Search

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Context: The decline of birds in farmland is of global concern. Aims. The aim of this paper was to provide a local-scale case study of the bird fauna of temperate inland eastern Australia's sheep-wheat belt. Methods. Relationships between species occurrence and various habitat elements in the landscape were examined in a 342 km2 area of agricultural countryside near Wagga Wagga in southern inland New South Wales, Australia. The pre-agricultural bird fauna of this area was also investigated by collating records from previous studies of nearby larger woodland remnants. Key results: The study identified a bird fauna of 115 species compared to 160 species known from nearby woodland remnants. Significant relationships were found with the presence of farm dams, extent of local woodland cover and roadside woodland at the levels of individual species, guilds and total fauna. A small ephemeral wetland also contributed substantially to waterbird diversity. Conclusion. Twenty commonly recorded species typical of the farmland matrix and 15 species considered at particular risk of local extinction were identified. At the guild level, frugivore/granivores, small insectivores and hollow-users were found to be associated with remaining woodland elements in the agricultural landscape. Implications. Ecologically sustainable management of agricultural areas is essential to avoid further local extinctions. Hollow-using species are expected to be particularly affected by the anticipated widespread loss of trees in the landscape over the next century. [ABSTRACT FROM AUTHOR]

Context: Herbicide-resistant annual ryegrass (Lolium rigidum ; ARG) is a major weed of commercial significance globally, including no-till wheat-based production systems in south-eastern Australia. Aims: To compare the cost-effectiveness of different crop sequences and intensities of weed management to control ARG in rainfed grain production. Methods: Two on-farm studies in southern New South Wales, Australia, compared the effect of combinations of 3-year crop-sequence options (continuous wheat, 1- or 2-years of break crops), conservative or aggressive weed-control measures, hay cuts, legume brown manure (BM), and/or weed-free winter fallow on in-crop ARG infestations and soil seedbanks. Gross margins were calculated for each combination of treatments to compare system economic performance. Key results: Double-breaks consisting of two consecutive broadleaf crops, or canola–cereal hay, were frequently the most profitable and effective ARG control strategies. Single canola or lupin crops, BM, cereal hay, and fallow all significantly reduced subsequent in-crop ARG and seedbank numbers compared with continuous wheat. Aggressive in-crop control measures in wheat were more expensive than those applied to break crops. Gains in ARG control could be lost by a single year of poor weed control. Conclusions: High levels of control (>95%) over three consecutive seasons are required to reduce ARG seedbanks, and this is most cost-effectively achieved with diverse crop sequences. Implications: Farmers with high populations of ARG can reduce seedbanks by growing three crops sequentially that achieve complete weed seed control. This must be followed with ongoing high levels of control in subsequent years to keep ARG seedbanks low. The paper reports the outcomes of two on-farm experiments that aimed to identify the most cost-effective strategies to control herbicide-resistant annual ryegrass in rainfed, no-till, wheat-based farming systems in southern NSW. The studies linked efficacy of annual ryegrass control with the relative profitability of combinations of different crop sequences and agronomic management. The results showed that three consecutive years of >95% weed control by using diverse crops are required to cost-effectively reduce annual ryegrass seedbanks in soil to manageable levels. [ABSTRACT FROM AUTHOR]

Context: Opportunity exists to expand serradella (Ornithopus spp.) use onto heavier, duplex soil types in permanent pasture environments of south-eastern Australia. This requires cultivars with appropriate flowering times and flowering-date stability (i.e. flowering at the same date in spring regardless of timing of the autumn break). Aim: This work examined evidence of variation in flowering date and flowering-date stability in the NSW southern tablelands for a widely-used French serradella (O. sativus) cv. Margurita. Methods: Seed (sourced from a commercial supplier) was sown 21 March 2019 (Canberra, ACT) and 231 individual plants were monitored for time to first flower. A subset of plants exhibiting 'early' or 'late' flowering were identified and their seeds collected. In 2020, seed from ~15 plants from each selection was sown in Canberra in late March and early May to represent an 'early' and a 'later' break of season (n = 3). Key results: In the early-sown treatment, 'early-flowering' selections typically reached the median date of first flower (50%-flowering) from mid- to late August, while 'late-flowering' selections reached 50%-flowering early- to mid-September. When sown later, the 'early-flowering' selections began flowering from mid- to late September, while the 'late-flowering' selections flowered mid-September to early October. The 'early' selections exhibited greater flowering-date instability than 'late' selections and flowered particularly early when sown early. This indicated diversity within cv. Margurita for flowering-time control (e.g. vernalisation and/or photoperiod requirements). Implications: Evaluating cultivars of serradellas for flowering date and flowering date stability in their target environment(s) is essential to ensure cultivars are suitably adapted to these environments. Serradellas (Ornithopus spp.) are a novel legume option for the permanent pasture environments of south-eastern Australia. This paper investigated evidence of variation in flowering time characteristics within a widely used cultivar of French serradella. We recommend that new cultivars of serradellas be evaluated for flowering time characteristics in their target environment(s) to assess whether the cultivars are suitably adapted to these environments. This is essential to maximise production, feeding value and facilitate effective grazing management. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Lifestyle risk factors are antecedents to many chronic conditions and are largely modifiable. Health professional support is often sought to reduce lifestyle risk. The ongoing relationship general practice nurses typically have with patients situates them ideally to provide this support. This paper explores the barriers and facilitators to lifestyle risk communication by registered nurses (RNs) in Australian general practice. Fifteen general practice RNs from south-eastern Australia participated in semistructured interviews. Verbatim transcriptions of the audio-recorded interviews were analysed using thematic analysis. Six themes emerged in terms of perceived barriers and facilitators: educational preparation and confidence; organisational and funding arrangements; lifestyle risk prioritisation; organisational support; autonomous roles; and supporting patients' needs. Although communication about lifestyle risk factors is within the general practice nurses' scope of practice, concerted efforts fostering interdisciplinary collaboration, the prioritisation of time, funding and educational opportunities would better support this role, at the same time optimising chronic disease management and patient outcomes. General practice nurses undertake chronic disease management and discuss lifestyle risk reduction with patients. However, a concerted approach is required to support this practice. Prioritising time, funding, education, collaborative relationships and optimising the capacity for general practice nurses to work to their full scope of practice are necessary to support communication related to lifestyle risk reduction. [ABSTRACT FROM AUTHOR]

Injured flying-foxes (Pteropus spp.) are frequently taken into care in eastern Australia. In particular, the grey-headed flying-fox (P. poliocephalus), a vulnerable species, is affected by several threats, which are partly mitigated through rescue and rehabilitation. This study examined patterns in flying-fox rescues in New South Wales (NSW) between 2011–12 and 2016–17 using annual reporting data from wildlife rehabilitation organisations. Specifically, we examined (1) species and demographic patterns in flying-foxes rescues; (2) the geographical distribution of flying-fox rescues; (3) reported causes of injury; and (4) release rates of rehabilitated flying-foxes. P. poliocephalus accounted for the largest proportion of flying-fox rescues. Most rescues occurred in coastal regions, with more than one-third of P. poliocephalus rescues occurring in the Sydney region and more than one-third of black (P. alecto) and little red (P. scapulatus) flying-fox rescues occurring on the NSW Far North Coast. A broad range of factors was involved in flying-foxes coming into care, the main ones being entanglements, heat stress, orphaned pups and electrocutions. Release rates of rehabilitated flying-foxes were high, especially in pups and juveniles. These results demonstrate the potential conservation value of flying-fox rehabilitation. High proportions of injuries caused by entanglements, heat stress and electrocutions highlight the importance of ongoing threat mitigation efforts. This paper examines patterns in flying-fox rescues in New South Wales, Australia. The vulnerable grey-headed flying-fox (Pteropus poliocephalus) accounted for most rescues, which were mostly in coastal regions. Entanglements, heat stress, orphaned pups and electrocutions were dominant causes of flying-foxes coming into care. A high proportion of rehabilitated flying-foxes survived to release. [ABSTRACT FROM AUTHOR]

We aimed to elucidate nesting requirements and nest success of the threatened little eagle (Hieraaetus morphnoides). Nest sites (n = 12 active and 2–5 recent historical nests) near Armidale, New South Wales, were measured in 2017 at three scales: the nest tree, the nest woodland (≤25 m from the nest tree), and (using GIS) the landscape scale (within 200-m and 2-km radii of the nest). The eagles typically nested ≥14 m above ground in the canopy of emergent (>20 m tall) living eucalypts in sheltered positions (midslope, with a north-easterly to southerly aspect), in woodland patches >5 ha (mean 76 ha), <200 m (mean 78 m) from the woodland edge, though ≥11 m (mean 190 m) from an agricultural edge, ≥38 m (mean 485 m) from the nearest rural dwelling, >1 km from suburbia, and farther from sealed roads (mean 832 m) than gravel roads (mean 490 m) than minor tracks (mean 291 m). Breeding productivity in 2017–18 (n = 15 and 18 territories, respectively) was 0.91 young fledged per attempt (clutch laid) and 0.67 young fledged per occupied territory per year. Nest sites were used annually for at least 3–7 years. Nest abandonments or site shifts were associated with human disturbance (e.g. clearing, earthmoving, subdivision and construction in or beside the nest patch), death of the nest tree or nest stand ('eucalypt dieback' or rural tree decline), pindone baiting for rabbits (Oryctolagus cuniculus), and displacement by wedge-tailed eagles (Aquila audax) and ravens (Corvus sp.). As most little eagle nests were located on private land, we recommend, inter alia , greater protection of breeding habitat, nest sites and foraging habitat, woodland regeneration (especially riparian), and a buffer around established nests of ≥1 km from major developments such as urbanisation. Historically, information on the little eagle's breeding habitat, nest-site characteristics and response to human impacts in eastern Australia has been largely anecdotal. This paper identifies baseline requirements for little eagle nesting habitat and provides some suggestions for further conservation management of this vulnerable and declining species. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe rates of exposure to bullying and sexual harassment in junior doctors in first- or second-year prevocational medical training (PGY1 or PGY2 respectively) positions in New South Wales (NSW) and the Australian Capital Territory (ACT), and to explore the types of actions taken in response. Methods: A cross-sectional survey of junior doctors in PGY1 or PGY2 positions was undertaken in 2015 and 2016 (n = 374 and 440 respectively). Thematic analysis was undertaken on free-text responses to describe the reporting process and outcomes in more depth. Results: The estimated response rate was 17–20%. Results from both surveys followed almost identical trends. Most respondents in 2015 and 2016 reported being bullied (n = 203 (54.3%) and 253 (57.5%) respectively), 16–19% reported sexual harassment (n = 58 and 82 respectively) and 29% of females reported sexual harassment. Qualitative analysis elucidated reasons for not taking action in response to bullying and harassment, including workplace normalisation of these behaviours, fear of reprisal and lack of knowledge or confidence in the reporting process. For respondents who did take action, most reported ineffective or personally harmful outcomes when reporting to senior colleagues, including being dismissed or blamed, and an intention not to trust the process in the future. Conclusions: The findings suggest that interventions targeted at the level of junior doctors to improve the culture of bullying and harassment in medicine are unlikely to be helpful. Different approaches that address the problem in a more systemic way are needed, as is further research about the effectiveness of such interventions. What is known about the topic?: Bullying and sexual harassment are common workplace experiences in the medical profession. What does this paper add?: Over half the junior doctors in the present study experienced bullying and nearly one-fifth experienced sexual harassment. Junior doctors are reluctant to speak out, not only for fear of reprisal, but also because they do not believe it is worth doing so. What are the implications for practitioners?: The data confirm a systemic problem of bullying in NSW. Primarily focusing on interventions with junior doctors (e.g. resilience training) is unlikely to solve the problem. Different and multipronged approaches (e.g. raising awareness in senior colleagues and training bystanders to intervene) should be tried and studied. [ABSTRACT FROM AUTHOR]

Many montane avian communities are likely to be impacted negatively by future climate change. The ability to monitor these ecosystems effectively is therefore a priority. As species are expected to track their preferred climates by moving upwards in elevation, using indicator species of elevations has been suggested as a climate change monitoring strategy and has been explored for a variety of taxa in eastern Australia. Birds have great potential as vertebrate indicators due to their familiarity, detectability, and well known life histories. We used automated recording units (ARUs) and point counts to sample the avifauna along two elevational gradients in subtropical rainforest in north-eastern New South Wales, Australia. We used the indicator value protocol to identify avian indicators of elevation suitable for long-term monitoring. Pairs of species were more reliable than single species as indicators, and searching for indicators of elevational ranges (e.g. 300–500 m) proved more effective than looking for indicators of single elevations (e.g. 300 m). Point counts and ARUs were equally effective at determining indicators of elevations and ARUs performed particularly well in spring. We present avian indicator sets of lowland and highland sites, which provide a baseline for future monitoring of the effects of climate change on the region's avifauna. The methodology employed here is broadly suitable for similar studies elsewhere. We propose that the use of ARUs to identify indicator species of elevations is an effective strategy for monitoring the effects of climate change on montane avian communities worldwide. The birds of Australia's eastern rainforests are largely confined to mountain ranges, making them vulnerable to climate-change-driven changes in these ecosystems. We identify avian indicators of elevation that are suitable for the long-term monitoring of climate change effects. The approach described in this paper may lead to more efficient climate change monitoring, and help inform conservation programs. [ABSTRACT FROM AUTHOR]

Objectives: To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods: An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results: There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion: Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic?: There are nearly 11 million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850 million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add?: There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners?: Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear. [ABSTRACT FROM AUTHOR]

Little is known about the environmental and organisational determinants of workplace violence in correctional health settings. This paper describes the views of health professionals working in these settings on the factors influencing workplace violence risk. All employees of a large correctional health service in New South Wales, Australia, were invited to complete an online survey. The survey included an open-ended question seeking the views of participants about the factors influencing workplace violence in correctional health settings. Responses to this question were analysed using qualitative thematic analysis. Participants identified several factors that they felt reduced the risk of violence in their workplace, including: appropriate workplace health and safety policies and procedures; professionalism among health staff; the presence of prison guards and the quality of security provided; and physical barriers within clinics. Conversely, participants perceived workplace violence risk to be increased by: low health staff-to-patient and correctional officer-topatient ratios; high workloads; insufficient or underperforming security staff; and poor management of violence, especially horizontal violence. The views of these participants should inform efforts to prevent workplace violence among correctional health professionals. [ABSTRACT FROM AUTHOR]

The relationship between spirituality/religion and health is receiving increasing academic interest, but few studies have explored the experience of Australians. This paper presents data from an exploratory survey of patients and families in a public teaching hospital in Sydney. The findings show that the majority of hospital service users: • believe there are links between spirituality/religion and health; • believe that rituals and customs can help people when they are sick/suffering; • have valued practices associated with their beliefs; • feel it is helpful for health staff to know their patients' beliefs; • are willing to be asked about their beliefs; or • want hospital staff to respect and support the beliefs and practices of all patients. Spirituality and religion, and the beliefs and practices associated with them, were found to be eclectic, individualised and evolving in response to life events such as loss and health crises. This paper concludes that a person-centred framework of health practice includes attention to the religious/spiritual dimension of patients and their families. [ABSTRACT FROM AUTHOR]

In 2005, the Australian Productivity Commission made a recommendation that a national health registration regimen and a consolidated national accreditation regimen be established. On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) for health practitioners came into effect and the Australian Health Practitioner Regulation Agency (AHPRA) became the single national oversight agency for health professional regulation. It is governed by the Health Practitioner Regulation National Law Act (the National Law). While all states and territories joined NRAS for registration and accreditation, NSW did not join the scheme for the handling of complaints, but retained its existing coregulatory complaint-handling system. All other states and territories joined the national notification (complaints) scheme prescribed in the National Law. Because the introduction of NRAS brings with it new processes and governance around the management of complaints that apply to all regulated health professionals in all states and territories except NSW, where complaints management remains largely unchanged, there is a need for comparative analysis of these differing national and NSW approaches to the management of complaints/notifications about health professionals, not only to allow transparency for consumers, but also to assess consistency of decision making around complaints/notifications across jurisdictions. This paper describes the similarities and differences for complaints/notifications handling between the NRAS and NSW schemes and briefly discusses subsequent and potential changes in other jurisdictions. [ABSTRACT FROM AUTHOR]

The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context. What is known about the topic?  Caseload midwifery models of care have been established in a variety of community based and hospital settings throughout Australia with a reported reduction in clinical intervention rates while maintainning safety of mothers and babies. What does this paper add?  This case study illustrates the strategies used to achieve a large sustainable clinical service redesign project based on the introduction of the caseload midwifery model of care. What are the implications for practitioners?  Establishing midwifery group practice care within the mainstream maternity services has far reaching implications for the retention and recruitment of midwives and the improvement of clinical outcomes in childbirth. [ABSTRACT FROM AUTHOR]