The interface of acute and aged care : the role of the nurse in a provincial area

Objective This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the large amount of data collected during this project, that is,the role of the nurse in the continuum of health care involving elderly people. Method The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients. Results The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge. Conclusion The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Shifting global power and shifting state power

The adoption of the Declaration on the Rights of Indigenous Peoples (DRIP) by the United Nations General Assembly in September 2007 has been heralded by many as a major breakthrough in the promotion of Indigenous rights under international law. Many however are sceptical as to whether DRIP actually promotes Indigenous rights or rather limits them in ways that serve the interests of nation states thereby diminishing the universality of human rights with respect to Indigenous peoples. This paper will examine how shifts in global power from the United States to the BRIC nations (Brazil, Russia, India and China) are likely to impact on the realisation of the right of self determination for Indigenous peoples. It will start by outlining the right of self determination as articulated in the Declaration, and in particular how the United States and its allies - the CANZUS group (Canada, Australia, New Zealand and United States) - were influential in shaping its form and content. The paper will then assess the extent to which the right to self determination is realised in Australia, the United States and the BRJC nations to provide an indication of the likely future direction of recognition and realisation of Indigenous rights at a global level.

Validation of the interRAI Cognitive Performance Scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients

Objective To compare the diagnostic accuracy of the interRAI Acute Care (AC) Cognitive Performance Scale (CPS2) and the Mini-Mental State Examination (MMSE), against independent clinical diagnosis for detecting dementia in older hospitalized patients. Design, Setting, and Participants The study was part of a prospective observational cohort study of patients aged ≥70 years admitted to four acute hospitals in Queensland, Australia, between 2008 and 2010. Recruitment was consecutive and patients expected to remain in hospital for ≥48 hours were eligible to participate. Data for 462 patients were available for this study. Measurements Trained research nurses completed comprehensive geriatric assessments and administered the interRAI AC and MMSE to patients. Two physicians independently reviewed patients’ medical records and assessments to establish the diagnosis of dementia. Indicators of diagnostic accuracy included sensitivity, specificity, predictive values, likelihood ratios and areas under receiver (AUC) operating characteristic curves. Results 85 patients (18.4%) were considered to have dementia according to independent clinical diagnosis. The sensitivity of the CPS2 [0.68 (95%CI: 0.58–0.77)] was not statistically different to the MMSE [0.75 (0.64–0.83)] in predicting physician diagnosed dementia. The AUCs for the 2 instruments were also not statistically different: CPS2 AUC = 0.83 (95%CI: 0.78–0.89) and MMSE AUC = 0.87 (95%CI: 0.83–0.91), while the CPS2 demonstrated higher specificity [0.92 95%CI: 0.89–0.95)] than the MMSE [0.82 (0.77–0.85)]. Agreement between the CPS2 and clinical diagnosis was substantial (87.4%; κ=0.61). Conclusion The CPS2 appears to be a reliable screening tool for assessing cognitive impairment in acutely unwell older hospitalized patients. These findings add to the growing body of evidence supporting the utility of the interRAI AC, within which the CPS2 is embedded. The interRAI AC offers the advantage of being able to accurately screen for both dementia and delirium without the need to use additional assessments, thus increasing assessment efficiency.

Queensland diabetic foot hospitalisations (2005-10) : in what state is our foot hospital problem?

Background Diabetes foot complications are a leading cause of overall avoidable hospital admissions. Since 2006, the Queensland Diabetes Clinical Network has implemented programs aimed at reducing diabetes-related hospitalisation. The aim of this retrospective observational study was to determine the incidence of diabetes foot-related hospital admissions in Queensland from 2005 to 2010. Methods Data on all primary diabetes foot-related admissions in Queensland from 2005-2010 was obtained using diabetes foot-related ICD-10-AM (hospital discharge) codes. Queensland diabetes foot-related admission incidences were calculated using general population data from the Australian Bureau of Statistics. Furthermore, diabetes foot-related sub-group admissions were analysed. Chi-squared tests were used to assess changes in admissions over time. Results Overall, 24,917 diabetes foot-related admissions occurred, resulting in the use of 260,085 bed days or 1.4% of all available Queensland hospital bed days (18,352,152). The primary reasons for these admissions were foot ulcers (49.8%), cellulitis (20.7%), peripheral vascular disease (17.8%) and osteomyelitis (3.8%). The diabetes foot-related admission incidence among the general population (per 100,000) reduced by 22% (103.0 in 2005, to 80.7 in 2010, p < 0.001); bed days decreased by 18% (1,099 to 904, p < 0.001). Conclusion Diabetes foot complications appear to be the primary reason for 1.4 out of every 100 hospital beds used in Queensland. There has been a significant reduction in the incidence of diabetes foot-related admissions in Queensland between 2005 and 2010. This decrease has coincided with a corresponding decrease in amputations and the implementation of several diabetes foot clinical programs throughout Queensland.

Flag state responsibility for maritime terrorism

Modern international shipping is largely a flag state-based system. Only the flag state has complete authority over the vessels that fly its flag, and as a result, other states’ jurisdiction over these vessels is very limited. Against this backdrop, this article examines the flag state’s responsibility for maritime terrorism, a major security issue and vulnerability in the global supply chain. It is not an exaggeration that the global community’s repeated statements regarding the illegality of terrorism have created a customary international law obligation for states to take all possible steps for the prevention of terrorism. This article argues that providing flags to suspicious entities in an obscure registration system is not compatible with this obligation.

State responsibility for maritime terrorism

Maritime terrorism is one of the main maritime security issues in the contemporary world. The threat of maritime terrorism is more apparent than ever in the post-September 11 era. Although maritime terrorism is an old issue, the disastrous events of 11 September 2001 brought this issue again onto the global agenda. This incident brought to the forefront the longstanding concerns that terrorists could severely disrupt the global maritime supply chain by using shipping containers or vessels to attack major business centres, port facilities and offshore installations. A number of international criminal law studies have been conducted to identify international legal challenges in maritime security. Some of these works have critically examined the international legal framework for maritime security and identified the lacunas in the existing system. Some of these writings have also identified that emerging maritime terrorism issues are prompting States to introduce some stringent measures. Although the international legal regime related to maritime terrorism is a well-researched area, very little research work has explored the legal issues related to State responsibility for maritime terrorism. This article argues that, although the United Nations Convention on the Law of the Sea (UNCLOS) provisions related to maritime piracy may not be applicable for some dimensions of maritime violence, different provisions of UNCLOS may relevant in identifying State responsibility for maritime terrorism.

The Australian welfare state : who benefits now?

This text outlines the links between Australian's conceptions about welfare and the redistributive outcomes of the welfare state, canvassing theoretical explanations about why many Australians develop and maintain misconceptions of the broad disyributive mechanisms of the Ayustralian welfare state and hold negative attitudes towards its social welfare element. The book is an indispensable resource for students undertaking studies in sociology, social policy, public administrion and social work.

Work and the Welfare State : Street-Level Organizations and Workfare Politics

Work and the Welfare State places street-level organizations at the analytic center of welfare state politics, policy and management. This volume offers a critical examination of efforts to change the welfare state to a workfare state by looking at on-the-ground issues in six countries: the United States, United Kingdom, Australia, Denmark, Germany and the Netherlands.

Traffic state estimation from partial Bluetooth and volume observations : case study in the Brisbane metropolitan area

The application of the Bluetooth (BT) technology to transportation has been enabling researchers to make accurate travel time observations, in freeway and arterial roads. The Bluetooth traffic data are generally incomplete, for they only relate to those vehicles that are equipped with Bluetooth devices, and that are detected by the Bluetooth sensors of the road network. The fraction of detected vehicles versus the total number of transiting vehicles is often referred to as Bluetooth Penetration Rate (BTPR). The aim of this study is to precisely define the spatio-temporal relationship between the quantities that become available through the partial, noisy BT observations; and the hidden variables that describe the actual dynamics of vehicular traffic. To do so, we propose to incorporate a multi- class traffic model into a Sequential Montecarlo Estimation algorithm. Our framework has been applied for the empirical travel time investigations into the Brisbane Metropolitan region.

A state-wide systems approach to embedding the learning and teaching of sustainability in teacher education

Education systems have a key role to play in preparing future citizens to engage in sustainable living practices and help create a more sustainable world. Many schools throughout Australia have begun to develop whole-school approaches to sustainability education that are supported by national and state policies and curriculum frameworks. Preservice teacher education, however, lags behind in building the capacity of new teachers to initiate and implement such approaches (ARIES, 2010). This proposed project seeks to develop a state-wide systems approach to embedding Education for Sustainability (EfS) in teacher education that is aligned with the Australian National Curriculum and the aspirations for EfS in the Melbourne Declaration and other national documents. Representatives from all teacher education institutions and other agents of change in the Queensland education system will be engaged in a multilevel systems approach, involving collaboration at the state, institutional and course levels, to develop curriculum practices that reflect a shared vision of EfS.

The Current State of BPM Education in Australia : Teaching and Research Challenges

As business processes, services and relationships, are now recognized as key organizational assets, the demand for the so-called boundaryspanning roles and process-aware professionals is continuing to grow. The world-wide demand for these roles will continue to increase, fueled by the unprecedented interest in Business Process Management (BPM) and the other emerging cross-functional disciplines. This, in turn, creates new opportunities, as well as some unforeseeable challenges for BPM education, both in university and industry. This paper reports on an analysis of the current BPM offerings of Australian universities. It presents a critical review of what is taught and how it is taught, and identifies a series of gaps and concerns. Explanations and recommendations are proposed and a call made for BPM educators worldwide, for urgent action.