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The purpose of this case study is to explain the development of Queensland's strategic approach to health system reform, which promotes partnership across the health system to better deliver integrated and value-based health care across the continuum of care. The new health system vision was informed by undertaking literature searches on national and international health system approaches to reform and supported by extensive consultation across Queensland with more than 1100 stakeholders. Thematic analysis was undertaken to identify key themes that were translated into a high-level vision document that communicated Queensland's renewed focus on wellness and delivering more care in the community. This was circulated to stakeholders for iterative and collaborative refinement before final approvals. Collaboratively and iteratively developing the new health system vision for Queensland with key stakeholders has contributed to a shared understanding and ownership of a vision that is committed to system reform, focused on delivering high-value care that reflects what is important to consumers and health system stakeholders. What is known about the topic? Vision statements for organisations including health are common. However, there is little information available in the literature regarding approaches to developing a vision for a health system. What does this paper add? An overview of an approach to developing a new health system vision through comprehensive consultation that engages stakeholders broadly to develop an informed vision that has support from all levels of the health system. What are the implications for practitioners? The method used to develop this vision could be replicated across any large-scale organisation. Although time consuming, the outcome is a vision that is widely supported and sets the organisation up for success for implementation. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons' Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities. Locally developed, evidence-based interventions were selected by workshop participants for each priority area: a Residential Aged Care Facility acute care Support Service (RaSS); improved early identification and management of frail older persons presenting to hospital emergency departments (GEDI); optimisation of inpatient care (Eat Walk Engage); and enhancement of advance care planning. These interventions have been implemented across metropolitan and regional areas, and their impact is currently being evaluated through process measures and system-level outcomes. In this narrative paper, we conceptualise the healthcare organisation as a complex adaptive system to explain some of the difficulties in achieving change within a diverse and dynamic healthcare environment. The Frail Older Persons' Collaborative Program demonstrates that translating research into practice and effecting change can occur rapidly and at scale if clinician commitment, high-level leadership, and adequate resources are forthcoming. What is known about the topic? Providing frailty-focused care can improve outcomes, particularly by avoiding unnecessary admissions to hospital and reducing hospital-acquired complications, such as delirium and functional decline. Several evidence-based interventions exist that apply to specific points in the trajectory of older frail patients from hospital presentation to discharge and beyond, but these are not generally well integrated across the entire patient journey. What does this paper add? This paper describes a whole-of-healthcare system approach to improving care and outcomes for frail older people in Queensland. Rather than developing new care initiatives, the approach was taken to invest in pre-existing evidence-based interventions developed and validated in Queensland clinical settings and scale them across the state over 3 years. What are the implications for practitioners? This state-wide scale-up of evidence-based interventions has profiled how the healthcare system can be redesigned to implement models that better support vulnerable older people. [ABSTRACT FROM AUTHOR]

Introduction: Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia. Main recommendations: The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care. Changes in management as result of the guideline: The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care. [ABSTRACT FROM AUTHOR]

Background: With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system.Methods: In this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines.Results: Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce.Conclusions: Progress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital. [ABSTRACT FROM AUTHOR]

Purpose Recent advances in technology have raised a potentially promising service to overcome difficulties associated with remote witnesses: live video-feed interviews. The efficacy of this mode of interviewing, however, lacks empirical evidence, particularly with children in an investigative context. Methods This study explored the effects of live video-feed compared to face-to-face interviewing on the memory reports of 100 children (aged 5-12). Children participated in an innocuous event and were interviewed 1-2 days later by experienced interviewers. Results Analyses indicated that live video-feed interviewing was just as effective as face-to-face interviewing in terms of the accuracy and informativeness of children's accounts. Video-feed interviews, however, required a higher number of clarification prompts compared to face-to-face interviews. These findings were not influenced by children's familiarity with technology. Conclusions An initial test of live video-feed interviewing indicates it is a safe and effective method for interviewing children about an innocuous event. [ABSTRACT FROM AUTHOR]

There is a vast array of clinical and quality data available within healthcare organisations. The availability of this data in a timely and easy to visualise way is an essential component of high-performing healthcare teams. It is recognised that good quality information is a driver of performance for clinical teams and helps ensure best possible care for patients. In 2012 the Internal Medicine Program at The Prince Charles Hospital developed a clinical dashboard that displays locally relevant information alongside relevant hospital and statewide metrics that inform daily clinical decision making. The data reported on the clinical dashboard is driven from data sourced from the electronic patient journey board in real time as well as other Queensland Health data sources. This provides clinicians with easy access to a wealth of local unit data presented in a simple graphical format that is being captured locally and arranged on a single screen so the information can be monitored at a glance. Local unit data informs daily decisions that identify and confirm patient flow problems, assist to identify root causes and enable evaluation of patient flow solutions. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether providing thermal clothing to heart failure patients improves their health during winter. Design: A randomised controlled trial with an intervention group and a usual care group. Setting: Heart failure clinic in a large tertiary referral hospital in Brisbane, Australia. Participants: Eligible participants were those with known systolic heart failure who were over 50 years of age and lived in Southeast Queensland. Participants were excluded if they lived in a residential aged care facility, had incontinence or were unable to give informed consent. Fifty-five participants were randomised and 50 completed. Interventions: Participants randomised to the intervention received two thermal hats and tops and a digital thermometer. Primary and secondary outcome measures: The primary outcome was the mean number of days in hospital. Secondary outcomes were the number of general practitioner (GP) visits and self-rated health. Results: The mean number of days in hospital per 100 winter days was 2.5 in the intervention group and 1.8 in the usual care group, with a mean difference of 0.7 (95% CI -1.5 to 5.4). The intervention group had 0.2 fewer GP visits on average (95% CI -0.8 to 0.3), and a higher self-rated health, mean improvement -0.3 (95% CI -0.9 to 0.3). The thermal tops were generally well used, but even in cold temperatures the hats were only worn by 30% of the participants. Conclusions: Thermal clothes are a cheap and simple intervention, but further work needs to be done on increasing compliance and confirming the health and economic benefits of providing thermals to at-risk groups. Trial registration: The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000378820) [ABSTRACT FROM AUTHOR]

Keywords: Health services for the aged EN Health services for the aged 206 206 1 09/01/21 20210901 NES 210901 The concept of the "ABCD of CGA" would result in varying assessments depending on the environment and needs of the patient The comprehensive geriatric assessment (CGA) is considered the gold standard assessment tool for evaluating and providing care to at-risk and frail older patients. The information gathered is used to inform and formulate a detailed and individualised care plan with identified goals focusing on restoring or maintaining function with clear follow-up.1-3 The concept of the geriatric evaluation was developed in the 1930s by British geriatrician Marjory Warren, who recognised that older patients with multiple comorbidities and poor functional status often lacked diagnoses and clear management plans. We propose a new concept of the "ABCD (abbreviated, brief, comprehensive, detailed) of CGA" with varying models of CGA depending on the setting and needs of the patient. [Extracted from the article]

From 1989 through to and including 1994 extensive premature defoliation of black locust ( Robinia pseudoacacia L.) was observed in a progeny test plantation in Greene County, in the Georgia Piedmont. During July 1991 and 1992, all observed trees suffered greater than 50% defoliation. Leaflets of black locust showing symptoms of leaf spotting began abscising as early as mid-June following wet springs. Onset and progress of defoliation was followed on 50 trees in two plots in 1993 and 1994. In both years, sample trees were cut at the base and allowed to regrow from sprouts. A protectant fungicide, chlorothalonil (Daconil WDG 1.5 g/l water) was applied to run-off weekly to one-half of the growing sprouts beginning 17 April through 22 August 1994 by backpack sprayer. Air temperature, relative humidity, rainfall, and leaf wetness were monitored. Abscission of unprotected leaflets in 1993, a dry, hot year, began in mid-July and averaged 36% by late August; abscission of unprotected leaflets in 1994, a wet, cool year, began in mid-June and averaged 80% by late August; whereas, abscission of protected leaflets in 1994 began in late June and averaged 70% by late August. The Gompertz model described the increase of leaflet abscission with time. The estimated rate of leaflet abscission for unprotected leaflets in 1993 was significantly slower ( k = 0.056/wk) compared to the rate of abscission of unprotected leaflets in 1994 ( k =0.070/wk). Estimated rates of leaflet abscission were not significantly different between protected ( k = 0.063/wk) and unprotected trees ( k =0.070/wk) in 1994. Cumulative hours of leaf wetness of 600 h were associated with initial leaf spotting and defoliation in 1993 and in 1994. Delay in leaflet abscission of protected trees indicates that fungal infection may have contributed to premature defoliation of black locust with onset related to moisture conditions favourable for infection. [ABSTRACT FROM AUTHOR]

The article explains ways to distinguish two types of oedema including pitting and non-pitting for determining treatment and underlying aetiology. Topics covered include general or localised oedema, grading of peripheral oedema as to proximal extent and factors such as higher intravascular hydrostatic pressure and increased permeability of blood vessel walls. Also cited are oedema pathophysiology, generalised oedema related to kidney disease and hypoplastic aetiology of non-pitting oedema.