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Scott Sloan (1954–2019) was a leader of academic engineering in Australia and beyond, as evidenced by his numerous professional accolades and important research achievements, which have had significant impact on his chosen profession of geotechnical engineering. Educated in Australia and the United Kingdom, he returned to Australia in 1984 and developed a large and active research group at the University of Newcastle, and tackled a wide range of important problems in civil and mining engineering. These include the development of computational methods to predict the mechanical behaviour of soil and rock masses, and his pioneering methods to predict the collapse states of structures made of, on, and in, earth materials, allowing engineers to design cheaper and safer civil infrastructure around the globe. Sloan established long-standing international collaborations and was awarded many honours for his research achievements. He was also a keen and skilful fisherman and a more than competent blues guitar player. Scott William Sloan, AO, FAA, FTSE, FREng, FRS, was a distinguished Australian geotechnical engineer, who pioneered many advances in computational methods that are now used routinely to design structures constructed in and of earth materials. This paper describes his career development and his numerous research achievements, as well as his role in mentoring other engineers. [ABSTRACT FROM AUTHOR]

The global burden of chronic disease has forced health systems to focus on improved care. This has led to improved health outcomes for some populations, but not for all people or for all conditions. The rising prevalence of chronic disease has also significantly increased demands on healthcare systems, with unsustainable costs to funders. To improve health and social outcomes for all people with chronic disease, it is critical to embrace allied health professionals as key members of primary healthcare teams. The recognised efficacy and cost-effectiveness of many allied health interventions suggest that implementation into usual care would result in enhanced outcomes for people accessing healthcare, their families and communities, and for health systems. Our aim is to highlight the current unacceptable lack of allied health integration into primary healthcare teams, and illustrate the potential value of improved and equitable access to allied health professionals for managing chronic conditions and multimorbidity. Recent policy initiatives in Australia have increased the involvement of allied health in the management of people with chronic conditions in primary care. Although this is positive, there is an opportunity for allied health to make a greater contribution. This paper highlights the gaps in the integration of allied health into primary healthcare teams, and provides some discussion as to how this could be improved to reduce the burden of chronic conditions on the healthcare system. [ABSTRACT FROM AUTHOR]

Perennial pastures are the dominant feedbase in many regions of the world, and offer several advantages when compared with an annual pasture system. In Western Australia (WA) there has been a concerted effort over seven decades to develop new perennial pasture options and expand the adoption of suitable species. The agricultural region of WA (i.e. south-western Australia) is characterised by a Mediterranean climate where the 5–7 month summer drought has proved a considerable challenge with only a small number of the many promising species being adopted commercially. Research, development, and extension have covered a wide range of herbaceous perennial legumes, leguminous and native shrubs, herbs, and temperate and warm season grasses. This paper reviews the literature to determine whether a perennial pasture must satisfy the following criteria to be successful and widely adopted in south-western Australia: (i) sourced from a similar Mediterranean environment and adapted to the target soils; (ii) have a relative advantage over the annual-based system it replaces; (iii) a robust management package; and (iv) a viable seed supply. The findings of this review highlight that perennial pastures must indeed satisfy multiple criteria to be commercially successful. Notably, the requirement for the source of the germplasm to have a good match between climate and soils is less clear because some of the commercially successful species come from diverse environments. We conclude with some key learnings for future perennial pasture development as climate change intensifies the research challenge and the drive for producers to adapt. In Western Australia, there has been a concerted effort to develop new perennial pasture options. Research, development, and extension have covered a range of herbaceous perennial legumes, leguminous and native shrubs, herbs and temperate and warm season grasses. Overall, this search has proved to be a considerable challenge in a Mediterranean environment with many promising species having little or no commercial impact, and only a small number of species have had widespread commercial adoption. This review explores the key requirements for perennial species to become more than a niche pasture in a Mediterranean climate. [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]

This case study describes the implementation of a ward-based respiratory care unit to improve access to specialised respiratory failure management at an Australian metropolitan health service. Using a case study approach, we describe the conception, development and implementation of a respiratory care unit within a previously inexperienced ward. Key barriers and facilitators are explored and the importance of a safety culture and an aspiration for continuous quality improvement are detailed. Three key aspects of implementation were identified: physical environment, expertise and governance. Continuous review of clinical and quality data was also considered critical to success. Stakeholder engagement was identified as both a barrier and facilitator to successful implementation. Early success was demonstrated through increased utilisation of respiratory interventions but with less utilisation of the intensive care unit and no apparent deterioration in clinical outcomes. Successful implementation of ward-based management of respiratory failure can be undertaken within non-tertiary settings but requires a comprehensive plan. Essential aspects include the support of clinical champions, early and continuous stakeholder engagement and an aspirational culture of safety and continuous quality improvement. What is known about the topic?: Non-invasive ventilation and high-flow oxygen therapy are now established as key treatments in the management of acute respiratory failure. Access to these treatments is often limited to critical care locations (emergency department, intensive care unit (ICU) and operating theatre), but ward-based use can be safe and effective when applied with appropriate clinical policies, expertise and staffing. What does this paper add?: This report describes the successful and rapid development of a specialised respiratory care unit within an inexperienced ward at an Australian metropolitan health service. Prior to development of the unit, the health service only provided non-invasive ventilation and high-flow oxygen therapy within critical care locations. Successful implementation was associated with increased utilisation of these therapies with significantly less ICU utilisation and no apparent deterioration in outcomes. What are the implications for practitioners?: An explanation of a model for implementation is provided that may help health services improve access to complex respiratory failure management outside of critical care locations. Key factors in the success of the model are identified and examined. [ABSTRACT FROM AUTHOR]

Objective: Although there is some research on women's choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia. Methods: This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman's choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson's Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes. Results: Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman's decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care. Conclusion: This study provides insights into the factors influencing a woman's complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one's doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector. What is already known?: The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal. What does this paper add?: This study provides insight into how PHI status and other factors influence a woman's decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system. What are the implications for practitioners?: This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector. [ABSTRACT FROM AUTHOR]

Objective: Health assessments (HAs) are available annually for community-dwelling older people: the 75+HA for non-Indigenous Australians aged ≥75 years and the 55+IHA for Indigenous Australians aged ≥55 years. Medicare requires general practitioners (GPs) to cover the items within the relevant HA form. This study explored the views of experienced GPs and practice nurses (PNs) towards the older-person HA forms. Methods: Thirty-nine experienced GPs and PNs responded to an online questionnaire. Results: In this study, experienced GPs and PNs suggested that current items within the 75+HA Medicare-provided guideline form need reviewing, such as those relating to psychological function, medication and exercise and falls. There were also recommendations to consider including items consistently across both the 55+IHA and 75+HA and to include new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases, whether other screening is up to date and future planning. Many parts of the HA were deemed irrelevant or condescending to 'well' older Australians, so should be optional. Healthcare professionals also requested reintroducing conducting the HA at the community-dwelling patient's home. User-friendly integrated forms would improve healthcare professionals' time management and provide better communication with patients and carers, and create greater opportunities for multidisciplinary referral processes, as well as provide linkages to MyAgedCare and myHealthRecord. Conclusion: Capturing the views of healthcare professionals towards older-person HA forms generated suggested improvements. The adoption of these suggestions would elicit more holistic health information for older Australians. What is known about the topic?: Annual HAs are available for older Australians (75+HAs and 55+IHAs). Medicare requires GPs cover items within their prescribed HA form. The 75+HAs and 55+IHAs allow for the monitoring of health problems specific to community-dwelling older people, which may be difficult to address in the time frames of a standard GP consultation; however, there is very little research on the experiences of health professionals regarding the conditions required to be assessed within the HAs. What does this paper add?: This study examined the views of experienced GPs and PNs to identify potential changes to the current procedures. Capturing the views of healthcare professionals towards older-person HA forms generated important suggested improvements, such as reviewing psychological function, medication, exercise and falls items. There were recommendations to include items across both the 55+IHA and 75+HA and new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases assessments, future planning and whether the patient's screening is up to date. What are the implications for practitioners?: The experienced GPs and PNs in this study suggested significant additions and revisions to the current HA forms. The incorporation of these suggestions should lead to permanent modifications of the current forms to make them more relevant and appropriate for older Australians, but the challenge for implementation is how these additional items would be funded. [ABSTRACT FROM AUTHOR]

Objective: In 2018 the Australian Commission on Quality and Safety in Health Care released a new consumer driven Australian Hospital Patient Experience Question set. The objective was to explore the acceptability, adoption, appropriateness, feasibility, fidelity, penetration, resources and sustainability of implementing the AHPEQS, and to review which questions correlated with overall rating of care. Methods: Thirty-six Australian private hospitals participated in the AHPEQS implementation over an 18-month period. Results: Responses were analysed for 86 180 patient experience surveys. Positive patient experiences (Question 12) correlated most highly with Question 2 (My individual needs were met; correlation coefficient (CC) 0.45, P < 0.001), Question 4 (I felt cared for; CC 0.45, P < 0.001) and Question 9 (When I was in the hospital, I felt confident in the safety of my treatment and care; CC 0.44, P < 0.001). Day procedure patients rated their experience higher than overnight patients. Uptake was rapid across the 36 hospitals, with minimal resources and demonstrable acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability. Conclusion: Utilising a consumer-driven survey highlighting treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. What is known about the topic?: Patient experience in hospital is associated with healthcare quality, safety and outcomes. What does this paper add?: From a consumer perspective, feeling cared for, having needs met and confidence in the safety of care, correlated with a positive patient experience. What are the implications for practitioners?: Investing staff time and health service resources into a consumer-driven patient experience survey tool, which highlighted treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. [ABSTRACT FROM AUTHOR]

Objective: To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods: In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results: Most patients (n = 1430, 84%) were aged ≥60 years, with a low percentage (n = 208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n = 1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4–48 h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48 h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n = 621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n = 1047) experienced active intervention in their final 48 h. Conclusions: Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic?: The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high - quality end - of - life care. What does this paper add?: The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48 h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners?: Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care. [ABSTRACT FROM AUTHOR]

The Royal Commission's recommendation for nursing home minimum time standards and the Australian Government's response do not support best practice resident care. We recommend that higher mandated minimum staffing levels and skills mix should be phased in by mid-2026. What is known about the topic?: The Australian Government has not committed to fully implementing the Commission's recommendations for mandated minimum staff time standards. What does this paper add?: We highlight issues with the Commission's recommendations and the Australian Government's response where they do not support sufficient minimum time to provide best practice care. What are the implications for practitioners?: Mandated evidence-based minimum staffing levels and skills mix should be phased in by mid-2026 to support best practice care. [ABSTRACT FROM AUTHOR]

The symposium 'Recent Advances in Animal Nutrition – Australia' (RA) was instigated at the University of New England (UNE) in the early 1970s. In the 1950s and 1960s, under the visionary leadership of Professor G. L. (Bill) McClymont, a talented group of young biochemists and nutritionists was recruited to become the Department of Biochemistry and Nutrition at UNE and quickly developed a strong reputation for nutritional research on ruminant and monogastric animals. Its members were keen to share their findings with relevant industry representatives and to learn about the major industry challenges. The idea for RA emerged ~1970 when Drs Robin Cumming and David Farrell saw the opportunity for regular RA schools, bringing invited experts from Australia or overseas to interact with UNE staff, post-graduate students and representatives of the monogastric and ruminant livestock industries. The first RA school was probably held in 1974. Aided by flexible working arrangements at UNE, David Farrell was able to champion further RA meetings that were held successfully about every 2 years. However, ~1990, the federal Education Minister John Dawkins began a process of amalgamating Australian higher-education institutions that produced detrimental administrative and financial ramifications for UNE and drained staff morale. After the 1993 meeting, Professor David Farrell left UNE, followed soon afterwards by Professor Ron Leng. The future of RA was at a crossroads; its funding and organisation needed overhauling to enable it to survive. A second, more formal phase of RA meetings (13 in all; 1995–2021), was instigated within a newly formed Department of Animal Science at UNE. The meetings became more formalised and even more financially dependent on industry support and sponsorship; meetings were planned by larger organising committees. Soon, papers were being formally refereed and the scope for provocative speculation of the type promoted at earlier meetings was somewhat curtailed in favour of scientific rigour. Organisers experimented with changed meeting dates, formats and venues at UNE, cumulating with a contentious decision to hold this meeting away from UNE. Despite its challenges, RA has grown in stature over 47 years from the small, informal schools of the early 1970s, to become Australia's leading animal nutrition symposium. 'Recent Advances in Animal Nutrition – Australia' has grown in stature over half a century to become Australia's leading nutrition symposium. This history describes how the first 'nutrition school' was conceived at the University of New England, Armidale (UNE), in the early 1970s, and covers the 25 biennial meetings held at UNE; it pays homage to the many organisers, invited speakers and attendees who have focussed on finding innovative solutions to industry-relevant problems, thereby ensuring the symposium's long-term success. [ABSTRACT FROM AUTHOR]

Context: Dual-purpose wheat (Triticum aestivum L.) and canola (Brassica napus L.) crops have been extensively researched for grazing in Australian farming systems, with a focus on grazing by sheep. In some regions, dual-purpose crops have been grazed by cattle, but there have been reports of animal health problems. Aims: This paper sought to collate all known experiments conducted throughout Australia of cattle grazing dual-purpose crops, in order to evaluate grazing management options for cattle on dual-purpose crops that result in high growth rates and good animal health outcomes. Methods: There were six experiments. In Expts 1–3, cattle were grazed on wheat crops with and without available mineral supplementation of NaCl and MgO in a 1:1 ratio. In Expt 3, lime was also added to the mineral mix. In Expts 4 and 5, dual-purpose crops were grazed in combination with annual pastures to determine whether strategic use of dual-purpose crops could increase whole farm livestock productivity. In Expt 6, cattle were introduced to dual-purpose canola with different periods of adaptation (0, 4 and 7 days). Liveweight gain was monitored regularly to assess differences between adaptation treatments. Key results: Liveweight gain was increased by 0–27% when cattle grazing high quality, dual-purpose wheat were provided with mineral supplement. Cattle had an initial lag in growth rate when introduced to dual-purpose canola for grazing and this was not affected by the adaptation strategy used. Cattle that experienced a shorter adaptation period achieved higher weight gains more quickly. After the lag phase, average daily gain (ADG) was ≥2 kg/head.day, with an ADG over the entire grazing period for all treatments of 1.75 kg/head.day. The effect on the farm system was determined by extending the length of the grazing period on the dual-purpose crops. Grazing periods of shorter duration did not increase overall liveweight gains compared with grazing only pasture, whereas extending the period of dual-purpose crop grazing resulted in increased cattle weights. Conclusions: Cattle benefit from the addition of mineral supplements when grazing a dual-purpose wheat crop, with a response similar to that previously demonstrated in sheep. Cattle can safely graze dual-purpose canola and achieve high ADG. Inclusion of dual-purpose crops can improve overall cattle performance in the farming system. Implications: The potential area for production of dual-purpose crops within the Australian mixed farming zone is large and there may be insufficient livestock numbers within the zone to utilise the potential forage production. Cattle from other regions could be introduced during autumn and winter to realise this large forage potential during a period that is commonly a feed deficit on grazing-only properties. Estimates suggest that up to two million young cattle could be supported for 60 days, increasing liveweight by 90 kg/head. Beef cattle grazing dual-purpose crops on mixed farms can achieve high liveweight gains during periods of pasture deficit. Use of dual-purpose crops for beef production offers significant opportunity for the southern Australian beef industry. Growth rates of young cattle can be improved by appropriate mineral supplementation and livestock management. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic. Methods: An anonymous online cross-sectional survey was conducted in a large metropolitan tertiary health service located in Melbourne, Australia. The survey was completed by nurses, midwives, doctors and allied health (AH) staff between 15 May and 10 June 2020. The Depression, Anxiety and Stress Scale – 21 items (DASS-21) assessed the psychological well-being of respondents in the previous week. Results: In all, 668 people responded to the survey (nurses/midwives, n = 391; doctors, n = 138; AH staff, n = 139). Of these, 108 (16.2%) had direct contact with people with a COVID-19 diagnosis. Approximately one-quarter of respondents reported symptoms of psychological distress. Between 11% (AH staff) and 29% (nurses/midwives) had anxiety scores in the mild to extremely severe ranges. Nurses and midwives had significantly higher anxiety scores than doctors (P < 0.001) and AH staff (P < 0.001). Direct contact with people with a COVID-19 diagnosis (P < 0.001) and being a nurse or midwife (P < 0.001) were associated with higher anxiety scores. Higher ratings of the health service's pandemic response and staff support strategies were protective against depression (P < 0.001), anxiety (P < 0.05) and stress (P < 0.001). Conclusions: The COVID-19 pandemic had a significant effect on the psychological well-being of hospital clinical staff, particularly nurses and midwives. Staff would benefit from (additional) targeted supportive interventions during the current and future outbreaks of infectious diseases. What is known about the topic?: The outbreak of COVID-19 is having, and will have, a considerable effect on health services. No Australian data about the effect of COVID-19 on the psychological well-being of hospital clinical staff are available. What does this paper add?: Australia healthcare providers have experienced considerable emotional distress during the COVID-19 pandemic, particularly nurses and midwives and clinical staff who have had direct contact with people with a COVID-19 diagnosis. In this study, nurses and midwives had significantly higher levels of anxiety, depression and stress during the pandemic than general Australian adult population norms, and significantly more severe anxiety symptoms than medical and AH staff. Despite a lower number of COVID-19 cases and a lower death rate than in other countries, the proportion of Australian hospital clinical staff experiencing distress is similar to that found in other countries. What are the implications for practitioners?: Targeted well-being interventions are required to support hospital clinical staff during the current and future outbreaks of infectious diseases and other 'crises' or adverse events. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to review the demographic details of those who have undergone lower limb amputation (LLA) surgery in Central Australia and determine the region-specific age-adjusted incidence rate of LLA. Methods: A retrospective audit of service users who underwent LLA in a Central Australian hospital from 2012 to 2017 was undertaken. Demographic, operative and postoperative outcomes data were collected. The age-adjusted incidence rate of LLA was determined using the direct method. Demographic data were analysed using descriptive parametric analysis. Results: In the period 2012–17, 166 service users underwent a total of 291 amputations in 231 episodes of care (hospital admissions). The age-adjusted incidence rate of LLA was 87.4 per 100 000 for females and 104.6 per 100 000 for males in this region. In total, 84% (n = 140) of those requiring amputation surgery identified as Aboriginal Australians (P < 0.001), 54% (n = 75) of whom were female. Aboriginal Australians who underwent LLA were, on average, 13 years younger and were more likely to have type 2 diabetes (P < 0.001) and require renal dialysis (P < 0.001) than the non-Aboriginal Australian cohort. Of the Aboriginal Australians who underwent LLA, 82% (n = 103) lived very remotely (>100 km from the central town's centre), compared with 23% of non-Aboriginal Australians (P < 0.001). In addition, 46% (n = 64) of Aboriginal Australians who underwent LLA required renal dialysis. Those requiring renal dialysis were more likely to require subsequent amputation (P = 0.014) and had a higher mortality rate following amputation (P = 0.031). Partial foot amputation was the most common level of amputation in Central Australia (38%). Conclusions: Central Australia appears to have the highest incidence rate of LLA for any region in Australia, with Aboriginal Australians, particularly females and those undergoing renal dialysis, being disproportionately represented. Further studies should aim to determine targeted, culturally safe and successful methods of diabetic foot ulcer prevention, early detection and management with a view to reducing the high amputation rates for these cohorts. What is known about the topic?: Large health inequalities between Aboriginal and non-Aboriginal Australians exist. Aboriginal Australians are currently fourfold as likely as non-Aboriginal Australians to have type 2 diabetes (T2D), increasing their risk of LLA. There is a geographical variance in the incidence of LLA in Australia; the Northern Territory is overrepresented, with rates two- to threefold higher than that of the national average. Regional incidence rates are not currently known. What does this paper add?: This study showed that the age-adjusted incidence rate for LLA in Central Australia is significantly higher than in other regions in Australia. Most LLA surgeries undertaken in Central Australia were performed for Aboriginal Australians who have T2D, with a disproportionate representation of females and those requiring renal dialysis. What are the implications for practitioners?: This study shows that there is a need for further research and preventative measures to address the high rates of LLA among Aboriginal Australians, particularly for females and those with renal impairment. These groups could benefit from targeted, culturally safe approaches to early identification, referral and management of lower limb ulceration by relevant service providers. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

There is a growing population of people from refugee backgrounds settling in Australia. They have often been forced to flee from their homes in violent circumstances and may have spent many years in refugee camps with poor health support. There are multiple barriers to their effective access to health services. Community engagement with this community can be tokenistic and difficult to effect. This paper highlights the importance of developing a meaningful strategy for community engagement that is not 'one-size-fits-all', which is achieved over time. There is a rich resource available to health practitioners if engagement with refugee-background communities is managed according to the set of trauma-informed and structural principles outlined in this paper. [ABSTRACT FROM AUTHOR]

Objective: In response to escalating alcohol and other drug (AOD)-related emergency department (ED) presentations, a tertiary Melbourne hospital embedded experienced AOD clinical nurse consultants in the ED on weekends to trial a model for screening, assessment and brief intervention (BI). The aim of the present study was to evaluate the relative contributions of AOD to ED presentations and to pilot a BI model. Methods: Using a customised AOD screening tool and a framework for proactive case finding, screened participants were offered a comprehensive AOD assessment and BI in the ED. Immediate effects of the intervention were evaluated via the engagement of eligible individuals and a self-administered 'intention to change' survey. Results: Over the 32-month pilot, 1100 patients completed a comprehensive AOD assessment, and 95% of these patients received a BI. The most commonly misused substances were, in order, alcohol, tobacco, amphetamine-type stimulants, gamma-hydroxybutyrate and cannabis. Thirty-two per cent of patients were found to be at risk of dependence from alcohol and 25% were found to be at risk of dependence from other substances. Forty per cent of the people assessed reported no previous AOD support or intervention. On leaving the ED, 78% of participants reported an intention to contact community support services and 65% stated they would change the way they used AOD in the future. Conclusion: This study of a pilot program quantifies the relative contribution of AOD to ED presentations and demonstrates that hospital EDs can implement a feasible, proactive BI model with high participation rates for people presenting with AOD-related health consequences. What is known about the topic?: Clinician-led BI for high-risk consumption of alcohol has been demonstrated to be effective in primary care and ED settings. However, hospital EDs are increasingly receiving people with high-risk AOD-related harms. The relative contribution of other drugs in relation to ED presentations has not been widely documented. In addition, the optimal model and effects of AOD screening and BI programs in the Australian ED setting are unknown. What does this paper add?: This paper describes a 'real-life' pilot project embedding AOD-specific staff in a metropolitan Melbourne ED at peak times to screen and provide BI to patients presenting with AOD-related risk and/or harms. The study quantifies the relative contribution of other drugs in addition to alcohol to ED presentations and reports on this model's much higher levels of patient engagement in receiving BI than has been reported previously. What are the implications for practitioners?: This study demonstrates the relative contribution of drugs, in addition to alcohol, to ED presentations at peak weekend times. Although BI has been well proven, the pilot project evaluated herein has demonstrated that by embedding AOD-specific staff in the ED, much higher rates of patient engagement, screening and BI can be achieved. [ABSTRACT FROM AUTHOR]

Objective: This paper examines the implementation and implications of four development and research initiatives, collectively titled the Curriculum Renewal Studies program (CRS), occurring over a 6-year period ending in 2015 and focusing on interprofessional education (IPE) within Australian pre-registration health professional education. Methods: The CRS was developed as an action-focused and participatory program of studies. This research and development program used a mixed-methods approach. Structured survey, interviews and extensive documentary analyses were supplemented by semi-structured interviews, focus groups, large group consultations and consensus building methods. Narrative accounts of participants' experiences and an approach to the future development of Australian IPE were developed. Results: Detailed accounts of existing Australian IPE curricula and educational activity were developed. These accounts were published and used in several settings to support curriculum and national workforce development. Reflective activities engaging with the findings facilitated the development of a national approach to the future development of Australian IPE – a national approach focused on coordinated and collective governance and development. Conclusion: This paper outlines the design of an innovative approach to national IPE governance and development. It explores how ideas drawn from sociocultural theories were used to guide the choice of methods and to enrich data analysis. Finally, the paper reflects on the implications of CRS findings for health professional education, workforce development and the future of Australian IPE. What is known about the topic?: IPE to enable the achievement of interprofessional and collaborative practice capabilities is widely accepted and promoted. However, many problems exist in embedding and sustaining IPE as a system-wide element of health professional education. How these implementation problems can be successfully addressed is a health service and education development priority. What does this paper add?: The paper presents a summary of how Australian IPE was conceptualised, developed and delivered across 26 universities during the period of the four CRS studies. It points to strengths and limitations of existing IPE. An innovative approach to the future development of Australian IPE is presented. The importance of sociocultural factors in the development of practitioner identity and practice development is identified. What are the implications for practitioners?: The findings of the CRS program present a challenging view of current Australian IPE activity and what will be required to meet industry and health workforce expectations related to the development of an Australian interprofessional- and collaborative-practice-capable workforce. Although the directions identified pose considerable challenges for the higher education and health sectors, they also provide a consensus-based approach to the future development of Australian IPE. As such they can be used as a blueprint for national development. [ABSTRACT FROM AUTHOR]

Objective: Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods: PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results: Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n = 25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n = 55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n = 64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion: The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic?: Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add?: This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners?: Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify the number, costs and reported injury mechanisms of serious injury claims for allied health professionals. Methods: Using Australian Workers' Compensation injury data, the number, mechanism, and costs of injury claims were calculated for eight groups of allied health professions (chiropractors and osteopaths, speech pathologists and audiologists, occupational therapists, physiotherapists, psychologists, podiatrists, social workers and prosthetists/orthotists) between the 2000–01 and 2013–14 financial years. Workforce injury rates were calculated using the 2011 Australian Census Workforce data (denominator) and 2011 Workers' Compensation Statistics claims data (numerator). Results: Across the allied health professions, 7023 serious injuries (minimum 5 days absence from work) were recorded with an associated total compensation cost of A$201 970 000. Fewer than 1.5% of each allied health professional group had an injury claim, with the exception of prosthetists/orthotists who had a rate of 25.9% serious injury claims (95% confidence interval 21.9–30.4). The average cost per claim varied across the allied health professions, from the lowest cost of A$19 091 per injury for occupational therapists to the highest of A$48 466 per claim in chiropractic and osteopathy. Body stressing followed by mental stress were the most common mechanisms of injury. Conclusions: Mechanism of injury, both physical and psychosocial, were identified. Prosthetists/orthotists are at the highest risk of workplace injury of all allied health professions. This suggests the need for further investigation and development of appropriately targeted injury prevention programs for each allied health profession. What is known about this topic?: Retention of allied health professionals is a significant issue, with workplace injuries identified as one contributing factor to this problem. Healthcare workers are potentially at high risk of injury as they are exposed to a range of physical and psychosocial hazards in their workplace. What does this paper add?: This paper is the first to report on serious injuries, minimum 5 days absence from work, from Australian Workers' Compensation data, across a range of allied health professions. Various allied health professions were examined to identify the number, mechanism and cost of serious workplace injuries finding there is an average of 500 serious claims per year at a cost of A$14 million. Prosthetists/orthotists were identified as having the highest proportion of claims per workforce population. What are the implications for practitioners?: These results suggest highly varied injury rates across allied health professions. Compensation data does not enable accurate identification of causal factors. Further work is required to identify relevant causal factors so that targeted risk reduction strategies can be developed to reduce workforce injuries. [ABSTRACT FROM AUTHOR]

Accreditation to demonstrate engagement with the National Safety and Quality Health Service Standards (Standards) is compulsory for most hospital and healthcare settings, but to date remains voluntary for private dental practices (PDPs). The regulatory framework governing the dental profession lacks a proactive element to drive improvements in quality and safety of care, and an accreditation scheme can strengthen existing regulation. The current model of accreditation operating in accordance with the Australian Health Service Safety and Quality Accreditation Scheme (Scheme) is based on the Standards, which were written for a hospital model of healthcare service. The majority of PDPs are small office-based businesses with clear leadership structure and employing six staff or fewer. The Scheme is overly bureaucratic given the simplicity of the PDP business model. This article considers whether accreditation has a proven track record of improving quality of service and offers opinions about how a more appropriate safety management program for PDPs may look. What is known about the topic?: There has been minimal research about the impact of accreditation schemes in improving patient safety in PDP. What does this paper add?: This paper proposes a redesign of the Scheme to make it more relevant to PDPs. The paper offers strategies to minimise duplication of purpose between accreditation and existing legislation; and to strengthen critical elements of accreditation to improve effects on patient safety. What are the implications for practitioners?: A redesigned accreditation scheme will support dental practitioners to implement a quality assurance system with improved efficiency, reduced administrative burden, and optimised patient safety. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to estimate the potential savings to the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) in 2015–16 if biosimilar versions of selected biologic medicines (biologics) had been available and listed on the PBS. Methods: The research involved retrospective analysis of Australian Medicare expenditure data and PBS price data from 2015–16 for biologics, for which biosimilar competition may be available in future, listed on the PBS. Results: Australian Government expenditure on biologics on the PBS and RPBS was estimated at A$2.29 billion dollars in 2015–16. If biosimilar versions of these medicines had been listed on the PBS in 2015–16, at least A$367 million dollars would have been saved in PBS and RPBS subsidies. Modelling based on price decreases following listing of biosimilars on the PBS suggests that annual PBS outlays on biologics could be reduced by as much as 24% through the timely introduction of biosimilars. Conclusions: Biologic medicines represent a large proportion of government expenditure on pharmaceuticals. Reducing the length of monopoly protections on these medicines could generate savings of hundreds of millions of dollars per year. What is known about the topic?: Biologics take up an increasing share of pharmaceutical expenditure, but no previous published studies have examined Australian Government expenditure on biologics or the potential savings from reducing the duration of monopoly protection. What does this paper add?: This paper provides new evidence about Australian Government expenditure on biologics and potential savings for selected medicines that are still subject to monopoly protection and thus are not yet subject to biosimilar competition. In 2015–16 Australian Government expenditure on biologics through the PBS and RPBS was estimated at A$2.29 billion dollars. If biosimilar versions of these medicines had been listed on the PBS at that time, at least A$367 million dollars would have been saved. What are the implications for practitioners?: Reducing the duration of monopoly protection on biologic medicines could save hundreds of millions of dollars annually that could be redirected to other areas of the healthcare system. [ABSTRACT FROM AUTHOR]

The Voluntary Assisted Dying Act 2017 (Vic) will come into force in June 2019, becoming the first law in Australia in 20 years to permit voluntary assisted dying (VAD). This paper considers how other Australian states and territories are likely to respond to this development. It analyses three key factors that suggest that law reform is likely to occur in other parts of Australia: (1) the growing international trend to permit VAD; (2) social science evidence about how VAD regimes operate; and (3) changes to the local political environment. The paper argues that these three factors, coupled with the effect of Victoria changing its law, suggest that other VAD law reform is likely to occur in Australia. It also considers the different types of laws that may be adopted, including whether other states and territories will follow the very conservative Victorian approach or adopt more liberal models. What is known about the topic?: Despite sustained law reform efforts in parliaments across the country, Victoria is the first Australian jurisdiction to pass a law permitting VAD in 20 years. What does this paper add?: This paper addresses likely future trends in VAD law reform in Australia. Drawing on international developments, a growing body of social science evidence about how VAD regimes work in practice, and evidence about a changing local political environment, the paper argues that other states and territories in Australia will also enact laws about VAD. What are the implications for practitioners?: The legalisation of VAD has significant implications for health professionals, health administrators and health systems. Understanding how reform may occur and what legal models may be considered supports participation in the law reform process and preparation for likely change. [ABSTRACT FROM AUTHOR]

Many countries across the world have legislated for their constituents to have control over their death. Commonalities and differences can be found in the regulations surrounding the shape and practices of voluntary assisted dying (VAD) and euthanasia, including an individual's eligibility and access, role of health professions and the reporting. In Australia there have been perennial debates across the country to attempt legislative change in assisting a terminally ill person to control the ending of their life. In 2017, Victoria became the first state to successfully legislate for VAD. In describing the Victorian process that led to the passage of legislation for VAD, this paper examines the social change process. The particular focus of the paper is on the vital role played by a multidisciplinary ministerial advisory panel to develop recommendations for the successful legislation, and is written from their perspective. What is known about the topic?: VAD has not been legal in an Australian state until legislation passed in Victoria in 2017. What does this paper add?: This paper describes how the legislation was developed, as well as the significant consultative and democratic processes required to get the bill to parliament. What are the implications for practitioners?: In documenting this process, policy makers and others will have an understanding of the complexities in developing legislation. This information will be useful for other Australian jurisdictions considering similar legislative changes. [ABSTRACT FROM AUTHOR]

Objective: Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders' knowledge and perceptions of RRA in Australian nursing homes. Methods: A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants' knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Results: Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n = 8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. Conclusion: The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. What is known about the topic?: RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. What does this paper add?: This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. What are the implications for practitioners?: A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue. [ABSTRACT FROM AUTHOR]

Objectives: Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods: The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results: In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6–59.0%) reported current teaching or supervisory activities. Factors significantly (P < 0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14–0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24–6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02–3.94). Conclusions: Rural–urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic?: Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add?: This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners?: Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to quantify the use of linked data for health and human services research in Australia since the establishment of the Population Health Research Network (PHRN) in 2009. Methods: A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist to search for all publications involving the use of Australian linked data between 2009–10 and 2016–17. Publications were categorised by subject, data linked and data linkage unit involved. Results: In all, 7153 articles were identified from the initial search, and 1208 were included in the final analysis. An increase in the number of publications involving linked data was observed from 2009–10 through to 2015–16. Most articles (82%) featured data linked by at least one PHRN-funded data linkage unit. The research areas of 86% of publications were able to be classified according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM). The number of publications involving cross-sectoral linked data also increased. Conclusions: Investment in Australian data linkage infrastructure has seen an increase in the number of research publications involving the use of linked health and human services data. This study identified areas where linked data is commonly used and those where use could be improved. What is known about the topic?: Data linkage is a method of bringing together information about individual people, places and events from different sources in a way that protects individual privacy. Individual jurisdictions have reported benefits from research conducted using linked data, including the generation of new knowledge and supporting improvements in the delivery of a wide range of health and human services. There has been significant investment in national data linkage infrastructure in Australia over the past 8 years. To date, there has been no systematic investigation of the effect of this investment on the use of linked population data by the research community. What does this paper add?: This paper provides evidence of the increased use of high-quality population-based linked data in research over the 8-year period studied. It demonstrates the application of data linkage across a wide range of health areas and highlights the small but growing number of studies using cross-sectoral data to investigate complex conditions. What are the implications for practitioners?: It is important to demonstrate to funders, policy makers, data custodians and researchers the value of robust data linkage capacity as an important national resource. Its use by researchers can bring enormous social and economic benefits by providing a more complete picture of the health and well-being of the community. The range of data collections routinely linked is increasing, as is the pool of researchers experienced in handling and analysing the data. Continued investment in Australia's data linkage infrastructure and the inclusion of other collections including general practice data will augment the use of this infrastructure in expanding the evidence base for policy makers and practitioners. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to describe the experience of developing key performance indicators (KPIs) for Sydney Children's Hospital Network (SCHN), the largest paediatric healthcare entity in Australia. Methods: Beginning with a published methodology, the process of developing KPIs involved five phases: (1) identification of potential KPIs referencing the organisational strategic plan and pre-existing internal and external documents; (2) consolidation into a pragmatic set; (3) analysis of potential KPIs against selection criteria; (4) mapping these back against the strategic plan and management structure; and (5) presentation to key stakeholders to ensure suitability and traction. Consistent with the strategic plan, a subset of indicators was selected to address quality of care for children from priority populations. Results: A pragmatic list of 60 mandated and 50 potential KPIs was created from the 328 new and 397 existing potentially relevant KPIs generated by the executive team. Of these, 20 KPIs were selected as the most important; 65% were process measures. The majority of mandated KPIs were process measures. Of the KPIs selected to highlight inequities, there were proportionately more outcome measures (44% outcome, 27% process). Less than one-third could currently be measured by the organisation and were thus aspirational. Conclusion: Developing a KPI suite requires substantial time, effort and organisational courage. A structured approach to performance measurement and improvement is needed to ensure a balanced suite of KPIs that can be expected to drive an organisation to improve child health outcomes. Future directions for SCHN include a systematic approach to implementation beyond the mandated KPIs, including KPIs that reflect equity and improved outcomes for priority populations, development of meaningful measures for the aspirational KPIs, adding structure KPIs and measurement of changes in child health outcomes related to the development of this KPI process. What is known about the topic?: Health services are increasingly required to demonstrate accountability through KPIs. There is a body of literature on both theoretical frameworks for measuring performance and a long list of possible measures, however developing a meaningful suite of KPIs remains a significant challenge for individual organisations. What does this paper add?: This paper describes lessons learned from the practical, pragmatic application of a published methodology to develop a suite of KPIs for the largest paediatric healthcare entity in Australia. It provides a select list of the highest-level KPIs selected by the organisation to stimulate further discussion among similar organisations in relation to KPI selection and implementation. What are the implications for practitioners?: Developing and implementing a suite of meaningful KPIs for a large organisation requires courage, an understanding of health informatics, stakeholder engagement, stamina and pragmatism. The process we describe can be replicated and/or modified as needed, with discussion of key lessons learned to help practitioners plan ahead. [ABSTRACT FROM AUTHOR]

Objective: The choice of whether to admit under a specialist or a generalist unit is often made with neither clear rationale nor understanding of its consequences. The present study compared the characteristics and outcomes of patients admitted with community-acquired pneumonia to either a general medicine or respiratory unit. Methods: This study was a retrospective cross-sectional study using data from public hospitals in Adelaide, South Australia. Over 5 years there were 9775 overnight, unplanned appropriate adult admissions. Patient length of hospital stay, in-patient mortality rate and 30-day unplanned readmission rate were calculated, with and without adjustment for patient age and comorbidity burden. Results: Over 80% of these patients were cared for by a general medicine unit rather than a specialist unit. Patients admitted to a general medicine unit were, on average, 4 years older than those admitted to a respiratory unit. Comorbidity burdens were similar between units at the same hospital. Length of in-patient stay was >1 day shorter for those admitted to a general medicine unit, without significant compromise in mortality or readmission rates. Between each hospital, general medicine units showed a range of mortality rates and length of hospital stay, for which there was no obvious explanation. Conclusions: Compared with speciality care, general medicine units can safely and efficiently care for patients presenting to hospital with community-acquired pneumonia. What is known about the topic?: Within the narrow range of any specific disease, generalist medical services are often cited as inferior in performance compared with a speciality service. This has implications for hospital resourcing, including both staffing and ward allocation. What does this paper add?: This paper demonstrates that most patients admitted with a principal diagnosis of community-acquired pneumonia were admitted to a generalist unit and did not apparently fare worse than patients admitted to a specialist service; patients admitted to a generalist unit spent less time in hospital and there was no difference in mortality or readmission rate compared with patients admitted to a specialist service. What are the implications for practitioners?: The provision of generalist services at urban hospitals in Australia provides a safe alternative admission option for patients presenting with pneumonia, and possibly for other common acute medical conditions. [ABSTRACT FROM AUTHOR]

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic?: Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add?: We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners?: Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to better understand senior medical directors' perceptions of public reporting of hospital performance data, how public reporting affects institutional behavioural change towards quality improvement and how it could be improved. Methods: Interviews were undertaken with 17 medical directors representing 26 metropolitan and regional public hospitals in Victoria, Australia, between June and August 2016. Data were analysed thematically. Results: Medical directors are well placed to comment on clinical and administrative aspects of quality, safety and performance monitoring in public hospitals. Their responses largely suggested that public reporting of hospital performance data in Australia is immature and not fulfilling its potential. There was little consensus among informants around what public reporting is, who it is for or its purpose. Although public reporting was considered to have important functions for hospitals and consumers, it was generally considered to lack robustness and have underutilised potential to inform consumers, build trust and drive quality and performance improvements within hospitals. Conclusions: The next steps needed to advance public reporting of hospital performance data in Australia include engaging clinicians and patients in selection and development of metrics, improving timeliness of reporting, and improving communication of information so that it is accessible and meaningful for different audiences. What is known about the topic?: Public reporting of hospital performance data is a mechanism increasingly used in the Australian health system, but it has attracted little research. What does this paper add?: This paper reveals a lack of shared understanding among medical directors in Victoria, Australia, on what public reporting of hospital performance data is, who it is for and its purpose. The paper highlights the potential importance of public reporting of hospital performance data for rural and regional healthcare consumers and how it may be strengthened. What are the implications for practitioners?: Stronger systems of public reporting of hospital performance data have the potential to increase consumer engagement and improve hospital performance, quality and safety. Awareness of the discourse around public reporting of hospital performance data can increase practitioners' engagement in debate and development of reporting systems. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods: A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results: The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion: The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic?: Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add?: This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners?: Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically. [ABSTRACT FROM AUTHOR]

Objective: To develop and examine a profile of the demographic, hospital admission and clinical characteristics of high users of hospital resources within a cohort of privately insured Australians. Methods: Hospital admissions claims data from a group of private health insurance funds were analysed. The top 1% of hospital users were selected based on three measures of resource utilisation: number of admissions, total bed days and total insurance benefits paid. The demographic, hospital admission and clinical characteristics data were compared for these three measures of resource utilisation. Results: Compared with the general insured population, the three high-use cohorts are older, have more public hospital admissions and have more same-day admissions. The three high-use cohorts have the same top five principal diagnosis categories. These five categories account for more than two-thirds of admissions. The top 1% of users is responsible for a large proportion of total resource utilisation, accounting for 13% of total costs and 21% of total bed days. Conclusions: The highest users of hospital resources have a distinct profile, accounting for a large proportion of total resource utilisation for a narrow range of health conditions. The age and hospital admission profile of this group suggest both policy and service considerations for the targeting of interventions to support this high-needs group. What is known about this topic?: Statistics are regularly published on the uptake and use of private health insurance in Australia but there is little detailed information on resource utilisation in specific subgroups, particularly those with the highest levels of hospitalisation. What does this paper add?: This paper provides a profile of high resource utilisation among a privately insured cohort, describing demographic, hospital admission and clinical characteristics across three measures of resource utilisation. Patterns of use are detailed in this profile, for example the top 1% of users have a higher proportion of public hospital admissions as a private patient. The clinical profile of admissions was similar for the three measures of resource utilisation and there was considerable overlap in the individuals categorised in each high-use group. What are the implications for practitioners?: The narrow demographic and clinical profile of the high resource utilisation groups shows a chronic disease burden that is different to the focus of current chronic disease policy measures. The high-use conditions identified in this study are less amenable to preventive measures and new strategies may be required to target this high-needs group. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate whether the content of annual Victorian quality of care reports had an increased consumer participation focus following the introduction of the National Safety and Quality Health Service (NSQHS) Partnering with Consumers standard. Methods: A mixed-methods approach comprising a comparative descriptive observational study design with quantitative data analysis was used. Nine large Victorian metropolitan public health services' annual quality of care reports from 2011 and 2014 were analysed using a newly devised analysis framework consisting of elements of the NSQHS 'Partnering with Consumers' standard and minimal requirements for Quality of Care reporting by the Department of Health and Human Services. Results: Of the nine 2014 quality of care reports, in only three were total scores higher compared with scores in the 2011 reports; in one of the 2014 reports, the total scores remained the same, and in the remaining five reports total scores were lower than in the 2011 reports. Overall, there was an improved total score for the 2014 reports compared with the 2011 reports, corresponding to a higher consumer participation focus. Conclusion: Overall, the present study demonstrated mixed findings and, in some cases, lower scores for the 2014 reports, which was after the introduction of the Partnering with Consumers NSQHS standard, compared with the 2011 reports. Overall, there is future scope to enhance the degree of consumer participation evident within the quality of care reports. What is known about the topic?: Partnering with consumers has been associated with improved clinical outcomes, decreased readmission rates and rates of hospital-acquired infections, and improved adherence to treatment recommendations and health literacy. Engaging consumers has been recognised as a means to increase the accessibility and appropriateness of healthcare to individuals. Public reporting is a tool through which health services communicate with and engage their consumers in order to improve the quality of care they provide, and is a key element in Australia of the NSQHS Partnering with Consumers standard. What does the paper add?: This paper links the principles of consumer participation with public reporting. The paper highlights the potential for healthcare organisations to use their public reporting media to engage with consumers and communicate about the quality of care they deliver. What are the implications for practitioners?: The unexpected findings of a lower emphasis on consumer participation suggests the need for Victorian health services to review the purpose and processes for developing the publicly reported quality of care reports in order to improve their compliance. [ABSTRACT FROM AUTHOR]

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations. School-based nurses are ideally located to advocate for services and policies to address the health inequities experienced by vulnerable school populations. However, these nurses can confront barriers that limit their capacity to embed health advocacy into their practice and to meaningfully effect change. Guidance is required to redress this situation. School-based nurses who are competent and supported health advocates are required to achieve substantial and sustained health equity and social justice outcomes for vulnerable students and school populations. [ABSTRACT FROM AUTHOR]

Objective: This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods: For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results: Cumulative PC over the study period for dental PBS prescriptions was A$28 783 361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2 214 105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59 756 per year; r = 0.98: P < 0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions: This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic?: Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add?: This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners?: This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule. [ABSTRACT FROM AUTHOR]

Objective: This study determined the economic impact of 16 'high-priority' hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an individual Australian health service. Methods: A retrospective cohort study was performed using a deidentified patient dataset containing 93 056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. Results: In all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracranial injury were associated with the highest additional cost (A$17 173). The biggest increase in additional LOS was unplanned admissions to the intensive care unit (5.42 days). Conclusions: This study shows the economic impact of HACs from the perspective of an individual health service. The methodology used demonstrates how other health services could determine safety priorities corresponding to their own casemix. What is known about the topic?: HACs are a major issue in Australian health care; however, their effect on cost and LOS at the individual health service level is not well quantified. What does this paper add?: Additional cost and LOS implications for 16 high-priority HACs have been quantified within an Australian health service. There is substantial variation in terms of the number of HACs and the economic impact of each HAC. What are the implications for practitioners?: This study provides a template for other health services to assess the economic impact of HACs corresponding to their own casemix and to inform targeted patient safety programs. [ABSTRACT FROM AUTHOR]

Published evidence confirms poor access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory. This study aimed to identify the practical causes and recommend improvement. Pathways to wait-listing for a kidney transplant were reviewed to identify potential barriers. Processes were mapped to identify potential problem areas, provide comparison of the actual versus the ideal, identify where data needed collecting and provide clear presentation of the processes. Staff involved in the work-up of patients going for wait-listing were asked to list the barriers. Data were collected for patients from the transplant database between 1 January 2017 to 31 August 2018. Quality improvement statistical processes and charts were used to analyse and present the results. There were 102 patients in the transplant work-up process; 81.4% were Aboriginal and Torres Strait Islander, 71.6% were progressing with the work-up, 28.4% were on-hold. Of the 29 patients on hold, 92.9% were Aboriginal and Torres Strait Islander. Causes of delays to wait-listing included: failure to attend appointments due to competing priorities and communication barriers, access and navigating complex pathways to specialist services, transport, co-morbidities requiring multiple tests and multiple specialty services, and pressures on dialysis and hospital bed capacity. In conclusion, barriers to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians are complex and can be addressed by redesigning healthcare provision, including increasing the Aboriginal and Torres Strait Islander workforce to provide education and patient navigation of the healthcare system and improve communication, streamlining investigations and coordinating specialist services. What is known about the topic?: Access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory is poor. Barriers to wait-listing for kidney transplantation can occur anywhere along the pathway of care from a patient's first contact with the renal service to wait-listing. What does this paper add?: Identified barriers to wait-listing for kidney transplantation include health service workforce and resources shortages, patient and health service barriers such as patients' competing priorities, poor communication between the health service and patients, transport and accommodation for patients from remote communities, complex comorbidities, and access to specialist services. What are the implications for practitioners?: Recruitment and retention of Aboriginal and Torres Strait Islander mentors, healthcare workers and patient navigators should be prioritised to provide an effective culturally appropriate service. Effective communication strategies with patients and improved access to streamlined appropriate investigations and collaboration among specialist services will invariably improve access to wait-listing for kidney transplantation. [ABSTRACT FROM AUTHOR]

Objectives: General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods: This data linkage study used a cohort of 10 240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007–14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results: Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70–0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90–1.17). Conclusion: The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic?: There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add?: This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners?: Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system. [ABSTRACT FROM AUTHOR]

Objective: This study examined the distribution of the sexes across Australian medical procedural specialties in 2017 and investigated the proportion of currently registered female specialists based on their graduation date from 1969 to 2008. Methods: A cross-sectional analysis of current Australian procedural and surgical specialists registered with the Australian Health Practitioner Registration Agency as of January 2017 was undertaken. Participants included 4851 surgical specialists (594 female, 4257 male) and 14 948 specialists in specialties with high levels of procedural clinical work (4418 female, 10 530 male). The number of male and female specialists across each procedural specialty and the medical school graduation date of current female specialists were analysed. Results: In 2017, female fellows represented only one in 10 surgeons and three in 10 procedural specialists. All surgical specialties are underrepresented by female specialists. Cardiology is least represented by female practitioners (one in 10), followed by intensive care and ophthalmology (two in 10). General surgery, otolaryngology and urology saw more female specialists with graduation dates between 1983 and 2003 compared with the other surgical specialties. Conclusion: The number of female practitioners registered as specialists is increasing, but they continue to be underrepresented at specialist level across many procedural and surgical specialties. What is known about the topic?: Although the number of female students entering medical school now outnumbers that of males, female practitioners remain underrepresented at the specialist level. What does this paper add?: Surgery continues to be underrepresented by female specialists, but general surgery, otolaryngology and urology have shown increases in females reaching specialist level. All procedural specialties have shown increasing numbers of female practitioners reaching the specialist level. What are the implications for practitioners?: All surgical specialties and nearly all procedural specialties need to adopt evidence-based practices to make their training programs both appealing and sustainable to female trainees in order to work towards achieving gender parity. [ABSTRACT FROM AUTHOR]

The aphid Aploneura lentisci is widespread in Australia and New Zealand, living all year round on roots of its secondary grass hosts. The fungal endophyte (Epichloë festucae var. lolii), strain AR37 in Lolium perenne is known to greatly reduce populations and was a likely reason for the superior growth and persistence of this association previously observed in the field. Aphid populations were quantified in a field trial near Ballarat, comparing yields of perennial ryegrass infected with eight different endophyte strains and an endophyte-free (Nil) control in a common ryegrass background (Grasslands Samson (G. Samson)). AR37 and another endophyte strain, AR5, had significantly fewer aphids than all other endophytes. These differences were significantly related to yield increases taken before and after sampling that persisted until the end of the trial. In a pot trial comparing commercially available ryegrass-endophyte combinations with equivalent Nil controls, aphid numbers were lower on G. Samson AR37 and Banquet II with AR5 (Endo®5) than on all other cultivar-endophyte combinations. Compared with Nil controls, the common toxic strain in G. Samson, and two strains in Trojan also reduced aphid numbers. The AR5 endophyte produces the alkaloid ergovaline but high concentrations of this in roots of potted plants could not account for differences in root aphid numbers. Root concentrations of epoxyjanthitrems, the only known alkaloids produced by AR37, were low and unlikely to be the cause of resistance to A. lentisci. An aphid, Aploneura lentisci , that feeds on grass roots is widespread in pastures in New Zealand and Australia. This paper reports data confirming that perennial ryegrass infected with a strain of Epichloë fungal endophyte, AR37, is highly resistant to this aphid and shows that another endophyte strain, AR5, gives the same level of control. Suppression of high aphid populations by these endophytes in the field at Ballarat resulted in a 37% increase in pasture production over endophyte-free ryegrass over a 5-month period. [ABSTRACT FROM AUTHOR]

Australia needs a new shared vision that the current trajectory of loss of natural heritage on its offshore islands is not acceptable and needs to change. This Special Issue brings together seven papers from leaders and practitioners with experience in offshore islands across the Australian and New Zealand context. The fundamentals for each paper are to suggest potential solutions or scenarios to move forward with island policy, and management. [ABSTRACT FROM AUTHOR]

Livestock producers are facing increasing pressure to reduce the environmental and animal-welfare impacts of production, while also managing the challenge of an increasingly variable climate and diminishing resources. This perspective paper highlights the role for animal scientists to contribute to the sustainability of future livestock systems. We argue the need for a broader, more inclusive and more integrated concept of animal science, better connections among scientists, producers, consumers and policy makers, and more support for the next generation of animal scientists. Animal scientists have an important role to play in providing the evidence to support the social licence of livestock production and inform decisions made by policy makers and consumers regarding the production and consumption of livestock products. Animal scientists can also assist producers to adapt to social, environmental and political challenges that affect their livelihoods and the way they farm. Traditionally, animal science has focussed on species- and discipline-specific areas of research such as ruminant nutrition, genetics or reproductive physiology. While this fundamental research remains essential to understand the underlying biology of livestock production and improve production efficiency, it needs to be better integrated into research applied at and beyond the herd or flock level. Systems thinkers who can apply this knowledge across farm, regional and national scales also have an important role in providing information to key decision makers, from farmers to national government. Better engagement with the social and economic sciences can inform how animal scientists and extension services interact with producers to understand constraints to production as well as adoption of new technology and co-develop evidence-based solutions. Underlying this, the demographics of those who study and work in animal science are changing. Australian animal industries require the best and brightest minds to overcome future challenges and engaging these students as the new face of Australian animal science is an essential step towards sustainable future livestock systems. Livestock production is facing new challenges from consumers and operating environments, and, so, the role of animal science must also change to adequately solve these complex problems. The increasingly diverse next generation of animal science graduates has less traditional career pathways and links to primary industries, and will require new methods of mentoring and professional development to support the needs of livestock producers. Integrating other disciplines and systems approaches with species- and discipline-specific science will be essential to ensuring a sustainable future for livestock production in Australia. [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]

Objective. New South Wales (NSW) experienced a severe influenza season in 2017. In 2018, NSW Health implemented a campaign to improve healthcare worker (HCW) influenza vaccination coverage. The South Eastern Sydney Local Health District (LHD) trialled a centralised online database to monitorHCWuptake of the vaccination. This paper outlines how the monitoring system was chosen and developed, the process of implementation and the effectiveness of the system in this setting. Methods. A literature review was conducted to identify an appropriate database. Stakeholder working groups took place across the LHD regarding implementation. An online vaccination consent form was developed and installed on the LHD network within 2 weeks. Administrative staff ensured timely entry of HCW data and vaccination status and analysis of uptake using Microsoft Excel. Results. REDCap (Vanderbilt University, Nashville, TN, USA) was identified as the most appropriate web-based platform based on the ease of developing a secure and inexpensive data collection tool in a short time period. In all, 10 064 employees were recorded in REDCap as having received the influenza vaccine. Customised REDCap reports allowed managers to follow up staff yet to receive their vaccination, which resulted in further vaccinations. Conclusions. REDCap was successfully used as a data collection tool to track the influenza vaccination rates of staff. The data assisted the District Workforce Services in ensuring that facilities complied with NSW Health policy. This study highlights how REDCap may be used by similar organisations to monitor influenza vaccination of HCWs. [ABSTRACT FROM AUTHOR]

Globalisation has increased the occurrence of species being introduced outside of their natural range. The African carder bee, Pseudoanthidium (Immanthidium) repetitum (Hymenoptera: Megachilidae), is one such species. P. repetititum was first recorded in Australia in 2000 in Queensland (north-east Australia), and rapidly spread down the east coast of Australia, and by 2015 was reported to be a common component of bee assemblages in urban community gardens in Victoria (southern Australia). Here, I report the first occurrences of this species in Western Australia, on the other side of the continent, representing a major expansion of the distribution of the species. Thus far there are three confirmed and one unconfirmed localities where this species has been seen, all localised to the Mandurah region in residential areas of Western Australia. Female specimens were collected from a garden in Halls Head, where it was observed to be abundant. Other bees, both native and the introduced European honeybee, were foraging alongside it. The occurrence of P. repetitum represents a major expansion in its distribution. It remains rare and localised; however, given known negative impacts of introduced species on native fauna and flora, especially in Australia, vigilance is required to monitor this species. The African carder bee, Pseudoanthidium (Immanthidium) repetitum (Hymenoptera: Megachilidae), is an introduced species in Australia. It was first reported in 2000 and rapidly spread across the east coast. This paper reports the first observations of P. repetitum on the other side of the continent in Western Australia, representing a major range expansion. Potential impacts on native fauna and flora of this species are discussed. [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]

Context: Data collected from producers in south-eastern Australia found that the survival of twin-born lambs decreased by 3.5% for each extra 100 ewes in the mob at lambing. Increasing stocking rate by 1 ewe/ha decreased lamb survival by a further 0.7%. These survey findings suggest that lamb survival could be improved by optimising the allocation of ewes to mobs and paddocks at lambing. Aim: The present paper reports two experiments. Experiment 1 tested the hypotheses that (1) the survival of twin-born lambs would be greater when ewes lamb in smaller mobs and at lower stocking rates, and (2) the effects of mob size and stocking rate would be greater in Merinos than in non-Merino breeds. Experiment 2 tested the hypothesis that the survival of twin-born Merino lambs would be greater at lower mob sizes when ewes lambed at stocking rates <4 ewes/ha. Methods: Experiment 1 investigated a 2 × 2 factorial combination of mob size (high or low) and stocking rate (high or low) on the survival of twin-born Merino and non-Merino lambs at 70 on-farm research sites across southern Australia. Experiment 2 investigated the effect of high or low mob size on the survival of twin-born Merino lambs when ewes lambed at stocking rates of <4 twin ewes/ha at 15 on-farm research sites. In both experiments, adult twin-bearing ewes were randomly allocated into a treatment and lambing paddock on Day 140 from the start of joining at each farm. Lamb survival in each mob was calculated based on lamb losses between pregnancy scanning and lamb marking. Key results: In both experiments, the effect of mob size on lamb survival was found to be linear, with survival of twin-born lambs decreasing by between 1.9% and 2.5% per additional 100 ewes in the mob at lambing, regardless of breed (P < 0.001). In Experiment 1, there was no effect of stocking rate or mob size by stocking rate on lamb survival. Conclusions: The present research demonstrated that reducing mob size but not stocking rate will improve the survival of twin-born lambs to marking for extensive enterprises in Australia where ewes lamb at stocking rates of up to 12 ewes/ha. Implications: These findings will contribute to guidelines for optimising ewe nutrition and resource allocation to improve lamb survival. Improving lamb survival has the potential to increase profit to the Australian sheep industry by AU$1 billion per year. Our national research demonstrated that reducing mob size at lambing will improve lamb survival. These findings will contribute to current guidelines for managing lambing ewes to improve lamb survival across Australia. [ABSTRACT FROM AUTHOR]

Objective. Identifying and quantifying the health needs of a population are the basis of evidence-based health policy and workforce planning. The motivation for undertaking the present study was to evaluate whether the current level of medication review services corresponds to population need, as proxied by the rate of polypharmacy, and to undertake a preliminary analysis of the sufficiency of the current workforce. This paper: (1) estimates the age- and sex-standardised rates of polypharmacy as a proxy for population need for home medicines review; (2) compares the rate of polypharmacy with current service provision of home medicines reviews; and (3) links the estimated need for services with the current number and location of pharmacist providers. Methods. Age- and sex-adjusted polypharmacy rates, by state, were estimated from the National Health Survey of Australia (2017-18), service levels were estimated from national-level administrative claims data (2017-18) and the current workforce was estimated from the Australian Association of Consultant Pharmacists (2018). The current level of service provision was compared to the estimated population need for services, alongside the size of the pharmacy workforce required if need was met. Results. The adjusted rate of polypharmacy in Australia, using the strictest definition of 10 medications and 3 current chronic illnesses, was 1389 per 100 000 population. The illustrative needs-based analysis suggests that there may be a disconnect between the current level of service provision and population health needs. Conclusion. Given that polypharmacy is a risk factor for medication-related problems, and that medication review is one of the few targeted strategies currently available to address medication-related problems in the population, service provision may be inadequate. Policy options to improve service provision could include interventions to increase workforce productivity and relaxing the current eligibility criteria for review, especially in rural and remote areas. [ABSTRACT FROM AUTHOR]