Hospital admissions to a major wildlife hospital in south-east Queensland, Australia, over a 10-year period, 2012–2022

Simple SummaryLittle is understood about the overall success of current wildlife rehabilitation techniques and the implications of these as an effective conservation strategy. This study collated admission records from four major wildlife hospitals catering to sick and injured koalas across southeast Queensland from 2009 to 2014, and analyzed specific factors that may be important when quantifying the extent and effectiveness of this work. The study found koalas to be at an increased risk from urbanization and human disturbance, that various rehabilitation techniques are employed amongst the four wildlife hospitals, and that a majority of koalas are either euthanized or die whilst in care rather than being released back to the wild. These results provide an interesting insight into current koala rehabilitation practices and have important implications for further research to better understand the practice of rescue and rehabilitation as an effective conservation strategy for this species.Koala populations in southeast Queensland are under threat from many factors, particularly habitat loss, dog attack, vehicle trauma and disease. Animals not killed from these impacts are often rescued and taken into care for rehabilitation, and eventual release back to the wild if deemed to be healthy. This study investigated current rescue, rehabilitation and release data for koalas admitted to the four major wildlife hospitals in southeast Queensland (Australia Zoo Wildlife Hospital (AZWH), Currumbin Wildlife Sanctuary Hospital (CWH), Moggill Koala Hospital (MKH) and the Royal Society for the Prevention Against Cruelty to Animals Wildlife Hospital at Wacol (RSPCA)), and suggests aspects of the practice that may be changed to improve its contribution to the preservation of the species. It concluded that: (a) the main threats to koalas across southeast Queensland were related to urbanization (vehicle collisions, domestic animal attacks and the disease chlamydiosis); (b) case outcomes varied amongst hospitals, including time spent in care, euthanasia and release rates; and (c) the majority (66.5%) of rescued koalas were either euthanized or died in care with only 27% released back to the wild. The results from this study have important implications for further research into koala rescue and rehabilitation to gain a better understanding of its effectiveness as a conservation strategy.

The causes and prognoses of different types of fractures in wild koalas submitted to wildlife hospitals

Koala populations are in catastrophic decline in certain eastern Australian regions. Spanning from 1997–2013, a database derived from wildlife hospitals in southeast Queensland with N = 20,250 entries was classified by causes of morbidity and mortality. A total of 11 aetiologies were identified, with chlamydiosis, trauma, and wasting being most common. The clinical diagnosis at submission varied significantly over the observation period. Combinations of aetiologies were observed in 39% of koalas submitted, with chlamydiosis frequently co-occurring. Urogenital (cystitis 26.8%, bursitis 13.5%) and ocular (conjunctivitis 17.2%) chlamydiosis were the most frequently diagnosed representations of the infection. Approximately 26% of submissions comprised koalas involved in vehicle accidents that were otherwise healthy. Age and sex of the koala as well as season and submission period were compared for the case outcomes of ‘dead on arrival’, ‘euthanized’, or ‘released’ for the four most common clinical diagnoses using multinomial logistic regression models. Exploratory space-time permutation scans were performed and overlapping space-time clusters for chlamydiosis, motor vehicle traumas and wasting unveiled high risk areas for koala disease and injury. Our results suggest that these aetiologies are acting jointly as multifactorial determinants for the continuing decline of koalas.

To describe the current practice of prophylactic antibiotic prescribing for patients presenting to the ED with a dog bite, and compare management against existing guidelines. We performed a descriptive retrospective study on all consecutive patients who presented to one tertiary teaching hospital and one regional district hospital in Southeast Queensland between 1 July 2017 and 30 June 2018 with a presentation of a dog bite. Data on demographics and management were collected from the electronic medical record using a standardised data collection tool. Risk factors supporting prophylaxis were taken from the electronic Therapeutic Guidelines. Of the 336 patients included for analysis, 299 received antibiotics, of which 23 were for established infection. A total of 276 (82% of overall cohort) received a prescription for prophylactic antibiotics, either in hospital (ED or admitting ward) and/or on discharge. Of the 178 patients who received prophylactic antibiotics in hospital, 91 (51.1%) received intravenous antibiotics. Of the patients who presented to ED without a previously established infection 271 (86.6%) received prophylactic antibiotics on discharge. Over one quarter (27.5%) of patients who were given prophylactic antibiotics did not meet any high-risk factors as outlined in guidelines. Prophylactic antibiotics are extensively used for patients with dog bites. There is scope to rationalise antibiotic use and route of antibiotic administration in patients with dog bites.

Metastatic colorectal cancer has a large burden of disease in Australia. Medical therapy is fundamental to extending survival and improving quality of life. The benefits of two costly medicines, bevacizumab and cetuximab, used in Australia remain unclear. The aim of this study was to retrospectively examine the use of these two medicines in metastatic colorectal cancer across five public hospitals in south east Queensland and to compare clinical outcomes to those of published clinical trials. We extracted data from the chemotherapy prescribing database for patients planned for bevacizumab or cetuximab therapy between 2009 and 2013. Median overall survival was estimated using Kaplan-Meier methods. There were 490 bevacizumab-containing protocols planned and 292 patients received at least one dose of bevacizumab. Median overall survival was 17.2 months (95% confidence interval [CI], 15.4-19.3). Of 208 planned cetuximab-containing protocols, 134 patients received at least one dose of cetuximab. Median overall survival was 9.1 months (95% CI, 7.6-12.0). Thirty-day mortality rates from date of first dose were 0.7% for bevacizumab and 7.5% for cetuximab. Overall survival of patients receiving bevacizumab and cetuximab was consistent with clinical trials, providing some assurance that benefits seen in trials are observed in usual practice. This study provides a methodology of using routinely collected health data for clinical monitoring and research. Because of the high cost of these medicines and the lack of toxicity data in this study, further analysis in the postmarketing setting should be explored.

The koala (Phascolarctos cinereus), while being an iconic Australian marsupial, has recently been listed as endangered. To establish an improved understanding of normal reproductive anatomy, this paper brings together unpublished research which has approached the topic from two perspectives: (1) the establishment of an artificial insemination program, and (2) the definition of Chlamydia spp.-derived histopathological changes of the female koala urogenital system. Based on the presentation and histological processing of over 70 opportunistic specimens, recovered from wildlife hospitals in Southeast Queensland (Australia), we describe the gross and microanatomy of the koala ovary, oviduct, uteri, vaginal complex, and urogenital sinus during the interestrous, proliferative, and luteal phases of the reproductive cycle.

Aviadenoviruses are widespread in wild birds but rarely cause disease in nature. However, when naïve species are exposed to poultry or aviaries, aviadenoviruses can lead to disease outbreaks. This study characterised a novel aviadenovirus infection in a native Australian bird, the tawny frogmouth (Podargus strigoides) during an outbreak investigation. The identified complete genome of aviadenovirus, named tawny frogmouth aviadenovirus A (TwAviAdV-A) was 41,175 bp in length containing 52 putative genes. TwAviAdV-A exhibits the common aviadenovirus genomic organisation but with a notable monophyletic subclade in the phylogeny. The TwAviAdV-A virus was hepatotrophic and the six frogmouths presented to the wildlife hospitals in South Eastern Queensland most commonly exhibited regurgitation (in four frogmouths). Three were died or euthanized, two recovered, and one showed no signs. The detection of TwAviAdV-A in frogmouths coming into care re-emphasizes the need for strict biosecurity protocols in wildlife hospitals and care facilities.

The weather determined how ‘hot’ the tick paralysis season was in eastern Australia: 2018–2024

Pharmacy assistants and technicians, as pharmacy support staff, play an important role in hospital pharmacy departments by alleviating pharmacists’ time to concentrate on more clinically oriented tasks. Whilst organisations such as the Society of Hospital Pharmacists Australia (SHPA) have recognised the need to further integrate pharmacy assistants and technicians into more advanced roles, such as medication reconciliation, there is currently limited research on the availability of training and consistency in service delivery provided by these support staff in Australian hospital settings. As a result, hospitals/organisations around the country have implemented individualised in-house training suited to their respective needs and environment. In order for pharmacy support staff to be equipped to perform advanced roles, training frameworks and support from pharmacists are required. The aim of this study was to explore and compare the perceptions of roles and available training frameworks that support career advancement for pharmacy support staff, amongst pharmacists and support staff, in the hospital sector. A literature review was completed to inform international comparisons of roles, training frameworks and benefits of support staff advancement within the pharmacy profession. Semi-structured interviews were conducted with personnel from both private and public hospitals to explore key issues identified in the literature. A total of 25 participants consisting of ten pharmacists and 15 pharmacy support staff were recruited from a private (n=13) and a public (n=12) hospital in South East Queensland. Interviews were conducted either face-to-face or via telephone between October 2017 to August 2018 across both sites, with a mean duration of 39.85 minutes (range: of 20.08 to 60.04 minutes). All interviews were audio-recorded, transcribed verbatim, and quality checked by a second researcher prior to data analysis using the qualitative software NVivo® 11. The general inductive approach was used for thematic data analysis, which allowed for the emergence of new themes and sub-themes within the research topic. Findings from this research confirmed that the core duties of pharmacy support staff were dispensing and inventory management in both hospital settings, with greater clinical task involvement sought by participants. Tasks such as assisting with medication history taking, collating pathological results, research involvement, and discharge facilitation were considered as technical tasks within a clinical setting. Most participants supported the career advancement of pharmacy support staff irrespective of their own professional role, and believed that with appropriate training, this could include technical tasks in a clinical setting and administrative roles currently performed by pharmacists. Professional autonomy, time, and monetary incentives were commonly reported by participants as motivators, with lack of organisational support and course availability reported as common barriers for pharmacy support staff career progression. With some participants having international knowledge and experiences, emerging themes such as pharmacy technician registration and the need for governing bodies such as universities and registration boards were also expressed. Other emerging themes included the perception of hierarchy from inside and outside of the pharmacy profession by selected participants. This study also identified inconsistencies in the application of role titles used across both sites with pharmacy assistant and pharmacy technician used interchangeably, and differences in role expectations. For example, tasks such as supply of inpatient medication performed across both hospital environments had diverse processes with different levels of pharmacist involvement. As a result, this study highlighted the need for greater consistency in the definition and application of pharmacy support staff titles and roles. Additionally, participants revealed the need for governing bodies to streamline roles and training frameworks similar to the accreditation and registration processes seen internationally, as means of ensuring and maintaining the quality of service provided to stakeholders. This exploratory study provides valuable insight into the thoughts and motivation of pharmacy support staff and pharmacists that can inform the evolution of support staff career pathways. By documenting the accounts and views of pharmacists and pharmacy support staff in two different hospital environments, this study has added to existing research by being one of the first studies to obtain insight into the lived experience of pharmacy staff within the Australian hospital environment. This study has also identified potential areas for further research in the field of pharmacy support staff education and professional practice.

Objective The aim of this study was to provide a detailed description of the flexible working arrangements (FWA) used by allied health professionals (AHP) on return from maternity leave. This is a crucial issue for staff management practices in a changing regulatory context. Methods A retrospective convenience sample of AHP employed by Queensland Health (QH) in 2006, using deidentified payroll data, was analysed descriptively to determine employment status on return from maternity leave in 2006 to December 2014. A qualitative study that surveyed managers of AHP departments was subsequently undertaken to complement the data from the payroll study. Twelve managers, across six allied health professions in three hospitals in south-east Queensland were surveyed for this component. Results The payroll study included 169 employees (138 full-time equivalent (FTE)), 61 of whom resigned over the study period. Of those who returned to work after the 2006 maternity event (n=152), 92% (n=140) initially returned part-time. At 31 December 2014, of the 108 staff working for QH, 77% (n=83) were part-time. In total, 75.4 FTE positions were released over the 8-year period through reduced working hours and resignations. The perceptions of surveyed managers were consistent with the data from the payroll study. Conclusion The study showed that most AHPs who took maternity leave returned to work part-time and remained part-time for an extended period. The data suggest that managers could permanently backfill a proportion of hours released due to FWA after maternity leave without major budgetary risk due to the need to accommodate existing employees' entitlements. However, this would require a significant policy change. What is known about this topic? Current research on this topic has concentrated on the benefits of paid maternity leave, timing of return to work and use of FWA by employees on return to work after maternity leave. What does this paper add? This paper presents the first comprehensive data on patterns of return to work and part-time hours following maternity leave for AHP employees. Access to a unique payroll dataset provided the opportunity to describe this for a cohort of AHP employees over a period of 8 years following a maternity event. A survey of AHP managers' experience with maternity leave and return to work arrangements supported the findings, underlining the associated difficulties with staff management. What are the implications for practitioners? The hours released through resignations or reduced hours over this period of study suggest that management could backfill a proportion of released hours permanently, or at least offer temporary staff longer-term contracts, once an employee returns from maternity leave on reduced hours.

Oral health in South East Queensland Koalas: Prevalence of periodontal disease and other pathologies

The primary goal of chronic obstructive pulmonary disease (COPD) management is to optimise a patient's functional status and quality of life. By encouraging effective patient self-management within primary healthcare, unplanned and potentially avoidable COPD admissions to the emergency department (ED) can be avoided. The aim of this study is to examine whether distance to hospital influences the rate of ED presentation, hospital admission and hospital length of stay for COPD patients. The 2016 to 2018 resulted in a total of 5253 patient presentations with a primary medical diagnosis code of J44 (COPD). These were at the main hospitals of three Queensland Hospital and Health Services: Toowoomba, Ipswich and Gold Coast. To examine the variations in patient characteristics based on distance, a one-way ANOVA (analysis of variance) test was conducted. The Kruskal-Wallis test indicated that there were group differences. This study identified significant variation in COPD-related hospital length of stay and distance to hospital among COPD patients within three hospitals in South East Queensland, Australia. These results confirm that distance plays an important role in determining duration of hospital stay (in number of days) among COPD patients, with clear evidence of the distance 'decay phenomenon'. It appears from the findings of the current study that distance to the hospital is not associated with the greater likelihood of ED presentation but may influence length of stay. Several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital.

IntroductionPerioperative hypothermia is a common and preventable complication of surgery. Systems level change that enables perioperative teams to integrate hypothermia prevention into practice in ways that are contextually appropriate is...

Objective: The present study extends our knowledge of the main determinants of burnout among nurses working in public hospitals and investigates the impact of work support on the stress‑burnout relationship. Design: A cross‑sectional, survey design. Setting: Data were collected from three public hospitals in south east Queensland, Australia. Subjects: A convenience sample of 273 nursing staff (235 females, 38 males) participated in the study. Main outcome measures: The influence of work stressors (ie. job‑specific stressors and role stressors) and work support (ie. supervisor and coworker support) on burnout amongst public hospital nurses. Results: Overall, nurses reported moderate levels of burnout (emotional exhaustion, depersonalisation and reduced personal accomplishment). Hierarchical regression analyses revealed that socio‑demographic factors play a small, but significant role in predicting burnout. Role Overload, Job Conflicts and Role Boundary contributed to higher levels of Emotional Exhaustion. Role Boundary and Professional Uncertainty contributed to higher levels of Depersonalisation and Role Boundary and Role Ambiguity contributed to lower levels of Personal Accomplishment. Only Supervisor Support had a significant effect on Depersonalisation and Personal Accomplishment. No evidence was found to indicate that work support had a buffering effect on the stress‑burnout relationship. Conclusions: The results highlight the need for organisational interventions to reduce the workload placed on nurses. Supervisors are in a better position than co‑workers to reduce burnout among nurses by clearly outlining the boundaries and expectations of the nursing role.

Common among patients with COPD is declining health-related quality of life (HRQOL). Although results of research identified some factors associated with HRQOL, resilience factors are yet to be fully investigated. This study examined resilience and demographic factors associated with HRQOL. Participants >40 y old were recruited from community health programs and hospitals in South East Queensland. Self-administered questionnaires were used to query subjects' HRQOL and levels of resilience. A decision tree examined the factors important to HRQOL in 159 subjects with COPD. Factors of importance in the HRQOL of subjects with COPD were found in 3 domains of the St George Respiratory Questionnaire. Of importance on the breathlessness domain was marital status, defensive coping, coping, number of comorbidities, relationships, decision-making, self-esteem, self-efficacy, and professional support of health and well-being. Of the symptoms domain, self-efficacy, recruitment location, anxiety/depression, decision-making, self-esteem, coping, relationships, professional support of health and well-being, and risks were important. The cough domain found recruitment location, anxiety/depression, professional support of health and well-being, coping, and defensive coping to be important for subjects' HRQOL. Resilience and confounding factors were of importance in the HRQOL of subjects with COPD. Thus, consultation with a medical professional, especially at discharge, who identifies, encourages, and approves of the patient's disease management abilities will enhance both resilience and HRQOL.