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The traditional break–fix model of healthcare, characterised by reactive interventions after the onset of diseases, is undergoing a significant transformation globally, including in Australia. This is occurring at the same time that revolutionary technologies such as artificial intelligence and precision prevention of disease are emerging. This article explores the imperative to transition from our current break–fix model of health care towards a predict–prevent model, emphasising proactive healthcare strategies underpinned by technology. [ABSTRACT FROM AUTHOR]

As health care continues to change and evolve in a digital society, there is an escalating need for physicians who are skilled and enabled to deliver care using digital health technologies, while remaining able to successfully broker the triadic relationship among patients, computers and themselves. The focus needs to remain firmly on how technology can be leveraged and used to support good medical practice and quality health care, particularly around resolution of longstanding challenges in health care delivery, including equitable access in rural and remote areas, closing the gap on health outcomes and experiences for First Nations peoples and better support in aged care and those living with chronic disease and disability. We propose a set of requisite digital health competencies and recommend that the acquisition and evaluation of these competencies become embedded in physician training curricula and continuing professional development programmes. [ABSTRACT FROM AUTHOR]

Keywords: Technology; Chronic disease; Prevention and control; Datasets as topic EN Technology Chronic disease Prevention and control Datasets as topic 384 388 5 05/17/23 20230515 NES 230515 Smartwatches can count every step towards a predict-prevent health care system, but clinical regulation is the first leap Australia is struggling with the ever-increasing burden of chronic disease. As health care professionals, we can further our understanding of smartwatch use in chronic disease through further research using real world data - with the ultimate goal of improving autonomy and health outcomes for consumers. [Extracted from the article]

Keywords: eHealth; Information management; Health financing; Health services research EN eHealth Information management Health financing Health services research 53 57 5 02/07/23 20230201 NES 230201 Focusing solely on financial measures is unlikely to deliver a comprehensive view of the value of digital health Digital health, which refers to the use of digital technology to provide and support health care services, promises to strengthen health systems worldwide and has been accelerated by the coronavirus disease 2019 (COVID-19) pandemic.[1] Amid the rapid digital transformation of health care,[[2]] the value of sizeable digital health investments remains unclear.[[3]] The investments required for digital health are often substantial and may come at a cost to existing health care delivery models. Conclusion Health care organisations are currently not measuring the true value of digital health implementations and, thus, digital investment may not be prioritised given the competing health care demands. With the burden on the health care system to continue service delivery with static resourcing, an ageing population and growing health inequities, digital health provides an unrivalled opportunity to improve care at scale. [Extracted from the article]

Introduction: In Australia, the available published literature demonstrated a spike in dispensed prescription medicines after the onset of the COVID‐19 pandemic that subsequently returned to expected levels. Smoking cessation medicines may not follow this pattern because quit attempts are influenced by a range of factors. Knowledge of whether dispensing of these medicines has changed since the pandemic is lacking. We explored the change in dispensing of publicly subsidised smoking cessation medicines since the pandemic. Methods: Australia's universal health‐care system provides access to government‐subsidised medicines via the Pharmaceutical Benefits Scheme and records of dispensed medicines are publicly available on a nationally aggregated level. We retrieved Pharmaceutical Benefits Scheme data from January 2016 to January 2021. We used interrupted time series modelling to quantify the impact of COVID‐19 on dispensing of nicotine replacement therapy (NRT) patches, varenicline and all smoking cessation treatments combined separately. Results: After an initial spike in medicines at the onset of the pandemic, the monthly rate of prescriptions dispensed for varenicline was predominantly within predicted ranges, while that of NRT patches was predominantly below predicted ranges. Discussion and Conclusions: There has been a differential change in the number of subsidised smoking cessation medicines supplied in Australia since the COVID‐19 pandemic, with varenicline prescriptions largely within, and NRT patches largely lower than, expected ranges. The reasons for the apparent change in dispensing of subsidised smoking cessation medicines are unclear. [ABSTRACT FROM AUTHOR]

The article discusses the adoption of artificial intelligence (AI) in healthcare and the need for a thoughtful and inclusive approach to this data-driven revolution. The authors highlight the importance of amplifying the voices of people who receive healthcare and ensuring that they have control over their personal data. The article presents the findings of a citizens' jury, which recommended an independent national charter for AI in health and emphasized the importance of rigorous evaluation, fairness, patient rights, and community involvement. The authors conclude that while the advent of AI in healthcare is inevitable, it should be accompanied by robust governance and privacy measures, guided by the principle of "nothing about me without me." [Extracted from the article]

Background and objective: An epidemic of silicosis has emerged due to a failure to control risks associated with exposure to high‐silica content respirable dust generated while working with artificial stone products. Methods for quantification of alveolar crystal burden are needed to advance our understanding of the pathobiology of silica‐related lung injury as well as assisting in the diagnosis, clinical management and prognostication of affected workers. The objective of this study was to develop and validate novel methods to quantify alveolar crystal burden in bronchoalveolar lavage (BAL) fluid from patients with artificial stone silicosis. Methods: New methods to quantify and analyse alveolar crystal in BAL from patients with artificial stone silicosis were developed. Crystals were isolated and counted by microscopy and alveolar crystal burden was calculated using a standard curve generated by titration of respirable α‐Quartz. The utility of the assay was then assessed in 23 patients with artificial stone silicosis. Results: Alveolar crystal burden was greater in patients with silicosis (0.44 picograms [pg]/cell [0.08–3.49]) compared to patients with other respiratory diagnoses (0.057 pg/cell [0.01–0.34]; p < 0.001). Alveolar crystal burden was positively correlated with years of silica exposure (ρ = 0.49, p = 0.02) and with decline in diffusing capacity of the lungs for carbon monoxide (ρ = −0.50, p = 0.02). Conclusion: Alveolar crystal burden quantification differentiates patients with silicosis from patients with other respiratory disorders. Furthermore, crystal burden is correlated with the rate of decline in lung function in patients with artificial stone silicosis. [ABSTRACT FROM AUTHOR]

Radiological dirty bombs and improvised nuclear devices pose a significant threat to both public health and national security. Growing networks of radiation sensors have been deployed by a number of offices within the U.S. and international agencies. Detecting such threats while minimizing false alarm rates presents a considerable challenge to homeland security and public health. This research aims to achieve a higher probability of detection with a lower probability of false alarms. It focuses on the local spatial instability of radiation levels in order to detect radioactive materials based on robust outlier detection methods. Our approach includes a three‐step abnormality detection method consisting of one‐dimensional robust outlier detection for all gamma‐ray counts, a density‐based clustering analysis, and a two‐dimensional robust outlier detection method using a bagplot, based on spatial associations. The effectiveness of the method proposed is demonstrated through a case study, wherein radioactive materials are detected in urban environments, and its performance is compared with alternative methods employing a k‐sigma approach, local Getis–Ord (Gi*) statistic, and the goodness of fit of the Poisson distribution. [ABSTRACT FROM AUTHOR]

Unwell patients in the ED requiring inpatient admission must negotiate the interface between the ED and inpatient wards. Despite its importance and scale, this ED-inpatient interface (EDii) is poorly characterised. The aim of this paper is to clearly define the EDii and to describe its importance to (i) the patient: delays to admission and errors in communication across the EDii can increase adverse outcomes; (ii) the hospital: poor EDii function reduces hospital efficiency and effectiveness; and (iii) the healthcare system: half of all hospital inpatient admissions occur via the EDii and so EDii affects system-wide performance. The EDii can be defined as the dynamic, transitional phase of patient care in which responsibility for, and delivery of care, is shared between ED and inpatient hospital services. The EDii is characterised by a complex interplay of patient, hospital and system factors. A clear definition of the EDii and an understanding of its importance will assist future research and interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges at the Princess Alexandra Hospital (PAH) in Australia for transforming into an integrated digital tertiary hospital, with topics including the use of electronic medical records (EMR) in the hospital, medical technology management, and the medical care quality.

Objective We sought to obtain a deeper understanding of the differing needs and expectations of inpatient and ED medical staff regarding the admission process for medical patients. Design Online questionnaire regarding their attitudes to and perceptions of various aspects of the admission process was used. Setting The setting is a tertiary 640-bed adult hospital with over 60 000 ED presentations per year and an inpatient admission rate of 30%. Results A total of 42 out of 56 (75%) internal medical trainees (IMT) felt that the ED admission workup standard was lower or much lower than the inpatient standard; however, 10 of 16 (62.5%) ED trainees (EDT) thought it was similar ( P = 0.009). Regarding why IMT order additional tests in the ED, the major reason supported by IMT was to 'identify or exclude urgent pathology' (53/56, 96.4%); however, this reason ranked only fifth for EDT (2/16, 12.5%) who ranked 'to ensure nothing was missed' (12/15, 80%) first. A total of 24 out of 56 (42.8%) IMT felt that if ED admissions were enacted without IMT review, inappropriate admissions to hospital would occur regularly although only one of 16 EDT (6.3%) agreed ( P = 0.025). A total of 14 out of 16 (87.5%) EDT but only 16 of 56 (23.2%) IMT were comfortable with admissions occurring without inpatient review in the ED ( P < 0.001). The top two perceived barriers to a smooth and timely admission process for IMT were patient instability (34/43, 79.1%) and inadequate ED workup (37/49, 75.5%); for EDT, they were excessive IMT workload (11/14, 78.6%) and referral close to the end of an IMT shift (7/11, 63.6%). Conclusion Substantial barriers to more harmonious admission processes exist. A 'paradigm shift' where roles and responsibilities are clear might be required. Defusing tension across the ED-inpatient interface should improve efficiency and ensure that patient outcomes remain the focus. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has highlighted the lack of readily available evaluation processes to provide health services with the assurance that PPE sourced using novel methods, such as crowdsourcing or 3D printing, is fit for purpose and TGA compliant. Protective devices, Health services research, Health services, Health systems, Quality assurance, health care, Risk management, COVID-19, Infectious diseases, Respiratory tract infections Keywords: Protective devices; Health services research; Health services; Health systems; Quality assurance; health care; Risk management; COVID-19; Infectious diseases; Respiratory tract infections EN Protective devices Health services research Health services Health systems Quality assurance health care Risk management COVID-19 Infectious diseases Respiratory tract infections 496 496 1 06/23/21 20210615 NES 210615 Novel PPE, such as 3D printed face shields, must be compliant with regulatory requirements and a clinical evaluation protocol should be developed Personal protective equipment (PPE) is critical in protecting hospital staff during the treatment of patients throughout the coronavirus disease 2019 (COVID-19) pandemic. [Extracted from the article]

Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: We explored the relationship between the National Emergency Access Target (NEAT) compliance rate, defined as the proportion of patients admitted or discharged from emergency departments (EDs) within 4 hours of presentation, and the risk-adjusted in-hospital mortality of patients admitted to hospital acutely from EDs.Design, Setting and Participants: Retrospective observational study of all de-identified episodes of care involving patients who presented acutely to the EDs of 59 Australian hospitals between 1 July 2010 and 30 June 2014.Main Outcome Measure: The relationship between the risk-adjusted mortality of inpatients admitted acutely from EDs (the emergency hospital standardised mortality ratio [eHSMR]: the ratio of the numbers of observed to expected deaths) and NEAT compliance rates for all presenting patients (total NEAT) and admitted patients (admitted NEAT).Results: ED and inpatient data were aggregated for 12.5 million ED episodes of care and 11.6 million inpatient episodes of care. A highly significant (P < 0.001) linear, inverse relationship between eHSMR and each of total and admitted NEAT compliance rates was found; eHSMR declined to a nadir of 73 as total and admitted NEAT compliance rates rose to about 83% and 65% respectively. Sensitivity analyses found no confounding by the inclusion of palliative care and/or short-stay patients.Conclusion: As NEAT compliance rates increased, in-hospital mortality of emergency admissions declined, although this direct inverse relationship is lost once total and admitted NEAT compliance rates exceed certain levels. This inverse association between NEAT compliance rates and in-hospital mortality should be considered when formulating targets for access to emergency care. [ABSTRACT FROM AUTHOR]