ORCID Profile
0000-0002-9777-1105
Current Organisation
Children's Health Queensland Hospital and Health Service
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Performing Arts and Creative Writing not elsewhere classified | Linguistics | Performing Arts and Creative Writing | Drama, Theatre and Performance Studies | Discourse and Pragmatics |
The Performing Arts (incl. Theatre and Dance) | Expanding Knowledge in Language, Communication and Culture
Publisher: Mary Ann Liebert Inc
Date: 03-2014
Abstract: Pediatric palliative care is an evolving specialty that aims to improve the lives of children with a life-limiting condition. As an emerging specialty, there is much to be learned about service provision and the expected outcomes that can be achieved. Additionally, quantification of the needs for pediatric palliative care is complicated by the uncertainty of defining the population that requires care. Our aim was to define the characteristics of the population cared for by a newly formed state-wide service in Queensland, Australia, and describe the development of the service over a 24-month period. Data on all referrals and outcomes were collected. Descriptive statistics were used to describe patterns including the variation in outcomes between children with oncology and non-oncology diagnoses. Other factors influencing the development of the service including involved health professionals and the model of the Australian health care system are also described. Over a 24-month period, 150 patients were referred of whom 117 subsequently died. There was a wide range of diseases and ages, and significantly, 58% of children were from regional or rural locations where there are can be limited access to specialist pediatric services. The average length of service was 83 days. A variety of factors were identified as being important for providing optimal care including ensuring equity in access, timing of referral, and continuity of care. The importance of a population-based approach to pediatric palliative care in a state that is geographically large and erse like Queensland is highlighted. This article may provide valuable information to other health care providers who care for children with life-limiting illnesses.
Publisher: Elsevier BV
Date: 2007
Publisher: The Royal Australian College of General Practitioners
Date: 06-2021
Publisher: MDPI AG
Date: 04-01-2018
Publisher: Informa UK Limited
Date: 10-2021
DOI: 10.2147/AMEP.S334872
Publisher: Informa UK Limited
Date: 03-2023
DOI: 10.2147/AMEP.S393052
Publisher: BMJ
Date: 13-10-2020
DOI: 10.1136/BMJSPCARE-2020-002449
Abstract: Health service planning in paediatric palliative care is complex, with the erse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services. To quantify health service usage by children and young people aged 0–21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage. Retrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics. In iduals aged 0–21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital. Hospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16–18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by in iduals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838). Administrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.
Publisher: Wiley
Date: 28-01-2022
Abstract: Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video‐recorded paediatric palliative care consultations. Detailed turn‐by‐turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a ‘tag question’, which follows some statement (e.g. ‘he loves that, don't ya’). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.
Publisher: Informa UK Limited
Date: 2023
DOI: 10.2147/AMEP.S393051
Publisher: SAGE Publications
Date: 16-08-2020
Abstract: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children’s hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.
Publisher: Wiley
Date: 03-06-2014
DOI: 10.1111/JPC.12617
Abstract: Sleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses. Parents of children admitted to the hospital, aged between 1 and 18 years, were asked to complete a sleep diary during one night of their child's hospital stay. Children older than 12 years were asked to complete a diary independently. Descriptive statistics were used to summarise the data. Overall, 107 children were surveyed for one hospital inpatient night. The overall prevalence of poor sleep was 52.3%. The wide age range and variety of diagnosis limited further detailed analysis of specific causes of this problem. Poor sleep prior to admission was the strongest predictor of poor sleep in hospital suggesting that these children already had an underlying sleep problem. Unprompted awakenings were predominantly due to toileting (17.8%) or were spontaneous (17.8%). Factors specific to the hospital environment that woke children were nursing cares (25.2%), alarms (12.1%) and pain (12.1%). Children admitted to hospital have a higher prevalence of poor sleep compared with healthy children in the community. Children were woken frequently by both external noise and attention provided by hospital staff. Education of hospital staff about the importance of sleep for children and factors that affect children's sleep may reduce the negative impact of hospitalisation on children's sleep.
Publisher: Elsevier BV
Date: 07-2007
Publisher: AMPCo
Date: 04-2015
DOI: 10.5694/MJA15.00111
Publisher: MDPI AG
Date: 02-08-2020
DOI: 10.20944/PREPRINTS202008.0008.V1
Abstract: Background: Elevated respiratory rates (RR) have been described in several disease states, such as pneumonia, asthma and bronchiolitis. Despite this, there are few studies defining the range of RR found in healthy children. Available age percentiles for RR have been generated using methods that have the potential themselves to alter the rate. Aim: The aim of this study was to develop accurate percentile charts of RR specific for age in healthy children for potential use in pre-hospital care (first-aid), clinical medicine and for reference in respiratory research. Method: A newly developed optical respiratory sensor was used to measure RR which placed no restrictions on respiratory excursion. This technique enabled recording in awake children without the artefact of the observer& rsquo s presence on the subject& rsquo s RR. A cross-sectional s le of healthy children was obtained from maternity wards, childcare centres and schools in Brisbane, Queensland, Australia. Results: RR were observed in 560 awake and 103 sleeping children of which data from 343 awake and 94 sleeping children was used to create reference ranges for healthy children from newborn to 13 years of age. The recorded rates were significantly higher when children were awake compared to asleep. During quiet sleep, RR decreased from 40 (interquartile range 7) bpm at one month to 20 (interquartile range 3) in children aged 3 years. In awake children, RR ranged from a median of 40 bpm (interquartile range 18) at 1 year to 12 bpm (interquartile range 11) at 13 years respectively. Conclusion: The optical sensor was found to be an appropriate respiratory transducer, capable of measuring RR and reducing artefact by the subjective responses of alert children. The centile charts will be helpful as an aid to detecting abnormal RR in children and will contribute to further systematic reviews related to this vital sign.
Publisher: Mary Ann Liebert Inc
Date: 11-2014
Abstract: Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided. To define optimal components of an early pediatric palliative care consultation. Consensus of an expert group was sought in a five-round Delphi study. Based on the literature and existing standards for specialist palliative care, components of an early pediatric palliative care consultation were derived. In rounds 2 and 3, experts from around Australia participated in online surveys to review and prioritize the components and principles. Consensus of survey items was determined by defined criteria. A flowchart was developed in the fourth round and the final round involved review and refinement of the flowchart by the expert group. Nineteen experts participated and prioritized 34 components and principles in the first survey round, and 36 statements in the second survey round. There was consensus from all participants that the first priority of a consultation was to establish rapport with the family, and ex les of how to achieve this were defined. Other components of a consultation included: establishing the family's understanding of palliative care symptom management an emergency plan discussion of choices for location of care, and a management plan. Components considered suitable to defer to later consultations, or appropriate to address if initiated by family members, included: spiritual or religious issues discussion around resuscitation and life-sustaining therapies end-of-life care and the dying process. We have provided the first published framework from expert consensus that defines the components and principles of an early pediatric palliative care consultation. This framework will provide guidance for clinical practice as well as being useful for education and research in this area.
Publisher: University of Queensland Library
Date: 1995
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 03-04-2019
DOI: 10.1111/JPC.14461
Abstract: The rat lungworm, Angiostrongylus cantonensis, is well established in eastern Australia, where it is the almost exclusive cause of human eosinophilic meningoencephalitis (EME). While neuroangiostrongyliasis can result in severe morbidity or death, its diagnosis requires a high index of clinical suspicion among medical practitioners. Prevention requires a high level of public awareness. We report two cases of EME in children from Queensland and summarise all reported Australian cases from the literature. We discuss the pathogenesis of neuroangiostrongyliasis, with particular reference to the timing of prophylaxis and treatment. A 5-year-old girl developed severe headache, eosinophilic meningitis and abnormal neuroimaging following a holiday to Bali. A 10-year-old boy with Rubinstein-Taybi syndrome, marked developmental delay and pica developed EME following ingestion of a snail, resulting in long-term morbidity. From 1971 to 2018, 28 Australian cases have been reported, with acquisition restricted to Southeast Queensland and New South Wales. Ages ranged from 10 months to 45 years most were male and most likely acquired infection from consuming unwashed lettuce or vegetables. The mortality rate was 18% most fatalities occurred in children <1 year old. Long-term neurological deficit was reported in 14% of cases and a full recovery in 57% of cases. Heightened medical and public awareness of the parasite is required to prevent infection and subsequent disease. A better understanding of the efficacy of prophylactic anthelmintic following ingestion or handling of molluscs and further studies of epidemiology of this parasite will inform and facilitate public health recommendations.
Publisher: BMJ
Date: 07-03-2020
DOI: 10.1136/BMJSPCARE-2016-001130
Abstract: Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations. 9 consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised. The study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration: (1) soliciting the family's agenda for the consultation (2) initiating and maintaining topics where discussing deterioration is a relevant possibility. Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur. These communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a child's family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.PEC.2018.08.014
Abstract: To consider whether and how family members and clinicians discuss end of life during paediatric palliative care consultations. Nine naturally occurring paediatric palliative care consultations were video recorded and analysed using conversation analytic methods. Focusing on three consultations in which end of life was treated as a certain outcome, analysis explored ways in which end of life was made either implicit or explicit within these consultations. Our analysis suggests that end of life was made explicit when: 1) ancillary to the current focus of discussion, 2) in relation to someone else's child, or 3) specifically relevant to the local context of the discussion. More commonly, in all other instances in the data, end of life was made implicit during discussions relating to this matter. This preliminary research indicates that the local context of a conversation can influence how end of life is mentioned and discussed. Clinicians often are encouraged to promote honest and 'open' discussions about end of life. Our findings show that it is not necessary to explicitly mention end of life in order to discuss it.
Publisher: Wiley
Date: 16-03-2022
DOI: 10.1002/PBC.29621
Abstract: To synthesize existing qualitative research exploring the experiences of parents caring for children with cancer during the end‐of‐life phase, and the factors that influence parental decision‐making when choosing the location of end‐of‐life care and death for their child. This review included 15 studies of 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision‐making for the location of care included the quality of communication and the quality of care available. Themes related to choosing home for end‐of‐life care and death included honoring the child's wishes, the familiarity of home, and parents’ desire to be their child's primary carer. Preference for the location of death in the hospital included trust in hospital staff, practical logistics, and the safety of the hospital environment.
Publisher: BMJ
Date: 17-07-2021
DOI: 10.1136/BMJSPCARE-2020-002333
Abstract: Our aim was to synthesise the available evidence surrounding the structure, processes and outcomes of family meetings in the paediatric palliative care literature. We undertook an integrative literature review informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered with PROSPERO (CRD42019138938). Electronic databases were systematically search using keywords and hand searching of reference articles and grey literature was also completed. Ten empirical studies and five theoretical articles were included in the synthesis. Empirical studies provided more information about meeting structure, whereas theoretical articles more frequently described a desired process for planning and undertaking meetings. No articles identified how the success of a meeting was defined or made recommendations for doing so. Despite reports that family meetings are commonly occurring, few articles described outcomes from either the family or clinician perspectives. Family meetings are essential communication strategies commonly used in paediatric palliative care, yet there is little guidance about how meetings should be organised and conducted, who should participate and when they should occur. The limited data available on the outcomes of family meetings suggest improvements are required to meet the needs of families. We present a framework that synthesises the available evidence. The framework offers an overview of the elements to consider when planning for and undertaking family meetings in paediatric palliative care and may be useful for both clinicians and researchers.
Publisher: MDPI AG
Date: 02-10-2020
Abstract: (1) Background: Increased respiratory rates (RRs) are described in several medical conditions, including pneumonia, bronchiolitis and asthma. There is variable methodology on how centiles for RR are derived in healthy children. Available age percentiles for RR have been generated using methods that have the potential themselves to alter the rate. (2) Methods: An optical respiratory sensor was used to measure RR. This technique enabled recording in awake children without the artefact of the observer’s presence on the subject’s RR. A cross-sectional s le of healthy children was obtained from maternity wards, childcare centres and schools in Brisbane, Queensland, Australia. (3) Results: RRs were observed in 560 awake and 103 sleeping children of which data from 320 awake and 94 sleeping children were used to develop centile charts for children from birth to 13 years of age. RR is higher when children are awake compared to asleep. There were significant differences between awake and sleeping RR in young children. The awake median RR was 59.3 at birth and 25.4 at 3 years of age. In comparison, the median sleeping RR was 41.4 at birth and 22.0 at 3 years. (4) Conclusions: The centile charts will assist in determining abnormal RRs in children and will contribute to further systematic reviews related to this important vital sign. This is particularly in relation to the data on children aged from 0 to 3 years, where data are presented on both the awake and sleeping state. Many studies in the literature fail to acknowledge the impact of sleep state in young children on RR.
Publisher: MDPI AG
Date: 12-2017
DOI: 10.20944/PREPRINTS201712.0004.V1
Abstract: Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in pediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children& rsquo s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented (RP). This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (PICU or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP which was documented within the last 48 hours of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on in idual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration (particularly involving PICU and PPC services) in developing protocols of how to manage this difficult but inevitable clinical scenario.
Publisher: Wiley
Date: 23-08-2017
DOI: 10.1111/JAR.12389
Abstract: Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care. This study describes the complex care of children with life-limiting conditions and intellectual disability by means of a literature synthesis and commentary with "best-practice" guide. As few articles concerning children with intellectual disability and palliative care needs were identified by formal systematic review, our expert consensus group has drawn from the paediatric palliative, oncology and adult intellectual disability literature to highlight common clinical challenges encountered in the day-to-day care of children with intellectual disability and life-limiting conditions. A longitudinal child- and family-centred approach is key to ensuring best-practice care for families of children with life-limiting conditions and intellectual disability. As highlighted by the great absence of literature addressing this important patient population, further research in this area is urgently required.
Publisher: Informa UK Limited
Date: 12-2018
DOI: 10.2147/AMEP.S180526
Publisher: SAGE Publications
Date: 10-2014
Abstract: We compared the records of paediatric palliative consultations undertaken face-to-face, with telemedicine consultations undertaken in patients’ homes. A convenience s le of consecutive paediatric palliative care patients was identified from the hospital's palliative care database. A total of 100 consultations was reviewed (50 telemedicine consultations during home visits and 50 face-to-face consultations) according to 14 established principles and components of a paediatric palliative care consultation. In the telemedicine group there was a higher proportion of patients in a stable condition (58% vs 7%), and a lower proportion of patients in terminal phase (2% vs 17%). Discussion about pain and anorexia were significantly more common in the telemedicine group. Discussion about follow up was significantly more common in the telemedicine group (86% vs 56%), whilst resuscitation planning was more common in deteriorating patients receiving inpatient care. All other components and principles of a palliative care consultation were documented equally regardless of method of consultation. The findings confirm that palliative consultations via telemedicine are just as effective as face-to-face consultations in terms of the documented components of the consultation.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 16-06-2014
Publisher: MDPI AG
Date: 27-06-2018
Publisher: Informa UK Limited
Date: 11-2019
DOI: 10.2147/AMEP.S219721
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Location: Australia
Start Date: 12-2018
End Date: 11-2023
Amount: $588,592.00
Funder: Australian Research Council
View Funded ActivityStart Date: 12-2022
End Date: 12-2025
Amount: $300,000.00
Funder: Australian Research Council
View Funded Activity