Clinical Practice In Australia Research Articles

THE USE OF OUTCOME MEASURES IN EXERCISE PHYSIOLOGY CLINICAL PRACTICE IN AUSTRALIA

INTRODUCTION AND AIMS Outcome measure (OM) implementation in clinical settings has become a standard in allied health evidence-based practice over the last 20 years, with their use being encouraged by governing and funding bodies. This study investigated the application of standardised OMs by accredited exercise physiologists (AEPs) in Australia. This study aimed to identify commonly used OMs and explore the barriers and facilitators to OM implementation in AEP clinical practice in Australia. METHODS This study utilised a questionnaire-based, cross-sectional, descriptive design to determine the OMs used by AEPs in current clinical practice and investigated trends related to OM use within different AEP demographics and settings. Participants were also asked to identify any barriers and facilitators that affected their use of OMs in clinical practice. The OMs that were most frequently used were identified and the results analysed according to demographic variables, to determine how they influenced OM use in clinical practice. RESULTS Eighty-seven OMs were assessed, with 41% ‘never’ used by most participants. A further 48% of the OMs were identified as being underutilised with over 50% of respondents selecting ‘never’ or ‘sometimes’. Only three OMs were used frequently by most respondents. The most common barriers to OM use identified related to a lack of time, knowledge, and limited perceived value from clinicians. These reflect the barriers identified in prior research related to other allied health professions. CONCLUSIONS AEPs in Australia experience many of the same barriers to OM use as other allied health disciplines. Currently, the standardised OM resource for AEPs is outdated and underutilised in clinical practice. Updated resources for clinicians in the form of educational seminars and a searchable online database with easy access to evidence-based outcome measures are essential to the promotion of OMs to support evidence-based practice for AEPs.

Direct-Acting Antivirals Remain Cost-Effective Treatments for Chronic Hepatitis C in Australia Despite Changes to the Treated Population and the Availability of Retreatment: The Glecaprevir/Pibrentasvir (Maviret®) Example.

The first direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection were reimbursed via Australia's Pharmaceutical Benefits Scheme (PBS) in March 2016. This was based on the recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) that the regimens would be acceptably cost-effective at an incremental cost-effectiveness ratio (ICER) no greater than $15,000/quality-adjusted life-year (QALY). Since the initial PBS listings for DAA therapies and subsequent listings of newer DAA treatments such as glecaprevir/pibrentasvir (Maviret®), the demographics and some of the disease characteristics of currently treated patients have markedly changed. This analysis aims to reassess the cost-effectiveness of glecaprevir/pibrentasvir, accounting for the changes to the HCV population currently seeking treatment and incorporating retreatment in first-line failures and the treatment of new infections in previously treated individuals. To assess the cost-effectiveness 7years after initial listing of DAAs, an update was made to the Markov model used to achieve PBS reimbursement for Viekira-Pak® in May 2016. Amendments to the Viekira-Pak® model include: changes to baseline age and fibrosis distribution of treated patients, and inclusion of retreatment of first-line failures [those not achieving a sustained virologic response (SVR12)] and reinfected individuals. Treatment-related inputs including SVR12 response rates, adverse events, treatment-related disutility, and discontinuations were sourced from pivotal glecaprevir/pibrentasvir clinical trials. Using the published price of glecaprevir/pibrentasvir, the ICER is below $15,000/QALY. Despite changes in demographics and disease characteristics of treated patients, and changes to the model structure to reflect retreatment in clinical practice in Australia, DAAs remain cost-effective in 2023.

Public preference on sharing health data to inform research, health policy and clinical practice in Australia: A stated preference experiment.

To investigate public willingness to share sensitive health information for research, health policy and clinical practice. A total of 1,003 Australian respondents answered an online, attribute-driven, survey in which participants were asked to accept or reject hypothetical choice sets based on a willingness to share their health data for research and frontline-medical support as part of an integrated health system. The survey consisted of 5 attributes: Stakeholder access for analysis (Analysing group); Type of information collected; Purpose of data collection; Information governance; and Anticipated benefit; the results of which were analysed using logistic regression. When asked about their preference for sharing their health data, respondents had no preference between data collection for the purposes of clinical practice, health policy or research, with a slight preference for having government organisations manage, govern and curate the integrated datasets from which the analysis was being conducted. The least preferred option was for personal health records to be integrated with insurance records or for their data collected by privately owned corporate organisations. Individuals preferred their data to be analysed by a public healthcare provider or government staff and expressed a dislike for any private company involvement. The findings from this study suggest that Australian consumers prefer to share their health data when there is government oversight, and have concerns about sharing their anonymised health data for clinical practice, health policy or research purposes unless clarity is provided pertaining to its intended purpose, limitations of use and restrictions to access. Similar findings have been observed in the limited set of existing international studies utilising a stated preference approach. Evident from this study, and supported by national and international research, is that the establishment and preservation of a social license for data linkage in health research will require routine public engagement as a result of continuously evolving technological advancements and fluctuating risk tolerance. Without more work to understand and address stakeholder concerns, consumers risk being reluctant to participate in data-sharing and linkage programmes.

Frailty knowledge, training and barriers to frailty management: A national cross-sectional survey of health professionals in Australia.

To understand Australian health professionals' perceptions of their knowledge and previous training about frailty, as well as barriers to frailty assessment and management in their practice. A cross-sectional online survey was developed and distributed to health professionals (medical, nursing and allied health) engaged in clinical practice in Australia through convenience and snowball sampling techniques from March to May 2022. The survey consisted of five sections: frailty training and knowledge; confidence in recognising and managing adults with frailty; the importance and relevance of frailty; barriers to assessing and managing frailty in practice; and interest in further frailty training. Responses were analysed using descriptive statistics. The survey was taken by 736 health professionals. Less than half of respondents (44%, 321/733) reported receiving any training on frailty, with 14% (105/733) receiving training specifically focussed on frailty. Most respondents (78%, 556/712) reported 'good' or 'fair' understanding of frailty. The majority (64%, 448/694) reported being 'fairly' or 'somewhat' confident with identifying frailty. Almost all respondents (>90%) recognised frailty as having an important impact on outcomes and believed that there are beneficial interventions for frailty. Commonly reported barriers to frailty assessment in practice included 'lack of defined protocol for managing frailty' and 'lack of consensus about which frailty assessment tool to use'. Most respondents (88%, 521/595) were interested in receiving further education on frailty, with a high preference for online training. The findings suggest frailty is important to health professionals in Australia, and there is a need for and interest in further frailty education.

Functional outcome and frailty in colorectal surgery patients.

Frailty is a recognized risk and predictor of poor health outcomes in older patients undergoing surgery. A significant proportion of elderly patients undergoing colorectal cancer-related surgery are nevertheless not routinely assessed for frailty in current clinical practice in Australia. We examined the preoperative use of the Clinical Frailty Scale (CFS) to predict post-operative functional outcomes in geriatric patients undergoing colorectal cancer surgery. This retrospective observational cohort study included elderly colorectal cancer patients (n = 227) who underwent elective major colorectal surgery from 2016 to 2020 at Nepean Hospital, Australia. CFS was calculated retrospectively from medical records and the relationship between CFS and functional outcome factors was analysed. Frail patients (n = 111) had a significant postoperative functional decline as demonstrated by discharge to supported care (57% vs. 0.9%), Barthel Index change (P<0.05) and inability to self-manage stoma (P<0.05) compared to non-frail patients (n = 116). Multivariate analysis with adjustment for age, comorbidities as measured by Charlson Comorbidities Index (CCI), and cognitive impairment, demonstrated frailty was the most significant independent predictor of discharge to supported care (OR 109.3). Cognitive impairment and an increased CCI were also found to be important predictors. Preoperative frailty is significantly associated with postoperative functional decline and postoperative adverse outcomes, highlighting the potential utility of CFS in preoperative frailty assessment.

Health-care practitioner use of prescription drug monitoring programs in clinical practice in Australia: A qualitative study.

Prescription drug monitoring programs (PDMP) are electronic databases used by prescribers and pharmacists to monitor the use of high-risk prescription medications subject to extramedical use. This study aimed to explore how Australian pharmacists and prescribers are using PDMPs in practice and to gain an understanding of barriers to tool use, as well as practitioner recommendations to increase tool usability and uptake. Semi-structured interviews were conducted with pharmacists and prescribers who use a PDMP (n = 21). The interviews were audio-recorded, transcribed and thematically analysed. The four themes that emerged were: (i) PDMP notifications combined with practitioner clinical judgement guide PDMP usability; (ii) practitioners use PDMPs to facilitate patient and practitioner communication; (iii) workflow systems integration impacts tool usability; and (iv) optimising PDMP information and data access including practitioner-tool engagement to improve tool uptake and usability. Practitioners appreciate the value of PDMP information support for clinical decisions and patient communication. However, they also acknowledge the challenges to tool use and recommend improvements including enhanced workflow, systems integration, optimisation of tool information and national data sharing. Practitioners provide an important perspective on PDMP use in clinical practice. The findings can be drawn on by PDMP administrators to improve tool usefulness. Consequently, this may lead to an increase in practitioner PDMP use and optimise the delivery of quality patient care.

Symbols and rituals are alive and well in clinical practice in Australia: Perspectives from a longitudinal qualitative professional identity study

Purpose Many factors impact an individual’s professional identity on their journey to becoming a doctor, including their experiences, the learning environment, role models, and symbols and rituals. Rituals and symbols associated with the medical profession have historically included wearing a white coat (now rare) and the stethoscope. This study explored two medical students’ perspectives of symbolic identifiers in a six-year longitudinal study in Australia (2012–2017). Methodology A 2012 qualitative cross-sectional qualitative professional identity study in an Australian five-year undergraduate medical programme was extended to a longitudinal study with annual interviews. A conversation about the symbolism of the stethoscope and other identifiers began in Year 1 and concluded when the students were junior doctors. Findings Symbols and rituals remain part of the ‘becoming’ and ‘being’ a doctor. In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with ‘professional attire’ distinguishing medical students and doctors from other team members (uniform). The study identified lanyard colour and design as a symbol and language as a ritual. Conclusions Although symbols and rituals may change over time and across cultural contexts, some forms of treasured material possessions and rituals will persist in medical practice. Practice points On the journey of ‘becoming’ and eventually ‘being’ a doctor, many factors influence the development of an individual’s professional identity, not least symbols and rituals. For a range of reasons, e.g. cultural, contamination, symbols and rituals change but will be replaced. In Australia, and perhaps in other similar contexts, The stethoscope, once seen as an extension of a doctor’s anatomy, may no longer be perceived as such, making way for other identifiers such as lanyards and ‘professional attire.’ COVID-19 may influence some symbols and rituals, but this will depend on the persistence of SARS-CoV-2 variants.

Diagnosis of Nocturnal Hypoventilation in Pediatric Neuromuscular Disorders: A Survey of Clinical Practice in Australia and New Zealand

Objectives: Nocturnal hypoventilation is a complication of neuromuscular disorders. There are various recommendations for measuring pCO&lt;sub&gt;2&lt;/sub&gt; during polysomnography and numerous national and international definitions of hypoventilation that could contribute to significant variations in clinical practice. We therefore aimed to determine clinical practices implemented by Australasian pediatric sleep physicians.Methods: Pediatric sleep physicians completed an electronic survey for information regarding pCO&lt;sub&gt;2&lt;/sub&gt; measurements and definitions of hypoventilation that are followed for children with neuromuscular disorders.Results: It was found that transcutaneous measurement of pCO&lt;sub&gt;2&lt;/sub&gt; was performed in all centers, with 25% of the centers simultaneously performing capnography. Twelve definitions of hypoventilation were used, including published definitions from the American Academy of Sleep Medicine (AASM) manual and recommendations of the pediatric Australasian Sleep Association/Australasian Sleep Technologists Association. The most commonly used definition of hypoventilation (9/17, 53%) was the 2012 pediatric AASM definition (pCO&lt;sub&gt;2&lt;/sub&gt; &gt;50 mmHg for &gt;25% of the total sleep time). There was a discrepancy between centers and individuals within the same center when defining hypoventilation. Answers stating the use of the Australasian definitions (rise in pCO&lt;sub&gt;2&lt;/sub&gt; ≥10 mmHg from wake to sleep, average rise in pCO&lt;sub&gt;2&lt;/sub&gt; ≥3 mmHg from non rapid eye movement to rapid eye movement sleep) were more frequent when asked specifically via a checkbox (yes/no) compared to free text.Conclusions: These results confirm the heterogeneity and lack of standardization of clinical practice within Australasia when measuring pCO&lt;sub&gt;2&lt;/sub&gt; during polysomnography and defining hypoventilation. The Australasian definitions were not used as frequently as anticipated.

Work readiness of graduating nursing students: Case study research

Work readiness of nursing graduates is still a concern. This research explored how final year students perceive themselves as work ready for RN roles and clinical practice in Australia? Using case study methodology participants were surveyed and interviewed. The five themes found were work readiness definition and perceptions; flying high; flying under the radar; unbalance of clinical evaluation; and beyond the curriculum. Clinical placements are key to practicing competency necessary for work readiness. Consistent use of a student performance evaluation tool is essential. Students are not always gaining necessary practice due to lack of opportunities putting students at risk for not being work ready. Clinical staff need further training about the importance of consistent and objective evaluation of student performance.

CD30‐positive lymphoproliferative disorders—An Australian Clinical Practice Statement from the Peter MacCallum Cancer Centre

The CD30-postive lymphoproliferative disorders, including lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, account for up to 30% of all cutaneous T-cell lymphomas (CTCLs) and are the second most common form of CTCLs after mycosis fungoides. Both conditions differ in their clinical presentations; however, they share the expression of the CD30 antigen as a common immunophenotypic hallmark. There is a wide spectrum of management options depending on factors such as extent of disease, staging and treatment tolerability. This Clinical Practice Statement is reflective of the current clinical practice in Australia.

Changes in prostate specific antigen (PSA) “screening” patterns by geographic region and socio-economic status in Australia: Analysis of medicare data in 50–69 year old men

BackgroundWhile it is known that national PSA testing rates have decreased in Australia since 2007, it is not known whether these trends are consistent by broad geographical areas, nor whether previously reported area-specific differences have remained in more recent time periods. MethodsPopulation-based cohort study of Australian men (n = 2793,882) aged 50–69 who received at least one PSA test (Medicare Benefit Schedule item number 66655) during 2002–2018. Outcome measures included age-standardised participation rate, annual percentage change using JoinPoint regression and indirectly standardised participation rate ratio using multivariable Poisson regression. ResultsDuring 2005–09, two thirds (68%) of Australian men aged 50–69 had at least one PSA test, reducing to about half (48%) during 2014–18. In both periods, testing rates were highest among men living in major cities, men aged 50–59 years, and among men living in the most advantaged areas. Nationally, the Australian PSA testing rate increased by 9.2% per year between 2002 and 2007, but then decreased by 5.0% per year to 2018. This pattern was generally consistent across States and Territories, and socio-economic areas, however the magnitude of the trends was less pronounced in remote and very remote areas. ConclusionsThe decreasing trends are consistent with a greater awareness of the current guidelines for clinical practice in Australia, which recommend a PSA test be done only with the informed consent of individual men who understand the potential benefits and risks. However, given there remain substantial geographical disparities in prostate cancer incidence and survival in Australia, along with the equivocal evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer to be implemented consistently regardless of where men live.

P137 Diagnosis of nocturnal hypoventilation in children with neuromuscular disorders by polysomnography – a survey of clinical practice in Australia and New Zealand

Abstract Background Diagnosis of nocturnal hypoventilation requires measurement of pCO2 during sleep, which can occur via exhaled gas (capnography) or transcutaneous methods. Different national and international definitions of hypoventilation exist, which may contribute to significant variation in clinical practice. Methods An electronic survey was completed by pediatric sleep physicians in Australia and New Zealand to determine how pCO2 was measured during polysomnography, what pCO2 data was available to reporting physicians/included in the report and which definitions of hypoventilation physicians use. Results More than two thirds (70%) of physicians indicated that in their centre pCO2 was collected via transcutaneous measurement only and 30% by both transcutaneous and end-tidal measurement. Twelve definitions of hypoventilation were used, including published definitions from the American Academy of Sleep Medicine manual and the pediatric Australasian Sleep Association/Australasian Sleep Technologists Association recommendations. The most commonly used definition was an increase in pCO2 &amp;gt;50mmHg for &amp;gt;25% total sleep time. The percentage of total sleep time with pCO2 &amp;gt;50mmHg was routinely included in the report and/or easily available in the raw data for 70% of physicians. Discussion There was significant variation and lack of standardisation within Australia and New Zealand when measuring and reporting pCO2 during polysomnography as well as definitions of hypoventilation used by pediatric sleep physicians. The Australasian Sleep Association/Australasian Sleep Technologists Association recommendations were not frequently used, possibly due to relevant information not being available to reporting physicians, recommendations being irrelevant and/or outdated and excessive cognitive load associated with remembering multiple definitions.

Assessing functioning for individuals with neurodevelopmental conditions: Current clinical practice in Australia.

In the disability sector globally, and specifically in Australia, assessments of functioning have become key to diagnostic processes, and accessing therapy and funding. Over half of all individuals accessing support through Australia's National Disability Insurance Scheme have a neurodevelopmental condition diagnosis. Little is known about assessments of functioning for this population. A mixed methods online survey was designed to understand the current assessment of functioning practices (including clinical contexts, concepts being assessed, and assessment methods) and barriers and facilitators to clinicians using best practice. Results were analysed descriptively, and differences between professions calculated where possible. Content analysis was used to explore qualitative comments. Clinicians from various medical and allied health backgrounds completed the survey (n = 93), with varying ranges of age, experience, and education. Clinicians reported that they assessed functioning across age, setting, sector, funding body, and individuals with a wide variety of diagnoses. Missing from current practice is a clear transdisciplinary conceptualisation of functioning. The largest barriers to best practice were limited time, large caseloads, availability of appropriate tools, and lack of clarity from funding bodies. Missing from current practice is a clear transdisciplinary conceptualisation of functioning.These results will help inform steps forward to improve assessment of functioning practices to ensure that all individuals receive appropriate and sufficient support.

A national survey of oncology physiotherapy services for cancer survivors in Australia.

Cancer is a leading cause of illness globally. Advancements in screening and treatment have led to improved survivorship. Physiotherapy is integral in improving survivorship for people with cancer, with strong evidence supporting the use of various physiotherapy services. However, the scope and extent of these services within clinical practice in Australia is unknown. Identify and describe physiotherapy service provision for cancer survivors in Australia and describe the scope of physiotherapy services provided to cancer survivors. This cross-sectional study recruited physiotherapists and their respective managers involved in cancer service/s provision across Australia. Physiotherapy departments of tertiary hospitals and known oncology rehabilitation programs were contacted through a government directory and snowball sampling. The online survey included questions related to the extent and scope of service provision of physiotherapy for cancer survivors. Quantitative data were descriptively analyzed whereas open-ended responses were analyzed and presented narratively. Seventy-nine physiotherapy services were identified from 159 hospitals and/or health networks. Of the 55 (70%) responses received, 87% were from metropolitan areas, whereas 13% were regionally/rurally based services. Prehabilitation services mostly offered individual programs whereas rehabilitation programs had a mix of individual and group-based programs. The service content between prehabilitation and rehabilitation were similar, comprising primarily exercise-based interventions, followed by education and impairment-based therapies. Few designated physiotherapy services for cancer survivors exist in Australia. There is also disparity between service provision between metropolitan and regional/rural areas highlighting a need for clinicians, managers, and policy makers to invest more resources in establishing oncology physiotherapy services.

Utilisation and predictors of use of exposure therapy in the treatment of anxiety, OCD and PTSD in an Australian sample: a preliminary investigation

BackgroundCognitive-behavior therapy (CBT) is known to be an effective treatment for the anxiety and related disorders, with exposure therapy being a key component of this treatment package. However, research on the use of exposure therapy in clinical practice has presented mixed results, potentially due to differences in samples and training programs across countries. The present study aimed to extend upon existing research by examining the use and predictors of use of exposure therapy in a sample of psychologists working in clinical practice in Australia who treat clients with an anxiety disorder, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD).MethodsOne hundred registered psychologists (Mage = 40.60; SD = 10.78; range 23 to 71 years; 84% female) participated in an online study investigating their clinical practices.ResultsResults suggested that while the general use of exposure therapy is high, the use of disorder specific techniques was considerably lower, particularly for anxiety disorders and PTSD but not OCD. Psychology registration status and level of training were positively associated with use of exposure therapy as was the experience in treating anxiety disorders.ConclusionsThese findings suggest that further or ongoing professional training may be required to optimize the use of disorder specific techniques.

Asthma patients' and physicians’ perspectives on the burden and management of asthma

BackgroundThe 2021 Global Initiative for Asthma (GINA) report recommends as-needed inhaled corticosteroid (ICS)/formoterol irrespective of severity, and maintenance and reliever treatment (MART) from GINA Step 3 as part of Treatment Track 1, partly based on the SYGMA studies. We investigated how current clinical practice in Australia, Canada, China and the Philippines relates to latest GINA recommendations. MethodsPatients and physicians were recruited from online panels between July and August 2020 and invited to complete an online survey. Inclusion criteria: age ≥18 years, current/past physician diagnosis of asthma (patients); primary care (Canada also included respirologists/respiratory therapists), treating ≥4 patients with asthma per month, ≥3 years in clinical practice (physicians). ResultsOverall, 1216/70,183 patients and 803/8376 physicians replied and were eligible for inclusion. Only 8–15% of patients were using MART; 66–81% used regular maintenance therapy with/without an as-needed reliever. Across the four countries, physicians classified 48–63% of their patients as mild (GINA Steps 1–2) and 28–36% as moderate (GINA Steps 3–4). Generally, physicians rated symptom control over exacerbation reduction as their main treatment goal; patients also ranked symptom relief as very important. Approximately 9–29% of patients and 24–45% of physicians were unaware of MART, and among those who prescribed MART, 80–95% prescribed an additional (non-ICS) as-needed reliever. InterpretationMost physicians prioritized managing asthma symptoms over exacerbations. A lack of awareness and understanding of MART dosing exists among physicians. Practical strategies are required to implement GINA recommendations effectively in real-world clinical practice and to identify appropriate patients for MART.

EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol

BackgroundLow back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings.Methods/designWe will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants’ opinions and any barriers encountered throughout the trial.DiscussionThe findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas.Trial registrationThis study was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12618001494224) registered 09.05.2018.

Mycosis fungoides and Sézary syndrome: Australian clinical practice statement.

Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas with distinct clinical presentations, histopathologic features, treatment approaches and outcomes. The cutaneous T-cell lymphomas, which include mycosis fungoides and Sézary syndrome, account for the majority of the cutaneous lymphomas. This Clinical Practice Statement is reflective of the current clinical practice in Australia. An expanded form of the Clinical Practice Statement (and updates), along with helpful patient resources and access to support groups, can be found at the following (http://www.australasianlymphomaalliance.org.au).

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

AbstractAimThe role of clinical pharmacists in the care of hospitalised general medicine patients is evolving from a reactive model of care to a model with an emphasis on interdisciplinary care and more advanced models of care. The purpose of this review was to evaluate the published literature on the effects of roles of clinical pharmacists that extend beyond those activities considered to be standard clinical practice in Australia, on clinical outcomes in hospitalised general medicine patients.Data sourcesA search of English‐language publications in six databases was conducted.Study selectionPeer‐reviewed, English‐language articles were identified across the date range January 2000 to June 2020. Studies were included if they evaluated an inpatient pharmacy service in a general medicine population and the article included a study design with a clear comparator and outcomes such as medication errors or medication appropriateness. Studies evaluating pharmacists’ activities that are considered standard clinical practice for pharmacists in Australia, such as participation on ward rounds, medication reconciliation and patient education were excluded.ResultsTwelve studies met the inclusion criteria: four evaluating pharmacist‐led anticoagulation or thromboprophylaxis management, one evaluating pharmacist‐led vaccination, three evaluating a pharmacist charting model, two evaluating pharmacist‐led de‐escalation of therapy, one evaluating a pharmacist intervention in patients with chronic kidney disease and one evaluating pharmacist‐led glycaemic control.ConclusionsThe addition of advanced clinical pharmacist services in the care of general medicine inpatients generally resulted in improved care, with no evidence of harm. Future studies should include multiple sites, larger sample sizes, reproducible interventions and identification of patient‐specific factors that lead to improved outcomes.

Clinicians' and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys.

Clinicians' delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public's perceptions of the routine use of a screening tool to predict risk of death for older people. Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public. Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40years) clinicians (81.2% vs. 71.2%, p = 0.0058). The concept of integrating prognostication of death in routine practice was not resisted by either target group. Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.