Inclusive housing in Australia – a voluntary response

The lack of inclusive housing in Australia contributes to the marginalization and exclusion of people with disability and older people from family and community life. The Australian government has handed over the responsibility of increasing the supply of inclusive housing to the housing industry through an agreed national access standard and a voluntary strategy. Voluntary strategies have not been successful in other constituencies and little is known about what would work in Australia today. Findings from a research project into the voluntariness of the housing industry indicate that a reliable and consistent supply is unlikely without an equivalent increase in demand. The strategy has, however, an important role to play in the task of changing housing industry practices towards building more inclusive communities.

The current workforce status of prehospital care in China

Abstract The Chinese Emergency Medicine System is primarily composed of three sectors; prehospital care, emergency department in a city hospital, and intensive care unit ward. While all sectors are integral to the system, the prehospital care system is less developed than the others. There are many possible contributors to the under-development of the prehospital care system, however, workforce issues may play a significant role. Firstly, there is no officially recognised paramedic profession in China. The staff members working in the prehospital care system are medical doctors, registered nurses, patient-carriers, and drivers. Secondly, these doctors and nurses are either over-qualified or under-qualified for practicing in the prehospital care system. Lastly, Chinese health professionals have taken actions to improve the current workforce status with initiatives such as short-term training workshops for doctors and nurses, implementation of a trial unit in a university, and development of a Major Degree of Emergency Medicine in a medical university. All of these actions are important steps toward improving the current workforce status in the prehospital care system. However, a long term workforce development plan is still essential for the Chinese system, and implementation of a professional paramedic education system in a medical university/college in China, may provide the solution. Keywords: China; emergency medicine system; health services; prehospital care system; workforce; service delivery

Quality of life detriments through self-reported swelling associated with gynaecological cancer

Background and aims: Lower-limb lymphoedema is a serious and feared sequela after treatment for gynaecological cancer. Given the limited prospective data on incidence of and risk factors for lymphoedema after treatment for gynaecological cancer we initiated a prospective cohort study in 2008. Methods: Data were available for 353 women with malignant disease. Participants were assessed before treatment and at regular intervals after treatment for two years. Follow-up visits were grouped into time-periods of six weeks to six months (time 1), nine months to 15 months (time 2), and 18 months to 24 months (time 3). Preliminary data analyses were undertaken up to time 2 using generalised estimating equations to model the repeated measures data of Functional Assessment of Cancer Therapy-General (FACT-G) quality of life (QoL) scores and self-reported swelling at each follow-up period (best-fitting covariance structure). Results: Depending on the time-period, between 30% and 40% of patients self-reported swelling of the lower limb. The QoL of those with self-reported swelling was lower at all time-periods compared with those who did not have swelling. Mean (95% CI) FACT-G scores at time 0, 1 and 2 were 80.7 (78.2, 83.2), 83.0 (81.0, 85.0) and 86.3 (84.2, 88.4), respectively for those with swelling and 85.0 (83.0, 86.9), 86.0 (84.1, 88.0) and 88.9 (87.0, 90.7), respectively for those without swelling. Conclusions: Lower-limb swelling adversely influences QoL and change in QoL over time in patients with gynaecological cancer.

Comparing measures of fat-free mass in overweight older adults using three different bioelectrical impedance devices and three prediction equations

Objectives: To compare measures of fat-free mass (FFM) by three different bioelectrical impedance analysis (BIA) devices and to assess the agreement between three different equations validated in older adult and/or overweight populations. Design: Cross-sectional study. Setting: Orthopaedics ward of Brisbane public hospital, Australia. Participants: Twenty-two overweight, older Australians (72 yr ± 6.4, BMI 34 kg/m2 ± 5.5) with knee osteoarthritis. Measurements: Body composition was measured using three BIA devices: Tanita 300-GS (foot-to-foot), Impedimed DF50 (hand-to-foot) and Impedimed SFB7 (bioelectrical impedance spectroscopy (BIS)). Three equations for predicting FFM were selected based on their ability to be applied to an older adult and/ or overweight population. Impedance values were extracted from the hand-to-foot BIA device and included in the equations to estimate FFM. Results: The mean FFM measured by BIS (57.6 kg ± 9.1) differed significantly from those measured by foot-to-foot (54.6 kg ± 8.7) and hand-to-foot BIA (53.2 kg ± 10.5) (P < 0.001). The mean ± SD FFM predicted by three equations using raw data from hand-to-foot BIA were 54.7 kg ± 8.9, 54.7 kg ± 7.9 and 52.9 kg ± 11.05 respectively. These results did not differ from the FFM predicted by the hand-to-foot device (F = 2.66, P = 0.118). Conclusions: Our results suggest that foot-to-foot and hand-to-foot BIA may be used interchangeably in overweight older adults at the group level but due to the large limits of agreement may lead to unacceptable error in individuals. There was no difference between the three prediction equations however these results should be confirmed within a larger sample and against a reference standard.

A virtual environment to simulate the experience of psychosis

Psychosis is a mental disorder that affects 1-2% of the population at some point in their lives. One of the main causes of psychosis is the mental illness schizophrenia. Sufferers of this illness often have terrifying symptoms such as hallucinations, delusions, and thought disorder. This project aims to develop a virtual environment to simulate the experience of psychosis, focusing on re-creating auditory and visual hallucinations. A model of a psychiatric ward was created and the psychosis simulation software was written to re-create the auditory and visual hallucinations of one particular patient. The patient was very impressed with the simulation, and commented that it effectively re-created the same emotions that she experienced on a day-to-day basis during her psychotic episodes. It is hoped that this work will result in a useful educational tool about schizophrenia, leading to improved training of clinicians, and fostering improved understanding and empathy toward sufferers of schizophrenia in the community, ultimately improving the quality of life and chances of recovery of patients.

Recovery model of care within the PICU

Nurses are the primary care providers of consumers admitted to the High Dependency Ward (HDU) or Psychiatric Intensive Care Unit (PICU). They are the largest professional group providing care to the acutely unwell, managing crisis and complex clinical psychiatric scenarios. It is timely to review the skills and expertise of this nursing specialty for further definition and acknowledgement.

How do Australasian hospitals identify and manage malnutrition in their acute care wards?

One aim of the Australasian Nutrition Care Day Survey was to explore nutrition care practices in acute care hospital wards across Australia and New Zealand. Managers of Dietetic departments completed a questionnaire regarding ward nutrition care practices. Overall, 370 wards from 56 hospitals participated. The median ward size was 28 beds (range: 8–60 beds). Although there was a wide variation in full-time equivalent availability of dietitians (median: 0.3; range: 0–1.4), their involvement in providing nutrition care across ward specialities was signifi cantly higher than other staff members (χ2, p < 0.01). Feeding assistance, available in 89% of the wards, was provided mainly by nursing staff and family members (χ2, p < 0.01). Protected meal times were implemented in 5% (n = 18) of the wards. Fifty-three percent of the wards (n = 192) weighed patients on request and 40% (n = 148) on admission. Routine malnutrition screening was conducted in 63% (n = 232) of the wards and 79% (n = 184) of these wards used the Malnutrition Screening Tool, 16% (n = 37) the Malnutrition Universal Screening Tool, and 5% (n = 11) other tools. Nutrition rescreening was routinely conducted in 20% of the wards. Among wards that implemented nutrition screening, 41% (n = 100) routinely referred patients “at risk” of malnutrition to dietitians as part of their standard protocol for malnutrition management. Results of this study provide new knowledge regarding current nutrition care practice, highlight gaps in existing practice, and can be used to inform improved nutrition care in acute care wards across Australia and New Zealand.

Gender and Leader Effects in the 2010 Australian Election

The impact of voters’ gender on leader evaluations in parliamentary systems has been largely unexplored, while the impact of female leaders on voter attitudes and preferences remains to be fully established. This paper uses Julia Gillard’s historic candidacy in the 2010 Australian federal election to explore how voters evaluated Australia’s first female prime minister, and to test the impact of their assessments on vote choice. The authors also examine whether Gillard’s high-profile candidacy affected women’s levels of political interest, awareness and engagement in what had been largely a ‘man’s game’. Their findings confirm that Gillard enjoyed a gender-affinity effect in 2010 in terms of both leader evaluations and vote choice, and women’s political engagement was significantly affected by the Gillard candidacy.

Fatal flaws : the risks for beneficiaries who assist a suicide

The recent criminal conviction of Queensland teacher Merin Nielsen for aiding the suicide of an elderly acquaintance, Frank Ward, raises some timely issues, particularly for succession lawyers.

Testing the accuracy of luminance maps acquired by smart phone cameras

This paper looks at the accuracy of using the built-in camera of smart phones and free software as an economical way to quantify and analyse light exposure by producing luminance maps from High Dynamic Range (HDR) images. HDR images were captured with an Apple iPhone 4S to capture a wide variation of luminance within an indoor and outdoor scene. The HDR images were then processed using Photosphere software (Ward, 2010.) to produce luminance maps, where individual pixel values were compared with calibrated luminance meter readings. This comparison has shown an average luminance error of ~8% between the HDR image pixel values and luminance meter readings, when the range of luminances in the image is limited to approximately 1,500cd/m2.

Getting in the door : the voluntary provision of accessible housing in Australia

This paper outlines the methodology used in a PhD qualitative research study on the agency of the housing industry in Australia in the provision of accessible housing. Previous studies have identified the need for an increased supply of accessible housing to optimise the inclusion and participation of all people, yet the demand for accessible housing by new home buyers is minimal and voluntary strategies to increase supply have typically failed. In 2010, housing industry leaders agreed to adopt a national voluntary access guideline for housing (Livable Housing Design) and a strategy to provide minimum access features in all new housing by 2020. This study explores the “escaped” phenomenon; how individual agents within the housing industry respond to such initiatives. As the paper is written mid-study it uses a preliminary theme in the findings, that is, minimal demand, to illustrate the methodology of the research.

SSCRC Austin ICU Handover

Video presented as part of Melbourne Smart Services CRC Participants conferences. Video showing the results of our collaboration with the Smart Services CRC and Austin Health. We created an environment for nurses to learn ICU Handover processes. Handover processes in an ICU involve, briefing meetings with ward nurses, and then a bedside handover of patient care information to the nurse starting the next shift. This simulation will allow students to remotely practice their handover skills, thus freeing up expensive resources at teaching hospitals, and enabling them to be at a higher skill level when they commence live training. More information available at: www.bpmve.org.

CSG A Greener Tomorrow : Comprehensive Organizational and Socialistic Report

Humans have altered environments and enhanced their wellbeing unlike any other creature on the planet (Hielman & Donda, 2007); this is no different whether the environment is ecological, social or organizational. In recent times, the debate regarding greenhouse effects on the global weather patterns and the sustainment of the earth’s temperature necessary for life support has become quite infamously problematic as society pushes to find new sources of energy both renewable and environmentally sustainable. The feedback received on CSG from both government and companies alike is that the opportunities this industry creates has a lasting range of social and economic benefits worth over fifty (50) billion dollars in projects (Queensland Government, 2013). This however, has been overshadowed by social activist and lobbyist groups as ‘Lock the Gate Alliance’ saying, as one part of their report noted from the National Water Commission, “coal seam gas development could cause significant social impacts by disrupting current land-use practices and the local environment through infrastructure construction and access” (Lock the Gate Alliance, n.d.), and “In recent years both a NSW and Federal Senate inquiry into coal seam gas production were deliberately mislead by an organization that claims to work on behalf of the farming community, This is the battle for the end of the fossil fuel industry. This is the end game..." (Ward, 2013).

P.I.C.U., H.D.U., A.O.A. What treatment do we provide?: Current descriptions of the function of intensive care for inpatient Psychiatric Health Care.

Purpose – This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings. Design/methodology/approach – Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups. Findings – Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature. Practical implications – Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent. Originality/value – Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.