ORCID Profile
0000-0003-3341-6793
Current Organisation
University of Tasmania
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Publisher: MDPI AG
Date: 30-05-2023
DOI: 10.3390/HEALTHCARE11111599
Abstract: Overuse of computed tomography pulmonary angiograms (CTPAs) for diagnosis of pulmonary embolism (PE) has been recognised as an issue for over ten years, with Choosing Wisely Australia recommending that CTPAs only be ordered if indicated by a clinical practice guideline (CPG). This study aimed to explore the use of evidence-based practice within regional Tasmanian emergency departments in relation to CTPA orders by determining whether CTPAs were ordered in accordance with validated CPGs. We conducted a retrospective medical record review of all patients who underwent CTPA across all public emergency departments in Tasmania between 1 August 2018 and 31 December 2019 inclusive. Data from 2758 CTPAs across four emergency departments were included. PE was reported in 343 (12.4%) of CTPAs conducted, with yield ranging from 8.2% to 16.1% between the four sites. Overall, 52.1% of participants had neither a CPG documented, nor a D-dimer conducted before their scan. A CPG was documented before 11.8% of scans, while D-dimer was conducted before 43% of CTPAs. The findings presented in this study indicate that Tasmanian emergency departments are not consistently ‘Choosing Wisely’ when investigating PE. Further research is required to identify explanations for these findings.
Publisher: Informa UK Limited
Date: 06-01-2021
Publisher: MDPI AG
Date: 10-01-2021
Abstract: Influenza, a vaccine preventable disease, is a serious global public health concern which results in a considerable burden on the healthcare system. However, vaccine hesitancy is increasingly becoming a global problem. One prevalent misconception is that influenza vaccinations can cause the flu. We carried out this study to determine whether people undertaking influenza vaccination presented less with acute respiratory tract infection (ARTI) and influenza-like-illness (ILI) following vaccination. We utilised the Oxford Royal College of General Practitioners Research and Surveillance Centre sentinel database to examine English patients who received vaccination between 2014/2015 and 2018/2019. Of the 3,841,700 influenza vaccinations identified, vaccination details and primary care respiratory consultation counts were extracted to calculate the relative incidence (RI) per exposure risk period using the self-controlled case series methodology. Results showed a significant increase in the RI of respiratory consultation rates within fourteen days of vaccination across all five years. Less than 6.2% of vaccinations led to consultations for ARTI or ILI in primary care (crude consultation rate 6196 per 100,000). These findings, particularly if confirmed in further research, may reduce the risk of cross-infection between waiting patients and increase uptake of influenza vaccine.
Publisher: MDPI AG
Date: 13-09-2023
Publisher: Wiley
Date: 25-01-2022
DOI: 10.1111/AJR.12835
Abstract: To understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic. The study employed a qualitative enquiry, utilising semi‐structured interviews lasting 30‐60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth. A wide range of locations across Tasmania, Australia. Twelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and in idual behavioural factors. The provision of telehealth consultations to vulnerable clients. Four global themes were discovered: i) Telehealth saves time, money and energy ii) User friendly technology facilitates care iii) Rapport and confidentiality helps clients to feel safe and iv) Fit for purpose telehealth provides a quality service. The discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit‐for‐purpose telehealth devices. This research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit‐for‐purpose telehealth devices will need to be addressed.
Publisher: MDPI AG
Date: 19-04-2022
DOI: 10.3390/HEALTHCARE10050753
Abstract: Computed tomography pulmonary angiography (CTPA) has become the most widely used technique for diagnosis or exclusion of a pulmonary embolism (PE). It has been suggested that overuse of this imaging type may be prevalent, especially in emergency departments (EDs). The purpose of this literature review was to explore the use of CTPAs in EDs worldwide. A review following PRISMA guidelines was completed, with research published between September 2010 and August 2020 included. Five key topics emerged: use of CTPAs explanations for overuse use of D-dimer variability in ordering practices between clinicians and strategies to reduce overuse. This review found that CTPAs continue to be overused in EDs, leading to superfluous risks to patients. Published studies identify that while clinical practice guidelines (CPGs) have a strong effect on reducing unnecessary CTPAs with no significantly increased risk of missed diagnosis, the adoption of these tools by ED clinicians has remained low. This literature review highlights the need for further research into why CTPAs continue to be overused within EDs and why clinicians are hesitant to use CPGs in the clinical setting. Moreover, investigations into other potential strategies that may combat the overuse of this diagnostic tool are essential to reduce potential harm.
Publisher: MDPI AG
Date: 23-07-2020
Abstract: Healthcare organizations must continue to improve services to meet the rising demand and patient expectations. For this to occur, the health workforce needs to have knowledge and skills to design, implement, and evaluate service improvement interventions. Studies have shown that effective training in health service improvement and redesign combines didactic education with experiential project-based learning and on-the-ground coaching. Project-based learning requires organizational support and oversight, generally through executive sponsorship. A mixed-methods approach, comprising online surveys and semi-structured interviews, was used to explore the experiences of expert coaches and executive sponsors as key facilitators of workplace-based projects undertaken during an Australian postgraduate healthcare redesign course. Fifteen (54%) expert coaches and 37 (20%) executive sponsors completed the online survey. Ten expert coaches and six executive sponsors participated in interviews. The survey data revealed overall positive experiences for coaches and mixed experiences for sponsors. Interview participants expressed a sense of fulfillment that came from working with project teams to deliver a successful project and educational outcomes. However, concerns were raised about adequate resourcing, organizational recognition, competing priorities, and the skills required to effectively coach and sponsor. Expert coaches and executive sponsors sometimes felt under-valued and may benefit from cohort-tailored and evidence-based professional development.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.APPET.2017.09.029
Abstract: In Australia, children are not eating according to the Australian Dietary Guidelines despite the incorporation of numerous public health initiatives in the school setting. Literature regarding children's views about what influences their food choice is limited. Incorporating children in the creation of strategies to build healthy public policy aligns with the World Health Organisation (WHO) Ottawa Charter framework. In this qualitative study we used participatory action research to determine why children make the food choices they do. Five action cycles were used to collect data from school children and the school canteen. Two of the action cycles, which are the focus of this paper, used Discovery Days (where children worked in groups to design a canteen menu) to collect data from 100 students on each day across grades two to six. Each group recorded and presented the reasons they made the food choices for the menu. Each day was captured by video and audio recordings were transcribed then analysed using a Conventional Content Analysis to identify themes and then theoretical concepts. Emerging theoretical concepts describing children's decision-making criteria included pleasure, texture, social acceptability, versatility and eating context. Our study found children are reliable informants about factors that influence their food choice. Using theoretical concepts as reported by children could be the foundation required to build more effective programs to facilitate healthy decision-making, supportive environments and health policy in the school setting to create healthy food that is desirable to children.
Publisher: CSIRO Publishing
Date: 19-11-2020
DOI: 10.1071/AH19290
Abstract: Objective Clinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the ‘right care’, in the ‘right place’, at the ‘right time’ and ‘tailored to the needs of communities’. This ideal is being h ered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC. Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of complexity into policy, subsequent service planning and development of models of care. Methods The WHO components of health policy were used as the basis for the framework. Literature was drawn on to develop a policy framework that integrates complexity into health policy. Results Within the framework, complexity is juxtaposed between the WHO components of ‘vision’, ‘priorities’ and ‘roles’. Conclusion This framework, supported by the literature, provides a means for policy makers and health planners to conduct analyses of and for policy. Further work is required to better model complexity in a manner that integrates consumer needs and provider capabilities. What is known about the topic? There is a growing body of evidence regarding patient complexity and its impact on the delivery of health services, but there is little consideration of patient complexity in policy, which is an important consideration for service provision. What does this paper add? This paper presents an argument for the inclusion of patient complexity in health policy and provides a framework for how that might occur. What are the implications for practitioners? The inclusion of patient complexity in policy could provide a means for policy makers to consider the factors that contribute to patient complexity in service provision decisions.
Publisher: MDPI AG
Date: 14-11-2022
Abstract: Healthcare workers are under increasing pressure to use limited resources more efficiently and improve patient outcomes. Healthcare redesign, a quality improvement methodology derived from the automotive industry, is a proven means of achieving these goals. Continuing Professional Development (CPD) opportunities for nurses seeking to build their capacity for healthcare redesign often come in the form of university courses, which can be costly and prohibitively time-consuming. We developed a Massive Open Online Course (MOOC) with a view to increasing the number of healthcare workers undertaking CPD in healthcare redesign and subsequently using these principles in their workplaces. The aim of the current study is to describe the development of our MOOC and its initial feedback from users. Materials and Methods: The theoretical and practical components of an existing postgraduate award course unit were made fit for purpose by being arranged into six weekly modules, before being transposed to an established learning management platform for MOOCs. Related quizzes, videos and interactive activities were then developed and included in each of these modules. Peer review of this content was completed by subject matter and teaching and learning experts prior to the MOOC being launched. Results: After running for nine months, 578 participants had enrolled in the MOOC, of whom 118 (20%) had followed through to completion. Participants were overwhelmingly from Australia (89%) and identified as female (78%). Preliminary feedback obtained from participants was positive, with 81% of respondents agreeing that they were satisfied with their experience, and 82% intending to apply their knowledge in practice. Conclusions: The MOOC has addressed a learning need by providing a brief and free form of education learning from its development will help others seeking similar educational solutions. Initial feedback suggests the MOOC has been well-received and is likely to be translated into practice.
Publisher: MDPI AG
Date: 09-09-2022
DOI: 10.3390/HEALTHCARE10091731
Abstract: While altruism has been studied in healthcare professions such as nursing and medicine, the exploration of the characteristics of altruism, as related to paramedicine and emergency care in Australia, is limited. This scoping review explores altruism in paramedicine from the perspective of the paramedic as practitioner, learner, and educator as seen through the lens of the paramedic and the patient. Also discussed is the positive impact of altruism on the patient experience of care. A scoping review was used to assess the availability of data related to altruism in paramedicine. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used to guide the process. Search categories were orientated around the subject (altruism) and discipline (paramedicine). A total of 27 articles are included in this scoping review. Initial searching identified 742 articles after duplicate removal, 396 articles were screened with 346 excluded. Fifty articles were full-text reviewed and 23 excluded. The final 27 were extracted following full-text screening. None of the articles are specific to altruism in paramedicine. The data related to the practice of altruism in paramedicine are extremely limited. The preponderance of data arise from Europe and North America which, due to crewing and service differences, may impact the practice of altruism in different regions. Recent changes to the scope of paramedic practice, workload, education, and case acuity may influence behaviour regarding altruism, compassion, caring, and associated caring behaviours. The practice and education of paramedics including altruism, compassion, caring and caring behaviours in the Australasian setting warrants further research.
Publisher: MDPI AG
Date: 09-07-2019
DOI: 10.3390/HEALTHCARE7030090
Abstract: Evidence suggests that it is challenging for universities to develop workplace-relevant content and curricula by themselves, and this can lead to suboptimal educational outcomes. This paper examines the development, implementation, and evaluation of Australia’s first tertiary graduate course in healthcare redesign, a partnership initiative between industry and university. The course not only provides students with an understanding of person-centered sustainable healthcare but also the skills and confidence to design, implement, and evaluate interventions to improve health service delivery. Increasing students’ application of new knowledge has been through work-integrated learning, a pedagogy that essentially integrates theory with the practice of workplace application within a purposely designed curriculum. The specific aim of this study was to examine the outcomes of the course after two years, utilizing an anonymous online survey of graduates. Sixty-two graduates (48%) completed the survey. Kirkpatrick’s four-level evaluation model was used to analyze the data. The analysis revealed high satisfaction levels in relation to the course content and delivery. Through successful completion of the innovative course, students had increased their knowledge of health system redesign methods and, importantly, the ability to translate that knowledge into everyday practice. Graduates of the clinical redesign course reported that they had been able to transfer their skills and knowledge to others in the workplace and lead further improvement projects.
Publisher: ClinMed International Library
Date: 19-09-2019
Publisher: MDPI AG
Date: 15-08-2022
DOI: 10.3390/ORAL2030020
Abstract: Patient experience has been acknowledged as a critical dimension of healthcare quality alongside patient safety and clinical effectiveness. However, patient experiences in complete removable denture wearing have not been well established qualitatively. The purpose of this review was to synthesize qualitative studies that investigated the experiences of people wearing removable dentures in order to gain a deeper understanding of the issues and their causes. Databases of PubMed, SCOPUS, and CINAHL were searched to assess articles published in English from 2010 to 2021 globally. Qualitative studies that reported on experiences of people wearing removable dentures were included. A total of ten studies were included. People who wear dentures expressed ersified experiences (both negative and positive), including physical, social, psychological processes, and affective responses. Furthermore, experiences were related to emotions, maintenance of dentures, hygiene, access to care, and cost. Those wearing implant retained dentures reported more positive experiences than those who wear conventional complete dentures. Denture wearing experiences is a complex phenomenon involving the patient in wholeness including their environment. Healthcare professionals should be considering a holistic approach when providing denture rehabilitation. There is a need to further explore denture wearing experiences using qualitative approaches, as understanding of patient experiences can inform and provide clear directions on quality improvement initiatives and health-care policy development.
Publisher: MDPI AG
Date: 03-05-2022
DOI: 10.3390/HEALTHCARE10050842
Abstract: The Australian state of Tasmania has seen a spike in Emergency Department presentations in recent years, particularly among the elderly. A novel extended scope occupational therapy (ESOT) service was implemented by the Tasmanian Health Service, aimed at supporting hospital avoidance. Clients were referred to the ESOT service by other services after being assessed as having a high risk of imminent hospital presentation. Occupational Therapists provided short-term interventions related to falls, mobility, nutrition, and initiated onward referrals to other services. A convergent parallel mixed methods design was used to evaluate the ESOT service. Quantitative data from routinely collected administrative records and a purpose-built survey of referring clinicians were used alongside qualitative data from semi-structured interviews with clients/carers, to enable the triangulation of data. Quantitative data were analysed using descriptive statistics, while qualitative data collected in interviews were thematically analysed. A total of 104 extended scope interventions were provided to 100 clients. Most clients were able to stay at home. Qualitative data revealed that mobility, support, and facilitating access to support services were factors which added value to the client and carer experience. In conclusion, the ESOT program contributed to potentially avoiding hospital admissions and to improving the quality of life of participating clients.
Publisher: MDPI AG
Date: 04-11-2019
DOI: 10.3390/HEALTHCARE7040132
Abstract: Transformational leadership (TL) is known to be essential to achieving Magnet® recognition, an internationally prestigious status for nursing care excellence. Since its inception in the 1980s, empirical studies have identified benefits of implementing the Magnet® Model involving improved patient care and nursing workforce outcomes. However, little is known about the leadership styles of nurse managers (NMs) working in a regional Australian context, which may hinder achieving Magnet® status. To close the knowledge gap, a self-administered survey was conducted to measure leadership styles of NMs at a large health organization comprising hospitals with a wide range of service profiles in regional Australia using a validated tool—the Multifactor Leadership Questionnaire (MLQ-6S). One-way of variance (ANOVA) was used to identify statistical significance between respondents’ demographic characteristics (e.g., age, education, gender) and their MLQ-6S scores. Respondents (n = 78) reported their leadership styles as more transformational, compared to transactional or passive/avoidant leadership styles. The findings indicated that NMs’ higher education (p = 0.02) and older age (p = 0.03) were associated with TL styles, whereas passive/avoidant leadership was generally reported by female (p = 0.04) and younger (p = 0.06) respondents. This study has identified differences in reported leadership styles among NMs, providing a unique organizational insight into developing strategies to improve NMs’ TL, which could help to facilitate the implementation of the Magnet® framework. Healthcare organizations in similar settings could benefit from replicating this study to identify a dominant leadership style and customize strategies to improve TL.
Publisher: AOSIS
Date: 20-03-2013
Abstract: Orientation: Measuring the target outcomes of leadership development programmes provides evidence for the effectiveness of these interventions and the validity of their theoretical underpinnings.Research purpose: The aim of this study was to determine whether staff from the Tasmanian Department of Health and Human Services (Australia) experienced increased levels of self-efficacy, social support within the workplace and positive affect, following participation in a leadership development programme.Research design, approach and method: Quantitative and qualitative methods were used, allowing for triangulation of results. The General Self-Efficacy Scale and the Berlin Social-Support Scale (perceived available support, instrumental) were applied in an online survey administered before and nine months following the programme. Participant satisfaction surveys captured immediate responses and semi-structured interviews captured longer-term reflections.Main findings: Descriptive statistics indicated a moderate overall increase in self-efficacy, with strong increases in resilience, dealing with opposition, resourcefulness and problem solving. There was some evidence of greater overall social support and a strong increase in the development of social support networks. There was no support for an increase in participants’ positive orientation towards their jobs in the quantitative data. The impact of adverse environmental factors on participants’ perceptions also became evident through the interviews.Practical implications: Leadership development programmes that strengthen positive psychological resources provide participants with confidence and resilience in times of change. Organisations benefit from increased levels of employee self-efficacy as engagement and problem-solving abilities are enhanced.Contribution/value-add: These results contribute to the body of knowledge associated with effective leadership development.
Publisher: Wiley
Date: 10-05-2018
DOI: 10.1002/JMRS.280
Publisher: SAGE Publications
Date: 10-01-2020
Abstract: Online electronic records such as patient portals and personally controlled electronic health records (PEHRs) have been widely viewed as a key component to modernising the delivery of healthcare but the uptake of such systems has been slow. The purpose of this literature review was to determine what influences consumers to engage and interact with their clinical data online. A scoping literature review following PRISMA guidelines was completed. Electronic patient record research published between January 2009 and December 2018 was included. Following screening and full-text reviews, a total of 64 records were included in this review. Three key areas of influence on consumer engagement with their clinical data online emerged: demographic factors affecting consumer interaction with PEHRs consumers’ perceived benefits and detriments of PEHR use and the influence of PEHR use on consumer empowerment and responsibility. Consumer motivation and readiness for engaging with their clinical data online and their long-term ongoing use of these systems requires further exploration. As worldwide rates of consumer interactions with in idual online clinical data remain low, what influences consumer engagement with a PEHR remains unknown. Further research into the consumer perspective of, and interaction with, a PEHR, needs to be undertaken to determine if factors such as frequent usage of the system by consumers leads to improved clinical outcomes.
No related grants have been discovered for Pieter Jan Van Dam.