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Objectives. This study explored associations between demographic, socioeconomic, behavioural risk, and health factors (study factors) and detection of type 2 diabetes. Methods. A secondary analysis of data extracted from the AusDiab study was undertaken. Participants were classified as known diabetes (KDM), newly detected diabetes (NDDM), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or normal according to results of a glucose tolerance test. Results. The weighted prevalence of diabetes was 6.9%; 49.6% of participants with diabetes (NDDM+KDM) were classified as NDDM. Although study factors were associated with diabetes prevalence, most were not associated with proportion of diabetic participants classified as NDDM. Among participants with diabetes, NDDM was more likely among those who spoke English at home, were in good general health and did not report past history of cardiovascular disease. Conclusions. Although a range of personal and socioeconomic factors are associated with diabetes prevalence, these factors are not similarly associated with prior detection of diabetes. These findings highlight the importance of systematic approaches to screening for diabetes risk focussed on the whole population, with selective screening based on multi-factorial assessment of diabetes risk using the AUSDRISK Assessment Tool. What is known about the topic? Type 2 diabetes is an increasing public health problem and early detection is associated with improved outcomes. About half of the participants with diabetes in the AusDiab study had been diagnosed previously with diabetes, with the remainder being newly diagnosed in the study. What does this paper add? A range of demographic, socioeconomic, behavioural risk and health factors were associated with increased risk of diabetes. However, these factors did not differentiate between those with a prior diagnosis of diabetes and those with newly diagnosed diabetes. Among participants with diabetes, NDDM was more likely among those who spoke English at home, were in good general health or reported no past history of cardiovascular disease. What are the implications for practitioners? Screening for type 2 diabetes should be broadly focussed on the whole population, with selective blood testing based on multi-factorial assessment of diabetes risk using the AUSDRISK Assessment Tool. [ABSTRACT FROM AUTHOR]

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

Objective. The aim of this paper is to examine the progress and effect of the current 5-year $244 million national Young People in Residential Aged Care program on the reduction of young people in aged care. Method. Semi-structured telephone interviews with 20 service providers, 10 advocacy organisations and 6 public servants across Australia actively involved in the implementation of the program. Results. The development of new accommodation options has been slow. The 5-year program aims to move 689 young people out of nursing homes; in the first 4 years of the initiative only 139 people had moved out. The lives of those who have been helped by the program have been enormously improved. Conclusions. This study highlights the challenges of achieving a long-term reduction in the number of young people in residential aged care, including the challenge of achieving systemic change to prevent new admissions. Implications. The accommodation options currently being developed for this target group will soon be at capacity. Without sustained investment in developing alternative accommodation options and resources to implement systemic change ~250 people under 50 are likely to continue to be admitted to aged care each year in Australia. [ABSTRACT FROM AUTHOR]

Purpose. To explore the referral pathways of patients with newly diagnosed colorectal cancer to surgeons. Method. Australian surgeons from three states completed a questionnaire and their records were audited. Results. Thirty-three surgeons provided data on 530 patients seen in the preceding 12 months. The median time between colonoscopy and first surgical consult was 10 days, with 19% of patients waiting more than 28 days. After adjustment for clustering, no surgeon factors were associated with the number of days between colonoscopy and surgery. A report back to the general practitioner (GP) was found in 78% of patients' records. This feedback varied between surgeons but none of the specific surgeon characteristics examined could explain this. Conclusion. Surgeons usually communicated with GP regardless of whether they were the referral source. However, communication with GP varied considerably among surgeons, with no evidence of a report to the GP in one-fifth of cases. What is known about the topic? Referral from general practice is the main pathway to specialist services in Australia. There has been little research describing factors that affect referral patterns, particularly following diagnosis of cancer to investigation for surgery. What does this paper add? A significant minority of GP were not informed of the referral for colonoscopy and did not receive a copy of the report. No surgeon factors were associated with the number of days between colonoscopy and surgery. What are the implications for practitioners? Although the referral pathway for colorectal cancer often begins in general practice, GP are not always fully informed of the pathways used and other important treatment decisions. Improved use of audit, dissemination of results and improved information exchange generally may all make a significant impact. [ABSTRACT FROM AUTHOR]

Background. Diabetes can be effectively managed in general practice (GP). This study used record linkage to explore associations between diabetes care in GP and hospitalisation. Methods. Data on patients with type 2 diabetes were extracted from a Division of GP diabetes register (CARDIAB) for 2002-05 and were linked to the New South Wales Admitted Patient and Emergency Department (ED) Data Collection to create a unit record data collection containing demographic, clinical and health service records. Rates of admission and ED presentation per patient-year of follow up were calculated for the year following CARDIAB record. Results. The study included 1178 diabetic patients with 2959 patient-years of follow up. Their mean age was 65.7 years and duration of diabetes was 5.9 years. All-cause admission and ED presentation rates were 0.7 and 0.2 per patient-year of follow up respectively and length of admission 3.2 days (s.d. 11.7 days). Admission was associated with age, duration of diabetes and prior admission. The number of processes of care recorded for each patient-year was associated with admission. Admission and length of stay were not associated with achievement of clinical targets. Conclusions. These data suggest that receipt of processes of care, rather than clinical targets, will prevent admission. One explanation may be that continuity of care in GP provides opportunity for early intervention and treatment. What is known about the topic? Diabetes is a serious public health problem that is largely managed in primary care. Health care planners use health service use (hospital admissions) for diabetes as an indicator of primary care. Guidelines for diabetes care are known to be effective in reducing diabetes-related complications. What does this paper add? This paper created a linked data collection comprising demographic and clinical data from general practice and administrative health records of hospital admissions and emergency department presentations. The paper explores the associations between processes of primary care and control of diabetes and cardiovascular risk factors, and use of health services for a general practice population with diabetes. What are the implications for practitioners? The study suggests that processes of care and not technical control of diabetes and cardiovascular risk factors are important in preventing hospital admission. Continuity of care in general practice that ensures implementation of processes of care provides opportunity for early intervention and treatment. [ABSTRACT FROM AUTHOR]

Objective. This study sought to explore the impact of care recipient falls on caregivers. Methods. Ninety-six community-dwelling caregiver-care recipient dyads participated in a 12-month prospective study. Falls and other accidents and service use were recorded. Dyads were assessed at baseline and after each fall. Assessment included the Zarit Burden Interview and a post-accident survey developed for the present study. Focus groups were then conducted to further explore the impact of falls on caregivers. Results. Fifty-four care recipients (56%) experienced falls within the 12 months of the study. There was a significant increase in caregiver burden after the first fall (Zarit Burden Interview score increased from 24.2 ± 14.2 to 27.6 ± 14.5, P < 0.01). Twenty-four percent of caregivers reported that they had altered their usual routine after the fall, mainly not wanting to leave the care recipient alone. However, there was no increase in the number of services used. Focus group discussions highlighted the need for constant vigilance of the care recipient, a lack of knowledge about support services and concerns related to utilising respite care. Conclusion. Falls among care recipients have a significant impact on carers, including an increased fear of falling, prompting the need for even closer vigilance. What is known about the topic? Falls are a significant problem for older people as one in three older people fall each year and injurious falls are the leading cause of injury-related hospitalisation in older people. In Australia falls cost the economy over $500 million per year. What does this paper add? This paper adds a unique perspective to the falls literature, that of the older person's carer. Falls are a significant problem for community-dwelling carers of older people, contributing to carer burden and impeding the carer's ability to undertake activities of daily living because of the perceived need for constant vigilance to prevent the person they care for from falling. What are the implications for practitioners? Practitioners should ensure that carers are aware of evidence-based falls-prevention practices and services, such as group and individual exercise programs, home modifications and podiatry, that might assist to prevent falls in the person they care for and therefore reduce the burden of care. [ABSTRACT FROM AUTHOR]

Objectives. This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. Methods. The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. Results. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. Conclusions. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. What is known about the topic? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. What does this paper add? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. What are the implications for practitioners? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia. [ABSTRACT FROM AUTHOR]

Objective To evaluate cardiac arrest outcomes following the introduction of the Australian Resuscitation Council (ARC) 2006 amended guidelines for basic and advanced life support. Methods A retrospective study of all consecutive cardiac arrests during a 3-year phase pre-implementation (2004-06) and a 3-year phase post-implementation (2007-09) of the ARC 2006 guidelines was conducted at a tertiary referral hospital in Brisbane, Australia. Results Over the 6-year study phase 690 cardiac arrests were reported. Resuscitation was attempted in 248 patients pre-implementation and 271 patients post-implementation of the ARC 2006 guidelines. After adjusting for significant prognostic factors we found no significant change in return of spontaneous circulation (ROSC) (odds ratio 1.21, 95% confidence interval 0.80-1.85, P = 0.37) or survival to discharge (odds ratio 1.49, 95% confidence interval 0.94-2.37, P = 0.09) after the implementation of the ARC 2006 guidelines. Factors that remained significant in the final model for both outcomes included having an initial shockable rhythm, a shorter length of time from collapse to arrival of cardiac arrest team, location of the patient in a critical-care area, shorter length of resuscitation and a day-time arrest (0700-2259 hours). In addition the arrest being witnessed was significant for ROSC and younger age was significant for survival to discharge. Conclusions There are multiple factors that influence clinical outcomes following an in-hospital cardiac arrest and further research to refine these significant variables will assist in the future management of cardiac arrests. What is known about this topic? The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. What does this paper add? This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines, which included a refocus on providing quality cardiopulmonary resuscitation with minimal interruptions. What are the implications for practitioners? Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding cardiopulmonary resuscitation is essential to improve outcomes. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. Methods. Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. Results. There was an overall significant 36% (P < 0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P < 0.05) in staff, 37% (P < 0.05) in visitors and remained unchanged among inpatients. Conclusions and implications. The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority. What is known about the topic? Smoke-free environment policies have been developed and introduced worldwide. These policies reduce tobacco use and protect the community from environmental tobacco smoke. What does this paper add? This paper focusses on a method used to monitor compliance of a smoke-free environment policy in a healthcare setting. The paper tracks what happened over 2 years before and after the policy was implemented. Among staff, there was evidence of compliance with the policy; however, there was no apparent change in policy compliance amongst inpatients. What are the implications for practitioners? Policy makers and staff implementing smoke-free policies should ensure adequate support for staff and inpatients are available, with continued promotion and enforcement of the policy. Further investigations are needed into multi-strategic cessation interventions for inpatients who smoke. [ABSTRACT FROM AUTHOR]

Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9-24 months), and initial appointment-to-surgery (12-15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an individual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an individual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of individuals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to describe the prevalence of perceived workplace bullying in the Australian medical workforce, and investigate the relationship between workplace bullying and job satisfaction, health status, and current and planned medical workforce participation. Methods. An electronic cross-sectional survey of doctors currently in the paid workforce, conducted between April 2008 and October 2009, was nested within a longitudinal cohort study investigating factors affecting the recruitment and retention of the Australian medical workforce. To address the specific aims of this study, a subset of questions in the survey investigated the prevalence of self-reported bullying; physical and mental health; workforce participation patterns; job satisfaction; and job stressors. Results. Seven hundred and forty-seven participants responded to the bullying question and were included in this analysis. Twenty-five percent of participants reported being bullied in the last 12 months. There were no differences in the reported rates of bullying across age groups, sex and country of medical qualification. Bullied doctors were least satisfied with their jobs (P <; 0.001), had taken more sick leave in the last 12 months (P <; 0.001), and were more likely to be planning to decrease the number of hours worked in medicine in the next 12 months (P = 0.01) or ceasing direct patient care in the next 5 years (independent of their age or the number of hours currently worked in patient care) (P = 0.006). Conclusions. Our findings suggest that Australian doctors, independent of age or sex, have experienced workplace bullying, and although no conclusions can be made about causal pathways, there were strong associations between this exposure and poorer health and wellbeing, and on remaining in the medical workforce. What is known about the topic? Bullying and harassment have a significant impact on mental health, job satisfaction, and intention to leave the workforce. Workplace bullying in healthcare organisations affects the individuals involved, the organisations and the patients. The prevalence of workplace bullying throughout the medical workforce in Australia or elsewhere has not been investigated, with previous studies focussing on subsets of doctors, particularly junior doctors. What does this paper add? This paper found that 25% of doctors participating in this study reported experiencing persistent behaviours in the last 12 months that had undermined their professional confidence or self-esteem. There were no differences in the prevalence of bullying observed between sexes, age groups, country of medical qualifications, or employment sector. Victims of bullying had poorer mental health, had taken more sick leave in the last 12 months, were less satisfied with their current jobs and with being doctors, were more affected by job stressors and were more likely to be considering ceasing direct patient care than non-bullied doctors. What are the implications for practitioners? Practitioners need to be alert for potential bullying and harassment within healthcare organisations and be prepared to act decisively to minimise its impact on staff health, satisfaction and retention, and patient quality of care. [ABSTRACT FROM AUTHOR]

Objective. Capture-recapture analysis was used to more accurately quantify the admission rate for acute pancreatitis in a regional hospital setting, in comparison to the usual method of case ascertainment. Reasons for differences in capture for the various methods were also sought. Methods. Admissions for acute pancreatitis were enumerated over a 40-month period using three data sources: hospital classification of admission diagnoses, prospective case identification, and receipt of diagnosis-specific pathology specimens. Capture-recapture analysis was applied with log-linear modelling to account for likely dependency between data sources. Covariates were noted to explain capture probability by the various data sources and for eventual stratification in the analysis process. Results. For the census period, there were 304 admissions after merging of data sources, giving a crude admission rate of 7.6 per month. Crude ascertainment rates for discharge records and prospective identification were 44% and 52% respectively. Following log-linear modelling, total admissions more than doubled to 644 (adjusted admission rate 16.1 per month). Of the covariates considered, admissions of less than three days' duration and those occurring in December and January were significantly associated with increased capture by the hospital discharge records data source. Conclusions. In this clinical setting, admissions for acute pancreatitis are grossly underestimated by the standard case ascertainment method. The reasons for this are not clear. Hospital discharge records are nevertheless more effective than prospective case ascertainment for certain cases, such as brief admissions and those in holiday periods. What is known about the topic? Capture-recapture analysis was originally developed in animal ecology, but has since been used to estimate both prevalent and incident cases of human disease. What does this paper add? This study exposes possible deficiencies in the single-source case ascertainment methods used by most hospitals to enumerate incident cases. It is the first time that capture-recapture techniques have been used to estimate acute pancreatitis admissions. What are the implications for practitioners? To obtain accurate admissions estimates for diseases such as acute pancreatitis, capture-recapture analysis with multiple data sources is advisable. One possible solution may be to conduct intermittent prospective censuses to complement existing retrospective ascertainment methods. On a more general level, clinical staff should be better trained to provide more accurate and detailed information in case records. [ABSTRACT FROM AUTHOR]

Objective. To identify the perceptions of nurse managers in Western Australia, Singapore and Tanzania regarding desirable attributes for effective management of their health services, and to identify and discuss the implications for health-management education provided by Australian universities. Methods. Nurse managers completed a questionnaire covering four key dimensions: personality characteristics, knowledge and learning, skills, and beliefs and values. Each of 75 items were rated as to their effect on management effectiveness, according to a 5-point Likert scale. Results. Skills were considered the most important for management effectiveness by each group. Tanzanian respondents rated knowledge and learning almost as highly, and significantly higher than Western Australian respondents. They also rated personality characteristics and beliefs and values significantly higher than Western Australian respondents. No significant differences were found between Singapore and Western Australia. Conclusions. Participants desired a different relative mix of attributes in their nurse managers, with Western Australian respondents most likely to indicate that transformational leadership contributed most to managerial effectiveness. Tanzanian nurse managers were most likely to advocate transactional leadership, whereas Singaporean nurse managers' views were located somewhere between. Given that these perceptions are valid, the content and curricula of management-development courses need to be cognisant of the cultural backgrounds of participants. What is known about the topic? Views differ as to the extent to which the criteria for management effectiveness are broadly universal or contingent on culture. This applies to the area of nurse management as it does to healthcare management in general. What does this paper add? It is demonstrated that each of the three quite different countries or states considered identified a distinctive combination of attributes as desirable, with the nurse managers of Western Australia most likely to favour a transformational style of leadership, those from Tanzania a transactional leadership style and those from Singapore somewhere in between. What are the implications for practitioners? Given the country- or state-specific desire for a different relative mix of attributes in their nurse managers, management educators in Australia need to ensure that the content and curricula of their courses are cognisant of the cultural backgrounds of their students. There are also important lessons to be taken on board regarding recruitment of nurses into management positions in terms of each of the four dimensions considered, particularly in terms of desirable personality characteristics and beliefs and values. [ABSTRACT FROM AUTHOR]

Objective. To compare Jarman-derived hospital standardised mortality ratios (HSMR) and Linkage-derived cumulative mortality ratios (CMR). Methods. HSMR and CMR values for four groups of hospitals were derived from four single-year cohorts of linked patient admissions and deaths, and compared; differences were explored and reasons for non-matching and discordance were suggested. Results. For the group of metropolitan teaching hospitals the Jarman-derived HSMR value of 0.95 (95% CI 0.93-0.97) was significantly lower than the Linkage-derived CMR value of 0.99 (95% CI 0.97-1.01). The opposite result was seen for the group of metropolitan non-teaching public hospitals: the Linkage-derived CMR of 0.81 (0.77-0.85) was significantly lower than the Jarman method HSMR of 1.03 (0.98-1.07). Unmatched deaths in the study resulted from a condition unique to the Jarman method. Besides there being fewer deaths based only on the hospital separation records, 593 of these records suggested wrongly diagnosed deaths, possibly due to erroneous coding. Also, 467 hospital separation records deemed not to have involved transfer in the Jarman method database were detected by the Linkage method. However, excluding these unmatched deaths did not result in total concordance for two-method hospital-related deaths. Conclusions. Incorrect deaths in the Jarman method can be overcome by using the Linked method. The Jarman method, unable to adjust for the contiguous transfers related to the death, apportioned excess deaths unfairly to the teaching hospitals group. What is known about the topic? HSMR based on hospital separation record information can reflect hospital performance if monitored over a regular period. Despite considerable variability, inter-hospital comparison league tables of hospitals based on such ratios have been published. What does this paper add? This study demonstrated that the Linkage-derived CMR, utilising valid details from the state death registry, more accurately ascertains number of deaths than does the Jarman method-derived HSMR. What are the implications for practitioners? Where data linkages are possible, dual death derivations by the Jarman method and the Linked method can identify any unmatched or discordant deaths. Detailed exploration may help identify any differing hospital discharge practices. [ABSTRACT FROM AUTHOR]

Objective. To explore the effectiveness of the current clinical supervision (CS) processes for allied health professionals (AHPs) at a regional health service from the perspective of the supervisor. Method. A mixed method study with two phases, involving AHPs across nine disciplines, employed at a regional health service and providing CS. In the first phase 14 supervisors participated in focus groups which were followed by the completion of a questionnaire by 26 supervisors. Results. Focus group results indicated confusion between CS, line and performance management and mentoring. Clinical supervision was perceived to contribute to the quality of patient care and reflective practice. The challenges of time for busy clinical staff were reported. The questionnaire response rate was 52.1% and the mean total score for the questionnaire was 162.96 (s.d. 13.47), being 76% of the maximum possible total score. Clinical supervision was considered to improve care quality despite the avoidance of addressing personal issues. Identified CS improvements included empowerment through education, resources development, streamlined documentation and use of best practice protocols. Conclusions. The results identified AHP supervisors' perceptions of CS and possible improvements to CS processes, including differentiating CS from line management, protecting CS time and the provision of critical feedback. What is known about the topic? There are limited published reports about CS for AHPs, with AHP supervisor experience and knowledge not previously reported. What does the paper add? This is the first study to identify current supervisor understanding and practice of CS for AHPs. What are the implications for practitioners? CS is a valued activity, the effectiveness of which may be supported by education and resources. [ABSTRACT FROM AUTHOR]

Objective. Studies have found that health workers are at elevated risk of being abused while at work. Little is known, however, about workplace abuse among correctional health professionals. We implemented a cross-sectional study to investigate the prevalence, sources and consequences of workplace abuse among correctional health professionals in New South Wales, Australia. Methods. All employees of Justice Health (a statutory health corporation) were invited to complete a self-administered survey, which was delivered via the internet. Among nurses, medical doctors and allied health professionals, 299 usable surveys were returned; a response rate of 42%. Results. In the preceding 3 months, 76% of participants had personally experienced some form of abuse in their workplace, all but one of whom recalled verbal abuse. Only 16% reported physical abuse. Seventy per cent reported feeling safe in their workplace. Patients were identified as the main perpetrators of abuse, followed by fellow health staff. Participants felt that incidents of workplace abuse increased their potential to make errors while providing care to patients and reduced their productivity while at work. Conclusions. Compared with health workers who practise in a community setting, the risk of physical abuse among correctional health professionals appears to be low. What is known about the topic? Health professionals are at a high risk of workplace abuse. Studies have demonstrated that the risk of abuse varies by health profession and the practice environment. There is a paucity of research exploring workplace abuse among correctional health professionals. What does this paper add? A cross-sectional survey found that a relatively small proportion of correctional health professionals in New South Wales had been subjected to physical abuse in their workplace in the preceding 3 months. Verbal abuse, however, was reported by a majority of participants. Although patients were the most commonly reported source of abuse, a worrying level of health worker on health worker abuse (also known as horizontal abuse) was found. What are the implications for practitioners? Preventive strategies should address the temporal, environmental and structural determinants of workplace abuse in correctional and forensic facilities. More research is needed to identify the factors associated with horizontal abuse among correctional health professionals. This would allow the establishment of tailored preventive programs. [ABSTRACT FROM AUTHOR]

Objective. To determine the workplace needs of Western Australian midwives working in public metropolitan secondary hospitals. Method. Using a three-round Delphi approach, Round 1 incorporated focus groups and a questionnaire. Fifteen focus groups were conducted with midwives also having the option of contributing through an open-ended questionnaire. During Round 2, 38 items reflecting seven themes were prioritised with a final ranking performed in Round 3. In total, 114 midwives participated in Round 1, 72 in Round 2 and 89 in Round 3. Results. During Round 1, workplace needs identified as being met included: working across all areas of midwifery; ability to work in areas of interest; opportunity to work with low to moderate risk women; supportive colleagues; accessible parking; hospital close to home and friendly work atmosphere. Round 2 items revealed the five top unmet needs as: adequate midwifery staff coverage; access to maintained equipment; competitive pay scales; patient safety issues and opportunities to implement midwifery models. The top ranked needs from Round 3 included: recognising the unpredictable nature of midwifery services; provision of competent medical coverage, and adequate midwifery staff coverage. Conclusions. Demand for maternity services is unpredictable; however, in order to maintain a sustainable maternity workforce, WA midwives' prioritised needs would suggest health management focus upon expanding the availability of midwifery models of care, fostering flexible working conditions and ensuring collaboration between maternity health professionals occurs within clinically safe staffing levels. What is known about the topic? Dissatisfaction with working conditions, staff shortages, and feeling undervalued or unsupported contribute to healthcare workforce attrition. However, positive practice environments and health service management and leadership can influence employee satisfaction and retention. What does this paper add? These insights into Western Australian midwives' met and unmet needs within the context of public metropolitan secondary units provide a more practical basis for the revision of work conditions than has been reported previously. What are the implications for practitioners? Our findings reinforce the urgent need to address the midwifery workforce priorities highlighted in the Australian National Maternity Services Plan. Specifically, this study strongly underscores the requirement to expand the availability of midwifery models of care, foster flexible working conditions and ensure collaboration between maternity health professionals occurs within clinically safe staffing levels. [ABSTRACT FROM AUTHOR]