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Aim: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co‐design of new mealtime interventions. Methods: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo‐elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. Results: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. Conclusions: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co‐design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. Practice Implications: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co‐designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. Impact: What problem did the study address?: Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require.Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings?: Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re‐prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal.There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement.Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact?: The research provides a framework for multidisciplinary teams to begin co‐designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. Reporting Method: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. Patient or Public Contribution: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript). [ABSTRACT FROM AUTHOR]

Background Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation. Objective To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes. Design Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals. Methods Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality. Results Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0–35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2–27.2]) at discharge and 193/776 (24.9% [95% CI 21.9–28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4–16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8–19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P  = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses. Conclusion Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication. [ABSTRACT FROM AUTHOR]

This essay looks at contemporary art works produced by three young women who took part in a research project that was exploring the spiritual meanings of art in the lives of adolescents. Nineteen students were interviewed and we asked them to tell us about their art works which we then analysed in relation to a set of descriptors that we developed defining spiritual symbols and stories. We developed a central term--Connected Knowing--which seeks to appreciate a "spiritual rationality" in works of art. This essay reports on three of these art works and explores the ways in which the artist understands the connections between self and other, self and world, self and community. We used theory on art perception and gender to understand the ways in which spiritual meaning was produced by the artists. A central theme that emerged from the three works was that identity is a struggle and not a given, and that multiple perspectives of self in the development of identity is experienced as a positive embodied value. (Contains 1 note and 4 figures.)

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not‐frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program. Design Secondary analysis of EJECTION‐HF randomized trial (ACTRN12608000263392). Setting: Five HF‐specific CR programs in Queensland, Australia. Participants: Adults recently hospitalized with HF. Intervention: All participated in CR including home exercise prescription and monitoring; half were randomized to center‐based ET. Measurements A frailty index (FI) was constructed at randomization and 6‐month follow‐up. Outcomes included ET attendance, change in 6‐min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all‐cause death or readmission. Results: The FI was measured in 256 participants at randomization: 110 (43%) were not‐frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI ≥0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02–0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not‐frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12‐month death or readmission. Conclusion: Frail people with HF participating in CR that includes home and/or center‐based ET often achieve PA guidelines, and some may have meaningful reductions in frailty. See related editorial by Pandey et al. [ABSTRACT FROM AUTHOR]

Background: Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient‐reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient‐reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. Methods: A cross‐sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27‐item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. Results: Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). Conclusions: This survey highlights areas of positive patient‐reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. Method: Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. Results: The median length of hospital stay was 14 days (1–70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. Conclusion: Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. [ABSTRACT FROM AUTHOR]

Aims: To describe the baseline characteristics and treatment of Australian patients diagnosed with atypical haemolytic uraemic syndrome (aHUS) reported to the Global aHUS Registry. Methods: Descriptive analysis of the Australian cohort with aHUS (n = 106) was undertaken for demographics, disease characteristics and prior treatment with eculizumab; comparing with the global cohort (n = 1688) for certain pre‐specified disease characteristics. Results: In Australia, almost two‐thirds of patients diagnosed with aHUS were female and over 80% of patients were Caucasians, with similar proportions reported in the global cohort. Less than 6% of patients in the Australia and global cohorts were reported to have a history of autoimmune disease (4% vs 2%, respectively; P =.21) or cancer (5% vs 5%, respectively; P =.93), conditions that have been associated with secondary HUS. In the Australian cohort, 26% had received a kidney transplant and 68% of patients had received eculizumab. Kidneys were the most common organ involvement, followed by gastrointestinal tract (26%) and cardiovascular system (19%), with 35% of patients reported to have had at least two organs involved within 6 months prior to baseline visit or entry into the registry. Complement factor H was the most common pathogenic complement gene variant in the Australian patients. Conclusion: Data from the aHUS registry confirms and defines region‐specific disease characteristics among a selected group of Australian children and adults with aHUS reported to the registry. Ongoing and more inclusive data will provide further information about temporal trends and treatment outcomes, representing a unique opportunity for clinicians and researchers to further develop knowledge surrounding this rare disease. SUMMARY AT A GLANCE: The registry shows baseline characteristics of patients with atypical haemolytic uraemic syndrome (aHUS) in Australia in which almost two‐thirds were female and over 80% were Caucasians, similar to global numbers. Less than 6% of patients have a history of autoimmune disease or cancer; 26% had received a kidney transplant and 68% of patients had received eculizumab. Kidneys were the most common organ involvement, and complement factor H was the most common pathogenic complement gene variant. [ABSTRACT FROM AUTHOR]

Candida albicans is the most prevalent human fungal commensal organism and is reported to be the most frequent aetiological organism responsible for infection associated with incontinence-associated dermatitis. However, it remains unclear whether incontinence predisposes a patient to increased Candida colonisation or whether incontinence acts as a trigger for Candida infection in those already colonised. The purpose of this observational cross-sectional study was to estimate colonisation rates of C. albicans in continent, compared to incontinent patients, and patients with incontinence-associated dermatitis. Data were collected on 81 inpatients of a major Australian hospital and included a pelvic skin inspection and microbiological specimens to detect C. Albicans at hospital admission. The mean age of the sample was 76 years ( SD = 12.22) with 53% being male. Incontinent participants ( n = 53) had a non-significant trend towards greater Candida colonisation rates at the perianal site (43% versus 28%) χ2(1, N = 81) = 4·453, p = ·638 and the inguinal site (24% versus 14%) χ2(1, N = 81) = 6·868, p = ·258 compared to continent patients ( n = 28). The incontinent subgroup with incontinence-associated dermatitis ( n = 22) showed no difference in colonisation rates compared to those without incontinence-associated dermatitis. Understanding the epidemiology of colonisation may have implications for the prevention of Candida infection in these patients. [ABSTRACT FROM AUTHOR]

This article proposes that in the crossing of learning thresholds, it is possible to identify a number of significant intersections between three key areas – (1) stories about teaching challenges provided by an initial survey of 60 selected online adults studying religious education (RE), spirituality and theology; (2) the crossing of the Australian bush, frontier, or desert landscape; and (3) threshold concept (TC) theory. This survey of online teacher views revealed five specific teacher learning challenges that could be compared with five selected features of the Australian bush or desert landscape. Narratives of teacher learning challenges were extracted from a range of online discussion scripts, while certain features of the Australian landscape emerged from a later, unplanned literature analysis of that topic. This article examines two of these thematic clusters, related to liminality and to ‘stretching’ of teachers, in relation to desert literature and TC theory. The article closes with a series of conclusions and discussion points emerging from the research. [ABSTRACT FROM PUBLISHER]

This article focuses on an analysis of threshold concepts (TCs) within disability theology. It explores a range of ideas linked to TCs and the experience of people living with a disability (people LWD). The world in which Christian parishioners encounter people LWD (the focus of this article), could be described as a ‘liquid world’ which is fuzzy, uncertain, unstable and marked by ‘dissolving boundaries’ (Barnett, R. 2012. “The Coming of the Ecological Learner.” InTransitions and Transformations in Learning and Education, edited by P. Tynjälä, M.-L. Stenström and M. Saarnivaara, 9–20. Dordrecht, NL: Springer) The authors argue that, despite such boundaries, or perhaps because of them, certain thresholds need to be crossed by members of faith communities in order for a person LWD to feel as if he/she genuinely belongs to a community. Nevertheless it is acknowledged that some people involved might be both people LWD and parishioners. The three interrelated thresholds examined within this article are — empowerment, hospitality and neighbourliness. The article links these thresholds with TC theory, and also addresses two related topics — a definition of disability within the discipline of theology, and Jesus asthemodel for threshold crossing within the Christian tradition. Reflections on TCs in this article are deliberately grounded in the most recent collection of TC theory from Land, R., J. H. F. Meyer and M. T. Flanagan, editors. (2016.Threshold Concepts in Practice. Rotterdam, NL: Sense). Finally, the article considers some relevant, practical responses which, it is argued, members of Christian faith communities ought to consider, so that people LWD feel that they genuinely belong to that particular community. It concludes with a summary of key insights and some possible future research directions. [ABSTRACT FROM PUBLISHER]

This paper updates a previous 'Call to Action' paper ( Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes. [ABSTRACT FROM AUTHOR]

Objective. Multimorbidity and associated polypharmacy are risk factors for hospital re-admission. The Targeting Hospitalization Risks in Vulnerable Elders (THRIVE) clinic is a novel multidisciplinary out-patient clinic to improve transitions of care and decrease re-admission risk for older medical patients with frequent hospital admissions. This pilot study examined the effect of the THRIVE model on medication count, tablet load and potentially inappropriate medicines (PIMs). Methods. Participants with frequent medical admissions were referred within 2 weeks of discharge from hospital and assessed at baseline and then at 4 and 12 weeks by the THRIVE team. A thorough reconciliation of all medications was performed collaboratively by a clinical pharmacist and a physician. Optimising medications, including deprescribing, was in collaboration with the participants' general practitioner. The complete medication history of each patient was compared retrospectively by an independent assessor at baseline and after the 12-week clinic, comparing total number of regular medications, tablet load and PIMs (measured using the Screening Tool of Older Persons Prescriptions (STOPP) tool). Results. All 17 participants attending the pilot THRIVE clinic were included in the study. At 12 weeks, there was a significant reduction in mean medication count (from 14.3 to 11.2 medications; P < 0.001) and mean tablet load (from 20.5 to 16.9 tablets; P < 0.01). There was an absolute reduction in the total number of PIMs from 38 to 14. Common medications deprescribed included opioids, tricyclic antidepressants, benzodiazepines and diuretics. Conclusions. Patients who attended the THRIVE clinic had a significant reduction in medication count and tablet load. The pilot study demonstrates the potential benefits of a multidisciplinary out-patient clinic to improve prescribing and reduce unwarranted medications in an elderly population. An adequately powered comparative study would allow assessment of clinical outcomes and costs. [ABSTRACT FROM AUTHOR]

The article focuses on the Eat Walk Engage, an evidence-based multidisciplinary delirium prevention program developed at Royal Brisbane and Women's Hospital. It mentions that the program develops and supports effective collaboration among local interdisciplinary teams to improve care processes, while embedding and sustaining changes in practices and associated processes of care. It informs that facilitator's role is then to support the team to develop and implement these iterative improvements.

Background: Despite the widely recognised importance of sustainable health care systems, health services research remains generally underfunded in Australia. The Australian Centre for Health Services Innovation (AusHSI) is funding health services research in the state of Queensland. AusHSI has developed a streamlined protocol for applying and awarding funding using a short proposal and accelerated peer review. Method: An observational study of proposals for four health services research funding rounds from May 2012 to November 2013. A short proposal of less than 1,200 words was submitted using a secure web-based portal. The primary outcome measures are: time spent preparing proposals; a simplified scoring of grant proposals (reject, revise or accept for interview) by a scientific review committee; and progressing from submission to funding outcomes within eight weeks. Proposals outside of health services research were deemed ineligible. Results: There were 228 eligible proposals across 4 funding rounds: from 29% to 79% were shortlisted and 9% to 32% were accepted for interview. Success rates increased from 6% (in 2012) to 16% (in 2013) of eligible proposals. Applicants were notified of the outcomes within two weeks from the interview; which was a maximum of eight weeks after the submission deadline. Applicants spent 7 days on average preparing their proposal. Applicants with a ranking of reject or revise received written feedback and suggested improvements for their proposals, and resubmissions composed one third of the 2013 rounds. Conclusions: The AusHSI funding scheme is a streamlined application process that has simplified the process of allocating health services research funding for both applicants and peer reviewers. The AusHSI process has minimised the time from submission to notification of funding outcomes. [ABSTRACT FROM AUTHOR]

A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus (HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate (TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine and dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment and ongoing monitoring of renal function is an important part of routine management of patients with HIV. Given the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring could be performed in Australian patients on ART regimens, especially those involving TDF. A group of nephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical and reasonable renal management strategies for patients particularly those on TDF-based combination regimens (in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group considered which investigations should be performed as part of routine practice, their frequency, and when specialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with plasma phosphate and an assessment of urinary protein (rather than albumin) and glucose. Here we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g. cobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this value used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly thereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment should be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol may be logical. [ABSTRACT FROM AUTHOR]

Abstract: Background: Medical patients with a recent previous hospitalisation are at very high risk of subsequent readmission. Evidence suggests that improving key transition processes may reduce hospital readmissions. This study describes quality of transition processes in frequently admitted medical patients, to inform system improvements for this high risk group. Methods: Retrospective records review of consecutive medical inpatients aged 50years or older in a major metropolitan teaching hospital in Australia with a recent (within 6months) prior hospitalisation. Information was sought on 4 key processes: discharge summary completed and sent within 2weeks; discharge medication reconciliation; patient/carer discharge education; and timely scheduling of outpatient review with the treating team. Readmission rates were obtained from a state-wide admissions database. Results: Discharge processes for 209 live discharges in 164 patients were reviewed. Although timely discharge summary completion (81%) and discharge medication reconciliation by a pharmacist (81%) were high, there were major gaps in patient education (33%) and in timely outpatient review (12%). Outpatient systems appear poorly organised to support high quality transitions. Readmission rates were high (23% at 30days and 58% at 180days). Individual discharge quality processes did not predict readmissions. Discussion: Gaps in transitional care of frequently attending medical patients provide potential targets for improvement. In particular, opportunities for better patient/carer education and timely, structured outpatient review may inform design of improved transitions for this high risk group, to be tested in prospective controlled trials. [Copyright &y& Elsevier]

Background Clinical practice guidelines have been developed to improve screening, prevention and management of delirium. Aims To implement delirium guidelines in general medical patients to reduce incidence and duration of delirium and improve outcomes in delirious patients. Methods Implementation was led by a multidisciplinary team of clinicians and project staff on one medical ward. Evaluation was undertaken as a controlled trial in patients aged 65 years or older with/at risk of delirium, compared with a control medical ward. Interventions included risk screening, delirium detection, multidisciplinary education, ward modifications including a four-bed delirium bay, behaviour and medication protocols, and use of nursing assistant and volunteers. Primary outcome measures were incidence and duration of delirium; secondary outcomes were length of stay, mortality, falls and discharge destination in delirious subgroup. Process measures included ward moves, use of neuroleptics, allied health review and delirium bay use. Results Of 206 consenting older medical patients, 22% were delirious at admission and 44% were at risk. No incident cases of delirium were identified. In the delirious subgroup, significantly fewer intervention participants were discharged with persistent delirium (32% vs 71%, P = 0.016), with trends to reduced inpatient mortality (0% vs 18.5%, P = 0.07) and falls (11% vs 22%, P = 0.16), at the expense of a longer medical ward stay (16 days vs 8 days, P = 0.01). Conclusions Low incidence of new delirium may reflect the established interdisciplinary care environment. Improved outcomes in the delirious group are encouraging although implementation was costly, including increased length of acute ward stay. [ABSTRACT FROM AUTHOR]

Background: residents of aged care are old, frail and frequently require hospital management of intercurrent illness, but hospital outcomes are poor.Objective: to identify the impact of an interdisciplinary care model on medical inpatients admitted from residential aged care (RAC).Design: pre-planned subgroup analysis of controlled trial.Setting: general medical units of a teaching hospital in Brisbane, Australia.Subjects: consecutive patients aged over 65 admitted from RAC (n = 189) or the community (n = 815).Methods: all admitted general medical patients were allocated by existing cyclical roster to control (usual care) or intervention units (interdisciplinary care consisting of improved allied health staffing, consistent teams, daily team meetings and early discharge planning). Patient characteristics and outcomes of care were compared between RAC and community subgroups. In the RAC subgroup, outcomes were compared between the control and intervention groups.Results: patients admitted from RAC had much higher in-hospital mortality (13 versus 6%) and 6-month mortality (35 versus 17%) than those from community. RAC residents receiving the intervention had a significant reduction in in-hospital mortality (4 versus 22% P < 0.001) sustained at 6 months (28 versus 44% P = 0.02).Conclusions: poor hospital outcomes for RAC residents may reflect prevailing models of inpatient care. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis technique survival in Australia and New Zealand is lower than in other parts of the world. More than two-thirds of technique failures are related to infective complications (predominantly peritonitis) and 'social reasons'. Practice patterns vary widely and more than one-third of peritoneal dialysis units do not meet the International Society of Peritoneal Dialysis minimum accepted peritonitis rate. In many cases, poor peritonitis outcomes reflect significant deviations from international guidelines. In this paper we propose a series of practical recommendations to improve outcomes in peritoneal dialysis patients through appropriate patient selection, prophylaxis and treatment of infectious complications, investigation of social causes of technique failure and a greater focus on patient education and clinical governance. This manuscript addresses the reasons why the peritoneal dialysis technique survival time is lower in Australia and New Zealand compared with many other parts of the world. The authors propose a series of practical recommendations to improve the outcomes in PD through appropriate patient selection, prevention and treatment of infectious complications, examining the causes of 'social' technique failure and addressing the need for a greater focus on patient education and clinical governance. [ABSTRACT FROM AUTHOR]

The article presents a survey which identifies Australia as the number one location to conduct pharmaceutical clinical trials, based on the study by "The Economist Intelligence Unit." Australia scored highly for many indicators relating to the industry skills pool, practices, and regulatory processes. It has found out that Australia does less well on the total amount of clinical trials taking place even on a per-capita basis, suggesting there is capacity for further within the sector.

Background: Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement., Methods: Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis., Results: One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment., Conclusion: Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research., (© 2024. The Author(s).)