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]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [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]

This qualitative descriptive study explored health consumers' preferences for receiving nutrition care in Australian primary care. The study was underpinned by a constructivist research paradigm. Semistructured telephone interviews were conducted with 25 health consumers (age 19–78 years; 19 female) from across Australia between May and August 2020. Content analysis, using an inductive approach revealed emergent themes. was used to reveal emergent themes. Five themes were identified in the data: (1) health consumers want to receive nutrition care from a qualified person; (2) nutrition care is viewed as important, and health consumers want to receive it in a format that meets their needs; (3) nutrition care should be low cost and available to everyone; (4) nutrition care services should be conveniently located; and (5) health consumers want nutrition care to be offered frequently, across their lifespan. Health consumers have a clear idea of how they would like to receive nutrition care in the primary care setting, but reported challenges to receiving this care within the current system. New models of service delivery are needed to meet the needs of health consumers. Diet-related chronic diseases are the leading cause of death and disability worldwide, and primary care provides an ideal setting to provide nutrition care to people at risk of chronic disease. This paper provides health consumer views on how the nutrition care model should be tailored to meet patient needs. The findings highlight the need for practice and healthcare system change to the current model of nutrition care in Australia to better meet the needs of patients. [ABSTRACT FROM AUTHOR]

Ground pearls (Hemiptera: Margarodidae), so called for their shiny spherical cyst stage, are important root-feeding pests of a broad range of plants predominantly belonging to the family Poaceae. In the tropical and subtropical regions of eastern Australia, ground pearl species cause significant damage on sugarcane and turf grasses and have been identified at multiple sites of pasture dieback in Queensland. The potential impact of ground pearls on pasture production in Australia and elsewhere is largely unknown. This paper reviews Australian and international literature on the biology and management of this poorly understood group of pests. Ground pearls have several features that make control difficult, including a resilient cyst which provides resistance to drought and excessive moisture, a relative impermeability to insecticides, and ease of dispersal through movement of soil. Ground pearls can also modulate the period of encystment to survive adverse environmental conditions, with some species capable of surviving for years while disassociated from a host. No insecticide effectively controls ground pearl cysts. Biological control agents have been identified for some species; however, these pathogens are relatively ineffective on subterranean ground pearl cysts. Cultural control methods such as cultivation and fallowing have helped to reduce ground pearl populations in sugarcane. In turf, practices that maintain plant health such as adequate irrigation and nutrition can mask signs of ground pearl infestation. The paucity of research conducted on the biology and impact of ground pearls represents a constraint to improving management of this pest. Ground pearls are important pests of a broad range of plants predominantly belonging to the grass family (Poaceae). In eastern Australia, they cause significant damage on sugarcane and turf grasses, and have recently been found in pasture situations in Queensland, but their impacts are unknown. This work reviews Australian and international literature on the biology and management of ground pearls, finding that relatively little research has been undertaken and several knowledge gaps remain. [ABSTRACT FROM AUTHOR]

Faced with scarce resources and a demand for health care that exceeds supply, health policy makers at all levels of government need to adopt some form of rationing when deciding which health services should be funded in the public health system. With a relatively small investment, programs such as Queensland Health's New Technology Funding Evaluation Program (NTFEP) fosters innovation by providing funding and pilot studies for new and innovative healthcare technologies. The NTFEP assists policy makers to make informed decisions regarding investments in new safe and effective technologies based on available evidence gathered from real-world settings relevant to Queensland patients and clinicians. In addition, the NTFEP allows appropriate patient access, especially in rural and remote locations, to potentially beneficial technologies and acts a gatekeeper, protecting them from technologies that may be detrimental or harmful. What is known about the topic?: Jurisdictions have struggled to identify ways to manage the introduction of new and innovative health technologies into clinical practice. The 2009 review of health technology in Australia recommended better assessment and appraisal by ensuring real-life practices in hospitals and community settings were considered, with a consumer and patient focus. What does this paper add?: Queensland Health's NTFEP provides a robust and transparent mechanism to manage the introduction of innovative healthcare technologies into clinical practice, providing an opportunity to collect real-world data outside of formal clinical trials. These data can not only be used to inform clinical, but also purchasing, decision-making within the public health system. This model of investment and innovation has the potential to be implemented in other jurisdictions and provide opportunities to share learnings. What are the implications for practitioners?: Programs such as the NTFEP provide reassurance to practitioners and patients alike that innovative healthcare technologies are adopted in public hospitals using an evidence-based approach after demonstrating that they are not only safe and clinically effective, but represent value for money and improved patient outcomes in a public health system. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient-practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism. [ABSTRACT FROM AUTHOR]

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants. [ABSTRACT FROM AUTHOR]

For the past fifty years, Sandringham Station has provided a major focus for scientific work in southwestern Queensland, an arid region that includes the Simpson Desert and the Channel Country (together 'Desert Channels'). This paper explores the role of place, chance and private enterprise in supporting science in this region. Unlike other parts of inland Australia, where government initiatives were prominent, science in Queensland's arid country was privately supported, and research there had an ecological or eco-physiological rather than an economic focus. It began later than elsewhere (1960s), and its scientific questions were different from those framed in research stations set up to address agricultural and pastoral imperatives. The location of Sandringham on the ecological edge between the ephemeral wetlands of the anastomosing channels and the dune country of the Simpson Desert created an ecotonal area that was rich in animals adapted to living in Australian desert country, and a particular opportunity to observe their adaptations to the boom-and-bust ecological conditions. The role of local observers, particularly station managers and naturalists, has been critical in studying the often cryptic animals of the region, and the ongoing support of the station itself was essential to investigations that were mostly on private leasehold lands. [ABSTRACT FROM AUTHOR]

The health status of Aboriginal and Torres Strait Islander peoples continues to be significantly poorer than Australia's general population. Clearly there is a need for change, hence the renewed interest in transitioning to a community control model for health services as a health intervention. Yet this requires a significant change management process, which is a process developed using Western business philosophies, and may not be applicable for community-controlled services that need to operate within the Aboriginal cultural domain. This paper examines the literature on organisational change management processes, and features of Aboriginal community-controlled health organisations and Aboriginal management styles. It identifies challenges and synergies that can be used to inform more effective transition processes to a community-control model for health services. The findings also highlight the need for a fundamental systems change approach to achieve such major reform agendas through the creation of a "collective responsibility" to achieve the vision for change, utilising participatory change management processes both internally and externally. [ABSTRACT FROM AUTHOR]