Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Individual foraging site fidelity in lactating New Zealand fur seals : Continental shelf vs. oceanic habitats

Wide-ranging marine central place foragers often exhibit foraging site fidelity to oceanographic features over differing spatial scales (i.e., localized coastal upwellings and oceanic fronts). Few studies have tested how the degree of site fidelity to foraging areas varies in relation to the type of ocean features used. In order to determine how foraging site fidelity varied between continental shelf and oceanic foraging habitats, 31 lactating New Zealand fur seals (Arctocephalus australis forsteri1) were satellite tracked over consecutive foraging trips (14–108 d). Thirty-seven foraging trips were recorded from 11 females that foraged on the continental shelf, in a region associated with a coastal upwelling, while 65 foraging trips were recorded from 20 females that foraged in oceanic waters. There were no significant differences in the mean bearings (to maximum distance) of individual's consecutive foraging trips, suggesting individual fidelity to foraging areas. However, overlap in area and time spent in area varied considerably between continental shelf and oceanic foragers. Females that foraged on the continental shelf had significantly greater overlap in consecutive foraging trips when compared to females that foraged in oceanic waters (overlap in 5 × 5 km grid cells visited on consecutive trips 55.9%± 20.4% and 13.4%± 7.6%, respectively). Females that foraged on the continental shelf also spent significantly more time within the same grid cell than females that foraged in oceanic waters (maximum time spent in 5 × 5 km grid cells: 14%± 5% and 4%± 2%, respectively). This comparatively high foraging site fidelity may reflect the concentration of productivity associated with a coastal upwelling system, the Bonney Upwelling. Lower foraging site fidelity recorded by seals that foraged in oceanic waters implies a lower density/larger scale habitat, where prey are more dispersed or less predictable at fine scales, when compared to the continental shelf region.

A study of children’s musical preference: A data mining approach

Musical preference has long been a research interest in the field of music education, and studies consistently confirm the importance of musical preference in one’s musical learning experiences. However, only a limited number of studies have been focussed on the field of early childhood education (e.g., Hargreaves, North, & Tarrant, 2006; Roulston, 2006). Further, among these limited early childhood studies, few of them discuss children’s musical preference in both the East and the West. There is very limited literature (e.g., Faulkner et al., 2010; Szymanska, 2012) which explores the data by using a data mining approach. This study aims to bridge the research gaps by examining children’s musical preference in Hong Kong and in South Australia by applying a data mining technique – Self Organising Maps (SOM), which is a clustering method that groups similar data objects together. The application of SOM is new in the field of early childhood education and also in the study of children’s musical preference. This paper specifically aims to expand a previous study (Yim & Ebbeck, 2009) by conducting deeper investigations into the existing datasets, for the purpose of uncovering insights that have not been identified through data mining approach.

The stress of fire fighting - implications for long term health outcomes

Fire and rescue staff routinely endure significant psychological and environmental stress exposure on the job. While much has been done to improve understanding of the physiological effects of exposure to these conditions, little has been done to quantify the inflammatory stress response that firefighters are exposed to during wildfire suppression. Therefore the aim of the present study was to explore whether firefighters experienced a change in inflammatory markers following one day, and across two days of wildfire suppression tasks. Twelve male fire-fighters participated in two consecutive days of live-fire prescribed burn operations in Ngarkat National Park, South Australia. Typical work tasks included lighting burns, patrolling containment lines, supressing spot fires, and operating vehicles. A number of the inflammatory markers changed significantly across the course of a shift and several presented with an attenuated response across the second day. This finding implies that there was a compounding effect of repeated exposure to these stressors which could have considerable implications for managing fire-fighters health and wellbeing over a multi-day campaign. Further research is required to see which fire ground stressor, or combination of stressors is causing these changes in the inflammatory markers across consecutive work shifts.

Postcolonial theory and cross-culturalism : collaborative ‘signposts’ of discursive practices

This paper is a forerunner of a detailed piece of work. It explores the notions of postcolonial theory and cross-culturalism, and whether they can be regarded as collaborative ‘signposts’ of discursive practices. The aim of this paper is to move beyond the contemporary constructs of race, culture and identification and into the arena of hybridity and multiplicity and the constituting and reconstituting of self. In this discussion, I will first outline the notions of postcolonial theory and cross-culturalism, and then explore focal points of collaborative discursive practices. In doing so, I will discuss perceptions of language and discourse and their relationships to postcolonial theory and cross-culturalism. In the context of this topic, I shall use Australia as an example of a diverse community and English as the language being discussed under the term ‘discursive practices’.

Workplace bullying a risk for permanent employees

Objective: We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. Methods: A cross-sectional population-based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self-report into four categories: permanent, casual, fixed-term and self-employed. Self-report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. Results: Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed-term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never-married workers. Conclusions: Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. Implications: A finer understanding of psycho-social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment.

Storm versus calm : Variation in fauna associated with drifting macrophytes in sandy beach surf zones

New insights about nearshore dynamics came from studying the effects of regular storms in South Australia on drifting marine macrophytes, consequent wrack accumulation and associated fauna in beach surf zones across three different regions. This study examined whether the influence of storms may be more pronounced in sheltered coastal waters compared to more exposed coastlines where biota could have adaptations to persist in larger swell conditions. There were obvious regional differences for wrack species richness, abundances and assemblages that matched the attached floral subtidal landscape in each region. Consequently, invertebrates also differed amongst regions, which highlight the close affinity that some invertebrates have with drifting macrophytes. Fish were not so closely aligned to the regional patterns identified for wrack or invertebrates suggesting that many fish are using wrack accumulations as habitat but, being highly mobile, they may actively and constantly move into, out of and within these habitat features. Well-known beach-type models focused upon beach morphology may be more pertinent to the ecology of the surf zones offshore than previously thought, being the most consistent indicator of wrack accumulations and their fauna. This new evidence on the ecology of nearshore waters during storm versus calm weather in multiple regions and the subsequent influence on wrack-fauna associations in sandy-beach surf zones are important for future beach management, particularly when and where large wrack accumulations occur.