Hospital In South-east Queensland Research Articles

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

The eastern paralysis tick, Ixodes holocyclus, is a tick of much veterinary importance in Australia. Each year, thousands of dogs and cats present to veterinary clinics and hospitals with signs of tick paralysis. In a previous paper, we constructed two models to explain prevalence and temporal distributions of tick paralysis cases presenting to emergency veterinary hospitals in South East Queensland (2009–2020) and the Northern Beaches of Sydney (1999–2017). The first model accounted for the intensity of the clinical burden of tick paralysis based on the prevalence of cases of tick paralysis in the tick paralysis season whereas the second model accounted for the start of the tick paralysis season. In the present paper, we test our models further, with much additional data from 2021 to 2023 (South East Queensland) and from 2018 to 2023 (Northern Beaches of Sydney). During the defined tick paralysis season in these locations, 10.3 % (3207 of 31,217) of veterinary-consultations were for tick paralysis. On average, predictions for the prevalence of cases of tick paralysis were 1.3 % (0.013) away from the actual prevalence whereas predictions for the start of the tick paralysis season were 1.7 weeks away from the actual start of the season. The prediction of the prevalence of tick paralysis cases was most accurate for Brisbane and least accurate for the Northern Beaches of Sydney whereas, curiously, the prediction for the start of the tick paralysis season was most accurate for the Northern Beaches of Sydney and least accurate for Brisbane. We re-fitted the models with the new data. We predict that about 10 % (Sunshine Coast), 5 % (Brisbane), 7 % (Gold Coast) and 12 % (Northern Beaches of Sydney) of veterinary-consultations in the tick paralysis season of 2024 will be cases of tick paralysis, resulting in a tick paralysis clinical burden intensity of similar magnitude to previous years. Such predictions allow for timely public education campaigns around the importance of prevention and appropriate resource planning for veterinary clinics.

Impact of a prospective feedback loop aimed at reducing non-beneficial treatments in older people admitted to hospital and potentially nearing the end of life. A cluster stepped-wedge randomised controlled trial.

To investigate if a prospective feedback loop that flags older patients at risk of death can reduce non-beneficial treatment at end of life. Prospective stepped-wedge cluster randomised trial with usual care and intervention phases. Three large tertiary public hospitals in south-east Queensland, Australia. 14 clinical teams were recruited across the three hospitals. Teams were recruited based on a consistent history of admitting patients aged 75+ years, and needed a nominated lead specialist consultant. Under the care of these teams, there were 4,268 patients (median age 84years) who were potentially near the end of life and flagged at risk of non-beneficial treatment. The intervention notified clinicians of patients under their care determined as at-risk of non-beneficial treatment. There were two notification flags: a real-time notification and an email sent to clinicians about the at-risk patients at the end of each screening day. The nudge intervention ran for 16-35weeks across the three hospitals. The primary outcome was the proportion of patients with one or more intensive care unit (ICU) admissions. The secondary outcomes examined times from patients being flagged at-risk. There was no improvement in the primary outcome of reduced ICU admissions (mean probability difference [intervention minus usual care] = -0.01, 95% confidence interval -0.08 to 0.01). There were no differences for the times to death, discharge, or medical emergency call. There was a reduction in the probability of re-admission to hospital during the intervention phase (mean probability difference -0.08, 95% confidence interval -0.13 to -0.03). This nudge intervention was not sufficient to reduce the trial's non-beneficial treatment outcomes in older hospital patients. Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).

Anatomy of the Female Koala Reproductive Tract.

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

Reduced incidence of tick paralysis cases in dogs and cats at two emergency clinics in South-East Queensland since 2015: new generation prophylactics as possible explanatory variables.

This study aimed to determine the incidence of canine and feline tick paralysis cases presenting to two veterinary emergency hospitals before and after the introduction of new generation prophylactic acaricides. This was a retrospective study, investigating the number of tick paralysis cases presenting to two emergency and critical care veterinary hospitals in South-East Queensland, from 2008 to 2021. A total of 10,914 dogs and 3696 cats were included over the course of the study. To assess if the introduction of new generation prophylactics in 2015 has coincided with any variation in case numbers, data for each species were analysed graphically and numerically in the first instance, then interrupted time series analyses were performed for the dog and cat data independently. Accounting for seasonal and climatic variation, we estimated a 54.8% reduction in dog (95% CI 45.3%-62.7%) and 44% reduction in cat (95% CI 19.5%-46%) tick paralysis cases presenting to these two clinics. This reduction corresponded with the timing of new generation prophylactic agents being introduced, including isoxazolines and imidacloprid/flumethrin impregnated collars. In the population studied, a significant reduction in the incidence of tick paralysis cases treated by veterinarians has occurred from 2015 onwards and was found to be associated with the timing of the release of new generation acaricidal products.

Pregnancy in women with cystic fibrosis and diabetes: An audit of outcomes at two tertiary obstetric hospitals in Australia in the pre-cystic fibrosis transmembrane conductance regulator modulator era

Background Pregnancy in women with cystic fibrosis (CF) is becoming more common. Long-term metabolic issues such as diabetes are also becoming more common and have potentially important impacts on pregnancy outcomes. This study aimed to assess the impact of diabetes on pregnancy outcomes for women with CF. Methods We undertook a retrospective chart audit of pregnancies to women with CF at the two tertiary obstetric hospitals in Southeast Queensland associated with CF and transplant management clinics between 2006 and 2016. Results A total of 38 pregnancies among 26 women were identified. Four women (five pregnancies) had cystic fibrosis-related diabetes (CFRD) diagnosed prior to pregnancy, and 12 women (15 pregnancies) developed gestational diabetes (GDM) complicating pregnancy. CFRD and GDM were associated with higher rates of delivery complications, prematurity, and the need for neonatal intensive care unit admission. Conclusion Diabetes is common during pregnancy in women with CF and impacts pregnancy outcomes.

Barriers and enablers to embedding fundamental nursing care for older patients-Implications of a mixed methods study for nursing leadership.

To understand the enablers and barriers for delivering fundamental care to hospitalized older patients. Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results. Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations. There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs. The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions. Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.

Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

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

Virtual Fracture Clinic: A pandemic-ready tool for improving the efficiency of fracture clinic

Background: The traditional model of care of the Orthopaedic Fracture Clinic (OFC) is labour intensive, expensive, has poor satisfaction rates, and often has minimal impact on management and outcomes of patients with minor injuries. Our aim was to implement a Virtual Fracture Clinic (VFC) for the management of minor injuries that is safe, reduces OFC clinic workload and reduces the OFC failure to attend (FTA) rate. Methods: This study was a retrospective longitudinal audit of OFC workload before (January 2012 -February 2017) and after (March 2017 – December 2019) implementation of the VFC. It was performed in an urban district general hospital in South East Queensland, Australia. The primary outcome measures included attendances per timepoint (month). Results: Overall, we observed a significant reduction in total number of patients from 1,055 (IQR 104.5) to 831 (IQR: 103) per month) coming through the OFC following the introduction of the VFC (F = 21.9; df=1; p <0.0001). The failure to attend rate was reduced by 44% from 271 (IQR: 127.3) to 151 (IQR: 72.8) (F=4.0; df=1; p = 0.047). Conclusion: The VFC implementation was successful in improving efficiency and reducing the current OFC workload, as well as reducing FTA rate. Reduction in clinic workload allows more time to be spent with complex patients, prevents clinic backlogs and overbooking, and crowding of waiting rooms. In the midst of a global pandemic that is spread by close contact, virtual clinics seem the way of the future to treat patients whilst minimising risk of COVID-19 spread.

Metformin reduces 12-month change in body weight among people newly commenced on clozapine: a retrospective naturalistic cohort study.

Background:People with schizophrenia have a 15–20-year reduction in life expectancy, driven in part by the metabolic effects of antipsychotics. Clozapine is associated with the highest rates of weight gain. As clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), identifying treatments to ameliorate clozapine-induced weight gain (CIWG) is urgently needed to reduce this morality gap.Methods:We retrospectively analysed digital health records of patients with TRS aged 18–65 newly initiated on clozapine at four tertiary hospitals in south-east Queensland from 1 March 2017 to 30 June 2019. Our primary outcome was the effect of metformin on change in percentage bodyweight at 12 months after clozapine initiation, with secondary outcome being proportion with >5% or >7% bodyweight change. We also explored impact on bodyweight change of other variables including sex, tobacco smoking, type 2 diabetes (T2DM), age, clozapine level and dose and clozapine/norclozapine ratio.Results:Among 90 patients initiated on clozapine, metformin use (n = 48) was associated with a smaller increase in percentage bodyweight (1.32% versus 5.95%, p = 0.031), lower rates of >7% gain in bodyweight (37.8% versus 63.0%, p = 0.025) but not >5% gain in bodyweight. Age below the median (32.0 years) was associated with greater bodyweight gain (5.55% versus 1.22%, p = 0.046). Sex, tobacco smoking, T2DM, clozapine dose and level and clozapine/norclozapine ratio were not associated with differences in change in bodyweight.Conclusion:In this small retrospective cohort study, use of metformin within 12-months of clozapine initiation was associated with a statistically and clinically significant reduction in CIWG. Although there is increasing evidence for the role of metformin to ameliorate bodyweight gain at time of clozapine initiation, our findings need replication and testing in a randomised controlled trial before recommending metformin co-commencement with clozapine as standard clinical practice.

Low serum selenium in pregnancy is associated with reduced T3 and increased risk of GDM.

Thyroid disorders are the most common endocrine disorders affecting women commencing pregnancy. Thyroid hormone metabolism is strongly influenced by selenium status; however, the relationship between serum selenium concentrations and thyroid hormones in euthyroid pregnant women is unknown. This study investigated the relationship between maternal selenium and thyroid hormone status during pregnancy by utilizing data from a retrospective, cross-sectional study (Maternal Outcomes and Nutrition Tool or MONT study) with cohorts from two tertiary care hospitals in South East Queensland, Australia. Pregnant women (n = 206) were recruited at 26-30 weeks gestation and serum selenium concentrations were assessed using inductively coupled plasma mass spectrometry. Thyroid function parameters were measured in serum samples from women with the lowest serum selenium concentrations (51.2 ± 1.2 µg/L), women with mean concentrations representative of the entire cohort (78.8 ± 0.4 µg/L) and women with optimal serum selenium concentrations (106.9 ± 2.3 µg/L). Women with low serum selenium concentrations demonstrated reduced fT3 levels (P < 0.05) and increased TPOAb (P < 0.01). Serum selenium was positively correlated with fT3 (P < 0.05) and negatively correlated with TPOAb (P < 0.001). Serum fT4 and thyroid-stimulating hormone (TSH) were not different between all groups, though the fT4/TSH ratio was increased in the low selenium cohort (P < 0.05). Incidence of pregnancy disorders, most notably gestational diabetes mellitus, was increased within the low serum selenium cohort (P < 0.01). These results suggest selenium status in pregnant women of South East Queensland may not be adequate, with possible implications for atypical thyroid function and undesirable pregnancy outcomes.

A qualitative investigation into clinical documentation: why do clinicians document the way they do?

Clinical documentation is a fundamental component of patient care. The transition from paper based to electronic medical records/electronic health records has highlighted a number of issues associated with documentation practices including duplication. Developing new ways to document the care provided to patients and in turn, persuading clinicians to accept a change, must be supported by evidence that a change is required. In Australia, there has been a limited number of studies exploring the clinical documentation practices and beliefs of clinicians. To gain an in-depth understanding of clinician documentation practices. A qualitative design using semi-structured interviews with clinicians (allied health professionals, doctors (physicians) and nurses) working in a tertiary-level hospital in South-East Queensland, Australia. Several themes emerged from the data: environmental factors, including departmental policy and systemic issues, and personal factors, including verification, clinical reasoning and experience influencing documentation practices. Our study identified that the documentation practices of clinicians are complex, being driven by both environmental and systemic factors and personal factors. This in turn leads to duplication and some redundancy. The documentation burden of duplication could be reduced by changes in policy, supported by multidisciplinary documentation procedures and electronic systems aligned with clinician workflows, while retaining some flexible documentation practices. The documentation practices of individuals, when considered from the perspective of enhancing quality care, are considered legitimate and therefore will continue to form part of the health (medical) record regardless of the format.

Antibiotic prescribing in patients who presented to the emergency department with dog bites: A descriptive review of current practice.

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

The impact of an integrated electronic health record on nurse time at the bedside: A pre-post continuous time and motion study

BackgroundEvidence about the effectiveness of electronic health records in improving nursing workload efficiency is uncertain. AimTo measure, compare and describe nurse time spent on patient care prior to, and following implementation of an integrated electronic health record roll-out using a standardised approach. DesignStructured, continuous observation, pre-post time and motion design. MethodsContinuous observations took place in general wards in surgical and medical divisions of a tertiary hospital in South East Queensland from November 2015 to July 2017. Trained nurse observers independently observed and recorded patient care provided by consenting direct-care nurses over the course of an entire clinical shift in surgical wards or during medication rounds in medical wards. Care activities were timed and coded into categories (direct care, indirect care, ward related activities, documentation, personal and miscellaneous activities), and additional elements that influence nursing care. Descriptive statistics including frequency, percentages and median duration were reported for care activities with differences between pre- and post-implementation reported. FindingsDirect-care nurses (n = 51) were observed for the duration of an entire clinical shift or during a medication round with a total of 6209 activities observed in both divisions. Most nursing activities occurred at the patient’s bedside prior to and following the implementation of an integrated electronic health record. In the surgical division, direct care activities (such as assessing patient needs and preparing and administering ordered medications), and ward related activities (such as cleaning and clerical work) showed a significant decrease (p = <0.001), although both had significant increases in median duration. The number of indirect care activities (such as verbal reporting) also increased (p = 0.010), although there was a downward trend in their median duration (p = 0.015). Documentation (such as computer data entry) increased significantly in number of activities (p = <0.001), and median duration (p = 0.002). In the medical division, there were no significant changes in direct or indirect care or ward related activities or median time. However, documentation activities and associated median duration increased significantly (p = <0.001). DiscussionThere was a significant increase in median time for documentation activities within an 18-month period following roll-out. However, this increase occurred as a result of the integrated electronic health record roll-out. Pre-implementation training assisted nurse adaptation. Workflows may improve as clinicians become more familiar with the digital system. ConclusionWhile the move from paper-based patient records to an integrated electronic health record did not significantly change the amount of nurse time at the bedside, or for the preparation and administration of ordered medications, there was a clear and consistent trend of increased documentation time and activities following implementation of the electronic health record. This knowledge may assist nurse leaders when implementing electronic health records.

Education for delirium prevention: Knowing, meaning and doing

Hospital-acquired delirium is a common complication for older patients. Delirium prevention programs have been shown to reduce incident delirium and decrease length of stay; however, incorporating delirium prevention into nursing practice continues to be challenging. A three-element delirium prevention educational program was conducted with 42 nurses in a medical ward in a tertiary hospital in southeast Queensland. The education program focused on knowing, meaning and doing, consisting of a brief online course, case discussions with experts, and a high-fidelity simulation. A repeated cross-sectional design was utilised, with data collected over four time points before (T0), during the education program (T1, T2) and three months post completion of the study (T3). There were high levels of participation in the elements (48%–85%). Correct responses on the knowledge survey increased over time from 74.5% (T0) to 86.4% (T3; p = .003), suggesting a program focused on knowing, meaning and doing, was effective in improving nurses’ knowledge about delirium. The increase in knowledge post completion indicates that learning about delirium prevention continued without structured education. Further research into how knowledge might be shared between nurses as part of everyday work may reveal other practice-based learning techniques which support practice change.

Compassion in rehabilitation nurses who provide direct patient care: principles to pragmatics

Introduction: Compassion is a core nursing value that is expected in health care, but it is unclear how rehabilitation nurses practise compassion in direct care where care demands usually compete for limited resources. Aim: This paper reports qualitative findings from a study on the dynamics of nursing compassion in rehabilitation settings where direct patient care is provided. Method: This qualitative study was conducted in a specialist rehabilitation unit in a tertiary hospital in south-east Queensland, Australia, between August and December 2017. A convenience sample of nurses from the spinal injuries unit or brain injury rehabilitation unit participated in audio-recorded focus group discussions guided by open-ended questions. The transcripts were analysed thematically. Findings: Twenty participants attended one of seven focus groups. The first theme explored the moralities of compassion in rehabilitation nursing, revealing that compassion was a discretionary aspect of daily practice governed by individual rules in a context dominated by tasks. The second theme explored the differential compassion in rehabilitation nursing, highlighting both the versatility of compassion and factors which enabled and depleted compassion. Discussion: Rehabilitation nurses managed potential conflicts between expectations and realities by making choices that sometimes prioritised tasks and rationed compassion. Some nurses engaged in the additional, complex and less visible work of intervening to compensate for an observed lack of compassion in a person-centred model of care. Conclusion: Although compassion is recognised as an individual nursing action, it is also an organisational ideal which suggests opportunities for organisational initiatives to strengthen and sustain compassion in rehabilitation nursing.

Allied health professionals in Queensland Health returning to work after maternity leave: hours of work and duration of time on part-time hours.

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

Implementing Same Day Discharge Following Percutaneous Coronary Intervention: A Process Evaluation.

The safety and effectiveness of same day discharge (SDD) following percutaneous coronary intervention are well demonstrated; however, the uptake of this model of care is low. The aim was to examine the effectiveness of implementing SDD using a process evaluation methodology. This study was undertaken in a cardiac services department of a tertiary teaching hospital in southeast Queensland, Australia. It was anticipated before the implementation that 120 patients could be discharged the same day in a 6 months' time period. Patient selection process and guideline adherence were assessed along with patients' and relatives' satisfaction. During implementation, 22 patients were discharged home the same day. It was found that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The uptake of SDD was low in this implementation. The study is important as it provides direction for future improvement both in the criteria and the implementation process.

Chlamydia pecorum Infection in the Male Reproductive System of Koalas ( Phascolarctos cinereus).

Chlamydiosis is the most documented and serious disease of koalas, characterized by ocular, urinary, and reproductive lesions. Since little attention has been paid to the pathological effects of this infection in the male reproductive system, we aimed to determine the incidence and severity of reproductive pathology associated with chlamydial infection in male koalas submitted to koala hospitals in southeast Queensland. The entire reproductive tract from 62 sexually mature male koalas not suitable for rehabilitation was evaluated and 677 tissue samples were collected for histology, immunohistochemistry (IHC), and real-time polymerase chain reaction (qPCR). Lymphoplasmacytic inflammation was observed in 178 of 677 (26.3%) tissue samples from the upper and lower reproductive tract, mainly in the prostatic, penile, and membranous urethra. IHC was positive for the chlamydial antigen in 19 of 451 normal samples (4.2%) and 46 of 178 samples with inflammation (25.8%), located within the cytoplasm of epithelial cells of the epididymis, vas deferens, prostate, bulbourethral glands, and the prostatic membranous and penile urethra. Chlamydia pecorum was detected via qPCR in 319 of 451 normal samples (70.7%) and 159 of 178 samples with inflammation (89.3%), with the highest incidence in the penile urethra, prostate, membranous urethra, and bulbourethral glands. This study suggests that Chlamydia infection in the male reproductive tract is more widespread than originally thought. Furthermore, the male reproductive tract might be a reservoir for persistent chlamydial infections in koalas, with important implications for prophylactic strategies and epidemiology.

Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions

BackgroundThe Safewards model is gaining increasing acceptance in the mental health field in Australia and overseas. One of the most important goals of inpatient psychiatric services is to provide a safe and therapeutic environment for both patients and staff. However, this goal can be difficult to achieve if staff-patient interaction is not conducive to preventing violence and aggression. ObjectiveThe purpose of this study was to explore nursing staff perceptions of the factors impacting on their capacity to establish Safewards in acute adult inpatient wards. DesignThis study was guided by a phenomenological approach to develop a rich understanding of staff perceptions using semi-structured interviews. Setting and sampleThe setting was three acute mental health wards attached to general hospitals; one in a large provincial hospital and two in metropolitan hospitals in south-east Queensland. Interview participants were a purposive sample of fifteen registered nurses across each of the three wards. MethodSemi-structured interviews were conducted at 12 months post-implementation of Safewards. The study was underpinned by Michie’s integrative framework of behaviour change that helped identify target areas in order to enhance successful implementation of this model. ResultsContent analysis of interview transcripts highlighted a range of factors including failure to address the difficulties encountered by some staff in engaging with Safewards interventions, lack of support from management, poor use of nurse educator time, the ‘language’ of Safewards, high acuity on the study wards, and staff and patient turnover. ConclusionThis study highlights some difficulties with implementing Safewards and maintaining fidelity of the Safewards interventions in busy acute inpatient wards. Although these findings are from a qualitative study consisting of only 15 staff, our results indicate that efforts to implement Safewards need to address challenges faced by staff in engaging with the interventions, ensure buy-in from management, ensure adequate training and support during implementation and review training materials to ensure they fit with the local (i.e. Australian) context. Safewards provides an opportunity for a change in attitudes and development of a more therapeutic ward environment.

Resilience Factors Important in Health-Related Quality of Life of Subjects With COPD

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