Multidisciplinary case conference reviews: Improving outcomes for nursing home residents, carers and health professionals

Aim of study: This study sought to determine whether multidisciplinary case conference reviews improved outcomes for nursing home residents, and the effects of this team approach to resident care on carers, including the hands-on carers employed by the nursing home, and health professionals. Method: 245 residents of three Canberra nursing homes were enrolled in this non-randomised controlled trial. The intervention consisted of sessions of three case conference reviews held between 10/4/96 and 4/12/96. These sessions were attended by the General Practitioners (GPs) of the residents discussed, the GP project officer from the ACT Division of General Practice, a clinical pharmacist, senior nursing staff, other health professionals eg physiotherapist, and occasionally the resident concerned or their representative. At each review, a case presentation by the resident's GP was followed by a multidisciplinary discussion of all aspects, medical and non-medical, of the resident's care. The review concluded with a management plan for the resident. In total 75 residents were reviewed. Main outcome measures: Medication use and cost, and mortality. Results: One month after the reviews were completed comparisons between those who were reviewed and those who were not showed non-significant reductions in medication orders, medication cost, and mortality in the reviewed group. Many of the 92 recommendations in the management plans that were carried out benefited the residents (n=37) and/or carers (n=24). The responses of the GPs and the Directors of Nursing to the reviews were overwhelmingly positive. Conclusion: Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers. Given the support shown by key stakeholders, multidisciplinary conferences should be used more.

Matching prescription claims with medication data for nursing home residents: Implications for prescriber feedback, drug utilisation studies and selection of prescription claims database

Medication data retrieved from Australian Repatriation Pharmaceutical Benefits Scheme (RPBS) claims for 44 veterans residing in nursing homes and Pharmaceutical Benefits Scheme (PBS) claims for 898 nursing home residents were compared with medication data from nursing home records to determine the optimal time interval for retrieving claims data and its validity. Optimal matching was achieved using 12 weeks of RPBS claims data, with 60% of medications in the RPBS claims located in nursing home administration records, and 78% of medications administered to nursing home residents identified in RPBS claims. In comparison, 48% of medications administered to nursing home residents could be found in 12 weeks of PBS data, and 56% of medications present in PBS claims could be matched with nursing home administration records. RPBS claims data was superior to PBS, due to the larger number of scheduled items available to veterans and the veteran's file number, which acts as a unique identifier. These findings should be taken into account when using prescription claims data for medication histories, prescriber feedback, drug utilisation, intervention or epidemiological studies. (C) 2001 Elsevier Science Inc. All rights reserved.

Overexpression of a Slit homologue impairs convergent extension of the mesoderm and causes cyclopia in embryonic zebrafish

Slit is expressed in the midline of the central nervous system both in vertebrates and invertebrates. In Drosophila, it is the midline repellent acting as a ligand for the Roundabout (Robo) protein, the repulsive receptor which is expressed on the growth cones of the commissural neurons. We have isolated cDNA fragments of the zebrafish slit2 and slit3 homologues and found that both genes start to be expressed by the midgastrula stage well before the axonogenesis begins in the nervous system, both in the axial mesoderm, and slit2 in the anterior margin of the neural plate and slit3 in the polster at the anterior end of the prechordal mesoderm. Later, expression of slit2 mRNA is detected mainly in midline structures such as the floor plate cells and the hypochord, and in the anterior margins of the neural plates in the zebrafish embryo, while slit3 expression is observed in the anterior margin of the prechordal plate, the floorplate cells in the hindbrain, and the motor neurons both in the hindbrain and the spinal cord. To study the role of Slit in early embryos, we overexpressed Slit2 in the whole embryos either by injection of its mRNA into one-cell stage embryos or by heat-shock treatment of the transgenic embryos which carries the slit2 gene under control of the heat-shock promoter. Overexpression of Slit2 in such ways impaired the convergent extension movement of the mesoderm and the rostral migration of the cells in the dorsal diencephalon and resulted in cyclopia. Our results shed light on a novel aspect of Slit function as a regulatory factor of mesodermal cell movement during gastrulation. (C) 2001 Academic Press.

The potential of telemedicine for home nursing in Queensland

The potential for telemedicine in home nursing was examined by retrospectively reviewing the case-notes relating to home visits made by nurses in Queensland. The case-notes of 166 clients were randomly selected from 10 domiciliary nursing centres run by the Blue Care nursing organization in south-east Queensland. Two experienced community registered nurses independently undertook a retrospective review of the case-notes. Each reviewer made an independent judgement as to whether any of the home nursing visits in the episode of care could have been conducted by telemedicine. Visits requiring hands-on care were deemed to be unsuitable for telemedicine. A total of 12,630 home visits were reviewed. The median number of visits per client was 27 (range 1-722). The mean age of the clients was 72 years (range 2-93 years). A total of 1521 home visits (12%) were judged suitable for telemedicine. There was no significant difference in suitability between males (13%) and females (12%). Care interventions suitable for telemedicine were more likely to be those of a supportive, educational or review nature. Forty per cent of clients lived up to 5 km from the home nursing centre, 33% lived 5-10 km from the centre and 27% lived over 10 km from the centre. The results of the present study confirm the potential for telemedicine in home nursing in Australia.

A phylogeny for the genus Isoodon and a range extension for I-obesulus peninsulae based on mtDNA control region and morphology

Short-nosed bandicoots, Isoodon, have undergone marked range contractions since European colonisation of Australia and are currently divided into many subspecies, the validity of which is debated. Discriminant function analysis of morphology and a phylogeny of Isoodon based on mtDNA control region sequences indicate a clear split between two of the three recognised species, I. macrourus and I. obesulus/auratus. However, while all previously recognised taxa within the I. obesulus/auratus group are morphologically distinct, I. auratus and I. obesulus are not phylogenetically distinct for mtDNA. The genetic divergence between I. obesulus and I. auratus (2.6%) is similar to that found among geographic isolates of the former (I. o. obesulus and I. o. peninsulae: 2.7%). Further, the divergence between geographically close populations of two different species (I. o. obesulus from Western Australia and I. a. barrowensis: 1.2%) is smaller than that among subspecies within I. auratus (I. a. barrowensis and I. auratus from northern Western Australia: 1.7%). A newly discovered population of Isoodon in the Lamb Range, far north Queensland, sympatric with a population of I. m. torosus, is shown to represent a range extension of I. o. peninsulae (350 km). It seems plausible that what is currently considered as two species, I. obesulus and I. auratus, was once one continuous species now represented by isolated populations that have diverged morphologically as a consequence of adaptation to the diverse environments that occur throughout their range. The taxonomy of these populations is discussed in relation to their morphological distinctiveness and genetic similarity.

Stability of nest range, home range and movement of the northern bettong (Bettongia tropica) following moderate-intensity fire in a tropical woodland, north-eastern Queensland

Nest use, home-range characteristics and nightly movements by the northern bettong (Bettongia tropica) were examined before and after a low- to moderate-intensity fire in sclerophyll woodland in north-eastern Australia using radio-telemetry. In all, 23 animals were radio-tracked at three-month intervals between February 1995 and May 1996. During November 1995 a low- intensity experimental fire burned the entire home range of most animals. The northern bettong appeared fairly catholic in choice of nest site, with a variety of nest locations and nesting materials used. Prior to the fire, nests were generally located in areas of dense cover, such as the skirts of grass trees (46%) or grass close to a log (29%). After fire removed most ground cover in the nesting areas of most animals, bettongs used remaining shelter such as boulder piles (45%), recently fallen trees (8%) and patches of unburnt vegetation (21%). Nest areas (10.1 ha) of males were significantly larger than those of females (5.4 ha). Home ranges of both sexes were large (59 ha) and most ranges lacked distinct core areas, suggesting that bettongs used all parts of their home ranges equally. High mean rates of nightly movement by the northern bettong indicated that large distances were moved within home ranges during nightly foraging. No significant fire-related changes were detected in home-range size, home-range location, nest-area location or mean rates of nightly movement, suggesting that the northern bettong is well adapted to the low- and medium-intensity fires that characterise its habitat.

Tree use, diet and home range of the koala (Phascolarctos cinereus) at Blair Athol, central Queensland

Free-ranging koalas (Phascolarctos cinereus) were monitored by means of radio-relocation in the area of Blair Athol Coal Mine and surrounding properties. Daytime tree use, home range and diet of these koalas was determined in spring and autumn, as was the leaf moisture composition of potential fodder species. Koalas used on average 93 (male koalas) and 56 (female koalas) trees during the period of observation, occupying home ranges of 135 and 101 ha respectively. Mean sightings per tree were 1.19 for both males and females and home-range sizes were not significantly different between sexes or seasons. Koalas were observed returning to previously used daytime roosting trees infrequently (

Effects of paternal drinking, conduct disorder and childhood home environment on the development of alcohol use disorders in a Thai population

Aims To identify influences on the development of alcohol use disorders in a Thai population, particularly parental drinking and childhood environment. Design Case-control study. Setting A university hospital, a regional hospital and a community hospital in southern Thailand. Participants Ninety-one alcohol-dependents and 177 hazardous/harmful drinkers were recruited as cases and 144 non-or infrequent drinkers as controls. Measurements Data on parental drinking, family demographic characteristics, family activities, parental disciplinary practice, early religious life and conduct disorder were obtained using a structured interview questionnaire. The main outcome measure was the subject's classification as alcohol-dependent, hazardous/harmful drinker or non-/infrequent drinker. Findings A significant relationship was found between having a drinking father and the occurrence of hazardous/harmful drinking or alcohol dependence in the subjects. Childhood factors (conduct disorder and having been a temple boy, relative probability ratios, RPRs and 95% CI: 6.39, 2.81-14.55 and 2.21, 1.19-4.08, respectively) also significantly predicted alcohol dependence, while perceived poverty and ethnic alienation was reported less frequently by hazardous/harmful drinkers and alcohol-dependents (RPRS and 95% CIs = 0.34, 0.19-0.62 and 0.59, 0.38-0.93, respectively) than the controls. The relative probability ratio for the effect of the father's infrequent drinking on the son's alcohol dependence was 2.92 (95% CI = 1.42-6.02) and for the father's heavy or dependent drinking 2.84 (95% CI=1.31-6.15). Conclusions Being exposed to a light-drinking, father increases the risk of a son's alcohol use disorders exhibited either as hazardous-harmful or dependent drinking. However, exposure to a heavy- or dependent-drinking father is associated more uniquely with an increased risk of his son being alcohol-dependent. The extent to which this is seen in other cultures is worthy of exploration.