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Background: Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long‐term complications and patient‐reported outcomes. Methods: This retrospective cohort study evaluated patient perceived recurrence and pain in patients who had undergone a primary ventral hernia (epigastric, supraumbilical, or umbilical) repair or small (≤20 mm) midline incisional hernia repair 10 years after the procedure. Short‐term follow‐up occurred up to 6 weeks after the initial operation, while long‐term follow‐up included patients who were reviewed clinically or interviewed via telephone at or beyond 3 years after the procedure. Results: Most (75/100, 75.0%) patients had an extra‐peritoneal sandwich mesh repair. Short‐term follow‐up showed minimal pain and normal activities for all patients (97/97, 100%). Long‐term follow‐up (median 12 years [IQR 11–13]) was achieved in 95.9% (93/97) of patients with only a small number reporting a slight bulge (5/93, 5.4%) and intermittent mild discomfort (8/93, 8.6%). Nine patients (9/97, 9.3%) experienced hernia recurrence, diagnosed at a median of 26 months [interquartile range, IQR, 7–58] post‐operatively. Conclusions: These findings suggest that an open sandwich mesh technique is a safe and effective method for repairing primary ventral hernias and small midline incisional hernias and is associated with favourable long‐term patient‐reported outcomes. [ABSTRACT FROM AUTHOR]

Aim: This study explores the impact on arteriovenous fistula (AVF) creation and maturation of four methods of heating the scanning environment during ultrasound upper limb mapping, and sonographer perceived useability of the environments. Method: A retrospective audit at Orange and Bathurst hospitals involving patients who underwent ultrasound upper limb mapping (2016–2022). Patients were scanned using warm gel and three additional methods of warming. Two sonographers provided their preference and opinions on each environment. Data on AVF type, brachial artery blood flow (QBRA), AVF maturity status at 3 and 6 months and intervention within this timeframe was retrieved. Data from the three additional heated environments was combined for analysis (heated environments) against the heated gel only environment (gel environment). Results: Eighty‐five patients met selection criteria. There was no significant difference in the proportion of successfully created AVFs between the heated and the gel environments (90% vs. 94%). A greater percentage of AVFs mapped in the heated environments reached maturity without intervention compared to the gel environment (70% vs. 48%, respectively). There was a statistically significant higher QBRA in the AVFs mapped in the heated environments (1.25 L/min) that reached maturity by 3 months without intervention compared to the gel environment (0.95 L/m; p =.008). Sonographers found a warm blanket/electric throw the easiest methods of heating the scanning environment. Conclusion: Using an electric throw and/or a warm blanket during ultrasound upper limb mapping is practical and optimises the scan environment, which provides surgeons with quality information that ultimately improves AVF creation outcomes. [ABSTRACT FROM AUTHOR]

Background: Individuals living in residential aged care facilities with cognitive decline are at risk of social isolation and decreased wellbeing. These risks may be exacerbated by decline in communication skills. There is growing awareness that group singing may improve sense of wellbeing for individuals with dementia. However, to date few studies have examined broader rehabilitative effects on skills such as communication of individuals with dementia. Aims: To determine the feasibility and acceptability of the MuSic to Connect (MuSiCON) choir and language/communication assessment protocol in people with cognitive impairment living in non-high-care wards of a residential facility. Methods: Six individuals with mild-moderate cognitive impairment participated (age range 55–91 years, five female, one male). A mixed method approach was used. Quantitative outcomes included attendance rates, quality of life and communication measures. The qualitative measure was a brief survey of experience completed by participants and carers post-intervention. Results: Overall, MuSiCON was perceived as positive and beneficial, with high attendance, perception of improved daily functioning and high therapeutic benefit without harmful effects. While there was no reliable change in communication skills over the course of the six-week intervention, most participants successfully engaged in the conversational task, suggesting it is a suitable and ecologically valid method for data collection Conclusions: The MuSiCON protocol demonstrated feasibility and was well received by participants and staff at the residential facility. A co-design approach is recommended to improve upon feasibility, acceptability and validity of the assessment protocol prior to Phase II testing. [ABSTRACT FROM AUTHOR]

Despite high unmet demand for health services across rural Australia, uptake of telehealth has been slow, piecemeal and ad hoc. We argue that widespread failure to understand telehealth as a socio-technical practice is key to understanding this slow progress. To develop this argument, we explore how technocentric approaches to telehealth have contributed to critical blind spots. First, the 'hype' associated with the technological possibilities of telehealth discourages thoughtful consideration of the unanticipated consequences when technologies are rolled out into complex social fields. Second, it contributes to critical gaps in the telehealth evidence base, and particularly a paucity of analyses focussing on the experiences of service users and patients. A third blind spot concerns the limited attention paid to the social determinants of health and digital divides in rural areas. The final blind spot we consider is an apparent reluctance to engage community stakeholders in co-designing and coproducing telehealth services. We used an iterative approach to identify studies and commentary from a range of academic fields to explain the significance of the telehealth blind spots and how they might be addressed. Insights suggest how expanding understanding of the social dimensions of telehealth could enhance its accessibility, effectiveness and responsiveness to community needs and contexts. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities (ID) experience high levels of psychiatric comorbidity and difficulties accessing services, particularly in rural areas. An Intellectual Disability Mental Health Outreach Clinic was established to provide specialised psychiatric care in rural Australia through telepsychiatry and in‐person assessment. The study aims were to (i) contrast the characteristics of clinic attendees assessed by telepsychiatry or in‐person; (ii) assess the feasibility of care delivery by synchronous videoconference (telepsychiatry) or in‐person; and (iii) assess acceptability to, and experiences of, participating carers (family members, non‐government organisation workers or Community Mental Health Case Managers). An audit of clinical records was conducted of clients reviewed by the Clinic between August 2018 and April 2021. A survey of carers, either employed or family members, evaluated Clinic acceptability and experiences with the Clinic assessment, and as well as perceptions of thoroughness, accessibility, and ease. Of 145 people with ID, 46% were reviewed by telepsychiatry. These 67 telepsychiatry clients were more likely to have milder ID (p < 0.01) and were seen more frequently (p < 0.05) than the 78 clients with in‐person reviews. Results from the carer survey (31.7% response rate, n = 46/145) indicated high overall service acceptability, with telepsychiatry perceived to offer more convenient appointment times (91% agreed vs. 75% of in‐person, p < 0.05). The high uptake of telepsychiatric review indicates that it is feasible and acceptable to carers of people with ID and comorbid mental health concerns. Telepsychiatry is a potential tool to address equity of access to mental health services for people with ID—particularly those from disadvantaged and rural populations. [ABSTRACT FROM AUTHOR]

Background: The Nutrition Dashboard is an interactive nutrition technology platform that displays food provision and intake data used to categorise the nutrition risk of hospitalised individuals. The present study aimed to investigate the Nutrition Dashboard's ability to identify malnutrition compared with a validated malnutrition screening tool (MST). Methods: A retrospective observational study at a 99‐bed hospital was conducted using medical record and food intake data presented via the Nutrition Dashboard. Inter‐Rater Reliability of food intake estimation between hospital catering staff and a dietitian reported good agreement across 912 food items (κ = 0.69, 95% confidence interval = 0.65–0.72, p < 0.001). Default nutritional adequacy thresholds of 4500 kJ and 50 g protein were applied for Nutrition Dashboard categorisation of supply and intake. Generalised estimating equation regression models explored the association between the Nutrition Dashboard risk categories and the MST, with and without controlling for patient demographic characteristics. Results: Analyses from 216 individuals (1783 hospital‐stay days) found that those in the highest risk Nutrition Dashboard category were 1.93 times more likely to have a MST score indicating risk compared to the lowest Nutrition Dashboard category (unadjusted odds ratio = 1.93, 95% confidence interval = 1.17–3.19, p < 0.01). When patient weight was added to the model, lower weight became the only significant predictor of MST ≥ 2 (p < 0.01) Conclusions: The present study indicates a role for nutrition intake technology in malnutrition screening. Further adaptions that address the complexities of applying this technology could improve the use of the Nutrition Dashboard to support identification of malnutrition. Key points: 1.Timely, accurate identification of malnutrition is essential in the acute care setting, but under‐identification of malnutrition remains common despite best practice guidelines for malnutrition screening.2.The present study identified that an interactive platform that displays food intake and nutrient data for hospitalised patients has potential to improve the identification of malnutrition when used in parallel with existing malnutrition screening.3.The Nutrition Dashboard may improve the management of malnutrition by providing dietitians with malnutrition risk information directly rather than completely relying on the multi‐disciplinary team to initiate screening and referrals. [ABSTRACT FROM AUTHOR]

Background: Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. Methods: To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. Results: Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached; (2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. Conclusions: Rural women with unintended pregnancy experienced gaps in service quality and described a lack of woman-centred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy. Rural women in Australia are more likely to experience unintended pregnancy, yet little is known about how well local primary care services meet their needs. Our findings confirm rural women have clear, but often unmet expectations of the local care they receive, including provider knowledge about all pregnancy and contraception options, time efficiency, choice and aftercare. Improvements to rural reproductive health involve not only removing access barriers, but better equipping local rural primary care providers to offer woman-centred care. [ABSTRACT FROM AUTHOR]