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Objective: To determine the impact of the COVID‐19 state‐wide lockdown on ED presentations for older adults in Queensland, Australia. Methods: A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre‐pandemic average), 2020 (COVID‐19 state‐wide lockdown) and 2021 (post‐state‐wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. Results: There was 380 854 older adult presentations. During the COVID‐19 state‐wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867–0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post‐state‐wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21–1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre‐pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. Conclusion: There was a significant decrease in presentation rates to EDs during the COVID‐19 state‐wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post‐state‐wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods: Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results: Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions: Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic?: There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add?: For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What are the implications for practitioners?: Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aim Design Methods Results Conclusion Implications for the Profession Impact Statements Reporting Method Patient or Public Contribution Geographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end‐of‐life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution.To describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia.A convergent mixed methods design.Qualitative data were collected, in 2022–2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long‐Term Care. Data were analysed according to type and integrated.Relational care for residents and families is highly valued but provision of quality is challenging where time‐poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings.Identifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt.Context‐specific needs extend far beyond a nurse practitioner providing additional expertise in care provision.What problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting.What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements.Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare.The GRAMMS checklist was followed in reporting of this study.Two lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications. [ABSTRACT FROM AUTHOR]

Aim: This investigation compared the combination effect of polyhexamethylene biguanide (PHMB) and low-frequency contact ultrasonic debridement (LFCUD) on the bacterial load in hard-to-heal wounds in adults, to ultrasonic debridement alone. Secondary outcomes included wound healing, quality of life (QoL), and pain scores. Bacterial species were also identified. Method: In this single-blinded, randomised controlled trial, fifty participants were randomised to two groups. All participants received LFCUD weekly for six weeks, plus six weeks of weekly follow-up (12 weeks total). The intervention group received a 15-minute topical application of PHMB solution post-LFCUD, at each dressing change and in a sustained dressing product. The control group received non-antimicrobial products and the wounds were cleansed with clean water or saline. Wound swabs were taken from all wounds for microbiological analysis at weeks 1,3,6 and 12. Results / Discussion: The intervention group (n=25) had a lower bacterial load at week 12 compared with the control (n=25, p<0.001). No difference was seen in complete wound healing between the groups (p=0.47) or wound related QoL (p=0.15). However, more wounds deteriorated in the control group (44%) compared with the intervention group (8%, p=0.01). More wounds reduced in size in the intervention group (61% versus 12%, p=0.019). Pain was lower in the intervention group at week six, compared with controls (p=0.04). Bacterial species found at baseline were Pseudomonas aeruginosa (56%), Staphylococcus aureus (44%) and coagulase-negative Staphylococci (12%), with 52% of wounds containing polymicrobial loads. Conclusion: LFCUD without the addition of an antimicrobial agent such as PHMB, cannot be recommended. Further research requires longer follow-up time and would benefit from being powered sufficiently to test the effects of multiple covariates. [ABSTRACT FROM AUTHOR]