Search

Purpose: Broadly speaking, student voice can be defined as initiatives that involve consultation of, feedback from, and engagement with students regarding their own education. This study's aim was to explore teachers' experiences and perceptions of enacting student voice in primary physical education. Method: Participants included six primary school health and physical education specialist teachers within Victoria, Australia. Data were collected via six rich and detailed one-on-one semistructured interviews. Results: Three main themes include: (a) "same-same but different" highlighting participants' varying conceptualizations and enactment of student voice, (b) "language matters" emphasizing the importance of language used when discussing and implementing student voice, and (c) "barriers and challenges to implementation" capturing participants' experience and limiting factors to the enactment of student voice practices. Discussion/Conclusion: Grounded in education for transformation and patterns of partnership theories, the discussion focuses on the disassociation between teachers' perceived understanding and enactment and the implications for students resulting from the misalignment. [ABSTRACT FROM AUTHOR]

Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health. [ABSTRACT FROM AUTHOR]

As land becomes increasingly expensive in Australia fewer people can afford it, with consequences for wealth distribution and housing. Real estate, in particular the family home, has formed a foundation for Australians' wealth over many decades, but the possibility of home ownership has been deteriorating in recent years. Alternative proposals for property investment include issuing fractions of land title on blockchain with parallel registration in the land registry. While such proposals are technically feasible, they are silent as to the means of integrating the blockchain ledger with the land administration system. As the land administration system comprises multiple statutory processes, this article uses the Queensland system as a case study, to analyse the relevant statutes in terms of the integration of a fractionalised blockchain titles system. The aim is to identify the law reform necessary to achieve a high level of integration of fractionalised land titles on a blockchain, within an existing land administration system --without detracting from the policy goals of that system., I INTRODUCTION As land becomes increasingly expensive in Australia fewer people can afford it, with consequences for wealth distribution and housing. Real estate, in particular the family home, has formed [...]

The passage of the Human Rights Act 2019 (Qld) ('HRA 2019') was a significant achievement, particularly in a state often known for its parochial conservatism and disinterest in, if not outright rejection of, human rights. The HRA 2019 is substantially based upon the human rights Acts in place in Victoria and the Australian Capital Territory. However, there are some small, but potentially important differences between the HRA 2019 and the corresponding state and territory equivalents. In this article, i focus on one of these differences: the definition of discrimination contained in the HRA 2019. Unlike the Charter of Human Rights and Responsibilities Act 2006 (Vic) the definition of discrimination in the HRA 2019 is not tied to the definition or grounds of discrimination in the state discrimination legislation. This small but important distinction could feasibly allow courts to define discrimination and the broader notion of equality in a more substantive manner, covering a wider variety of actions and conduct, and apply that wider definition to a broader range of attributes (commonly understood as 'grounds'). The purpose of this article is to consider the possibilities and potential challenges confronting Queensland courts in broadening the definition of discrimination in the context of HRA 2019. I argue that, though a substantive interpretation of discrimination and equality is challenging and requires a degree of 'creativity' on the part of judges, it is a challenge worth undertaking., I INTRODUCTION The manner in which the meanings of discrimination and equality have been interpreted by Australian courts has been consistently critiqued. (1) With respect to anti-discrimination statutes, while courts [...]

This article seeks to establish transnational links between South Yorkshire and the colony of Victoria in Australia during the late nineteenth-century. Examining definitions of 'northernness' and challenging arguments that depict northern identity and culture as inward-looking, it explores the relative absence of 'northernness' in narratives of migration and makes the case for the interconnection of ideas, events and individuals across cultural, political and national boundaries. Exploring Sheffield's links and relationship with Victoria this article places recent research about population transfers, civic identity, protest and business practice in a global perspective that highlights overlaps and connections over disjunctures, difference and the particular. Throughout, the emphasis of the article is on the diverse and wide-ranging nature of these links in an imperial context. Against this background, neither steel workers in Sheffield, nor the shearers in outback Australia appear as insular and inward-looking, as has often been asserted. In short, the article poses questions about the nature and scale of a transplanted northern identity, and the relevance of the environment of the Australian colonies to a developing sense of what it was to be from Sheffield. [ABSTRACT FROM AUTHOR]

The OECD's PISA is seen as a 'global yardstick' against which countries measure the quality of their education systems. In 2018 PISA included an assessment of global competence. This paper starts with the premise that in using a single global instrument to 'measure' this phenomenon, PISA claims standardisation over contextually rich data that can then inform policy and, arguably, in turn practice. Data for this study is based on tracking 'global competence' through documentary analysis, interviews, and then 'survey encounters' where PISA global competence questionnaire items were discussed by principals and teachers in three schools in Victoria, Australia. The analysis illustrates that schools and teachers variously educate for global competence according to the specific cultural context, policy and curriculum in ways that highlight the inadequacy of a global metric. With the growing attention to educating for global citizenship and the OECD's development of global measures, this investigation of localised understandings of global competence magnifies the 'situatedness' of knowledge (and therefore assessment practices). Questions are raised about what is ignored in metrics when such a contested concept is operationalised, and points to the lack of validity of this metric because it de-contextualises how global competence is understood by teachers and enacted in curriculum. [ABSTRACT FROM AUTHOR]

Residents in aged care homes constitute a significant proportion of Australia's population. The elderly population is vulnerable to poor indoor air quality (IAQ). Because mobility declines with age, they tend to spend longer indoors compared with the general population. This study evaluated the effectiveness of an affordable ventilation retrofit to improve the IAQ in aged care homes in Victoria, Australia. The fresh filtered air ventilation system was installed independently of the existing heating, ventilation, and air conditioning (HVAC) system in each facility. The monitoring characterized the ventilation of aged care homes to establish the baseline performance. The results showed that air change rates (ACH) in the common rooms were from 0.84 ACH to 3.81 ACH. This was generally sufficient for low or average occupancy but insufficient when the rooms were fully occupied. Up to a 1,000 ppm reduction in the carbon dioxide (CO2) concentration was achieved with the addition of a supplementary ventilation system. However, there was no reduction in the levels of particulate matter (PM). Local activities and the movement of people inside the room influenced the PM concentration. A systematic approach for the regular monitoring of IAQ, analyzing data, and adopting appropriate interventions is required to better prepare the community and the health systems against the consequences of climate change. [ABSTRACT FROM AUTHOR]

Aim: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. Design: A qualitative descriptive study was undertaken using individual interviews and focus groups. Methods: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi‐structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. Results: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. Conclusions: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university‐level education and clinical placement, the employment model can create a third space for student learning via on‐the‐job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. Implications for the Profession and/or Patient Care: Impact: This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID‐19 pandemic.This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce.Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice.In addition to university‐level education and clinical placement, this employment model creates a third space for learning via on‐the‐job training. Reporting Method: COREQ guidelines were followed in the reporting of this study. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Alphavirus infections are transmitted by mosquitoes, but the mode of transmission for Mycobacterium ulcerans, which causes Buruli ulcer, is contested. Using notification data for Victoria, Australia, during 2017–2022, adjusted for incubation period, we show close alignment between alphavirus and Buruli ulcer seasons, supporting the hypothesis of mosquito transmission of M. ulcerans. [ABSTRACT FROM AUTHOR]

This mixed‐methods study evaluated a peer‐led support group for ED caregivers; the Eating Disorders Families Australia strive support groups. Quantitatively, 110 past or current strive attendees completed an online survey assessing their own and their care recipients' demographic profiles, strive's impact on caregiving experiences, and caregivers' psychological distress, burden, caregiving skills and self‐efficacy. Qualitative assessment comprised open‐ended survey questions about caregivers' strive experiences, reinforced by in‐depth focus group assessment of nine participants. Quantitative analyses revealed that participants felt more confident and supported, and less isolated in their caregiving since attending strive. Caregivers displayed mid‐range psychological distress and caregiver burden, and moderate caregiver skills and self‐efficacy. Qualitatively, the most helpful aspects of strive were the shared experience among participants, education, and support. The most difficult elements were emotional distress and overly dominant members. Reflections discussed the necessity of caregiver support and factors impacting strive attendance. Participants recommended resuming face‐to‐face contact and differentiating groups based on participant characteristics (e.g. care recipients' age/stage of illness). The current findings provide support for the importance and overall positive contribution of support groups led by caregivers, such as strive. Highlights: The Strive participants presented with increased caregiver confidence and support, reduced isolation, despite mid‐range psychological distress and moderate caregiver skills/efficacy.Caregivers value shared experiences, education, and support within the strive programme.Emotional distress and group dynamics posed hurdles in strive, highlighting the need for improved support structures. [ABSTRACT FROM AUTHOR]

Background: Women with diabetes in pregnancy have decreased exclusivity and duration of breastfeeding compared with women without diabetes, and their infants are at increased risk of hypoglycemia. Clinicians often suggest pregnant women with diabetes to express breastmilk, and studies have reported increased breastfeeding exclusivity in the early postnatal period for patients who have expressed. Little is known about longer term outcomes. We investigated whether advising low‐risk women with diabetes in pregnancy to express beginning at 36 weeks of pregnancy increased exclusivity and maintenance of breastfeeding at 3 months. Methods: We conducted a multicenter, two‐group, randomized controlled trial at six hospitals in Melbourne, Australia, between 2011 and 2015. Women were randomized to either standard maternity care or advised to hand express for 10 min twice daily, in addition to standard care. Women were telephoned at 12–13 weeks postpartum and asked a series of questions about feeding their baby, perceptions of their milk supply, and other health outcomes. Results: Of 631 women in the study, data for 570 (90%) were analyzed at 12–13 weeks. After adjustment, we found no evidence that women allocated to antenatal expressing were more likely to be giving only breastmilk (aRR 1.07 [95% CI 0.92–1.22]) or any breastmilk (aRR 0.99 [95% CI 0.92–1.06]) at 12–13 weeks postpartum compared with women in the standard care group. Conclusion: While the practice of antenatal expression for low‐risk women with diabetes during pregnancy is promising for increasing exclusivity of breastmilk feeding in hospital, at 12–13 weeks, there was no association with breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. Methods: Population‐based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi‐square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. Results: Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower‐risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13–1.32)), 39 (aOR 1.31(1.23–1.40)), 40 (aOR 1.42(1.35–1.50)), and 41 weeks of gestation (aOR 1.43(1.35–1.51)). Perinatal mortality was rare in both groups and non‐significantly lower in the induced group at most gestations. Discussion: For lower‐risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only. [ABSTRACT FROM AUTHOR]

Background: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high‐quality evidence for effective interventions to improve safety and quality of care for these patients. Aims: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Methods: Design: An exploratory mixed methods study. Setting: A major metropolitan teaching hospital in Melbourne, Australia. Participants: Patients in hospital isolation for transmissible infections. Data collection: Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis: Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Results: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. Conclusion: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Implications for the Profession and/or Patient Care: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. Reporting Method (EQUATOR): EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR‐RHS). Patient or Public Contribution: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

Objectives: Mental health triage services are the first contact for people wanting support for their mental health and provide access to public mental health services in Victoria, Australia. People living with young-onset dementia and their families may contact triage services seeking assistance for behaviour changes and pathways to care as there are few alternative services available. Methods: The authors reviewed the minimum triage dataset from one of the largest mental health services in Victoria, Australia from 2018 to 2021 investigating reasons for referral for people with young-onset dementia. Results: Of the 1766 referrals for 'dementia', 145 were for young-onset dementia. Of these, 69% were referred for behaviour changes. About half of the referrals for behaviour changes were triaged as 'advice only'. One-third of referrals were from general practitioners. Conclusions: The availability of dementia-specific support services that could provide advice on dementia as well as advice for behaviour changes related to the disease could potentially ease the burden of phone calls received by mental health triage services. What is known about the topic? Young-onset dementia refers to a dementia with onset at less than 65 years of age. People with young-onset dementia may contact mental health services for support but the reasons for contact are unknown. What does this paper add? The reasons for contacting one Victorian mental health service included behaviour changes such as agitation or aggression and psychotic symptoms (74%) and general advice, including about dementia pathways (14%). General practitioners made up one-third of referral sources. What are the implications for practitioners? Victorian mental health services are generally overloaded and complex. There is a need to promote alternative dementia support organisations in order to provide an alternative contact for people affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Objective: This study explored the experiences, concerns and perceptions of hospital clinical staff returning to work after parental leave during the COVID-19 pandemic. Methods: An exploratory mixed-methods study was performed. Eligible staff employed at a large metropolitan tertiary health service in Melbourne, Australia, completed an ethics-approved anonymous online cross-sectional survey and/or participated in an interview between February and June 2021. Results: Ninety-six staff completed a survey and four participated in an interview. Staff reported both positive and negative aspects of being on parental leave during the COVID-19 pandemic including disappointment their leave had not gone as planned; feeling isolated from family and friends; wanting greater communication from their health service; appreciating the increased opportunities for them and their partner to be at home and bond with their baby; and concerns about returning to work such as limited knowledge of COVID-19 workplace policies and potentially infecting their baby and family. Conclusions: The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of hospital clinical staff. The findings suggest that staff would benefit from formal return to work policies and programs including regular contact with their manager while on parental leave and workplace reorientation on their return, especially during events such as a pandemic. What is known about the topic? Healthcare workers often experience additional challenges and stressors returning to work after parental leave compared to other workers. What does this paper add? The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of healthcare workers who reported positive and negative aspects including isolation, limited workplace communication and increased opportunities for bonding with their baby. What are the implications for practitioners? Appropriate organisational initiatives may alleviate staff distress and support their return to work and could include formal return to work programs, regular managerial contact and workplace reorientation. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to examine the roles and needs of allied health professionals (AHPs) working in public healthcare settings in rural and regional Victoria, Australia in providing components of palliative care in their routine practice. Methods: A cross-sectional study was conducted between March and May 2023. Surveys were collected from AHPs working in public healthcare settings in the Loddon Mallee region of Victoria, Australia. Clinicians reported on the frequency of provision of care to patients with terminal illness, and their self-reported skill and confidence in providing interventions to patients with palliative care needs. Results: In total, 121 clinicians completed the survey. Almost every respondent reported they had provided care to patients with a terminal illness, with 41% of clinicians providing this care daily or weekly. The respondents were confident carrying out generalist interventions such as maintaining physical function but reported lower confidence in managing common symptoms of terminal illness such as loss of appetite, swallowing difficulties and changing communication needs. Two-thirds of respondents had not undertaken any training specific to palliative care, with many unaware of how to access palliative care-specific training. Conclusion: AHPs in rural and remote areas regularly provide care to patients with terminal illness. As the number of patients seen in non-specialist palliative care settings is likely to increase in rural and regional areas, the low self-reported confidence in providing common components of care, and the low uptake of palliative care-specific training must be addressed to ensure AHPs can provide high-quality care to people with terminal illness. What is known about the topic? Due to the increasing demand for palliative care services, this care is increasingly delivered by general non-specialist clinicians such as allied health professionals. What does this paper add? This study provides evidence for how often a surveyed population of allied health professionals in rural and regional Australia are providing care to people with a terminal illness, as well as their confidence, competence and learning needs. What are the implications for practitioners? High-quality care is needed at end-of-life, therefore rural and regional health services need to support allied health professionals to increase confidence and competence in providing palliative care. [ABSTRACT FROM AUTHOR]

Objectives: Individuals living with young-onset dementia fall through the gaps of adult and geriatric services. Given that non-cognitive symptoms of dementia in younger people are often psychiatric and behavioural in nature, these people may contact mental health services. There is sparse information investigating the frequency of people with young-onset dementia who contact mental health triage in Victoria. Methods: Triage data were obtained from the Victorian Agency for Health Information. The data contained demographics for people registered with Victorian mental health services. Consumers who had an International Classification for Diseases code for dementia and were aged less than 65 years were identified as people with young-onset dementia. Using information of the frequency of people with young-onset dementia who were registered with each area-based mental health service, population census statistics were used to make estimates of the frequency of young-onset dementia. Results: Of the 6172 people who had a dementia diagnosis, 1020 of them were aged less than 65 years and had young-onset dementia. There were proportionally more men who had young-onset dementia compared to women. There were more people with young-onset dementia registered to rural mental health services compared to metropolitan services. Conclusion: Findings provide important information for service planning in Victoria. Recommendations include upskilling and education for the assessment of dementia for those clinicians who work in mental health services, particularly in rural regions. What is known about the topic? Young-onset dementia refers to a dementia with onset at an age less than 65 years. Accessing age-appropriate services for these people is difficult as they fall through the gaps of adult and aged services due to their age. What does this paper add? Due to the behavioural and psychiatric manifestations related to young-onset dementia, data is provided about mental health service involvement for these people. What are the implications for practitioners? There is a need to upskill mental health clinicians, especially in rural areas, as younger people with dementia are accessing these services. [ABSTRACT FROM AUTHOR]

Objective: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low‐acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. Methods: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. Results: A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time‐critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out‐of‐hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. Conclusion: The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED. [ABSTRACT FROM AUTHOR]

Objective: Preventable transmission of blood‐borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at‐risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. Methods: We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD‐related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. Results: The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD‐related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. Conclusions: Our study describes the utility of ambulance data to identify a sub‐population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services. [ABSTRACT FROM AUTHOR]

Background: Many clinicians overestimate mortality and disability rates in infants born extremely preterm. We developed a digital tool ('NIC‐PREDICT') that predicts infant mortality and survival with and without major disability in infants born 23–27 weeks' gestation. Aims: To determine if clinicians could use NIC‐PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021. Materials and Methods: Midwives, nurses, obstetricians, neonatologists and paediatricians working in tertiary and non‐tertiary hospitals in Victoria were asked to use NIC‐PREDICT to estimate three mutually exclusive outcomes: (i) mortality; (ii) survival free of major disability; and (iii) survival with major disability for six different scenarios where a liveborn infant was offered survival‐focused care after birth. The proportions who completed the survey (responded to all six scenarios) and the proportions able to provide 100% accurate results for all scenarios were determined. Estimates of the three outcomes were compared with true rates. Results: A total of 85 clinicians responded: 70 (82%) completed the survey, with an overall accuracy of 76%. Overall, predictions of mortality were accurate (mean difference from true value 0.7% (95% confidence interval (CI) −0.7, 2.1) P = 0.33), as were predictions of survival without major disability (mean difference − 0.7 (95% CI –3.0, 1.7) P = 0.58). However, survival with major disability was overestimated by 4.9% ((95% CI 1.7, 8.0) P = 0.003). Conclusions: Most perinatal clinicians who responded used NIC‐PREDICT correctly to estimate expected outcomes in infants born extremely preterm who are offered intensive care. Undue pessimism about survival with major disability remains an ongoing concern. [ABSTRACT FROM AUTHOR]

Background: Regional analgesia is a common and effective form of in‐labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes. Aims: To examine the association between regional analgesia and maternal and neonatal outcomes. Materials and Methods: A retrospective population‐based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used. Results: There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52–3.67), caesarean section (aOR = 2.30, 95% CI: 2.24–2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3–27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21–1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40–1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65–1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56–1.62). Conclusion: Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk–benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision‐making. Further large prospective studies and randomised controlled trials will be useful. [ABSTRACT FROM AUTHOR]

Adolescent violence in the home is a growing public health issue and remains under reported and under-researched. The focus of the present research is to investigate factors that may contribute to adolescent violence in the home, among acohort of young people with co-occurring early psychosis. Data relates to 50 young people (16 females, 33 males, 1 nonbinary) aged from 16-25 who were clients at a youth early psychosis service in Melbourne, Australia. Results from a discriminant function analysis revealed the two major contributing factors to whether someone used violence in the home, were whether a young person had a coexisting neurodevelopmental or intellectual disability and whether they used violence outside the home. The findings provide preliminary evidence that engaging in violence outside the home and the presence of a neurodevelopmental or intellectual disability may make it more likely for young people with early psychosis to use violence in the home. [ABSTRACT FROM AUTHOR]

Extreme heat alerts are the most common form of weather forecasting services used in Australia, yet very limited studies have documented their effectiveness in improving health outcomes. This study aimed to examine the temporal changes in temperature-related mortality in relation to the activation of the heat-health alert and response system (HARS) in the State of Victoria, Australia. We examined the relationship between temperatures and mortality using quasi-Poisson regression and the distributed lag non-linear model (dlnm) and compared the temperature-mortality association between the two periods: period 1– prior-HARS (1992–2009) and period 2– post-HARS (2010–2019). Since the HARS heavily weights heatwave effects, we also compared the main effects of heatwave events between the two periods. The heatwaves were defined for three levels, including 3 consecutive days at 97th, 98th, and 99th percentiles. We also controlled the potential confounding effect of seasonality by including a natural cubic B-spline of the day of the year with equally spaced knots and 8 degrees of freedom per year. The exposure-response curve reveals the temperature mortality was reduced in period 2 in comparison with period 1. The relative risk ratios (RRR) of Period 2 over Period 1 were all less than one and gradually decreased from 0.86 (95% CI, 0.72–1.03) to 0.64 (95% CI, 0.33–1.22), and the differences in attributable risk percent increased from 13.2 to 25.3%. The reduction in the risk of heatwave-related deaths decreased by 3.4% (RRp1 1.068, 95% CI, 1.024–1.112 versus RRp2 1.034, 95% CI, 0.986–1.082) and 10% (RRp1 1.16, 95% CI, 1.10–1.22 versus RRp2 1.06, 95% CI, 1.002–1.119) for all groups of people. The study indicated a decrease in heat-related mortality following the operation of HARS in Victoria under extreme heat and high-intensity heatwaves conditions. Further studies could investigate the extent of changes in mortality among populations of differing socio-economic groups during the operation of the heat-health alert system. [ABSTRACT FROM AUTHOR]

Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background. [ABSTRACT FROM AUTHOR]

Purpose: Unmanaged mental health problems following a stroke can be detrimental to recovery. We aimed to explore the lived experience of (a) poststroke mental health difficulties, (b) help-seeking for mental health, including factors that influenced treatment access and utilization, and (c) receiving treatment and support. Research Method: Individual semistructured interviews were conducted in 2022 with 13 participants (62% female, age at stroke 35–76 years) who had experienced mental health difficulties following their stroke. Data were analyzed using reflexive thematic analysis with a critical realist approach. Results: Six themes were identified. Mental health challenges poststroke were diverse in nature. Attitudes and previous experiences relating to mental health influenced the inclination to seek help. Participants valued an individualized approach to the provision and timing of psychoeducation. Accessibility of services was impacted by financial and transportation barriers, as well as availability of services and appropriately trained clinicians. Participation in support groups was a positive experience for most participants. Lived experience of mental health treatment ranged from positive to negative, and participants conveyed helpful and unhelpful aspects. Conclusions: Findings highlight the importance of early screening and psychoeducation provision for poststroke mental health difficulties, alongside accessible community-based mental health support services throughout the stroke recovery journey. Having varied options for mental health support and treatment may aid stroke survivors in finding an approach that personally works for them. Additionally, it may be helpful to train clinicians to tailor mental health treatment to accommodate stroke-related impairments (e.g., cognitive, sensorimotor). Impact and Implications: Although poststroke mental health problems are common and can hinder recovery, existing research primarily examines mental health treatment access and utilization within the general population. This study expands on the existing limited quantitative evidence in the stroke population by investigating previously unexplored qualitative insights. This study offers a holistic understanding of the diverse nature and progression of mental health difficulties after stroke, as well as the challenges stroke survivors encounter when seeking mental health support. It highlights additional factors that require attention to ensure equitable treatment access and elucidates the perceived quality and effectiveness of mental health services and supports. It is important to screen for mental health problems and provide psychoeducation throughout the stroke recovery journey, starting in the hospital. Various formal and informal support options should be made available, tailored to individual preferences and stroke-related consequences. Engaging social supports (e.g., family, friends, stroke peers) in mental health management may be beneficial. [ABSTRACT FROM AUTHOR]

Background: Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. Aims: To assess the impact of general medicine consultant‐led ward rounds (CWRs) in the ED on patient length of stay (LOS). Methods: One‐month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1‐month audit, with the primary outcome being LOS and the secondary outcome being 30‐day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. Results: Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30‐day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. Conclusions: A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the leading cause of cancer death in Australia. Immunotherapy has improved outcomes in patients with metastatic non‐small cell lung cancer (NSCLC). Pembrolizumab is approved in first‐line treatment as single‐agent immunotherapy (SAI) or combination chemoimmunotherapy (CIT). In metastatic NSCLC programmed death‐ligand 1 (PD‐L1) ≥50% either regimen may be used. Aims: We aim to identify patient and tumour characteristics that influence treatment selection. Methods: This is a retrospective observational study. Pharmacy records identified patients with metastatic/recurrent NSCLC receiving pembrolizumab at two metropolitan centres in Victoria, Australia, since 2018. Demographics, tumour characteristics, Charlson Comorbidity Index (CCI) and treatment data were collected. Descriptive and multivariate analyses were performed. Results: Sixty‐one patients had metastatic NSCLC PD‐L1 ≥50% and received pembrolizumab with median age of 65.6 years, Eastern Cooperative Oncology Group 0–1 in 82%. CIT was administered to 23% (14) with no difference in rate of delivery between centres (P = 0.808). CCI mean score differed (3.38 SAI vs 2.36 CIT, P = 0.042). Patients with high CCI score (≥2) were less likely to receive CIT (OR = 0.15, P = 0.003, 95% confidence interval (CI) 0.04–0.57). Primary tumours over 5 cm were more likely to receive CIT (OR = 3.74, P = 0.043, 95% CI = 1.04–13.42). Site‐specific metastases of liver, brain and pericardial effusion were not associated with CIT. Conclusions: Patients with higher comorbidity score were less likely to receive CIT, suggesting chemotherapy avoidance in comorbid patients. Larger tumours are associated with CIT use, indicating that oncologists may use tumour size as a surrogate of disease burden. Limitations include small sample size and data cut‐off. Future prospective studies could incorporate comorbid status and a validated disease burden score to stratify patients. [ABSTRACT FROM AUTHOR]

Background: Anxiety is prevalent in older people and is associated with adverse health outcomes. Early detection and intervention are imperative, yet clinically significant anxiety in older people is often under-diagnosed. When diagnosed, pharmacotherapy is often the initial treatment, but resistance due to stigma, polypharmacy concerns, and side effects are common among the elderly. Non-pharmacological interventions such as deep breathing and progressive muscle relaxation may offer more acceptable and cost-effective options to managing anxiety. While primary care is ideal for addressing anxiety in older adults, it is important to assess the feasibility and acceptability of nurse-led interventions in general practice. Objective: To explore the perspectives of General Practice Nurses (GPNs) on the feasibility and acceptability of implementing a guided relaxation intervention for older people living with symptoms of anxiety, in Australian metropolitan and regional settings. Methods: GPNs were trained and then administered a guided relaxation intervention to older people at three metropolitan general practices and one large rural practice encompassing four sites. Subsequently, five GPNs participated in semi-structured interviews exploring the acceptability and feasibility of implementing the intervention. Interviews were recorded, transcribed and findings were mapped to four key domains of interest: "Screening", "Training and Delivery", "Perceived impact of the Intervention" and "Barriers to the intervention". Results: Overall, GPNs reported that the intervention was easy to implement, was well received, helped build relationships and enabled conversations about mental health and well-being. They noted broader applicability of acquired knowledge and skills with other clients. Conclusion: The intervention shows promise in promoting and supporting healthcare capabilities in primary care. GPNs are ideally placed to detect clinical symptoms of anxiety among older people and deliver brief well-being initiatives. However, to sustain and scale well-being interventions structured skill development, commitment from general practices, and policy shifts such as government rebates for GPNs are required. [ABSTRACT FROM AUTHOR]

This article presents the outcomes of a study conducted in Victoria, Australia, that recognised teachers' knowledge and understanding of phonics teaching, and early literacy acquisition processes more generally. In total, 45 teachers and 220 students from the 18 focus schools who engaged in the reform initiative agreed to participate in this study. The questions posed considered understandings associated with the professional learning programme and processes that support the implementation of the phonics teaching and the impact this had on students' literacy learning. We share the data used to map teachers' stories of change and practice and some of the key factors, including structures, practices and attitudes, that influenced the implementation. The impact on students' reading and writing outcomes throughout the reform process are also reported. Combined, the findings indicate that the teaching of phonic knowledge, integrated into rich contexts for learning, contributed to improvements in teaching and students' early literacy skills. Furthermore, this study fills an important and common missing gap in professional learning as it explores implementation processes and practice in the classroom. The results inform continuing reform efforts and targeted research necessary to refine phonics teaching practice and further advance students' literacy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists work with forensic mental health patients in solitary confinement to counter impacts of mental illness and occupational deprivation, to promote well‐being and support transition to less restricted environments. There is little literature describing occupational therapy in this context. This study aimed to explore and describe the work, context and professional reasoning of occupational therapists working in solitary confinement settings within a large forensic mental health service in Victoria, Australia. Methods: A qualitative design used semi‐structured interviews with 11 occupational therapists and reflexive thematic analysis. Findings: Three central organising themes, it's all about risk, the work we do and why we do what we do, provided rich description of the context and work of occupational therapists in solitary confinement settings, including approaches used to engage patients in occupation and how the Model of Human Occupation and recovery principles informed their professional reasoning. Despite the setting restrictions, participants engaged in core elements of the occupational therapy practice process and described creative work that offered patients choice and meaningful occupation. They described occupational enrichment to address occupational deprivation and create opportunities for change within the highly restrictive and risk‐focussed environment of solitary confinement. Assessment was mainly unstructured, and the need for better evaluation of therapy outcomes acknowledged. Goal setting often focussed on immediate needs. Working in a risk‐focussed environment influenced participants' professional reasoning and work with patients, and while they advocated for occupational opportunities for patients, frustration was experienced in response to limits to occupational therapy involvement in risk assessment. Conclusion: The findings address a gap in the literature about the work of occupational therapists in forensic solitary confinement. Though participants' reasoning was informed by occupational and recovery principles, and they described working in occupation‐based ways, they did not always articulate explicit connections between theory and practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria. Design: This study was an online cross‐sectional design conducted between December 2022 and February 2023. Settings and Participants: AHPs employed at a large multi‐site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia. Main Outcome Measure(s): The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers. Results: The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6–10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self‐perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment. Conclusion: CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities. [ABSTRACT FROM AUTHOR]

Objective: To explore the preparedness and training needs of a regional public mental health workforce to support people with intellectual disability and mental ill health. Setting and Participants: Staff from a regional public mental health service in Victoria, Australia. Design: A mixed‐methods design comprised a survey, interviews and a focus group to collect data about staff attitudes, confidence, education and professional development regarding supporting people with intellectual disability and mental ill health. Descriptive and thematic analyses were used. Results: Data from 31 survey respondents, seven interviews and one focus group were analysed. Survey descriptive analyses showed participants believed treating people with intellectual disability was part of their role but reported areas of low confidence along with insufficient education and training in intellectual disability mental health. Thematic analyses from interviews showed that underpinning confidence, education and training were the themes (1) need for flexibility, such as having more time and (2) solutions but with challenges, such as limited opportunity to upskill and availability of experts. A need for collaborative problem‐solving where staff share skills and information to work towards person‐centred solutions was a key theme from the focus group analysis. Conclusion: Professional development in intellectual disability mental health is required for the regional public mental health workforce but needs to account for the challenges experienced and reflect how teams function. Exploration of described preparedness offered a possible learning approach informed by workforce members. Collaborative learning approaches to supporting people with intellectual disability and mental ill health are suggested. [ABSTRACT FROM AUTHOR]

Background: StrokeLine is a stroke‐specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. Aim: The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. Methods: An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi‐structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio‐recorded Zoom conference calling and transcribed verbatim for thematic analysis. Results: A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub‐themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. Conclusions: Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self‐manage their condition. Patient or Public Contribution: Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study. [ABSTRACT FROM AUTHOR]