Academic literature on the topic 'Medical records Australia'

Flinders Medical Centre (FMC) in South Australia has a storage problem. The space available for filing existing medical records is full, while the demand for additional storage continues its linear growth. The hospital plans to use this “crisis” as an opportunity to review the entire basis for the management of the medical record and pilot an optical disk system as a precursor to paperless medical records. There are many constraints to this objective, but many advantages if the scheme proves successful. Michael describes the events which precipitated this project and outlines the steps in FMC's planned progression to a paperless record. (AMRJ, 1989, 19(4), 149–154).

This article compares the attitudes of Australian and Swedish patients towards the use of computerised medical records and unique identifiers in medical practices in Australia and Sweden. A Swedish translation of an Australian survey was conducted and results were compared. Surveys were distributed to patients at a medical practice in Sweden in 2003 and compared to the results of an Australian study by Bomba and Land (2003). Results: Based on the survey samples (Australia N=271 and Sweden N=55), 91% of Swedish respondents and 78% of Australian respondents gave a positive appraisal of the use of computers in health care. Of the Swedish respondents, 93% agreed that the computer-based patient record is an essential technology for health care in the future, while 86% of the Australian respondents agreed. Overwhelmingly, 95% of Swedish respondents and 91% of Australian respondents stated that the use of computers did not interfere with the doctor-patient consultation. Both groups preferred biometric identification as the method for uniquely identifying patients but differed in their preferred method to store medical information - a combination of central database and smart card for Australian respondents and central database for Swedish respondents. This analysis indicates that patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden are positive; however, there are concerns over information privacy and security. These concerns need to be taken into account in any future development of a national computer health network.

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital’s current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events. What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement. What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).

The issue of, and access to, medical records has been a contentious matter for some years in Australia. The recent High Court decision of Breen v Williams has clarified the law nationwide. The High Court confirmed that the ownership of medical records is vested in the creator of the records. The High Court further held that a patient has no right at law to access his or her medical records in the absence of any statute granting such a right, or other legal process.

In recent years, influenced by the pervasive power of technology, standards and mandates, Australian hospitals have begun exploring digital forms of keeping this record. The main rationale is the ease of accessing different data sources at the same time by varied staff members. The initial step in this transition was implementation of scanned medical record systems, which converts the paper based records to digitised form, which required process flow redesign and changes to existing modes of work. For maximising the benefits of scanning implementation and to better prepare for the changes, Austin Hospital in the State of Victoria commissioned this research focused on elective admissions area. This structured case study redesigned existing processes that constituted the flow of external patient forms and recommended a set of best practices at the same time highlighting the significance of user participation in maximising the potential benefits anticipated. In the absence of published academic studies focused on Victorian hospitals, this study has become a conduit for other departments in the hospital as well as other hospitals in the incursion.

SummaryObjectives: To clarify health record background information in the Asia-Pacific region, for planning and evaluation of medical information systems.Methods: The survey was carried out in the summer of 2009. Of the 14 APAMI (Asia-Pacific Association for Medical Informatics) delegates 12 responded which were Australia, China, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, the Philippines, Singapore, Thailand, and Taiwan.Results: English is used for records and education in Australia, Hong Kong, India, New Zealand, the Philippines, Singapore and Taiwan. Most of the countries/regions are British Commonwealth. Nine out of 12 delegates responded that the second purpose of medical records was for the billing of medical services. Seven out of nine responders to this question answered that the second purpose of EHR (Electronic Health Records) was healthcare cost cutting. In Singapore, a versatile resident ID is used which can be applied to a variety of uses. Seven other regions have resident IDs which are used for a varying range of purposes. Regarding healthcare ID, resident ID is simply used as healthcare ID in Hong Kong, Singapore and Thailand. In most cases, disclosure of medical data with patient’s name identified is allowed only for the purpose of disease control within a legal framework and for disclosure to the patient and referred doctors. Secondary use of medical information with the patient’s identification anonymized is usually allowed in particular cases for specific purposes.Conclusion: This survey on the health record background information has yielded the above mentioned results. This information contributes to the planning and evaluation of medical information systems in the Asia-Pacific region.

The South Australian Health Commission has embarked on a long term project to establish an Electronic Patient Record (EPR) for South Australia. The process requires extensive evaluation at the conclusion of each phase of development using a range of existing and purpose-developed evaluation tools. This paper describes a purpose-developed evaluation tool that uses the functional aspects of, and existing standards for, paper-based medical records in hospitals as its basis. The resulting EPR Standards are a tool which can be used to establish a benchmark against which to evaluate the efficiency and effectiveness of an electronic patient record.

Large numbers of people die each year in hospitals as a result of preventable errors. High profile cases like the Royal Bristol Infirmary in the UK or the King Edward Memorial Hospital in Western Australia highlight the problem in the popular media, putting pressure on governments, providers and the professions to improve safety and quality in hospitals. In Australia, the Quality in Australian Health Care study reviewed the medical records of 14,179 admissions to 28 hospitals and found that an adverse event occurred in 16.6% of cases, with 51% considered to have been preventable (Wilson et al., 1995).

The Royal Flying Doctor Service (RFDS) of Australia was founded in 1928 by the Reverend John Flynn to deliver health services to the people of the Australian Outback. In this unique environment the RFDS Queensland Section provides both Primary Health Care and Aeromedical services to rural and remote communities throughout Queensland. It provides health services from a hub and spoke model and its clinicians work very closely with other health service providers, such as Queensland Heath, within the communities it visits. Currently, the RFDS' health records are both paper and electronic and clinicians duplicate much of patient information and data between RFDS and non-RFDS health records. Introduction of an off-the-shelf electronic medical record (EMR) would not meet the RFDS' clinical and organisational needs because of complexity, the multidisciplinary nature of the teams and the lack of communication technology in the communities the RFDS visits. This article defines the vision for a health information system designed to meet the requirements of the RFDS, and describes its implementation throughout RFDS Queensland using the PRINCE2 project management methodology.

Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.

With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation. ¶ Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system? ¶ The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australia’s national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions. ¶ For the Australian ‘Medical Devices study’, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed. ¶ A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study. ¶ The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas. ¶ Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection. ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed. ¶ The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research. ¶ Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.

With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation. ¶ ... ¶ The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. ... ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). ...¶ ... Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.

A better health care service must ensure patients receive the right care, in the right place, at the right time. In enabling better health care, the impact of technology is immense. Technological breakthroughs are revolutionising the way health care is being delivered. To deliver better health care, sharing health information amongst health care providers who are involved with the care is critical. An Electronic Health Record (EHR) platform is used to share the health information among those health care providers faster, as a result of technological advancement including the Internet and the Cloud. However, when integrating such technologies to support the provision of health care, they lead to major concerns over privacy and security of health sensitive information. The privacy and security concerns include a wide range of ethical and legal issues associated with the system. These concerns need to be considered and addressed for the implementation of EHR systems. In a shared environment like EHRs, these concerns become more significant. In this thesis, the author explores and discusses the situations where these concerns do arise in a health care environment. This thesis also covers different attacks that have targeted health care information in the past, with potential solutions for every attack identified. From these findings, the proposed system is designed and developed to provide considerable security assurance for a health care organisation when using the EHR systems. Furthermore, the My Health Record (MyHR) system is introduced in Australia to allow an individual’s doctors and other health care providers to access the individual’s health information. Privacy and security in using MyHR is a major challenge that impacts its usage. Taking all these concerns into account, the author will also focus on discussing and analysing major existing access control methods, various threats for data privacy and security concerns over EHR use and the importance of data integrity while using MyHR or any other EHR systems. To preserve data privacy and security and prevent unauthorised access to the system, the author proposes a three-tier security model. In this three-tier security model, the first tier covers an access control mechanism, an Intermediate State of Databases (ISD) is included in the second tier and the third layer involves cryptography/data encryption and decryption. These three tiers, collectively, cover different forms of attacks from different sources including unauthorised access from inside a health care organisation. In every tier, a specific technique has been utilised. In tier one, an Improved Access Control Mechanism (IACM) known as log-in pair, pseudonymisation technique is proposed in tier two and a special new encryption and decryption algorithm has been developed and used for tier three in the proposed system. In addition, the design, development, and implementation of the proposed model have been described to enable and evaluate the operational protocol. Problem 1. Non-clinical staff including reception, admin staff access sensitive health clinical information (insiders). Solution 1. An improved access control mechanism named log-in pair is introduced and occupied in tier one. Problem 2. Researchers and research institutes access health data sets for research activities (outsiders). Solution 2. Pseudonymisation technique, in tier two, provides de-identified required data with relationships, not the sensitive data. Problem 3. The massive amount of sensitive health data stored with the EHR system in the Cloud becomes more vulnerable to data attacks. Solution 3. A new encryption and decryption algorithm is achieved and used in tier three to provide high security while storing the data in the Cloud.

The main aim of embracing evolutionary digital e-health technologies such as ‘My Health Records' is to transform and empower the patients to control their health records, access, choose the right healthcare provider and suitable treatment, when required. It has been a challenge for the healthcare practitioners, hospital staff, as well as patients to accept, embrace, and adopt transformative digital e-health technologies and manage their healthcare records amidst concerns of slow adoption by the patient due to data privacy and cybersecurity issues. Australia, since COVID-19, has stressed the importance of secure online connectivity for the government, business, and the consumers. It is essential that My Health Record platform is cyber-safe, and user-friendly so that consumers feel conformable, safe and secure regarding their personal health records. This chapter discussed the challenges of embracing e-health digital technologies and assurance of advancing cybersecurity of online My Health Record, which will transform e-health provision and empower patients and healthcare providers.

ICT has been used in medical General Practice throughout Australia now for some years, but although most General Practices make use of ICT for administrative purposes such as billing, prescribing and medical records, many individual General Practitioners themselves do not make full use of these ICT systems for clinical purposes. The decisions taken in the adoption of ICT in general practice are very complex, and involve many actors, both human and non-human. This means that actor-network theory offers a most suitable framework for its analysis. This article investigates how GPs in a rural Division of General Practice not far from Melbourne considered the adoption and use of ICT. The study reported in the article shows that, rather than characteristics of the technology itself, it is often seemingly unimportant human issues that determine if and how ICT is used in General Practice.

In the 21st century, the digital revolution is disrupting every sector of the economy. Australia has adopted the digital healthcare technological revolution such as My Health Record (MyHRC) to improve healthcare practice for clinicians/medical professionals and empower consumers to provide positive health management experience with a patient-centred approach to digital health revolution and digital literacy. My Health Record has its benefits, but it has been a challenge for the healthcare practitioners, hospital staff, as well as patients as consumers to accept, embrace, and uptake digital technologies and manage their healthcare records amidst concerns of slow adoption by the patient, data privacy, and implications of the secondary use of their personal data by non-government entities.

In the 21st century, the digital revolution is disrupting every sector of the economy. Australia has adopted the digital healthcare technological revolution such as My Health Record (MyHRC) to improve healthcare practice for clinicians/medical professionals and empower consumers to provide positive health management experience with a patient-centred approach to digital health revolution and digital literacy. My Health Record has its benefits, but it has been a challenge for the healthcare practitioners, hospital staff, as well as patients as consumers to accept, embrace, and uptake digital technologies and manage their healthcare records amidst concerns of slow adoption by the patient, data privacy, and implications of the secondary use of their personal data by non-government entities.

Globally, implementation of electronic medical records (EMRs) has accelerated. Australia is starting on this necessary but arduous path. Anecdotes suggest many nurses enquire “You Want Me to Use This EMR? Opinions on the use and usefulness of EMRs are not positive. This research proffers the use of a rich theoretical lens, taken from the information system’s domain, to understand the root concerns and create solutions; providing insight into nursing acceptance and adoption of the EMR.

In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses’ perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses’ adoption of the EMR; and 2) explore older nurses’ perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.

Based on the Diffusion of Innovation theory, this chapter addresses the following research question: Whether factors of diffusion of innovation theory influence care providers' willingness to adopt Shared Electronic Health Records (SEHRs). Data was collected through a self-administered questionnaire distributed to over 5000 active members of the Australian Medical Association Queensland. A total of 588 valid responses were received from currently active care providers in Queensland. Multiple regression analysis and Chi-Square analysis were conducted to test the research hypotheses and answer the research question. The data revealed that while 72% of those surveyed were willing to adopt SEHRs, significant differences existed between public and private sector care providers and across the various tiers of the health system. In relation to the factors influencing future willingness to adopt, the variables comprising relative advantage were shown to have a significant impact upon future willingness to adopt shared electronic health records. The findings from this chapter will benefit those responsible for the future introduction of SEHRs, specifically by allowing policy makers to target the factors that influence care providers' willingness to adopt.

Based on the Diffusion of Innovation theory, this chapter addresses the following research question: Whether factors of diffusion of innovation theory influence care providers' willingness to adopt Shared Electronic Health Records (SEHRs). Data was collected through a self-administered questionnaire distributed to over 5000 active members of the Australian Medical Association Queensland. A total of 588 valid responses were received from currently active care providers in Queensland. Multiple regression analysis and Chi-Square analysis were conducted to test the research hypotheses and answer the research question. The data revealed that while 72% of those surveyed were willing to adopt SEHRs, significant differences existed between public and private sector care providers and across the various tiers of the health system. In relation to the factors influencing future willingness to adopt, the variables comprising relative advantage were shown to have a significant impact upon future willingness to adopt shared electronic health records. The findings from this chapter will benefit those responsible for the future introduction of SEHRs, specifically by allowing policy makers to target the factors that influence care providers' willingness to adopt.

ABSTRACT Background: The health information system, especially medical records in hospitals must be carried out accurately and completely. Medical records are important as evidence for the courts, education, research, and policy makers. This study aimed to investigate the factors affecting the compliance with completeness of filling patient’s medical re­cords at hospitals. Subjects and Methods: A systematic review was conducted by searching from Pro­Quest, Scopus, and National journals using keywords medical records, filling of medical records, and non- compliance filling medical records. The abstracts and full-text arti­cles published between 2014 to 2019 were selected for this review. A total of 62,355 arti­cles were conducted screening of eligibility criteria. The data were reported using PRIS­MA flow chart. Results: Eleven articles consisting of eight articles using observational studies and three articles using experimental studies met the eligible criteria. There were two articles analyzed systematically from the United States and India, two articles reviewed literature from the United States and England, and seven articles were analyzed statis­tically from Indonesia, America, Australia, and Europe. Six articles showed the sig­nificant results of the factors affecting non-compliance on the medical records filling at the Hospitals. Conclusion: Non-compliance with medical record filling was found in the hospitals under study. Health professionals are suggested to fill out the medical record com­pletely. The hos­pital should enforce compliance with complete medical record fill­ing by health professionals. Keywords: medical record, compliance, hospital Correspondence: Chrismatovanie Gloria. Hospital Administration Department, Faculty Of Public Health, Uni­­ver­sitas Indonesia, Depok, West Java. Email: chrismatovaniegloria@gmail.com. Mo­­­­bi­le: +628132116­1896 DOI: https://doi.org/10.26911/the7thicph.04.29

Aim/Purpose This paper investigates the association between publishing during doctoral candidature and completion time. The effects of discipline and of gaining additional support through a doctoral cohort program are also explored. Background Candidates recognize the value of building a publication track record to improve their career prospects yet are cognizant of the time it takes to publish peer-reviewed articles. In some institutions or disciplines, there is a policy or the expectation that doctoral students will publish during their candidature. How-ever, doctoral candidates are also under increasing pressure to complete their studies within a designated timeframe. Thus, some candidates and faculty perceive the two requirements – to publish and to complete on time – as mutually exclusive. Furthermore, where candidates have a choice in the format that the PhD submission will take, be it by monograph, PhD-by-publication, or a hybrid thesis, there is little empirical evidence available to guide the decision. This pa-per provides a quantitative analysis of the association between publishing during candidature and time-to-degree and investigates other variables associated with doctoral candidate research productivity and efficiency. Methodology Multivariate logistic regression analyses were used to examine the predictors (discipline [field of research], gender, age group, domestic or international student status, and belonging to a cohort program) of doctoral candidate research productivity and efficacy. Research productivity was quantified by the number of peer-reviewed journal articles that a candidate published as a primary author during and up to 24 months after thesis submission. Efficacy (time-to-degree) was quantified by the number of Full-Time Equivalent (FTE) years of candidature. Data on 1,143 doctoral graduates were obtained from a single Australian university for the period extending from 2000 to 2020. Complete publication data were available on 707 graduates, and time-to-degree data on 664 graduates. Data were drawn from eight fields of research, which were grouped into the disciplines of health, biological sciences, agricultural and environmental sciences, and chemical, earth, and physical sciences. Contribution This paper addresses a gap in empirical literature by providing evidence of the association between publishing during doctoral candidature and time-to-degree in the disciplines of health, biological sciences, agricultural and environmental sciences, and chemical, earth, and physical sciences. The paper also adds to the body of evidence that demonstrates the value of belonging to a cohort pro-gram for doctoral student outcomes. Findings There is a significant association between the number of articles published and median time-to-degree. Graduates with the highest research productivity (four or more articles) exhibited the shortest time-to-degree. There was also a significant association between discipline and the number of publications published during candidature. Gaining additional peer and research-focused support and training through a cohort program was also associated with higher research productivity and efficiency compared to candidates in the same discipline but not in receipt of the additional support. Recommendations for Practitioners While the encouragement of candidates to both publish and complete within the recommended doctorate timeframe is recommended, even within disciplines characterized by high levels of research productivity, i.e., where publishing during candidature is the “norm,” the desired levels of student research productivity and efficiency are only likely to be achieved where candidates are provided with consistent writing and publication-focused training, together with peer or mentor support. Recommendations for Researchers Publishing peer-reviewed articles during doctoral candidature is shown not to adversely affect candidates’ completion time. Researchers should seek writing and publication-focused support to enhance their research productivity and efficiency. Impact on Society Researchers have an obligation to disseminate their findings for the benefit of society, industry, or practice. Thus, doctoral candidates need to be encouraged and supported to publish as they progress through their candidature. Future Research The quantitative findings need to be followed up with a mixed-methods study aimed at identifying which elements of publication and research-focused sup-port are most effective in raising doctoral candidate productivity and efficacy.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.