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McLeod, Sharynne. "A Non-Systematic Review of Evidence-Based Practice within Speech Pathology in Australia." South African Journal of Communication Disorders 55, no. 1 (December 31, 2008): 16–19. http://dx.doi.org/10.4102/sajcd.v55i1.765.
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In this non-systematic review, evidence-based practice (EBP) in Australian speech pathology research and practice is examined. Many Australian researchers are contributing to the theoretical evidence through systematic reviews, randomised controlled trials, and other clinical research. Additionally, Australian researchers are integrating international theoretical evidence via speechBITE™ and other initiatives. Australian speech pathologists'clinical expertise is supported via Speech Pathology Australia and an example of the implementation of EBP in clinical contexts is the NSWEBP Network. Within Australia, research attention also has been directed towards the client's choice and the client's voice. This paper acknowledges limitations of implementing EBP in Australia: suggesting that inclusion of the client's voice could be formalised and that additional research needs to be undertaken to address practical differences in service delivery models between Australian and international contexts.
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Lambert, Robyn, Naomi Burgess, Nadine Hillock, Joy Gailer, Pravin Hissaria, Tracy Merlin, Chris Pearson, Benjamin Reddi, Michael Ward, and Catherine Hill. "South Australian Medicines Evaluation Panel in review: providing evidence-based guidance on the use of high-cost medicines in the South Australian public health system." Australian Health Review 45, no. 2 (2021): 207. http://dx.doi.org/10.1071/ah20018.
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ObjectiveThe South Australian Medicines Evaluation Panel (SAMEP) was established in 2011 to make evidence-based recommendations on the funding of high-cost medicines in South Australian public hospitals via a high-cost medicines formulary. SAMEP represents one component of South Australia’s process for state-based health technology assessment (HTA). The aim of this study was to describe the experience of SAMEP in the context of Australia’s complex governance model for hospital-based care. MethodsA retrospective review was conducted of the SAMEP process and outcomes of medicine evaluations. Decision summaries and meeting minutes were reviewed and reflected upon by the authors to explore the views of the SAMEP membership regarding the function of the committee and state-based HTA more broadly. ResultsSAMEP has reviewed 29 applications, with 14 (48%) listed on the high-cost medicines formulary. Three applications have been the subject of outcome review and confirm expectations of patient benefit. ConclusionRetrospective review of the committee experience suggests that state-based HTA as operationalised by SAMEP is feasible, provides greater equity of access to high-cost medicines in the South Australian public hospital system and allows for access with evidence development. What is known about the topic?State-based hospital funders often need to make decisions on the provision of high-cost medicines for which there is no national guidance or subsidy. Little published information exists about state-based approaches to medicines evaluation and reimbursement within public hospitals in Australia. What does this paper add?The South Australian experience demonstrates a method for states and territories to tackle the challenges of providing evidence-based access to high-cost medicines in Australian public hospitals. What are the implications for practitioners?This paper provides information for other jurisdictions considering state-based approaches to medicines evaluation and contributes to the broader literature about state-based HTA in Australia.
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Morris, Brian J., Athos Katelaris, Norman J. Blumenthal, Mohamed Hajoona, Adrian C. Sheen, Leslie Schrieber, Eugenie R. Lumbers, Alex D. Wodak, and Phillip Katelaris. "Evidence-based circumcision policy for Australia." Journal of Men's Health 18, no. 6 (May 30, 2022): 132. http://dx.doi.org/10.31083/j.jomh1806132.
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Barendregt, Jan J. "Towards evidence‐based dementia screening in Australia." Medical Journal of Australia 194, no. 7 (April 2011): 375. http://dx.doi.org/10.5694/j.1326-5377.2011.tb03019.x.
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Terpening, Zoe, John R. Hodges, and Nicholas J. Cordato. "Towards evidence‐based dementia screening in Australia." Medical Journal of Australia 194, no. 2 (January 2011): 60–61. http://dx.doi.org/10.5694/j.1326-5377.2011.tb04166.x.
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BEYLİK, Umut. "Analysis Of Articles on Evidence-Based Medicine." Gevher Nesibe Journal IESDR 6, no. 15 (November 25, 2021): 87–108. http://dx.doi.org/10.46648/gnj.288.
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The aim of this study is to conduct a bibliometric analysis of articles on evidence-based medicine. Using Bibliometrix and VOSviwer software, the most efficient author, country, organization, and journals were identified. Web of Science articles between the years of 1975-2019 were downloaded with a search strategy and analyzed with Bibliometrix and VOSviwer software. It has been observed that evidence-based medicine articles were grouped under three main clusters (Management and Decision Support, Drug and Experiment and Measurment). The first three countries that have the highest international collaboration rate are Switzerland, New Zealand, and Sweden. The first five countries regarding publication numbers are the USA, United Kingdom, Canada, Australia, and Germany. While Khan and Green have the highest grade in h and g index; Baglı, Castagnetti and Fossum have the highest grade in m index. Guyatt is the author who has the highest number of citations whereas Phillips is the one who has the most publications. While, on one hand, evidence-based medicine extends its function in illness and drug treatments, on the other hand, it is used as policy input to improve the education, curriculum, and the health system. Policy-makers, decision-makers, educators, and researchers can develop strategies according to the findings identified above.
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Egger, Garry, and Sam Egger. "Lifestyle Medicine." American Journal of Lifestyle Medicine 6, no. 1 (May 26, 2011): 26–30. http://dx.doi.org/10.1177/1559827611405287.
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Changes in disease patterns from predominantly infectious to predominantly chronic diseases in Australia, in line with economic development throughout the developed world, have led to the need for changes in conventional health practice. This has resulted in a movement toward an evidence-based discipline of lifestyle medicine incorporating aspects of both public health and clinical medicine, aimed at moderating lifestyle and environmentally based etiologies. A professional association, postgraduate and continuing professional development training, working text, interactive Web site, and annual conference, as described here, are designed to complement conventional medical knowledge and practices. Changes to the Australian health system, which operates on a dual public/private model have made this approach more feasible and continue to be adapted to allow a more comprehensive approach to lifestyle-related health problems.
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Bucknall, Tracey. "Evidence‐Based Practice in Australia: An Unremitting Challenge for Quality!" Worldviews on Evidence-Based Nursing 1, no. 2 (May 21, 2004): 85–87. http://dx.doi.org/10.1111/j.1741-6787.2004.04029.x.
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Fox, Russell, Umesh Sharma, and Erin Leif. "A Study of Victorian Teachers’ Beliefs About Student Behaviour and Their Perception of Preparation and Confidence to Engage inand Their Perception of Preparation and Confidence to Engage in Evidence-based Behaviour SupportEvidence-based Behaviour Support." Australian Journal of Teacher Education 47, no. 1 (January 2022): 14–29. http://dx.doi.org/10.14221/ajte.2022v47n1.2.
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Positive and proactive approaches to behaviour support have been recognised as one component required to create effective and inclusive school environments (Finkelstein et al., 2019). States and territories within Australia have increasingly adopted school- wide positive behavioural interventions and supports (SWPBIS) as a means to creating effective social and behavioural change (Poed & Whitefield, 2020). However, ensuring staff implement SWPBIS as it is intended has been a challenge, both in Australia and internationally (McIntosh et al., 2016; NSW Ombudsman, 2017). The current study identifies and seeks to address two gaps in the existing literature exploring noted barriers to the successful and sustained implementation of SWPBIS. First, limited exploration of teachers’ perceptions of their preparation (pre-service and in-service) and confidence to engage in SWPBIS practices and supports has been undertaken in Australia. Additionally, the degree to which teachers agree with a functional approach to understanding and supporting student behaviour has not been undertaken in an Australian context. The findings from such exploration may be used to inform the development of teacher training programs, and support efforts to successfully and sustainably implement SWPBIS in Australian schools.
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Belowska, Jarosława, Mariusz Panczyk, Aleksander Zarzeka, and Joanna Gotlib. "Knowledge and attitudes of nursing students towards evidence-based medicine and evidence-based nursing practice." Polish Journal of Public Health 125, no. 4 (December 1, 2015): 201–4. http://dx.doi.org/10.1515/pjph-2015-0055.
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Abstract Introduction. Modern nursing practice requires Nursing students to expand their knowledge both in the field of specialized nursing and learning the basics of medicine, as based on scientific evidence. The dissemination of research activities in nursing and the development of the profession, knowledge and practice based on Evidence-based Nursing may contribute to the increase of the effectiveness and improving the quality of healthcare services. Nursing teaching curricula should include subjects related to Evidence-based Medicine, such as scientific research methodology or critical analysis of scientific literature. Aim. The aim of the study was to analyze the knowledge and attitudes of nursing students towards Evidence-based Medicine (EBM) and Evidence-based Nursing Practice (EBNP). Material and methods. Out of 127 Master’s degree students in Nursing at the Medical University of Warsaw (4 men), 72% work as a nurse. Mean age of the study group was 26.55 years (min. 22, max. 51, SD=7.52) with 63% of the students attending full-time studies, with 90% being students of the first year. Some 53% earned their bachelor’s degree in Nursing in 2013. A standardized Evidence – Based Practice Profile Questionnaire from University of South Australia, quantitative analysis of the study results. Results. Nearly 30% of the respondents have never encountered EBM or EBNP during their time at the University (n=41). Most students intend to use relevant scientific literature in order to update their knowledge (n=68) and to upgrade their skills, so as to integrate EBNP into their everyday professional practice (n=67). Some 60% of the respondents deem scientific reports useful for their work (n=76) but nearly half of them regards clinical experience as more important than the results of scientific studies, when it comes to making the right decisions in their professional practice (n=56). Nearly a half of the studied group (n=66) have never heard about the term minimum clinically worthwhile effect and only one person declared the correct explanation systematic review (n=1). 42% declare reading published scientific studies once a month but nearly 30% have never referred scientific findings to their own diagnosis (n=41) and 40% have never assessed its methodological correctness (n=51). Conclusions. 1. The educational programs in the framework of Nursing studies should be supplemented with subjects of EBM and EBNP, so as to expand the nursing students’ knowledge and let them reap the benefits of using the latest study results in their future professional practice. 2. The level of knowledge about the principles of assessment of reliability of scientific evidence was strongly insufficient and requires urgent supplementation of knowledge and skills of students in this area. 3. It is necessary for students to update their knowledge, particularly when it comes to using the latest scientific literature in everyday clinical practice and skills connected with critical analysis of scientific evidence.
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Bayer, Jordana, Harriet Hiscock, Katherine Scalzo, Megan Mathers, Myfanwy McDonald, Alison Morris, Joanna Birdseye, and Melissa Wake. "Systematic Review of Preventive Interventions for Children's Mental Health: What Would Work in Australian Contexts?" Australian & New Zealand Journal of Psychiatry 43, no. 8 (January 1, 2009): 695–710. http://dx.doi.org/10.1080/00048670903001893.
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In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0–8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australia's population, and programme compatibility with Australia's service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted children's behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost–benefits for children's mental health without delaying dissemination.
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Norman, R., and J. Hall. "Can hospital-based doctors change their working hours? Evidence from Australia." Internal Medicine Journal 44, no. 7 (July 2014): 658–64. http://dx.doi.org/10.1111/imj.12414.
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Mui, Jasmine, Darren J. Mayne, Kimberley J. Davis, Jose Cuenca, and Steven J. Craig. "Increasing use of intraoperative cholangiogram in Australia: is it evidence‐based?" ANZ Journal of Surgery 91, no. 7-8 (May 12, 2021): 1534–41. http://dx.doi.org/10.1111/ans.16912.
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Zulkefli, Noorfatin Jihan, Vanitha Mariappan, Kumutha Malar Vellasamy, Chun Wie Chong, Kwai Lin Thong, Sasheela Ponnampalavanar, Jamuna Vadivelu, and Cindy Shuan Ju Teh. "Molecular evidence ofBurkholderia pseudomalleigenotypes based on geographical distribution." PeerJ 4 (March 15, 2016): e1802. http://dx.doi.org/10.7717/peerj.1802.
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Background.Central intermediary metabolism (CIM) in bacteria is defined as a set of metabolic biochemical reactions within a cell, which is essential for the cell to survive and respond to environmental perturbations. The genes associated with CIM are commonly found in both pathogenic and non-pathogenic strains. As these genes are involved in vital metabolic processes of bacteria, we explored the efficiency of the genes in genotypic characterization ofBurkholderia pseudomalleiisolates, compared with the established pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) schemes.Methods.Nine previously sequencedB. pseudomalleiisolates from Malaysia were characterized by PFGE, MLST and CIM genes. The isolates were later compared to the other 39B. pseudomalleistrains, retrieved from GenBank using both MLST and sequence analysis of CIM genes. UniFrac and hierachical clustering analyses were performed using the results generated by both MLST and sequence analysis of CIM genes.Results.Genetic relatedness of nine MalaysianB. pseudomalleiisolates and the other 39 strains was investigated. The nine Malaysian isolates were subtyped into six PFGE profiles, four MLST profiles and five sequence types based on CIM genes alignment. All methods demonstrated the clonality of OB and CB as well as CMS and THE. However, PFGE showed less than 70% similarity between a pair of morphology variants, OS and OB. In contrast, OS was identical to the soil isolate, MARAN. To have a better understanding of the genetic diversity ofB. pseudomalleiworldwide, we further aligned the sequences of genes used in MLST and genes associated with CIM for the nine Malaysian isolates and 39B. pseudomalleistrains from NCBI database. Overall, based on the CIM genes, the strains were subtyped into 33 profiles where majority of the strains from Asian countries were clustered together. On the other hand, MLST resolved the isolates into 31 profiles which formed three clusters. Hierarchical clustering using UniFrac distance suggested that the isolates from Australia were genetically distinct from the Asian isolates. Nevertheless, statistical significant differences were detected between isolates from Malaysia, Thailand and Australia.Discussion.Overall, PFGE showed higher discriminative power in clustering the nine MalaysianB. pseudomalleiisolates and indicated its suitability for localized epidemiological study. Compared to MLST, CIM genes showed higher resolution in distinguishing those non-related strains and better clustering of strains from different geographical regions. A closer genetic relatedness of Malaysian isolates with all Asian strains in comparison to Australian strains was observed. This finding was supported by UniFrac analysis which resulted in geographical segregation between Australia and the Asian countries.
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Coory, Michael D. "Ageing and healthcare costs in Australia: a case of policy‐based evidence?" Medical Journal of Australia 180, no. 11 (June 2004): 581–83. http://dx.doi.org/10.5694/j.1326-5377.2004.tb06096.x.
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Searle, Judith. "Evidence‐based obstetrics in Australia: can we put away the wooden spoon?" Medical Journal of Australia 174, no. 11 (June 2001): 588–89. http://dx.doi.org/10.5694/j.1326-5377.2001.tb143445.x.
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Costa, Caroline M. "Evidence‐based obstetrics in Australia: can we put away the wooden spoon?" Medical Journal of Australia 175, no. 9 (November 2001): 503–4. http://dx.doi.org/10.5694/j.1326-5377.2001.tb143701.x.
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Searle, Judith. "Evidence‐based obstetrics in Australia: can we put away the wooden spoon?" Medical Journal of Australia 175, no. 9 (November 2001): 504. http://dx.doi.org/10.5694/j.1326-5377.2001.tb143702.x.
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Hunt, Jennifer M., and Judith Lumley. "Are recommendations about routine antenatal care in Australia consistent and evidence‐based?" Medical Journal of Australia 176, no. 6 (March 2002): 255–59. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04402.x.
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Gool, Kees Van, Emily Lancsar, Rosalie Viney, Jane Hall, and Philip Haywood. "Diagnosis and prognosis of Australia&s health information for evidence-based policy." Journal of Health Services Research & Policy 7, no. 1_suppl (July 2002): 40–45. http://dx.doi.org/10.1258/135581902320176368.
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Without adequate information it is difficult to determine the success or failure of health policies. This paper assesses the adequacy of Australia&s health information for evidence-based policy. Three policy areas are analysed: the impact of changing the public and private health financing mix; waiting lists and waiting times; and pooling of funds. In each, the issue is analysed to identify the key policy questions, the available data and existing analyses are examined, and gaps in data availability and analysis are assessed. There is variability in the extent and usefulness of current health information. In terms of the impact of changing the financing mix, there is good information on the distribution of finance, but much less available on comparative use or efficiency of public and private hospitals. There is comprehensive information available on waiting lists and waiting times but little analysis of the implications of this for equity of access or the costs and benefits of reducing waiting times. There is insufficient information for the development of the capitation based formulae required for the introduction of the pooling of funds, nor enough information to assess the extent and impact of current cost-shifting which might be addressed by pooling funds. While the concept of evidence-based medicine has been embraced with regard to specific treatment decisions, there has not been a parallel investment in the use of evidence to drive policy decisions.
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Jones, Jacqueline, and Simon Stewart. "Optimising Stroke Outcomes through Evidence-Based Nursing Practice: An Australian Perspective." European Journal of Cardiovascular Nursing 1, no. 4 (December 2002): 227–35. http://dx.doi.org/10.1016/s1474-51510200042-7.
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Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of ‘best practice’. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI–both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.
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Hunt, Jennifer M., and Judith Lumley. "Are Recommendations About Routine Antenatal Care in Australia Consistent and Evidence-Based?" Obstetrical & Gynecological Survey 57, no. 10 (October 2002): 652–54. http://dx.doi.org/10.1097/00006254-200210000-00005.
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Field, Kathryn M., Suzanne Kosmider, Michael Jefford, Ross Jennens, Michael Green, and Peter Gibbs. "Chemotherapy Treatments for Metastatic Colorectal Cancer: Is Evidence-Based Medicine in Practice?" Journal of Oncology Practice 4, no. 6 (November 2008): 271–76. http://dx.doi.org/10.1200/jop.0852002.
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Purpose:The optimal regimen for the treatment of metastatic colorectal cancer (CRC) remains uncertain. We sought to document clinicians' treatment recommendations and determine the motivation behind them.Materials and Methods:A postal questionnaire was sent to all members of the Medical Oncology Group of Australia concerning chemotherapy treatment options in the setting of metastatic CRC.Results:The response rate was 59.7% (n = 188). One hundred sixty-two physicians (86%) treated patients with CRC. Of the 162 physicians, 92.6% (n = 150) recommended oxaliplatin-based regimens as first-line treatment for CRC due to perceived superior efficacy (66.9%; n = 107) or toxicity profile (17%; n = 27). Fluorouracil (FU), leucovorin (LV), and oxaliplatin (FOLFOX6) was the most popular regimen (59.3%; n = 98). Calcium and magnesium to prevent oxaliplatin-related neurotoxicity was routinely used by 34.6% of physicians (n = 56) from cycle 1. Despite the lack of phase III data at the time, 8.6% of physicians (n = 14) selected capecitabine and oxaliplatin (XELOX) a preferred first-line regimen; 61.7% of physicians (n = 100) recommended FU, LV, and irinotecan (FOLFIRI) second-line treatment. Concerning LV dose, one third of physicians (33.3%; n = 54) selected 20 mg/m2and one third of physicians (32.7%, n = 53) selected 200 mg/m2, with 25.3% of physicians (n = 41) using a fixed 50 mg bolus.Conclusion:This survey demonstrated considerable variation regarding recommended chemotherapy for patients with metastatic CRC. Of considerable concern is the use of calcium and magnesium based on retrospective data alone. Given that this variation in practice may significantly impact patient outcomes, additional studies are required to improve understanding of physician attitudes and the motivations behind treatment decision making.
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Einfeld, Colette. "Nudge and evidence based policy: fertile ground." Evidence & Policy: A Journal of Research, Debate and Practice 15, no. 4 (November 1, 2019): 509–24. http://dx.doi.org/10.1332/174426418x15314036559759.
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Nudge is an approach to public policy that changes the decision-making environment to encourage citizens to make a particular choice. The approach has been eagerly adopted by administrations around the world, with some governments establishing dedicated nudge units to advance their use. One reason proposed for nudge’s popularity is that it supports evidence-based policy. Nudging seems to be firmly positioned in evidence-based policy rhetoric, and encourages the use of Randomised Control Trials to determine the effectiveness of a policy. There is little empirical understanding on whether nudge’s association with this rhetoric has contributed to its increasingly widespread application. This research explores how nudge is understood in relation to the evidence-based movement, from the perspective of those designing, developing and implementing nudge policies. In-depth, qualitative interviews were undertaken with policymakers in Australia. This paper finds policymakers perceive an interconnected relationship between nudging and evidence-based policy, with each providing fertile ground for the growth of the other. Consequences for scholarship and practice are discussed including implications for what constitutes legitimate evidence in the public service.
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Hall, Alix, Sang Minh Nguyen, Lisa Mackenzie, Rob Sanson-Fisher, Ian Olver, Tran Van Thuan, and Tran Thanh Huong. "What Caused My Cancer? Cancer Patients’ Perceptions on What May Have Contributed to the Development of Their Cancer: A Cross-Sectional, Cross-Country Comparison Study." Cancer Control 26, no. 1 (January 1, 2019): 107327481986378. http://dx.doi.org/10.1177/1073274819863786.
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Accurate public perceptions on the risk factors associated with cancer are important in promoting primary, secondary, and tertiary prevention. Limited studies have explored this topic among patients with cancer in non-western, low-to-middle-income countries. A cross-sectional survey to compare Australian and Vietnamese cancer patients’ perceptions of what caused their cancer was undertaken. Adult, patients with cancer from both countries, receiving radiotherapy treatment completed a standardized survey, which included a 25-item module assessing their beliefs on the causes of their cancer. Items ranged from known evidence-based causes (eg, smoking, sun exposure) to non-evidence-based beliefs (eg, stress or anxiety, physical injury, or trauma). Country-specific logistic regression analyses were conducted to identify differences in the determinants of patients’ top perceived causes. A total of 585 patient surveys were completed (75% response rate; 285 from Australia, and 300 from Vietnam). Most patients were male (58%) and aged 60 years and older (55%). The most frequently reported risk factor overall and for the Australian sample was “getting older” (overall = 42%, Australia = 49%, and Vietnam = 35%). While the most frequently reported risk factor for the Vietnamese sample was “poor diet” (overall = 39%, Australia = 11%, and Vietnam = 64%). There were differences in the characteristics associated with the top causes of cancer identified by Australian and Vietnamese patients. Patients’ beliefs about what may have caused their cancer are complex and likely to be impacted by multiple factors, including the country from which they reside. Developing public awareness campaigns that are accurate and tailored to address the specific beliefs and possible misconceptions held by the target community are needed.
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Thomas, S. L., K. Lam, L. Piterman, A. Mijch, and P. A. Komesaroff. "Complementary medicine use among people living with HIV/AIDS in Victoria, Australia: practices, attitudes and perceptions." International Journal of STD & AIDS 18, no. 7 (July 1, 2007): 453–57. http://dx.doi.org/10.1258/095646207781147292.
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There is limited evidence suggesting the underlying reasons for the use of complementary and alternative medicines (CAMs) by people with HIV/AIDS, or individual attitudes and beliefs about the use of CAMs. Using focus groups and a survey with 151 individuals attending the HIV Clinics at The Alfred Hospital, Melbourne, we aimed to provide insights into factors that influence the use of CAMs among people living with HIV/AIDS. Roughly half (49%) of the participants had used CAMs to manage their HIV/AIDs. Users of CAMs utilized a wide range of treatments in managing their condition, but costs of the CAMs meant that users were not necessarily able to use them as much as they might have liked. Use of CAMs was based on a desire to find something beneficial rather than on being dissatisfied with conventional medicine. Further research is needed into (a) the effects of CAMs and (b) the enhancement of communication and collaboration between patients, doctors and complementary medicine practitioners.
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Walter, Garry, Ken Kffikby, Isaac Marks, Harvey Whtteford, Gavin Andrews, and Richard Swinson. "Outcome Measurement: Sharing Experiences in Australia." Australasian Psychiatry 4, no. 6 (December 1996): 316–18. http://dx.doi.org/10.3109/10398569609082075.
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There is growing attention to evidence-based medicine both in informing medical education and in guiding clinical practice. The result is increasing emphasis on evaluating treatment efficacy, the structure of health care delivery, the allocation of the health dollar and the application of information technology to these tasks. Implications are emerging for psychiatric care in Australia from everyday clinical practices to the political level. Collective experience in this area, as discussed at a conference forum in Sydney [1], is summarized in this paper. This information is presented to stimulate thought, foster comparisons and encourage a synthesis of clinical, administrative and political directions in this field.
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Lee, R. P., B. Venkatesh, and P. Morley. "Evidence-based Evolution of the High Stakes Postgraduate Intensive Care Examination in Australia and New Zealand." Anaesthesia and Intensive Care 37, no. 4 (July 2009): 525–31. http://dx.doi.org/10.1177/0310057x0903700422.
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The fellowship examination for intensive care medicine in Australia and New Zealand, first held in 1979, has undergone four major periods of development and change since inception. These periods are characterised as: 1. 1979 to 1996 – initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. 2. 1997 to 2001 – revision to increase breadth of coverage, increase reliability for a growing number of candidates and ensure that each candidate received the same exam: • Expansion: to incorporate assessment of CanMEDS skills (including communication, procedures and professional qualities). • Lengthening: to increase the number of exposures, to ensure reliability. • Quarantining of candidates: to allow the provision of a similar exam for each candidate. 3. 2002 to 2006 – increasing emphasis on examiner training, standard setting and increasing feedback to candidates to improve the educational experience and guide exam preparation. Blueprinting of questions to maintain validity. 4. 2008 onwards – logistic revision to ensure feasibility for a rapidly growing number of candidates and refinement to apply modem standard setting and quality control The exam has been regarded as a ‘tough but fair’ assessment in its 30 years of existence and the committee overseeing its development has aimed to continually review the process to maintain those qualities as well as reliability, validity and feasibility. The increasing number of candidates has allowed accumulation of usable statistics but has tested the feasibility of running such a labour intensive exam. To date, there have been 800 presentations to the exam with 498 successful candidates.
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Hoare, Erin, Andrew Thorp, Nadine Bartholomeusz-Raymond, Alicia McCoy, Helen Butler, and Michael Berk. "Be You: A national education initiative to support the mental health of Australian children and young people." Australian & New Zealand Journal of Psychiatry 54, no. 11 (August 14, 2020): 1061–66. http://dx.doi.org/10.1177/0004867420946840.
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Early learning services and schools provide unique settings for mental health promotion and early intervention due to the potential for population-level dosage and reach in terms of reducing multiple risk factors and enabling protective factors among young people. Educators play a key role in supporting children and young people’s experiences of, and access to mental health promotion opportunities, and hold unparalleled opportunity in terms of creating mental health–promoting learning environments. In 2018, the Australian National Mental Health in Education Initiative, Be You, was launched. Be You is a multi-million-dollar Australian government–supported initiative, freely available to all 24,000 early learning services, primary and secondary schools throughout Australia. The potential for subsequent population reach is proposed to potentially exceed that of any mental health promotion initiative for children and young people previously observed in Australia. Be You aims to foster mentally healthy learning communities across Australia through building capacity among educators to embed mental health promotion strategies. The Initiative was developed based on a review and integration of previous national mental health promotion frameworks, with an overall alignment to existing state and territory education, social and emotional well-being frameworks, and the Australian Curriculum. In delivering facilitated support from specialised consultants to early learning services and schools participating in the initiative, Be You draws on professional learning principles designed to build capacity in educators and educational systems relating to mental health promotion. It uses an updated, multi-module online platform providing interactive, evidence-based resources. This paper presents the Be You framework, describes the evidence sources used to inform the underlying principles and objectives, discusses the specific components that form the initiative, details the professional learning modules and content, and discusses potential implications for population mental health and prevention efforts.
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Andrews, Gavin, Caroline Bell, Philip Boyce, Christopher Gale, Lisa Lampe, Omar Marwat, Ronald Rapee, and Gregory Wilkins. "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder." Australian & New Zealand Journal of Psychiatry 52, no. 12 (November 30, 2018): 1109–72. http://dx.doi.org/10.1177/0004867418799453.
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Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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Schofield, Deborah, Michelle M. Cunich, and Lucio Naccarella. "An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature." Australian Health Review 38, no. 5 (2014): 495. http://dx.doi.org/10.1071/ah14018.
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Objective There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. Methods The National Health and Medical Research Council of Australia’s (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results Of the14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic? Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add? This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners? Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.
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Monrouxe, Lynn V., Peter Hockey, Priya Khanna, Christiane Klinner, Lise Mogensen, D. A. O'Mara, Abbey Roach, Stephen Tobin, and Jennifer Ann Davids. "Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol." BMJ Open 11, no. 9 (September 2021): e045822. http://dx.doi.org/10.1136/bmjopen-2020-045822.
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IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.
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Rachele, Jerome N., Vincent Learnihan, Hannah M. Badland, Suzanne Mavoa, Gavin Turrell, and Billie Giles-Corti. "Are Measures Derived From Land Use and Transport Policies Associated With Walking for Transport?" Journal of Physical Activity and Health 15, no. 1 (January 1, 2018): 13–21. http://dx.doi.org/10.1123/jpah.2016-0693.
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Background: There is growing urgency for higher quality evidence to inform policy. This study developed geographic information system spatial measures based on land use and transport policies currently used in selected Australian states to assess which, if any, of these measures were associated with walking for transport. Methods: Overall, 6901 participants from 570 neighborhoods in Brisbane, Australia, were included. Participants reported their minutes of walking for transport in the previous week. After a review of state-level land use and transport policies relevant to walking for transport across Australia, 7 geographic information system measures were developed and tested based on 9 relevant policies. Data were analyzed using multilevel multinomial logistic regression. Results: Greater levels of walking for transport were associated with more highly connected street networks, the presence of public transport stops, and having at least 2 public transport services per hour. Conversely, neighborhoods with shorter cul-de-sac lengths had lower levels of walking for transport. There was no evidence of associations between walking for transport and street block lengths less than 240 m or traffic volumes. Conclusions: These findings highlight the need for urban design and transport policies developed by governments to be assessed for their impact on transport-related physical activity.
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Skinner, John, Yvonne Dimitropoulos, Woosung Sohn, Alexander Holden, Boe Rambaldini, Heiko Spallek, Rahila Ummer-Christian, et al. "Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia." Healthcare 9, no. 8 (August 11, 2021): 1029. http://dx.doi.org/10.3390/healthcare9081029.
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This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.
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Zbukvic, Isabel, Demee Rheinberger, Hannah Rosebrock, Jaclyn Lim, Lauren McGillivray, Katherine Mok, Eve Stamate, Katie McGill, Fiona Shand, and Joanna C. Moullin. "Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework." Implementation Research and Practice 3 (January 2022): 263348952110657. http://dx.doi.org/10.1177/26334895211065786.
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Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.
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Fealy, Shanna, Jenna Hollis, Julia Martin, Lucy Leigh, Christopher Oldmeadow, Clare E. Collins, Roger Smith, Shelley Wilkinson, and Alexis Hure. "Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort." Nutrients 14, no. 2 (January 17, 2022): 381. http://dx.doi.org/10.3390/nu14020381.
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Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)’s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks’ gestation using the minimum weight change parameter of +/−2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61–0.83) and specificity (0.72, 95% CI 0.61–0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.
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Sarna, Mohinder, Ross Andrews, Hannah Moore, Michael J. Binks, Lisa McHugh, Gavin F. Pereira, Christopher C. Blyth, et al. "‘Links2HealthierBubs’ cohort study: protocol for a record linkage study on the safety, uptake and effectiveness of influenza and pertussis vaccines among pregnant Australian women." BMJ Open 9, no. 6 (June 2019): e030277. http://dx.doi.org/10.1136/bmjopen-2019-030277.
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IntroductionPregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers and infants. In Australia, uptake is not routinely monitored but coverage appears sub-optimal. Evidence on the safety of combined antenatal IIV and dTpa is fragmented or deficient, and there remain knowledge gaps of population-level vaccine effectiveness. We aim to establish a large, population-based, multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions. This is a first step toward assessing the impact of antenatal vaccination programmes in Australia, which can then inform government policy with respect to future strategies in national vaccination programmes.Methods and analysis‘Links2HealthierBubs’ is an observational, population-based, retrospective cohort study established through probabilistic record linkage of administrative health data. The cohort includes births between 2012 and 2017 (~607 605 mother-infant pairs) in jurisdictions with population-level antenatal vaccination and health outcome data (Western Australia, Queensland and the Northern Territory). Perinatal data will be the reference frame to identify the cohort. Jurisdictional vaccination registers will identify antenatal vaccination status and the gestational timing of vaccination. Information on maternal, fetal and child health outcomes will be obtained from hospitalisation and emergency department records, notifiable diseases databases, developmental anomalies databases, birth and mortality registers.Ethics and disseminationEthical approval was obtained from the Western Australian Department of Health, Curtin University, the Menzies School of Health Research, the Royal Brisbane and Women’s Hospital, and the West Australian Aboriginal Health Ethics Committees. Research findings will be disseminated in peer-reviewed journals, at scientific meetings, and may be incorporated into communication materials for public health agencies and the public.
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Gibson, Noula, Meredith Wynter, Pam Thomason, Felicity Baker, Heather Burnett, H. Kerr Graham, Megan Kentish, et al. "Australian hip surveillance guidelines at 10 years: New evidence and implementation." Journal of Pediatric Rehabilitation Medicine 15, no. 1 (March 29, 2022): 31–37. http://dx.doi.org/10.3233/prm-220017.
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Optimum management of hip displacement in children with cerebral palsy (CP) is facilitated by an approach that focuses on anticipatory and preventive measures. Hip surveillance programs for children with CP were developed at the beginning of the new millennium, with the purpose of identifying hip displacement sufficiently early to permit a choice of effective management options. In the early years, hip surveillance was guided by epidemiological analysis of population-based studies of prevalence. In Australia, a National Hip Surveillance in CP Working Group was first convened in 2005. This resulted in a 2008 Consensus Statement of recommendations published and endorsed by Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM). The group undertook that the recommendations should be reviewed every 5 years to ensure currency and congruency with the emerging evidence base. As new evidence became available, hip surveillance guidelines developed, with the most recent 2020 Australian Hip Surveillance Guidelines endorsed by the AusACPDM. Implementing comprehensive hip surveillance programs has now been shown to improve the natural history of hip dislocations and improve quality of life. Standardised hip surveillance programs can also facilitate planning for multicentre research through harmonisation of data collection. This, in turn, can help with the identification of robust new evidence that is based on large cohort or population studies. Here a review of evidence informing the updated 2020 Hip Surveillance Guidelines is presented.
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Kraatz, J. A., S. Reid, L. Rowlinson, and S. Caldera. "Housing as critical social and economic infrastructure: A decision-making framework." IOP Conference Series: Earth and Environmental Science 1101, no. 4 (November 1, 2022): 042023. http://dx.doi.org/10.1088/1755-1315/1101/4/042023.
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Abstract Housing is an important social and economic asset for society. However, increasing costs of living and demand for affordable housing is outpacing supply in Australia. Governments and housing providers, particularly community housing providers, are grappling with these challenges. This paper discusses steps towards building a more rigorous, evidence-based approach for social and affordable housing provision in Australia. It is proposed that housing be considered like other critical social and economic infrastructure such as schools, hospitals and civil infrastructure (i.e., roadways). The paper presents findings of Australian industry-led social and affordable housing research undertaken between 2014 to 2020. Past and current research findings inform the decision-making framework, including: (i) a productivity-based conceptual framework; (ii) the establishment of nine impact domains including meaningful and measurable outcomes and indicators; (iii) a composite return on investment approach which addresses the broader benefits of access to safe and secure housing; and (iv) thirteen elements being used to map the complex and integrated social and affordable housing network. The emergent decision-making framework resulting from this longitudinal study will be a critical tool for government and social and affordable housing providers to achieve economically and socially sustainable outcomes.
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Kisely, Steve, and Jeffrey CL Looi. "The Productivity Commission’s Draft Report illustrates the benefits and risks of economic perspectives on mental healthcare." Australian & New Zealand Journal of Psychiatry 54, no. 11 (August 27, 2020): 1072–77. http://dx.doi.org/10.1177/0004867420951255.
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In 2018, the Australian Government instructed the Productivity Commission to examine the social and economic effects of poor mental health, as well as make recommendations on how they might be addressed. The resulting Draft Report demonstrates both the benefits and risks of an economic approach to these issues. Some of the broader systemic recommendations have merit such as the need for stepped care, coordinated crisis management and the important role of welfare, housing and the workplace in improving mental health. However, there are areas of concern, particularly for mental health services in the public sector. One is a disproportionate emphasis on prevention and intervention in the early years of life for strategies where evidence for effectiveness is limited. Another is the introduction of market-based approaches such as shadow billing or a commissioner/provider split to the funding of mental health services across Australia. Among the numerous problems of such market-driven approaches are the increased costs of additional bureaucracy and the lack of commissioner expertise in planning services or evidence-based practice. As a result, similar arrangements have been abandoned in other jurisdictions. The Commission’s final recommendations and the Australian Government’s response are awaited and the resulting changes to the mental health system, and beyond, may well be influenced by the COVID-19 pandemic. However, reform should be based on evidence and achieved without increasing administrative complexity.
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FURUKAWA, T. A., G. ANDREWS, and D. P. GOLDBERG. "Stratum-specific likelihood ratios of the General Health Questionnaire in the community: help-seeking and physical co-morbidity affect the test characteristics." Psychological Medicine 32, no. 4 (May 2002): 743–48. http://dx.doi.org/10.1017/s0033291702005494.
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Background. In evidence-based medicine, stratum-specific likelihood ratios (SSLRs) are now being increasingly recognized as a more convenient and generalizable method to interpret diagnostic information than an optimal cut-off and its associated sensitivity and specificity. We previously examined the SSLRs of the General Health Questionnaire (GHQ) in primary care settings. The present paper aims to examine if these SSLRs are generalizable to the community settings.Methods. The Composite International Diagnostic Interview (CIDI) and the GHQ were administered on a representative sample of the Australian population in the Australian National Survey of Mental Health and Well-Being. We first compared the SSLRs of GHQ in urban Australia with the estimates that we had previously obtained from the developed urban centres in the WHO Psychological Problems in General Health Care study. If the SSLRs in the community were found to differ significantly from those in the primary care, we sought for explanatory variables.Results. The SSLRs in urban Australia and in the urban centres in the WHO study were significantly different for three out of the six strata. When we limited the sample to those with physical problems who visited a health professional, however, the SSLRs in the Australian study were strikingly close to those observed for primary care settings.Conclusions. Different sets of SSLRs apply to primary care and general population samples. For general population surveys in developed countries, the results of the Australian National Survey represent the currently available best estimates. For developing countries or rural areas, the results are less definitive and an investigator may wish to conduct a pilot study.
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Fitts, Michelle S., John Humphreys, Terry Dunbar, Lisa Bourke, Edward Mulholland, Steven Guthridge, Yuejen Zhao, et al. "Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol." BMJ Open 11, no. 8 (August 2021): e043902. http://dx.doi.org/10.1136/bmjopen-2020-043902.
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IntroductionAccess to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.Methods and analysisThis paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services.Ethics and disseminationThe study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
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Kalo, Eric, Nashwa Sheriff, Marina Isaac, Asma Baig, Scott Read, and Golo Ahlenstiel. "A Call for Implementation of an Evidence-Based, Quality Improvement, Decompensated Cirrhosis Discharge Care Bundle in Australia." Livers 2, no. 2 (June 20, 2022): 97–104. http://dx.doi.org/10.3390/livers2020007.
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A growing body of research suggests that evidence-based interventions can tackle high rates of hospital readmissions among patients with decompensated cirrhosis. Care bundles are a prime example of an evidence-based intervention to reduce hospital readmissions through documentation and communication. In this pilot study, a comprehensive baseline audit of electronic medical records of 497 discharges for 175 patients was conducted to assess the current standards of care on discharge from Blacktown Hospital, Australia, and the scope for introducing a care bundle. Our results demonstrated suboptimal discharge communication in a number of areas: Only 54% of decompensated cirrhosis patients had a follow-up appointment pre-scheduled at discharge. Despite alcohol being identified as a key cause of cirrhosis in 60% of patients, a review by alcohol services was conducted on only 24.9% of patients. Moreover, a general lack of focus on patient education and health literacy was identified. In conclusion, our pilot study has highlighted areas for improvement in the standard of care provided to this cohort of patients. Implementation of a standardized care bundle could address the current shortfalls, improve the standard of care and refocus discharge planning to address health literacy and education in patients admitted with a decompensated liver.
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Flores, Cindy J., Angelina Yong, Eleanor Knights, Jodie Grech, Ben Saxon, Corey Markus, Romi Sinha, and Kym Osborn. "Maternity iron, anaemia and blood management in South Australia: a practice‐based evidence for clinical practice improvement." Vox Sanguinis 115, no. 8 (July 7, 2020): 735–44. http://dx.doi.org/10.1111/vox.12969.
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Qin, X., J. Hung, T. Teng, T. Briffa, and F. Sanfilippo. "Prevalence of Evidence-Based Medications Dispensed in Older Patients with Heart Failure in Western Australia, 2003-2011." Heart, Lung and Circulation 25 (August 2016): S120. http://dx.doi.org/10.1016/j.hlc.2016.06.285.
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Sezgin, Gorkem, Andrew Georgiou, Rae-Anne Hardie, Ling Li, Lisa G. Pont, Tony Badrick, Guilherme S. Franco, et al. "Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data." BMJ Open 8, no. 11 (November 2018): e024223. http://dx.doi.org/10.1136/bmjopen-2018-024223.
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IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.Methods and analysisAccess to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.Ethics and disseminationEthics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).
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Sidhu, Navdeep S., Alwin Chuan, and Christopher H. Mitchell. "Recommendations and resources for regional anaesthesia Fellowships in Australia and New Zealand." Anaesthesia and Intensive Care 47, no. 5 (August 22, 2019): 452–60. http://dx.doi.org/10.1177/0310057x19861113.
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Regional anaesthesia is a fundamental aspect of anaesthesia practice. Structured Fellowships in regional anaesthesia facilitate the development of expert clinicians, scholars and future leaders. The Australian and New Zealand College of Anaesthetists accredits training sites for the final year of Fellowship training but does not outline specific guidance for subspecialty training. Based on evidence from a systematic literature review and best-practice medical education principles, the ideal structure for a regional anaesthesia Fellowship programme in Australia and New Zealand is outlined in four categories: (a) structure and duration of training; (b) educational aspects; (c) institutional organization; (d) evaluation and improvement. Departments may use this resource to help design, implement and improve their Fellowship programmes while trainees may employ it as a reference to achieve their learning goals at any training stage. Continuing professional education plays a central role in achieving and maintaining mastery of regional anaesthesia competencies.
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Wright, C. A., B. Hilder, and M. E. Schneider-Kolsky. "Meeting the research agenda in Australian radiation therapy: the current picture." Journal of Radiotherapy in Practice 8, no. 2 (June 2009): 67–77. http://dx.doi.org/10.1017/s1460396908006596.
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AbstractIn recent years the role of the radiation therapist (RT) has increasingly evolved. In Australia, one of the major developments has been the transition from practice which was rarely based on scientific evidence, to the profession today which engages in and incorporates research into everyday practice. The aim of this article is to provide an insight into the current status of Australian radiation therapy research. In order to present a national overview, a survey relating to research activity was e-mailed to all (48) clinical centres in Australia. Thirty-six out of the 48 centres responded, representing 13 private and 23 public centres. The results demonstrated that a research culture is beginning to be established and that there are challenges associated with implementing research. The role of universities in facilitating the development of research skills was considered important with an increasing number of practitioners undertaking higher research degrees. Overall, research activity in the Australian radiation therapy community is becoming more prevalent. If the profession is to continue to strengthen its research profile the professional body and universities need to continue providing academic and funding support. Greater focus on multidisciplinary collaboration is needed with direct involvement of RTs in multi-centre studies.
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O’Connor, Mark, Tracey Bucknall, and Elizabeth Manias. "Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions." American Journal of Critical Care 19, no. 3 (May 1, 2010): 285–95. http://dx.doi.org/10.4037/ajcc2009541.
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Objective To explore the use of sedatives and analgesics, tools for scoring level of sedation, sedation and pain protocols, and daily interruptions in sedation in Australian and New Zealand intensive care units and to examine doctors’ and nurses’ opinions about the sedation management of critically ill patients. Methods A cross-sectional Internet-based survey design was used. In total, 2146 members of professional critical care organizations in Australia and New Zealand were e-mailed the survey during a 4-month period in 2006 through 2007. Results Of 348 members (16% response rate) who accessed the survey, 246 (71%) completed all sections. Morphine, fentanyl, midazolam, and propofol were the most commonly used medicines. Newer medicines, such as dexmedetomidine and remifentanil, and inhalant medications, such as nitrous oxide and isoflurane, were rarely used by most respondents. Respondents used protocols to manage sedatives (54%) and analgesics (51%), and sedation assessment tools were regularly used by 72%. A total of 62% reported daily interruption of sedation; 23% used daily interruption for more than 75% of patients. A disparity was evident between respondents’ opinions on how deeply patients were usually sedated in practice and how deeply patients should ideally be sedated. Conclusions Newer medications are used much less than are traditional sedatives and analgesics. Sedation protocols are increasingly used in Australasia, despite equivocal evidence supporting their use. Similarly, daily interruption of sedation is common in management of patients receiving mechanical ventilation. Research is needed to explore contextual and personal factors that may affect sedation management.
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Page, Andrew, Jo-An Atkinson, Mark Heffernan, Geoff McDonnell, Ante Prodan, Nathaniel Osgood, and Ian Hickie. "Static metrics of impact for a dynamic problem: The need for smarter tools to guide suicide prevention planning and investment." Australian & New Zealand Journal of Psychiatry 52, no. 7 (January 23, 2018): 660–67. http://dx.doi.org/10.1177/0004867417752866.
Full textAbstract:
Objectives: This study investigates two approaches to estimate the potential impact of a population-level intervention on Australian suicide, to highlight the importance of selecting appropriate analytic approaches for informing evidence-based strategies for suicide prevention. Methods: The potential impact of a psychosocial therapy intervention on the incidence of suicide in Australia over the next 10 years was used as a case study to compare the potential impact on suicides averted using: (1) a traditional epidemiological measure of population attributable risk and (2) a dynamic measure of population impact based on a systems science model of suicide that incorporates changes over time. Results: Based on the population preventive fraction, findings suggest that the psychosocial therapy intervention if implemented among all eligible individuals in the Australian population would prevent 5.4% of suicides (or 1936 suicides) over the next 10 years. In comparison, estimates from the dynamic simulation model which accounts for changes in the effect size of the intervention over time, the time taken for the intervention to have an impact in the population, and likely barriers to the uptake and availability of services suggest that the intervention would avert a lower proportion of suicides (between 0.4% and 0.5%) over the same follow-up period. Conclusion: Traditional epidemiological measures used to estimate population health burden have several limitations that are often understated and can lead to unrealistic expectations of the potential impact of evidence-based interventions in real-world settings. This study highlights these limitations and proposes an alternative analytic approach to guide policy and practice decisions to achieve reductions in Australian suicide.