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Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medicine & Dentistry, Griffith Health, This research has sought to identify important factors relating to quality patient care and the management of risk in the acute healthcare sector. Key stakeholders including consumers, healthcare workers, health delivery organisations and those involved in the governance of healthservice organisations are part of a critically important continuum of service users and providers, who require and seek to deliver high-quality patient care. The concepts of quality, risk and safety domains are defined within the context of operating complex health organisations that deliver care in a high-risk environment. The aim of this research was to ascertain important elements and actions of key stakeholder groups and organisations in relation to quality and risk and to propose ways of engaging on identified interaction points to enhance the impact of management of quality and risk for healthcare outcomes. The purpose of this research was to identify where changes in practice and operations could enhance the understanding of quality and risk factors and improve their management. Moreover, this research aimed to identify areas of interdependence across the stakeholder continuum that might be positively exploited to improve and enhance patient care outcomes. Four specific research projects have been completed. Original data and information were collected through a national telephone survey of consumers and semi-structured interviews involving current directors of governing health boards. Also analysed were secondary data related to healthcare worker job satisfaction in a complex health organisation, and accreditation survey reports for hospitals and health facilities. In all studies, key themes were identified and interpretations of results were formed into journal article manuscripts submitted to peer-reviewed journals. Consumers, as current, past or potential patients, identified that an assessment of healthcare providers’ reputation and capacity for strong, effective interpersonal e

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medical Science, Griffith Health, Metabolic syndrome (MetS) is a condition that is linked to the increased risk of developing chronic diseases, including type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The association between MetS and chronic disease development lies in the cardiometabolic risk factors that comprise MetS: abdominal obesity, hypertension, hyperglycaemia and dyslipidaemia [1]. The development of MetS is also associated with the dysregulation of many different body systems, such as the immune system [2] and gut microbiome [3]. Due to its multifactorial nature, research in MetS requires the simultaneous analysis of multiple biomarkers across different body systems. As most research thus far have utilised univariate analysis, no biomarker profile has been identified to characterise individuals more at risk of MetS and related diseases. The current study has therefore implemented the use of correlationbased network analysis (CNA) and multiple classification models to identify the biomarkers that collectively link to increased MetS development. Four variable groups comprising of multiple different measurements were obtained from 117 healthy weight controls and 35 obese with MetS individuals. The four variable groups consisted of: anthropometric measures, haematological measures, gene expression levels and gut microbial counts. The use of CNA allowed a better understanding of the relationships between biomarkers affected by MetS. As expected, the obese with MetS network was denser than the healthy weight control network, demonstrating the complex nature of MetS. The results found molecular interactions supporting the findings of previous literature, particularly correlations that demonstrated the development of anaemia of inflammation in the obese with MetS network. There were also three key hubs identified using gene expression levels, involving transcription factor EB (TFEB), lipocalin 2 (LCN2), and cluster of differentiation- (CD-) 68. The three genes are associated wit

Otitis media (OM) encompasses a spectrum of clinical presentations ranging from the readily identifiable Acute OM (AOM), which is characterised by otalgia and fever, to chronic otitis media with effusion (COME) where impaired hearing due to middle ear effusion may be the only clinical symptom. Chronic suppurative OM (CSOM) presents as a more severe form of OM, involving perforation of the tympanic membrane. The pathogenesis of OM in these varied clinical presentations is unclear but activation of the innate inflammatory responses to viral and/or bacterial infection of the upper respiratory tract performs an integral role. This localised inflammatory response can persist even after pathogens are cleared from the middle ear, eustachian tubes and, in the case of respiratory viruses, even the nasal compartment. Children prone to OM may experience an over exuberant inflammatory response that underlies the development of chronic forms of OM and their sequelae, including hearing impairment. Treatments for chronic effusive forms of OM are limited, with current therapeutic guidelines recommending a “watch and wait” strategy rather than active treatment with antibiotics, corticosteroids or other anti-inflammatory drugs. Overall, there is a clear need for more targeted and effective treatments that either prevent or reduce the hyper-inflammatory response associated with chronic forms of OM. Improved treatment options rely upon an in-depth understanding of OM pathogenesis, particularly the role of the host innate immune response during acute OM. In this paper, we review the current literature regarding the innate immune response within the middle ear to bacterial and viral otopathogens alone, and as co-infections. This is an important consideration, as the role of respiratory viruses as primary pathogens in OM is not yet fully understood. Furthermore, increased reporting from PCR-based diagnostics, indicates that viral/bacterial co-infections in the middle ear are more commo

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medicine, Griffith Health, Passive immunisation is an important means of preventing communicable diseases post-exposure, particularly for subpopulations most vulnerable to complications from infection. The blood product normal human immunoglobulin (NHIG) is used in Australia for post-exposure prophylaxis in certain non-immune populations to prevent measles and hepatitis A and is recommended in certain circumstances for non-immune pregnant women to prevent rubella and congenital rubella syndrome. Practices with respect to passive immunisation post-exposure for these conditions vary around the globe and importantly, vary among countries similar to Australia such as New Zealand, the United Kingdom and the United States. The series of studies presented here aimed to understand the possible reasons behind these differences in practice and, using this information, make recommendations for the most effective and efficient use of NHIG in public health practice in Australia. An overview of passive immunisation, rubella, measles, and hepatitis A and the public health management of these conditions, current at the time of thesis commencement, is provided. This is followed by an exploration of why practices of passive immunisation post-exposure to measles, rubella and hepatitis A might vary among high-income countries, concluding that a lack of collated evidence of the effectiveness of passive immunisation for preventing measles and rubella, unanswered questions about the minimum effective doses of NHIG as post-exposure prophylaxis for each disease, and differences in disease-specific antibodies in available immunoglobulin products may be significant. To redress these deficits, two systematic reviews collated existing evidence of the effectiveness of passive immunisation for preventing measles, and rubella and congenital rubella syndrome; disease-specific antibody concentrations were measured in samples of Australian blood products used for passive immunisation; and simulation modelling validated by the