Metropolitan Adelaide Research Articles

The 'unnecessary' use of emergency departments by older people: findings from hospital data, hospital staff and older people.

Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations'. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.

Tick-Tock, Tick-Tock: Valuing patient’s time by creating a collaborative of health-care providers and crossing traditional boundaries

Introduction: A persons time is their most precious commodity – no matter your age, your cultural or socioeconomic background we all have the same amount of time in each day and it’s never enough to do all we want. When unwell, our health systems, processes and decision making do not afford the coordination to minimise time wasted resulting in patients waiting for appointments and results, having time away from work and in some instances early entry into supportive care. The Southern Adelaide Health Alliance (SAHA) has facilitated collaboration between over twentyfive local health provider and consumer organisations that have made a commitment to implementing initiatives that will give back 500,000 healthy hours to the Southern Adelaide community by 2017. Commencing in December 2013, SAHA has already given back almost 50,000 hours through its first round of six projects. Background: Southern metropolitan Adelaide has 400,000 residents, 100 GP Practices, 77 aged care facilities, three public and two private hospitals, over 300 private providers and two Aboriginal Health practices. The growing pressure within the hospital system to reduce activity and promote hospital avoidance created a catalyst for conversations outside the hospital walls in an effort to better integrate care. Southern Adelaide Local Health Network, SAFKI Medicare Local, SA Ambulance and the Health Consumers Alliance SA invited other interested providers to join them in sharing information and resources to develop projects focused on optimising access to care in the most appropriate settings through planned care pathways and responsive efficient service delivery. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116593– http://www.ijic.org/ Challenge: To bring together disconnected, siloed providers with disparate funding models to improve patient’s experience and outcomes and increase service efficiency. Method: Three target areas were identified and task force groups created Specialist and Outpatient Care, Emergency and Ambulatory Care and Community Interface. First round of projects used 100 day methodology to encourage early outcomes. Second round had an EOI process and projects launched in August 2014. Selection is based on a set of key criteria that included giving back time to the community. Three of the core organisations committed staffing resources to delivering outcomes although a majority of project deliverables were achieved by integration of projects into day-to-day operation. Highlights and opportunities: Six initial projects (www.saha.org.au/projects) have provided encouraging results supporting the hypothesis that local, ground level change to integrate care will be effective if willingness for collaboration is present. The SAHA model and governance structure is well positioned to be transferred to other regions across Australia. SAHA already demonstrated its potential for long term Sustainability through the volume of EOI from community and organisational commitment. Conclusion: SAHA has already has created a vehicle to harness a momentum to create change from a local level. It has proven that in an environment of service and fiscal pressures there are still opportunities to improve the health outcomes and efficiency of services by integrating care. Strong leadership and executive commitment to change the way we do business as well as a skilled and willing workforce to operationalise initiative and ideas has supported the case for integrated care.

Missed opportunities: a qualitative exploration of the experiences of smoking cessation interventions among socially disadvantaged pregnant women.

Pregnant women who smoke are rarely consulted in the design and evaluation of the interventions that target them. In Australia, women will typically be counselled for smoking cessation as a part of routine antenatal care. However this approach achieves only modest rates of cessation. This study aimed to privilege the perspectives of women from low socioeconomic backgrounds who are most likely to smoke during pregnancy and who are less likely to quit spontaneously. Guided by feminist principles, in-depth interviews were undertaken with a purposive sample of six pregnant women, who resided in lower socioeconomic status areas in South Australia. Their experiences and views of being part of a smoking cessation intervention in metropolitan Adelaide were explored. Transcriptions were thematically analysed using an inductive approach and an open coding framework. An over-arching theme of 'missed opportunities' and four inter-related sub-themes encapsulated the predominantly negative experiences of the intervention for the women. The women's interest in quitting was hindered by a didactic communication style employed by maternity care professionals. The participants' information and support needs were reported as being superficially managed by maternity care professionals or Quitline workers who provided care in routine ways. These findings indicate that smoking cessation interventions and associated Quitline support needs to become more personalised and sensitive to the needs of women who face barriers posed by complex socio-economic disadvantage. These findings have important policy and practice implications for Australian public maternity care settings where smoking cessation interventions are embedded.

Seagrass rehabilitation off metropolitan Adelaide: a case study of loss, action, failure and success

Heavy losses of 6200 ha of seagrass off the Adelaide metropolitan coast since 1949 have had substantial implications for beach management, fisheries and biodiversity. Here, we describe for managers some promising initial trials to develop a cost‐effective method to rehabilitate some of these lost seagrasses.

Phone Use While Driving: Results From an Observational Survey

Objectives: The aim of this study was to quantify the level of handheld phone use when driving in South Australia. The study also sought to investigate any driver, site, and vehicle characteristics associated with handheld phone use to inform countermeasure development and publicity campaigns.Method: An on-road observational survey of handheld phone use was undertaken as part of a larger restraint use survey. The survey was conducted at 61 sites in metropolitan Adelaide and rural regions within South Australia on weekdays and a weekend in 2009.Results: A total of 64 (0.6%) of the 11,524 drivers observed during the survey were using handheld phones. Handheld phone usage rates ranged from 0.8 percent in metropolitan Adelaide to 0.3 percent in the rural region of The Riverland. Of all driver, site, and vehicle characteristics examined, the only statistically significant difference in handheld phone usage was for the number of vehicle occupants. The odds of a driver using a handheld phone while traveling alone was over 4 times higher than for a driver traveling with passengers.Conclusions: The level of handheld phone use among drivers in South Australia appears to be low relative to other jurisdictions. The level of enforcement activity and severity of penalties do not offer a clear explanation for the higher levels of compliance with phone laws. Given the rate of increase in phone technology, it is important to conduct regular roadside surveys of phone use among drivers to monitor trends in usage over time.

Public Transport Usage in Adelaide

In revitalising the urban public transport system in Adelaide, a greater understanding is required of the travel patterns of patrons to provide a system that caters for needs now and into the future. This paper takes stock of how the public transport system is used in Adelaide to identify opportunities to improve the system. An on-board transit customer survey conducted in 2009 for metropolitan Adelaide by the Department of Planning, Transport and Infrastructure (DPTI) in South Australia is used to identify the travel patterns of bus users taking into consideration a number of factors including socio-demographics. The survey findings serve as an important tool for service planning, service delivery and the development of appropriate public transport policies that meet customer needs. This paper reports on the findings from the survey and infers opportunities for rationalisation of bus routes especially at key centres like CBD, Bedford Park, Rostrevor, and Modbury. The findings are then used to infer possible improvements that could potentially increase public transport patronage.

Measuring waste management performance using the ‘Zero Waste Index’: the case of Adelaide, Australia

Adelaide is one of the high-consuming cities of the world that has developed and implemented a zero waste strategy to achieve optimum resource recovery from waste. Many similar cities are adopting a zero waste strategy with a key goal of 100% diversion rate of waste from landfill. This study argues that achieving a 100% diversion rate will be inadequate and does not reflect the core concept of the zero waste philosophy. In a previous study, the Zero Waste Index (ZWI) was presented as an alternative waste management performance assessment tool for zero waste management systems. The ZWI is a new indicator to measure and compare virgin material replacement by urban zero waste management systems. In addition, the ZWI quantifies energy, material and water conservation through recycling efforts rather than simply measuring waste diverted from landfills. In the current study, waste management performance in Adelaide during the years 2003–2010 is analysed using the proposed Zero Waste Index tool and thereby Adelaide's performance in waste management in 2015 and 2020 is predicted. The study indicates that waste composting is increasing significantly in Adelaide and by 2015 the amount of waste composted should be higher than that going to landfill. For this reason, the biological waste treatment infrastructure, particularly in waste composting facilities, should be stimulated in Adelaide. In addition, the study identifies that despite the zero waste strategy being in place, overall waste management performance in Adelaide may not reach the targeted zero waste goals, particularly in optimum resource recovery from waste. The projected results indicate that by 2020, if similar waste diversion rates continue, Adelaide should have reached a diversion rate of over 82% of municipal solid waste from landfill and the Zero Waste Index would then be 0.45 (around 45% material substitution from its current ZWI = 0.41 with a 72% diversion rate). The study also involved an online survey on the views of local waste experts in metropolitan Adelaide. By combining the waste performance and survey findings, the study identifies the most important priority areas for future waste management strategies in Adelaide.

Improving the Health and Well-Being of Community-Dwelling Caregivers of Dementia Sufferers: Study Protocol of a Randomized Controlled Trial of Structured Meditation Training

Caring for a person with dementia can be an unrelenting and burdensome task, one that is often detrimental to the caregiver's health, well-being, and functionality. The enduring stress and frustration of the caregiver role can also contribute to poorer outcomes for dementia sufferers. Building on growing clinical interest in the capacity for Transcendental Meditation(®) (TM; a relaxation technique) to reduce stress and anxiety in healthy workers, this study examines whether similar improvements could be experienced by dementia caregivers. The study objective was to ascertain whether a TM program can improve psychological stress, quality of life, affect, and cognitive performance of dementia caregivers. The study was a pilot prospective, single-center, randomized wait-list controlled trial with two parallel arms. Community-dwelling carers of persons with diagnosed dementia, residing in metropolitan Adelaide, South Australia, were included in this study. Participants will be randomly assigned to a 13-hour TM training program or wait-list control over 12 weeks. Primary outcomes include quality of life and stress. Secondary outcomes include affect, cognitive performance, cost-effectiveness, and study feasibility. Outcomes will be assessed at baseline, week 12 (postintervention), and week 24 (follow-up). Results are expected to be available early in 2014. This project responds to a need for robust evidence of the clinical and economic effectiveness of TM for the management of caregiver stress. If Transcendental Meditation is shown to be effective, it could indicate a simple, cost-effective, and easily implemented strategy to assist many of the growing numbers of caregivers to cope with the demanding and often difficult caregiver role.

A survey of the reformulation of Australian child-oriented food products.

BackgroundChildhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009–2011.MethodsIn 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time.ResultsOf 120 products, 40 remained unchanged in nutrient composition from 2009–2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation.ConclusionPositive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009–2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Airborne fungal profiles in office buildings in metropolitan Adelaide, South Australia: Background levels, diversity and seasonal variation

The presence of bioaerosols in indoor non-industrial workplace environments has become an increasing concern to indoor air quality assessors and Occupational Health and Safety professionals. The paucity of workplace survey information and national standards limits the comparisons that can be made when investigating suspected indoor fungal contamination. Data are needed on typical non-problem conditions, thereby providing background survey information. This study examined viable fungi in 128 air samples (89 indoor: 39 outdoor) from office buildings in Adelaide, South Australia, which has an arid Mediterranean climate. Results across four consecutive seasons show that the viable airborne fungal concentrations in indoor air were on average 75% lower than those in outdoor air. A seasonal influence was noted with higher fungal levels in autumn and summer compared with winter and spring. The most common culturable airborne fungi, across all seasons and conditions, were Penicillium, Aspergillus, Cladosporium and Alternaria. A weak correlation between fungal spore concentration in indoor air and carbon dioxide was observed (r = 0.26). No other correlations with indoor air quality parameters were noted. This study provides a profile of airborne fungal diversity and abundance in non-problem indoor environments and practical guidance to indoor air quality assessors on the interpretation of indoor fungal monitoring data.

Performance anxiety in adolescent musicians

Ninety secondary school music students (49 females, 41 males aged 12–18 years) from four Adelaide metropolitan schools with selective music programmes completed the Music Performance Anxiety Inventory for Adolescents (MPAI-A), State-Trait Anxiety Inventory, Junior Eysenck Personality Questionnaire Revised Short Form, and Adolescent Coping Scale Short Form. Females reported significantly more music performance anxiety (MPA) than males. Trait anxiety and neuroticism were significantly positively correlated with MPA and extraversion was significantly negatively correlated with MPA. Unproductive coping strategies were significantly positively correlated with MPA, but no significant association was found between MPA and productive coping strategies. Hierarchical regression analysis found that, after controlling for intercorrelations among variables, trait anxiety was the strongest significant predictor of MPA. Correlations between MPA with neuroticism and with extraversion were significantly accounted for by trait anxiety. The MPAI-A may hold promise as a screening tool for the early identification of potential MPA.

Area-level socioeconomic characteristics and incidence of metabolic syndrome: a prospective cohort study.

BackgroundThe evidence linking socioeconomic environments and metabolic syndrome (MetS) has primarily been based on cross-sectional studies. This study prospectively examined the relationships between area-level socioeconomic position (SEP) and the incidence of MetS.MethodsA prospective cohort study design was employed involving 1,877 men and women aged 18+ living in metropolitan Adelaide, Australia, all free of MetS at baseline. Area-level SEP measures, derived from Census data, included proportion of residents completing a university education, and median household weekly income. MetS, defined according to International Diabetes Federation, was ascertained after an average of 3.6 years follow up. Associations between each area-level SEP measure and incident MetS were examined by Poisson regression Generalised Estimating Equations models. Interaction between area- and individual-level SEP variables was also tested.ResultsA total of 156 men (18.7%) and 153 women (13.1%) developed MetS. Each percentage increase in the proportion of residents with a university education corresponded to a 2% lower risk of developing MetS (age and sex-adjusted incidence risk ratio (RR) = 0.98; 95% confidence interval (CI) =0.97-0.99). This association persisted after adjustment for individual-level income, education, and health behaviours. There was no significant association between area-level income and incident MetS overall. For the high income participants, however, a one standard deviation increase in median household weekly income was associated with a 29% higher risk of developing MetS (Adjusted RR = 1.29; 95%CI = 1.04-1.60).ConclusionsWhile area-level education was independently and inversely associated with the risk of developing MetS, the association between area-level income and the MetS incidence was modified by individual-level income.

Migratory Patterns and Settlement Experiences of African Australians of Refugee Background in Murray Bridge, South Australia

ABSTRACT In the past decade Australian immigration policy has emphasised settlement of refugees/humanitarian entrants in rural and regional locations, in preference to metropolitan areas. The settlement outcomes of a case study of African humanitarian entrants of South Sudanese background in Murray Bridge, a regional centre in South Australia, are examined. These participants were self-settled secondary movers from metropolitan Adelaide. The factors which attracted them were centred on employment. Settlement outcomes for Murray Bridge respondents were better than their urban counterparts, in terms of both housing and employment outcomes. However, some later left Murray Bridge because of a lack of opportunities for tertiary education. The results highlight issues of sustainability of settlement and retention, in regional centres in Australia, and of the fluidity of attraction and retention factors and therefore settlement in regional centres.

Psychosocial service use: a qualitative exploration from the perspective of rural Australian cancer patients

This study aims to identify key issues associated with the provision of psychosocial care from the perspective of rural Australian cancer patients and determine culturally appropriate methods that may reduce barriers to service use. Seventeen purposively sampled adult South Australians who lived outside metropolitan Adelaide, had a diagnosis of cancer and various demographic and medical histories participated in semi-structured, face-to-face interviews. Participants also completed a demographic questionnaire. Qualitative data were analysed using thematic analysis. Five key themes were identified: (1) psychosocial support is highly valued by those who have accessed it, (2) having access to both lay and professional psychosocial support is vitally important, (3) accessing psychosocial services is made difficult by several barriers (lack of information about services, initial beliefs they are unnecessary, feeling overwhelmed and concerns about stigma and dual relationships), (4) medical staff located in metropolitan treatment centres are not sufficiently aware of the unique needs of rural patients and (5) patients require better access to psychosocial services post-treatment. Methods through which rural patients believe access to psychosocial services could be improved include: (1) providing more rural-specific information on psychosocial care, (2) improving communication between health care providers and referral to psychosocial services and (3) making psychosocial services a standard part of care. Rural cancer patients want their unique needs to be recognised and to be treated differently to their urban counterparts. There is a need for more targeted and rurally relevant information for rural cancer patients, both to inform them of, and change their attitudes towards, psychosocial services. Other practical recommendations are also discussed.

Water Scarcity and Urban Forests: Science and Public Policy Lessons from a Decade of Drought in Adelaide, Australia

Drawing on the experience of greater metropolitan Adelaide, South Australia, Australia, the paper points to the links and gaps between science and public policy. The paper explores urban stormwater management lessons emerging from a ten-year, prolonged dry period that impacted the integrity of urban forests in the City of Adelaide. Among the questions addressed: will stormwater remain, as its historic and institutional settings suggest, a liability or can it become an asset? Who owns stormwater resources and to whom is its management vested? The paper examines these issues with consideration to the dangers of continuing to use urban forestry management practices that are not informed by science. The study concludes that a more integrated approach to urban water management can maintain the integrity of urban forests in ways that potentially enhance social amenities and economic efficiency.

Feasibility of ω-3 fatty acid supplementation as an adjunct therapy for people with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.

BackgroundThere is evidence to support the use of supplementation with long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) from oily fish or fish oil for the treatment of various inflammatory diseases such as rheumatoid arthritis. Chronic obstructive pulmonary disease (COPD) is a progressive, terminal disease characterized by persistent airflow limitation, lung and systemic inflammation. To date, one randomized controlled trial has been published that assessed the efficacy of LCn-3PUFA in people with this condition. The aim of this article is to discuss the feasibility of conducting a trial to evaluate fish oil supplementation as adjunct therapy in people with COPD.Methods/DesignA 16-week parallel, double-blind, randomized, placebo-controlled dietary supplementation trial will be evaluated. Forty participants meeting spirometric and clinical criteria for COPD will be recruited from metropolitan Adelaide, South Australia. Participants will be randomized by minimization, based on a score derived from the modified Medical Research Council Scale for breathlessness, to receive 6 g/day of fish oil (approximately 3.6 g/day of LCn-3PUFA), or placebo (6 g/day of corn oil) capsules. Feasibility outcomes (recruitment, retention, supplement adherence, and time lost to exacerbation) and scientific outcomes (effect size and estimates of variance for inflammatory biomarkers, incorporation of LCn-3PUFA into erythrocytes, small airways function, dyspnea and functional exercise capacity) will be assessed pre- and post-intervention. Key feasibility criteria include recruitment of 40 participants in 52 weeks, 75% participant retention rate, 2% increase in the proportion of long-chain omega-3 fatty acids in erythrocytes, and a positive moderate effect size in at least three efficacy measures.DiscussionThere are a number of challenges in designing supplementation intervention studies with this population. These include the lack of prior data from which to select appropriate primary outcomes or to estimate effect sizes, and the feasibility of continuous supplementation in a population characterized by multiple comorbidities and a high likelihood of exacerbations, potentially requiring hospitalization or change in medication. Upon completion of this protocol, feasibility outcomes will guide the direction of future multicentre dietary interventions in this population.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000158864

A Survey of Child Care Centers about Breastfeeding Support in Adelaide, South Australia

Australia has high rates of breastfeeding initiation, with a consistent decline over the first year. Furthermore, there is a growing trend of maternal employment and rising numbers of children enrolled in different types of child care services, both of which can have a negative impact on breastfeeding. To provide evidence to better inform implementation of breastfeeding-friendly strategies in child care settings, this study examined breastfeeding policy and practice in child care centers in metropolitan Adelaide. The paper reports on a survey sent to 292 child care centers in metropolitan Adelaide in 2010. The survey collected information on center location and type, number of enrolled children under age 2, and number of breastfed babies. The survey also included questions about breastfeeding facilities and support, breastfeeding policies, staff training, and barriers to and recommendations to enhance breastfeeding support in child care centers. Of the 62 completed returned surveys (21% response rate), 43 centers (69.4%) reported that they currently have children who receive breast milk at the center; however, in most centers, the total number of breastfed children was reported to be between 1 and 4; 76% reported that the center was supportive of exclusive breastfeeding for 6 months; and 80.6% had statements on breastfeeding as part of their food and nutrition policies or guidelines. Furthermore, 64.5% reported there was no formal or informal training for staff on breastfeeding support, but 50% reported that staff members do provide breastfeeding advice to mothers of children in their center. Despite some strategies in place to support breastfeeding, there are no standards on breastfeeding policies, practices, and training in child care settings. Therefore, the extent and scope of such support depend on parental request and the perceptions and attitudes of child care center staff toward breastfeeding.

Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life

Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea. With appropriate training and simplified management tools, primary care physicians are ideally positioned to take on a greater role in diagnosis and treatment. To compare the clinical efficacy and within-trial costs of a simplified model of diagnosis and care in primary care relative to that in specialist sleep centers. A randomized, controlled, noninferiority study involving 155 patients with obstructive sleep apnea that was treated at primary care practices (n=81) in metropolitan Adelaide, 3 rural regions of South Australia or at a university hospital sleep medicine center in Adelaide, Australia (n = 74), between September 2008 and June 2010. Primary care management of obstructive sleep apnea vs usual care in a specialist sleep center; both plans included continuous positive airway pressure, mandibular advancement splints, or conservative measures only. The primary outcome was 6-month change in Epworth Sleepiness Scale (ESS) score, which ranges from 0 (no daytime sleepiness) to 24 points (high level of daytime sleepiness). The noninferiority margin was -2.0. Secondary outcomes included disease-specific and general quality of life measures, obstructive sleep apnea symptoms, adherence to using continuous positive airway pressure, patient satisfaction, and health care costs. There were significant improvements in ESS scores from baseline to 6 months in both groups. In the primary care group, the mean baseline score of 12.8 decreased to 7.0 at 6 months (P < .001), and in the specialist group, the score decreased from a mean of 12.5 to 7.0 (P < .001). Primary care management was noninferior to specialist management with a mean change in ESS score of 5.8 vs 5.4 (adjusted difference, -0.13; lower bound of 1-sided 95% CI, -1.5; P = .43). There were no differences in secondary outcome measures between groups. Seventeen patients (21%) withdrew from the study in the primary care group vs 6 patients (8%) in the specialist group. Among patients with obstructive sleep apnea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the 2 treatment modes may be comparable. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12608000514303.

Perioperative anesthetic documentation: Adherence to current Australian guidelines

Purpose:The lack of adequate perioperative documentation has legal implications and can potentially affect the quality and safety of patient care. Despite the presence of guidelines, the adequacy of perioperative documentation in Australasia has not been adequately assessed. The aim of this study is to assess the adequacy of anesthetic documentation on the pre and intraoperative encounters and to test the hypotheses that documentation is incomplete in the settings of emergency vs. elective procedures, regional vs. general anesthesia, and manual vs. electronic documentation.Materials and Methods:The study was an observational retrospective study in the setting of a 250-bed teaching hospital in metropolitan Adelaide, Australia. The perioperative records of 850 patients were analyzed. A scoring system was designed, based on a policy statement from the Australian and New Zealand College of Anesthetists and a survey of the hospital anesthetists. Scored and categorical data was analyzed using Chi-square test. Numerical data was analyzed using student t-test. The null hypothesis was accepted or rejected at 0.05 significance.Results:There were significant deficiencies in the adequacy of preanesthetic and intraoperative records. This has been shown to be true in all cases. Documentation was found to be poorer in the emergency setting when compared to elective cases (median scores 15 vs. 21 P = 0.03) as well as documentation of airway assessment for cases done solely under regional anesthesia (42 vs. 85%, P = 0.05). There were no significant differences in the adequacy of electronic vs. manual records (P = 0.92).Conclusion:There are significant deficiencies in the adequacy of perioperative records. This has been shown to be true in all cases, but is especially so in emergency cases and for patients having only regional anesthesia.

Effectiveness of nurse home-visiting for disadvantaged families: results of a natural experiment

ObjectiveTo evaluate the effects of a postnatal home-visiting programme delivered by community health nurses to socially disadvantaged mothers in South Australia.DesignThe intervention group of 428 mothers lived in metropolitan Adelaide...