Search

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this pragmatic stepped‐wedge cluster RCT was to determine the efficacy of a co‐designed dementia specialist training program (the PITCH program) for home care workers (HCWs) to improve their confidence and knowledge when providing care for clients living with dementia. Methods: HCWs who provided care to clients with dementia were recruited from seven home care service provider organisations in Australia between July 2019 and May 2022, and randomised into one of 18 clusters. The primary outcome was HCW's sense of self‐competence in providing care services to people living with dementia at 6 months post PITCH training measured by the Sense of Competence in Dementia Care Staff (SCIDS) Scale. Results: Two hundred and thirteen HCWS completed baseline assessment and almost half (48.4%) completed all three study assessments. HCWs in clusters that received PITCH training had significantly higher sense of competence (measured by SCIDS) than those who had not received PITCH training. Post hoc analysis revealed that face‐to‐face PITCH training consistently resulted in improvements in the HCWs sense of competence, dementia attitudes and knowledge when compared to online training and when compared to no training. PITCH training had no effect on the sense of strain HCWs felt in delivering dementia care. Conclusions: Given the majority of care for people living with dementia is provided at home by family carers supported by HCWs, it is essential that HCWs receive training that improves their skills in dementia care. This study is an important step towards better care at home for people living with dementia. [ABSTRACT FROM AUTHOR]

One of the important questions for any educator is, "How can I teach difficult and abstract concepts in a way that connects with students' real life?". This is especially true in the senior years, when students are often confronted with ideas that don't appear relevant to their lives, are primarily explainable using mathematics rather than everyday language, and/or use equipment that students have never seen before, and will possibly never see again. In Year 12 physics, students must develop an understanding of the nature of light. This includes interference and diffraction phenomena. To assist in developing this understanding, many students undertake practicals in which diffraction gratings are used to produce a series of bright points of light and, by measuring this pattern and using mathematics, students can calculate the wavelength of the light producing the pattern. This article features an activity that enables students to produce a reasonably accurate measurement from something that is near and dear to their hearts-their phone. It also provides a good opportunity to practice mathematical calculations (conversion of units, mathematical manipulations, etc.), and to identify and discuss possible errors in an experimental procedure.

The authors compared business journal ranking systems from 6 countries. Results revealed a low degree of agreement among the systems, and a low to moderate relationship between pairs of systems. In addition, the French and United Kingdom ranking systems were different from each other and from the systems in Australia, Germany, Hong Kong, and the United States. The authors discuss results from a cultural embeddedness perspective. They provide conceptual implications and managerial implications for business schools. (Contains 2 tables.)

The growth in methamphetamine usage worldwide continues to present increasing societal and health care challenges. With the escalation of its usage in a variety of social demographics, the entity of methamphetamine-associated cardiomyopathy (MA-CMP) has emerged. This entity is increasingly responsible for an important proportion of heart failure burden in both admissions to hospital and in those individuals requiring chronic heart failure care. MA-CMP poses some unique challenges including its recognition, particularly in younger patients presenting with new-onset heart failure, its severity at presentation and complications as well as management options. The challenging nature of methamphetamine addiction and the necessity to achieve abstinence is a fundamental aspect of management of this condition. As methamphetamine use continues at high levels in Australia, the burden of MA-CMP will inevitably increase and, therefore, all clinicians responsible for heart failure management require an awareness of this disease entity and the specific clinical challenges of its care. [ABSTRACT FROM AUTHOR]

Background: Our objective was to explore what people receiving and providing care consider to be 'good' in-home care for people living with dementia.Methods: We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke's six-step approach.Results: Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers' understanding of dementia and its impact; 2) Home care workers' demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers' knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers.Conclusions: It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services.Trial Registration: ACTRN 12619000251123 . [ABSTRACT FROM AUTHOR]

Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well‐being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community‐based care for people with dementia can be challenging. Workers often lack training in dementia‐specific care for clients with increasingly complex needs, and typically work without direct supervision. As the demand for person‐centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in‐depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person‐centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care. The findings of this study will be used to inform the essential elements of a training program aimed at enabling and empowering a skilled, specialist home care workforce to support older people with dementia to live well at home for as long as possible. [ABSTRACT FROM AUTHOR]

Proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAb) have progressed from showing marked low density lipoprotein cholesterol lowering in early phase trials through to reducing cardiovascular events in large clinical outcome trials. Recently in Australia, the indication for evolocumab has been expanded to include both heterozygous and homozygous familial hypercholesterolaemia under the Pharmaceutical Benefits Scheme (PBS). With prices remaining high currently their use in non-familial hypercholesterolaemia in Australia remains by private prescription only at this stage. This manuscript summarises the major outcomes trials of the PCSK9 mAbs and the secondary analyses that have assessed their benefits in high risk patient groups, and describes the consensus of authors on which patients would most likely benefit from PCSK9 mAb therapy. [ABSTRACT FROM AUTHOR]

The importance of family's involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families. [ABSTRACT FROM AUTHOR]

Summary: We pilot-tested a trial of home exercise on individuals with osteoporosis and spine fracture.Our target enrollment was met, though it took longer than expected. Participants stayed in the study and completed the exercise program with no safety concerns.Future trials should expand the inclusion criteria and consider other changes.Purpose: Osteoporotic fragility fractures create a substantial human and economic burden. There have been calls for a large randomized controlled trial examining the effect of exercise on fracture incidence. The B3E pilot trial was designed to evaluate the feasibility of a large trial examining the effects of home exercise on individuals at high risk of fracture.Methods: Community-dwelling women ≥ 65 years with radiographically confirmed vertebral compression fractures were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12-month home exercise program or equal attention control group, both delivered by a physiotherapist (PT). Participants received six PT home visits in addition to monthly phone calls from the PT and a blinded research assistant. The primary feasibility outcomes of the study were recruitment rate (20 per site in 1 year), retention rate (75% completion), and intervention adherence rate (60% of weeks meeting exercise goals). Secondary outcomes included falls, fractures and adverse events.Results: One hundred forty-one participants were recruited; an average of 20 per site, though most sites took longer than anticipated. Retention and adherence met the criteria for success: 92% of participants completed the study; average adherence was 66%. The intervention group did not differ significantly in the number of falls (IRR 0.97, 95% CI 0.58 to 1.63) or fragility fractures (OR 1.11, 95% CI 0.60 to 2.05) compared to the control group. There were 18 serious adverse events in the intervention group and 12 in the control group.Conclusion: An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials. [ABSTRACT FROM AUTHOR]

One of the main concerns in designing and operating data centers is the significant energy consumption of the cooling systems. Over the past years, developing and applying more energy efficient cooling strategies to reduce the environmental footprint and the total cost of ownership of data centers has drawn considerable attention. Cooling systems with air-side economizer cycle provide one of the most efficient methods. Their effectiveness in terms of energy and exergy, and the environmental and economical impact have been analyzed quantitatively in this research. Since the effectiveness highly depends on the local climate conditions, the analysis has been carried out for 23 locations across Australia. First, a detailed cooling load of the data center has been estimated by considering the workload and heat generation characteristics of the running IT equipment. Then, a comprehensive energy, exergy, environment and economic model of nine different air-side economizer cycles has been developed. Finally, the effectiveness and profitability of each economizer cycle has been compared to a conventional cooling system by evaluating the annual and monthly saving potential at each location. The air-side economizers can yield maximum savings of 84%, 80%, 75% and 85% in the annual cooling energy consumption, exergy destruction, CO 2 emission and cooling costs, respectively. The power usage effectiveness (PUE) of the data centers can be also reduced from an average of 1.42 to 1.22. These savings and efficiency enhancements are highly correlated with the type and geographic location of the air-side economizers. In general, the saving potential increases as we move further south in Australia, due to more favorable climate conditions. [ABSTRACT FROM AUTHOR]

A speech about the Australian history of the Mormon denomination Reorganized Church of Jesus Christ of Latter Day Saints (RLDS, also known as the Community of Christ) by historian Mark A. Scherer at the January 7, 2012 quarterly meeting of the Saints History Association of Victoria is presented. The roles of missionaries Charles Wesley Wandell and Glaud Rodger are noted, along with the influence of British colonial policy on their work.

Insomnia is common in nursing home settings but assessment and management of sleep disturbance is often suboptimal. New assessment procedures that target potentially remediable clinical causes of insomnia were implemented and evaluated at two high level residential aged care Facilities (HLRACFs) (formerly called nursing homes), in Melbourne, Australia. Fifty-eight of 147 residents (39%) who complained of insomnia, or were nominated by nursing staff as having disturbed sleep, and had confirmation of sleep disturbance on overnight sleep log, were provided with a structured assessment protocol. A multidisciplinary team then considered the causes of each resident's insomnia. A potentially remediable medical or psychiatric cause was identified in 66% of residents with insomnia. More than one such factor was identified in 34%. Pain was a likely factor in 39%. Depression was a likely factor in 30%. Insomnia, depression and pain were significantly correlated. [ABSTRACT FROM AUTHOR]

To determine the prevalence of vitamin D deficiency in older people in residential care and the influence that the level of vitamin D may have on their incidence of falls. Prospective cohort. Residential care facilities for older people in several states of Australia. Six hundred sixty-seven women in low-level care and 952 women in high-level care, mean age 83.7 years. Serum 25-hydroxyvitamin D (25D) levels and recognized risk factors for falls including current medication use, a history of previous fractures, weight, tibial length (as a surrogate for height), cognitive function, walking ability, and frequency of going outdoors were determined. The women in low-level care and high-level care were followed for an average of 145 and 168 days, respectively. Falls were recorded prospectively in diaries completed monthly by residential care staff. Vitamin D deficiency (defined as a serum 25D level below 25 nmol/L) was present in 144 (22%) women in low-level care and 428 (45%) in high-level care. After excluding 358 bed-bound residents and adjusting for weight, cognitive status, psychotropic drug use, previous Colles fracture, and the presence of wandering behavior, log serum 25D level remained independently associated with time to first fall. The adjusted hazards ratio was 0.74 (95% confidence interval=0.59–0.94; P= .01), implying a 20% reduction in the risk of falling with a doubling of the vitamin D level. Vitamin D deficiency is common in residential care in Australia. A low level of serum vitamin D is an independent predictor of incident falls. [ABSTRACT FROM AUTHOR]

Australia shares with several small European economies the characteristic of having a relatively coordinated union movement with the ability to influence real wage levels. This article explores the course of wages policy over the last decade by applying to Australia a model of wage determination originating in Europe, a model which assumes that the union movement can determine the real wage level. The wage level the union movement chooses is influenced by choices it faces between real wage increases and employment growth. The unions are also influenced by the public sector employment generating activity of government. Stagflation in the late 1970s ,is analysed by hypothesising a misperception by the union movement of the policy options available to government, and a mistrust by government of the unions' willingness to moderate wage increases if employment levels rise rapidly. The model suggests that an accord between unions and government (such as that which has been in place in Australia since 1983) is a way to escape some of these policy dilemmas. [ABSTRACT FROM AUTHOR]

It is the purpose of this article to demonstrate that, at least in Australia, such appeals to the "additional worker" effect are unjustified. While United States data show that the additional worker is a real effect which can be observed by comparing families with employed and unemployed husbands respectively, in Australia similar comparisons show that the wives of unemployed husbands are less likely to enter the labour force than are the wives of employed husbands. Part It Of this article surveys the United States evidence on this topic, Part III presents comparable empirical evidence for Australia. Part IV suggests reasons for the paradox. [ABSTRACT FROM AUTHOR]

The article discusses a study about the role of vitamin D in preventing falls in older people in residential care in Australia. Researchers found vitamin D deficiency in about one fifth of Australian hostel and one half of nursing home residents. Key findings indicated that vitamin D supplementation has the greatest effect in preventing falls among older people who have low or suboptimal pre-existing vitamin D levels.