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End of life care is an essential part of the role of Australian aged care homes (ACHs). However, there is no national framework to support aged care staff in systematically identifying residents with palliative care needs or to routinely assess, respond to, and measure end of life needs. The Palliative Care Outcomes Collaboration (PCOC) is a national outcomes and benchmarking programme which aims to systematically improve palliative care for people who are approaching the end of life, and for their families and carers. The PCOC Wicking Model for Residential Aged Care was developed and piloted in four Australian ACHs. This paper reports on the qualitative findings from semi-structured interviews and focus groups conducted with ACH staff (N = 37) to examine feasibility. Thematic analysis identified three overarching themes about the pilot: (i) processes to successfully prepare and support ACHs; (ii) appropriateness of PCOC tools for the ACH setting; and (iii) realised and potential benefits of the model for ACHs. The lessons presented valuable insights to refine the PCOC Wicking Model and enrich understanding of the potential challenges and solutions for implementing similar programs within ACHs in future. The results suggest that key to successfully preparing ACHs for implementation of the PCOC Wicking Model is an authentic and well-paced collaborative approach with ACHs to ensure the resources, structures and systems are in place and appropriate for the setting. The PCOC Wicking Model for Residential Aged Care is a promising prototype to support ACHs in improving palliative and end of life care outcomes for residents and their carers., (© 2023 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.

Objective: To investigate the possibility of early changes in erythropoiesis during prolonged exercise being reflected in reticulocyte parameters., Design: This was a case-control field study of hematological variables in a group of ultramarathon runners competing in a 6-day track race., Setting: A 6-day ultramarathon in Colac, Australia., Participants: 7 male and 1 female experienced ultramarathon runners., Intervention: A track race of 6 days' duration., Main Outcome Measures: A wide range of red cell and reticulocyte parameters., Results: Resting red cell parameters were within normal clinical limits. However, except for the expected findings typical of hemodilution, red cell parameters were relatively unchanged during and after the event, with the exception of small but statistically significant changes in number and percentage of macrocytic, microcytic, hypochromic, and hyperchromic red cells. No reticulocytosis was found in an event that would have been expected to be associated with significant foot-strike hemolysis; however, an increase in the percentage of reticulocytes with high RNA content late in the event indicates early release from the marrow. Reduction in reticulocyte mean cell volume, which is consistent with functional iron deficiency, was demonstrated during the event. This finding is consistent with changes in some of the iron-related parameters associated with the acute phase response, but the dissociation in time between these changes makes a causal relationship unlikely. Other changes such as those in reticulocyte hemoglobin distribution width, reticulocyte distribution width, cell hemoglobin concentration mean, and lack of change in corpuscular hemoglobin are not typical of true iron deficiency, and the mechanism of these changes is currently unknown., Conclusion: The hematopoietic system demonstrates remarkable stability in the face of very significant exercise stress. No reticulocyte response was demonstrated in this study, but reticulocyte changes both consistent with and contrary to early release from the marrow were demonstrated after several days of strenuous running. The significance of several newly developed ratios of red cell and reticulocyte parameters in conditions of exercise stress requires further investigation.

Background: Cord blood mononuclear cells have demonstrated specific immune responses to environmental allergens., Objective: To establish whether the nature of this response is related to the level of maternal antenatal exposure to house dust mite (HDM) allergen and, hence, whether antenatal allergen avoidance may have a role in the prevention of allergic sensitization in children., Methods: Children with a family history of asthma were recruited antenatally as subjects in a randomised controlled trial: the Childhood Asthma Prevention Study. HDM allergen (Der p 1) concentrations were measured in dust collected from the maternal bed at 36 weeks gestation. Cord blood mononuclear cells were stimulated in culture, separately, with phytohaemaglutinin (PHA) and HDM extract. Cytokine IL-4, IL-5, IL-10 and IFN-gamma concentrations in supernatant were measured by ELISA. mRNA signals for these cytokines were measured using RT-PCR., Results: The median concentration of HDM allergen was 18.4 microg/g (interquartile range 7.3-35.3 microg/g). Median concentrations of IL-4, IL-5, IL-10 and IFN-gamma, after PHA stimulation were 4, 19, 401 and 1781 pg/mL, respectively. After HDM allergen stimulation the median concentrations were 0, 0, 20 and 14 pg/mL, respectively. The distribution of mRNA cytokine signals was similar. Neither cytokine protein concentrations nor cytokine mRNA signal levels were correlated with the concentration of HDM allergen in the mothers' beds at 36 weeks gestation., Conclusion: These findings do not support the view that the prevention of allergic disease in children requires the institution of HDM avoidance interventions during pregnancy.

Current practice is for a number of blood tests to be routinely performed on intensive care unit (ICU) patients. A survey of routine blood testing amongst ICUs in Australia and New Zealand was conducted. Ninety-six ICUs completed the survey form. Blood electrolytes, liver function, arterial blood gases and full blood count were the most frequently ordered tests. Routine blood testing was not practised in 12.6% of ICUs. The presence or absence of written guidelines did not influence the frequency of the most commonly performed routine blood tests. Clinical and operational factors specific to each ICU appear to impact on such blood tests and guidelines for their use.

Objectives: To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events., Design: Cohort comparison study after casemix adjustment., Patients and Setting: All adult (> or = 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996. INTERVENTION STUDIED: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams., Main Outcome Measures: Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented., Results: There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04]; Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference in the rates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order., Conclusions: The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were lower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.