Marginal costs of hospital-acquired conditions : information for priority-setting for patient safety programmes and research

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

Research on injury compensation and health outcomes : ignoring the problem of reverse causality led to a biased conclusion

Objective This study highlights the serious consequences of ignoring reverse causality bias in studies on compensation-related factors and health outcomes and demonstrates a technique for resolving this problem of observational data. Study Design and Setting Data from an English longitudinal study on factors, including claims for compensation, associated with recovery from neck pain (whiplash) after rear-end collisions are used to demonstrate the potential for reverse causality bias. Although it is commonly believed that claiming compensation leads to worse recovery, it is also possible that poor recovery may lead to compensation claims—a point that is seldom considered and never addressed empirically. This pedagogical study compares the association between compensation claiming and recovery when reverse causality bias is ignored and when it is addressed, controlling for the same observable factors. Results When reverse causality is ignored, claimants appear to have a worse recovery than nonclaimants; however, when reverse causality bias is addressed, claiming compensation appears to have a beneficial effect on recovery, ceteris paribus. Conclusion To avert biased policy and judicial decisions that might inadvertently disadvantage people with compensable injuries, there is an urgent need for researchers to address reverse causality bias in studies on compensation-related factors and health.

Do instructional attributes pose multicollinearity problems? An empirical exploration

It is commonly perceived that variables ‘measuring’ different dimensions of teaching (construed as instructional attributes) used in student evaluation of teaching (SET) questionnaires are so highly correlated that they pose a serious multicollinearity problem for quantitative analysis including regression analysis. Using nearly 12000 individual student responses to SET questionnaires and ten key dimensions of teaching and 25 courses at various undergraduate and postgraduate levels for multiple years at a large Australian university, this paper investigates whether this is indeed the case and if so under what circumstances. This paper tests this proposition first by examining variance inflation factors (VIFs), across courses, levels and over time using individual responses; and secondly by using class averages. In the first instance, the paper finds no sustainable evidence of multicollinearity. While, there were one or two isolated cases of VIFs marginally exceeding the conservative threshold of 5, in no cases did the VIFs for any of the instructional attributes come anywhere close to the high threshold value of 10. In the second instance, however, the paper finds that the attributes are highly correlated as all the VIFs exceed 10. These findings have two implications: (a) given the ordinal nature of the data ordered probit analysis using individual student responses can be employed to quantify the impact of instructional attributes on TEVAL score; (b) Data based on class averages cannot be used for probit analysis. An illustrative exercise using level 2 undergraduate courses data suggests higher TEVAL scores depend first and foremost on improving explanation, presentation, and organization of lecture materials.

Study burden, academic stress and mental health among high school students in Vietnam

Pressure on children to succeed in high schools is a serious problem in Asian societies. The focus of this study in three provinces of Vietnam was to identify the thresholds at which supplementary study has positive or negative effects on mental health and academic achievement. The findings contribute evidence for parents, teachers and young people about optimal levels of supplementary study (2–3 hours per day) and the most beneficial mode (self-study versus cram classes and private tutors). The work will be used to inform policy makers about strategies to minimize harmful effects of study burden for high school students.

Extinction risk analysis of exploited green turtle stocks in the Indo-Pacific

In parts of the Indo-Pacific, large-scale exploitation of the green turtle Chelonia mydas continues to pose a serious threat to the persistence of this species; yet very few studies have assessed the pattern and extent of the impact of such harvests. We used demographic and genetic data in an age-based model to investigate the viability of an exploited green turtle stock from Aru, south-east Indonesia. We found that populations are decreasing under current exploitation pressures. The effects of increasingly severe exploitation activities at foraging and nesting habitat varied depending on the migratory patterns of the stock. Our model predicted a rapid decline of the Aru stock in Indonesia under local exploitation pressure and a shift in the genetic composition of the stock. We used the model to investigate the influence of different types of conservation actions on the persistence of the Aru stock. The results show that local management actions such as nest protection and reducing harvests of adult nesting and foraging turtles can have considerable conservation outcomes and result in the long-term persistence of genetically distinct management units. © 2010 The Authors. Animal Conservation © 2010 The Zoological Society of London.

The effects of parental illness and other ill family members on youth caregiving experiences

Informed by a model of family role-redistribution derived from the Family Ecology Framework (Pedersen & Revenson, 2005), this study examined differences in two proposed psychological components of role-redistribution (youth caregiving experiences and responsibilities) between youth of a parent with illness and their peers from ‘healthy’ families controlling for the effects of whether a parent is ill or some other family member, illness type, and demographics. Based on self-report questionnaire data, four groups of Australian children were derived from a community sample of 2474youth (‘healthy’ family, n=1768; parental illness, n=336; other family member illness, n=254; both parental and other family member illness, n=116). The presence of any family member with a serious illness is associated with an intensification of youth caregiving experiences relative to peers from healthy families. This risk is elevated if the ill family member is a parent, if more illnesses are present, and by certain youth and family demographics, and especially by higher caregiving responsibilities. The presence of a family member, particularly a parent, with a serious medical condition has pervasive increased effects on youth caregiving compared to healthy families, and these effects are not fully accounted for by illness type, demographics or caregiving responsibilities.

Superpixel-based appearance change prediction for long-term navigation across seasons

Changing environments pose a serious problem to current robotic systems aiming at long term operation under varying seasons or local weather conditions. This paper is built on our previous work where we propose to learn to predict the changes in an environment. Our key insight is that the occurring scene changes are in part systematic, repeatable and therefore predictable. The goal of our work is to support existing approaches to place recognition by learning how the visual appearance of an environment changes over time and by using this learned knowledge to predict its appearance under different environmental conditions. We describe the general idea of appearance change prediction (ACP) and investigate properties of our novel implementation based on vocabularies of superpixels (SP-ACP). Our previous work showed that the proposed approach significantly improves the performance of SeqSLAM and BRIEF-Gist for place recognition on a subset of the Nordland dataset under extremely different environmental conditions in summer and winter. This paper deepens the understanding of the proposed SP-ACP system and evaluates the influence of its parameters. We present the results of a large-scale experiment on the complete 10 h Nordland dataset and appearance change predictions between different combinations of seasons.

Teaching manufacturing engineering at tertiary institutions in conjunction with engineering design and engineering materials

Tertiary institutions now face serious challenges. Modern industry requires engineering graduates with strong knowledge of modern technologies, highly practical focus, management skills, ability to work individually and in a team, understanding of environmental issues and many other skills and graduate attributes. Institutions in the tertiary sector change courses and modify curriculum to reflect challenges of the modern industry and make engineering graduates better prepared for the “real world”. Queensland University of Technology in the recent years introduced an innovative structure of engineering courses with a common core for Bachelor of Engineering Mechanical, Infomechatronics and Medical, where manufacturing is taught in conjunction with engineering design and engineering materials. In this paper we discuss the innovative curriculum structure, teaching and learning approaches of coherent delivery of manufacturing in conjunction with engineering design and

Reflexive and automatic violence: A function of aberrant perceptual inhibition

It’s commonly assumed that psychiatric violence is motivated by delusions, but here the concept of a reversed impetus is explored, to understand whether delusions are formed as ad-hoc or post-hoc rationalizations of behaviour or in advance of the actus reus. The reflexive violence model proposes that perceptual stimuli has motivational power and this may trigger unwanted actions and hallucinations. The model is based on the theory of ecological perception, where opportunities enabled by an object are cues to act. As an apple triggers a desire to eat, a gun triggers a desire to shoot. These affordances (as they are called) are part of the perceptual apparatus, they allow the direct recognition of objects – and in emergencies they enable the fastest possible reactions. Even under normal circumstances, the presence of a weapon will trigger inhibited violent impulses. The presence of a victim will also, but under normal circumstances, these affordances don’t become violent because negative action impulses are totally inhibited, whereas in psychotic illness, negative action impulses are treated as emergencies and bypass frontal inhibitory circuits. What would have been object recognition becomes a blind automatic action. A range of mental illnesses can cause inhibition to be bypassed. At its most innocuous, this causes both simple hallucinations (where the motivational power of an object is misattributed). But ecological perception may have the power to trigger serious violence also –a kind that’s devoid of motives or planning and is often shrouded in amnesia or post-rational delusions.

Employee perceptions of alcohol and drug policy effectiveness: Policy features, concerns about drug testing, and the key role of preventative measures

As negative employee attitudes towards alcohol and other drug (AOD) policies may have serious consequences for organizations, the present study examined demographic and attitudinal dimensions leading to employees’ perceptions of AOD policy effectiveness. Survey responses were obtained from 147 employees in an Australian agricultural organization. Three dimensions of attitudes towards AOD policies were examined: knowledge of policy features, attitudes towards testing, and preventative measures such as job design and organizational involvement in community health. Demographic differences were identified, with males and blue-collar employees reporting significantly more negative attitudes towards the AOD policy. Attitude dimensions were stronger predictors of perceptions of policy effectiveness than demographics, and the strongest predictor was preventative measures. This suggests that organizations should do more than design adequate and fair AOD policies, and take a more holistic approach to AOD impairment by engaging in workplace design to reduce AOD use and promote a consistent health message to employees and the community.

Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

What is the impact of research funding on research productivity?

A research protocol for our prospective study of research funding. How much research funding improves research productivity is a question that has relevance for all funding agencies and governments around the world. Previous studies have used observational data that compares productivity between winners of different amounts of funding, but researchers who win lots of funding are usually very different from those who win little or no funding. This difference creates potentially serious confounding which biases any estimate of the effect of funding based on observational data that simply compares research output for those who did and did not win funding. This means we do not currently know the return on investment for our research dollars, of which billions are invested around the world every year. By using a study design that incorporates randomisation this will be the world’s first unbiased study of the impact of researcher funding.

Improving the identification of fatigue-related crashes in the Australian Capital Territory

It has been well established nationally and internationally that fatigue-related driving is an important contributory factor in fatal and serious injury crashes. The purpose of this report was to survey a large, representative sample of residents living in both the NSW and ACT to ask about their experience of fatigue and their involvement in fatigue-related crashes and incidents. This will provide valuable data about the number and characteristics of fatigue-related crashes and incidents of ACT residents. Specifically this study assessed the prevalence of incidents of fatigue-related driving for residents of NSW and the ACT, the characteristics surrounding the incident, if the report would fit within the NSW, QLD, or ATSB proxy definition or if it would fall outside of the proxy definition...

Report to VicRoads: Extent of unlicensed driving - follow up Ref 143 - Alcohol Harms Inquiry

Unlicensed driving is a serious problem in many countries, despite ongoing improvements in traffic law enforcement practices and technology. The term "unlicensed driver" is generally used to refer to people who drive or ride a motor vehicle without a valid driver's licence, including those who: • Have let their licence expire, • Have been disqualified or suspended from driving, • Hold an inappropriate licence for the class of vehicle they drive, • Drive outside the restrictions of a special licence, • Don’t currently hold a licence, or • Have never held a licence (Watson, 2003, 2004a)...

Crash involvement patterns of unlicensed drivers and riders in Queensland. Report to Queensland Department of Transport and Main Roads

Unlicensed driving remains a serious problem for road safety, despite ongoing improvements in traffic law enforcement practices and technology. While it does not play a direct causative role in road crashes, unlicensed driving undermines the integrity of the driver licensing system and is associated with a range of high-risk behaviours. This report examines official road crash data from Queensland for the years 2003-08 to compare the crash involvement patterns of unlicensed drivers with those of licensed drivers and explore the scope and nature of unlicensed driving. This study replicates and extends upon two previous studies examining the involvement of unlicensed drivers in crashes in Queensland (Watson, 2004a; 2004b; Watson & Steinhardt, 2006).