Variation in health care-associated infection surveillance practices in Australia

In the absence of a national health care-associated infection surveillance program in Australia, differences between existing state-based programs were explored using an online survey. Only 51% of respondents who undertake surveillance have been trained, fewer than half perform surgical site infection surveillance prospectively, and only 41% indicated they risk adjust surgical site infection data. Wide- spread variation of surveillance methods highlights future challenges when considering the development and implementation of a national program in Australia.

Malnutrition prevalence in aged care residents: A pilot study

Malnutrition is a significant clinical and public health problem. The prevalence of malnutrition was determined in a sample of older people living in 2 residential aged care facilities in Australia. The Subjective Global Assessment tool was used to determine the prevalence of malnutrition in 57 residents. The majority of residents were well nourished (67), 26 moderately malnourished, and 7 severely malnourished. Prevalence of malnutrition was higher for those receiving high-level care (42), but this was not statistically significant (P =.437). No relationship was found between malnutrition status and age (P =.529) or sex (P =.839).

Role of pharmacists in collaborative care of travellers with chronic conditions

We refer to a paper recently published in the Journal of travel Medicine and Infectious Disease where clinicians have been shown to have in have many questions related to travellers to multiple destinations, going for prolonged duration of travel, with chronic medical conditions, and potential drug interactions.[1] This study highlighted the inadequacy of available information sources to resolve the wide range of different medical issues for travellers. In addition, the study also highlighted the significance of collaboration in travel health...

Safe to crush? A pilot study into solid dosage form modification in aged care

Aims To observe medication solid dosage form modification in aged care facilities (ACFs), and assess staff levels of self-perceived knowledge of medication modification and the types of resources available to them. Method Observation of medication rounds in a convenience sample of Australian Capital Territory ACFs and assessment of staff knowledge of dosage form modification and available resources. Results From 160 observations across six medication rounds, 29 residents had a total of 75 medications modified by the nursing staff prior to administration, with 32% of these instances identified as inappropriate. The methods used for crushing and administration resulted in drug mixing, spillage and incomplete dosing. The staff reported adequate resources; however, a lack of knowledge on how to locate and use these resources was evident. Conclusions Improved staff training on how to use available resources is needed to reduce the observed high incidence of inappropriate medication crushing.

Equipping the mud crab industry with innovative skills through extension of best practice handling

Maximum adoption throughout the supply-chain of research findings that attained premium quality for live mud crabs.

Technical support improved Best Management Practices in irrigated grains farming systems in the Fiztroy Basin Association priority catchments

Broadscale irrigation is a major land use in many of the priority neighbourhood catchments (45,218 hectares in Central Highlands and Dawson) and there is a requirement to provide technical support to sub-regional group field officers and landholders in these priority catchments. This technical support will assist field staff and land managers to identify and implement appropriate, sustainable technologies and management practices.

Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis

Objective To assess the impact of exercise referral schemes on physical activity and health outcomes. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection - Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. - Population: sedentary individuals with or without medical diagnosis. - Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. - Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings. Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.

Republished research: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

Study question Can exercise referral schemes improve health outcomes in individuals with or without pre-existing conditions? Summary answer We found weak evidence of a short term increase in physical activity and reduction in levels of depression in sedentary individuals after participation in exercise referral schemes, compared with after usual care. What is known and what this paper adds Exercise referral schemes are commonly used in primary care to promote physical activity. Evidence indicating a health benefit of these schemes is limited, so their value in primary care remains to be ascertained.

Pen parameters for improving the performance of sheep imported from Australia to Persian Gulf feedlots

Summer in the Persian Gulf region presents physiological challenges for Australian sheep that are part of the live export supply chain coming from the Australian winter. Many feedlots throughout the Gulf have very high numbers of animals during June to August in order to cater for the increased demand for religious festivals. From an animal welfare perspective it is important to understand the necessary requirements of feed and water trough allowances, and the amount of pen space required, to cope with exposure to these types of climatic conditions. This study addresses parameters that are pertinent to the wellbeing of animals arriving in the Persian Gulf all year round. Three experiments were conducted in a feedlot in the Persian Gulf between March 2010 and February 2012, totalling 44 replicate pens each with 60 or 100 sheep. The applied treatments covered animal densities, feed-bunk lengths and water trough lengths. Weights, carcass attributes and health status were the key recorded variables. Weight change results showed superior performance for animal densities of ≥1.2 m2/head during hot conditions (24-h average temperatures greater than 33 °C, or a diurnal range of around 29–37 °C). However the space allowance for animals can be decreased, with no demonstrated detrimental effect, to 0.6 m2/head under milder conditions. A feed-bunk length of ≥5 cm/head is needed, as 2 cm/head showed significantly poorer animal performance. When feeding at 90 ad libitum 10 cm/head was optimal, however under a maintenance feeding regime (1 kg/head/day) 5 cm/head was adequate. A minimum water trough allowance of 1 cm/head is required. However, this experiment was conducted during milder conditions, and it may well be expected that larger water trough lengths would be needed in hotter conditions. Carcass weights were determined mainly by weights at feedlot entry and subsequent weight gains, while dressing percentage was not significantly affected by any of the applied treatments. There was no demonstrated effect of any of the treatments on the number of animals that died, or were classified as unwell. However, across all the treatments, these animals lost significantly more weight than the healthy animals, so the above recommendations, which are aimed at maintaining weight, should also be applicable for good animal health and welfare. Therefore, best practice guidelines for managing Australian sheep in Persian Gulf feedlots in the hottest months (June–August) which present the greatest environmental and physical challenge is to allow feed-bunk length 5 cm/head on a maintenance-feeding program and 10 cm/head for 90 ad libitum feeding, and the space allowance per animal should be ≥1.2 m2/head. Water trough allocation should be at least 1 cm/head with provision for more in the summer when water intake potentially doubles.

Pen parameters for improving the performance of sheep imported from Australia to Persian Gulf feedlots

Summer in the Persian Gulf region presents physiological challenges for Australian sheep that are part of the live export supply chain coming from the Australian winter. Many feedlots throughout the Gulf have very high numbers of animals during June to August in order to cater for the increased demand for religious festivals. From an animal welfare perspective it is important to understand the necessary requirements of feed and water trough allowances, and the amount of pen space required, to cope with exposure to these types of climatic conditions. This study addresses parameters that are pertinent to the wellbeing of animals arriving in the Persian Gulf all year round. Three experiments were conducted in a feedlot in the Persian Gulf between March 2010 and February 2012, totalling 44 replicate pens each with 60 or 100 sheep. The applied treatments covered animal densities, feed-bunk lengths and water trough lengths. Weights, carcass attributes and health status were the key recorded variables. Weight change results showed superior performance for animal densities of ≥1.2 m2/head during hot conditions (24-h average temperatures greater than 33 °C, or a diurnal range of around 29–37 °C). However the space allowance for animals can be decreased, with no demonstrated detrimental effect, to 0.6 m2/head under milder conditions. A feed-bunk length of ≥5 cm/head is needed, as 2 cm/head showed significantly poorer animal performance. When feeding at 90% ad libitum 10 cm/head was optimal, however under a maintenance feeding regime (1 kg/head/day) 5 cm/head was adequate. A minimum water trough allowance of 1 cm/head is required. However, this experiment was conducted during milder conditions, and it may well be expected that larger water trough lengths would be needed in hotter conditions. Carcass weights were determined mainly by weights at feedlot entry and subsequent weight gains, while dressing percentage was not significantly affected by any of the applied treatments. There was no demonstrated effect of any of the treatments on the number of animals that died, or were classified as unwell. However, across all the treatments, these animals lost significantly more weight than the healthy animals, so the above recommendations, which are aimed at maintaining weight, should also be applicable for good animal health and welfare. Therefore, best practice guidelines for managing Australian sheep in Persian Gulf feedlots in the hottest months (June–August) which present the greatest environmental and physical challenge is to allow feed-bunk length 5 cm/head on a maintenance-feeding program and 10 cm/head for 90% ad libitum feeding, and the space allowance per animal should be ≥1.2 m2/head. Water trough allocation should be at least 1 cm/head with provision for more in the summer when water intake potentially doubles.

Patient perspectives of factors contributing to inadequate dietary intake in acute care patients in hospital

Up to 30% of acute care patients consume less than half of the food provided in hospital. Inadequate dietary intake can have adverse clinical outcomes, including a higher risk of in-hospital mortality. This study aimed to investigate the reasons for poor intake among acute care patients in hospital. Patients with an observed intake of ≤50% of the food provided at lunch were approached to participate in the study. Thirty-two patients participated in semi-structured interviews over a three week period, to provide their perspective of food and mealtimes in hospital and discuss the reasons and factors influencing inadequate intake. Responses were coded and analysed thematically using the framework method. Patients reported both individual and organisational factors contribute to their inadequate intake. Half the patients reported the size of the meals were too large, with some patients reporting that large meal sizes puts them off their food and reduced their intake. ‘Not important to eat all the food provided’, and ‘do not need to eat much food in hospital’ were common attitudes among the patients. Half the patients reported that nurses did not observe their intake and were not concerned if all the food was not eaten. Identifying the reasons for poor intake can assist with the development of suitable interventions to improve dietary intake and reduce the risk of adverse clinical outcomes. Further investigation of suitable interventions to reduce portion sizes and improve both staff and patient perceptions of the importance of food in hospital is recommended.

Dental Service Utilization, Dental Health Production and Equity in Dental Care: the Finnish Experience

This thesis is grounded on four articles. Article I generally examines the factors affecting dental service utilization. Article II studies the factors associated with sector-specific utilization among young adults entitled to age-based subsidized dental care. Article III explores the determinants of dental ill-health as measured by the occurrence of caries and the relationship between dental ill-health and dental care use. Article IV measures and explains income-related inequality in utilization. Data employed were from the 1996 Finnish Health Care Survey (I, II, IV) and the 1997 follow-up study included in the longitudinal study of the Northern Finland 1966 Birth Cohort (III). Utilization is considered as a multi-stage decision-making process and measured as the number of visits to the dentist. Modified count data models and concentration and horizontal equity indices were applied. Dentist s recall appeared very efficient at stimulating individuals to seek care. Dental pain, recall, and the low number of missing teeth positively affected utilization. Public subvention for dental care did not seem to statistically increase utilization. Among young adults, a perception of insufficient public service availability and recall were positively associated with the choice of a private dentist, whereas income and dentist density were positively associated with the number of visits to private dentists. Among cohort females, factors increasing caries were body mass index and intake of alcohol, sugar, and soft drinks and those reducing caries were birth weight and adolescent school achievement. Among cohort males, caries was positively related to the metropolitan residence and negatively related to healthy diet and education. Smoking increased caries, whereas regular teeth brushing, regular dental attendance and dental care use decreased caries. We found equity in young adults utilization but pro-rich inequity in the total number of visits to all dentists and in the probability of visiting a dentist for the whole sample. We observed inequity in the total number of visits to the dentist and in the probability of visiting a dentist, being pro-poor for public care but pro-rich for private care. The findings suggest that to enhance equal access to and use of dental care across population and income groups, attention should focus on supply factors and incentives to encourage people to contact dentists more often. Lowering co-payments and service fees and improving public availability would likely increase service use in both sectors. To attain favorable oral health, appropriate policies aimed at improving dental health education and reducing the detrimental effects of common risk factors on dental health should be strengthened. Providing equal access with respect to need for all people ought to take account of the segmentation of the service system, with its two parallel delivery systems and different supplier incentives to patients and dentists.

Towards an understanding of the information dynamics of the handover process in aged care settings: A prerequisite for the safe and effective use of ICT

Background Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. Purpose The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. Methods The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Results Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I “Information gathering by RN”, HOP II “Preparation of preliminary handover sheet” and HOP III “Execution of handover meeting”. Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. Conclusion By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.