Australian Practice Research Articles

Antenatal care addressing gestational weight gain (GWG): a cross sectional study of pregnant women’s reported receipt and acceptability of recommended GWG care and associated characteristics

BackgroundThe Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women’s acceptability of recommended care is unknown. This study examines women’s reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability.MethodsFrom September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses.ResultsOf 514 women, 13.1% (95%CI:10.3–16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8–9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6–12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05–1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05–1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27–8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09–82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable.ConclusionMost women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women.

Australian psychologists' knowledge, confidence, and practices in fetal alcohol spectrum disorder diagnostic assessment.

Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). There are many documented barriers to FASD diagnostic assessment, including a limited number of trained clinicians. This study aimed to establish baseline levels of Australian psychologists' knowledge and practices in FASD assessment to develop training and improve future diagnostic capacity. An online survey was completed by 106 Australian psychologists. The survey elicited respondents' demographics, knowledge about FASD, confidence in various aspects of assessment and perceived future training needs. Respondents reported a broad understanding of the FASD diagnostic term and potential harm of prenatal alcohol exposure (PAE). However, most respondents were not confident in their ability to conduct the psychometric assessments that provide a diagnostic assessment of FASD or ask about PAE. There was a significant positive correlation between the number of correct knowledge items and the psychologists' confidence in conducting FASD assessments. The clinical neuropsychologists demonstrated significantly greater knowledge and confidence in applying FASD diagnostic criteria and assessing PAE than school, clinical, and other psychologists. Most psychologists were more confident in their ability to apply the diagnostic criteria for other neurodevelopmental disorders. Recognition of FASD is growing in Australia, however, further work is required to improve clinicians' understanding of and confidence in completing FASD assessments. Most participants indicated a preference for online training to learn more about FASD assessment.

A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services

Introduction Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines. Method Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards. Results Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence. Conclusion This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.

Attachment and the (mis)apprehension of Aboriginal children: epistemic violence in child welfare interventions

Child protection systems in Australia continue to disproportionately investigate Aboriginal families and intervene to remove Aboriginal children, applying non-Indigenous constructs and understandings of child development that contribute to these enduring inequities. Attachment theory is one such prevalent framework with significant applications in child protection. While constructions of attachment have attempted to grapple with diversity, its application in Australian child protection policy and practice reflects dominant socio-cultural perceptions as a foundation for decision making that misrepresents Aboriginal families and their children’s developmental needs. We position this socio-legal application of attachment specifically, and developmental sciences more broadly, within a long history of settler-colonial intervention, providing a façade of scientific authority that perpetrates further harms on Aboriginal children, families and communities. We offer insights about a new frame for attachment that respects Aboriginal worldviews as part of structural transformations to address those harms.

Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices.

Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. Appraise the clinical quality of the Australian treatment access criteria. The Fabry Australia Medical Advisory Committee (N = 6) used the Appraisal of Guidelines for REsearch and Evaluation Global Rating Scale (AGREE II GRS) to assess the clinical quality of the current treatment eligibility criteria. They reviewed the literature, developed 17 clinical statements to help guide reforms of the eligibility criteria and achieved consensus (achievement of ≥75% agreement in the range 5-7 on a 7-point Likert scale) through anonymous voting. The findings were applied to develop proposals for revised classification and treatment initiation criteria. The current treatment eligibility criteria underperformed on the AGREE II GRS. They are pragmatic but out-of-step with contemporary data. Consensus was achieved on all 17 proposed clinical statements. There was strong agreement to differentiate classical male Fabry patients to facilitate timelier access to Fabry-specific treatment. There was also agreement on the value of adopting relevant organ involvement criteria in classical female patients and patients with non-classical disease. Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.

Prospective Study of 506 Dogs with Tick Paralysis: Investigating Measures of Severity and Clinical Signs as Predictors of Mortality and Assessing the Benefits of Different Therapeutics.

Survey data from 42 Australian eastern seaboard veterinary practices involving 506 cases are reported with regard to clinical signs, disease severity, mortality, use of pharmaceuticals, and recovery times. New measures of disease severity (visual analogue scales (VAS) and facial expressions) were tested alongside "gold standard" measures (neuromuscular junction (NMJ) scores). Univariable and multivariable logistic regression analyses were conducted to evaluate associations between variables. The VAS scores were progressive, prognostic (especially the respiratory scores) and correlated with the NMJ scores. The presence of inspiratory dyspnoea and crackles on the day of hospitalisation, progressing to expiratory dyspnoea and an expiratory wheeze 24 h later, were highly predictive of mortality. Altered facial features on hospital admission were also highly predictive of mortality. The previously used respiratory score (using various clinical signs) was not predictive of mortality. Older animals had a higher mortality rate, and no gender or breed susceptibility was found. The only pharmaceuticals that were positively associated with mortality were tick antiserum and, in severe cases, antibiotics. The use of many pharmaceutical products (acepromazine, atropine, steroids, antihistamines, antiemetics, diuretics, and S8 anti-anxiety and sedation drugs) had no effect on mortality. More drug classes were used with increasing clinical severity and specific factors (e.g., vomiting/retching, hydration) affected the period of hospitalisation. Geographic variation in respiratory signs and toxicity scores was evident, whereas mortality and disease severity were not different across regions.

Barriers and facilitators to the assessment of cognitive-communication disorders in children and adolescents after traumatic brain injury: a survey of Australian clinical practice

Barriers and facilitators to the assessment of cognitive-communication disorders in children and adolescents after traumatic brain injury: a survey of Australian clinical practice

Promoting effective interprofessional collaborative practice in the primary care setting: recommendations from Queensland physiotherapy private practitioners.

Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training.

The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession.

Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

Australian music education training and teaching practice: investigating the latitude of ICT resourcing and application

Covid-19 disrupted the way in which music teachers taught across education settings. It challenged and opened up new possibilities to think about pedagogy, content, assessment, and delivery. This paper forms part of a national study Reimaging the future: music teaching and learning, and ICT in blended environments in Australia. The authors are tertiary music educators working in initial teacher education (ITE) programs. In this paper, they discuss two questions: what can be learnt from teachers across education settings as they embraced pedagogical challenges? What are the implications for future focused classrooms? A mixed methodology were employed drawing on quantitative and qualitative data through an anonymous Qualtrics survey. The data reported were collected in Phase One March-April 2021 (N=105) and Phase Two December 2022-February 2023 (N=108) using thematic analysis to identify and analyse patterns of meaning. Three emergent themes: changes across teacher practice, collaborating and connecting practice through ICT, shifts in teacher confidence and competence are discussed. The study highlights the changes and reform required for ITE programs as students prepare for future focussed classrooms that meet the demands of the 21st Century. The findings may resonate with other countries, and generalisations to other learning areas cannot be made. Recommendations are offered that highlight the need for ITE programs and in-service for teachers to rethink, reframe and reimagine the latitude of ICT resourcing and application in music teaching.

Which parents provide zero-alcohol beverages to adolescents? A survey of Australian parents' practices and intentions

ObjectiveZero-alcohol beverages (<0.5% alcohol by volume) appear and taste similar to alcoholic beverages but are regulated similarly to soft drinks in many countries, blurring the distinction between alcoholic and non-alcoholic beverages. How parents view provision of zero-alcohol beverages to adolescents is likely a key determinant of adolescent consumption. We investigated factors associated with parents' provision of zero-alcohol beverages to adolescents, including attitudes toward zero-alcohol beverages and demographic, knowledge, and behavioural factors known to be associated with provision of alcoholic beverages. MethodsWe conducted an online cross-sectional survey of N = 1197 Australian parents of adolescents aged 12–17 years in April–May 2022. We examined associations with zero-alcohol beverage provision using binomial logistic regression, and with future provision intentions using multinomial logistic regression analyses. ResultsFactors significantly associated (p < .001) with parents' provision and future intentions to provide zero-alcohol beverages to their adolescent included beliefs that zero-alcohol beverages had benefits for adolescents (Adjusted Odds Ratio [AOR] 2.69 (provision); 3.72 (intentions)), provision of alcoholic beverages (AOR 2.67 (provision); 3.72 (intentions)), and an incorrect understanding of alcohol guidelines for adolescents (AOR 2.38 (provision); 1.95 (intentions)). ConclusionsParents' provision and intentions to provide zero-alcohol beverages were associated with beliefs about zero-alcohol beverages as well as some factors associated with provision of alcoholic beverages. Precautionary advice to parents that the provision of zero-alcohol beverages may serve to normalise alcohol consumption may be warranted.

Prognostic and predictive biomarkers in melanoma

Biomarkers help to inform the clinical management of patients with melanoma. For patients with clinically localised primary melanoma, biomarkers can help to predict post-surgical outcome (including via the use of risk prediction tools), better select patients for sentinel lymph node biopsy, and tailor catch-all follow-up protocols to the individual. Systemic drug treatments, including immune checkpoint inhibitor (ICI) therapies and BRAF-targeted therapies, have radically improved the prognosis of metastatic (stage III and IV) cutaneous melanoma patients, and also shown benefit in the earlier setting of stage IIB/C primary melanoma. Unfortunately, a response is far from guaranteed. Here, we review clinically relevant, established, and emerging, prognostic, and predictive pathological biomarkers that refine clinical decision-making in primary and metastatic melanoma patients. Gene expression profile assays and nomograms are emerging tools for prognostication and sentinel lymph node risk prediction in primary melanoma patients. Biomarkers incorporated into clinical practice guidelines include BRAF V600 mutations for the use of targeted therapies in metastatic cutaneous melanoma, and the HLA-A∗02:01 allele for the use of a bispecific fusion protein in metastatic uveal melanoma. Several predictive biomarkers have been proposed for ICI therapies but have not been incorporated into Australian clinical practice guidelines. Further research, validation, and assessment of clinical utility is required before more prognostic and predictive biomarkers are fluidly integrated into routine care.

The Barriers to Interprofessional Collaborative Practice: Perspectives from Australian Physiotherapy Private Practitioners

Background: Despite the growing presence of physiotherapy private practitioners within Australia’s healthcare workforce, little is known about their perspectives of interprofessional collaborative practice (IPCP). This study aims to explore the barriers to IPCP from the perspective of Australian physiotherapy private practitioners. Methods: Semi-structured interviews were conducted with 28 physiotherapists and 64 hours of observation was completed in 10 private practice sites in Queensland, Australia. Interview and observation data were pooled and analyzed using reflexive thematic analysis. Findings: Data analysis produced five themes that characterized physiotherapists’ perspectives of IPCP: a) competition for clientele, b) personal attitudes and beliefs, c) time constraints and work schedules, d) geographic location, and e) rules of funding schemes. Conclusion: The findings from this study suggest that implementing IPCP in the Australian physiotherapy private practice setting presents several challenges. Financial concerns, such as physiotherapy private practitioners’ perceived need to compete for clientele, were significant barriers to IPCP. The introduction of financial incentives and adoption of alternative payment models may be necessary to provide physiotherapy private practitioners with a clear motivation to engage in IPCP. The need for more formal opportunities to bring health practitioners from diverse professional backgrounds together to gain new insights and knowledge of other professions’ expertise and challenge their own assumptions was also highlighted.

Development of a clinical practice guideline for physiotherapy management of adults invasively ventilated with community-acquired pneumonia

Background and settingPatients hospitalised with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit (ICU) for invasive mechanical ventilation and receive treatment by physiotherapists. However, clinical physiotherapy practice is variable for this ICU cohort. ObjectivesTo develop a clinical practice guideline for physiotherapy management of adults invasively ventilated with CAP using the best available evidence. MethodsGuideline development using evidence synthesis according to the GRADE and JBI approaches, incorporating findings from four preceding phases of a mixed-methods research program: systematic review and meta-analysis, national survey of Australian ICU physiotherapy practice, e-Delphi study to determine expert consensus, and multidisciplinary peer-review of the expert consensus statements by senior ICU clinicians to determine validity and applicability of the statements for translation into practice. ResultsThe guideline comprises 26 recommendations, encompassing physiotherapy assessment, patient selection and prioritisation, and treatment. Physiotherapy treatment covers domains of humidification, patient positioning, hyperinflation techniques, manual chest wall techniques, normal saline instillation, active treatment, and mobilisation. Recommendations are rated as strong or conditional based on JBI criteria, and certainty of evidence according to GRADE. Considerations for practice are provided within the guideline to enhance clarity and practicality, particularly for conditional recommendations where evidence is limited or conflicting. ConclusionThis guideline, based on the best available evidence for clinical physiotherapy practice for adults invasively ventilated with CAP, is intended to support clinicians with clinical decision making. Further research is required to evaluate guideline implementation into clinical practice, and incorporate the values and preferences of ICU patients and their families. Contribution of paper•This world first clinical practice guideline was developed based on the best available evidence for physiotherapy management of adults invasively ventilated with non-COVID-19 community-acquired pneumonia.•The evidence-based guideline provides 26 recommendations across nine domains of physiotherapy assessment and treatment, to guide best practice for this common ICU cohort.

The Kessler Psychological Distress Scale in Australian adolescents: Analysis of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

The 10-item Kessler Psychological Distress Scale (K10) is used to screen adolescents for mental disorders in Australian clinical practice; however, there are no Australian adolescent normative data. Data were drawn from a nationally representative sample (N = 2964) of Australian adolescents (11-17 years). This study had three aims: (1) to examine concurrent validity between the K10 and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms subscale, (2) to establish normative Australian adolescent K10 data and (3) to determine optimal K10 cut-off scores for screening for major depressive disorder (MDD) via receiver operator characteristic curve analysis and stratum-specific likelihood ratios. The K10 and SDQ emotional symptoms scales were moderately correlated (rs = 0.63, p < 0.001). Older female adolescents reported higher total K10 scores compared with younger female adolescents (15-17 years: M = 20.2, standard error [SE] = 0.3; 11-14 years: M = 16.8, SE = 0.3) and male adolescents (11-14 years: M = 16.6, SE = 0.2; 15-17 years: M = 16.0, SE=0.2). K10 scores to optimally discriminate those with and without MDD varied by age and sex and had low specificities. Stratum-specific likelihood ratios indicated adolescents with a K10 score of ≥30 will have a 12.9 (95% confidence interval = [10.2, 16.2]) increased likelihood of MDD. The K10 has utility for assessing psychological distress in health care and epidemiological research in Australian adolescents. Adolescents with K10 scores in the 'very high' range are at increased risk of MDD. Further assessment of these young people is indicated to identify those with or at risk of developing MDD.

Mapping pre-consumer food waste in quick service restaurants on a university campus: Two Australian case studies

Mapping and monitoring the process of pre-consumer food waste generation in the foodservice sector is needed to fully understand food waste, identify hotspots, and strengthen the evidence-base in this sector of the food supply chain. The purpose of this study was to validate a tool for separation and quantifying pre-consumer food waste in a quick service restaurant (QSR) setting, and to map the food waste generation process using statistical process control methodology. This included consideration of food waste categories and edible versus inedible waste. The study also explored key foodservice and menu practices which may impact food waste production. Food waste audits were undertaken in two food outlets (FOs) in an Australian university campus over a two-week operating period for each outlet using a direct weighing method. Foodservice operation and menu practices occurring in the outlets during the audit period were also recorded. These observations validated practices reported by the owner-manager of the FOs during interviews. The amount of waste collected separately from each outlet was analysed using statistical process control methodology. While each FO was treated as a separate case study, the same methodology was applied to each, allowing some comparison between outlets. Despite differences in foodservice style and menus, the average daily pre-consumer food waste produced from all food waste categories was approximately 25 kg for both outlets, with about 60% from inedible waste. This equated to approximately 5.5–6.1 kg of pre-consumer waste per full-time-equivalent employee (FTE) per day. Used coffee grounds was the largest single contributor of total pre-consumer waste for both FOs. Both FOs demonstrated compliance with Australian best practice in foodservice operations and menu design. The study concludes that the method used to separate pre-consumer food waste into different categories and quantify this waste was a practical tool for these QSRs and allowed researchers to validate both the separation process and the amount of waste collected. Analysis of data using statistical process control allowed differentiation between common and special cause of variations. These findings can help inform processes which generate food waste in these types of foodservice settings and assist with the development of food waste reduction initiatives.

Dry needling perceptions and experiences: A survey of Australian physiotherapists

BackgroundThere is a lack of information on the use of dry needling in Australian physiotherapy practice. ObjectivesOur primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DesignCross-sectional online survey. MethodWe developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. Results/findingsWe invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). ConclusionsWe found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.

Client experiences and understandings of dreams in contemporary Australian psychological practice: An IPA study.

Client experiences and understandings of dreams in contemporary Australian psychological practice: An IPA study.

PP49 Cost Of Cardiac Implantable Electronic Device (CIED) Infections In Australia: A Private And Public Sector Payer Perspective

IntroductionIn Australia, approximately 200,000 patients have a cardiac implantable electronic device (CIED), and in an aging population that number is rising. CIED-related infections are also increasing, causing considerable morbidity and mortality, and substantial healthcare costs. Internationally, the rate of CIED infection ranges from 1.0 percent to 1.6 percent, while in Australia, the reported range is from less than 1 percent to 7.0 percent. The average hospital cost to treat an infection in the US ranges between USD48,000–USD83,000. To date, few publications have estimated the cost of CIED infections in Australia. Critical appraisal of these studies has highlighted issues in their methodology, making them unreliable sources for use in economic evaluations. The purpose of this study was to utilize Australian routinely collected health data to robustly model costs of CIED infections to reduce uncertainty for future health technology assessment (HTA).MethodsThe cost of treating a CIED infection was modeled for the public and private sector including cost of system removal and re-implantation procedures, hospital and intensive care unit (ICU) stay, and outpatient follow-up. Cost inputs were obtained from the Australian Prostheses List, Medicare Benefits Schedule, Australian Institute of Health and Welfare, and Private Hospital Data Bureau. Other inputs were obtained by surveying Australian clinicians, which were validated with published data. Phone interviews and online surveys were conducted with clinicians to elicit specific Australian practice pathways for patients with a CIED infection.ResultsThe majority of patients with a CIED have their device system removed (95-100%) and re-implanted (83%) once the infection has cleared. In the private sector, cost of infection ranged from AUD80,869 (USD54,384) for a single chamber pacemaker (PM), to AUD140,103 (USD94,248) for a dual chamber Implantable Cardioverter-defibrillator (ICD). Modeled costs of CIED infection were slightly lower in the public sector (AUD73,643-AUD88,446 (USD49,555 – USD59,516) for the same devices).ConclusionsThe cost of a CIED infections to the healthcare system is high and differs by device type. Utilizing local real-world data to estimate costs will improve accuracy of economic evaluations and reduce uncertainty for decision makers.

Polycentric self-governance and Indigenous knowledge

This article's main aim is to discuss research exploring how the self-governing practices found in Indigenous societies, biota and modern organisations can be embedded into the constitutions of legal entities to protect and share the wellbeing of humanity, biota and the planet. In this paper, we explore how Australian Indigenous knowledge and practices can be embedded into organisational entities and discuss how this can be achieved by reformatting Ostrom's design principles to be incorporated into corporate constitutions following an ecological form of governance practised by Indigenous Australians. This form of polycentric self-governance can aggregate the voices of minorities representing local environments up to a global level. We use case studies, system science and biomimicry to explore polycentric self-governance and how organisations can adopt it to focus on the wellbeing of all stakeholders. In particular, the paper highlights how Indigenous knowledge can contribute globally to achieving societal sustainability.