ORCID Profile
0000-0001-6739-0558
Current Organisation
UNSW Sydney
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Publisher: Microbiology Society
Date: 12-05-2023
DOI: 10.1099/JMM.0.001705
Abstract: Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a well-established antifungal drug commonly utilized for acute and long-term RVVC treatment. This insight review provides an overview of known vaginal and gastrointestinal microbiota characteristics in RVVC, presents the potential impacts of fluconazole therapy on multi-microbiome relationships and discusses implications for future research and clinical practice. Next-generation sequencing (NGS) and molecular methods to accurately define vaginal microbiota trends in RVVC are not comprehensively available, limiting understanding of microbiota roles in RVVC. Inconsistencies and variances in Lactobacillus profiles in RVVC women suggest poorly understood disease implications on the bacterial and fungal microbiomes. Investigations of environmental conditions like vaginal pH, drug therapy’s impact, especially fluconazole maintenance therapy, and the elucidation of multi-microbiome relationships in RVVC are required to further investigate disease pathogenesis and responsible antimicrobial prescribing.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-09-2022
Abstract: Bronchiolitis is the leading cause of pediatric hospital admissions. Hospital-at-Home (HAH) delivers hospital-level care at home, relieving pressure on the hospital system. We aimed to review the feasibility, acceptability, and safety of HAH for bronchiolitis, and assess the cost-impact to hospitals and society. Ovid Medline, Embase, Pubmed, Cochrane Library, CINAHL, and Web of Science. Studies (randomized control trials, retrospective audits, prospective observational trials) of infants with bronchiolitis receiving HAH (oxygen, nasogastric feeding, remote monitoring). Studies were limited to English language since 2000. We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias. Ten studies met inclusion criteria, all for home oxygen therapy (HOT). One abstract on nasogastric feeding did not meet full inclusion criteria. No studies on remote monitoring were found. HOT appears feasible in terms of uptake (70%–82%) and successful completion, both at altitude and sea-level. Caregiver acceptability was reported in 2 qualitative studies. There were 7 reported adverse events (0.6%) with 0 mortality in 1257 patients. Cost studies showed evidence of savings, although included costs to hospitals only. Small number of studies with heterogenous study design and quality. No adequately powered randomized control studies. Evidence exists to support HOT as feasible, acceptable, and safe. Evidence of cost-effectiveness remains limited. Further research is needed to understand the relevant impact of HAH versus alternative interventions to reduce oxygen prescribing. Other models of care looking at nasogastric feeding support and remote monitoring should be explored.
Publisher: Oxford University Press (OUP)
Date: 2022
DOI: 10.1093/IJPP/RIAB082
Publisher: BMJ
Date: 09-2015
Managing Complex Healthcare Change: A Qualitative Exploration of Current Practice in New South Wales, Australia
Publisher: Informa UK Limited
Date: 12-2020
DOI: 10.2147/JHL.S274958
Publisher: Wiley
Date: 23-09-2023
DOI: 10.1111/HEX.13881
Publisher: Informa UK Limited
Date: 03-2021
DOI: 10.2147/JHL.S289176
Publisher: Springer Science and Business Media LLC
Date: 08-07-2020
DOI: 10.1186/S12939-020-01223-2
Abstract: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings the evidence of patient safety events arising among ethnic minority healthcare consumers internationally and the in idual, service and system factors that contribute to unsafe care. A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the in idual, inter- and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. This systematic review is registered with Research Registry: reviewregistry761.
Publisher: BMJ
Date: 22-06-2016
DOI: 10.1136/BMJSTEL-2016-000111
Abstract: Despite peer-led teaching demonstrating benefits in patient safety education, few studies have evaluated these programmes from the perspective of peer leaders. To evaluate the impact of peer leader participation in a patient safety education workshop in improving their patient safety attitudes. 34 final year pharmacy student peer leaders. An interactive peer-led patient safety workshop was delivered to 249 first year pharmacy students. Peer leaders' attitudes were assessed 2 months prior to and immediately after peer leader training and immediately after and 1 month following the workshop. Using a validated patient safety attitudinal survey, repeated measures analysis of variance and pairwise comparisons were used to evaluate changes in four key attitudes over time: being quality improvement focused internalising errors questioning more senior healthcare professionals' behaviours and attitudes towards the open disclosure of errors. Compared to baseline, peer leaders' attitudes towards open disclosure significantly improved immediately following the workshop (p=0.010) and were sustained after 1 month (p=0.028). Attitudes towards being quality improvement focused also improved significantly 1 month after the workshop (p=0.003). Participation in a peer-led patient safety education programme benefits both students and peer leaders, enabling further mastery of concepts and enhancing generational change in patient safety practices.
Publisher: Oxford University Press (OUP)
Date: 27-11-2018
DOI: 10.1111/IJPP.12495
Publisher: Springer Science and Business Media LLC
Date: 19-09-2022
DOI: 10.1186/S12905-022-01973-X
Abstract: Recurrent vulvovaginal candidiasis (RVVC) is experienced by up to 10% of pre-menopausal women globally, yet there is limited research exploring the perspective of women living with this challenging condition. Semi-structured interviews with Australian women experiencing RVVC were conducted between April–July 2021. Interviews were transcribed verbatim, and qualitative interpretative phenomenological analysis (IPA) was conducted. Ten RVVC patients were interviewed. IPA revealed an uncertain journey living with RVVC for all participants ranging from initial symptoms and difficulties in obtaining a diagnosis, the trial and error of symptom management, to the overall debilitating impact of living with a personal and intimate health condition. Four key themes were identified: Theme 1 outlined challenges and delays in diagnosis and clinically appropriate management. Theme 2 found that health care professional (HCP) knowledge limitations impacted RVVC management. Theme 3 illustrated the consequences of a lack of HCP support leading to self-referral and self-education. Theme 4 details the significant emotional and psycho-social repercussions of RVVC. This debilitating, life-long disease has a prolonged effect on women both physically and psychologically. Living with RVVC seems an uncertain journey that, to a large degree, women feel they must navigate alone. While resilience and self-empowerment were noted, better support through evidence-based treatment options, educated and evidence-informed HCPs and a sympathetic social support network is needed to decrease the disease burden. Future clinical management guidelines and patient support need to consider the findings of this study.
Publisher: Wiley
Date: 19-08-2022
DOI: 10.1111/HEX.13577
Abstract: Patient experience is a complex phenomenon that presents challenges for appropriate and effective measurement. With the lack of a standardized measurement approach, efforts have been made to simplify the evaluation and reporting of patient experience by using single‐item measures, such as the Net Promoter Score (NPS). Although NPS is widely used in many countries, there has been little research to validate its effectiveness and value in the healthcare setting. The aim of this study was to systematically evaluate the evidence that is available about the application of NPS in healthcare settings. Studies were identified using words and synonyms that relate to NPS, which was applied to five electronic databases: Medline, CINAHL, Proquest, Business Journal Premium, and Scopus. Titles and abstracts between January 2005 and September 2020 were screened for relevance, with the inclusion of quantitative and qualitative studies in the healthcare setting that evaluated the use of NPS to measure patient experience. Twelve studies met the inclusion criteria. Four studies identified benefits associated with using NPS, such as ease of use, high completion rates and being well‐understood by a range of patients. Three studies questioned the usefulness of the NPS recommendation question in healthcare settings, particularly when respondents are unable to select their service provider. The free‐text comments section, which provides additional detail and contextual cues, was viewed positively by patients and staff in 4 of 12 studies. According to these studies, NPS can be influenced by a wide range of variables, such as age, condition/disease, intervention and cultural variation therefore, caution should be taken when using NPS for comparisons. Four studies concluded that NPS adds minimal value to healthcare improvement. The literature suggests that many of the proposed benefits of using NPS are not supported by research. NPS may not be sufficient as a stand‐alone metric and may be better used in conjunction with a larger survey. NPS may be more suited for use in certain healthcare settings, for ex le, where patients have a choice of provider. Staff attitudes towards the use of NPS for patient surveying are mixed. More research is needed to validate the use of NPS as a primary metric of patient experience. Consumer representatives were provided with the research findings and their feedback was sought about the study. Consumers commented that they found the results to be useful and felt that this study highlighted important considerations when NPS data is used to evaluate patient experience.
Publisher: Wiley
Date: 30-08-2023
DOI: 10.1111/IJN.13197
Abstract: The utilization of patient experience surveying by health care institutions has become increasingly prevalent, yet its effectiveness in promoting quality improvement remains uncertain. To enhance the utility of patient feedback, the examination of free‐text comments may provide valuable insights to guide patient experience strategy. This study aims to explore the utility of free‐text comments and identify key differences for patient experience drivers between Net Promoter Score (NPS) subcategories of Detractors, Passives, and Promoters. Evaluation and classification of comments was conducted using the eight Picker Principles of Person Centred Care, with descriptive analysis of patient comments performed on the NPS data. Analysis of patient NPS comments can be classified into three key drivers: “feeling well‐treated” (for Detractors), “feeling comfortable” (for Passives), and “feeling valued” (for Promoters). Specifically, Detractor comments provided the most comprehensive and detailed feedback to guide patient experience improvement activities. This study highlights differences between NPS subcategories, particularly regarding aspects of safety, comfort, and feeling valued. Comments from Detractor respondents may be especially useful for guiding quality improvements due to increased specificity and insights. These results also emphasize the essential nature of empathy and compassionate interactions between patients and clinicians to achieve the highest level of patient satisfaction and experience.
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/17455057231194138
Abstract: Recurrent vulvovaginal candidiasis management primarily entails azole therapy used as required or as an extended daily or weekly maintenance therapy for 6 months or more. Unfortunately, relapse within 3–6 months of ceasing maintenance therapy is experienced for more than half the patients, for whom indefinite treatment is required. To explore the feasibility of trial design examining a prophylaxis treatment to prevent recurrent vulvovaginal candidiasis symptomatic episodes and reduce adverse effects. A double-blinded randomized controlled feasibility trial was conducted in Australia. Women with recurrent vulvovaginal candidiasis were enrolled. An intravaginal prophylaxis application of lactic acid and acetic acid (Intravaginal Combination Therapy of Acetic and Lactic Acid) was compared with placebo. Primary outcomes comprised recruitment and retention, compliance to study medications and study assessments. Secondary outcomes included the reduction of symptomatic recurrence over the trial period and the acceptability, satisfaction, safety and tolerability of the intervention. The feasibility of quality-of-life measures was also explored. Fifteen participants were enrolled and randomized (active = 9, placebo = 6). Consent rate was 23.4%. Eight participants were lost to follow-up (active = 5, placebo = 3). Forty-seven per cent of participants (n = 7) were 100% compliant with the intervention, six of which completed the trial with good assessment compliance. The blinding process was effective. The study demonstrated a reduction in relapse in both active and placebo groups with only four participants across both groups reporting symptomatic episodes while enrolled. The intervention demonstrated good tolerability. Quality-of-life data showed minimal variance with a high quality-of-life measure. This trial assesses the feasibility of conducting a large-scale study exploring the efficacy of the Intravaginal Combination Therapy of Acetic and Lactic Acid intravaginal intervention and hints on the importance of psychological support through appropriate disease-specific communication and clinical attention. Consideration of the reported recruitment challenges, the inclusion of suitable quality-of-life measures and digital data collection is warranted for adaptation to a fully powered trial.
Publisher: Oxford University Press (OUP)
Date: 28-04-2015
DOI: 10.1111/IJPP.12115
Abstract: To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture – one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. Australian hospital pharmacists hold a variety of attitudes that reflect erse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings.
Publisher: Informa UK Limited
Date: 21-12-2020
Publisher: The Beryl Institute
Date: 02-08-2023
Publisher: Daedalus Enterprises
Date: 23-06-2020
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.5688/AJPE6110
Publisher: BMJ
Date: 12-2015
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.CPTL.2018.08.002
Abstract: Appropriate evaluation processes are important in experiential placements. With the growing ersity between placements, consideration for standardization of some of these processes would be beneficial, particularly for those skills that are transferable regardless of the placement type. The objectives of this study was: (1) to explore the experiences, evaluation strategies, and feedback processes of Australian preceptor pharmacists from three primary experiential areas (community, hospital, and industry) in providing student placements and (2) to inform the future development of the current local experiential program and future extended international experiential programs. A qualitative, exploratory study with three preceptor focus groups (community, hospital, and industry) were conducted, recorded, and transcribed verbatim. Data were analyzed using Bazeley's "describe - compare - relate" method for thematic analysis. There were a total of 16 participants. Four themes emerged: (1) motivation and purpose of being a preceptor (2) expectations of students and the university (3) organizational planning and conduct of experiential placements and (4) importance of appropriate evaluation and feedback processes to include evaluation of interpersonal skills, which were considered by all focus group members as highly desirable for future employability. The need for standardized processes across different experiential placements, although difficult given the ersity, is important particularly with respect to evaluation and feedback. As interpersonal attributes are transferable and desirable for all types of experiential settings including rural and international environments, standardizing the evaluation of students to include these could be beneficial and applicable for students on local experiential placements and/or cross globally on international experiential placements.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.SAPHARM.2016.10.001
Abstract: Safety climate evaluation is increasingly used by hospitals as part of quality improvement initiatives. Consequently, it is necessary to have validated tools to measure changes. To evaluate the construct validity and internal consistency of a survey tool to measure Australian hospital pharmacy patient safety climate. A 42 item cross-sectional survey was used to evaluate the patient safety climate of 607 Australian hospital pharmacy staff. Survey responses were initially mapped to the factor structure previously identified in European community pharmacy. However, as the data did not adequately fit the community pharmacy model, participants were randomly split into two groups with exploratory factor analysis performed on the first group (n = 302) and confirmatory factor analyses performed on the second group (n = 305). Following exploratory factor analysis (59.3% variance explained) and confirmatory factor analysis, a 6-factor model containing 28 items was obtained with satisfactory model fit (χ This study has demonstrated the validity of a survey to evaluate patient safety climate of Australian hospital pharmacy staff. Importantly, this validated factor structure may be used to evaluate changes in safety climate over time.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Wiley
Date: 08-06-2021
DOI: 10.1111/BCP.14924
Abstract: Most research into medication safety has been conducted in hospital settings with less known about primary care. The aim of this study was to characterise the nature and causes of medication incidents (MIs) in the community using a pharmacy incident reporting programme. Thirty community pharmacies participated in an anonymous or confidential MI spontaneous reporting programme in Sydney, Australia. The Advanced Incident Management System was used to record and classify incident characteristics, contributing factors, severity and frequency ratings. In total, 1013 incidents were reported over 30 months, 831 of which were near misses while 165 reports involved patient harm. The largest proportion of cases pertained to patients aged years (35.7%). Most incidents involved errors during the prescribing stage (61.1%), followed by dispensing (25.7%) and administration (23.5%), while some errors occurred at multiple stages (17.9%). Systemic antibacterials (12.2%), analgesics (11.8%) and renin–angiotensin medicines (11.7%) formed the majority of implicated classes. Participants identified erse and interrelating contributing factors: those concerning healthcare providers included violations to procedures/guidelines (75.6%), rule‐based mistakes (55.6%) and communication (50.6%) those concerning patients included cognitive factors (31.9%), communication (25.5%) and behaviour (6.1%). Organisational safety culture and inadequate risk management processes were rated as suboptimal. An MI reporting programme can capture and characterise medication safety problems in the community and identify the human and system factors that contribute to errors. Since medicine use is ubiquitous in the community, morbidity and mortality from MIs may be reduced by addressing the prioritised risks and contributing factors identified in this study.
No related grants have been discovered for Ramesh Walpola.