It's all a bit wishy washy : the challenge of building partnerships for effective mental health evaluation

Mental wellbeing and social connectedness is a key health priority in Victoria. Actions and interventions that may contribute to the promotion of community level mental wellbeing and social connectedness often occurs in other, non-health sectors. Including evidence from these sectors in evaluations of community based interventions around mental wellbeing and social connectedness is important to ensure comprehensive evaluation, and the development of best practice in this health priority area. However, published evaluation material of community based interventions around this health topic is limited, and rarely captures information from non-health sectors. This pilot study investigated the capacity of health promotion practitioners and other key stakeholders working in this area in Victoria to undertake evaluation of community based mental wellbeing and social connectedness interventions, issues and barriers faced in evaluation, and practitioners’ needs to be able to conduct effective and comprehensive evaluations.

Qualitative methods including semi-structure interviews and document analysis were used. Data was coded and analysed inductively, and key themes developed.

Results indicate that evaluating such interventions is challenging for practitioners due to the broad nature of the topic, and the measurement tools available. Many practitioners would like to conduct more comprehensive evaluation and include evidence from other sectors. Managerial and organizational support to develop partnerships both within the health sector and inter-sectorally was identified as a need in order to develop evaluation skills and facilitate more comprehensive evidence gathering.

This study underscores the importance of inter-sectoral partnerships for developing best evidence-based practice in community health. Partnerships are necessary for conducting comprehensive and effective evaluation to contribute to the evidence base. However, developing effective partnerships is challenging, and acts as a barrier to effective evaluation in a key health area for some community health practitioners. The findings also highlight an agenda for more action by managers to facilitate the development of relevant inter-sectoral partnerships.

Identification of mental illness in police cells: a comparison of police processes, the brief jail mental health screen and the jail screening assessment tool

The study investigated current police practices employed to identify those with a mental illness in police custody, and to evaluate the predictive utility of the Brief Jail Mental Health Screen (BJMHS) and the Jail Screening Assessment Tool (JSAT). One hundred and fifty detainees were recruited from two police stations in Melbourne, Australia. Measures included the Structured Clinical Interview for DSM-IV-TR, BJMHS and JSAT. Axis-I disorders were compared with police decisions regarding identification of mental illness based on their usual practices. Participants were classified as requiring referral for further mental health evaluation according to the screening tools. Results indicated that current police practices produced high false negatives, with many of those experiencing mental illness not identified. There was no significant difference in performance between BJMHS (AUC =0.722) and JSAT (AUC =0.779) in identifying those with a serious mental illness (p=0.109). However, JSAT performed significantly better at identifying any Axis-I disorder, excluding substance use disorders, as compared with BJMHS (AUC =0.815, vs AUC =0.729; p=0.018). Given the high prevalence of mental illness among detainees, there is a pressing need to introduce standardised screening tools for mental illness in police custody. This can assist the police in managing detainees appropriately and securing mental health services as required.

Does the poor quality of Australian health education documentation undermine the message? A review of documents informing pregnant women about alcohol

Background. The advice given to pregnant women about alcohol consumption during pregnancy is variable across countries and within countries.Aim. The aim of this study was to review the content and design of existing Australian health education documentation regarding alcohol consumption in pregnancy that is available to pregnant women. Methods. A documentary analysis was conducted. This involved the identification and collection of a range of health education documents, which were then systematically analysed. The thematic and symbolic elements of each document were compared and contrasted using a modified version of the DISCERN instrument. Findings. A total of 32 documents were retrieved via general and targeted internet searching. Documents varied considerably in their purpose, language levels, accessibility, and quality. The majority of documents scored as low to moderate quality. Implications. Although there are many and varied existing documents relating to alcohol consumption during pregnancy in Australia, these are not of high quality and could be substantially improved by including publication dates, using simple language, and providing sources of information. This may result in a more effective public health message and so help to reduce the number of pregnant women who continue to drink during pregnancy.

Will he get back to normal? survival and functional status after intensive care therapy

The study aim was to address healthcare workers’ and patients’ questions about the likely level of recovery at 6 months of patients admitted to an Australian intensive care unit (ICU). Ninety-three consecutive, eligible adults were identified and followed prospectively. Severity of illness on admission was assessed using Acute Physiological and Chronic Health Evaluation (APACHE II), while functional status at 6 months was evaluated using the Sickness Impact Profile (SIP). Cumulative mortality was 25%. Admission severity of illness was associated with survival at 6 months (P≤0.001). Fifty-one (78%) of the 70 survivors were interviewed. Admission severity of illness scores correlated with functional status at 6 months (r=0.34, P=0.01), a finding reported in only one other study. More than half of those interviewed had returned to near pre-admission functional status. Those with poor functional status included high proportions of people with chronic illness and head injury. Overall, physical recovery was more complete than psychosocial recovery. The findings provide useful information for addressing questions relating to physical and psychosocial recovery, appetite, sleep patterns and return to work post discharge.

A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit

Objective: To compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients. Design: Randomized, controlled trial. Setting: General intensive care unit (24 beds) in an Australian metropolitan teaching hospital. Patients: Adult, mechanically ventilated patients (n = 312). Interventions: Patients were randomly assigned to receive sedation directed by formal guidelines (protocol group, n = 153) or usual local clinical practice (control, n = 159). Measurements and Main Results: The median (95% confidence interval) duration of ventilation was 79 hrs (56-93 hrs) for patients in the protocol group compared with 58 hrs (44-78 hrs) for patients who received control care (p = .20). Lengths of stay (median [range]) in the intensive care unit (94 [2-1106] hrs vs. 88 (14-962) hrs, p = .58) and hospital (13 [1-113] days vs. 13 (1-365) days, p = .97) were similar, as were the proportions of subjects receiving a tracheostomy (17% vs. 15%, p = .64) or undergoing unplanned self-extubation (1.3% vs. 0.6%, p = .61). Death in the intensive care unit occurred in 32 (21%) patients in the protocol group and 32 (20%) control subjects (p = .89), with a similar overall proportion of deaths in hospital (25% vs. 22%, p = .51). A Cox proportional hazards model, after adjustment for age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic category, and doses of commonly used drugs, estimated that protocol sedation management was associated with a 22% decrease (95% confidence interval 40% decrease to 2% increase, p = .07) in the occurrence of successful weaning from mechanical ventilation. Conclusions: This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management. Qualified high-intensity nurse staffing and routine Australian intensive care unit nursing responsibility for many aspects of ventilatory practice may explain the contrast between these findings and some recent North American studies. (C) 2008 Lippincott Williams & Wilkins, Inc.

An examination of the consistency of investigative interviewers' performance

Three original studies were conducted to examine the consistency of investigative-interviewer performance across similar and distinct interview tasks. Overall, the degree of consistency depended on numerous factors, including the nature of the event and interview paradigm, the precision of the assessment measure and whether group versus individual stability was measured. The portfolio highlights and discusses some of the complexities that can arise when conducting a parenting capacity assessment with a patient who has, or is suspected of having, an intellectual disability. Four case studies are presented.

Assessment of measures of physical activity of children with cerebral palsy at home and school: a pilot study

ABSTRACT
Home and school are important settings where children can accrue health promoting physical activity (PA). Little is known about the PA levels and associated environmental characteristics at home and school in children with cerebral palsy (CP). An observational tool - Behaviors of Eating and Activity for Children’s Health Evaluation System (BEACHES) - offers potential for providing information.

Model to predict inpatient mortality from information gathered at presentation to an emergency department: The Triage Information Mortality Model (TIMM)

OBJECTIVES: To derive and validate a mortality prediction model from information available at ED triage. METHODS: Multivariable logistic regression of variables from administrative datasets to predict inpatient mortality of patients admitted through an ED. Accuracy of the model was assessed using the receiver operating characteristic area under the curve (ROC-AUC) and calibration using the Hosmer-Lemeshow goodness of fit test. The model was derived, internally validated and externally validated. Derivation and internal validation were in a tertiary referral hospital and external validation was in an urban community hospital. RESULTS: The ROC-AUC for the derivation set was 0.859 (95% CI 0.856-0.865), for the internal validation set was 0.848 (95% CI 0.840-0.856) and for the external validation set was 0.837 (95% CI 0.823-0.851). Calibration assessed by the Hosmer-Lemeshow goodness of fit test was good. CONCLUSIONS: The model successfully predicts inpatient mortality from information available at the point of triage in the ED.

Sodium bicarbonate infusion in patients undergoing orthotopic liver transplantation: a single center randomized controlled pilot trial

BACKGROUND: Liver transplantation-associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation-associated AKI. METHODS: In this double-blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0.9% sodium chloride (n = 30). Primary outcome: AKI within the first 48 h post-operatively.RESULTS: There were no significant differences between the two treatment groups with regard to baseline characteristics, model for end-stage liver disease and acute physiology and chronic health evaluation (APACHE) II scores, and pre-transplantation renal function. Intra-operative factors were similar for duration of surgery, blood product requirements, crystalloid and colloid volumes infused and requirements for vasoactive therapy. Eleven patients (37%) in the bicarbonate group and 10 patients (33%) in the sodium chloride group developed a post-operative AKI (p = 0.79). Bicarbonate infusion attenuated the degree of immediate post-operative metabolic acidosis; however, this effect dissipated by 48 h. There were no significant differences in ventilation hours, ICU or hospital length of stay, or mortality. CONCLUSIONS: The intra-operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.

Evaluation of the environments for health framework

Environments for Health, Five Years On…
Since its release in 2001, Victoria’s Environments for Health Municipal Public Heath Planning Framework, has represented a leading edge approach to supporting quality public health planning at the local government level.

In 2006 the Department of Human Services appointed an external evaluation team from Deakin and Melbourne Universities to assess the introduction of the Environments for Health framework to municipal public health planning and to make recommendations for its future direction.

The evaluation aimed to determine the extent to which Environments for Health and related implementation activities had:

* been incorporated by local governments in their policies and practices
* created greater opportunities for health gain, and
* been supported effectively by the Department of Human Services and other stakeholders

The evaluation project involved participation from a broad range of key stakeholders, including all local Councils within Victoria. Data collection covered four distinct stages - document analysis, key informant interviews, state-wide survey of practitioners, and council and stakeholder forums, all with opportunities for input to the evaluation.

Quantitative evaluation in health promotion : What's the difference?

This is the third in a series of articles on quantitative evaluation in health promotion written by Damien Jolley for the Health Promotion Journal of Australia. The first of these articles, published in the December 2000 issue, discussed the ideas behind sample surveys and how they can be used to improve evaluation of health promotion initiatives.1 The second, in the April 2001 issue, discussed confidence intervals in more detail and presented some strategies for computing confidence intervals for population percentages, both manually and using appropriate computer software. 2