ORCID Profile
0000-0001-7776-8534
Current Organisations
Griffith University
,
University of Sydney
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Informa UK Limited
Date: 15-03-2022
DOI: 10.1080/21548331.2022.2054633
Abstract: Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program's implementation. A prospective convergent mixed-methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, and caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls. Participants valued the preexisting trauma service atient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient's recovery, whilst patients felt 'cared for' and 'not forgotten' post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support.Staff spontaneously developed the program to incorporate clinical follow-up processes by providing guidance, advice, and referrals to patients who indicated ongoing issues such as pain or emotional problems. Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical atient relationships, staff teamwork and leadership support.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2012
Publisher: Wiley
Date: 19-11-2009
DOI: 10.1111/J.1440-1584.2009.01106.X
Abstract: To map clinical oncology services in regional and rural Australia. A self-administered survey was sent to 161 regional hospitals administering chemotherapy (RHAC) in Australia. RHAC were categorised by state, Hospital Peer Group and the Australian Standard Geographical Classification (ASGC) Remoteness Areas classification. Survey data provided percentage and aggregate figures about availability of medical, radiation and surgical oncologists, chemotherapy nurses, breast cancer nurses, palliative care physicians and allied health professionals according to remoteness and state. Chemotherapy prescribing practices, adherence to occupational health and safety guidelines and availability of multidisciplinary clinics were also explored. A 98% survey completion rate was achieved. Significant deficiencies in service provision were identified in RHAC. Only 21% of RHAC reported a resident medical oncology service, 7% had a radiation oncology unit, and 6% had a resident surgical oncologist. Only 24% of RHAC reported a dedicated palliative care specialist and 39% identified a dedicated oncology counselling service. Other issues included administration of chemotherapy by nurses outside a recognised facility or by nurses without recognised oncology training, limited availability of funded breast care nurses and lack of multidisciplinary clinics. Survey data highlight marked cancer service deficiencies in rural and regional Australia. It is not unreasonable to conclude that these deficiencies might contribute to poorer outcomes for cancer patients living in these areas. The results suggest the need for short- and long-term measures to improve access to best-practice cancer services for patients living in regional, rural and remote areas of Australia.
Publisher: Wiley
Date: 15-12-2019
DOI: 10.1111/JRH.12407
Abstract: Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to in idual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07-1.71), head injury (RR 1.39, 95% CI: 1.19-1.62), extremity injuries (RR 1.82, 95% CI: 1.55-2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29-1.76). Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural-based traumatic injuries.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.INJURY.2022.03.044
Abstract: In Australia, people living in rural areas, compared to major cities are at greater risk of poor health. There is much evidence of preventable disparities in trauma outcomes, however research quantifying geographic variations in injuries, pathways to specialised care and patient outcomes is scarce. (i) To analyse the Australia New Zealand Trauma Registry (ATR) data and report patterns of serious injuries according to rurality of the injury location ii) to examine the relationship between rurality and hospital mortality and iii) to compare ATR death rates with all deaths from similar causes, Australia-wide. A retrospective cohort study of patients in the ATR from 1 Compared to major cities, rural patients were younger, more likely to have spinal cord injuries, and sustain traffic-related injuries that are 'off road'. Injuries occurring outside people's homes are more likely. Mortality risk was greater for patients sustaining severe traumatic brain injury (TBI) spinal cord injury (SCI) and head trauma in addition to intentional injuries. Compared to the ATR data, Australian population-wide trauma mortality rates showed erging trends according to rurality. The ATR only captures 14.1% of all injury deaths occurring in major cities and, respectively, 6.3% and 3.2% of deaths in regional and remote areas. Compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injuries. Patients with neurotrauma and intentional injuries who survived to receive definitive care at a MTC were at higher risk of hospital death. To inform prevention strategies and reduce morbidity and mortality associated with rural trauma, improvements to data systems are required that involve data linkage and include information about patient care from pre-hospital providers, regional hospitals and major trauma centres.
Publisher: Informa UK Limited
Date: 14-12-2019
DOI: 10.1080/09638288.2019.1698662
Abstract: This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries. A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey. Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden ( Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes.Implications for rehabilitationAfter 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function.The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden.Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community.Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2007
DOI: 10.1007/S00127-007-0182-3
Abstract: Only a limited number of population-based studies have been able to prospectively follow the mental health of their participants. We aimed to describe diagnostic changes in a population based cohort over a two year period, and to explore associations between a range of in idual factors and recovery from, or onset of, disorders. Two year, face-to-face follow-up of a community-based cohort drawn from random telephone screening using the CIDI as diagnostic instrument. Unlike most similar research we did not exclude in iduals with prior history from analysis. 1407 participants were administered face-to-face interviews and 968 were re-interviewed. In multivariate analysis, recent adverse life events, poor physical health, and high neuroticism score were significant predictors of developing a mental disorder in participants who were disorder free at baseline. Higher baseline levels of physical activity were protective of new disorders in univariate analysis. Most participants with a baseline disorder and not lost to follow-up were disorder-free two years later. For participants with a disorder at both interviews, there was marked lability in diagnoses, with only a small minority having an unchanged diagnosis at both baseline and follow-up. Factors predicting a poor outcome in participants with a disorder included the number of baseline diagnoses, high neuroticism score and adverse life events. These findings suggest that the diagnosis of common mental disorders is complex and that diagnoses are relatively unstable. The factors that influence the emergence of mental disorders in in iduals who may, or may not, have had a disorder in the past, are similar to those associated with the development of new disorders in subjects without a lifetime history.
Publisher: MDPI AG
Date: 31-12-2020
Abstract: Ambient fine particulate matter .5 µm (PM2.5) air pollution increases premature mortality globally. Some PM2.5 is natural, but anthropogenic PM2.5 is comparatively avoidable. We determined the impact of long-term exposures to the anthropogenic PM component on mortality in Australia. PM2.5-attributable deaths were calculated for all Australian Statistical Area 2 (SA2 n = 2310) regions. All-cause death rates from Australian mortality and population databases were combined with annual anthropogenic PM2.5 exposures for the years 2006–2016. Relative risk estimates were derived from the literature. Population-weighted average PM2.5 concentrations were estimated in each SA2 using a satellite and land use regression model for Australia. PM2.5-attributable mortality was calculated using a health-impact assessment methodology with life tables and all-cause death rates. The changes in life expectancy (LE) from birth, years of life lost (YLL), and economic cost of lost life years were calculated using the 2019 value of a statistical life. Nationally, long-term population-weighted average total and anthropogenic PM2.5 concentrations were 6.5 µg/m3 (min 1.2–max 14.2) and 3.2 µg/m3 (min 0–max 9.5), respectively. Annually, anthropogenic PM2.5-pollution is associated with 2616 (95% confidence intervals 1712, 3455) deaths, corresponding to a 0.2-year (95% CI 0.14, 0.28) reduction in LE for children aged 0–4 years, 38,962 (95%CI 25,391, 51,669) YLL and an average annual economic burden of $6.2 billion (95%CI $4.0 billion, $8.1 billion). We conclude that the anthropogenic PM2.5-related costs of mortality in Australia are higher than community standards should allow, and reductions in emissions are recommended to achieve avoidable mortality.
Publisher: Wiley
Date: 05-07-2012
DOI: 10.1111/J.1741-6612.2011.00545.X
Abstract: To identify the level of uptake of occupational therapists' home environmental audit recommendations by older community dwellers and the factors that contribute to adherence. Cohort nested within an RCT that compared two models of care for fall prevention located in Brisbane, Australia. Community-dwelling older people >60 at risk of falls (n = 80). An environmental audit and recommendations by an occupational therapist. Of the recommendations made, 55% were completed by 6 months. Increasing number of comorbidities was a significant predictor of adherence with recommendations. Recommendations requiring external providers were more likely to be completed than those relying on the client or family member. Occupational therapists need to consider a wide range of intrinsic and extrinsic factors, which may contribute to adherence with home modifications.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2011
Publisher: Informa UK Limited
Date: 05-2000
DOI: 10.1080/00039890009603403
Abstract: The organochlorine pesticide 1,1,1-trichloro-2,2-bis (p-chlorophenyl)-ethane (DDT), is a well-known and widely dispersed "environmental estrogen" (World Health Organization Criteria no. 9 Geneva, Switzerland [1979]). Kelce et al. (Nature, 1995 375:581-85) recently identified the DDT metabolite, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), has also recently been identified as a potent androgen receptor antagonist. The authors examined the relationship between serum levels of DDE and bone mineral density in 68 sedentary women who reported adequate dietary intake of calcium. Reduced bone mineral density was correlated significantly with age (r = -.36, p = .004), as well as with increases in the log of DDE levels in serum (r = -.27, p = .03). The authors also used multiple-regression analysis to examine the influence of other predictor variables on the relationship between log DDE and bone mineral density. The strongest model (p = .002) included log DDE (p = .018), age (p = .002), and years on hormone replacement therapy (p = .10) as predictor variables, and this model afforded prediction of 21% of bone mineral density variation. These results suggest that past community exposures to DDT may be associated with reduced bone mineral density in women.
Publisher: Wiley
Date: 24-09-2009
DOI: 10.1111/J.1440-1584.2009.01088.X
Abstract: The common coexistence of psychiatric disorders has been identified as a significant factor contributing to the disability associated with mental illness. Identifying indicators to the development of coexisting disorders has potential clinical implications. This study aimed to investigate the correlates and impact of coexisting disorders in a rural setting. Cross-sectional analyses of data from a cohort interviewed in two phases. A regional community s le in Northern New South Wales, Australia. A total of 1407 participants were interviewed and 968 were re-interviewed at follow up. Multinomial logistic regression modelling compared subjects with multiple psychiatric disorders with those with a single disorder for sociodemographic characteristics, measures of personal and social vulnerability, psychological distress, functional disabilities and help-seeking behaviours. Participants with coexisting disorders were more likely to be male, report a history of severe childhood assault and had higher levels of neuroticism, psychological distress and help-seeking behaviour. The findings suggest the role of early developmental factors on the complexity and severity of adult mental illness in a rural setting and the significant clinical consequences of comorbidity.
Publisher: Elsevier BV
Date: 10-1997
DOI: 10.1111/J.1467-842X.1997.TB01752.X
Abstract: Hydroxyl radical (HO·) formation initiated by the Fenton-type reactions of Fe and Cu complexes of l-leucine (Leu) amino acid as well as its oxidation reaction by HO· was computationally investigated by using the density functional theory method at the M05-2X/6-311++G(3df,2pd)//M05-2X/6-311++G(d,p) level of theory in the aqueous phase. The results showed that dipole-salt is the main form of Leu in the physiological condition. Leu exhibits high chelating potential towards both Fe(III)/Fe(II) and Cu(II)/Cu(I) ions with the most favourable coordinating positions at two oxygen atoms of the -COO functional group. Furthermore, the Leu-ions complexes show a high risk of HO· formation via Fenton-like reactions, especially when ascorbate anion exists in the environment as a reducing agent. Finally, the oxidation reaction of l-leucine by HO· demonstrated a relatively high overall apparent reaction rate,
No related grants have been discovered for Kathy Heathcote.