package of care for patients with early-stage breast cancer treated in the private health sector in Australia. What are the implications for practitioners? Lessons learned through this process provide considerations for expansion of this model of care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]
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- 2024
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36. The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis.
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Lindsay, Daniel, Schofield, Penelope, Nabukalu, Doreen, Roberts, Matthew J., Yaxley, John, Quinn, Stephen, Richards, Natalie, Frydenberg, Mark, Gardiner, Robert, Lawrentschuk, Nathan, Juraskova, Ilona, Murphy, Declan G., and Gordon, Louisa G.
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PROSTATE tumors treatment , *MEDICAL economics , *SELF-evaluation , *PUBLIC health surveillance , *CANCER relapse , *HEALTH insurance , *DESCRIPTIVE statistics , *MULTIVARIATE analysis , *DECISION making in clinical medicine , *FINANCIAL stress , *SURVEYS , *DATA analysis software , *CONFIDENCE intervals , *MEDICAL care costs , *COMORBIDITY - Abstract
Objective: This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods: This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results: Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion: Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option. What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review.
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Jolliffe, Laura, Williams, Cylie M., Bozyk, Natalie, Collyer, Taya A., Caspers, Kirsten, and Snowdon, David A.
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CROSS-sectional method , *CONSUMER attitudes , *PUBLIC sector , *HOSPITAL care , *HUMAN beings , *STATISTICAL sampling , *CONTENT analysis , *DESCRIPTIVE statistics , *RETROSPECTIVE studies , *ALLIED health personnel , *SURVEYS , *LONGITUDINAL method , *THEMATIC analysis , *ELECTRONIC health records , *MEDICAL records , *ACQUISITION of data , *RESEARCH methodology , *DATA analysis software , *TIME - Abstract
Objective: Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods: Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results: Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate–high concordance overall (range, 77–96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion: While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence. What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Access to primary eye care for people living with dementia: a call to action for primary care practitioners to 'think vision'.
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Piano, Marianne, Nguyen, Bao, Hui, Flora, and Pond, Constance Dimity
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HEALTH services accessibility , *ELDER care , *OCCUPATIONAL roles , *MEDICAL quality control , *VISION disorders , *PRIMARY health care , *GENERAL practitioners , *EYE care , *OPTOMETRISTS , *ALLIED health personnel , *DEMENTIA , *PHYSICIANS , *PSYCHOSOCIAL factors , *INTEGRATED health care delivery , *PREVENTIVE health services , *OLD age - Abstract
Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023–2024 budget allocated AU$445 million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia. Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. People living with dementia are at greater risk of experiencing vision impairment, preventable through regular eye examinations usually provided by community-based optometrists in a primary care capacity. We encourage all primary care practitioners to 'think vision' when consulting with people living with dementia, and advocate for a schedule of regular eye tests post-diagnosis. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Revisiting tropical pasture intake: what has changed in 50 years?
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Charmley, E., Thomas, D., and Bishop-Hurley, G. J.
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PASTURES , *DIGITAL technology , *GRAZING , *CATTLE industry , *INFORMATION technology , *FORAGE , *FOOD consumption - Abstract
The measurement and prediction of pasture intake in extensive grazing systems, typical of northern Australia, remain elusive after 50 years of research. The aim of this paper is to review research conducted over the past 50 years, highlight advances in understanding, discuss remaining challenges and consider future developments with digital technologies. While the fundamental components of voluntary intake are well understood, their measurement is difficult, particularly in extensive grazing systems, which has limited the development of predictive models that adequately address the interplay of factors influencing intake from the bite to the landscape scale. Ongoing research by the authors is used as an example to highlight the potential application of digital technologies to overcome limitations in measurement and prediction. Digital technologies offer the opportunity for monitoring factors that control voluntary pasture intake at scale and under commercial conditions. However, our ability to ground-truth novel indices of intake remains limited without ongoing development of physical methods. This will limit the accuracy and precision of predictive models incorporating digital technologies that can be applied to the extensive grazing conditions of northern Australia. The advent of precision livestock management for extensive cattle production is essential if the industry is to remain viable in the future where production is transparent, ethically sound and environmentally defensible as well as profitable. Feed intake is fundamental to animal performance and efficiency. Yet, for the cattle industry of northern Australia, our understanding of pasture intake is limited. While much is known about the components of feed intake, it remains difficult to integrate this knowledge into a dynamic and responsive estimation of voluntary intake under typical grazing conditions. This paper reviews the state of understanding, highlights gaps in knowledge and discusses the potential impact of digital technologies that will offer new solutions to old challenges. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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40. Leveraging the full expertise of radiographers for improved healthcare delivery.
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Murphy, Andrew and Neep, Michael J.
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POLICY sciences , *MEDICAL care use , *OCCUPATIONAL roles , *DIAGNOSTIC imaging , *INTERPROFESSIONAL relations , *PATIENT safety , *HEALTH policy , *WORK experience (Employment) , *DECISION making , *DIAGNOSIS , *QUALITY assurance , *TREATMENT delay (Medicine) , *INTEGRATED health care delivery , *HEALTH care teams - Abstract
The role of radiographers in healthcare has evolved significantly from operating imaging equipment to being essential in patient care and diagnosis. In Australia, radiographers play a crucial role in image interpretation, identifying and communicating significant findings to enhance patient outcomes. Preliminary image evaluation (PIE) allows radiographers to interpret images and ensure significant findings are noted, particularly in urgent situations, complementing diagnoses when radiologist reports are unavailable. Despite their potential, many radiographers lack empowerment, leading to delays and adverse patient outcomes. This underutilisation stems from a lack of support and systemic barriers. Radiographers, with their extensive expertise in imaging, are vital for ensuring patient safety and care quality. Policy changes are needed to integrate PIE into standard workflows, allowing radiographers to fully utilise their skills. Recognising and leveraging their expertise will enhance patient care, foster collaboration, and ensure radiographers contribute fully to the healthcare team, ultimately improving patient safety and care quality. What is known about the topic? Radiographers can form an essential role in preliminarily interpreting images and communicating critical findings to ensure timely patient care. What does this paper add? Unknown to many, the Medical Radiation Practice Board of Australia requires radiographers to take responsibility for patient care and communicate significant findings immediately to the treating team. This is executed via a system known as preliminary image evaluation. What are the implications for practitioners? Implementing preliminary image evaluation into local centres is an easy method to reduce diagnostic errors and ensure urgent findings are communicated in a timely manner. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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41. General Practice Based Multidisciplinary Care Teams in Australia: Still Some Unanswered Questions. A Discussion Paper from the Australian General Practice Network.
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Yates, Rachel, Wells, Leanne, and Carnell, Kate
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MEDICAL care , *MEDICINE , *MEDICAL informatics , *THERAPEUTICS - Abstract
Evidence indicates that general practice-based multidisciplinary teams can offer a means of addressing some of the key issues currently facing Western health systems, especially workforce and chronic disease management. Elements of team-working have been addressed in research and policy initiatives both overseas and in Australia, yet some important aspects of primary health care multidisciplinary team-working still remain unclear in the Australian context. This discussion paper has been developed by the Australian General Practice Network (AGPN) to raise awareness of and promote thought on four questions relating to multidisciplinary team-working that AGPN considers important but that, as yet, have not been fully addressed. (Except where indicated, it is not a position statement about AGPN's views on this matter.) Questions considered are: Who is in the team? What makes a successful team? How should teams be funded in Australia? Who coordinates the team? Each question broadly considers what is already known about the area through purposeful literature reviews of the published and grey literature, current policy impacting on the area, and suggested areas for policy development in the context of Australian general practice and primary care. [ABSTRACT FROM AUTHOR]
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- 2007
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42. Reverse triage in COVID surge planning: a case study of an allied health supported clinical care pathway in an acute hospital setting.
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Withiel, Toni Dianne, Blance-Palmer, Rachel, Plant, Cassandra, Juj, Genevieve, McConnell, Carly Louise, Rixon, Melissa Kate, Putland, Mark, Walsham, Nicola, and Klaic, Marlena
- Subjects
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LENGTH of stay in hospitals , *COVID-19 , *MEDICAL triage , *HOSPITAL emergency services , *ACADEMIC medical centers , *PATIENT readmissions , *RETROSPECTIVE studies , *ACQUISITION of data , *TERTIARY care , *MEDICAL protocols , *WORKFLOW , *MEDICAL care research , *RISK assessment , *CRITICAL care medicine , *ORGANIZATIONAL effectiveness , *MEDICAL records , *DESCRIPTIVE statistics , *HEALTH care teams , *MEDICAL referrals , *PATIENT education , *ALLIED health personnel , *LONGITUDINAL method , *DISCHARGE planning - Abstract
Objective: This case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the 'COVID community navigator team', applied established principles of reverse triage to create additional surge capacity. Methods: A retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021. Results: There were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a 'low risk pathway' with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward. Conclusion: The findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks. What is known about the topic? Reverse triage offers the potential to rapidly assess, treat and discharge patients from the emergency department. No known studies have explored this in response to the coronavirus 2019 (COVID-19) pandemic. What does this paper add? This paper supports a reverse triage approach to surge planning during the COVID-19 pandemic. We outline a multidisciplinary initiative to support discharge pathways. What are the implications for practitioners? Spearheaded by allied health, the reverse triage model described could provide a solution for surge planning during health crises. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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43. John Staer (1850–1933): the patronym behind Eucalyptus staeri, the Albany Blackbutt.
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Ludewig, Alexandra
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EUCALYPTUS , *BOTANICAL specimens , *TRADITIONAL knowledge , *COLLECTION & preservation of plant specimens , *BOTANY - Abstract
Millennia of evolutionary ecology have seen Australia become one of the driest and flattest continents on Earth—and in the process, home to more than 700 species of Eucalyptus. Colonial scientists named them using a binomial system, thereby overwriting local vernaculars that had persisted for tens of thousands of years. This paper traces the man commemorated in the Albany Blackbutt, Eucalyptus staeri , a tree unique to the Great Southern region of Western Australia, traditionally the land of the Menang Noongar people. Using a biographical lens, the paper examines the intersection of Western science and commerce in plant collection and naming, and the ways in which these processes exclude or discount Indigenous knowledge. The paper argues that a more holistic and inclusive historical interpretation of herbarium specimens of E. staeri is achieved by correcting and re-analysing information about the German settler after whom it is named, John Staer, while at the same time acknowledging the Noongar people's deep knowledge (kartijin) of plants that has been passed down over many thousands of years. Australia is home to more than 700 species of Eucalyptus, named by Colonial scientists with a binomial system that displaced local Aboriginal vernaculars. Using a biographical lens, this paper traces the man commemorated in the Albany Blackbutt, Eucalyptus staeri , a tree unique to the Great Southern region of Western Australia, traditionally the land of the Menang Noongar people. In doing so, it suggests corrections and additions to public documents that speak to a need to Indigenise and decolonise written sources in herbaria the world over. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
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44. Strawberry clover (Trifolium fragiferum): current status and future role in Australian agriculture.
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Smith, R. W., Penrose, B., Langworthy, A. D., Humphries, A. W., Harris, C. A., Rogers, M. E., Nichols, P. G. H., and Hayes, R. C.
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CLOVER , *WATERLOGGING (Soils) , *AGRICULTURE , *PASTURES , *STRAWBERRIES , *LEGUMES , *GERMPLASM - Abstract
Strawberry clover (Trifolium fragiferum L.) is periodically raised as an alternative perennial pasture legume for temperate regions of Australia. Its tolerance of waterlogging is widely known, yet its ability to persist through periods of soil moisture deficit is often understated. Other desirable characteristics include its stoloniferous growth habit and tolerance of mildly saline conditions. Only four strawberry clover cultivars have been registered in Australia, and the most popular, cv. Palestine, is a direct introduction, released in 1938 and first certified in 1951. Furthermore, strawberry clover's distribution has largely been confined to niche environments, particularly waterlogged and saline areas. This paper reviews the taxonomy and breeding system, morphology, distribution and ecology, and subsequent transfer of strawberry clover to Australia. It reviews and maps the suitability of strawberry clover for perennial pasture systems in the medium–-high rainfall and irrigated temperate zones of Australia, with reference to future climates. The paper also highlights the breeding focus, commercialisation and marketing required to supersede cv. Palestine and lists the germplasm available in the Australian Pastures Genebank, with origins. We conclude that, although strawberry clover is unlikely to become a dominant perennial pasture legume species in Australia, it could be used in a wider range of environments than just those affected by salinity and/or waterlogging stress. Strawberry clover has been suggested as an alternative perennial pasture legume for temperate regions of Australia. We review its taxonomy, morphology, native distribution and subsequent transfer to Australia. We map the suitability of strawberry clover for perennial pasture systems, with reference to future climates, and identify future research foci. Strawberry clover is unlikely to become a dominant pasture legume species in Australia but could be used in a wider range of environments. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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45. The burdensome logistics of data linkage in Australia -- the example of a national registry for congenital heart disease.
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Lloyd, Larissa K., Nicholson, Calum, Strange, Geoff, and Celermajer, David S.
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DATABASES , *REPORTING of diseases , *CONGENITAL heart disease , *PUBLIC health , *ACQUISITION of data , *MEDICAL record linkage , *INTERPROFESSIONAL relations - Abstract
Objective. Data linkage is a very powerful research tool in epidemiology, however, establishing this can be a lengthy and intensive process. This paper reports on the complex landscape of conducting data linkage projects in Australia. Methods. We reviewed the processes, required documentation, and applications required to conduct multi-jurisdictional data linkage across Australia, in 2023. Results. Obtaining the necessary approvals to conduct linkage will likely take nearly 2 years (estimated 730 days, including 605 days from initial submission to obtaining all ethical approvals and an estimated further 125 days for the issuance of unexpected additionally required approvals). Ethical review for linkage projects ranged from 51 to 128 days from submission to ethical approval, and applications consisted of 9-25 documents. Conclusions. Major obstacles to conducting multi-jurisdictional data linkage included the complexity of the process, and substantial time and financial costs. The process was characterised by inefficiencies at several levels, reduplication, and a lack of any key accountabilities for timely performance of processes. Data linkage is an invaluable resource for epidemiological research. Further streamlining, establishing accountability, and greater collaboration between jurisdictions is needed to ensure data linkage is both accessible and feasible to researchers. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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46. 'Can a relative override a patient's Advance Care Directive?': end-of-life legal worries of general practitioners and nurses working in aged care.
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White, Ben, Feeney, Rachel, Sellars, Marcus, Neller, Penny, Yates, Patsy, and Willmott, Lindy
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ADVANCE directives (Medical care) -- Law & legislation , *PALLIATIVE treatment laws , *NURSES' attitudes , *PROFESSIONS , *CROSS-sectional method , *HOME care services , *ASSISTED suicide , *PHYSICIANS' attitudes , *FEAR , *RESIDENTIAL care , *WORRY , *DATA analysis software , *DECISION making in clinical medicine , *ELDER care - Abstract
Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]
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- 2024
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47. Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study.
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Spooner, Catherine, O'Shea, Peri, Fisher, Karen R., Harris-Roxas, Ben, Taggart, Jane, Bolton, Patrick, and Harris, Mark F.
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PREVENTION of chronic diseases , *MEDICAL quality control , *HEALTH services accessibility , *FOCUS groups , *CAREGIVERS , *FAMILY medicine , *INTERVIEWING , *PREVENTIVE health services , *SEVERITY of illness index , *QUALITATIVE research , *CONCEPTUAL structures , *COMMUNICATION , *SOUND recordings , *RESEARCH funding , *HEALTH equity , *THEMATIC analysis , *MENTAL illness - Abstract
Background: People with lived experience of severe mental illness (PWLE) live around 20 years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Methods: Qualitative interviews (n = 10) and a focus group (n = 10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n = 5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. Results: PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. Conclusion: GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care. People with lived experience of severe mental illness (PWLE) experience poorer physical health and worse access to preventive care than the general population. This paper provides information from a lived experience perspective on how PWLE in Sydney, Australia have been able to access preventive care from a GP. These results highlight the importance of supporting PWLE to access effective preventive care across their journey and suggest specific areas for improvement in GP capabilities and care coordination/shared care. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.
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Cairns, Alice, Rodda, Danielle, Wymarra, Frances, and Bird, Katrina
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INDIGENOUS Australians , *ACTIVE aging , *REHABILITATION centers , *PATIENT participation , *RURAL health services , *STUDENT health services , *FUNCTIONAL status , *COMMUNITY health services , *MEDICAL care , *LABOR supply , *HEALTH care teams , *INTEGRATED health care delivery , *RURAL health , *RURAL health clinics - Abstract
Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community. Remote communities require primary care services that are inclusive of allied health and can be responsive to individual and community needs. Services require a workforce and a service model that can be creative and flexible. The Service described, delivered both a novel service model that complemented the primary care services already being delivered, and focused on workforce and community capacity building. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Strategies to minimise the impact of climate change and weather variability on the welfare of dairy cattle in New Zealand and Australia.
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Jago, Jenny, Beukes, Pierre, Cuttance, Emma, Dalley, Dawn, Edwards, J. Paul, Griffiths, Wendy, Saunders, Katie, Shackleton, Liz, and Schütz, Karin
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WEATHER & climate change , *DAIRY cattle , *CLIMATE change & health , *ANIMAL health surveillance , *CLIMATE change mitigation , *ANIMAL welfare - Abstract
This perspective paper provides industry leaders, researchers and policy developers strategic approaches to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to climate change. Farm systems and practices will evolve in response to the direct impacts of climate change and/or from responses to climate change, such as mitigation strategies to reduce dairy's greenhouse-gas (GHG) emissions. The five domains framework (nutrition, physical environment, health, behaviour, mental state) was used to assess the potential impacts on animal welfare and strategies to minimise these impacts are outlined. Given that the future climate cannot be certain these approaches can be applied under a range of emissions pathways to (1) ensure that the effects of GHG mitigations on animal welfare are considered during their development, (2) engage with end users and the public to ensure solutions to the effects of climate change and weather variability are accepted by consumers and communities, (3) identify and measure the areas where improved animal health can contribute to reducing GHG emissions from dairy production, (4) ensure those supporting farmers to develop and manage their farm systems understand what constitutes a good quality of life for dairy cattle, (5) ensure effective surveillance of animal disease and monitoring of welfare outcomes and farm-system performance in response to climate change and GHG mitigations. Overall, these strategies require a multidisciplinary co-development approach to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to the wider impacts of a changing climate. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
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50. Podiatric surgery: a canary in the coalmine for professional monopolies.
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Nancarrow, Susan and Borthwick OBE, Alan
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PROFESSIONAL ethics , *PROFESSIONAL practice , *ENDOWMENTS , *PATIENT safety , *OCCUPATIONAL achievement , *HEALTH insurance , *SURGEONS , *HEALTH occupations schools , *FOOT surgery , *LABOR demand , *SOCIAL boundaries , *PSYCHOSOCIAL factors , *GOVERNMENT regulation , *MEDICAL practice , *LABOR supply - Abstract
What is known about the topic? The health workforce and health tasks are highly contested and largely controlled by regulation. Since the introduction of medical regulation in the mid-19th century, the practice of surgery has been largely dominated by medically trained surgeons. A small group of Australian podiatrists have defied these historic boundaries by creating their own colleges of training and convincing government and regulators of their safety and efficacy in surgical practice. The Podiatry Board of Australia commissioned an independent review of the regulation and regulatory practices of podiatric surgeons in Australia. What does this paper add? This paper discusses the implications of a regulatory review of the role of podiatric surgeons for professional role boundaries. What are the implications for practitioners? Despite historic role boundaries and definitions, with appropriate training, regulation, and financing, the health workforce can be mobilised in different ways to meet population needs, overcoming a professional monopoly over roles. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
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