ORCID Profile
0000-0001-7354-2159
Current Organisation
University of Tasmania
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Publisher: Royal College of General Practitioners
Date: 21-12-2023
Publisher: Wiley
Date: 08-2023
DOI: 10.1002/GPS.5988
Abstract: Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. ‘One‐stop’ cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one‐stop State‐wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. A novel single‐visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross‐sectional evaluation was undertaken using the RE‐AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. Over the first 52 consecutive weekly clinics: Reach : 130 adults were assessed (mean age [SD] 70.12 years [10.31] 59.2% female) with 40 (36.8%) from rural/remote areas. Effectiveness : 98.5% (128/130) received a same‐day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption : 22.9% (156) of General Practitioners referred patients. Implementation : Nearly all ‘ideal’ diagnostic clinical practices were met and % of surveyed patients reported ‘good/very good’ clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). This ‘one‐stop’ model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.
Publisher: MDPI AG
Date: 12-07-2022
Abstract: This study aimed to investigate the moderating effect of psychological resilience on sleep-deterioration-related depression among patients with prostate cancer, in terms of the total score and in idual symptoms. From a survey of 96 patients with prostate cancer, 55 who reported a deterioration in their sleep quality since diagnosis and treatment completed the Zung Self-Rating Depression Scale, Connor–Davidson Resilience Scale, and the Insomnia Severity Index. Moderation analysis was conducted for the scale total scores and for the ‘core’ symptoms of each scale within this s le, based on data analysis. Interaction analysis was used to identify key associations. The moderation analysis suggested that psychological resilience moderated the depressive effect of sleep deterioration that patients reported occurred after their diagnosis and treatment and did so at the total and ‘core’ symptom levels of being able to see the humorous side of things and to think clearly when under pressure, but there was an interaction between this moderating effect, the strength of psychological resilience, and severity of sleep deterioration. Although it appears to be a successful moderator of depression arising from sleep deterioration that was reported by patients with prostate cancer, the effectiveness of psychological resilience is conditional upon the severity of patients’ sleep difficulties and the strength of their psychological resilience. Implications for the application of resilience training and concomitant therapies for patients with prostate cancer with sleep difficulties and depression are discussed.
Publisher: SAGE Publications
Date: 08-02-2022
DOI: 10.1177/14713012211067882
Abstract: This paper explores contemporary approaches to balancing truth with the provision of hope during the disclosure of a dementia diagnosis. We discuss the ethical significance of these practices as they relate to each member of the triad – the person, the carer and the clinician – at the point of diagnosis and beyond. The process of disclosing a diagnosis of dementia is complex. It encompasses breaking bad news while balancing hope, with truth about a progressive life-limiting condition. The process of receiving the diagnosis likewise challenges the person who may be unprepared for the diagnosis, while carers seek information and supports. The impact of receiving a diagnosis of dementia can be life-changing and harmful at the personal level – for both the person and carer. This risk of harm becomes a critical consideration for clinicians when deciding on the level of truth: what information should be relayed and to whom? That risk is also balanced against the ethical issue of patient autonomy, which includes the right to know (or not) and make informed decisions about therapeutic interventions. While the consensus is that the autonomy of the person living with dementia must be upheld, controversy exists regarding the extent to which this should occur. For instance, at diagnosis, it is common for clinicians to use euphemisms rather than the word dementia to maintain hope, even though people and carers prefer to know the diagnosis. This practice of therapeutic lying is a pervasive ethical issue in dementia care, made more acceptable by its roots in diagnosis disclosure.
Publisher: MDPI AG
Date: 20-10-2021
Abstract: Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint 2. Support for legislation 3. Restraint-free environments are not possible 4. Low-level restraint 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.
No related grants have been discovered for Katharine Salmon.