Effectiveness of pain management in hospital in the home programs

Objectives: The objective of the study was to examine patients’ experiences of pain in Hospital in the Home (HITH) programs and
identify the issues related to providing optimal pain management for acute care patients in the home environment.
Methods: A descriptive survey of patients’ experience of pain and pain management in 3 HITH programs in metropolitan Melbourne,
Australia (n=359). Data were collected by telephone interview using a modified version of The American Pain Society’s Patient Outcome Questionnaire. Patients were interviewed 48 to 72 hours after admission to the HITH program. Consecutive, adult, acute care patients were invited to participate in the study. Patients who had previously participated or had communication difficulties unable to be overcome with the assistance of an interpreter were excluded.
Results: Sixty-nine percent of patients interviewed experienced pain at home and 86% of these patients had experienced pain in the 24 hours before the interview. Over half (56%) of the patients had experienced moderate-to-severe worst pain in the previous 24 hours and 33% reported moderate-to-severe pain as their average pain experience. Two hundred thirty-two (93.2%) of the 250 patients who experienced pain had pain in hospital before being transferred to HITH. Of these patients, 52.2% (n=132) were prescribed analgesics to take home with them; the remaining 118 patients experiencing pain were not prescribed analgesics and either sourced analgesics once home (n=81, 68.1%) or did not take any analgesics (n=38, 31.9%).
Discussion: Treatment of pain at home was suboptimal with patients experiencing moderate-to-severe pain and discomfort during the treatment phase of their illness. Lack of appropriate discharge planning strategies meant that patients went home without adequate analgesia and use of non prescribed pain medication was common. The number of patients transferred home without analgesics indicates a worrying under recognition of the need for analgesia in this care context and poses a risk to patient safety that is no less significant because patients are at home.

Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—: A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

The theoretical underpinnings of rural injury and its impact on prevention programs

Many observations support the concept of an entity that could be described as ‘rural injury,’ yet the nature and limits of this concept are little explored. We demonstrate the complexity through descriptions along a single dimension: place.

Rural injury may be considered as consisting of both ‘Rural specific injury’ (Farm/agricultural, Forestry and Mining related injuries and Injuries in state/national parks) and also rural instances of ‘Injury which is not location specific’. Examples of the latter category include water related (especially boating & fishing), other industrial, Road Trauma, Sporting and Domestic injuries.

Industry and university perspectives of work integrated learning Programs in ICT Degrees

The ICT disciplines in Australian universities have a strong tradition of industry engagement in curriculum design and implementation particularly through work integrated learning programs. Work integrated learning (WIL) includes industry placements, internships, industry projects and other methods and approaches that aim to enhance the professional practice capabilities of students. There are various stakeholders involved in WIL programs including universities, students, government and industry, each with their own motivations and expectations. Whilst all stakeholders agree on the benefits to students, there are conflicting interests that jeopardise further development and innovation in WIL. This paper reports on surveys of industry and university stakeholders in order to understand representative views and current practices. The findings confirm a lack of a shared understanding between stakeholders regarding roles, responsibilities, models and benefits. The paper concludes with several recommendations regarding the adoption of an outcomes-based approach to the design and implementation of work integrated learning programs that will encourage innovation and quality in WIL.

A theory of change framework for developing cross-faculty programs : an information systems perspective

Information systems (IS) is a discipline that draws upon many other disciplines to bridge theory and practice and address the information and knowledge needs of individuals, organisations and society. We propose that an ideal education in IS would be delivered via cross-faculty programs of study that are not combinations of units from different faculties and disciplines, but programs which include a coherent and cohesive set of units co-designed and co-delivered by teaching staff from more than one faculty. This allows students, and teachers, to appreciate the different content and perspectives within the same context, as they will experience in the workplace, and allow them to develop deeper understandings of the complexity that can arise in their roles as mediators and communicators in finding appropriate IT solutions. Such a model poses a radical change, and thus the framework we offer uses a ‘theory of change’ agenda.

How to integrate the good lives model into treatment programs for sexual offending : an introduction and overview

The good lives model (GLM) represents a new theoretical framework informing sex offender treatment programs; however, substantial variation has been observed in terms of how GLM-related ideas and practices have been applied. Integrated appropriately, the GLM offers potential for improving outcomes of programs following a cognitive-behavioral therapy (CBT) approach and operating according to a narrow operationalization of risk, need, responsivity (RNR) principles. Conversely, misguided or otherwise poor integration could increase the very risk practitioners work to prevent and manage. The purpose of this article is to provide an introduction and overview on how to integrate the GLM into treatment using CBT and RNR. The authors describe clinical implications of the GLM as they relate to program aims and orientation, assessment and intervention planning, content, and delivery

A concert of powers and hybrid regionalism in Asia

With the rise of China the strategic competition between the US and China has gained momentum over the last 10 years and is likely to continue in the near future. To deal with this challenge, Hugh White has proposed a concert of powers in Asia. White’s proposal, however, has not received sufficient attention in Asia and is likely to be a failure if Asia does not take it seriously. This article examines the problematic assumptions of White’s proposal and argues that his proposal needs to incorporate the important role of ASEAN, an existing de facto Asian concert of powers. It shifts the idea of a concert of powers towards a new hybrid regionalism, identifies its key components and discusses how this hybrid regionalism can dilute the strategic conflict between China and the US.

Recruitment into diabetes prevention programs : what is the impact of errors in self-reported measures of obesity?

Background
Error in self-reported measures of obesity has been frequently described, but the effect of self-reported error on recruitment into diabetes prevention programs is not well established. The aim of this study was to examine the effect of using self-reported obesity data from the Finnish diabetes risk score (FINDRISC) on recruitment into the Greater Green Triangle Diabetes Prevention Project (GGT DPP).

Methods
The GGT DPP was a structured group-based lifestyle modification program delivered in primary health care settings in South-Eastern Australia. Between 2004–05, 850 FINDRISC forms were collected during recruitment for the GGT DPP. Eligible individuals, at moderate to high risk of developing diabetes, were invited to undertake baseline tests, including anthropometric measurements performed by specially trained nurses. In addition to errors in calculating total risk scores, accuracy of self-reported data (height, weight, waist circumference (WC) and Body Mass Index (BMI)) from FINDRISCs was compared with baseline data, with impact on participation eligibility presented.

Results
Overall, calculation errors impacted on eligibility in 18 cases (2.1%). Of n = 279 GGT DPP participants with measured data, errors (total score calculation, BMI or WC) in self-report were found in n = 90 (32.3%). These errors were equally likely to result in under- or over-reported risk. Under-reporting was more common in those reporting lower risk scores (Spearman-rho = −0.226, p-value < 0.001). However, underestimation resulted in only 6% of individuals at high risk of diabetes being incorrectly categorised as moderate or low risk of diabetes.

Conclusions
Overall FINDRISC was found to be an effective tool to screen and recruit participants at moderate to high risk of diabetes, accurately categorising levels of overweight and obesity using self-report data. The results could be generalisable to other diabetes prevention programs using screening tools which include self-reported levels of obesity.

West meets East : examining the use of reflective journals in international study programs

This paper documents the learning of a sample of 15 MBA students who have participated in an experiential international study program to China, and have used a reflective journal as a learning activity. Kolb and Kolb’s (2005) experiential model is used to analyse the learning experiences of the MBA students. Students encountered a number of learning benefits from reflective journal writing, and this included deep reflection, enjoyment, and being able to link theory with reality. The study found that students were able to develop knowledge from their experiences in China by crystallising those experiences when writing a reflective journal. The students developed knowledge about China’s economic growth, reasons for why it is growing, and students were able to critically analyse the challenges China faces from a moral, fairness, and environmental perspective.