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Aim: To describe the implementation of a trauma‐informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. Design: Discussion paper. Data Sources: Evidence gathered from a literature search (2008–2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. Discussion: The literature highlights the high prevalence of trauma in patients following COVID‐19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma‐informed model of care was implemented. Conclusion: Reconceptualizing COVID‐19 as a 'collective trauma' can help healthcare workers understand the needs of post‐COVID patients and enable them to respond empathetically. A trauma‐informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. Implications for Nursing and Patient Care: Frontline healthcare workers, particularly nurses, are well positioned to implement trauma‐informed care due to their high‐level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. Impact: The COVID‐19 pandemic has led to adverse physical and mental health outcomes for many.Trauma‐informed care is a way to promote reengagement with the healthcare system in this group.Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. Patient or Public Contribution: Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post‐COVID patient. [ABSTRACT FROM AUTHOR]

Objective: To explore how four small towns in rural New South Wales known as the 4Ts are addressing challenges accessing quality care and sustainable health services through a collaborative approach to workforce planning using the collaborative care framework. Design: Descriptive case study approach. Setting: The collaborative care project was developed as a result of ongoing partnerships between 2 rural Local Health Districts, 2 Primary Health Networks and a non‐governmental health workforce organisation. The collaboration works with 5 subregions each comprising 2 or more rural communities. This paper focuses on the 4Ts subregion. Participants: Stakeholders of the collaborative design including organisations and the community. Intervention: A place‐based approach to co‐designing health services with community in one sub‐region of Western New South Wales. Main outcome measures: A synthesis of field observations and experiences of community and jurisdictional partners in implementation of the 4Ts subregional model. Mapping of implementation processes against the collaborative care framework. Results: The collaborative care framework is a useful planning and community engagement tool to build health workforce literacy and to impact on system change at the local level. We identify key elements of effectiveness in establishing the 4Ts model, including the need for coordinated health system planning, better integrating existing resources to deliver services, community engagement, building health workforce literacy and town‐based planning. Conclusion: This study adds to the body of knowledge about how to successfully develop a collaborative primary health care workforce model in practice. The findings demonstrate that the implementation of a collaborative primary health care workforce model using the collaborative care framework can improve service access and quality, which in turn might facilitate workforce sustainability. [ABSTRACT FROM AUTHOR]

The Rohingya community living in the City of Canterbury-Bankstown in Sydney have been identified as a priority population with complex health needs. As part of ongoing work, AU$10 000 was provided to the community to address important, self-determined, health priorities through the Can Get Health in Canterbury program. Program staff worked with community members to support the planning and implementation of two community-led events: a soccer (football) tournament and a picnic day. This paper explores the potential for this funding model and the effect of the project on both the community and health services. Data were qualitatively analysed using a range of data sources within the project. These included, attendance sheets, meeting minutes, qualitative field notes, staff reflections and transcripts of focus group and individual discussions. This analysis identified that the project: (1) enabled community empowerment and collective control over funding decisions relating to their health; (2) supported social connection among the Australian Rohingya community; (3) built capacity in the community welfare organisation –Burmese Rohingya Community Australia; and (4) enabled reflective practice and learnings. This paper presents an innovative model for engaging with refugee communities. Although this project was a pilot in the Canterbury community, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia. The Rohingya Little Local provides an innovative model for engaging with marginalised communities. Although this project was a pilot, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia. This model is a promising and pragmatic approach to support community-led projects within place-based interventions. [ABSTRACT FROM AUTHOR]

Objective: To describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network. Methods: The Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration. Results: Early data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department. Conclusion: A model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services. What is known about the topic?: There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals. What does this paper add?: This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services. What are the implications for practitioners?: Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole. [ABSTRACT FROM AUTHOR]

Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi-organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses' experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience-based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network.MethodsThe Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration.ResultsEarly data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department.ConclusionA model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services.What is known about the topic?There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals.What does this paper add?This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services.What are the implications for practitioners?Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole. [ABSTRACT FROM AUTHOR]

Background: Healthy eating by primary school-aged children is important for good health and development. Schools can play an important role in the education and promotion of healthy eating among children. The aim of this review was to: 1) perform a systematic review of randomised controlled, quasi-experimental and cluster controlled trials examining the school-based teaching interventions that improve the eating habits of primary school children; and 2) perform a meta-analysis to determine the effect of those interventions. Methods: The systematic review was limited to four healthy eating outcomes: reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit); increased nutritional knowledge. In March 2014, we searched seven electronic databases using predefined keywords for intervention studies that were conducted in primary schools which focused on the four healthy eating outcomes. Targeted internet searching using Google Scholar was also used. In excess of 200,000 possible citations were identified. Abstracts and full text of articles of potentially relevant papers were screened to determine eligibility. Data pertaining to teaching strategies that reported on healthy eating outcomes for primary school children was extracted from the 49 eligible papers. Results: Experiential learning strategies were associated with the largest effects across the reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; and increased nutritional knowledge outcomes. Reducing sugar consumption and preference was most influenced by cross-curricular approaches embedded in the interventions. Conclusions: As with most educational interventions, most of the teaching strategies extracted from the intervention studies led to positive changes in primary school children's healthy eating behaviours. However, given the finite resources, increased overcrowding of school curriculum and capacity of teachers in primary schools, a meta-analysis of this scope is able to provide stakeholders with the best evidence of where these resources should be focused. [ABSTRACT FROM AUTHOR]

With the potentially devastating consequences of flooding, it is crucial that uncertainties in the modelling process are quantified in flood simulations. In this paper, the impact of uncertainties in design losses on peak flow estimates is investigated. Simulations were carried out using a conceptual rainfall-runoff model called RORB in four catchments along the east coast of New South Wales, Australia. Monte Carlo simulation was used to evaluate parameter uncertainty in design losses, associated with three loss models (initial loss-continuing loss, initial loss-proportional loss and soil water balance model). The results show that the uncertainty originating from each loss model differs and can be quite significant in some cases. The uncertainty in the initial loss-proportional loss model was found to be the highest, with estimates up to 2.2 times the peak flow, whilst the uncertainty in the soil water balance model was significantly less, with up to 60 % variability in peak flows for an annual exceedance probability of 0.02. Through applying Monte Carlo simulation a better understanding of the predicted flows is achieved, thus providing further support for planning and managing river systems. [ABSTRACT FROM AUTHOR]

Abstract: Topic: It is recognized that facilitating change in workplace culture is a significant challenge in healthcare service delivery. Practice development strategies and principles provide a framework for initiating and sustaining programs focused on enhancing patient‐centered care by concentrating on the therapeutic attributes of nursing. However, little literature exists on explicating “what worked” in practice development programs. Purpose: This paper details the processes, people, resources, and relationships that enabled the successful implementation, and led to the sustainability, of a practice development program employed in an acute adolescent mental health unit in Sydney, Australia. Sources used: Following an external review of the unit, a meeting of key stakeholders was convened and subsequently an advisory panel formed to address specific issues facing nursing staff. This process resulted in the development of an educational package and adoption of the tidal model as the framework for mental health nursing practice in the unit. Clinical reasoning sessions and journal article presentations were incorporated to consolidate and maintain the change in nursing care. Conclusions: A planned, structured, and inclusive practice development programhas transformed the nursing culture and vastly improved the care provided to adolescents presenting in acute states of distress to this mental health unit. [ABSTRACT FROM AUTHOR]

How often, as clinicians, do we see a really clever idea implemented in the workplace? In rural health in particular, creative work-around solutions are relatively commonplace. However, the evaluation and promotion of these ideas is less so, and this leads to lost opportunities for perpetuating these clever ideas. This paper explores one rural clinician's experience of what can happen if, instead of appreciating and complementing a great idea, that step of evaluating the great idea is taken. A reflective narrative was created, beginning with a corridor conversation ('What a great idea! Someone should evaluate that. . .'), continuing through a formal research project and ending with the impact of that project and the way its findings were communicated and implemented. The narrative outlines the effect of evaluating one great idea at the individual, workplace, organisational, state and national levels. Clinicians are well placed to identify great ideas in practice. Making the decision to evaluate these ideas can lead to personal growth, professional discovery and organisational benefits. With motivation and organisational support, who knows where evaluation may lead?. [ABSTRACT FROM AUTHOR]

Background: Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales – an area with high gambling expenditure. Methods: A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Results: Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Conclusions: Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities. Primary healthcare and community services are important settings for gambling harm screening, and more broadly can contribute to the prevention and treatment of gambling harm in communities. However, there has been limited research on how screening can be embedded into routine practice. This pilot research identifies the enablers and barriers to implementing a co-designed screening model in local primary care settings. [ABSTRACT FROM AUTHOR]

The index flood method is widely used in regional flood frequency analysis (RFFA) but explicitly relies on the identification of 'acceptable homogeneous regions'. This paper presents an alternative RFFA method, which is particularly useful when 'acceptably homogeneous regions' cannot be identified. The new RFFA method is based on the region of influence (ROI) approach where a 'local region' can be formed to estimate statistics at the site of interest. The new method is applied here to regionalize the parameters of the log-Pearson 3 (LP3) flood probability model using Bayesian generalized least squares (GLS) regression. The ROI approach is used to reduce model error arising from the heterogeneity unaccounted for by the predictor variables in the traditional fixed-region GLS analysis. A case study was undertaken for 55 catchments located in eastern New South Wales, Australia. The selection of predictor variables was guided by minimizing model error. Using an approach similar to stepwise regression, the best model for the LP3 mean was found to use catchment area and 50-year, 12-h rainfall intensity as explanatory variables, whereas the models for the LP3 standard deviation and skewness only had a constant term for the derived ROIs. Diagnostics based on leave-one-out cross validation show that the regression model assumptions were not inconsistent with the data and, importantly, no genuine outlier sites were identified. Significantly, the ROI GLS approach produced more accurate and consistent results than a fixed-region GLS model, highlighting the superior ability of the ROI approach to deal with heterogeneity. This method is particularly applicable to regions that show a high degree of regional heterogeneity. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government's 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources. [ABSTRACT FROM AUTHOR]

Qualitative findings on how evidence-based practice (EBP) is conceptualised and implemented in an Australian human service organisation are presented. The paper examines the application and relevance of the five-step decision-making model of EBP to the organisational context and also the position of standardised ‘evidence-based programmes’ in relation to EBP decision making. The case study has shown that the five-step model of EBP decision making is relevant to a human service organisational context, but that some modifications of the model would enhance its applicability and utility. First, it is proposed that the five-step model would be better conceived systemically to reflect the relational and contextual processes impacting on practice decision making in the teams and organisations in which social workers practise, rather than being confined to individual, clinical decision making. Second, a cyclic model is offered in order to capture a process of ongoing critical reflection, evidence gathering and programme modification as organisations develop and refine programmes to address priorities and improve client outcomes in complex and dynamic environments. [ABSTRACT FROM AUTHOR]

Individuals processing the information in a stated choice experiment are typically assumed to evaluate each and every attribute offered within and between alternatives, and to choose their most preferred alternative. However, it has always been thought that some attributes are ignored in this process for many reasons, including a coping strategy to handle one’s perception of the complexity of the choice task. Nonetheless, analysts typically proceed to estimate discrete choice models as if all attributes have influenced the outcome to some degree. The cognitive processes used to evaluate trade-offs are complex with boundaries often placed on the task to assist the respondent. These boundaries can include prioritising attributes and ignoring specific attributes. In this paper we investigate the implications of bounding the information processing task by attribute elimination through ignoring one or more attributes. Using a sample of car commuters in Sydney we estimate mixed logit models that assume all attributes are candidate contributors, and models that assume certain attributes are ignored, the latter based on supplementary information provided by respondents. We compare the value of travel time savings under the alternative attribute processing regimes. Assuming that all attributes are not ignored and duly processed, leads to estimates of parameters which produce significantly different willingness to pay (WTP) to that obtained when the exclusion rule is invoked. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to demonstrate that the performance of an elite female swimmer in the finals of the 200-m backstroke at the Olympic Games 2000 in Sydney can be predicted by means of the nonlinear mathematical method of artificial neural networks (Multi-Layer Perceptrons). The data consisted of the performance output of 19 competitions (200-m backstroke) prior to the Olympics and the training input data of the last 4 weeks prior to each competition. Multi-Layer Perceptrons with 10 input neurons, 2 hidden neuron, and 1 output neuron were used. Since the data of 19 competitions are insufficient to train such networks, the training input and competition data of another athlete were used in the training processes of the neural networks to pre-train the neural networks. The neural models were validated by the "leave-one-out" method, then the neural models were used to predict the Olympic competitive performance. The results show that the modeling was very precise; the error of the prediction was only 0.05 s, with a total swim time of 2:12.64 min:s. [ABSTRACT FROM AUTHOR]

Medicare is central to accessing health care in Australia, yet many asylum seekers are ineligible for this scheme. In NSW, Medicare ineligible asylum seekers have some access to public health care under the Medicare Ineligible Asylum Seekers - Provision of Specified Public Health Services policy. This policy was updated in November 2020 to clarify services where a fee waiver applies for asylum seekers without Medicare. We examined the experiences of Medicare ineligible asylum seekers in accessing health care in New South Wales (NSW) in light of the revised policy. Employing qualitative methods, we conducted semi-structured interviews with asylum seekers (n = 7) and service providers (n = 6) in South Western Sydney. The interviews were analysed using thematic analysis and the socio-ecological model was used to interpret the data. Participants identified that chronic and mental health conditions are the main health issues for asylum seekers. Factors across the four levels of the socio-ecological model were identified as influencing the health care of asylum seekers, including a lack of awareness about health care rights at the individual level , support from relatives and friends at the interpersonal level , providers' lack of awareness of fee waivers at the organizational level and limited access to primary health care at the policy level. The results imply that Medicare ineligible asylum seekers in NSW do not have optimal access to health care which may worsen existing health disparities. Educational initiatives that improve service providers' and asylum seekers' awareness of the revised policy are needed to improve asylum seeker health equity in NSW. [ABSTRACT FROM AUTHOR]

Cultural responsiveness is a term accepted by many as the best descriptor for professionals working with Indigenous clients in cross-cultural situations. This article sets out a guideline and a model of cultural responsiveness that can be adopted by mental health professionals worldwide. This model positions reflexivity at the centre and as the source and force that drives the cultural responsiveness dynamic. Domains of this model were previously identified from the literature and provide a guideline for students and practitioners to learn and to work in ways that are culturally responsive. Implications for the use of this model within teaching and learning contexts as well as within professional practice are discussed. Key points What is already known about this topic: Cultural responsiveness is a fundamental requirement for mental health practitioners working with Aboriginal and Torres Strait Islander people. Cultural responsiveness is a core learning component for students of psychology aspiring to work as mental health practitioners. Reflexivity is an important aspect of the cultural responsiveness dynamic. What this topic adds: A new model of cultural responsiveness that is dimensional and iterative. A model that centres reflexivity as the source and impetus for developing cultural responsiveness. A more defined guideline of cultural responsiveness that assists teaching and learning for institutions, students, and practitioners. [ABSTRACT FROM AUTHOR]

Abstract: We discuss the role and characteristics of water markets in Australia in facilitating efficient water allocation. Administrative, regulatory and/or political barriers to effective functioning of water markets are reviewed with a focus on the southern Murray-Darling Basin (MDB) region of Australia. A mathematical model is developed to estimate the costs of existing restrictions and the benefits from potential changes in water markets (e.g., removing barriers in temporary water markets). The modelling results reveal that expanding trade leads to an increase in mean annual net returns from AU $2502 million to AU $2590 million (i.e., an increase of AU $88 million). When the current volume restrictions, exchange rates, and trading charges are accounted for, mean annual net returns reduced from AU $2590 million to AU $2573 million (i.e., a reduction of AU $17 million). The exclusion of any of the three southern MDB states from the interstate water trading imposes significant costs. If South Australia, New South Wales or Victoria withdraws from the water market, net returns are reduced by AU $27 million, AU $31 million and $63 million, respectively. The paper outlines the policy implications of strategies to remove market barriers and to facilitate efficient and effective water trading. [Copyright &y& Elsevier]

Summary: The use of artificial neural networks (ANNs) for the modelling of water resources variables has increased rapidly in recent years. This paper addresses one of the important issues associated with artificial neural network model development; input variable selection. In this study, the partial mutual information (PMI) input selection algorithm is modified to increase its computational efficiency, while maintaining its accuracy. As part of the modification, use of average shifted histograms (ASHs) is introduced as an alternative to kernel based methods for the estimation of mutual information (MI). Empirical guidelines are developed to estimate the key ASH parameters as a function of sample size. The stopping criterion used with the original PMI algorithm is replaced with a more computationally efficient outlier detection technique based on the Hampel distance. The performance of the proposed PMI algorithm, in terms of computational efficiency and input selection accuracy, is first investigated by using it to identify significant variables for data series where dependencies of attributes are known a priori. The proposed ASH PMI input variable selection algorithm with the Hampel distance stopping criterion consistently selects the correct inputs, while being computationally efficient. The modified PMI algorithm is then applied to identify suitable inputs to forecast salinity in the River Murray at Murray Bridge, South Australia, with a lead time of 14 days using an ANN approach. The ANN models developed with the inputs selected with the modified PMI algorithm perform very well when compared with results obtained using ANN models with different input sets developed in previous studies. Furthermore, the proposed input variable selection algorithm results in more parsimonious ANN models. [Copyright &y& Elsevier]

BACKGROUND: A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI). OBJECTIVE: To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM). METHODS: A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor –Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale. RESULTS: SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers. CONCLUSIONS: This study contributes to better targeting strength-based family interventions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential gaming of the 4 h ED length of stay metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in New South Wales (NSW). Methods: Descriptive statistical analysis was used to recalculate and compare the scores for NEAT and the NSW ETP using variations in the definitions of their measurement on 32 184 presentations during 2016. A computer simulation using a discrete event model illustrated the effect of the use of ED short stay beds on the ETP scores. Results: Using the timestamp of the intent to discharge a patient, called, 'ready for departure' instead of the time of a patient physically leaving the department, resulted in an apparent 6% performance improvement. A local interpretation of the NSW state definition of the 'transferred' patient resulted in the ETP for 'admitted' patients improving by 16%. The discrete event model demonstrated that without changing patient length of stay, ETP scores can be improved by optimising the time of the admit decision or increasing the number of ED short stay beds. Conclusions: The opportunity of NEAT may be squandered unless gaming of the definitions and use of ED short stay beds is addressed. We argue that the longstanding issue of 'departure time' should be defined as 'physically leaving' the department, in accordance with the Australasian College for Emergency Medicine (ACEM) definition. Patient occupancy is a real measure of ED resource use and NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT definitions to ensure they truly reflect patient flow processes. [ABSTRACT FROM AUTHOR]

Aim: To define and quantify hospital‐acquired malnutrition, including the concept of preventable and non‐preventable malnutrition; and identify the main causes of preventable malnutrition. Furthermore, demonstrate potential cost‐savings for a quaternary hospital in Sydney (Australia) if a theoretical model of preventable malnutrition was applied to the penalties associated with hospital‐acquired malnutrition, compared to the current government framework. Methods: A retrospective audit was conducted on electronic medical records reassessing cases of hospital‐acquired malnutrition previously identified by dietitians or medical coders. Costs were calculated using the Independent Hospital Pricing Authority's (IHPA) pricing principles for hospital‐acquired complications (version 3, 2018). Results: Twenty‐three patients of 15 419 admissions were identified with hospital‐acquired malnutrition in the 3‐month study period. Sixteen cases (70%) were classified as preventable, two cases (9%) were classified as non‐preventable, and five cases were non‐hospital‐acquired cases of malnutrition. Under the IHPA proposed costing model, total cost of all hospital‐acquired malnutrition to the hospital is estimated to be $162 600 over 3 months. The theoretical model of preventable malnutrition resulted in a cost penalty of only $98 600, which is a hospital cost‐saving of $64 000 (or 40% of the overall penalty) when compared to the current government framework. Conclusions: The majority of hospital‐acquired malnutrition cases were found to have a preventable component. It is proposed that a costing model that penalises hospitals for only preventable hospital‐acquired malnutrition be considered, which would permit hospitals to focus on addressing preventable (and thus actionable) causes of hospital‐acquired malnutrition with not only potential health benefits to patients but cost‐savings to hospitals. [ABSTRACT FROM AUTHOR]

This study examines the domains of religious coping strategies among African Christians in New South Wales, Australia, and the role they play in negotiating quality of life and life stressors. Study themes were drawn from interview transcripts that showed positive and negative aspects of religious coping, involving multiple domains including personal, social, and environmental attributes. Of particular interest were the correlations that respondents drew between their personal biographies, environmental stressors, human-based coping, and religious coping behavior. These results position religious coping as a social cognitive model which may arise from relationship problems, while serving the need for autonomy. Implications are discussed. [ABSTRACT FROM AUTHOR]

Following a history of the Australian health system and funding models, we outline workforce issues, in particular, the lack of health professionals in regional locations. The role of the Australian government health departments in workforce planning is discussed. We describe research funded by the Commonwealth government focussing on the development of interprofessional education (IPE) for collaborative practice. New models of interprofessional care have been introduced to help tackle the population needs: in the Australian Capital Territory (ACT); HealthOne in New South Wales; health-care homes nationally; and partnerships between pharmacists and general practitioners in Victoria. Changes in care delivery necessitate innovations in health education, however how IPE is embedded in Australian health professional education still varies. There is a growing sense of an IPE community complemented by an interest in IPE from peak policy and workforce bodies. There are changes underway in health professional registration and accreditation that are likely to regulate shared and common learning to enable the continuous development of a flexible, responsive and sustainable health workforce. We conclude that there are significant opportunities for further development of IPE and collaborative practice as key strategies for adding to the ability of health systems to address individual needs in conjunction with aiming for optimal and universal health coverage. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the likely reduction in road trauma associated with the implementation of effective interventions to reduce road trauma among young Australians. Methods: A desktop evaluation was conducted to model the likely reduction in road trauma (deaths and serious injuries resulting in hospitalization) among young people aged 17–24 years residing in Queensland, New South Wales, and Victoria. Potential interventions were identified using a rapid literature review and assigned a score based on evidence of effectiveness and implementation feasibility with the 3 highest scoring interventions included in the modeling. Likely reduction in road trauma was estimated by applying the average risk reduction effect sizes for each intervention to baseline risk (passenger or driver death or serious injury per 100,000 population) of road trauma for young Australians. Point estimates were calculated for the potential number of deaths and serious injuries averted in each state and per 100,000 population, with a one-way sensitivity analysis conducted using uncertainty ranges identified. Results: Peer passenger and night driving restrictions as well as improved vehicle safety measures had the greatest potential to reduce road trauma. Peer passenger restrictions could avert 14 (range: 5–24) and 24 (range: 8–41) hospitalizations per year in Queensland and New South Wales, respectively, and night driving restrictions could avert 17 (range: 7–26), 28 (range: 12–45), and 13 (range: 6–21) hospitalizations annually in Queensland, New South Wales, and Victoria. These interventions reduced fatalities by less than 1 death annually in each state. Improved vehicle safety measures could avert 0–3, 0–4, and 0–3 deaths and 3–91, 4–156, and 2–75 hospitalizations in Queensland, New South Wales, and Victoria. Conclusions: Key elements of graduated licensing (peer passenger and night driving restrictions) along with vehicle safety interventions offer modest but practically significant reductions in road trauma for young Australians. State governments need to revise current legislation to ensure that these reductions in road trauma can be realized. [ABSTRACT FROM PUBLISHER]

Background: Poor housing is widely cited as an important determinant of the poor health status of Aboriginal Australians, as for indigenous peoples in other wealthy nations with histories of colonisation such as Canada, the United States of America and New Zealand. While the majority of Aboriginal Australians live in urban areas, most research into housing and its relationship with health has been conducted with those living in remote communities. This study explores the views of Aboriginal people living in Western Sydney about their housing circumstances and what relationships, if any, they perceive between housing and health.Methods: Four focus groups were conducted with clients and staff of an Aboriginal community-controlled health service in Western Sydney (n = 38). Inductive, thematic analysis was conducted using framework data management methods in NVivo10.Results: Five high-level themes were derived: the battle to access housing; secondary homelessness; overcrowding; poor dwelling conditions; and housing as a key determinant of health. Participants associated their challenging housing experiences with poor physical health and poor social and emotional wellbeing. Housing issues were said to affect people differently across the life course; participants expressed particular concern that poor housing was harming the health and developmental trajectories of many urban Aboriginal children.Conclusions: Housing was perceived as a pivotal determinant of health and wellbeing that either facilitates or hinders prospects for full and healthy lives. Many of the specific health concerns participants attributed to poor housing echo existing epidemiological research findings. These findings suggest that housing may be a key intervention point for improving the health of urban Aboriginal Australians. [ABSTRACT FROM AUTHOR]

Background: Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS. Objective: The aim was to examine the question: how can decision making that is both effective and patient‐centred be enacted in ALS multidisciplinary care? Setting and participants: Fifty‐four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi‐structured interviews. Interviews were transcribed, coded and analysed thematically. Results: Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision‐making process; patient‐centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non‐specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: ‘Participant Engagement’; ‘Option Information’; ‘Option Deliberation’; and ‘Decision Implementation’. Discussion: Effective and patient‐centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient‐centred decision making, by incorporating patients' cyclic decision‐making patterns and facilitating carer inclusion in decision processes. Conclusions: The model captures the complexities of patient‐centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. [ABSTRACT FROM AUTHOR]

Causal agents for workers' compensation claims and physical injury have largely been identified as physical demands. We proposed an integrated theory of physical injury (i.e. musculoskeletal disorder symptoms [MSDs]) and workers' compensation claims, which combined psychosocial and physical mechanisms. A random, population-based sample of 1095 Australian workers completed a telephone interview on two occasions 12 months apart. As expected, the physical mechanism was confirmed; physical demands were related to MSDs, which in turn predicted workers' compensation claims. Further, a novel psychosocial mechanism was confirmed. Psychosocial safety climate (PSC; perceptions about the organisation's climate for psychological health) was a precursor to psychosocial risks (e.g. harassment, violence, bullying and work pressure). In turn, these psychosocial risks were related to emotional exhaustion, MSDs and then workers' compensation claims. Evidence was therefore provided forpsychosocial-physical processesin explaining MSDs and workers' compensation for claims for physical injury. Occupational health and safety legislators and policy makers should be aware that, beyond physical demands, factors usually associated with risk for mental stress claims (e.g. harassment, bullying, and violence) may additionally manifest in physical health problems and workers' compensation injury claims. Focusing on modifying the PSC in an organisation, “the cause of the causes”, may be an effective injury prevention and intervention strategy. [ABSTRACT FROM PUBLISHER]

In New South Wales (NSW), a new suite of nutrition standards for menus and specifications for therapeutic diets to be used in hospitals has been developed. These standards were required to facilitate centralised menu planning and food production, with the move to management of most hospital food services by HealthShare NSW, a state-wide business unit of NSW Health. The standards also aim to improve communication between health professionals, particularly with the increasing use of computerised meal-ordering systems. Nutrition standards have been developed for adult, paediatric and mental health inpatients, and specifications for 147 different adult and paediatric therapeutic diets. There is still significant variation in the nutrition standards for nutrition and therapeutic diets in hospitals across the Australian states, and a move to a more nationally harmonised approach would be welcome. Further research is required to examine the impact of these standards on operating efficiency and patient care outcomes. [ABSTRACT FROM AUTHOR]

Peer support facilitates recovery. However, little is known about the role of peer support within the Clubhouse model. This article reports on Clubhouse members' experiences of peer support and the outcomes they identify from engaging in this phenomenon. Grounded theory guided the study design involving 17 semi-structured interviews conducted with 10 Clubhouse members. Constant comparison and open coding were undertaken to identify underlying concepts within transcripts. A conceptual model of peer support was derived from Clubhouse members' experience. Four levels of peer support emerged: Social inclusion and belonging; shared achievement through doing; interdependency; and at the deepest level, intimacy. Peer support within Clubhouse is a multi-layered construct in terms of depth and nature of relationships. Clubhouse appears to contribute a unique tier within the layered construct of peer support. This tier is based on the sharing of achievement through working together on shared tasks within the work-ordered day Clubhouse structure. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration. Design Longitudinal cohort study. Setting, participants and measurements Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997-31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i.e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration. Findings Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration; however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment. Conclusions In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth. [ABSTRACT FROM AUTHOR]

The regulation of pain and other emotions is a developmental process that takes place in the context of attachment relationships. Children with chronic, medically unexplained pain struggle to accurately identify, communicate and regulate negative body states, and to connect these body states to their day-to-day experience. This article describes an individual intervention – one component of a multimodal treatment programme – whose aim is to help children find skills to manage their pain. The intervention incorporates ideas and practices from several theoretical models – the dynamic-maturational model of attachment, cognitive-behavioural theories, narrative therapy, art therapy, sensorimotor approaches –pragmatically selected and adapted to help children presenting to our Chronic Pain Service achieve good clinical outcomes. At the outset we assess the child’s capacity to identify, regulate and communicate positive and negative body states, and tailor our individual intervention so as to extend each child’s proximal level of development. We initially focus on the body in an effort to equip the child with a non-verbal, image-based language for identifying and communicating pain and other negative body states. Once the child has developed a non-verbal way of knowing her body, a range of cognitive-behavioural, narrative and other strategies are introduced. The intervention aims to increase the child’s emotional functioning: her skill in identifying, symbolically representing, communicating and managing pain and other negative body states. [ABSTRACT FROM PUBLISHER]

Little research has been done on the experience of diabetes-related amputation. The aim of this study was to allow amputees to describe their experiences of amputation and to generate grounded theory that will lead health professionals towards a more comprehensive understanding of the realities of post-amputation life. Unstructured interviews were conducted with five participants with a diabetes-related amputation living in a rural setting, and their respective carers. The interviews were analysed using Grounded Theory methods. Data analysis revealed three categories: 'imposed powerlessness', 'adaptive functionality' and 'endurance'. The impact of participant's amputations were influenced by continuing limb problems post-amputation and co-existing complications affecting their physical function. Medical errors and lack of awareness of the risks for diabetic amputations resulted in uncertainty and fear. The participants' sense of grief, loss and shock post operatively continued later as they came to terms with their awkwardness of movement, yet they moved forward developing their own sense of hope through a coping process that revealed remarkable ability to endure and exert control over lives that seemed to be at the whim of an ongoing disease process. The substantive theory resulting from this grounded theory study was conceptualised as 'A Path of Perpetual Resilience'. It is important that psychosocial and not just physical adjustment is considered an indicator for determining outcomes for these people, and that future care involves strategies to promote this. A greater sample size is required to determine if these findings are transferable to the general diabetes-related amputation population. [ABSTRACT FROM AUTHOR]

Background HIV physicians have limited time for cognitive screening. Here we developed an extra-brief, clinically based tool for predicting HIV-associated neurocognitive impairment (HAND) in order to determine which HIV-positive individuals require a more comprehensive neurological/ neuropsychological (NP) assessment. Methods Ninety-seven HIV-positive individuals with advanced disease recruited in an HIV out-patient clinic received standard NP testing. A screening algorithm was developed using support vector machines, an optimized prediction procedure for classifying individuals into two groups (here NP-impaired and NP-normal) based on a set of predictors. Results The final algorithm utilized age, current CD4 cell count, past central nervous system HIV-related diseases and current treatment duration and required approximately 3 min to complete, with a good overall prediction accuracy of 78% (against the gold standard; NP-impairment status derived from standard NP testing) and a good specificity of 70%. Conclusion This noncognitive-based algorithm should prove useful to identify HIV-infected patients with advanced disease at high risk of HAND who require more formal assessment. We propose staged guidelines, using the algorithm, for improved HAND therapeutic management. Future larger, international studies are planned to test the predictive effect of nadir CD4 cell count, hepatitis C virus infection, gender, ethnicity and HIV viral clade. We recommend the use of this first version for HIV-infected Caucasian men with advanced disease. [ABSTRACT FROM AUTHOR]

Background Despite the decline in the incidence of cervical cancer in Australia as a result of population screening, a substantial proportion of women in NSW screen less regularly than the recommended two-yearly interval or do not screen. With higher rates of cervical cancer in unscreened and underscreened women, and despite the introduction of the human papillomavirus vaccine, there remains a need to continue to remind women to screen. The mass media has been shown to be effective at improving participation in cervical screening. A 2007 television advertising campaign to promote cervical screening in New South Wales (NSW) was examined. Methods Data from the NSW Papanicolaou (Pap) Test Register were used to compare weekly numbers of Pap tests for NSW overall and in metropolitan local government areas with low screening rates by age group and by time since the last Pap test. Time series regression analysis incorporating seasonal effects was used to estimate the strength of the association between screening and the media campaign. Results Overall during the advertising campaign, 15% more screens (16 700) occurred than expected for 2007 without the advertising campaign. Increases were evident among unscreened and underscreened women, with little overscreening occurring. Women living in low screening areas also showed a significant increase in mean weekly screens of 21% (388) over that expected in the absence of the media campaign. Conclusions Despite the ecological nature of this study, the mass media campaign appears to have been successful in increasing screening in unscreened and underscreened women in NSW. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore first-time mothers’ experiences of birth at home and in hospital in Australia. Background. The first birth has unique physical and psychological impacts on women. With the first birth, women become mothers. Design. A grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Methods. Nineteen women were interviewed in Sydney, Australia. The experiences of seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were contrasted with two mothers who gave birth for the first time in birth centres, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results. Following the birth, women ‘processed the birth’ by ‘remembering’, ‘talking (storytelling)’ and ‘feeling’. This activity appeared to help most women resolve their feelings about the birth and understand what it actually means to be a new mother. ‘Personal and social integration’ occurred for most women as they entered ‘motherland’. Conclusion. First-time mothers appear to ‘process the birth’ to a greater extent than multiparous women because they are experiencing this for the first time. These women also have limited social networks in ‘motherland’, and these are facilitated through sharing the experiences of their labour or ‘processing the birth’. Relevance to clinical practice. Identifying the novice status of first-time mothers and understanding the way they process the birth can help health providers to be sensitive to the specific needs of primiparous women. In particular, their need to tell their birth stories following birth; understanding that these stories help women to process the birth and connect to other women. [ABSTRACT FROM AUTHOR]

The performance of a power based fuel consumption and exhaust emissions model for spark ignition vehicles has been evaluated using a large Australian database derived from testing a wide range of in-use cars on a chassis dynamometer. It was also applied to results of on-road fuel consumption measurement using a "floating" car which was driven back and forth on hilly roadways in Sydney with a length of 8.6 km. The model is found to predict the fuel consumption well over the standard drive cycles and also for the floating car. Average exhaust emissions were also well predicted, but, as would be expected, vehicle-to-vehicle correlation is impossible due to the well-known high variability of emissions between nominally identical vehicles. [ABSTRACT FROM AUTHOR]