ORCID Profile
0000-0001-7592-832X
Current Organisations
Murdoch University
,
CSIRO
,
Bangladesh Agricultural Research Institute
,
Royal Flying Doctor Service
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Publisher: BMJ
Date: 08-03-2023
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JDIACOMP.2017.09.008
Abstract: To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control. Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience. There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes. It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.
Publisher: MDPI AG
Date: 31-01-2022
DOI: 10.3390/APP12031560
Abstract: Stroke is the second most common cause of death and remains a persistent health challenge globally. Due to its highly time-sensitive nature, earlier stroke treatments should be enforced for improved patient outcome. The mobile stroke unit (MSU) was conceptualized and implemented to deliver the diagnosis and treatment to a stroke patient in the ultra-early time window ( h) in the pre-hospital setting and has shown to be clinically effective. However, due to geographical challenges, most rural communities are still unable to receive timely stroke intervention, as access to specialized stroke facilities for optimal stroke treatment poses a challenge. Therefore, the aircraft counterpart (Air-MSU) of the conventional road MSU offers a plausible solution to this shortcoming by expanding the catchment area for regional locations in Australia. The implementation of Air-MSU is currently hindered by several technical limitations, where current commercially available CT scanners are still oversized and too heavy to be integrated into a conventional helicopter emergency medical service (HEMS). In collaboration with the Australian Stroke Alliance and Melbourne Brain Centre, this article aims to explore the possibilities and methodologies in reducing the weight and, effectively, the size of an existing CT scanner, such that it can be retrofitted into the proposed search and rescue helicopter—Agusta Westland AW189. The result will be Australia’s first-ever customized CT scanner structure designed to fit in a search-and-rescue helicopter used for Air-MSU.
Publisher: Unpublished
Date: 2018
Publisher: Cambridge University Press (CUP)
Date: 21-03-2018
DOI: 10.1017/S1049023X18000195
Abstract: a. Event type: Outdoor music festival. b. Event onset date: December 3, 2016. c. Location of event: Regatta Point, Commonwealth Park. d. Geographical coordinates: Canberra, Australian Capital Territory (ACT), Australia (-35.289002, 149.131957, 600m). e. Dates and times of observation in latitude, longitude, and elevation: December 3, 2016, 11:00-23:00. f. Response type: Event medical support. Abstract Young adult patrons are vulnerable to risk-taking behavior, including drug taking, at outdoor music festivals. Therefore, the aim of this field report is to discuss the on-site medical response during a music festival, and subsequently highlight observed strategies aimed at minimizing substance abuse harm. The observed outdoor music festival was held in Canberra (Australian Capital Territory [ACT], Australia) during the early summer of 2016, with an attendance of 23,008 patrons. First aid and on-site medical treatment data were gained from the relevant treatment area and service. The integrated first aid service provided support to 292 patients. Final analysis consisted of 286 patients’ records, with 119 (41.6%) males and 167 (58.4%) females. Results from this report indicated that drug intoxication was an observed event issue, with 15 (5.1%) treated on site and 13 emergency department (ED) presentations, primarily related to trauma or medical conditions requiring further diagnostics. This report details an important public health need, which could be met by providing a coordinated approach, including a robust on-site medical service, accepting intrinsic risk-taking behavior. This may include on-site drug-checking, providing reliable information on drug content with associated education. Luther M , Gardiner F , Lenson S , Caldicott D , Harris R , Sabet R , Malloy M , Perkins J . An effective risk minimization strategy applied to an outdoor music festival: a multi-agency approach . Prehosp Disaster Med . 2018 33 ( 2 ): 220 – 224 .
Publisher: SAGE Publications
Date: 21-10-2023
DOI: 10.1177/15586898221135291
Abstract: Meeting the mental health needs of rural populations is challenging internationally, with few methods and scarce data available to inform site-specific planning. We developed a mixed methods approach that integrates Not-for-profit (NFP) organization data in a Geographic Information System (GIS) to explore interrelated understandings of mental health experiences in rural places. Integrating qualitative experience data from online forums with quantitative data from service search and emergency pickup locations via GIS demonstrates how NFP health service data can be ethically sourced, reused, integrated, analyzed, and ground-truthed to explore how mental health is experienced in rural places. This article contributes to the mixed methods literature an ethical approach that utilizes NFP health service datasets to inform research in contexts of data scarcity.
Publisher: MDPI AG
Date: 26-07-2016
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.PLACENTA.2018.06.310
Abstract: Preterm birth is a common cause of adverse neonatal and childhood outcomes. It is commonly associated with infection of the maternal-fetal interface. The relationship between periodontitis and preterm labour is controversial. Control placental tissues from uncomplicated term births were compared with those from spontaneous preterm births for incidence of common periodontal bacteria. A chi-square analysis was used to compare the populations, with significance determined at p=<0.05. The study group comprised 29 control women who had an uncomplicated term birth, 25 delivered by caesarean section and 4 vaginal deliveries, and 36 women with a spontaneous preterm labour and subsequent delivery at less than 34 weeks gestation. There were significant (p= 0.05) differences between the groups fetal risk factors or co-morbidities, except the preterm group had a significantly higher (p=<0.05) rate of premature rupture of membrane (PROM). There were significantly (p=<0.01) more Fusobacterium spp. in the placentas from term births than preterm births. This study found that the common periodontal pathogen, Fusobacterium spp., is not detected more in placentas from preterm birth and may potentially be lower, possibly resulting from bacterial ecological factors in term placentas.
Publisher: Wiley
Date: 08-2019
DOI: 10.1002/AJUM.12179
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2017.05.025
Abstract: Stroke is one of the leading causes of disability and mortality. Patients who receive organized inpatient care in a stroke unit (SU) have better clinical outcomes. However, evidence on the cost analysis of an SU is lacking. The objective of this study was to assess the performance and analyze the cost-effectiveness of an SU. A retrospective observational study was conducted comparing the acute stroke patient care in a 6-month period before and after the establishment of an acute SU at Calvary Hospital in 2013-2014. There were 103 patients included in the pre-SU period, as compared to 186 patients in the post-SU period. In the pre- and post-SU groups, 54 and 87 patients, respectively, had ischemic stroke, with significant trends in improved morbidity and mortality in the post-SU group (P = .01). The average length of stay (LOS) for patients was reduced from 9.7 days to 4.6 days in the post-SU group (P = .001). There was a reduction of cost per admission from $6382 Australian dollars (AUD) with conventional ward care as compared to $6061 (AUD) with SU care. This study confirmed that the establishment of an SU not only improves treatment outcomes but also shortens LOS, thereby achieving cost-effectiveness.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2021
DOI: 10.1186/S12913-021-06404-5
Abstract: Inequalities in the availability of maternity health services in rural Australia have been documented, but not the impact on aeromedical retrievals. This study aims to examine the prevalence of pregnancy-related aeromedical retrievals, the most common conditions (overall and in specific age groups), and their distribution according to operation area and demographic characteristics. Cross-sectional study using administrative data from the Royal Flying Doctors Service (RFDS) including all pregnant women aged 15–49 years retrieved by the RFDS between 2015 and 2019. All pregnancy-related aeromedical retrievals were classified according to the International Classification of Diseases, Tenth Revision (ICD-10, chapter XV). The distribution of pregnancy-related conditions was presented overall and stratified by age group (i.e. 20 years, 20–34 years and 35+ years). Retrieval and receiving sites were geographically mapped with Tableau mapping software® based on postcode numbers of origin and destination. A total of 4653 pregnancy-related retrievals were identified (mean age 27.8 ± 6.1 years), representing 3.1% of all RFDS transfers between 2015 and 18 and 3.5% in 2018–19 ( p -value 0.01). The highest proportion of pregnancy-related retrievals (4.8%) occurred in Western operation. There was an apparent increase in pregnancy-related retrievals in South Australia and the Northern Territory (Central Operation) in 2018–19. Preterm labour/delivery was responsible for 36.4% of all retrievals (40.7% among women aged 15–19 years) and premature rupture of membranes for 14.9% (19.4% among women aged 35–49 years). Inter-hospital transfers represented 87.9% of all retrievals, with most patients relocated from rural and remote regions to urban hospitals most retrievals occurred during the day, with a median distance of 300 km. Adolescents and Aboriginal and Torres Strait Islander were overrepresented in the s le (four and eight times higher than their metropolitan counterparts, respectively). The proportion of pregnancy-related aeromedical retrievals varies geographically across Australia. Overall, one-third of retrievals were related to preterm/delivery complications, especially among adolescents. Most retrievals performed by the RFDS are susceptible to public health strategies aimed at improving antenatal care and preventing unintended pregnancies among adolescents and Aboriginal and Torres Strait Islander women. Greater capacity to manage pregnancy conditions in rural hospitals could reduce the requirement for aeromedical inter-hospital transfers.
Publisher: Wiley
Date: 27-05-2020
DOI: 10.1111/AJR.12631
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Sciedu Press
Date: 10-12-2015
DOI: 10.5430/JHA.V5N2P1
Abstract: Objective: This study was designed to improve patient discharge summary completion rates directly following patient hospital discharge. The primary reason for this was to improve continuity of patient care and reduce hospital readmissions within 28 days.Methods: The researcher benchmarked the discharge summary completion rate before conducting in idual feedback directly to clinicians. Content was deemed complete if the information was present and appropriate. Partially completed, unclear, or absent information was deemed outstanding. This information was gained by looking at the hospital’s patient records. The researcher benchmarked the readmission data. This data included establishing monthly patient discharges (excluding deaths) and the number of unplanned and unexpected readmissions within 28 days related to the primary admission. This information was used to compare pre-intervention to invention readmission rates.Results: The hospital’s total discharge completion rate statistically changed from 91.92% pre-intervention to 99.18% postintervention, with the biggest change occurring in Obstetrics and Gynaecology (O& G). O& G discharge completion rate improved from 46.94% pre-intervention to 98.84% post-intervention. A two s le t-test indicated that this difference was significant, t(2.0905) = 0.0458, p = .05. The readmission rates statistical changed from 0.49% pre-intervention to 0.26% during the intervention period. A two s le t-test indicated that this difference was significant, t(2.3679) = 0.04205, p = .05.Conclusions: This study provided evidence of the effectiveness of conducting audit and feedback sessions as it relates to patient discharge summaries and readmissions.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Unpublished
Date: 2019
Publisher: Wiley
Date: 12-06-2023
DOI: 10.1111/IMJ.16140
Abstract: Substance use disorders (SUDs) cause significant harm to regional Australians, who are more likely to misuse alcohol and other drugs (AODs) and encounter difficulty in accessing treatment services. The primary aims of this study were to describe the demographics of patients aeromedically retrieved from regional locations and compare hospital outcomes with a metropolitan‐based cohort. Retrospective case‐controlled cohort study. Participants were aeromedically retrieved within Western Australia for SUDs between 1 July 2014 and 30 June 2019. Retrieved patients were case‐matched based on age and hospital discharge diagnosis. Descriptive statistics and χ 2 analysis were used to summarise the findings. One hundred thirty‐six (91.3%) aeromedical retrievals were found, with the majority being male ( n = 95 69.9%). These were case‐matched to 427 metropolitan patients, the majority male ( n = 321 75.2%). Retrieved patients were more likely (all P 0.05) Indigenous (odds ratio [OR], 9.35 [95% confidence interval (CI), 5.96–14.85]), unemployed (OR, 2.9 [95% CI, 1.41–6.80]), referred to a tertiary hospital (OR, 2.18 [95% CI, 1.24–3.86]) and to stay longer in hospital (OR, 1.08 [95% CI, 1.02–1.14]). Findings highlight that unmarried and/or unemployed males were overrepresented in the retrieval group, with over half identifying as Indigenous. Regional variation in retrievals was noted, while hetamine‐type stimulants featured prominently in the retrieval cohort, who experienced longer hospital stays and more restrictive treatment. Comparing clinical outcomes for retrieved regional patients experiencing SUDs, service design and delivery should focus on offering culturally safe care for Indigenous people, catering for regional health care catchment areas, while ideally adopting collaborative and integrated approaches between AODs and mental health services.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DSX.2017.12.007
Abstract: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = 7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Rural and Remote Health
Date: 31-10-2022
DOI: 10.22605/RRH7541
Publisher: Sciedu Press
Date: 22-12-2015
DOI: 10.5430/JHA.V5N2P42
Abstract: Objective: This study was designed to reduce inappropriate Full Blood Count (FBC) pathology testing on specific hospital wards. It was hoped that by auditing requested Full Blood Counts, the researcher would be able to determine and benchmark appropriateness before conducting feedback interventions to promote appropriate pathology test ordering.Methods: To reduce inappropriate Full Blood Count pathology test ordering, the researcher audited patient notes and pathology test request forms in June 2015 before conducting audit and feedback interventions in July, August, and September 2015 on the hospital ward areas. The feedback intervention consisted of auditing patient notes, pathology request forms, and the local pathology clinical integration systems to determine Full Blood Count appropriateness. This data was then communicated to the attending doctor and requesting doctor during feedback sessions. To conceptualize appropriate pathology test ordering, the researchers highlighted the “Framework for analysis of test ordering” during scheduled feedback sessions. It was hypothesized that audit and feedback would decrease the amount of inappropriate Full Blood Counts ordered.Results: After receiving the audit and feedback intervention, clinicians were more likely not to order inappropriate Full Blood Counts (64.60% vs. 23.40%), specifically providing adequate clinical reasoning for the test, t(4.6706) = 0.0429, p = .05.Conclusions: This study found that audit and feedback sessions significantly improved appropriate pathology test ordering and the clinical reasoning associated with Full Blood Counts.
Publisher: Unpublished
Date: 2018
Publisher: Sciedu Press
Date: 24-02-2015
DOI: 10.5430/JHA.V5N1P73
Abstract: Objective: This study was designed as an educational program aimed at promoting evidence-based pathology ordering with the aim of reducing inappropriate test ordering.Methods: Researchers benchmarked the hospital’s pathology tests ordered in 2013-2014 before conducting a multifaceted education program in 2014-2015. The intervention consisted of main priorities including pathology test auditing, in-services and lectures, development and implementation of investigation pathways, and policy and procedure compliance. The main outcome measures was a reduction in commonly inappropriate ordered pathology testing leading to a reduction in the average test per hospital admission, and a reduction in specimen collection errors.Results: Through this educational method the researchers achieved a reduction in the average test per admission in 2014-2015 (M = 12.98) from 2013-2014 (M = 13.83). A two s le t-test indicated that this difference was significant, t(3.3006) = 0.0071, p = .01. The intervention included a focus on specimen collection errors and achieved a reduction in specimen error rates (M = 2,695) from the previous year (M = 3,000). A one s le t-test indicated that this difference was significant, t(3.0804) = 0.0105, p = .05. This intervention decreased commonly inappropriate pathology requests of Full Blood Count (FBC, -4.21%), Liver Function Tests (LFTs, -8.36%), Vitamin B12 (B12, -6.45%) and Coagulation profile (-21.22%). Commonly inappropriate pathology tests decreased (M = 7,120.33) from (M = 7,609.67). A two s le t-test indicated that this difference was significant, t(3.7730) = 0.0031, p = .005.Conclusions: Results confirmed that a multi-faceted education program can reduce inappropriate pathology test ordering, commonly over-ordered pathology test ordering, and pathology specimen error rates while maintaining positive patientoutcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
DOI: 10.1186/S13049-022-01053-X
Abstract: Aeromedical emergency retrieval services play an important role in supporting patients with critical and often life-threatening clinical conditions. Aeromedical retrieval services help to provide fast access to definitive care for critically ill patients in under-served regions. Typically, fixed-wing aeromedical retrieval becomes the most viable transport option compared with rotary-wing aircraft when distances away from centres of definitive care extend beyond 200 kms. To our knowledge, there are no studies that have investigated fixed-wing aeromedical services in the member countries of the organisation for economic cooperation and development (OECD). A description of the global characteristics of aeromedical services will inform international collaboration to optimise clinical outcomes for patients. In this scoping review, we aimed to describe the features of government- and not-for-profit organisation-owned fixed-wing aeromedical retrieval services in some of the member countries of the OECD. We followed scoping review methodology based on the grey literature search strategy identified in earlier studies. This mostly involved internet-based searches of the websites of fixed-wing aeromedical emergency retrieval services affiliated with the OECD member countries. We identified 460 potentially relevant records after searching Google Scholar (n = 24) and Google search engines (n = 436). After removing ineligible and duplicate information, this scoping review identified 86 government-and not-for-profit-operated fixed-wing aeromedical retrieval services as existing in 17 OECD countries. Concentrations of the services were greatest in the USA followed by Australia, Canada, and the UK. The most prevalent business models used across the identified OECD member countries comprised the government, not-for-profit, and hybrid models. Three-quarters of the not-for-profit and two-fifths of the hybrid business models were in the USA compared to other countries studied. The government or state-funded business model was most common in Australia (11/24, 46%), Canada (4/24, 17%), and the UK (4/24, 17%). The frequently used service delivery models adopted for patients of all ages included primary/secondary retrievals, secondary retrievals only, and service specialisation models. Of these service models, primary/secondary retrieval involving the transportation of adults and children from community clinics and primary health care facilities to centres of definitive care comprised the core tasks performed by most of the aeromedical retrieval services studied. The service specialisation model provided an extra layer of specialist health care dedicated to the transportation of neonates and paediatrics. At least eight aeromedical retrieval services catered solely for children from birth to 16 years of age. One aeromedical service, the royal flying doctor service in Australia also provided primary health care and telehealth services in addition to primary retrieval and interhospital transfer of patients. The doctor and registered nurse aramedic (Franco-German model) and the nurse and/or paramedic (Anglo-American model) configurations were the most common staffing models used across the aeromedical services studied. The development and composition of fixed-wing aeromedical emergency retrieval services operated by not-for-profit organisations and governments in the OECD countries showed ersity in terms of governance arrangements, services provided, and staffing models used. We do not fully understand the impact of these differences on the quality of service provision, including equitable service access, highlighting a need for further research.
Publisher: BMJ
Date: 16-05-2018
DOI: 10.1136/JRAMC-2018-000975
Abstract: Studies have identified that there are many barriers to treatment of mental health illnesses in military populations, including the negative-associated stigma. One such barrier includes perceptions of weakness, leading to concerns about leadership and competency and being seen as malingering. Furthermore, similarities can be seen in civilian health professionals, where concerns of negative perceptions can limit reporting and treatment of mental health illnesses. Despite the frequency of stressful events, military and health professionals do not become immune to stress and are often ill prepared to cope with acute stressors that can often build on each other until emotional exhaustion and/or crisis point. Even with targeted internal programmes, the stigma of seeking mental health assistance in the military and medicine is poor and is believed to contribute to poor outcomes, such as the potential of increased suicide prevalence.
Publisher: AMPCo
Date: 25-07-2019
DOI: 10.5694/MJA2.50272
Abstract: To characterise the people retrieved by the Royal Flying Doctor Service (RFDS) for treatment of mental and behavioural disorders, and to assess mental health care provision in rural and remote areas. Prospective review of routinely collected RFDS and Health Direct data. RFDS aeromedical retrievals of patients from anywhere in Australia except Tasmania during 1 July 2014 - 30 June 2017 for the treatment of mental or behavioural disorders. Retrievals by ICD-10 mental and behavioural disorder diagnoses. 2257 patients were retrieved by the RFDS for treatment of mental or behavioural disorders, including 1394 males (62%) and 863 females (38%) 60% of patients were under 40 years of age, 35% identified as Indigenous Australians. The most frequent mental and behavioural disorders were schizophrenia (227 retrievals, 16.5% of retrievals with ICD diagnoses), bipolar affective disorder (185, 13.5%), and depressive episodes (153, 11.2%). Psychoactive substance misuse triggered 194 retrievals (14.2%), including misuse of multiple drugs (85, 6.2%), alcohol (61, 4.5%), and cannabinoids (25, 1.8%). The mean age of patients retrieved for treatment of substance misuse (29.6 years SD, 11.6 years) was lower than for retrieved patients overall (37.0 years SD, 19.3 years) 38 of 194 patients retrieved after psychoactive substance misuse (19.6%) were under 19 years of age. Most retrieval sites were rural and remote communities with low levels of mental health care support. Mental and behavioural disorders are an important problem in rural and remote communities, and acute presentations trigger a considerable number of RFDS retrievals.
Publisher: AMPCo
Date: 18-07-2019
DOI: 10.5694/MJA2.50277
Publisher: Springer Science and Business Media LLC
Date: 24-06-2017
DOI: 10.1007/S11845-016-1476-9
Abstract: Cardiac Troponin I and Troponin T are both very sensitive and specific, with the troponin pathology test recommended for the diagnosis of myocardial infarction. The diagnosis of myocardial infarction, in conjunction with electrocardiogram myocardial infarction, is based on a rise or fall of troponin with at least one value above the 99th percentile for the population. Troponin levels are regularly ordered within hospitals, especially in emergency medicine. It has been suggested that much of this testing is ordered despite the absence of clinical suspicion for acute coronary syndrome. This study examined the appropriateness of troponin testing within one Australian teaching hospital. A retrospective chart review was conducted of 111 randomly selected patients who received a troponin assay within the hospital's Emergency Department. To determine appropriateness, the troponin test needed to reflect Australian clinical guidelines, and inform the ongoing management of the patient. Results demonstrate that the majority (76.6 %) of troponin testing was appropriate, with the remainder (23.4 %) deemed inappropriate due to not altering the ongoing patient management (n = 26), and not being informed by clinical guidelines (n = 26). Troponin testing is important in the diagnosis of myocardial infarction, although should not be ordered routinely, or unnecessary. This study has determined that using clinical guidelines can promote rational ordering, and that testing should ultimately benefit patient management. Reducing inappropriate pathology test ordering is important to maximize productive clinical time, reduce false positives, maximize patient care, and to reduce financial waste.
Publisher: Wiley
Date: 02-2020
DOI: 10.1002/AJUM.12198
Publisher: Elsevier BV
Date: 09-2020
Publisher: Cold Spring Harbor Laboratory
Date: 30-10-2022
DOI: 10.1101/2022.10.27.22281631
Abstract: The aim of this study was to describe the characteristics and outcomes of remote-dwelling pregnant people with threatened labour referred for aeromedical retrieval to a regional birthing centre, as well as factors associated with birth within 48 hours. This was a retrospective observational study of all pregnant people in the remote Central Australian region referred to the Medical Retrieval Consultation and Coordination Centre for labour weeks gestation, between 12 February 2018 – 12 February 2020. Data was extracted manually from written medical records on maternal, neonatal and retrieval mission characteristics. Univariate and multivariate statistical analysis was performed. There were 116 people referred for retrieval for labour. There were no births during transport and less than half of the cases in this cohort resulted in birth within 48 hours of retrieval. Tocolysis was frequently used. Predictors of birth with 48 hours were cervical dilatation 5cm or more, preterm gestational age and ruptured membranes in the univariate analysis. Nearly one-third of this cohort required intervention or had complications during birth. Birth during transport for threatened labour did not occur in this cohort, and more than half of retrievals did not result in birth within 48 hours, however the high risk of birth complications may offset any benefit of avoiding aeromedical transport from remote regions. Retrieval clinicians should have a lower threshold for urgent transfer in cases of ruptured membranes, cervical dilatation of 5cm or more, or gestational age is less than 37 weeks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-0055
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: University of Buckingham Press
Date: 26-09-0002
Abstract: Background: The sharing of a story, related to a co-worker or patient, is believed to lead to an increased personalisation of the empathy message. Previous clinical interventions aimed at improving empathy, primarily considered one stakeholder and were often patient-centric. Objective: The aim of this study was to test whether an intervention consisting of audio clips concerning the experiences of the people of an Emergency Department, can lead to increases in measured empathy.Methods: To promote a multidisciplinary approach, the researchers included patients (including their significant others) and clinical staff in the study design. The researchers recorded interviews focusing on the participants lived experience within the Emergency Department (ED).The audio recordings aimed to capture the perspective of: working in the ED (including the multidisciplinary team), being a patient in the ED and being a significant other in the ED (the people of an Emergency Department). This design enabled sharing of the lived experience of the participants, thus encouraging empathetic feelings bilaterally, between the patient and clinician. Results: Participants indicated that after listening to a story, 93.2% (n=55) felt they had a better understanding of the situation experienced by emergency department staff, patients or their visitors/significant others. Furthermore, 88.3% (n=53) of participants indicated that their empathy towards the people of the ED increased. Participants were asked to indicate their ability to empathise before listening to a recording, with a resulting weighted average of 3.25/5. This was then compared to their weighted average result, following listening to an audio recording of 4.17/5. Overall, the participant results were highly significant t(6.1174)=0.0001, p= .001. Conclusion: Audio recordings, demonstrating patient and healthcare clinician experiences, from a 360° perspective, are an effective way to share the familiarities of the people of an ED, promoting an ability in the listener to ‘walk in another’s shoes’.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Wiley
Date: 12-2020
DOI: 10.1111/IMJ.15091
Publisher: Unpublished
Date: 2018
Publisher: Wiley
Date: 08-2019
DOI: 10.1111/IMJ.14716
Abstract: Inequalities in access to renal services and acute care for rural and remote populations in Australia have been described but not quantified. To describe: the coverage of renal disease management services in rural and remote Australia and the characteristics of patients who had an aeromedical retrieval for renal disease by Australia's Royal Flying Doctor Service (RFDS). Data from the RFDS, the Australian Bureau of Statistics, and Health Direct were used to estimate provision of renal disease management services by geographic area. RFDS patient diagnostic data were prospectively collected from 2014 to 2018. Many rural and remote areas have limited access to regular renal disease management services. Most RFDS retrievals for renal disease are from regions without such services. The RFDS conducted 1636 aeromedical retrievals for renal disease, which represented 1.6% of all retrievals. Among retrieved patients, there was a higher proportion of men than women (54.6% vs 45.4%, P < 0.01), while indigenous patients (n = 546, 33.4%) were significantly younger than non-indigenous patients (40.9 vs 58.5, P < 0.01). There were significant differences in underlying diagnoses triggering retrievals between genders, with males being more likely than females to be transferred with acute renal failure, calculus of the kidney and ureter, renal colic, obstructive uropathy, and kidney failure (all P < 0.01). Conversely, females were more likely to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo-interstitial nephritis, and nephrotic syndrome (all P < 0.01). Aeromedical retrievals for acute care were from rural areas without regular access to renal disease prevention or management services.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2021
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.DSX.2017.07.034
Abstract: To determine if the Cardiac rehabilitation (CR) program had positive effects on the patient medically as well as effects on pathological risk factors, functional capacity, and mental health and the extent to which targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) are achieved. CR participant data was collected from 1st June 2014 until 31st December 2015 (19 months), which included: demographics, medical history, social history, medications, lipid profiles and anthropometric measurements. Additional data was collected on The Patient Health Questionnaire (PHQ-9) factors, and on the participants 6min walk test (6MWT). Study participants were eligible to participate in the study if they attended 10 or more CR program sessions out of 12 at the Calvary Public Hospital Canberra. Seventy nine (79) participants participated in the study. Significant reductions in BP (n=79) (p=<0.05), blood LDL cholesterol levels (n=26) (p=<0.05), and improvements in participants PHQ-9 scores (n=79) (p=<0.001), and their 6MWT (n=78) (p=<0.001) were noted. Participants were also able to better manage their medication (p=<0.05). Importantly, results indicated that significant improvements (p=<0.05) were made in DM patients (n=18) diastolic BP, physical ability and depression and anxiety. A CR program can reduce risk factors associated with CVD, and improves mental health and physical fitness of participants. Indicated that the CR program reduces DM patient risk factors through improved physical fitness and reductions in depression and anxiety, leading to reduced risk of future cardiovascular and renal disease.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/IMJ.14822
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000508578
Abstract: b i Introduction: /i /b Rural, remote, and Indigenous stroke patients have worse stroke outcomes than urban Australians. This may be due to lack of timely access to expert facilities. b i Objectives: /i /b We aimed to describe the characteristics of patients who underwent aeromedical retrieval for stroke, estimate transfer times, and investigate if flight paths corresponded with the locations of stroke units (SUs) throughout Australia. b i Methods: /i /b Prospective review of routinely collected Royal Flying Doctor Service (RFDS) data. Patients who underwent an RFDS aeromedical retrieval for stroke, July 2014–June 2018 (ICD-10 codes: I60–I69), were included. To define the locations of SUs throughout Australia, we accessed data from the 2017 National Stroke Audit. The main outcome measures included determining the characteristics of patients with an in-flight diagnosis of stroke, their subsequent pickup and transfer locations, and corresponding SU and imaging capacity. b i Results: /i /b The RFDS conducted 1,773 stroke aeromedical retrievals, consisting of 1,028 (58%) male and 1,481 (83.5%) non-Indigenous and 292 (16.5%) Indigenous patients. Indigenous patients were a decade younger, 56.0 (interquartile range [IQR] 45.0–64.0), than non-Indigenous patients, 66.0 (IQR 54.0–76.0). The most common diagnosis was “stroke not specified,” reflecting retrieval locations without imaging capability. The estimated median time for aeromedical retrieval was 238 min (95% confidence interval: 231–244). Patients were more likely to be transferred to an area with SU and imaging capability (both i /i & #x3c 0.0001). b i Conclusion: /i /b Stroke patients living in rural areas were younger than those living in major cities (75 years, Stroke Audit Data), with aeromedically retrieved Indigenous patients being a decade younger than non-Indigenous patients. The current transfer times are largely outside the time windows for reperfusion methods. Future research should aim to facilitate more timely diagnosis and treatment of stroke.
Publisher: OAE Publishing Inc.
Date: 2021
Publisher: Springer Singapore
Date: 2021
Publisher: AMPCo
Date: 11-2019
DOI: 10.5694/MJA2.50384
Abstract: To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs). Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 - June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme-linked immunosorbent FC assay method with a cut-off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS-2, an evidence-based quality assessment tool for diagnostic accuracy studies. MEDLINE and EMBASE reference lists of screened articles. Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74-86%), the specificity 81% (95% CI, 71-88%) area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80-93%), specificity 72% (95% CI, 59-82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut-offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77). FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system. CRD4201810507.
Publisher: Rural and Remote Health
Date: 22-05-2019
DOI: 10.22605/RRH5270
Publisher: Wiley
Date: 10-01-2021
DOI: 10.1111/AJO.13308
Abstract: Limited access to obstetrics and gynaecology (O& G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. To describe the characteristics of pregnancy aeromedical transfers, in‐hospital outcomes, and patient access to O& G services, as compared to whole of Australia data. We conducted a cohort study of women who required aeromedical retrieval for pregnancy‐related issues between the 1 January 2015 and 31 December 2017. Hospital outcome data were collected on 2171 (65.2%) mothers and 2438 (100.0%) babies. The leading retrieval reason was threatened preterm labour and delivery ( n = 883 40.7%). Most patients were retrieved from rural and remote areas ( n = 2224 93.0%). Retrieved patients were significantly younger (28.0 vs 30.0 years, 95% CI 27.7–28.3), more likely to be overweight or obese (52.2% vs 45.1%, 95% CI 47.5–56.9) and to have smoked during their pregnancy (14.0% vs 9.9%, 95% CI 12.5–15.5) compared to Australian pregnant women overall. Over one‐third of transferred women gave birth by Caesarean section ( n = 812 37.4%) the median gestational age at birth was 33.0 (95% CI 32.7–33.3) weeks. Early gestation is associated with low birth weights (median = 2579.5 g 95% CI 2536.1–2622.9), neonatal resuscitation (35.4%, 95% CI 33.5–37.3), and special care nursery admission (41.2%, 95% CI 39.3–43.2). There were 42 (1.7%, 95% CI 1.2–2.2) stillbirths, which was significantly higher than seen Australia‐wide ( n = 6441 0.7%). This study found that pregnant women retrieved by the Royal Flying Doctor Service were younger, with higher rates of obesity and smoking.
Publisher: Elsevier BV
Date: 10-2018
Publisher: SAGE Publications
Date: 15-11-2023
DOI: 10.1177/10398562221139129
Abstract: Estimate impact of socioeconomic factors and remoteness from tertiary hospital on incidence/duration of Australian mental health admissions. Retrospective analysis of incidence/duration of public mental health unit admissions (2018–19). Covariates included Indigenous population, potentially preventable hospitalisations (PPH) and socioeconomic disadvantage. Regional distance from hospital was correlated with socioeconomic disadvantage ( ρ: p 0.01). Population identifying as Aboriginal or Torres Strait Islander was associated with distance from hospital, socioeconomic disadvantage and PPH ( ρ: p 0.01). Bed days per capita was explained ( R 2 adj : 0.48) by distance and socioeconomic disadvantage ( p 0.0001). A 1% increase in distance from hospital was associated with a 0.37% decrease in per capita bed days. Admission rate per capita across Queensland and WA was explained ( R 2 adj : 0.36) by distance, education/occupation and state ( p 0.05). Across Queensland and WA a 1% increase in distance from hospital was associated with a 0.05% decreased incidence of admission. Rural Australians face high mental illness burden, socioeconomic disadvantage and limited service provision. Overcoming the additional disadvantages of reduced likelihood of admission to and reduced time in hospital with increasing distance from hospital will require increased outreach proportional to remoteness.
Publisher: Elsevier BV
Date: 2022
DOI: 10.2139/SSRN.4149841
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.AMJ.2022.02.005
Abstract: Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018. A total number of 236 air medical retrievals were deemed suitable for inclusion 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P < .05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis. Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight.
Publisher: Cold Spring Harbor Laboratory
Date: 19-08-2020
DOI: 10.1101/2020.08.16.20176230
Abstract: We aimed to compare the pre, lockdown, and post-lockdown aeromedical retrieval (AR) diagnostic reasons and patient demographics during a period of Coronavirus 2019 (COVID-19) social isolation. An observational study with retrospective data collection, consisting of Australians who received an AR between the 26 January to the 23 June 2020. The main outcome measures were patient diagnostic category proportions and trends prior (28 January to 15 March), during (16 March to 4 May), and following (5 May to 23 June 2020) social isolation restrictions. There were 16981 ARs consisting of 1959 (11.5) primary evacuations (PE) and 12724 (88.5) inter-hospital transfer (IHT), with a population median age of 52 years old (interquartile range [IQR] 29.0–69.0), with 49.0% (n = 8283) of the cohort being male and 38.0% (n = 6399) being female. There were a total of 6 confirmed and 209 suspected cases of COVID-19, with the majority of cases (n = 114 53.0%) in the social isolation period. As compared to pre-restriction, the odds of retrieval for the restriction and post-restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post-restriction periods (OR 1.12 95% CI 1.02-1.24 and OR 1.18 95% CI 1.08-1.30 respectively), increases in neoplasm in the post restriction period (OR 1.31 95% CI 1.04-1.64), and increases for congenital conditions in the restriction period (OR 2.56 95% CI 1.39-4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease retrievals in the restriction period (OR 0.72 95% CI 0.53-0.98). There were lower odds during the post-restriction period for a retrievals of the respiratory system (OR 0.78 95% CI 0.67-0.93), and disease of the skin (OR 0.78 95% CI 0.6-1.0). Distribution between the 2019 and 2020 time periods differed (p 0.05), with the lockdown period resulting in a significant reduction in activity. The lockdown period resulted in increased AR rates of circulatory and congenital conditions. However, this period also resulted in a reduction of overall activity, possibly due to a reduction in other infectious disease rates, such as influenza, due to social distancing.
Publisher: Frontiers Media SA
Date: 17-07-2023
DOI: 10.3389/FPUBH.2023.1019536
Abstract: The Royal Flying Doctor Service of Australia (RFDS) established a unique SARS-CoV-2 vaccination program for vaccinating Australians that live in rural and remote areas. This paper describes the preparation and response phases of the RFDS response. This study includes vaccinations conducted by the RFDS from 01 January 2021 until 31 December 2021 when vaccines were mandatory for work and social activities. Prior to each clinic, we conducted community consultation to determine site requirements, patient characteristics, expected vaccination numbers, and community transmission rates. Ninety-five organizations requested support. The majority ( n = 60 63.2%) came from Aboriginal Community Controlled Health Organizations. Following consultation, 360 communities were approved for support. Actual vaccinations exceeded expectations ( n = 70,827 vs. 49,407), with a concordance correlation coefficient of 0.88 (95% CI, 0.83, 0.93). Areas that reported healthcare workforce shortages during the preparation phase had the highest population proportion difference between expected and actual vaccinations. Areas that reported high vaccine hesitancy during the preparation phase had fewer than expected vaccines. There was a noticeable increase in vaccination rates in line with community outbreaks and positive polymerase chain reaction cases [ r (41) = 0.35, p = 0.021]. Engagement with community leaders prior to clinic deployment was essential to provide a tailored response based on community expectations.
Publisher: SAGE Publications
Date: 17-11-2017
Publisher: SAGE Publications
Date: 25-10-2018
Abstract: To determine the prevalence and outcomes of intrahepatic cholestasis of pregnancy. A review comparing intrahepatic cholestasis of pregnancy pregnancies to all other pregnancies in three tertiary care Australian hospitals over a 36-month period. There were 43,876 pregnancies. The prevalence of intrahepatic cholestasis of pregnancies ( n = 319) was 0.7%. There were differences between intrahepatic cholestasis of pregnancy and non-intrahepatic cholestasis of pregnancy mothers including higher prevalence of South Asian (22.6% versus 3.1%, p 0.001), Indigenous Australian (3.8% versus 1.8%, p 0.05), and Asian ethnicity (8.4% versus 5.7%, p 0.05), mothers with a body mass index kg/m 2 (10.6% versus 5.5%, p 0.001), those with diabetes mellitus (25.7% versus 9.8%, p 0.001), and those with twin births (8.7% versus 2.2%, p 0.001). The primary clinical outcomes of intrahepatic cholestasis of pregnancy included a median gestational age at delivery of 36.4 (SE 0.09) weeks compared to 38.6 (SE 0.01) weeks (p 0.001), a lower birth weight (3.12 (SE 0.03) versus 3.31 kg (SE 0.03), p 0.001), and an increase in special care nursery admissions (44.5% versus 15.3%, p 0.001). Treated intrahepatic cholestasis of pregnancy in the population described here had similar mortality outcomes although increased special care nursery admission as compared to the general population.
Publisher: Wiley
Date: 20-01-2020
DOI: 10.1111/AJR.12587
Abstract: To study the effect of nurse-led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease. Randomised control trial. Rural and remote China. Rural and remote patients were consecutively recruited from a medical centre located in China between January and December 2014. The control group received standard pre-procedure information from a ward nurse on the processes of the hospitalisation and percutaneous coronary intervention, and post-procedural care. The intervention group received a structured 30-minute counselling session the day before and 24 hours after the percutaneous coronary intervention, by nurse consultants with qualifications in psychological therapies and counselling. The health outcomes were assessed by a SF-12 scale and the Seattle Angina Questionnaire at 6 and 12 months after percutaneous coronary intervention. The anxiety and depression symptoms were evaluated by a Zung anxiety and depression questionnaire. Cardiac outcomes, quality of life and mental health status. Eighty patients were randomly ided into control (n = 40) and intervention groups (n = 40). There was a significant increase in the scores of the three domains of Seattle Angina Questionnaire 12 months after percutaneous coronary intervention in the intervention group (P < .01). The mental health and physical health scores also increased (P < .01). In the control group, the mean scores of Zung self-rating anxiety scale 12 months following percutaneous coronary intervention were higher than the baseline scores, and higher than in the intervention group (P < .01). Counselling by a clinician qualified in psychological therapies and counselling significantly reduces anxiety symptoms and improves quality of life.
Publisher: SAGE Publications
Date: 27-09-2021
DOI: 10.1177/10398562211043509
Abstract: To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic. Just over half of the services’ clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%). Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic.
Location: Bangladesh
Location: Australia
No related grants have been discovered for Fergus Gardiner.