Journal articles on the topic 'Medical referral Australia'
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Ford, Belinda, Lisa Keay, Blake Angell, Stephanie Hyams, Paul Mitchell, Gerald Liew, and Andrew White. "Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia." Australian Journal of Primary Health 26, no. 4 (2020): 293. http://dx.doi.org/10.1071/py20084.
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Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.
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Howe, Joanne, and Suzanne Le Mire. "MEDICAL REFERRAL FOR ABORTION AND FREEDOM OF CONSCIENCE IN AUSTRALIAN LAW." Journal of Law and Religion 34, no. 1 (April 2019): 85–112. http://dx.doi.org/10.1017/jlr.2019.14.
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AbstractThis article examines legislative changes related to abortion regulation in Australia that create obligations of medical referral on practitioners who have a conscientious objection to abortion. Despite a significant Australian history of accepting secularized conscience claims, particularly in the field of military conscription, the limitation of conscience claims about abortion can be traced to a failure to appreciate the significant secular arguments that can be made to support such claims. We draw on arguments of plurality and pragmatism as capable of providing a firm foundation for legislative protections of freedom of conscience in the case of medical referral for abortion. These justifications are not dependent on religious grounds, and therefore they have the potential to be relevant and persuasive in a secular society such as Australia. Acceptance of a pluralistic argument in favor of freedom of conscience is a powerful commitment to the creation of a society that values human autonomy and a diversity of opinion. It sits comfortably with the democratic values that are enshrined in the Australian political system and institutions. It avoids the potential damage to the individual that may be wrought when conscience is overridden by state compulsion.
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Byrnes, Joshua M., and Tracy A. Comans. "Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system." Australian Health Review 39, no. 1 (2015): 12. http://dx.doi.org/10.1071/ah13196.
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Objective To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. Methods A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Results Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government of up to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. Conclusions The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving. What is known about the topic? Extending Medicare rebates payable to patients when physiotherapists directly refer patients to specialist medical practitioners is a contentious topic. Physiotherapy groups have argued that direct referral with a rebate would allow faster access to consultant advice resulting in better patient care. However, it has also been argued that widening criteria for rebates would increase overall costs to Medicare Australia. What does this paper add? This analysis finds that allowing direct referral with a rebate would result in a cost saving to both the government funder and patient out-of-pocket costs. What are the implications for practitioners? Policymakers should consider widening the criteria for rebates payable for referral to medical specialists to include physiotherapists, as this could result in faster management of patients and cost savings for both patients and Medicare Australia.
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Hirani, Kajal, Donald N. Payne, Raewyn Mutch, and Sarah Cherian. "Medical needs of adolescent refugees resettling in Western Australia." Archives of Disease in Childhood 104, no. 9 (July 3, 2018): 880–83. http://dx.doi.org/10.1136/archdischild-2018-315105.
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ObjectiveTo investigate the medical needs and socioeconomic determinants of health among adolescent refugees resettling in Western Australia.DesignComprehensive medical and socioeconomic health data of resettling adolescent refugees aged 12 years and above attending a Refugee Health Service over a 1-year period were analysed.ResultsMedical records of 122 adolescents, median (range) age of 14 (12–17) years, were reviewed. Socioeconomic vulnerabilities included dependence on government financial support (50%), housing issues (27%) and child protection service involvement (11%). Medical concerns included non-communicable disorders (85%), infectious diseases (81%), nutrition/growth (71%) and physical symptoms of non-organic origin (43%). One quarter (27%) of female adolescents had sexual/reproductive health issues. A median (range) of 5 (2–12) health concerns were identified for each adolescent with 49% requiring referral to subspecialty services.ConclusionResettling adolescent refugees are socioeconomically vulnerable with a range of medical issues that frequently require additional subspecialty health referrals.
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Gamage, Prasanna J., Saran Seker, Jessica Orchard, David Humphries, Kylie Fitzgerald, and Jane Fitzpatrick. "Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician’s perspective." BMJ Open Sport & Exercise Medicine 7, no. 4 (November 2021): e001228. http://dx.doi.org/10.1136/bmjsem-2021-001228.
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ObjectivesSport and Exercise Physicians represent a relatively new specialty focusing on exercise in complex diseases including musculoskeletal diseases. Our objective was to describe the characteristics, type and complexity of patient presentations, their management strategies and referral information in Australian practice.MethodsA cross-sectional study including a cohort of 11 senior Sport and Exercise Physicians in Australia studied all new patient consultations within an 8-week period. Data were analysed relating to presentation, referral source, follow-up referrals, and patient management strategies.ResultsData from 419 patients were recorded. The majority, 97% (n=406), had musculoskeletal conditions, 53% (n=222) had one or more associated comorbidities and 47% (n=195) had ongoing symptoms for >12 months. Most patients, 82% (n=355), were referred by general practitioners. Prior consultations included physiotherapy 72% (n=301) and orthopaedic 20% (n=85). A multidisciplinary network of referrals from Sport and Exercise Physicians was observed, including 210 referrals to 9 allied health specialities and 61 referrals to 17 medical specialities. Over 74% (n=311) of patients received exercise-based intervention as part of the treatment plan, including 57% (n=240) physician managed exercise interventions.ConclusionOur work shines a light on the nature and complexity of the role of Sport and Exercise Physicians in an Australian practice context. Findings will assist in implementing measures to promote patient care at the community level in managing musculoskeletal conditions. Sport and exercise medicine stakeholders and government policy makers can use this information in developing appropriate programmes to support patients and create integrated sport and exercise medicine services for the community.
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Priede, Andre, Phyllis Lau, Ivan Darby, Mike Morgan, and Rodrigo Mariño. "Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review." Healthcare 10, no. 10 (October 13, 2022): 2020. http://dx.doi.org/10.3390/healthcare10102020.
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With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals’ (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals’ referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.
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Gentin, N., T. Howarth, and S. Heraganahally. "O039 Access to sleep health services for Indigenous children in the Northern Territory of Australia." SLEEP Advances 3, Supplement_1 (October 1, 2022): A15—A17. http://dx.doi.org/10.1093/sleepadvances/zpac029.038.
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Abstract Paediatric sleep disorders have significant impacts on physical and mental health, growth and development. Indigenous children may be further impacted due to high prevalence of other medical conditions, socioeconomic disparity and reduced access to healthcare. In 2016, a local paediatric sleep service in the Northern Territory (NT) was created. We assessed demographics and referral patterns of Indigenous and non-Indigenous paediatric patients referred to this service. Paediatric patients referred for a sleep study between 2016- 2020 were included. Demographics, referral source, time from consult to study and follow up were assessed and compared between Indigenous and non-Indigenous patients. There were 923 children referred for sleep studies. Indigenous patients made up 20%. Indigenous patients were older (median 7 vs. 5 years) and more likely to live remotely (24% vs. 10%). Most Indigenous patients were referred from the public hospital system (62%) and by a paediatrician (56%); while most non-Indigenous patients were referred from the private system (56%) and by an otorhinolaryngologist (55%). Indigenous patients had a median 33 days between referral and initial consult compared with 21 days for non-Indigenous patients (p<0.05). Reviews were scheduled for 81% of Indigenous and 77% of non-Indigenous patients, of which 6% and 2% respectively did not attend. Indigenous patients showed different demographic and referral patterns to non-Indigenous patients. Despite improvements made to sleep service access for NT Indigenous children; there are still barriers to treatment. Reasons for this and ways to overcome these barriers are important for the health and wellbeing of Indigenous people.
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Mazza, Danielle, Jane W. Seymour, Monisha Vaid Sandhu, Catriona Melville, Jacquie O’Brien, and Terri-Ann Thompson. "General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision." Australian Journal of Primary Health 27, no. 6 (2021): 456. http://dx.doi.org/10.1071/py20297.
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In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA’s telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.
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Miteff, Kirstin, Mark Jonathon Walters, Shahriar Raj Zaman, Wendy Nicholls, Steve Singer, and David Gillett. "Does the GOSLON yardstick predict the need for orthognathic surgery?" Australasian Journal of Plastic Surgery 1, no. 1 (March 1, 2018): 57–64. http://dx.doi.org/10.34239/ajops.v1n1.61.
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The ability of the GOSLON Yardstick, scored at 9 years of age, to predict the need for orthognathic surgery in a cohort of complete Unilateral Cleft Lip and Palate (UCLP) patients treated in the Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia was assessed. Sixty six consecutively treated UCLP patients with dental models at 9 years of age and details on referral for orthognathic surgery were retrieved from medical and dental records. Cephalometric appraisal at 18 year old patients was also conducted. Twenty four of sixty six patients were referred for orthognathic surgery at growth completion (36%). Referral pattern stratified by GOSLON scores at 9 years of age found that four of four patients (100%), with a GOSLON score of 5 were referred for orthognathic surgery. Eleven of fourteen patients (79%) with a GOSLON 4, four of sixteen patients (25%) with a GOSLON 3 and five of thirty two patients (15%) with a GOSLON 2 were referred. No patient recorded a GOSLON 1 at age 9. Cephalometric appraisals conducted on thirty eight subjects at age 18 significantly discriminated the referral group from the non-referral group. Of the seventeen patients referred for surgery eight fulfilled the objective cephalometric criteria for orthognathic surgery, none of the patients who were not referred for orthognathic surgery fulfilled the objective criteria. The GOSLON Yardstick was found to be a good predictor of the need for orthognathic surgery at growth completion in our unit.
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Miteff, Kirstin, Mark Jonathon Walters, Shahriar Raj Zaman, Wendy Nicholls, Steve Singer, and David Gillett. "Does the GOSLON yardstick predict the need for orthognathic surgery?" Australasian Journal of Plastic Surgery 1, no. 1 (January 30, 2018): 116–23. http://dx.doi.org/10.34239/ajops.v1i1.61.
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The ability of the GOSLON Yardstick, scored at 9 years of age, to predict the need for orthognathic surgery in a cohort of complete Unilateral Cleft Lip and Palate (UCLP) patients treated in the Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia was assessed. Sixty six consecutively treated UCLP patients with dental models at 9 years of age and details on referral for orthognathic surgery were retrieved from medical and dental records. Cephalometric appraisal at 18 year old patients was also conducted. Twenty four of sixty six patients were referred for orthognathic surgery at growth completion (36%). Referral pattern stratified by GOSLON scores at 9 years of age found that four of four patients (100%), with a GOSLON score of 5 were referred for orthognathic surgery. Eleven of fourteen patients (79%) with a GOSLON 4, four of sixteen patients (25%) with a GOSLON 3 and five of thirty two patients (15%) with a GOSLON 2 were referred. No patient recorded a GOSLON 1 at age 9. Cephalometric appraisals conducted on thirty eight subjects at age 18 significantly discriminated the referral group from the non-referral group. Of the seventeen patients referred for surgery eight fulfilled the objective cephalometric criteria for orthognathic surgery, none of the patients who were not referred for orthognathic surgery fulfilled the objective criteria. The GOSLON Yardstick was found to be a good predictor of the need for orthognathic surgery at growth completion in our unit.
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Dineen-Griffin, Sarah, Victoria Garcia-Cardenas, Kris Rogers, Kylie Williams, and Shalom Isaac Benrimoj. "Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial." JMIR Research Protocols 8, no. 8 (August 9, 2019): e13973. http://dx.doi.org/10.2196/13973.
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Background Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. Objective This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. Methods The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost-utility and cost-effectiveness analysis compared with usual care. Results The study began in July 2018. Thirty community pharmacies were recruited. Pharmacists from the 15 intervention pharmacies were trained. A total of 27 general practices consented. Pharmacy patient recruitment began in August 2018 and was completed on March 31, 2019. Conclusions This study may demonstrate the efficacy of a protocolized intervention to manage minor ailments in the community and will assess the clinical, economic, and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and appropriate self-medication may contribute to greater efficiency of health care resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a national MAS service in Australia, using a robust framework for management and referral for common ailments. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/13973
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O'Donovan, Claire, Steve Wright, Simon Towler, and Erin Furness. "56 Streamlining Referral Processes at a Tertiary Acute Medical Ambulatory Centre." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.32.
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Abstract Background The Acute Medical Ambulatory Centre (AMAC) was established with the goals of facilitating early discharge and preventing avoidable medical admissions. 12 months post its introduction, the service was inefficient and operating under capacity. A project aimed to improve the AMAC referral processes and increase the centre’s overall efficiency was undertaken. Methods Western Australia Department of Health Clinical Service Redesign methodology (a blend of Lean and Six Sigma methodologies) was used to complete the project. This involved process mapping, root cause analysis and solutions sessions with stakeholders, as well as a semi-structured phone interview with patients. Results Transition from a paper-based to an electronic referral system. Creation of an ‘AMAC Quick Reference Guide’ for doctors. Production of an AMAC contact card to be given to patients on discharge if they have AMAC follow up. Letters detailing the patient review are forwarded on the day of the appointment facilitating timely feedback to GPs. An AMAC information flyer for GPs is now available on the hospital website. Conclusion Redesigning the referral process to the AMAC has improved workflow and efficiency with significant improvements in staff satisfaction. The institution is aiming to become paperless and this redesign project has led to the elimination of another paper form. The success of the project is testament to the engagement of the staff involved and demonstrates the need for doctors to not only engage their medical colleagues, but also nursing and clerical staff. The redesign project has helped refocus hospital priorities and should hopefully see further support for the centre; developing the ambulatory model of care as an integral part of the service provided. Other centres can learn valuable lessons from our experience and develop similar strategies to cope with the ever-increasing demands on the public healthcare system.
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Hsieh, J. T., J. Chen, V. Reher, R. Lalloo, and P. Reher. "Referral patterns from general medical practitioners to dentists prior to the use of oral bisphosphonates in Australia." International Journal of Oral and Maxillofacial Surgery 40, no. 10 (October 2011): e30. http://dx.doi.org/10.1016/j.ijom.2011.07.1010.
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Wilson, C., G. Skaczkowski, P. Sanderson, M. Shand, and A. Byrne. "Triaging for Supportive Care Services: Do People Want and Accept Referral?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 117s. http://dx.doi.org/10.1200/jgo.18.10300.
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Background: Distress is the 6th vital sign in cancer yet it is only assessed in an ad hoc way in most cancer services. The Distress Thermometer (DT) and the associated Problem Checklist (PC) are the most widely available tools although few studies report on how they are used to effectively triage services. Aim: To explore the link between distress assessment, problem identification, referral to specific supportive care services by staff, and service uptake by cancer patients and survivors among a sample of people attending a major cancer hospital in Victoria Australia. Methods: A secondary analysis of quality assurance audit data were undertaken using data collected from patient medical records between January 2013 and June 2014. Data extracted were; age, sex, post code, language spoken, disease and treatment information, distress as measured by the DT and problems as identified by the PC. For the current study the focus was on the number of referrals offered and the number accepted or declined. The type of services referred to was also examined. Results: Data were collected for 877 patients although missing data resulted in a final sample size of 853. Only data associated with the first DT of each patient are presented. 729 patients (86%) participated in distress screening. The distress threshold of 4 was reported by 50% of participants, highlighting the prevalence of distress requiring support. This 50% reported an average of 9 problems on the PC, many of which came from the physical domain, with 91% reporting at least 1 physical problem. Other problems reported were emotional (74% of the sample); practical (24%), family (14%) and spiritual (2%). Referral data, which was available for 614 people, indicated that over 60% (372) were offered at least one referral. Referral offer was significantly predicted by DT score, and number of problems reported. Acceptance was significantly related to total number of problems, treatment type, and type of referral; referral for physical treatment was most likely to be accepted (87%) whereas referral for emotional support was least likely (53%). Conclusion: Routine distress screening and problem identification are critical to triaging to supportive care services. In a tertiary care setting, not all people will be screened or will want to be screened; not all people will be referred to services; and not all people will accept referral. Nonetheless, problems are extensive with most survivors reporting experiencing several problems. Despite a focus on the physical, these problems extend to other domains, including the emotional, and it is important that services are available to support these needs.
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Lillee, Alyssa, Aesen Thambiran, and Jonathan Laugharne. "Evaluating the mental health of recently arrived refugee adults in Western Australia." Journal of Public Mental Health 14, no. 2 (June 15, 2015): 56–68. http://dx.doi.org/10.1108/jpmh-05-2013-0033.
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Purpose – The purpose of this paper is to measure the levels of psychological distress in adults entering Western Australia (WA) as refugees through the Australian Humanitarian Programme. To determine if the introduction of mental health screening instruments impacts on the level of referrals for further psychological/psychiatric assessment and treatment. Design/methodology/approach – Participants were 300 consecutive consenting refugee adults attending the Humanitarian Entrant Health Service in Perth, WA. This service is government funded for the general health screening of refugees. The Kessler-10 (K10) and the World Health Organisation’s post-traumatic stress disorder (PTSD) screener were the principal outcome measures used. Findings – Refugees had a high rate of current probable PTSD (17.2 per cent) as measured with the PTSD screener and mean K10 scores were significantly higher than general population norms. The K10 showed high accuracy for discriminating those with or without probable PTSD. Being married and having more children increased the risk of probable PTSD. In regard to region of origin, refugees from Western and Southern Asia had significantly higher scores on both screeners followed by those from Africa with those from South-Eastern Asia having the lowest scores. Referral rate for psychiatric/psychological treatment was 18 per cent compared to 4.2 per cent in the year prior to the study. Practical implications – This study demonstrates increased psychological distress including a high rate of probable PTSD in a recently arrived multi-ethnic refugee population and also demonstrates significant variations based on region of origin. In addition, it supports the feasibility of using brief screening instruments to improve identification and referral of refugees with significant psychological distress in the context of a comprehensive general medical review. Originality/value – This was an Australian study conducted in a non-psychiatric setting. The outcomes of this study pertain to refugee mental health assessed in a general health setting. The implications of the study findings are of far reaching relevance, inclusive of primary care doctors and general physicians as well as mental health clinicians. In particular the authors note that the findings of this study are to the authors’ knowledge unique in the refugee mental health literature as the participants are recently arrived refugees from diverse ethnic groups.
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Krishnadas, Natasha, and Bruce Taylor. "Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia." BMJ Neurology Open 3, no. 1 (June 2021): e000145. http://dx.doi.org/10.1136/bmjno-2021-000145.
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IntroductionAnecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We therefore sought to determine the incidence and clinical features of IIH in Southern Tasmania, Australia.MethodNeurology discharge summaries and lumbar puncture referrals from the single tertiary referral centre in this region were screened for an IIH diagnosis. All regional neurologists were surveyed to capture patients diagnosed through private neurology clinics. A retrospective review of medical records was conducted to confirm the diagnosis and determine whether patients met the Modified Dandy Criteria (MDC). Patients were included if they were above the age of 18 years and received a new diagnosis of IIH between June 2016 and June 2018. Population statistics were obtained from the Australian Bureau of Statistics.ResultsIIH incidence was 5.4/100 000. All patients were females, aged between 18 and 45 years. Headache was the most commonly reported symptom, with high rates of pre-existing or concurrent migraine diagnoses. Weight loss and commencement of oral acetazolamide were the most common treatment approaches. Four patients were medically refractory and required surgical intervention.ConclusionThe incidence of IIH in Southern Tasmania is comparable with the incidence reported in subgroups of females of childbearing age in recent prior studies. The demographic, diagnostic and therapeutic data presented can inform future local health service provision and serve as a baseline for ongoing assessment of change in incidence and treatment of IIH at a community level.
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Ng, Natalie Su Quin, and Stephanie Alison Ward. "Diagnosis of dementia in Australia: a narrative review of services and models of care." Australian Health Review 43, no. 4 (2019): 415. http://dx.doi.org/10.1071/ah17167.
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Objective There is an impetus for the timely diagnosis of dementia to enable optimal management of patients, carers and government resources. This is of growing importance in the setting of a rising prevalence of dementia in an aging population. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referral to comprehensive memory services for dementia diagnosis, but in practice many patients may be diagnosed in other settings. The aim of the present study was to obtain evidence of the roles, effectiveness, limitations and accessibility of current settings and services available for dementia diagnosis in Australia. Methods A literature review was performed by searching Ovid MEDLINE using the terms ‘dementia’ AND ‘diagnosis OR detection’. In addition, articles from pertinent sources, such as Australian government reports and relevant websites (e.g. Dementia Australia) were included in the review. Results Literature was found for dementia diagnosis across general practice, hospitals, memory clinics, specialists, community, care institutions and new models. General practitioners are patients’ preferred health professionals when dealing with dementia, but gaps in symptom recognition and initiation of cognitive testing lead to underdiagnosis. Hospitals are opportunistic places for dementia screening, but time constraints and acute medical issues hinder efficient dementia diagnosis. Memory clinics offer access to multidisciplinary skills, demonstrate earlier dementia diagnosis and potential cost-effectiveness, but are disadvantaged by organisational complexities. Specialists have increased confidence in diagnosing dementia than generalists, but drawbacks include long wait lists. Aged care assessment teams (ACAT) are a potential service for dementia diagnosis in the community. A multidisciplinary model for dementia diagnosis in care institutions is potentially beneficial, but is time and cost intensive. New models with technology allow dementia diagnosis in rural regions. Conclusion Memory clinics are most effective for formal dementia diagnosis, but healthcare professionals in other settings play vital roles in recognising patients with dementia and initiating investigations and referrals to appropriate services. What is known about this topic? Delays in dementia diagnosis are common, and it is unclear where majority of patients receive a diagnosis of dementia in Australia. While the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referrals to services such as memory clinics for comprehensive assessment and diagnosis of dementia, such services may have limited capacity and may not be readily accessible to all. What does this paper add? This paper presents an overview of the various settings and services available for dementia diagnosis in Australia including evidence of the roles, accessibility, effectiveness and limitations of each setting. What are the implications for practitioners? This concerns a disease that is highly prevalent and escalating, and highlights the roles for practitioners in various settings including general practices, acute hospitals, specialist clinics, community and nursing homes. In particular, it discusses the potential roles, advantages and challenges of dementia diagnosis in each setting.
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St John, Winsome, Heather James, and Shona McKenzie. "Health Service Provision for Community-Dwelling People Suffering Urinary Incontinence: A Case Study of Neglect." Australian Journal of Primary Health 7, no. 3 (2001): 31. http://dx.doi.org/10.1071/py01043.
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Access to health services for common health problems is a fundamental principle of primary health care. Although there have been few Australian prevalence studies, it is estimated that about 900,000 adult Australians suffer from incontinence (National Health and Medical Research Council, 1994). The purpose of this study was to investigate urinary continence services for community-dwelling people in the Gold Coast region of Australia, prior to implementing new services. A case study design was used, including: a survey of general medical practitioners, specialist medical practitioners, physiotherapists, hospitals, and home visiting agencies in the region; a focus group with key stakeholders; and a critical review of the literature in relation to prevalence, treatment-seeking behaviour and service provision. Health practitioners were asked about services provided, policies, clinical pathways, referrals, and their views on what services they would like to see offered in the region. Results showed that while there were some existing continence-specific services in the region, they were inadequate to provide for the numbers of people in need. Many generalist health practitioners demonstrated a lack of interest in and knowledge of the plight of those suffering from incontinence. Links between services were found to be ad hoc, with inconsistent referral patterns between health professionals. These findings are consistent with international studies. It was concluded that, in general, community-dwelling people suffering incontinence were poorly served by health professionals due an inability of available services to meet demand, and a lack of knowledge and/or interest by many generalist health practitioners.
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Chang, Angela T., Belinda Gavaghan, Shaun O'Leary, Liza-Jane McBride, and Maree Raymer. "Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?" Australian Health Review 42, no. 3 (2018): 334. http://dx.doi.org/10.1071/ah16222.
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Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present for further specialist medical care. What does this paper add? This paper identifies that the majority (95%) of patients managed by an advanced practice physiotherapy-led service did not re-present for further medical care for the same condition within 12 months of discharge. What are the implications for practitioners? This paper supports the use of advanced practice physiotherapy-led services in the management of overburdened neurosurgical and orthopaedic specialist out-patient waiting lists.
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Arora, Maansi, Kaete Walker, Judy Luu, Robbert J. Duvivier, Tinashe Dune, and Katie Wynne. "Education of the medical profession to facilitate delivery of transgender health care in an Australian health district." Australian Journal of Primary Health 26, no. 1 (2020): 17. http://dx.doi.org/10.1071/py19102.
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Transgender individuals who desire medical transition need to access care through their local healthcare system. This is the first study to explore the perceptions of the community and attitudes of healthcare providers towards the delivery of transgender health care in an Australian context. An anonymous survey was conducted of trans and gender-diverse community members; and physicians and trainees in the Hunter New England Local Health District of New South Wales, Australia. Community members were surveyed about their healthcare experiences. Medical students, GPs and hospital physicians were surveyed on their attitudes towards the delivery of transgender health care before and after a 1-h education session that included the lived experience of a community member. Community members expressed a need for increased education for healthcare providers in transgender medicine. Following the intervention, significantly more healthcare providers felt confident to facilitate transgender health care for adults, adolescents and children; and more healthcare providers agreed that medical and surgical treatment should be offered to transgender patients if desired. The positive safety profile of treatment was felt to be the most persuasive factor for the provision of care. Healthcare providers identified a need for health education in transgender medicine; easy access to evidence-based resources; and local referral pathways as key strategies to improving transgender health care.
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Slavin, Monica A. "The epidemiology of candidaemia and mould infections in Australia." Journal of Antimicrobial Chemotherapy 49, suppl_1 (January 1, 2002): 3–6. http://dx.doi.org/10.1093/jac/49.suppl_1.3.
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Abstract A retrospective review of Candida bloodstream infections (BSI) in Australian hospitals between 1995 and 1998 was performed. Nine tertiary referral hospitals in the States of New South Wales, Victoria, South Australia and Queensland participated. Of all isolates, 56% were Candida albicans, 14% Candida parapsilosis, 13% Candida glabrata, 5% Candida krusei and 4.5% Candida tropicalis. There were significant differences in the distribution of species in different patient groups. Among surgical patients, 69% of candidaemia was due to C. albicans, whereas among medical patients the proportion was 52%, and in haematology patients 43% (P = 0.0012; Pearson χ2). BSI with C. krusei were almost exclusive to haematology patients and were the second leading cause of Candida infection in that group, accounting for 27% of infections. The temporal pattern of Candida isolates also revealed a relationship between the latter years of the study and a lower likelihood of infection with C. albicans. Logistic regression showed year of the study [P = 0.032; odds ratio (OR) 0.81; 95% confidence interval (CI) 0.67–0.98] and surgery (P = 0.005; OR 2.02; 95% CI 1.2–3.1) to be significant variables. The rate of candidaemia in Australian hospitals was similar to that reported for US hospitals at 0.1–0.27 per 1000 discharges. Since April 1998, the clinical database on the internet resource Mycology Online has invited submission of clinical details from cases of invasive mycoses from Australian clinicians. To date, descriptions of 43 patients with proven or presumptive mould infection have been entered on the database. Of these, the leading cause was infection with Aspergillus (n = 16), followed by Zygomycetes (n = 7), Fusarium (n = 5), Scedosporium (n = 5) and Exserohilum (n = 1). Although Aspergillus infections were the most frequent on the database, the variety of mould infections seen in this short time was surprising. A knowledge of local patterns of infection and antifungal susceptibility is useful in selecting empirical therapy and formulating prophylactic and pre-emptive strategies.
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Okurame, Josephine Chidinma, Lisa Cannon, Emily Carter, Sue Thomas, Elizabeth J. Elliott, and Lauren J. Rice. "Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol." BMJ Open 12, no. 9 (September 2022): e065327. http://dx.doi.org/10.1136/bmjopen-2022-065327.
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IntroductionPeople with fetal alcohol spectrum disorder (FASD) encounter a range of health and allied health providers and require specialised support to ensure health services are provided safely and effectively. Not all health professionals possess the knowledge or expertise required for the identification, assessment, referral and management of FASD. Accessible resources for understanding and managing FASD can help create awareness in health professionals and ensure patients receive the correct diagnosis and timely access to the necessary supports and services. The aim of this scoping review is to identify and analyse FASD resources for health professionals.Methods and analysisA comprehensive search of eight databases (MEDLINE, Scopus, PsycINFO, CINAHL, PubMED, EMBASE, Web of Science and Trip Medical Database) and nine grey literature databases (FASD Hub, NOFASD Australia, National Organisation for FASD, FASD United, HealthInfoNet, Proof Alliance, Child Family Community Australia, Foundation for Alcohol Research & Education and the Australian Department of Health websites) will be conducted using three search engines including PubMed, Ovid and Google advanced search (search dates: October 2021 to May 2022). Consultations will also be carried out with international and national experts in the diagnosis/management of FASD to obtain any additional relevant published or unpublished resources. Inclusion criteria were developed to guide the selection of resources that are publicly available, primarily focused on FASD and curated for health professionals for the identification, management or referral of FASD. Critical appraisal process will be executed using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) tool to assess the quality of selected resources.Ethics and disseminationEthical approval is not required for the scoping review. Scoping review results will be presented at relevant national and international conferences and published in peer-reviewed journals. Search results will be made available to ensure reproducibility and transparency.
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Comino, Elizabeth J., Nicholas A. Zwar, and Oshana Hermiz. "The Macarthur GP After-hours Service: a model of after-hours care for Australia." Australian Health Review 31, no. 2 (2007): 223. http://dx.doi.org/10.1071/ah070223.
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Introduction: The Macarthur GP After-hours Service (MGPAS) was established to streamline the provision of after-hours medical care in an outer-urban community. This paper reports on a process evaluation of the MGPAS. Methods: A mixed methods approach involving surveys, stakeholder interviews and analysis of administrative data was used. Results and discussion: This model of care was well accepted and regarded by general practitioners, Macarthur Health Service staff and the community. The MGPAS was found to be an acceptable and efficient model of after-hours medical care. Areas that required further review included the need for telephone triage, home visiting and improved communication and referral to the health service. The financial viability of the MGPAS depends on supplementary funding due to the constraints of the Medicare rebate, and limited opportunities to reduce costs or increase revenue. Further research, including an economic evaluation to identify opportunity costs of the service, is needed.
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Ranson, David L., and Lyndal Bugeja. "Medicolegal Death Investigation: Coroner and Forensic Pathology Functions and Processes in Victoria, Australia." Academic Forensic Pathology 7, no. 4 (December 2017): 567–81. http://dx.doi.org/10.23907/2017.048.
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The medicolegal death investigation in Victoria, Australia is a traditional coroner system based on the model in England and Wales in the early 20th Century. In 1985, the first of a series of legislative amendments were made that proved the vanguard of reform of the coroners' jurisdictions in Australia. The Victorian Institute of Forensic Medicine (the Institute) was established by the Coroners Act 1985 (Vic.), now the Victorian Institute of Forensic Medicine Act 1985 (Vic.), to provide forensic pathology, medical, and related scientific services needed by the justice system. In addition to death investigation, other forensic and scientific services are performed by the Institute including: clinical medical examinations and support services for assault victims and perpetrators, forensic toxicology services and molecular biology, and anthropology and odontology services in relation to human identification. Medical and nursing staff provide medical information and support to families in a therapeutic setting, as well as direct referral to clinical medical specialists. This takes place where a medical death investigation procedure uncovers genetic or familial disease that may place other family members at risk of future illness. A donor tissue bank ensures that a death also provides the opportunity for families to donate organs and tissues from the deceased for transplantation. Today, the traditional autopsy is one of several modalities of death investigation with postmortem radiology and imaging playing a significant role. This paper describes the principles and new processes at the Institute that support the coroner in death investigation and prevention as well as the therapeutic services designed to relieve the burden of disease on the community.
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Hilmi, S. C., J. McCloskey, P. Tenni, and J. Hughes. "36. VULVOVAGINAL CANDIDIASIS IN AUSTRALIA: LET'S TAKE A LOOK 'DOWN UNDER'." Sexual Health 4, no. 4 (2007): 298. http://dx.doi.org/10.1071/shv4n4ab36.
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Objectives: To determine: 1) The accuracy in patient self-diagnosis and medical diagnosis of vulvovaginal candidiasis (VVC) in Western Australia; 2) The contributing factors for self-diagnosing rather than seeking a medical diagnosis. Methods: A cross-sectional cohort community-based study, over a 13-month period, was conducted. All women wishing to purchase a topical antifungal product for their personal treatment of presumed VVC, from participating community pharmacies within a nominated division of general practice in Perth, Western Australia, were invited to participate in the study. Participants completed a detailed questionnaire prior to their immediate referral for evaluation and examination by an experienced medical practitioner, and underwent a range of laboratory tests to determine the cause of their symptoms. Chi-square testing for association was performed for univariate comparisons with that of culture proven VVC. Results: Ninety-four symptomatic women aged between 19 and 79 years were recruited. Of the 88 women who completed all aspects of the study, 41 (47%) were confirmed to have VVC by culture. The remaining 47 (53%) women either had another infectious cause (10 [11%]: urinary tract infection [4]; bacterial vaginosis [2]; chlamydia [2]; or genital herpes [2]) or their symptoms were not secondary to an infection (37 [42%]). Sixty-three percent of presumptive diagnoses made by medical practitioners were concordant with laboratory proven VVC. The women avoided seeking medical advice for a number of reasons. Conclusions: Over half of the study population self-diagnosed VVC incorrectly. The proportion of correct presumptive diagnoses made by medical practitioners was only slightly greater. Diagnosis based on presenting signs and symptoms alone could result in an incorrect diagnosis and a proportion of STIs being missed. Improving the management of VVC will be dependent on addressing factors influencing women's reluctance to seek medical advice and in addressing the current diagnostic processes. Over-the-counter antifungals, whilst convenient, may well compromise women's health.
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Sved Williams, Anne, and Jill Poulton. "Supporting Mental Health in the Community: New Systems for General Practice." Australian Journal of Primary Health 12, no. 2 (2006): 105. http://dx.doi.org/10.1071/py06029.
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General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.
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Chambers, Georgina M., Christopher Harrison, James Raymer, Ann Kristin Petersen Raymer, Helena Britt, Michael Chapman, William Ledger, and Robert J. Norman. "Infertility management in women and men attending primary care—patient characteristics, management actions and referrals." Human Reproduction 34, no. 11 (November 1, 2019): 2173–83. http://dx.doi.org/10.1093/humrep/dez172.
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Abstract STUDY QUESTION How did general practitioners (GPs) (family physicians) manage infertility in females and males in primary care between 2000 and 2016? SUMMARY ANSWER The number of GP infertility consultations for females increased 1.6 folds during the study period, with 42.9% of consultations resulting in a referral to a fertility clinic or specialist, compared to a 3-fold increase in the number of consultations for men, with 21.5% of consultations resulting in a referral. WHAT IS KNOWN ALREADY Infertility affects one in six couples and is expected to increase with the trend to later childbearing and reports of declining sperm counts. Despite GPs often being the first contact for infertile people, very limited information is available on the management of infertility in primary care. STUDY DESIGN, SIZE, DURATION Data from the Bettering the Evaluation and Care of Health programme were used, which is a national study of Australian primary care (general practice) clinical activity based on 1000 ever-changing, randomly selected GPs involved in 100 000 GP–patient consultations per year between 2000 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Females and males aged 18–49 years attending GPs for the management of infertility were included in the study. Details recorded by GPs included patient characteristics, problems managed and management actions (including counselling/education, imaging, pathology, medications and referrals to specialists and fertility clinics). Analyses included trends in the rates of infertility consultations by sex of patient, descriptive and univariate analyses of patient characteristics and management actions and multivariate logistic regression to determine which patient and GP characteristics were independently associated with increased rates of infertility management and referrals. MAIN RESULTS AND THE ROLE OF CHANCE The rate of infertility consultations per capita increased 1.6 folds for women (17.7–28.3 per 1000 women aged 18–49 years) and 3 folds for men over the time period (3.4–10.2 per 1000 men aged 18–49 years). Referral to a fertility clinic or relevant specialist occurred in 42.9% of female infertility consultations and 21.5% of male infertility consultations. After controlling for age and other patient characteristics, being aged in their 30s, not having income assistance, attending primary care in later years of the study and coming from a non-English-speaking background, were associated with an increased likelihood of infertility being managed in primary care. In female patients, holding a Commonwealth concession card (indicating low income), living in a remote area and having a female GP all indicated a lower adjusted odds of referral to a fertility clinic or specialist. LIMITATIONS, REASONS FOR CAUTION Data are lacking for the period of infertility and infertility diagnosis, which would provide a more complete picture of the epidemiology of treatment-seeking behaviour for infertility. Australia’s universal insurance scheme provides residents with access to a GP, and therefore these findings may not be generalizable to other settings. WIDER IMPLICATIONS OF THE FINDINGS This study informs public policy on how infertility is managed in primary care in different patient groups. Whether the management actions taken and rates of secondary referral to a fertility clinic or specialist are appropriate warrants further investigation. The development of clinical practice guidelines for the management of infertility would provide a standardized approach to advice, investigations, treatment and referral pathways in primary care. STUDY FUNDING/COMPETING INTEREST(S) This paper is part of a study being funded by an Australian National Health and Medical Research Council project grant APP1104543. G.C. reports that she is an employee of The University of New South Wales (UNSW) and Director of the National Perinatal Epidemiology and Statistics Unit (NPESU), UNSW. The NPESU manages the Australian and New Zealand Assisted Reproductive Technology Database on behalf of the Fertility Society of Australia. W.L. reports being a part-time paid employee and minor shareholder of Virtus Health, a fertility company. R.N. reports being a small unitholder in a fertility company, receiving grants for research from Merck and Ferring and speaker travel grants from Merck. TRIAL REGISTRATION NUMBER NA
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Lau, Simon C. P., Nathan G. Myhill, Rekha Ganeshalingam, and Gerald M. Y. Quan. "Cervical Spinal Cord Injury at the Victorian Spinal Cord Injury Service: Epidemiology of the Last Decade." Clinical Medicine Insights: Trauma and Intensive Medicine 5 (January 2014): CMTIM.S12939. http://dx.doi.org/10.4137/cmtim.s12939.
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Introduction Cervical spinal cord injury (CSCI) is a significant medical and socioeconomic problem. In Victoria, Australia, there has been limited research into the incidence of CSCI. The Austin Hospital's Victorian Spinal Cord Injury Service (VSCIS) is a tertiary referral hospital that accepts referrals for surgical management and ongoing neurological rehabilitation for south eastern Australia. The aim of this study was to characterise the epidemiology of CSCI managed operatively at the VSCIS over the last decade, in order to help fashion public health campaigns. Methods This was a retrospective review of medical records from January 2000 to December 2009 of all patients who underwent surgical management of acute CSCI in the VSCIS catchment region. Patients treated non-operatively were excluded. Outcome measures included: demographics, mechanism of injury and associated factors (like alcohol) and patient neurological status. Results Men were much more likely to have CSCI than women, with a 4:1 ratio, and the highest incidence of CSCI for men was in their 20s (39%). The most common cause of CSCI was transport related (52%), followed by falls (23%) and water-related incidents (16%). Falls were more prevalent among those >50 years. Alcohol was associated in 22% of all CSCIs, including 42% of water-related injuries. Discussion Our retrospective epidemiological study identified at-risk groups presenting to our spinal injury service. Young males in their 20s were associated with an increased risk of transport-related accidents, water-related incidents in the summer months and accidents associated with alcohol. Another high risk group were men >50 years who suffer falls, both from standing and from greater heights. Public awareness campaigns should target these groups to lower incidence of CSCI.
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Cook, Lachlan, Charmaine Woods, Tracey Nicholls, and Eng H. Ooi. "Delays in Time to Head and Neck Cancer Treatment: A South Australian Perspective." Medicina 58, no. 2 (January 18, 2022): 145. http://dx.doi.org/10.3390/medicina58020145.
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Background and Objectives: In head and neck cancer, delays in time to treatment are associated with poorer clinical outcomes. Within Australia, it is recommended that primary treatment is initiated within 56 days of initial referral. The aim of this study was to assess whether head and neck cancer treatment was delivered within these timeframe guidelines at our institution and identify factors associated with treatment delays. Methods: This retrospective cohort study assessed patients newly diagnosed with head and neck cancer over a 24 months period (2018 to 2019) at Flinders Medical Centre, Australia. Time to treatment intervals were calculated for comparison to local timeframe guidelines. Results: A total of 72 patients met the inclusion criteria. The median time from specialist referral to treatment initiation was 45.5 days (IQR 29–61), with 72% meeting the 56 days guideline. On univariate logistic regression, patients undergoing primary radiotherapy treatment were less likely to meet this guideline than those undergoing primary surgery (OR 8.8, 95% CI 2.6–28.9, p < 0.001), as were those requiring prophylactic gastrostomy tube insertion (OR 3.1, 95% CI 1.1–9.0, p < 0.05). Treatment initiation beyond 56 days had no significant impact on 12 months overall survival or disease-free survival. Conclusions: The findings of this study demonstrate that primary radiotherapy treatment is associated with delays in head and neck cancer treatment initiation, likely related to time consuming pre-treatment factors such as gastrostomy tube insertion.
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Wardle, Jon L., David W. Sibbritt, and Jon Adams. "Referral to Massage Therapy in Primary Health Care: A Survey of Medical General Practitioners in Rural and Regional New South Wales, Australia." Journal of Manipulative and Physiological Therapeutics 36, no. 9 (November 2013): 595–603. http://dx.doi.org/10.1016/j.jmpt.2013.09.003.
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Largey, Geraldine, Eli Ristevski, Helen Chambers, Heather Davis, and Peter Briggs. "Lung cancer interval times from point of referral to the acute health sector to the start of first treatment." Australian Health Review 40, no. 6 (2016): 649. http://dx.doi.org/10.1071/ah15220.
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Objective The aim of the present study was to compare lung cancer diagnostic and treatment intervals with agreed target measures across three large public health services in Victoria and assess any differences in interval times by treatment type and health service. Methods A retrospective medical record audit of 78 patients admitted with a new diagnosis of lung cancer was conducted. Interval times from referral to diagnosis, diagnosis to first treatment and referral to first treatment were recorded in three treatment types: surgery, chemotherapy and radiotherapy. Results There was a significant difference in the mean number of days from referral to diagnosis by treatment type. Patients who underwent surgery waited significantly longer (mean (± s.d.) 41.6 ± 38.4 days) to obtain a diagnosis than those who received radiotherapy (15.1 ± 18.6 days). Only 47% of surgical patients obtained a diagnosis within the recommended 28 days. Moreover, only 45% and 44% of patients, respectively, met the diagnosis-to-treatment target of 14 days and referral-to-treatment target of 42 days. Conclusion The present study highlights the effect of treatment type on lung cancer referral interval times. It demonstrates the benefits of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. What is known about the topic? Lung cancer is the leading cause of cancer mortality in Australia and has the lowest 5-year survival rate of all cancer types. Delays in the diagnosis of lung cancer can change the prognosis from potentially curable to incurable, particularly in faster-growing tumours. What does this paper add? This study reveals treatment type was a greater factor in explaining variations in diagnosis and treatment than health service. Surgical patients were consistently lower in meeting the recommended interval targets across referral to diagnosis, diagnosis to treatment and referral to treatment. What are the implications for practitioners? This study demonstrates the value of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. Such measures may further improve prognostic outcomes in lung cancer by reducing unwanted delays.
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McGrath, Pam D., David Henderson, John Tamargo, and Hamish A. Holewa. "'All these allied health professionals and you're not really sure when you use them': insights from Australian international medical graduates on working with allied health." Australian Health Review 35, no. 4 (2011): 418. http://dx.doi.org/10.1071/ah10949.
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Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. What is known about the topic? To date, there is no research available on the important topic of how IMGs understand and integrate with the allied health system in relation to multidisciplinary care in the Australian healthcare system. What does this paper add? The present findings make an important contribution to the literature by highlighting the need to focus on integrating IMGs into the allied health system. The findings presented in this paper indicate that, for the range of reasons summarised the IMGs’ understanding of the allied health system is limited. What are the implications for practitioners? The IMGs in this study called for assistance in understanding the allied health system, a process they considered difficult to do on their own. The strong recommendation is that it is most appropriate for allied health professionals in the hospital to take such leadership, and such efforts will be met by a readiness to learn on the part of the IMGs.
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Farinola, Nicholas, Gillian E. Caughey, J. Simon Bell, Sally Johns, Milka Hauta-aho, and Sepehr Shakib. "Influence of stroke and bleeding risk on prescribing of oral anticoagulants in older inpatients; has the availability of direct oral anticoagulants changed prescribing?" Therapeutic Advances in Drug Safety 9, no. 2 (December 20, 2017): 113–21. http://dx.doi.org/10.1177/2042098617747835.
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Background Little is known about changes in prescribing practices in Australia since the introduction of the direct oral anticoagulants (DOACs). Our objective was to examine if the availability of DOACs has coincided with a change in prescribing of oral anticoagulants in older hospital inpatients with regard to risk factors for stroke and bleeding. Methods A prospective observational study was conducted between October 2012 and August 2015 of inpatients aged over 60 years initiated on an oral anticoagulant in a large metropolitan, tertiary referral, public teaching hospital in Australia. Treatment groups were patients who commenced an oral anticoagulant prior to inclusion of DOACs on the formulary and those who commenced after the introduction of DOACs. Subgroup analyses were conducted in patients with atrial fibrillation (AF). Differences in clinical characteristics and risk for stroke and bleeding were calculated using the CHADS2 and HAS-BLED scores, respectively, were examined. Results A total of 289 patients were included. Inpatients prescribed an oral anticoagulant after the introduction of DOACs were significantly older, a greater proportion were female and more likely to have had a prior stroke. This was associated with a statistically higher CHADS2 score in the post-DOAC group. Similar findings were observed when limiting the sample to patients with AF. Patients with AF who were at greatest likelihood of having a bleeding event were less likely to be treated with a DOAC. Conclusion Since the introduction of the DOACs, patients who may have previously received no therapy or suboptimal treatment were now more likely to be receiving anticoagulation, suggesting an appropriate change in prescribing practice.
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Taylor, Kate P., Sandra C. Thompson, Marianne M. Wood, Mohammed Ali, and Lyn Dimer. "Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology." Australian Health Review 33, no. 4 (2009): 549. http://dx.doi.org/10.1071/ah090549.
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To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting.
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Annear, Michael, Peter Lucas, Tim Wilkinson, and Yasuo Shimizu. "Prescribing physical activity as a preventive measure for middle-aged Australians with dementia risk factors." Australian Journal of Primary Health 25, no. 2 (2019): 108. http://dx.doi.org/10.1071/py18171.
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Dementia is increasing in Australia in line with population ageing and is expected to peak by mid-century. The development of common forms of dementia, including Alzheimer’s disease, is associated with lifestyle-related risk factors that are prevalent among middle-aged Australians, including obesity, hypertension, high cholesterol, diabetes and depression. These risk factors can be significantly ameliorated through regular participation in moderate aerobic physical activity (PA). Current national and international guidelines recommend at least 150 min of aerobic PA per week for achieving health protective effects. Lifestyle intervention is a critical area for action as there are currently no medical or pharmaceutical interventions that can halt the progression of common dementias. Physician–patient discussions concerning risk reduction via habitual aerobic PA offers a complementary intervention as part of broader dementia management. Evidence suggests that to achieve the highest rates of adherence to PA, physician advice in primary care should be supported by wider policies, institutions and community services that offer a meaningful referral pathway and patient follow up after initial assessment. International Green Prescription programs provide examples of physician-led interventions in primary care that could inform further action in Australia.
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Mutsekwa, Rumbidzai N., Russell Canavan, Anthony Whitfield, Alan Spencer, and Rebecca L. Angus. "Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service." Frontline Gastroenterology 10, no. 3 (November 2, 2018): 229–35. http://dx.doi.org/10.1136/flgastro-2018-101063.
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ObjectiveThe demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service.DesignA dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period.SettingGold Coast University Hospital, Queensland, Australia (a public tertiary hospital).Patients658 patients were triaged to the clinic between June 2016 and March 2018.InterventionA dietitian first gastroenterology clinic for low-risk gastroenterology patients.Main outcome measuresWe examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey.ResultsAt the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction.ConclusionA dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.
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Roberts, D. M., J. F. Fraser, N. A. Buckley, and B. Venkatesh. "Experiences of Anticholinesterase Pesticide Poisonings in an Australian Tertiary Hospital." Anaesthesia and Intensive Care 33, no. 4 (August 2005): 469–76. http://dx.doi.org/10.1177/0310057x0503300408.
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There is limited information regarding the management and outcomes of patients presenting with anticholinesterase pesticide poisoning in Australia. Patients presenting to a tertiary referral hospital with anticholinesterase exposures were identified by discharge coding. The medical records of each patient were retrospectively reviewed. Based on clinical outcome, patients were classified as severe or non-severe poisonings. Forty-one presentations were noted between 1990 and 2003. Eight patients (20%) had severe poisoning of which tachycardia, fasciculations with weakness and metabolic acidosis were common manifestations. The diagnosis was delayed in four patients due to the absence of a clear history, which did not influence patient outcomes or put hospital staff at risk of nosocomial poisoning. The median length of hospital stay was prolonged in severe poisonings (20 days) compared to 12 hours in other patients. Two cases of intermediate syndrome were attributed to fenthion and diazinon, and one case of delayed polyneuropathy to trichlorfon. Cholinesterase activities were performed in only 49% of presentations. The overall mortality was 2.4% (1 death) and the mortality in patients with severe poisoning was 12.5%. The incidence of anticholinesterase poisoning in Australia is low. These outcomes were favourable and comparable with other published data. Measures to enhance the knowledge of medical staff supplemented by validated treatment protocols should be developed. For less significant exposures, an emphasis on adequate documentation of cholinergic signs and cholinesterase activities is necessary for rapid triage and may also have potential forensic implications if not performed.
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Beesley, Vanessa L., Aleksandra Staneva, Caroline Nehill, Vivienne Milch, Felicity Hughes, and Penelope M. Webb. "Patterns of, and barriers to supportive care needs assessment and provision for Australian women with gynecological cancer and their caregivers: a mixed-methods study of clinical practice." Palliative and Supportive Care 18, no. 2 (August 6, 2019): 170–77. http://dx.doi.org/10.1017/s147895151900052x.
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AbstractObjectivesTo document the current clinical practice in 2017 for assessment of supportive care needs and provision of supportive care to women with gynecological cancer and their caregivers in Australia, and to identify the main enablers and barriers to care provision.MethodsA total of 64 health professionals who care for Australian women with gynecological cancer responded to an electronic survey which explored their use of needs assessment, service-level processes and protocols for support service provision, and identified enablers and barriers to provision of care to both patients and caregivers. Eight respondents underwent an additional in-depth interview to elaborate on enablers, barriers, and gaps in the provision of supportive care.ResultsMostly, needs assessment for women and caregivers was part of current practice but done without validated tools or a checklist. Only 30% of respondents reported having documented referral pathways. Most respondents simply recorded a plan for meeting needs within the patients’ medical record (63% for patients; 46% for caregivers) rather than using a formalized care plan (15% for patients; 6% for caregivers). The interviewees’ comments supported survey results that having sufficient time to discuss issues was both the most important enabling factor and the greatest barrier to successful supportive care provision. The interviewees further discussed variations in needs based on age, cultural background, and phases within the cancer care continuum, and that best practice supportive care should involve a multidisciplinary team and customizable protocols.Significance of resultsThere is much room for improvement in the assessment of needs and provision of supportive care to women with gynecological cancer and their caregivers. Approaches to optimize use of consultation time (e.g., needs assessment tools and referral protocols) are necessary. Flexibility in the form and mode of delivery of support may be required to meet diverse personal preferences and incorporate caregivers.
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Dronavalli, Mithilesh, Manavi M. Bhagwat, Sandy Hamilton, Marisa Gilles, Jacquie Garton-Smith, and Sandra C. Thompson. "Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome." Australian Journal of Primary Health 23, no. 2 (2017): 170. http://dx.doi.org/10.1071/py15191.
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Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.
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Bradbury, R. S., L. F. Roddam, A. Merritt, D. W. Reid, and A. C. Champion. "Virulence gene distribution in clinical, nosocomial and environmental isolates of Pseudomonas aeruginosa." Journal of Medical Microbiology 59, no. 8 (August 1, 2010): 881–90. http://dx.doi.org/10.1099/jmm.0.018283-0.
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The virulence factor genotypes of a large cohort of clinical, nosocomial environment and community environment isolates (184 in total) of Pseudomonas aeruginosa from Tasmania, Australia, were determined by PCR. The virulence factor genotype of the majority of isolates was highly conserved, with the exception of the virulence gene exoU, which demonstrated low prevalence (33 isolates; 18 %) in the population tested. Isolates collected from the environment of intensive therapy wards (intensive care unit and neurosurgical units) of the major tertiary referral hospital in Tasmania were found to be more likely (P<0.001 and P<0.05, respectively) to possess the virulence factor gene exoU than all other isolates. Adult cystic fibrosis isolates showed a decreased prevalence of the exoU gene (P<0.01) when compared to other clinical isolates (P<0.01), which may indicate decreased virulence. No specific virulence factor genotype was associated with the cystic fibrosis epidemic strains tested.
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Morton, Anthony P., Archie C. A. Clements, Shane R. Doidge, Jenny Stackelroth, Merrilyn Curtis, and Michael Whitby. "Surveillance of Healthcare-Acquired Infections in Queensland, Australia: Data and Lessons From the First 5 Years." Infection Control & Hospital Epidemiology 29, no. 8 (August 2008): 695–701. http://dx.doi.org/10.1086/589904.
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Objective.To present healthcare-acquired infection surveillance data for 2001-2005 in Queensland, Australia.Design.Observational prospective cohort study.Setting.Twenty-three public hospitals in Queensland.Methods.We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons.Patients.A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI.Results.The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%–1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%–10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80,0.28, and 0.22 episodes per 1,000 occupied bed-days in level 1, 2, and 3 hospitals, respectively.Staphylococcus aureuswas the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus-associated BSI.Conclusions.Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions.
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Cairns, Rose, Jared A. Brown, and Nicholas A. Buckley. "Clonidine exposures in children under 6 (2004–2017): a retrospective study." Archives of Disease in Childhood 104, no. 3 (November 13, 2018): 287–91. http://dx.doi.org/10.1136/archdischild-2018-316026.
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ObjectiveTo describe trends in clonidine exposures in children under 6. Clonidine has become increasingly popular for management of paediatric behavioural disorders. Clonidine has a narrow therapeutic index, and toxicity can occur with inadvertent double dosing. Clonidine is not recommended for use in children under 6 years.Design and settingA retrospective review of clonidine exposures in children under 6 reported to the New South Wales Poisons Information Centre (NSWPIC, Australia’s largest poison centre), 2004–2017. This was compared with community clonidine utilisation using dispensing data from Australian Statistics on Medicines, 2004–2015. Australian trends were compared with clonidine exposure calls to US poison centres, 2006–2016.Main outcome measuresTrends in poisonings and dispensing; demographics, dose, exposure type, clonidine source, symptoms, disposition.ResultsThere were 802 clonidine exposures in the NSWPIC database, increasing 4.9% per year, 2004–2017 (95% CI 3.1% to 6.7%, p<0.001), correlated with increased dispensing, r=0.846 (95% CI 0.529 to 0.956, p<0.001). 78.6% were hospitalised and medical toxicologists were consulted in 7.2%, indicating high risk and/or morbidity. Clonidine was prescribed for the patient in at least 27.8%, providing evidence for prescribing outside of recommendations. US data reveals 19 056 clonidine exposures, with 3.7% increase per year, 2006–2016 (95% CI 2.2% to 5.3%, p<0.001).ConclusionsClonidine exposures in children under 6 are increasing, and this trend is not isolated to Australia. Exposures have a high hospital referral rate and high morbidity. Caution should be exercised when prescribing clonidine, and parent/carer education is important for safe storage and increased vigilance when dosing.
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Jackson, Mariann, Katie McGill, Terry J. Lewin, Jenifer Bryant, Ian Whyte, and Gregory Carter. "Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs." Australian & New Zealand Journal of Psychiatry 54, no. 6 (January 20, 2020): 591–601. http://dx.doi.org/10.1177/0004867419897818.
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Background: Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. Objective: To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45–64 years) during an index episode of hospital-treated deliberate self-poisoning. Methods: A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003–2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. Results: There were ( n = 157) older-aged and ( n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. Conclusion: Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.
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Siak, Meng, Amanda K. Burrows, Geoffrey W. Coombs, Manouchehr Khazandi, Sam Abraham, Jacqueline M. Norris, J. Scott Weese, and Darren J. Trott. "Characterization of meticillin-resistant and meticillin-susceptible isolates of Staphylococcus pseudintermedius from cases of canine pyoderma in Australia." Journal of Medical Microbiology 63, no. 9 (September 1, 2014): 1228–33. http://dx.doi.org/10.1099/jmm.0.076117-0.
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Meticillin-resistant Staphylococcus pseudintermedius (MRSP) has recently emerged as a worldwide cause of canine pyoderma. In this study, we characterized 22 S. pseudintermedius isolates cultured from 19 dogs with pyoderma that attended a veterinary dermatology referral clinic in Australia in 2011 and 2012. Twelve isolates were identified as MRSP by mecA real-time PCR and phenotypic resistance to oxacillin. In addition to β-lactam resistance, MRSP isolates were resistant to erythromycin (91.6 %), gentamicin (83.3 %), ciprofloxacin (83.3 %), chloramphenicol (75 %), clindamycin (66 %), oxytetracycline (66 %) and tetracycline (50 %), as shown by disc-diffusion susceptibility testing. Meticillin-susceptible S. pseudintermedius isolates only showed resistance to penicillin/ampicillin (90 %) and tetracycline (10 %). PFGE using the SmaI restriction enzyme was unable to type nine of the 12 MRSP isolates. However the nine isolates provided the same PFGE pulsotype using the Cfr91 restriction enzyme. Application of the mec-associated direct repeat unit (dru) typing method identified the nine SmaI PFGE-untypable isolates as dt11cb, a dru type that has only previously been associated with MRSP sequence type (ST)45 isolates that possess a unique SCCmec element. The dt11cb isolates shared a similar multidrug-resistant antibiogram phenotype profile, whereas the other MRSP isolates, dt11a, dt11af (dt11a-associated) and dt10h, were resistant to fewer antibiotic classes and had distinct PFGE profiles. This is the first report of MRSP causing pyoderma in dogs from Australia. The rapid intercontinental emergence and spread of multidrug-resistant MRSP strains confirms the urgent need for new treatment modalities for recurrent canine pyoderma in veterinary practice.
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Cooper, John, Andrea J. Phelps, Chee H. Ng, and David Forbes. "Diagnosis and treatment of post-traumatic stress disorder during the COVID-19 pandemic." Australian Journal of General Practice 49, no. 12 (December 1, 2020): 785–89. http://dx.doi.org/10.31128/ajgp-07-20-5557.
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Background The COVID-19 pandemic has caused unprecedented stress globally, and the associated medical and health-related traumatic experiences pose significant risks for the development of post-traumatic stress disorder (PTSD), and the exacerbation of pre-existing PTSD, among patients, general practitioners (GPs) and healthcare staff. Objective The aim of this article is to provide guidance to GPs and healthcare staff working in Australia about the diagnosis and treatment of both newly developed and pre-existing PTSD in the COVID-19 context. Case studies are presented; the authors discuss whether pandemic-related PTSD is different to PTSD caused by different types of traumatic exposure, and the associated implications for treatment. Discussion The role of GPs in the management of PTSD during the COVID-19 pandemic remains central, involving early detection, assessment and referral. Moreover, health professionals are not immune to the mental health effects of the pandemic and are encouraged to maintain their wellbeing and to seek professional treatment if needed.
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Kennedy, Michelle, Amanual Getnet Mersha, Raglan Maddox, Catherine Chamberlain, Sian Maidment, Peter O'Mara, Cathy Segan, et al. "Koori Quit Pack mailout smoking cessation support for Aboriginal and Torres Strait Islander people who smoke: a feasibility study protocol." BMJ Open 12, no. 10 (October 2022): e065316. http://dx.doi.org/10.1136/bmjopen-2022-065316.
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IntroductionSmoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples.Methods and analysisAn Aboriginal-led, multisite non-randomised single-group, pre–post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial.Ethics and disseminationEthics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation.Trial registration numberACTRN12622000654752.
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Kingston, Gail, Tilley Pain, Kym Murphy, Michelle Bennett, and Michelle Watson. "Perceptions of acute hospital occupational therapy services: developing a new model of care for occupational therapy on acute medical wards." International Journal of Therapy and Rehabilitation 26, no. 12 (December 2, 2019): 1–9. http://dx.doi.org/10.12968/ijtr.2017.0047.
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Background/Aims This study was conducted at a regional tertiary referral facility in Australia. It was part of a project to implement a new model of care for occupational therapy services on medical wards. Before the new model was implemented, focus groups were conducted to explore the perceived role of the occupational therapist on the acute medical ward, identify potential barriers to changing the service and garner support for the change in service. Methods Three focus groups were held. The groups consisted of nursing, physiotherapy and speech pathology staff who worked on acute medical wards. Participants were asked for their perception of the role of occupational therapy on the acute medical ward. Audio-recordings of the groups were transcribed and analysed. Results Qualitative content analysis highlighted the following themes: assessment of patient function; ‘safe discharge’; more than assessment; equipment and home modifications; collaboration and communication; delegating tasks to assistants; and specialist intervention strategies. Conclusions Multidisciplinary team members' overriding perception is that occupational therapists in acute care settings provide assessment of patient function for the specific purpose of safe discharge. Some participants recalled that occupational therapists had a greater role in ensuring patients returned to their chosen function through rehabilitation and home visits, suggesting support for a change to our proposed post-acute model of care. Concerns highlighted by focus group members regarding increased workload for multidisciplinary team members and loss of communication need to be addressed to ensure the change in service is successful.
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Einsiedel, Lloyd J., Eileen van Iersel, Robert Macnamara, Tim Spelman, Malcolm Heffernan, Linda Bray, Hamilton Morris, Brenda Porter, and Anthony Davis. "Self-discharge by adult Aboriginal patients at Alice Springs Hospital, Central Australia: insights from a prospective cohort study." Australian Health Review 37, no. 2 (2013): 239. http://dx.doi.org/10.1071/ah11087.
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Objective. To determine rates and risk factors for self-discharge by Aboriginal medical inpatients at Alice Springs Hospital. Methods. Prospective cohort study. Interviews were conducted in primary language by Aboriginal Liaison Officers, from July 2006 to August 2007. Topics included understanding of diagnosis, satisfaction with services and perceptions of staff and environment. Risk factors for self-discharge were then determined prospectively. Results. During the study period 202 (14.7%) of 1380 patients admitted to general medical units at Alice Springs Hospital, were interviewed. Self-discharge rates for all admissions were significantly lower during the study period than they had been previously (pre-study, mean 22.9 ± standard error 0.3%; study, 17.0 ± 0.2%) (P < 0.001). Most interviewees (73.4%) did not know their reason for admission (73.4%) or estimated length of stay (82.3%). Forty interviewees (19.8%) self-discharged. Mean monthly self-discharge rates differed between the three medical units (Unit A, 13.9 ± 0.3%; Unit B, 17.3 ± 1.37%; Unit C, 20.0 ± 0.4%) (P = 0.005). Multivariable predictors of self-discharge included male sex (hazard ratio (HR) 2.4; 95% confidence interval (CI) 1.1, 5.2), a past history of self-discharge (HR 3.2; 95%CI 1.5, 6), planned transfer to a tertiary referral centre (HR 3.8; 95%CI 1.3–7.4) and a desire to drink alcohol (HR 4.5; 95%CI 1.8–10.2). Conclusions. Physician, institutional and patient factors all contribute to self-discharge. Improving cultural safety may be the key to lowering self-discharge rates. What is known about the topic? Rates of self-discharge by Aboriginal adults in Central Australia are the highest reported worldwide. Previous studies have been retrospective and focussed on patient demographics without addressing the environmental and cultural contexts in which self-discharge occurs. What does this paper add? In this acute care setting, we found a pervasive failure to communicate effectively with Aboriginal patients. Consequently, most patients were unaware of their diagnosis or length of stay. Self-discharge was a common practice; nearly half of all previously admitted patients had self-discharged in the past. We demonstrate that physician, hospital and patient factors all contribute to this practice. Prospectively determined risk factors included the treating medical team, the need for transfer outside Central Australia, and patient factors such as male gender and alcohol dependence. Self-discharge rates fell significantly with Aboriginal Liaison involvement. What are the implications for practitioners? Cross-cultural communication skills must be markedly improved among medical staff caring for this marginalised population. Critical to reducing rates of self-discharge are improvements in institutional cultural safety by involving Aboriginal Liaison Officers and family members. However, persistently high self-discharge rates suggest a need to redirect medical services to a more culturally appropriate community-based model of care.
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Simpson, Steve, and Richard Turner. "Four decades of anal cancer in Tasmania, Australia: what do the case data tell us?" Sexual Health 9, no. 3 (2012): 213. http://dx.doi.org/10.1071/sh11002.
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Background Anal cancer is a rare cancer analogous to cervical cancer, largely caused by exposure to oncogenic human papillomavirus. We have sought to study this disease in the epidemiologically distinct population of Tasmania. Methods: Medical records at all tertiary and secondary referral centres in Tasmania were audited for records with corresponding International Classification of Diseases (ICD)-10 codes. Statistical significances of trends were evaluated using Fisher’s exact test, logistic regression or linear regression. Results: Of ~1350 screening records, 170 cases of anal cancer were found with patient presentation during 1973–2010, corresponding to 132 patients. This cohort was mostly female (66.7%), with squamous cell histology (81.8%) and anal canal primaries (72.0%). Most cases were detected at Stage II or below and the majority remained disease-free after treatment. Relatively few cases had documentation of typical risk factors for anal cancer, such as HIV seropositivity, a history of cancer or smoking. After 2000, there was a trend towards a lower stage at presentation, correlating with an increased 5-year survival. After 2000, no anal margin tumours presented beyond Stage II; nearly half were detected in situ and none were fatal. For anal canal tumours, there was virtually no change in the mean stage at detection or in survival. Conclusion: This is the first case series of anal cancer in Tasmania. We find that in many ways, including symptoms and pathology at presentation, epidemiology is typical. However, our cohort is distinct in its paucity of known risk groups, including HIV-positive people, those with a history of cancer and smokers.
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MacInnes, Louise, Carol Baines, Alexandra Bishop, and Karen Ford. "Patient knowledge and experience of hyperbaric oxygen treatment." Diving and Hyperbaric Medicine Journal 51, no. 1 (March 31, 2021): 72–77. http://dx.doi.org/10.28920/dhm51.1.72-77.
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Introduction: This paper presents a quantitative and qualitative study exploring patients’ knowledge and experience of hyperbaric oxygen treatment (HBOT). Methods: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description. Results: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a ‘diver’; and (4) burdens of HBOT. Conclusions: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a ‘diver’ and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.