Hospital malnutrition : prevalence, identification and impact on patients and the healthcare system

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition.

Implementation of the nurse practitioner role within a Victorian healthcare network : an organisational perspective

Objective
This paper presents a discussion of the development of a framework to implement and sustain the nurse practitioner (NP) role within one health service designed to strengthen the capacity of the health system and which could be readily transferable to other health services.
Setting
Eastern Health (EH) is a multi‑campus tertiary health care organisation servicing a population of approximately 800,000 people in the east and outer eastern suburbs of Melbourne, Australia. EH is committed to advancing the nursing profession and exploring innovative, research based models of practice that are responsive to the needs of the community it serves.
Primary argument
The Framework documents the processes of providing a new career pathway for advanced practice nurses that incorporates education and training, and utilises current evidenced‑based practice guidelines to define and promote the scope of practice.
Conclusion
Strong organisational support to facilitate interdisciplinary and multidisciplinary learning opportunities assists integration of the NP role into the healthcare team. Role clarity will assist interprofessional teams to understand and value the role NPs provide.

Incorporating sustainability into community-based healthcare practice

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.

Removing barriers to substantive equality : a case study of remedying disability discrimination complaints

Disability discrimination complaints are primarily resolved in the privacy of a conciliation conference. Few complaints reach the courts, so there is very little available information about the outcomes negotiated by the parties or how this type of discrimination is being addressed. Drawing on settlement agreements and decided cases from Queensland, this article examines how disability discrimination across a range of areas is remedied prior to hearing and by the tribunal. The data suggests that complaints are predominantly remedied in an individualised way, mainly with compensation. Although the parties negotiate wider, systemic outcomes on occasion — such as building modifications or better access to premises — courts rarely award remedies of this nature. The law in the United Kingdom takes quite a different approach. This article considers three mechanisms used in the United Kingdom which could be adopted in Australia to strengthen the law’s effectiveness for people with a disability: investing a public agency with enforcement powers; requiring organisations to make reasonable adjustments for people with a disability; and placing a positive duty on public authorities to promote equality for people with a disability.

Web health portal to enhance patient safety in Australian healthcare systems

The use of a web Health Portal can be employed not only for reducing health costs but also to view patient's latest medical information (e.g. clinical tests, pathology and radiology results, discharge summaries, prescription renewals, referrals, appointments) in real-time and carry out physician messaging to enhance the information exchanged, managed and shared in the Australian healthcare sector. The Health Portal connects all stakeholders (such as patients and their families, health professionals, care providers, and health regulators) to establish coordination, collaboration and a shared care approach between them to improve overall patient care safety. The paper outlines a Health Portal model for designing a real-time health prevention system. An application of the architecture is described in the area of web Health Portal.

A framework for the design of privacy preserving pervasive healthcare

Privacy is an important aspect of pervasive and ubiquitous computing systems, and, in particular, pervasive healthcare. With reference to previous approaches on developing privacy sensitive pervasive healthcare applications, we detail a framework for the design of such systems that aims to minimise the impact of privacy on such systems. In reviewing previous approaches, we extract and combine common elements in order to unify the approaches and create a more formal methodology for designing privacy mechanisms in pervasive healthcare applications. In doing so we also consider the manner in which ubiquitous technologies impact on privacy and methods for reducing this impact. We demonstrate how the framework can be applied by using examples from the previous approaches. In addressing privacy issues, the framework aims to remove a large obstacle to deployment of pervasive healthcare systems, acceptance of the technology.

Landmark based corridor discrimination

For a mobile robot to perform some sort of useful function it usually must have some sort of global understanding of its environment. This is usually expressed in the form of map. Through real-world experiments, using a mobile robot inspired by insect visual guidance, we present results showing the performance of a mobile robot in recognising a previously encountered corridor environment and discriminating between various corridors. This is achieved through the building and refinement of maps based on the observation of simple landmarks en route.

A theoretical framework of entrepreneurship and innovation in healthcare organisations

This paper examines the role of entrepreneurship and innovation in the context of healthcare management by offering a number of research propositions. In recent years, hospitals have attracted ever growing commentary about rising costs and the need for improving information technology systems. Whilst there have been some service innovations introduced from other industries, particularly the manufacturing industry, there have been few service innovations originating from the healthcare sector. In the healthcare sector, there are a number of service innovations, which are discussed in this paper in terms of their relevance to managerial roles of hospital staff members. In addition, this paper examines the role of entrepreneurial managers in determining innovative technology behaviour in healthcare organisations. Literature from innovation management, corporate intrapreneurship and healthcare management is used to explain the findings of this paper and future areas of research are also proposed.