District Health Research Articles

Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector.

Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD). Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described. A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs. The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.

Musculoskeletal Pathologies Affecting Shoulder Girdle: A Systematic Review with Anatomical and Radiological Validation

Abstract Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joint such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centres, rural hospitals, and district hospitals, but the scarcity of specialist orthopaedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. The study aims to determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Seventeen studies were included in the final analysis. Several case reports, case series and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. Radiological and anatomical basis of each of the cases were discussed. An algorithm was prepared to help diagnose shoulder girdle pathologies based on clinical presentation and examination findings.

The lived experiences of providing nursing care in coastal areas: A qualitative study.

To explore nurses' experiences in providing care in coastal areas. The phenomenological study was conducted from July to September 2020 in two coastal areas located in the Riau province of Indonesia, and comprised nurses working in public health centers, hospitals and district health offices. Data was collected using in-depth interviews. Data was subjected to thematic analysis. Of the 13 nurses, 10(77%) were females and 3(23%) were males. The overall age range was 24-44 years. Four themes that emerged were health problems in coastal areas, obstacles in nursing care delivery, irrelevant duty, and procedures in delivering nursing care. There were a total of 10 sub-themes as well. Despite the challenged faced by the nurses, communities in coastal areas deserve to get due healthcare services.

Evaluation of Covid-19 Impact on Maternal and Neonatal Health Services Continuity at the Cite-Verte Health District in Yaounde, Cameroon

Purpose: The goal of this study was to evaluate the impact of the 2020 Covid-19 outbreak in Cameroon on the continuity of Maternal and Neonatal Health Services (MNHS) at the Cite-Verte Health District.Problem: The advent of this pandemic has threatened the progress made so far in reducing maternal and neonatal mortality meanwhile the continued provision of MNHS is a predominant solution to support and improve the health of women and girls [1,2].Methods: A mixed study was carried out with 11 MNHS users and 4 health facilities in the Cite-verte health district. The indicators of MNHS continuity were listed using a questionnaire, a Dhis2 data collection form and a semi-structured interview guide. Data were subject to SPSS analysis based on the comparison of MNHS continuity and manual content analysis.Results: Context-Based Theory guided the discussion of our results which showed an indirect impact of the pandemic on MNHS continuity, characterized by a drop in number of MNHS health personnel with a high turnover rate of 79% and a staff attack rate estimated at 8%. We also found MNHS disruptions due to stock shortage in 100% of health facilities surveyed, a statistically significant decrease of 9% (Diff = 0.09; P-value = 0.000; 95%; CI = [0.075; 0.104]) and 17% (Diff = 0.17; P-value = 0.000; 95%; CI = [0.076; 0.264]), respectively for the indicators of family planning and neonatal deaths, a decrease of 22% on first ANC attendance, a drop of 28% on skilled birth attendance, and finally, an increase of 65% on maternal mortality. Nevertheless, MNHS user needs were met as they managed to overcome the feeling of fear, stress and depression caused by the Covid-19 pandemic in hospital settings.Conclusion: To mitigate the impact of Covid-19 on MNHS continuity, health managers must be ready to recruit more personnel, provide more supplies, and emphasize on community involvement during the outbreak.

PERSPECTIVES OF KIDNEY TRANSPLANT RECIPIENTS REGARDING THE BARRIERS AND ENABLERS TO EXERCISE

BACKGROUND Kidney transplant is a second chance at life for people with kidney failure. However, the post-transplant journey is difficult with high rates of complications such as new onset diabetes, steroid induced weight gain and cardiovascular disease. While exercise has the potential to improve quality of life and reduce the susceptibility these complications, kidney transplant recipients (KTRs) report lower levels of exercise and physical activity compared to the general population. Our qualitative study aimed to explore the barriers and enablers to exercise in KTRs. METHODS People with a stable kidney transplant treated in the Illawarra Shoalhaven Local Health District were invited to participate in the study. Interviews were conducted with n=11 KTRs with an age of 25-74 years, transplant duration of 1-19 years, and comorbidities included hypertension (n=9), cancer (n=4), diabetes (n=3) and dyslipidemia (n=4). Interviews were transcribed then inductively coded and deductively categorised according to the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Model of Behaviour. RESULTS KTRs expressed a desire to exercise though barriers specific to transplant were identified. Barriers included a lack of knowledge and specific guidance, physical limitations (e.g. fatigue, illness related to medications or comorbidities, injury or pain), and fear of harming the kidney (e.g. herniation, pain/pulling at surgical site, dehydration, immunocompromised state). Enablers to exercise included already living an active lifestyle, perceived mental benefits, exercise preferences and social support. CONCLUSIONS A key finding of this research was a preference from KTRs specific exercise information and guidance after kidney transplant. The findings of this study can be used to inform the development of exercise resources and interventions for KTRs and their health care professionals within the local community and at a greater level.

Implementation of a primary-tertiary shared care model to improve the detection of familial hypercholesterolaemia (FH): a mixed methods pre-post implementation study protocol

IntroductionFamilial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipid metabolism and a preventable cause of premature cardiovascular disease. Current detection rates for this highly treatable condition are low....

YOUNG STRONG AND DEADLY PROGRAM EVALUATION

INTRODUCTION & AIMS For Aboriginal young people, physical activity declines through puberty, adolescence, and early adulthood. Western Sydney Local Health District (WSLHD) departments, Aboriginal Health Hub and Youth Health, together with western Sydney Aboriginal communities co-designed the Young, Strong, and Deadly program. The program is an assertive intervention which aims to increase healthy behaviours and improve social and emotional wellbeing among young Aboriginal adolescents aged 12-16 years. The program is an Aboriginal researcher led, 14-week health education and physical exercise program that includes paid PCYC gym memberships, guided gym sessions, transport provision and nutrition education. METHODS The study used a mixed method pre-post design with a process evaluation. Participants were recruited through convenience and snowball sampling including engagement with schools and Aboriginal community-controlled organisations. Data were collected on participation and attendance, performance, satisfaction and intention to continue with activities. RESULTS For the first of three cohorts, 31 participants were recruited, of which 24 completed the 14week program. All participants demonstrated significant improvements in strength & conditioning. Five focus groups were conducted with 20 adolescents and seven parents, individually or in pairs. Adolescents enjoyed the program, particularly achieving gains in strength and fitness, learning and practicing new recipes and having an Aboriginal specific program. Parents spoke favourably of the program including improvements in their children’s health behaviours, focus on school and confidence, and appreciated the staff input and program operations. CONCLUSION Young Strong and Deadly has been implemented in community settings and has demonstrated feasibility and acceptability among Aboriginal adolescents and their families. Initial findings show that a culturally appropriate assertive intervention program can impact on social and emotional wellbeing as well as improving the health of young Aboriginal people.

Assessment of Greek Hospital Websites using HSWAI v1.1

In modern times, technology is the driving force behind all human activity. The Internet is an integral part of peo- ple's lives and the majority of daily activities are carried out through it. The health sector is no exception as new concepts such as e-health, mobile health etc. have been introduced. Patients and potential users of health services use the websites of healthcare institutions to find and access information about their health problems in health services. The present research carried out as part of a diploma the- sis for the Information and Communication Systems Engi- neering Department of the "Electronic Governance" Master's Program of the Aegean University, attempts to investigate the quality and completeness of the websites of Greek nurs- ing institutions. The object of the research is the evaluation of hospital websites using the HSWAI evaluation tool. It is an excel file containing four(4) criteria with sixteen(16) indica- tors and one hundred sixty-eight(168) sub-indicators. Each sub-indicator includes a presumption that is examined to see if it is met by the nursing website under investigation. In the end a score is produced that identifies the hospital website according to the iHSWAI index global ranking. This fact helps the users and potential customers of health services to com- pare and choose the provider that satisfies them while at the same time it helps the administrations of the institutions to improve and enrich their hospital websites. The research sample consists of public and private nursing institutions operating in the Greek territory. One hundred and twenty-three(123) public hospitals and one hundred and twenty-two(122) private hospitals were evaluated, while sixty-four(64) institutions were not evaluated due to a lack of a website or technical difficulties. The results of the survey revealed that public hospitals have more complete websites as they performed better in the HSWAI score than the private ones. Also, the comparisons made in the context of the research results showed that the more beds a hospital manages, the better quality and more complete website it has. Also, the quality of hospital websites depends on the geographic area where the hospitals are located and the Health District they belong to.

Assessment of the impact of pregnancy and malaria infection on the variation of neutrophil levels in women from San, Mali.

In patients with severe neutropenia, infections can rapidly become serious and life-threatening. It is essential to understand whether pregnancy induces changes in neutrophil levels thereby posing an increased threat to the health of gravidae. This cross-sectional study was conducted in San Health District (Mali) and involved pregnant women infected or not by malaria parasites and non-pregnant healthy volunteers. Subjects were categorized as having neutropenia, normal neutrophil levels, and neutrophilia regarding their neutrophil levels. A logistic regression analysis was performed to determine factors associated with neutrophil level variation in pregnant women. Whether or not the pregnant women were infected with malaria, 98 of the 202 cases (48.5%) showed neutrophilia. Surprisingly, 67 of the 71 cases of neutropenia (94.4%) observed in this study concerned healthy people who were not pregnant. The mean percentage of neutrophil levels was significantly (p < 0.001) lower (49.9%) in the first trimester compared to the second trimester of pregnancy (62.0%). A logistic regression model showed that compared to early pregnancy, the second (OR = 12.9, 95% CI 2.2-248.1, p = 0.018) and the third trimesters (OR = 13.7, 95% CI 2.3-257.5, p = 0.016) were strongly associated with the increase of neutrophil levels. Pregnancy can induce the production of mature neutrophils that are continually released into circulation. Neutrophil levels were lower during the first trimester of the pregnancy compared to the second and third trimesters, but not affected by the presence or absence of malaria infection.

Progress towards elimination of onchocerciasis in the Region du Sud-Ouest of Burkina Faso which was previously subject to a recrudescence event after vector control.

The Sud-Ouest region of Burkina Faso (especially the Bougouriba valley) has been historically problematic with respect to onchocerciasis control, with a recrudescence of infections after vector control carried out the WHO Onchocerciasis Control Programme was halted in 1989. After 1996, mass drug administration of ivermectin was instigated to control the recrudescence so that it would no longer constitute a public health problem. However, in 2010 WHO changed its recommended policy from control to elimination, and in 2013 biannual Community-Directed Treatment with Ivermectin (CDTI) was instigated. Epidemiological surveys were carried-out in 2011 and 2018 to determine whether CDTI was producing a decline in infection levels and progress towards elimination. A cross-sectional study was conducted across 20 villages in four health districts in 2011 and 29 villages in 2018. Individuals aged five years and above were examined by skin-snip, and the prevalence and microfilarial load was determined for each village. In 2011, 75% of villages had some infections and 20% had prevalences >5%, with a mean prevalence across all villages of 2.63% (range 0.0-9.7%), and community microfilarial load ranging from 0 to 0.25 microfilariae per biopsy. In 2018, nine villages (= 31% of total) had some infections, with prevalences ranging from 0.41% to 3.54%, and a mean prevalence across all villages of 0.37%. Community microfilarial load ranged from 0 to 0.1. Amongst those people found to be microfilarial positive, 87% had a history of migration. The endemicity of onchocerciasis infection in the Sud-Ouest region has declined to low levels and seems to be progressing towards elimination. Our findings indicated that biannual CDTI is having good effect, but it should continue for a number of years to ensure elimination of transmission. However, progress towards elimination has a troublesome history in this region, and it would be advisable to select more sentinel villages to have confidence in any future epidemiological and entomological surveys, especially Stop-MDA surveys. With positive individuals migrating between countries, cross-border collaboration needs more attention to ensure effective treatment for onchocerciasis elimination.

Health District at Queenstown: Catalyst for translational research.

Ageing societies dominating global demographics is not new. However, the pace of global population ageing is causing disquietude. In 2017, the global population over age 60 years exceeded those below 5 years for the first time in history, and only 3 years later, the population over age 65 surpassed those below 5.1,2 The US took 72 years to double its proportion of population over age 65 from 7% to 14% while Sweden took 85 years, but Asia has been projected to achieve this in about 23 years, with Singapore having taken 20 years.3 This unprecedented ageing acceleration in populations results from longer individual lifespans due to improvements in healthcare and population health, combined with a steady decline in total fertility rate—the latter being the mean number of children per woman in her lifetime. Unfortunately, the number of years in good health has not kept pace with lengthening lifespan; consequently, time spent in poor health is increasing.4 This demographic change, along with a widening healthspan and lifespan gaps will have dramatic impact on economic growth, workforce composition, healthcare, housing and transportation.

Brazilian Ministry of Health strategy to increase vaccination coverage at bordersEstrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras

Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC). Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

Cost-effectiveness of diagnosis and treatment of early gestational diabetes mellitus: economic evaluation of the TOBOGM study, an international multicenter randomized controlled trial

A recently undertaken multicenter randomized controlled trial (RCT) "Treatment Of BOoking Gestational diabetes Mellitus" (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 weeks') from a healthcare perspective. Participants' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and cost-effectiveness results. Bootstrapped cost-effect pairs were used to plot the cost-effectiveness (CE) plane and cost-effectiveness acceptability curve (CEAC). Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost-saving) [-5.6% composite adverse pregnancy outcome (95% CI:-10.1%,-1.2%),-$1373 (95% CI:-$3,749, $642)] compared with usual care. Our findings were confirmed by both the CE plane (88% of the bootstrapped cost-effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in the higher glycemic range (fasting blood glucose 95-109mg/dl [5.3-6.0mmol/L], 1-h blood glucose ≥191mg/dl [10.6mmol/L] and/or 2-h blood glucose 162-199mg/dl [9.0-11.0mmol/L]) was more effective and less costly (dominant) [-7.8% composite adverse pregnancy outcome (95% CI:-14.6%,-0.9%),-$2795 (95% CI:-$6,638,-$533)]; the intervention was more effective and tended to be less costly [-8.9% composite adverse pregnancy outcome (95% CI:-15.1%,-2.6%),-$5548 (95% CI:-$16,740, $1547)] among women diagnosed before 14 weeks' gestation as well. Our findings highlight the potential health and economic benefits from the diagnosis and treatment of early GDM among women with risk factors for hyperglycemia in pregnancy and supports its implementation. Long-term follow-up studies are recommended as a key future area of research to assess the potential long-term health benefits and economic consequences of the intervention. National Health and Medical Research Council (grants 1104231 and 2009326), Region O¨rebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project 15,205 and project 23,026), South Western Sydney Local Health District Academic Unit (grant 2016), and Western Sydney University Ainsworth Trust Grant (2019).

Sexually transmitted infections: Prevalence and clinical outcomes among pregnant women in Western Sydney.

We report the prevalence, characteristics and clinical outcomes of women with sexually transmitted infections (STIs) in pregnancy in the Western Sydney Local Health District (WSLHD) serving a large culturally and socio-economically diverse community in New South Wales (NSW), Australia, over the last 10 years. A retrospective cohort study of all pregnant women booked for antenatal care at three hospitals in WSLHD between September 2012 and August 2022 inclusive. Characteristics and birth outcomes associated with STIs diagnosed in pregnancy (chlamydia, gonorrhea, and syphilis) are reported using multivariable logistic regression adjusting for relevant confounders. During 2012-2022, there were 102 905 births and 451 women (0.44%) with an STI diagnosis during pregnancy. The number of women with a history of chlamydia prior to their current pregnancy has increased over the last 10 years (P < 0.001). STIs in pregnancy were more common in younger women aged <20 years (adjusted odds ratio [aOR] 7.30, 95% confidence interval [CI] 5.04-10.57), 20-24 years (aOR 3.12, 95% CI 2.46-3.96), and >40 years (adj OR 1.67, 95% CI 1.07-2.59), in women with body mass index >30 (aOR 1.73, 95%CI 1.37-2.19), and those who smoked (aOR 2.24, 95% CI 1.71-2.94) and consumed alcohol (aOR 3.14, 95% CI 1.88-5.23) and illicit drugs (aOR 2.10, 95% CI 1.31-3.36). STIs in pregnancy were borderline associated with stillbirth (aOR 2.19 95% CI 0.90-5.36) but did not have a significant impact on preterm birth (aOR 1.21, 95% CI 0.87-1.68), admission to neonatal intensive care unit (NICU) (aOR 1.02, 95% CI 0.77-1.34), or having a small-for-gestational-age (SGA) baby (aOR 0.97, 95% CI 0.74-1.27). Sociodemographic factors such as age, weight, smoking, and alcohol and drug use, were associated with the STI incidence in pregnancy. While the latter did not have an impact on preterm birth, NICU admission, and SGA in our cohort, there was a borderline association with stillbirth. Future research should identify barriers and facilitators to testing in a multicultural population and understanding the drivers of higher rates of STIs in certain population groups.

Domestic Accidents of Children in the Orodara District of Burkina Faso: Mothers' Knowledge of First-Aid Practices.

First-aid practices after a domestic accident are not always known, especially in Africa. This study aimed to measure mothers' knowledge of emergency procedures and attitudes in the event of domestic accidents in children. We conducted a cross-sectional study in the Orodara health district, Kénédougou province, Burkina Faso, among mothers of children aged 0-14 years. The dependent variable was the mothers' knowledge of domestic accident first-aid practices, and the independent variables were the sociodemographic characteristics of the households and the mothers. Determinants were identified using linear regression with a threshold of 5%. A total of 798 mothers were surveyed. The mean knowledge score was 6.9 (standard deviation = 1.5) out of 19. Upon our multivariate analysis, the factors associated with the mothers' knowledge about first-aid practices were the mothers' age, the number of children under 14 years old living in the same household, the household size, the score for knowledge of non-recommended attitudes, the mothers' level of education, and the place of residence. This study showed that awareness campaigns, especially in rural areas, seem important in improving mothers' knowledge of first-aid practices in domestic accidents and, therefore, reducing the morbidity and mortality associated with domestic accidents.

Investigating midwives and nurses reporting of ‘infant feeding at hospital discharge’: an online survey across NSW Australia

BackgroundThe collection of data on ‘infant feeding at hospital discharge’ is used to monitor breastfeeding outcomes, health service benchmarking, and research. While some Australian states have clear definitions of this data collection point, there is no operational definition of ‘infant feeding at hospital discharge’ in the Australian state of New South Wales. Little is known about how midwives interpret the term ‘infant feeding at hospital discharge’, in particular, the timeframe used to calculate these important indicators. The purpose of this study was to explore midwives’ and nurses’ practices of reporting ‘infant feeding at hospital discharge’ in the Australian state of New South Wales.MethodsAn online survey was distributed across public and private maternity hospitals in New South Wales, Australia. The survey asked midwives and nurses their practice of reporting ‘infant feeding at discharge’ from categories offered by the state Mothers and Babies report of either “full breastfeeding”, “any breastfeeding”, and “infant formula only”. The Qualtrics survey was available from December 2021 to May 2022.ResultsThere were 319 completed surveys for analysis and all 15 NSW Health Districts were represented. Some participants reported using the timeframe ‘since birth’ as a reference (39%), however, the majority (54%, n = 173) referenced one of the feeding timeframes within the previous 24 h. Most midwives and nurses (83%, n = 265) recommended 24 h before discharge as the most relevant reference timeframe, and 65% (n = 207) were in favour of recording data on ‘exclusive breastfeeding’ since birth.ConclusionThis study identified multiple practice inconsistencies within New South Wales reporting of ‘infant feeding at hospital discharge’. This has ramifications for key health statistics, state reporting, and national benchmarking. While the Baby Friendly Hospital Initiative accreditation requires hospitals to demonstrate and continuously monitor at least a 75% exclusive breastfeeding rate on discharge, only 11 New South Wales facilities have achieved this accreditation. We recommend introducing an option to collect ‘exclusive breastfeeding’ on discharge’ which is in line with participant recommendations and the Baby Friendly Hospital accreditation. Other important considerations are the updated World Health Organization indicators such as, “Ever breastfed”; “Early initiation of breastfeeding” (first hour); “Exclusively breastfed for the first two days after birth”.

Scarrifications Hospital Review of a Traditional Method of Managing Paediatric Hepatomegaly and Splenomegaly in Three Hospitals in the Limbe Health District, Cameroon

Scarrifications Hospital Review of a Traditional Method of Managing Paediatric Hepatomegaly and Splenomegaly in Three Hospitals in the Limbe Health District, Cameroon

Implementation of a simulation free palliative Radiation Therapy pathway: An inter-professional collaborative project

The Western New South Wales Local Health District (WNSWLHD) has a significant footprint within the state of New South Wales (NSW). Due to the significant size of the WNSWLHD, patients residing in the local health district face many barriers to receiving Radiation Therapy. The inter-professional collaboration behind the successful implementation and evaluation of a simulation free pathway for palliative Radiation Therapy in WNSWLHD will be explored within this narrative. The process known in WNSWLHD as Medical Imaging Simulated Radiation Therapy (MISRT) removes the need for a computed tomography (CT) simulation and allows for palliative Radiation Therapy to be planned on previously acquired diagnostic CT imaging. The implementation of MISRT has required significant inter-professional collaboration. This also extends to inter-centre partnership, intra-district cooperation with Medical Imaging and inter-discipline teamwork amongst Radiation Oncologists, Radiation Oncology Medical Physicists, Radiation Oncology Nursing and Radiation Therapists. The impact and involvement of the inter-disciplinary teamwork will be explored. The methods of implementing MISRT will be outlined covering changes to standard workflow, educational requirements and inclusion criteria. The evaluation of the implementation will also be covered with two evaluation surveys being conducted. Inter-professional communication, education, teamwork and collaboration is highlighted to demonstrate improving access to quality care in a rural and regional healthcare setting whilst reducing known barriers to accessing Radiation Oncology.

Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop.

Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization. The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project). Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare. These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Antibiotics administered as continuous intravenous infusion over 24 hours by elastomeric devices to patients treated at home: a study of infusion efficiency

AbstractBackgroundElastomeric infusion devices or ‘Infusors’ are commonly used to administer 24‐h continuous intravenous infusions to hospital patients at home, a service which can increase hospital capacity.AimThis study sought to determine Infusor efficiency by measuring infusion lengths administered by Infusors to patients in the community setting and reviewing any impacting factors on varying infusion rates, if observed.MethodPatients and nurses completed data collection forms daily over a 12‐month period. The following information was recorded: time Infusor attached to patient, time Infusor emptied, Infusor ‘empty’ or ‘not empty’ when removed, volume of antibiotic solution remaining, Infusor storage details, antibiotic solution and dose, indication for treatment, and date (season). Statistical analyses was conducted using Stata. Data were analysed using descriptive statistics, including median and range for continuous variables, and frequency counts and percentages for categorical variables. Ethical approval was granted by Northern Sydney Local Health District (NSLHD) Research Office (Reference no: RESP/14/184), the Human Research Ethics Committee (HREC) (Reference no: LNR/14/HAWKE/265) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via a study information leaflet that was provided with the patient questionnaire and patients were informed that their participation in the study was optional. Patients indicated their consent by completing the data collection form for each day of treatment.ResultsA significant number of Infusors (27%) emptied outside the expected infusion duration of 24 h ± 10% (21.6–26.4 h) and Infusors were removed ‘not empty’ when the nurse visited &gt;24 h on 35% of occasions. Infusors were more likely to empty &gt;24 h if they contained piperacillin‐tazobactam 13.5 g (predicted probability = 1.0), in winter (predicted probability = 0.83), and in cooler overnight storage locations (predicted probability = 0.64). Infusors were more likely to empty &lt;24 h if they contained vancomycin (predicted probability = 0.12).ConclusionInfusors delivering 24‐h continuous intravenous infusions in the home setting may empty at unpredictable times and may be affected by temperature or solutions with varying doses. Outpatient parenteral antimicrobial therapy clinicians should be aware of possible unfinished infusions from Infusors.