Flinders Clinical Effectiveness - Collected Works
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Item The implementation of intentional rounding using participatory action research(Wiley Publishing Asia Pty Ltd, 2013-07-08) Harrington, Ann Chrystine; Bradley, Sandra L; Jeffers, Lesley; Linedale, Ecushla; Kelman, Sue; Killington, Geoffrey‘Intentional’/’hourly rounding’ is defined as regular checks of individual patients carried out by health professionals at set intervals, rather than a response to a summons via a call bell. Intentional rounding places patients at the heart of the ward routine including the acknowledgement of patient preferences and in anticipation of their needs. The aim of this study was to implement intentional rounding using Participatory Action Research to increase patient care, increase staff productivity and the satisfaction of care provision from both patients and staff. Outcomes of the study revealed a drop in call bell use, no observable threats to patient safety, nursing staff and patient satisfaction with care provision. However, any future studies should consider staff skill mix issues, including the needs of newly graduated nursing staff as well as the cognitive status of patients when implementing intentional rounding on acute care wards.Item Current Advance Directive Use in South Australia: Results from the 2012 Spring South Australian Health Omnibus Survey(BMJ Publishing Group, 2013) Bradley, Sandra L; Woodman, Richard John; Phillips, Paddy Andrew; Tieman, JenniferBackground: Advance directives enable autonomous decision-making for future healthcare and welfare and are an integral part of many advance care planning programs. Current evidence of use of these instruments in South Australia (SA) is presented. Aim: To ascertain the prevalence and type of advance directives used in SA. Methods: Questions exploring the prevalence and type of advance directives experienced by the South Australian public were submitted to the Spring South Australian Health Omnibus Survey (HOS) 2012. The HOS has been conducted regularly since 1991 and is used by government and nongovernment organisations to assess the healthcare needs of the South Australian community. The survey comprises a random sample of 3000 members of the public drawn in a multi-stage, systematic sampling technique*. Results: Analysis of data yielded demographic and sociological characteristics such as age, gender, and education as well as: prevalence and type of advance directive completed; engagement with family or friends to complete advance directives; and substitute decision-making agency. Discussion: Using the HOS survey enabled analysis of demographic and sociological characteristics of the SA public with prevalence and type of advance directives experienced and provided evidence-based knowledge of the public’s engagement in autonomous decision-making for future healthcare and welfare. Conclusion: Accurate ascertainment of the South Australian public’s current levels of knowledge and engagement with advance directives can assist future advance care planning initiatives in South Australia as well as provide a basis for further research designed to enhance completion rates of these instruments by the general public.Item Use of advance directives by South Australians: Results from the Health Ominbus Survey Spring 2012.(Australasian Medical Publishing Company Ltd, 2014) Bradley, Sandra L; Woodman, Richard John; Tieman, Jennifer; Phillips, Paddy AndrewObjective: To determine the prevalence of completion of advance directives (ADs) and wills by South Australians aged 15 years and over. Design, setting and participants: Statewide population-based survey of a single member (aged 15 years and over) of 3055 South Australian households between 4 September and 12 December 2012. Main outcome measures: Prevalence and sociodemographic determinants of completion of the four recognised legal ADs in South Australia (enduring power of attorney [EPA] for finance, enduring power of guardianship [EPG] for health care/lifestyle, medical power of attorney [MPA] for medical treatment and anticipatory direction for end-of-life care) and wills. Results: Nearly half the 3055 survey participants had not completed any AD document or will. Financial documents were more likely to be completed than health care documents. In multivariate analysis, the odds of not having completed any AD was higher among those aged 15–24 years compared with those aged over 65 years (odds ratio [OR], 55.3; 95% CI, 31.3–97.7) and 25–44 years (OR, 24.9; 95% CI, 17.3–36.1). Similarly, the odds were higher for those born in another country (OR, 2.0; 95% CI, 1.6–2.4); those never married (OR, 3.1; 95% CI, 2.3–4.2) or in de facto relationships (OR, 2.8; 95% CI, 2.1–3.8) or separated/divorced (OR, 1.8; 85% CI, 1.3–2.4) compared with those married; those who left school in Year 12 or before (OR, 1.5; 95% CI, 1.1–1.9) or with a bachelor degree (OR, 1.5; 95% CI, 1.1–2.0) compared with those who had completed a trade/apprenticeship, certificate/diploma; and those in blue collar occupations (OR 1.6; 95% CI, 1.3–2.2) or not employed (OR, 2.2; 95% CI, 1.4–3.6) versus professionals. The odds of not having completed any AD were lower for those living in rural or regional areas (OR, 0.8, 95% CI, 0.6–1.0) compared with the metropolitan area, and for those in the highest income bracket earning more than $80 000 (OR, 0.6; 95% CI, 0.5–0.8) compared with those in the middle bracket earning $40 000–$80 000. Conclusion: Completion rates of ADs among South Australians remain low, with financial instruments more likely to be completed than health care and lifestyle instruments. The odds of not completing ADs were associated with age and socioeconomic characteristics. General practitioners are in a good position to target advance care planning towards relevant patient groups, which would likely improve rates of decision making in future health care.Item Dilemmas in assessing performance on fieldwork education placements(Sense Publishers, 2010) McAllister, Sue Margery; Lincoln, Michelle; Ferguson, Alison; McAllister, LindyOur students value fieldwork placements and their fieldwork educators highly. They enter our university programs with the goal of joining us in our practice. Competency-based assessment based on observed performance of students in the real world of the workplace is highly authentic and motivating for all. As described in this chapter, this assessment practice raises a number of dilemmas, many of which are common with any kind of assessment. However, valid and reliable competency-based assessments with positive impacts upon learning can be developed through careful thought and attention to the processes and content required to support fieldwork educators' judgments and the students' learning.Item Checklist of parent Lidcombe Program administration(Speech Pathology Australia, 2012) Swift, Michelle Catherine; O'Brian, Sue; Onslow, Mark; Packman, AnnThis article outlines the development of a checklist to document parent and child behaviours when implementing Lidcombe Program treatment during structured conversations. We present item development and reliability testing and instructions for use by speech pathologists. Finally, we present two case studies to demonstrate use of the checklist to aid clinical decision-making during Lidcombe Program treatment.Item Estrogen defines the dynamics and destination of transactivated EGF receptor in breast cancer cells: role of S1P3 receptor and Cdc42(Elsevier, 2013-02-15) Sukocheva, Olga Anatolyevna; Wadham, Carol; Xia, PuSphingosine-1-phosphate (S1P) receptors mediate transactivation of epidermal growth factor receptor (EGFR) by estrogen (E2). Here we report that the amount of intracellular EGFR remains elevated after stimulation of MCF-7 cells with E2 and S1P, although membrane-localized EGFR and S1P3 receptors are quickly internalized. Co-localization of internalized EGFR and LAMP-2 was lower in cells treated with E2/S1P, suggesting that endosomal EGFR might be directed for recycling instead of degradation. In addition, we found that E2/S1P activated Cdc42 and that knockdown of Cdc42 restores fast EGFR degradation after E2/S1P stimulation. Inhibition of S1P3 receptors prevented E2-induced activation of Cdc42, supporting the important role of the S1P receptor in E2 signaling. This is a novel mechanism further defining the effect of E2/S1P on the EGFR transactivation in breast cancer cells.Item How effective are programs at managing transition from hospital to home? A case study of the Australian transition care program(BioMed Central Ltd., 2012-03-14) Gray, Leonard C; Peel, Nancye M; Crotty, Maria; Kurrle, Susan E; Giles, Lynne Catherine; Cameron, Ian DAn increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases has led to new models of post-acute care for older people that offer coordinated discharge, ongoing support and often a focus on functional restoration. Overall, review of the literature suggests there is considerable uncertainty around the effectiveness and resource implications of the various model configurations and delivery approaches. In this paper, we review the current evidence on the efficacy of such programs, using the Australian Transition Care Program as a case study. Discussion: The Australian Transition Care Program was established at the interface of the acute and aged care sectors with particular emphasis on transitions between acute and community care. The program is intended to enable a significant proportion of care recipients to return home, rather than prematurely enter residential aged care, optimize their functional capacity, and reduce inappropriate extended lengths of hospital stay for older people. Broadly, the model is configured and targeted in accordance with programs reported in the international literature to be effective. Early evaluations suggest good acceptance of the program by hospitals, patients and staff. Ultimately, however, the program’s place in the array of post-acute services should be determined by its demonstrated efficacy relative to other services which cater for similar patient groups. Summary: Currently there is a lack of robust evaluation to provide convincing evidence of efficacy, either from a patient outcome or cost reduction perspective. As the program expands and matures, there will be opportunity to scrutinise the systematic effects, with lessons for both Australian and international policy makers and clinical leaders.Item Acupuncture to improve live birth rates for women undergoing in vitro fertilization: a protocol for a randomized controlled trial(BioMed Central Ltd., 2012-05-18) Smith, Caroline A; De Lacey, Sheryl Lynne; Chapman, Michael; Ratcliffe, Julie; Norman, Robert J; Johnson, Neil; Sacks, Gavin; Lyttleton, Jane; Boothroyd, ClareIVF is a costly treatment option for women, their partners, and the public. Therefore new therapies that improve reproductive and health outcomes are highly desirable. There is a growing body of research evaluating the effect of acupuncture administered during IVF, and specifically on the day of embryo transfer (ET). Many trials are heterogeneous and results inconsistent. There remains insufficient evidence to determine if acupuncture can enhance live birth rates when used as an adjunct to IVF treatment. The study will determine the clinical effectiveness of acupuncture with improving the proportion of women undergoing IVF having live births. Other objectives include: determination of the cost effectiveness of IVF with acupuncture; and examination of the personal and social context of acupuncture in IVF patients, and examining the reasons why the acupuncture may or may not have worked.Item The relationship between quality of life, health and care transition: an empirical comparison in an older post-acute population(BioMed Central Ltd., 2012-06-15) Couzner, Leah; Ratcliffe, Julie; Crotty, MariaBackground: The aim of this study was to explore, via empirical comparison, the relationship between quality of life, as measured by the ICECAP-O capability index (a new instrument designed to measure and value quality of life in older people), with both self-reported health status and the quality of care transition in adults aged 65 and over participating in two post-acute rehabilitation programs (outpatient day rehabilitation and the Australian National Transition Care residential program). Methods: The ICECAP-O was administered to patients receiving either outpatient day rehabilitation (n=53) or residential transition care (n=29) during a face to face interview. The relationships between the ICECAP-O and other instruments, including the EQ-5D (a self-reported measure of health status) and CTM-3 (a self-reported measure of the quality of care transitions), the type of post-acute care being received and socio-demographic characteristics were examined. Results: The mean ICECAP-O score for the total sample was 0.81 (SD: 0.15). Patients receiving outpatient day rehabilitation generally reported higher levels of capability, than p atients receiving residential transition care (mean 0.82 [SD: 0.15] and 0.79 [SD: 0.164] re spectively), however these differences were not statistically significant. The mean EQ-5D score for the total sample was somewhat lower than the ICECAP-O (mean 0.52; SD: 0.27) indicating significant levels of health i mpairment with the outpatient day rehabilitation group demonstrating slightly higher levels of health status than the transition care group (mean 0.54 [SD: 0.254] and mean 0.49 [SD: 0.30]). The ICECAP-O was found to be positively correlated with both the CTM-3 (Spearman ’ s r =0.234; p ≤ 0.05) and the EQ-5D (Spearman ’ sr=0.437;p ≤ 0.001). The relationships between the total EQ-5D and CTM-3 scores and the individual attributes of the ICECAP-O indicate health status and quality of care transition in this patient population to be influential in some, but not all aspects of capability. Conclusions: The correlations between the ICECAP-O, EQ-5D and CTM-3 instruments illustrate that capability is strongly and positively associated with health-related quality of life and the quality of care transitions. However further research is required to further examine the construct validity of the ICECAP-O and to examine its potential for incorporation into economic evaluation.Item The immunoreceptor tyrosine-based activation motif (ITAM) -related factors are increased in synovial tissue and vasculature of rheumatoid arthritic joints(BioMed Central Ltd., 2012-11-12) Crotti, Tania N; Dharmapatni, Anak ASSK; Alias, Ekram; Zannettino, Andrew CW; Smith, Malcolm Douglas; Haynes, David RThe immunoreceptor tyrosine-based activation motif (ITAM) pathway provides osteoclast co-stimulatory signals and regulates proliferation, survival and differentiation of effector immune cells. In the osteoclast, the receptors Triggering Receptor Expressed on Myeloid cells 2 (TREM2) and Osteoclast Associated Receptor (OSCAR) and their respective adaptor proteins, DAP12 and FcRγ mediate ITAM signals and induce calcium signaling and the crucial transcription factor, NFATc1. In rheumatoid arthritis (RA), OSCAR expression by monocytes is inversely correlated with disease activity. Additionally, serum levels of OSCAR are reduced in RA patients versus healthy controls suggesting that expression and secretion or cleavage of soluble (s) OSCAR is immune modulated. Recent data suggest that endothelial cells may also be a source of OSCAR.Item The FLASSH study: protocol for a randomised controlled trial evaluating falls prevention after stroke and two sub-studies(BioMed Central Ltd., 2009) Batchelor, Frances A; Hill, Keith D; Mackintosh, Shylie; Said, Catherine M; Whitehead, Craig HamiltonThis randomised controlled trial aims to evaluate the effectiveness of a multi-factorial falls prevention program for stroke survivors who are at high risk of falling when they return home after rehabilitation. Intervention will consist of a home exercise program as well as individualised falls prevention and injury minimisation strategies based on identified risk factors for falls. Additionally, two sub-studies will be implemented in order to explore other key areas related to falls in this population. The first of these is a longitudinal study evaluating the relationship between fear of falling, falls and function over twelve months, and the second evaluates residual impairment in gait stability and obstacle crossing twelve months after discharge from rehabilitation.Item Dietary intervention to lower serum cholesterol(The Royal Australian College of General Practitioners, 2009) Clifton, Peter Marshall; Colquhoun, David; Hewat, Claire; Jones, Peter; Litt, John Charles; Noakes, Manila; O'Brien, Richard; Shrapnel, Bill; Skeaff, MurrayInterventions that lower LDL-C lower the risk of cardiovascular disease. Comprehensive dietary intervention is indicated in all patients with an absolute 5 year risk for coronary disease of 10% or greater. Short term trials indicate that these interventions have the potential to lower LDL-C by approximately 20%. A year long trial has shown mean LDL-C lowering of 13%, with about one-third of subjects achieving a reduction greater than 20%, highlighting the importance of adherence to dietary advice. The most effective dietary strategies are replacing saturated and trans fatty acids with poly- and monounsaturated fats and increasing intake of plant sterols. Losing weight and increasing soluble fibre and soy protein intake can also lower serum cholesterol and may be considered when recommending a nutritionally balanced, cholesterol lowering diet. Motivational interviewing by general practitioners can improve the effectiveness of brief, behaviour orientated advice and dietary counselling to lower serum cholesterol.