Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system

OBJECTIVES: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. MAIN OUTCOME MEASURES: Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. RESULTS: Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P < 0.001). CONCLUSIONS: About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.

Addressing migration-related social and health inequalities in Australia: call for research funding priorities to recognise the needs of migrant populations

Objective Migrants constitute 26% of the total Australian population and, although disproportionately affected by chronic diseases, they are under-represented in health research. The aim of the present study was to describe trends in Australian Research Council (ARC)- and National Health and Medical Research Council (NHMRC)-funded initiatives from 2002 to 2011 with a key focus on migration-related research funding.Methods Data on all NHMRC- and ARC-funded initiatives between 2002 and 2011 were collected from the research funding statistics and national competitive grants program data systems, respectively. The research funding expenditures within these two schemes were categorised into two major groups: (1) people focused (migrant-related and mainstream-related); and (2) basic science focused. Descriptive statistics were used to summarise the data and report the trends in NHMRC and ARC funding over the 10-year period.Results Over 10 years, the ARC funded 15 354 initiatives worth A$5.5 billion, with 897 (5.8%) people-focused projects funded, worth A$254.4 million. Migrant-related research constituted 7.8% of all people-focused research. The NHMRC funded 12 399 initiatives worth A$5.6 billion, with 447 (3.6%) people-focused projects funded, worth A$207.2 million. Migrant-related research accounted for 6.2% of all people-focused initiatives.Conclusions Although migrant groups are disproportionately affected by social and health inequalities, the findings of the present study show that migrant-related research is inadequately funded compared with mainstream-related research. Unless equitable research funding is achieved, it will be impossible to build a strong evidence base for planning effective measures to reduce these inequalities among migrants.What is known about the topic? Immigration is on the rise in most developing countries, including Australia, and most migrants come from low- and middle-income countries. In Australia, migrants constitute 26% of the total Australian population and include refugee and asylum seeker population groups. Migrants are disproportionately affected by disease, yet they have been found to be under-represented in health research and public health interventions.What does this paper add? This paper highlights the disproportions in research funding for research among migrants. Despite migrants being disproportionately affected by disease burden, research into their health conditions and risk factors is grossly underfunded compared with the mainstream population.What are the implications for practitioners? Migrants represent a significant proportion of the Australian population and hence are capable of incurring high costs to the Australian health system. There are two major implications for practitioners. First, the migrant population is constantly growing, therefore integrating the needs of migrants into the development of health policy is important in ensuring equity across health service delivery and utilisation in Australia. Second, the health needs of migrants will only be uncovered when a clear picture of their true health status and other determinants of health, such as psychological, economic, social and cultural, are identified through empirical research studies. Unless equitable research funding is achieved, it will be impossible to build a strong evidence base for planning effective measures to reduce health and social inequalities among migrant communities.

Collaborating together: finding the emergent and disruptive in and between the fields of music therapy and medical rthnomusicology

Editorial for special issue

Psychological health and lifestyle management preconception and in pregnancy

Healthful lifestyles before and during pregnancy are important to facilitate healthy outcomes for mother and baby. For example, behaviors such as a sedentary lifestyle and consuming an energy-dense/nutrient-poor diet increase the risk of overweight/obesity before pregnancy and excessive weight gain during pregnancy, leading to adverse maternal and child health outcomes. Maternal psychopathology may be implicated in the development of suboptimal maternal lifestyle behaviors before and during pregnancy, perhaps through impacts on motivation. This article explores this notion using maternal obesity and excessive gestational weight gain as examples of the health impacts of psychological states. We suggest that factors such as psychological well-being, individual motivation for behavior change, and broader environmental influences that affect both individual and system-wide determinants all play important roles in promoting healthy lifestyles periconception and are key modifiable aspects for intervention designers to consider when trying to improve dietary behaviors and increase physical activity before and during pregnancy. In addition, implementing system-wide changes that impact positively on individual and environmental barriers to behavior change that are sustainable, measureable, and effective is required.

Predictors of awareness of standard drink labelling and drinking guidelines to reduce negative health effects among Australian drinkers

INTRODUCTION AND AIMS: This study examined rates of awareness of standard drink labelling and drinking guidelines among Australian adult drinkers. Demographic predictors of these two outcomes were also explored.

DESIGN AND METHODS: Online survey panel participants aged 18-45 years(n = 1061; mean age = 33.2 years) completed an online survey assessing demographics, alcohol consumption patterns, awareness of standard drink labels and the National Health and Medical Research Council (NHMRC) guidelines, and support for more detailed labels.

RESULTS: The majority (80%) of participants had seen standard drink labels on alcohol products; with younger drinkers, those from a regional/rural location and high-risk drinkers significantly more likely to have seen such labelling. Most respondents estimated at or below the maximum number of drinks stipulated in the NHMRC guidelines. However, their estimates of the levels for male drinkers were significantly higher than for female drinkers. High-risk drinkers were significantly less likely to provide accurate estimates, while those who had seen the standard drink logo were significantly more likely to provide accurate estimates of drinking levels to reduce the risk of long-term harms only. Just under three-quarters of respondents supported the inclusion of more information on labels regarding guidelines to reduce negative health effects.

DISCUSSION AND CONCLUSIONS: The current standard drink labelling approach fails to address high-risk drinkers. The inclusion of information about NHMRC guidelines on alcohol labels, and placing standard drink labelling on the front of products could improve awareness of what constitutes a standard drink and safe levels of consumption among Australian drinkers.

The Centre of Clinical Research Excellence in Aboriginal Health : an operational rationale and some reflections on progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

Enviromental health

Edited by two leading public health physicians with chapters written by 48 experts in various aspects of social injustice, this book addresses social injustice and its relationship to public health. Major sections of the book focus on how the health of specific population groups is affected by social injustice, how specific areas of public health and medical care are affected by social injustice, and what needs to be done to reduce social injustice and its impact on health. This book will be of value to a wide range of practitioners and students in health and human services, including medicine, nursing, and social services, as well as in law and other fields.

Playing their part: the role of physical activity and sport in sustaining the health and well being of small rural communities

It is widely recognised that the health of rural Australians is poor in comparison with their urban counterparts. Similarly, the role played by physical activity in maintaining health has been well researched and is well documented. However, little appears to have been published in recent years about the links between physical activity and health in rural communities. The objective of this article was to begin to address that gap. To achieve this, the article drew on research conducted in two small rural communities in Victoria Australia, and highlighted the role that physical activity and sport played in sustaining the health and wellbeing of individuals and communities in rural areas. Taking the World Health Organisation's definition of health (a state of complete physical, mental and social well-being and not merely the absence of disease) as its measure, the paper highlighted the many ways in which physical activity and sport in rural communities contribute to physical health, mental wellbeing and social cohesiveness. Based this finding, the authors suggest that physical activity and sport make a significant contribution to the health and wellbeing of rural people and their communities and suggest that further research is necessary to better define this apparent contribution.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Governing the Stressed Self: teacher "health and well-being" and "effective schools"

In diverse arenas there is much discussion about the dangerousness of contemporary lifestyles, including the stressful nature of work. These stresses associated with contemporary lifestyles and work are dangerous in so far as they are conceived as placing at risk the emotional, physical and psychic health and well-being of large populations. In this paper we engage with debates about the stressful nature of teachers' work, and the ways in which teacher health and well-being are constructed as being central to the task of delivering more effective schools. In this article we are not so much concerned with the nature of teacher stress as an indication of individual physical, emotional or psychic health and well-being, as with understanding how it is that at this particular historical juncture the self can be so widely conceived in terms of stress. Moreover, what processes make it possible at this moment to link the success or otherwise of a massive institutional process of state-regulated schooling to the health and well-being of teachers and the management of this health and well-being by school managers? We argue that in a policy context that devolves various responsibilities to self-managing schools, the government of the stressed self emerges as an ethical concern for teachers and those who manage them (Foucault, The Use of Pleasure , New York, Pantheon, 1985). Our purpose is to problematise these processes so that responsibilities for delivering on the promise of effective schools might be differently framed and debated.

Incentive or deterrent: which encourages greater focus on health and safety in the Victorian construction industry?

The Australian Government commissioned a Royal Commission into the building industry in Australia that reported to Parliament in August 2002. Volume 6 of this report, released in February 2003, discussed certain aspects in occupational health and safety in Australia and leaned toward deterrents as a means of achieving reform. This research defines both incentives and deterrents used to increase awareness of, and improve safety on, building sites in Victoria, a state of Australia. A pilot survey questionnaire was developed following a literature review and industry employer representatives were invited to participate. Industry awareness of Government incentive programmes was found to be low, with less than a quarter stating they read Government strategies. One fund that provides actual research monies into health and safety was known to very few of the respondents. Of the employers surveyed, the majority agreed that financial fines do act as a valid deterrent. Increases in worker compensation premiums were seen as the greatest deterrent due to the effect on company overheads and thus competitive tendering bids. Deterrent programmes were more readily acknowledged by employers as they had an element of self promotion with employers attempting to avoid their application.