Palliative care phase : inter-rater reliability and acceptability in a national study

Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. Aim: To test the reliability and acceptability of revised definitions of Palliative Care Phase. Design: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. Setting/participants: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. Results: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. Conclusion: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking

PURPOSE Every health care sector including hospice/palliative care needs to systematically improve services using patient-defined outcomes. Data from the national Australian Palliative Care Outcomes Collaboration aims to define whether hospice/palliative care patients' outcomes and the consistency of these outcomes have improved in the last 3 years. METHODS Data were analysed by clinical phase (stable, unstable, deteriorating, terminal). Patient-level data included the Symptom Assessment Scale and the Palliative Care Problem Severity Score. Nationally collected point-of-care data were anchored for the period July-December 2008 and subsequently compared to this baseline in six 6-month reporting cycles for all services that submitted data in every time period (n = 30) using individual longitudinal multi-level random coefficient models. RESULTS Data were analysed for 19,747 patients (46 % female; 85 % cancer; 27,928 episodes of care; 65,463 phases). There were significant improvements across all domains (symptom control, family care, psychological and spiritual care) except pain. Simultaneously, the interquartile ranges decreased, jointly indicating that better and more consistent patient outcomes were being achieved. CONCLUSION These are the first national hospice/palliative care symptom control performance data to demonstrate improvements in clinical outcomes at a service level as a result of routine data collection and systematic feedback.

Prescribing for nausea in palliative care : A cross-sectional national survey of Australian palliative medicine doctors

Background: Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable. Objective: The aim of this study was to codify the current clinical approaches and quantify any variation found nationally. Methods: A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first- and second-line antiemetic choices, commencing and maximal dose, and time to review were collected. Results: Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was “small, frequent snacks.” Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold. Conclusion: For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.

Harmonising occupational health and safety regulation in Australia: The first report of the national OHS review

The Australian government had set up a major National Review into Model Occupational Health and Safety Laws (National OHS Review) to examine the Occupational health and safety (OHS) statutes in Australia to identify areas of best practice, common practice and inconsistency and to make recommendations for a model OHS Act. The article analyses the first report of the review panel.

Healthcare-associated infections in Australia : time for national surveillance

Abstract Objective. Healthcare-associated infection (HAI) surveillance programs are critical for infection prevention. Australia does not have a comprehensive national HAI surveillance program. The purpose of this paper is to provide an overview of established international and Australian statewide HAI surveillance programs and recommend a pathway for the development of a national HAI surveillance program in Australia. Methods. This study examined existing HAI surveillance programs through a literature review, a review of HAI surveillance program documentation, such as websites, surveillance manuals and data reports and direct contact with program representatives. Results. Evidence from international programs demonstrates national HAI surveillance reduces the incidence of HAIs. However, the current status of HAI surveillance activity in Australian states is disparate, variation between programs is not well understood, and the quality of data currently used to compose national HAI rates is uncertain. Conclusions. There is a need to develop a well-structured, evidence-based national HAI program in Australia to meet the increasing demand for validated reliable national HAI data. Such a program could be leveraged off the work of existing Australian and international programs.

National working group meeting on ALK diagnostics in lung cancer

The global landscape of molecular testing is rapidly changing, with the recent publication of the International Association for the Study of Lung Cancer (IASLC)/College of American Pathologists (CAP) guidelines and the ALK Atlas. The IASLC/CAP guidelines recommend that tumors from patients with non-small cell lung cancer (NSCLC) be tested for ALK rearrangements in addition to epidermal growth factor receptor (EGFR) mutations. The spur for this recommendation is the availability of novel therapies that target these rearrangements. This article is based on coverage of a Pfizer-sponsored National Working Group Meeting on ALK Diagnostics in Lung Cancer, held around the 15th World Lung Cancer Conference, in Sydney on October 31, 2013. It is based on the presentations given by the authors at the meeting and the discussion that ensued. The content for this article was discussed and agreed on by the authors.

Metal Skin and the cinema of noise

In traditional communication and information theory, noise is the demon Other, an unwelcome disruption in the passage of information. Noise is "anything that is added to the signal between its transmission and reception that is not intended by the source...anything that makes the intended signal harder to decode accurately". It is in Michel Serres' formulation, the "third man" in dialogue who is always assumed, and whom interlocutors continually struggle to exclude. Noise is simultaneously a condition and a by-product of the act of communication, it represents the ever present possibility of disruption, interruption, misunderstanding. In sonic or musical terms noise is cacophony, dissonance. For economists, noise is an arbitrary element, both a barrier to the pursuit of wealth and a basis for speculation. For Mick (Jeremy Sims) and his mate Kev (Ben Mendelsohn) in David Caesar's Idiot Box (1996), as for Hando (Russell Crowe) and his gang of skinheads in Geoffrey Wright's Romper Stomper (1992), or Dazey (Ben Mendelsohn) and Joe (Aden Young) in Wright's Metal Skin (1994) and all those like them starved of (useful) information and excluded from the circuit - the information poor - their only option, their only point of intervention in the loop, is to make noise, to disrupt, to discomfort, to become Serres' "third man", "the prosopopoeia of noise" (5).

Prosecution of maritime pirates : the national court is dead—long live the national court

Piracy is one of the main maritime security concerns in the contemporary world. The number of piracy incidents is increasing rapidly, which is highly problematic for maritime security. Although international law provides universal jurisdiction for the prosecution of maritime pirates, the actual number of prosecutions is alarmingly low compared to the number of incidents of piracy. Despite many states becoming parties to the relevant international conventions, they are reluctant to establish the necessary legal and institutional frameworks at the national level for the prosecution of pirates. The growing incidences of piracy and the consequential problems associated with prosecuting pirates have created doubts about the adequacy of the current international legal system, which is fully dependent on national courts for the prosecution of pirates. This article examines the possible ways for ensuring the effective prosecution of pirates. Contrary to the different proposals forwarded by researchers in the wake of Somali piracy for the establishment of international judicial institutions for the prosecution of pirates, this article argues that the operationalization of national courts through the proper implementation of relevant international legal instruments within domestic legal systems is the most viable solution. However, this article submits that the operationalization of national courts will not be very successful following the altruistic model of universal adjudicative jurisdiction. A state may enact legislation implementing universal jurisdiction but will not be very interested in prosecuting a pirate in its national court if it has no relation with the piratical incident. Rather, it will be successful if the global community seriously implement the Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation (SUA Convention), which obligates the states that have some connection with a piratical incident to prosecute pirates in their national courts.

Explore Darwin and Litchfield National Park in the Northern Territory

The city as it now stands marks the fifth attempt at a settlement in the north. Fearful of Dutch territorial claims, the British were sure they had to establish a permanent base, and acted quickly to get one started. They had more than a little trouble getting one to work...

Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: A national one-day snapshot

Aim Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia. Methods Malnutrition, obesity and nutritional risk prevalence were investigated in 832 and 570 paediatric inpatients, respectively, in eight tertiary paediatric hospitals and eight regional hospitals across Australia on a single day. Malnutrition and obesity prevalence was determined using z-scores and body mass index (BMI) percentiles. High nutritional risk was determined as a Paediatric Yorkhill Malnutrition Score of 2 or more. Results The prevalence rates of malnourished, wasted, stunted, overweight and obese paediatric patients were 15%, 13.8%, 11.9%, 8.8% and 9.9%, respectively. Patients who identified as Aboriginal and Torres Strait Islander were more likely to have lower height-for-age z-scores (P < 0.01); however, BMI and weight-for-age z-scores were not significantly different. Children who were younger, from regional hospitals or with a primary diagnosis of cardiac disease or cystic fibrosis had significantly lower anthropometric z-scores (P = 0.05). Forty-four per cent of patients were identified as at high nutritional risk and requiring further nutritional assessment. Conclusions The prevalence of malnutrition and nutritional risk of Australian paediatric inpatients on a given day was much higher when compared with the healthy population. In contrast, the proportion of overweight and obese patients was less.

Australian horror movies and the American market

In Australian cinema since the mid-2000s, horror has become a popular and at times commercially viable genre for low-budget and emerging filmmakers targeting international markets. While the annual horror film output of Australia pales in comparison to that of other Anglophone nations like the United States, Great Britain, and Canada, it has produced several significant titles that have performed moderately well at the international box office, from Wolf Creek (Greg McLean, 2005) to Daybreakers (Michael and Peter Spierig, 2009). Yet as part of a broader tradition of Anglophone horror cinema, many Australian horror movies have been heavily influenced by US and to a lesser extent British horror films. Furthermore, Australian horror film production is largely an internationally-oriented sector that relies on its relationships with overseas distributors and often investors. Consequently, the content and style of Australian horror movies have regularly been tailored for international markets. As a direct consequence some filmmakers have sought to trade on the “Australianness” of their product, others have attempted to pass off their films as faux-American, while others still have attempted to develop placeless films effaced of national reference points. This chapter examines local production as part of a broader tradition of Anglophone horror cinema, the influence of US horror movies, and the limitations of the domestic marketplace. The article concludes with an analysis of how the lure of the US market influences Australian filmmakers’ textual strategies.

Globalisation and national curriculum reform in Australia : the push for Asia literacy

This chapter explores the policy context for the push for a national curriculum and the inclusion of Asia literacy for schooling in Australia in the light of current links between globalisation, education and policy analysis and the notion of the learning/knowledge society of the twenty-first century. It is anticipated that discussion of the Australian context will be insightful for those other nations concerned with positioning Asia in school curricula, including for example, New Zealand, Canada, USA and UK. In doing so, the chapter considers the challenges to the implementation of Asia literacy in Australia with specific reference to current and future teachers for, as with many nations, the teaching profession in Australia is on the cusp of generational change as large numbers of teachers aged in their mid to late fifties embark on retirement (Teaching Australia, 2007). A major challenge in addressing these demographic shifts in Australia, lies with meeting the demand for replacement teachers and preparing future teachers (Skilbeck, & Connell, 2004; McKenzie, 2012) with Asia-related knowledge.

Changes in healthcare-associated infections after the introduction of a national hand hygiene initiative

Introduction: Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effectiveway to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections. Methods: We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, centralline associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Staphylococcus aureus bacteraemia and surgical site infections. Results: The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia. Conclusions: The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative’s introduction.

Teacher education for high poverty schools : the National Exceptional Teachers for Disadvantaged Schools program

A vital element to improve outcomes for disadvantaged students is outstanding teachers. A reality, however, is that teacher graduates in the top quartile of academic scores are far less likely to accept positions in tough urban, regional, rural and remote schools. Further, because high poverty schools can be challenging environments, these teachers are retained for much shorter periods of time. In response to this challenge, the National Exceptional Teachers for Disadvantaged Schools program (NETDS) creates a pathway for the highest quality pre-service teachers to be fully prepared, professionally and personally, for roles within high poverty schools. The program identifies the highest-achieving mainstream preservice teachers in university programs across the country and offers them a specialised curriculum and supported practicum experience in a network of disadvantaged partner schools. By working closely with government, philanthropy and partner schools, the program also works to channel these exceptional pre-service teachers into employment in schools where they will have the greatest impact. Its initial results have been exceptional: over 90% of graduates are now employed as teachers in high poverty schools. This paper will discuss their research on how they are working to build the infrastructure and capacity for research on innovations that prepare teachers for 21st century schools in the Australian context.