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Purpose This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. Methods Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. Results A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5–10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. Conclusion People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.

Purpose Residents living in residential aged care facilities (RACF) are a vulnerable sector of the community during the Covid-19 pandemic, both from the disease and the resultant control measures, such as lockdowns, quarantines, and social distancing. In a patient centred health system, it is important that the views of residents and their relatives, ie. the ‘consumers’, are included to help understand the effect of these control measures. The Happy Life Index (HLI) is a consumer completed survey tool that measures modifiable quality of life indicators including food, environment and cleanliness, activities and lifestyle, staff friendliness, staff presence, management and care quality. This study explored the effect of Covid-19 related lockdowns on HLI scores from residents and their relatives. Methods This study is a secondary analysis using HLI data obtained from Australian RACF residents and relatives. The seven HLI components were rated on a 5-point scale (1 = Very bad; 5 = Excellent). The likelihood of residents and relatives giving a rating of “Excellent” was estimated using logistic regression comparing those who responded before the Covid-19 related restrictions to those who responded during the Covid-19 related restrictions. Results A total of 9,790 residents responded to at least one of the HLI questions. Fewer residents reported satisfaction associated with staff in their RACF, both in terms of friendliness and presence, during the Covid-19 restrictions compared to pre-Covid-19 lockdowns, whilst amongst relatives, fewer reported satisfaction with management during the restrictions. RACF residents were more likely to report satisfaction with their meals during the Covid-19 related restrictions than prior to the restrictions. Conclusion This study suggests that during Covid-19 related restrictions a greater emphasis on staff wellbeing and staffing numbers may help to maintain resident’s satisfaction with the service quality.

Chronic wounds are prevalent in care home residents. For effective treatment, specialist knowledge is required, knowledge that most staff in homes will not possess. Tabatha Rando and colleagues describe a project aiming to simplify product selection.

Objective: To demonstrate the effectiveness of a simplified wound dressing regimen and develop a decision tree tool for wound management, for use by nurses in a residential aged care setting. Method: A three-phase process was used. Firstly, practice was audited, including a cost analysis of existing wound treatment. Secondly, staff were educated on wounds, wound care products and a simplified wound management protocol. In the final phase, the new wound care products and protocol used for skin tears and other wounds (as assessed by a nurse practitioner) were evaluated and ongoing education provided as required. Results: A total of 93 residents from two residential aged care facilities participated in the study. Overall, 178 wounds were identified, of which 121 were considered eligible for treatment under the new protocol. The majority of residents were aged >85 years and the major wound type was skin tears 72.7% (n=88). The mean healing time for skin tears was significantly shorter than for other wounds (19.7±14.2 days versus 30.9±25.2 days, p=0.0359). Most wounds were suitable for the simplified dressing selection regimen. Data collected from a survey of nursing staff demonstrated that the simplified protocol products were easy to apply, conformed well, were easy to remove and stayed in place. In addition, patient satisfaction was positive and removal of dressings was generally pain free. Conclusion: In summary, data collected from this project showed that the dressings were effective, performed well and simplified wound dressing selection for nursing staff.

Objective: To systematically search the literature and construct a meta-synthesis of how6 choice and control are perceived by people with spinal cord injury (SCI) Data Sources: Medline, Academic Search Premier, CINAHL, Cochrane, EMBASE,8 Health Source, ProQuest, PsychInfo, SAGE and SCOPUS were searched from 1980 until9 September 2018 including all languages. Reference lists of selected studies were also10 reviewed. Study Selection: Eligible qualitative studies included perspectives about choice of control as12 reported by people with SCI. Studies were excluded if they included perspectives from other13 stakeholder groups. 6706 studies were screened for title and abstract and full text of 12714 studies were reviewed resulting in a final selection of 29. Data Extraction: Characteristics of the studies were extracted along with any data (author16 interpretations and quotes) relating to perspectives on choice and control. Data Synthesis: First order analysis involved coding the data in each study and second order18 analysis involved translating each segment of coded data into broader categories with third19 order analysis condensing categories to two broad overarching themes. These themes were20 experiencing vulnerability or security and adapting to bounded abilities. Conclusions: Perspectives of choice and control are influenced by inter-related22 environmental, interpersonal and personal contexts. From a personal perspective, participants23 reported a readiness for adaptation that included turning points where emotional and24 cognitive capacity to make choices and take control changed. Health professionals need to be25 responsive to this readiness, promote empowerment and foster, rather than remove, hope. Refereed/Peer-reviewed

Objective To establish the effectiveness of clinical guideline implementation strategies. Data sources/study setting Systematic reviews in full text, English language, 1987–2007, reporting any measure of clinical process change or cost–benefit analysis. Study design Overview of secondary evidence Data collection/extraction methods Independent critical appraisal using AMSTAR, primary author undertaking all data extraction using a purpose-built form. Principal findings We identified 144 potential papers, from which 33 systematic reviews were included. These reflected 714 primary studies involving 22 512 clinicians, in a range of health care settings. Implementation strategies were varied, rarely comparable, with variable outcomes. Effective implementation strategies included multifaceted interventions, interactive education and clinical reminder systems. Didactic education and passive dissemination strategies were ineffective. Cost-effectiveness studies were rare. Conclusions Successful guideline implementation strategies should be multifaceted, and actively engage clinicians throughout the process.

Background: Community services are playing an increasing role in supporting older adults who are discharged from hospital with ongoing non-acute care needs. However, there is a paucity of information regarding how community services are involved in the discharge process of older individuals from hospital into the community. Methods: 29 databases were searched from 1980 to 2012 (inclusive) for relevant primary published research, of any study design, as well as relevant unpublished work (e.g. clinical guidelines) which investigated community services’ involvement in the discharge of older individuals from hospital into the community. Data analysis and quality appraisal (using McMaster critical appraisal tools) was undertaken predominately by the lead author. Data was synthesised qualitatively.Results: 12 papers were eligible for inclusion (five randomised controlled trials, four before and after studies and three controlled trials), involving a total of 8440 older adults (> 65 years). These papers reported on a range of interventions. During data synthesis, descriptors were assigned to four emergent discharge methods: Virtual Interface Model, In-reach Interface Model, Out-reach Interface Model, and Independent Interface Model. In each model, the findings were mixed in terms of healthcare and patient and carer outcomes. Conclusions: It is plausible that each model identified in this systematic review has a role to play in successfully discharging different cohorts of older adults from hospital. Further research is required to identify appropriate population groups for various discharge models, and to select suitable outcomes measures to determine the effectiveness of these models, considering all stakeholders' involved.

Background: The need for chronic disease self-management (CDS-M) is increasing worldwide. CDS-M programs are variably effective for vulnerable and disadvantaged individuals. Objectives: The objects of this study were 1) To explore experiences of health workers leading CDS-M programs for vulnerable and disadvantaged populations, and 2) To develop guiding principles for the delivery of more effective CDS-M programs for vulnerable and disadvantaged populations. Methods: Two focus groups were undertaken, with all primary health workers, and allied health (AH) staff in a large community centre in an Australian city, who worked with vulnerable and disadvantaged individuals with chronic disease. Results: Consistent messages were identified, producing nine guiding principles. Self-management programs / messages should be tailored to cultural groups, learning styles and available supports, cultural sensitivities, group leadership requirements, language, literacy levels, belief systems and social circumstances and supports, past experiences, and individuals’ ability to motivate change. Implications: The draft guiding principles may assist others to deliver more effective CDS-M programs for disadvantaged and vulnerable populations. BACKGROUND Chronic disease (CD) poses an enormous challenge to Australian health and social systems. 1 CD in Australia now contributes to over 70% of the burden of disease, and is expected to increase to 80% by 2020.2 In response, the Australian Government has initiated a major focus on CD prevention and management through three complementary policies: the National Chronic Disease Strategy, National Service Improvement Framework, and the Blueprint for Chronic Disease Surveillance.3 This has been supported by increased government funding for CD self-manageme nt (S-M) programs delivered by primary health services across Australia.4 The priority CDs outlined under the National Service Improvement Framework are asthma, cancer, diabetes, heart disease, stroke and vascular disease, osteoarthritis, rheumatoid arthritis, and osteoporosis. 3

Background: This paper reports on the effectiveness of a checklist that assists patients to transition safely and sustainably from hospital to home. Methods: Medical wards in three tertiary public hospitals in metropolitan Adelaide provided subjects during 2004. Eligible patients were English-literate and aged at least 60 years, provided written informed consent and had an unplanned hospital admission for a new medical condition. Data was excluded post-hoc if subjects had another hospital readmission for the same condition within seven days of discharge. The study had a quasi-experimental study design in which each hospital acted as its own control. In each hospital, the first half of the study period measured the outcome of usual discharge planning practices (control phase), and the second half of the study period measured the outcome following administration of the checklist (intervention). Quantitative and qualitative (grounded theory) evaluation methods were used. Results: 464 potentially eligible patients were approached and 317 (63.3%) consented to participate (210 control and 107 intervention subjects). Post-hoc exclusion and loss to follow-up reflected 60% (control) and 42% (intervention) subjects. Unplanned readmission to hospital (post hoc exclusion) reflected 21% control and 39% intervention phase subjects. A key reason for loss to follow-up was inability to contact subjects seven days after discharge (29% control, 16% intervention phases). Complete outcome data was collected from 148 subjects. For patients with family/ friends who visited them in hospital, the checklist provided the opportunity for joint discussion and decision-making prior to discharge about daily living activities. These activities were often additional to formal discharge plans. The short duration of hospital admission, and generally poor health precluded many patients without family/ friends from obtaining maximum benefit from the checklist. Conclusion: The checklist improved patients’ preparedness for discharge, particularly when family/ friends were involved.

Question: What do residents in low-level residential care perceive as motivators and barriers to participating in exercise classes at the facility? Design: Qualitative study using focus groups. Participants: Residents, nursing staff and allied health staff of a low-level residential care facility. Conclusion: Recommendations from our findings to enhance exercise class participation include careful consideration of: class scheduling; class location; social aspects associated with exercise classes; support of social networks and health providers; health issues perceived to limit exercise; and marketing of classes. Results: Key motivators for residents to attend the exercise classes included personal benefits, such as improved health and opportunities to socialise, and the support and encouragement that they received from family members and health professionals. The barriers to participating in the exercise classes included: health issues like pain, incontinence, and hearing impairments; external constraints such as the location of the classes and the early morning time; and internal constraints associated with a lack of knowledge about the classes and the benefits of exercising. While the key themes that arose from this study are consistent with findings from studies of community-dwelling adults, several of the barrier subthemes were unique. Refereed/Peer-reviewed