Practice In Queensland Research Articles

Pandemic impacts on rural general practice: Trainees and supervision team working and learning together.

To explore the impact of COVID-19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team. Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic. Twenty-three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students. Audio-recorded semi-structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees. Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated.

The Impact of Anaemia on Outcomes, Admissions, and Costs in Patients with Chronic Kidney Disease in Two Public Nephrology Practices in Queensland: A CKD.QLD Registry Study.

Anaemia among patients with chronic kidney disease (CKD) leads to poor overall outcomes. This study explores anaemia and its impact on nondialysis CKD (NDD-CKD) patients. 2,303 adults with CKD from two CKD.QLD Registry sites were characterised at consent and followed until start of kidney replacement therapy (KRT), death, or censor date. Mean follow-up was 3.9 (SD 2.1) years. Analysis explored the impact of anaemia on death, KRT start, cardiovascular events (CVE), admissions, and costs in these NDD-CKD patients. At consent, 45.6% patients were anaemic. Males were more often anaemic (53.6%) than females, and anaemia was significantly more common over the age of 65 years. The prevalence of anaemia was highest among CKD patients with diabetic nephropathy (27.4%) and renovascular disease (29.2%) and lowest in patients with genetic renal disease (3.3%). Patients with admissions for gastrointestinal bleeding had more severe anaemia, but accounted for only the minority of cases overall. Administration of ESAs, iron infusions, and blood transfusions were all correlated with more severe degrees of anaemia. The number of hospital admissions, length of stay, and hospital costs were all strikingly higher with more severe degrees of anaemia. Adjusted hazard ratios (CI 95%) of patients with moderate and severe anaemia vs. no anaemia for subsequent CVE, KRT, and death without KRT were 1.7 (1.4-2.0), 2.0 (1.4-2.9), and 1.8 (1.5-2.3), respectively. Anaemia is associated with higher rates of CVE, progression to KRT and death in NDD- CKD patients, and with greater hospital utilisation and costs. Preventing and treating anaemia should improve clinical and economic outcomes.

Acute kidney injury in 18 cats after subcutaneous meloxicam and an update on non-steroidal anti-inflammatory drug usage in feline patients in Australia.

Acute kidney injury (AKI) is a well-known but poorly documented adverse effect of non-steroidal anti-inflammatory drugs (NSAIDs) in cats. We aimed to describe instances of NSAID-associated AKI in cats and survey Australian veterinarians on NSAID use in acute settings. Medical records of cats that developed an AKI subsequent to the administration of meloxicam were obtained by searching the databases of seven practices in Queensland, as well as by contemporaneously contacting select veterinary colleagues of the authors in both general and specialist small animal practice. An online questionnaire was created for the survey, and the URL distributed to Australian practitioners. A total of 18 cases were retrieved, all of which received injectable meloxicam. The indication(s) for its use and the dosage prescribed were within the manufacturer's recommendations for Australian veterinarians. The majority of cases (13/18 cats) received the label dose of 0.3 mg/kg subcutaneously (SC) on the day of the procedure. In 12/18 cats, the injection was given in association with general anaesthesia or sedation. Fourteen cats survived to hospital discharge. Of 187 survey respondees, 89% routinely administered NSAIDs for surgery-related analgesia, with 98% prescribing meloxicam and 84% of these giving it SC. Ninety percent of respondees routinely administered NSAIDs for non-surgical-related analgesia, with 99% prescribing meloxicam and 35% of those giving it SC. We strongly recommend that practitioners avoid prescribing meloxicam SC in cats. This recommendation is emphatic in situations where concurrent dehydration and/or hypotension are possible.

The School Counsellor’s Role in Trauma-Aware Education

It is not unusual for school counsellors to be involved in trauma-aware education practice; however, their role is not uniformly defined in the literature nor consistently applied in professional settings. Trauma-aware education is relatively new but rapidly growing in Australia and beyond. It involves supporting students in a neuroscience-informed manner to address the impacts of complex trauma on their capacities to feel safe, to relate, to emotionally regulate, and to learn. Twenty-six school counsellors completed questionnaires, and eight of those joined focus group discussions to explore the role of school counsellors in trauma-aware practice in Queensland, Australia. Drawing on the voices of practitioners, the present report discusses categories of practice that are prioritised by school counsellors and recommends supports to effectively undertake trauma-aware practice in school settings.

Chronic kidney disease in public renal practices in Queensland, Australia, 2011-2018.

To describe adults with (non-dialysis) chronic kidney disease (CKD) in nine public renal practice sites in the Australian state of Queensland. 7,060 persons were recruited to a CKD Registry in May 2011 and until start of kidney replacement therapy (KRT), death without KRT or June 2018, for a median period of 3.4 years. The cohort comprised 7,060 persons, 52% males, with a median age of 68 yr; 85% had CKD stages 3A to 5, 45.4% were diabetic, 24.6% had diabetic nephropathy, and 51.7% were obese. Younger persons mostly had glomerulonephritis or genetic renal disease, while older persons mostly had diabetic nephropathy, renovascular disease and multiple diagnoses. Proportions of specific renal diagnoses varied >2-fold across sites. Over the first year, eGFR fell in 24% but was stable or improved in 76%. Over follow up, 10% started KRT, at a median age of 62 yr, most with CKD stages 4 and 5 at consent, while 18.8% died without KRT, at a median age of 80 yr. Indigenous people were younger at consent and more often had diabetes and diabetic kidney disease and had higher incidence rates of KRT. The spectrum of characteristics in CKD patients in renal practices is much broader than represented by the minority who ultimately start KRT. Variation in CKD by causes, age, site and Indigenous status, the prevalence of obesity, relative stability of kidney function in many persons over the short term, and differences between those who KRT and die without KRT are all important to explore.

Use of telemedicine for rheumatology practice in Queensland, Australia: experiences before and during the COVID-19 pandemic.

In Australia there is a shortage of rheumatologists potentially translating to poorer outcomes. A possible solution in this setting is telemedicine (TM). To examine the utilisation and provider perceptions of TM in rheumatology in Queensland and explore the challenges faced when using TM before and during COVID-19. A sequential mixed-methods study design was used. Rheumatologists completed a questionnaire on demographics, clinical practice, TM uptake, models of care and clinician perceptions of TM. The qualitative phase utilised purposeful sampling of active users of TM through in-depth semi-structured interviews. Thirty rheumatologists participated, with 76.7% identifying as active TM users. Use of TM was limited prior to COVID-19 with 80.9% examining less than five patients per week. Patient populations served by TM included capital city (53.3%), regional (63.3%) and rural/remote (23.3%). Most rheumatologists prescribed conventional or biological disease modifying agents (90% and 55%) through TM consultations. Barriers to TM use included low confidence in joint assessments, limited distribution of technology, access to administrative and peripheral clinical staff and lack of financial incentives. During the COVID-19 pandemic, a significant expansion of TM via telephone calls occurred and rheumatologists reported low confidence and satisfaction with this model. Familiarity with TM exists in this rheumatologist cohort; however, its use in routine practice is limited due to multiple barriers. The COVID-19 pandemic highlighted low confidence in telephone calls as a form of TM underlining the need for appropriate TM models of care for rheumatology practice.

Patron banning policy and practice in Queensland, Australia: key informant perspectives

Patron banning policy and practice in Queensland, Australia: key informant perspectives

Then and now: Historical perspectives on 40 years of change in nephrology practice in Queensland

Then and now: Historical perspectives on 40 years of change in nephrology practice in Queensland

Patron banning policy and practice in Queensland, Australia: key informant perspectives

This paper explores attitudes to and experiences of patron banning policy (which prohibits an individual from entering a nightlife area or venue after engaging in anti-social behaviour) in Queensland, Australia. Key informant interviews were conducted with 66 participants from health, justice, industry, and government sectors across the state. Interviews were semi-structured, and transcripts were examined using thematic analysis. Overall, key informants reported that patron banning provisions helped to keep out customers who cause problems in venues and that ID scanners helped to enforce bans. There was some concern about displacement of banned patrons to other nightlife areas, the discretionary nature of venue bans, the potential for banning notices to be misused, and a general perception that police-imposed bans should be longer than the current 10 days. The majority of interviewees were supportive of patron banning and felt that it could (positively) affect patron behaviours. A number of recommendations were suggested to refine the framing and operation of Queensland’s banning policy.

"We'd be really motivated to do something about it": A qualitative study of parent and clinician attitudes towards predicting childhood obesity in practice.

In Australia, one in four (24.9%) children live with overweight or obesity (OW/OB). Identifying infants at risk of developing childhood OW/OB is a potential preventive pathway, but its acceptability is yet to be investigated in Australia. This study aimed to (1) investigate the acceptability of predicting childhood OW/OB with parents of infants (aged 0-2 years) and clinicians and (2) explore key language to address stigma and maximise the acceptability of predicting childhood OW/OB in practice. This was a cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants were multidisciplinary paediatric clinicians (n=18) and parents (n=13) recruited across public hospitals and health services in Queensland, Australia. Data were analysed under the Framework Method using an inductive, thematic approach. Five main themes were identified: (1) Optimism for prevention and childhood obesity prediction, (2) parent dedication to child's health, (3) adverse parent response to risk for childhood obesity, (4) language and phrasing for discussing weight and risk and (5) clinical delivery. Most participants were supportive of using a childhood OW/OB prediction tool in practice. Parents expressed dedication to their child's health that superseded potential feelings of judgement or blame. When discussing weight in a clinical setting, the use of sensitive (ie, "overweight", "above average", "growth" versus "obesity") and positive, health-focused language was mostly supported. Multidisciplinary paediatric clinicians and parents generally accept the concept of predicting childhood OW/OB in practice in Queensland, Australia. SO WHAT?: Clinicians, public health and health promotion professionals and policymakers can act now to implement sensitive communication strategies concerning weight and obesity risk.

A Modern History of Child Protection in Australia: Queensland 1965–1980

ABSTRACT This article examines child protection policy and practice in Queensland in the 1960s and 1970s, which was a period of major social change affecting relations between children, families, and the state. Using government annual reports from the period, the article traces developments in policy and service delivery. It discusses changes in two interlinked areas: the use of preventative family support approaches and the expansion of the professional knowledge base. Understanding the history of a policy field can facilitate critical reflection on current debates. The child protection field continues to revisit long-standing tensions about the best ways to safeguard children from abuse and neglect in their families, albeit in different ways. IMPLICATIONS It is important to recognise and value the social work profession’s strong contribution to building the child protection knowledge base. Many current debates in child protection are not new: since the child protection field developed in the 1960s, it has continually revisited tensions about how best to intervene to address the individual and social causes of child abuse and neglect. Documenting the history of a social policy field can facilitate critical reflection on current developments.

The Cat Desexing Policies and Activities of Private Veterinary Practices in Queensland.

Simple SummaryThe Royal Society for the Prevention of Cruelty to Animals (RSPCA) shelters around Australia take in hundreds of unwanted adult cats and kittens each year. Widespread desexing (or sterilizing) of cats before they have a chance to become pregnant would reduce numbers of kittens born, and hence, would be expected to reduce numbers of cats entering shelters. Veterinarians have an important role to play in promoting desexing of cats before they reach puberty, and this paper reports on a survey conducted to describe Queensland veterinary practice policies and activities. We ascertained ages that veterinarians recommended for desexing of cats, ages at which desexing actually occurs, what veterinary practices are doing to promote desexing, and what the respondents see as the barriers to desexing before puberty.Cats are prolific breeders, and if most cats were desexed prior to puberty, numbers of unwanted cats and kittens, and hence numbers entering shelters, would be expected to decline. Although traditionally in Australia it has been reported that 90% of veterinary clients’ cats are desexed, there are still hundreds of cats and kittens that end up unwanted and in shelter care annually. In this study, we surveyed Queensland veterinary practices to describe ages that veterinarians are recommending cats should be desexed at, ages at which desexing actually occurs, what veterinary practices are doing to promote desexing of cats, and what veterinarians see as the barriers to desexing of cats before puberty. A questionnaire was developed and sent to all veterinary practices in Queensland. The response rate was 50%. Almost 45% of respondents recommended desexing at the traditional age of 6 months, which is later than puberty in most cats; for more than 56% of practices, the actual average age at which desexing occurred was at least 6 months; and in a substantial proportion of practices, when desexed, high percentages of cats had already had litters. Most practices took steps to encourage their clients to have their cats desexed, and most thought these steps were effective. The results from this study suggest that although veterinarians generally agree that cats should be desexed prior to having their first litter, recommended and actual desexing ages are commonly too late to ensure this is achieved. Better understanding is required about both the likely impact of more veterinary practices recommending and conducting desexing before puberty on numbers of unwanted cats and numbers surrendered to shelters, and the drivers of age at which cats are desexed. This could inform strategies to reduce numbers of unwanted cats.

The Ckd. Qld fabRy Epidemiology (aCQuiRE) study protocol: identifying the prevalence of Fabry disease amongst patients with kidney disease in Queensland, Australia

BackgroundFabry disease (FD) is a rare, lysosomal storage disorder caused by the absence or deficiency of the enzyme alpha-galactosidase A (α-Gal A) that leads to the abnormal accumulation of the lipid globotriaosylceramide (GB3) in a variety of cell types and tissues throughout the body. FD has an x-linked inheritance pattern. Previously thought to be only carriers, females can also experience FD symptomatology. Symptoms vary in type and severity from patient to patient and tend to increase in severity with age. FD symptoms are non-specific and may be shared with those of other diseases. Misdiagnoses and diagnostic delays are common, often resulting in progressive, irreversible tissue damage. The estimated prevalence of FD in the general population is 1:40,000 to 1:117,000 individuals. However, it is estimated that the prevalence of FD in the dialysis population is 0.12 to 0.7%. Little is known about the prevalence of FD in the broader Chronic Kidney Disease (CKD) population.MethodsThis is an epidemiological study of the prevalence of FD in CKD patents identified from the public renal speciality practices in Queensland, Australia. A cascade approach to screening is being employed with dried blood spot testing for blood levels of alpha-galactosidase A (Alpha-Gal), with follow-up testing for patients with abnormal results by plasma levels of globotriaosylsphingosine (Lyso-GB3) for females and non-definitive cases in males. A diagnosis of FD is confirmed through genetic testing of the GLA gene in cases suspected of having FD based upon Alpha-Gal and Lyso-GB3 testing.DiscussionExpected outcomes of this study include more information about the prevalence of FD at all stages of CKD, including for both males and females. The study may also provide information about common characteristics of FD to assist with diagnosis and optimal management/treatment. Screening is also available for family members of diagnosed patients, with potential for early diagnosis of FD and intervention for those individuals.Trial registrationQueensland Health Database of Research Activity (DORA, https://dora.health.qld.gov.au) pj09946 (Registered 3rd July 2017).

SAT-242 THE END OF THE CKD JOURNEY - RENAL REPLACEMENT THERAPY (RRT) OR DEATH WITHOUT RRT: THE CKD.QLD EXPERIENCE

Patients with established chronic kidney disease (CKD) can exit the preterminal CKD state by starting RRT, or by dying without receiving RRT. The latter might die from untreated end stage kidney failure (ESKF), or from other causes. Characteristics of those starting RRT are well defined through incidence data in various registries, such as ANZDATA in Australia, but the features of those who die without RRT are less well defined. An AIHW study shows that the number of Australians who start RRT is equalled or exceeded by numbers who die with ESKF receiving RRT, but that study was not designed to define nonESKF causes of death in patients with preterminal CKD. We ascertained the outcomes of a cohort of CKD patients in public renal practices in Queensland who were enrolled in the CKD.QLD registry, and compared those who started RRT with those who died without receiving RRT. 6,371 patients in CKD.QLD (54% males, mostly CKD stages 3b, 4 and 5), were followed from consent to the CKD.QLD registry until the start of RRT, death, or a censor date of June 30, 2016. Outcomes and causes of death were further ascertained from Queensland Health records though to June 2017. Follow up ranged from 0 to 5.4 years, median (IQR) of 2.8 (3) years, or a total of 15,714 person years. By the censor date, 605 (9.5%) patients had started RRT, at a median (IQR) age of 63 (20) and 837 (13.1%) had died without RRT, at median (IQR) age 78 (14). Incidence rates were 2.79 (CI 3.4-4.0) and 5.2 (4.8-5.5) per 100 person years respectively. Rates of both were higher in males than females, with RRT incidences of 3.8 vs 2.7, p=0.001, and rates of death without 5.8 vs 4.8, p=0.001. Among 1,083 deaths without RRT through June 2017, most had multiple causes of death. ESKF was cause of death in 19%; an additional 24% had chronic renal failure documented and 25% had mention of CKD, while AKI was coexisting cause-of-death in 6.9%. Cardiovascular events were listed as causes in 69% of persons, but pulmonary deaths, malignancies, sepsis, multiorgan failure and other conditions were also frequently underlying or associated causes. Place of death was hospital for 69% of the whole nonRRT cohort, and for 80% of those who died with ESKF. Among these CKD patients from renal specialty practices, more died without RRT than started RRT. One fifth of those who died without receiving RRT died with ESKF: while chronic renal failure and CKD were associated diagnoses in an additional half. Cardiovascular events were very prominent, but other common morbidities were also well represented. Persons who died without RRT had an average survival more than 15 years longer than the dialysis–free survival of those who start RRT, and most had already exceeded the average life expectancy of people born in the same era; life expectancy was 58 for men and 62 for women people born in 1937. Most were long term survivors within their birth cohorts, a reminder that the increasing prevalence of CKD is, in part, a function of increasing longevity. Notably, ascertainment of clinically evident CKD in Queensland death certificates is now very good.

SAT-243 THE CKD.QLD REGISTRY: CHARACTERISTICS AND COURSE OF CHRONIC KIDNEY DISEASE (CKD) PATIENTS IN PUBLIC NEPHROLOGY CARE IN QUEENSLAND, AUSTRALIA

Stemming the rise of end stage kidney failure (ESKF) depends on understanding, preventing and modifying its preterminal stages of CKD. We describe people with CKD in public renal practices in Queensland, Australia, who have enrolled in the CKD.QLD registry. Queensland has a vast area of 1,730,648 km2, a population of over 5 million, both of great diversity, and an excellent public health system - Queensland Health. CKD patients enrol in the registry with informed consent and are followed until death, start of renal replacement therapy (RRT), discharge or specified censor dates. Enrolment started in 2011, and has embraced adult nephrology services across Queensland Health Hospital and Health Services. Through a data-linkage collaboration, Queensland Health has supplied data on all hospital admissions, public and private, of CKD.QLD patients for five years retrospective from mid 2017. 9,005 patients have enrolled, with a total follow up of about 30,000 person years. Median age at enrolment was 68 years, 54% were male, and most had CKD stages 3A to 5. 50.8% were obese, compared with 20.8% of the Australian population, and, within the CKD cohort, obesity was powerfully associated with several serious complications. Dominant primary renal diseases were glomerulonephritis (GN) and genetic disease (GRD) in younger subjects, and diabetic disease (DN) and renal vascular (RV) disease in older people. 48% of subjects had multiple renal diagnosis. There was >2-fold variation in frequency of GN, DN and RV among some sites, and a >6-fold variation in proportions with diagnoses of uncertain or unknown etiology. Proportions of diagnoses also differed by socioeconomic status and by ethnic group, including Indigenous status. Older subjects more often had advanced renal disease, multiple renal diagnoses and more comorbidities. Renal function deteriorated over one and two years in 25%, but was stable or improved in 75%. CKD stages 4 and 5, overt proteinuria/albuminuria, diabetic nephropathy, male gender and acute kidney injury (AKI) were significant predictors of progression. Up to June 2016, the incidence per 100 person years of RRT was 2.79 (CI 3.4-4.0), and of death without RRT was 5.2 (CI 4.8-5.5). Mean (SD) age at start of RRT was 58.5 (15 years) and of death without RRT was 76.7 (10.6 years). Among the first 1,083 persons who died without receiving RRT, 19% were due to ESKF, while chronic renal failure and CKD were documented in an additional 50%. Cardiovascular events were recorded in 69% of these deaths, with other conditions also prominent. 10% of CKD.QLD patients were responsible for 60% of hospital admissions and 70% of expenditures, exclusive of dialysis. Underlying diabetic nephropathy and superimposed AKI were especially associated with such “high end” usage. There is great variation in CKD by age and in CKD cause by region. Progression over the short term is not inevitable. Subjects who start RRT and those who die without RRT are different populations. These data underline need for several pathways of care. Associations of obesity with CKD prevalence and complications, and of AKI with hospitalisations and progression in CKD patients, indicate major opportunities for prevention and better management.

Body mass index in an Australian population with chronic kidney disease

BackgroundObesity emerged as the leading global health concern in 2017. Although higher body mass index (BMI) is a health risk in the general population, its implications for chronic kidney disease (CKD) are not entirely clear. Our aim was to compare BMI in an Australian CKD population with BMI in a sample of the general Australian population, and, in the same group of CKD patients, to describe associations of higher BMI categories with demographic and clinical features.MethodsA cross-sectional study of BMI in CKD patients was conducted from three major sites who were enrolled in the CKD.QLD registry between May 2011 and July 2015. BMI was categorized according to the World Health Organisation (WHO) guidelines. The prevalence of obesity was compared with a sample of the general Australian population from the most recent National Health Survey (NHS). Associations of BMI with demographic and clinical characteristics of the CKD patients were also analysed.ResultsThere were 3382 CKD patients in this study (median age 68, IQR 56–76 years); 50.5% had BMI ≥30, the WHO threshold for obesity, in contrast with 28.4% having BMI ≥30 in the NHS cohort. Higher BMI categories were correlated with age < 70 years, male gender, and lower socioeconomic status. After adjustment for age and gender, characteristics which significantly correlated with higher BMI category included hypertension, dyslipidemia, diabetes, diabetic nephropathy, coronary heart disease, other cardiovascular diseases, gout, obstructive sleep apnoea, depression and chronic lung disease.ConclusionsPatients with CKD in public renal specialty practices in Queensland have strikingly higher rates of obesity than the general Australian population. Within the CKD population, low socio-economic position strongly predisposes to higher BMI categories. Higher BMI categories also strongly correlated with important co-morbidities that contribute to burden of illness. These data flag major opportunities for primary prevention of CKD and for reductions in morbidity in people who already have CKD, which should be considered in public health policy in relation to obesity.

Content analysis to locate assistive technology in Queensland’s motor injury insurance rehabilitation legislation and guidelines

ABSTRACTIntroduction: Reforms to Australia’s disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state.Methods: Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy.Results and discussion: The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland’s motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability.Conclusion: The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.

'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans.

Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks. This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth. The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison. Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.

Exploring the characteristics of sustainable business practice in small and medium-sized enterprises: Experiences from the Australian manufacturing industry

Abstract With small and medium-sized enterprises (SMEs) being responsible for a significant proportion of global pollution, there are increasing calls for this type of businesses to engage in ‘sustainable business practice’. However it is still unclear what this term actually means in day to day operations. This study identifies key characteristics of sustainable business practice for SMEs through evaluating the experiences of senior decision makers from 13 companies engaged in lean and green practices in Queensland, Australia. Through a systematic literature review and an exploratory study, nine characteristics emanating from the three themes of environmental stewardship, process excellence, and sustainability oriented-culture were established. Furthermore, this study build on natural-resource-based view (NRBV) theory to present a ‘Natural Resources Based View Plus’ (‘NRBV+’) model that includes an additional strategy of ‘regenerative development’. These findings can immediately assist SMEs to evaluate their practices, and in doing so, identify sustainability performance improvement opportunities. It is proposed that these findings also have implications for addressing the United Nations' Sustainable Development Goal of responsible consumption and production.

Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia.

Warfarin is widely prescribed to decrease the risk of stroke in atrial fibrillation (AF) patients. Due to patient variability in response, regular monitoring is required, and time in therapeutic range (TTR) used to indicate quality of warfarin control with a TTR>60% is recommended. Recently, an Australian Government review of anticoagulants identified the need to establish current warfarin control and determine the potential place of the newer oral anticoagulants. To determine warfarin control by a pathology practice in Queensland, Australia and identify factors influencing TTR. Retrospective data were collected from Sullivan Nicolaides Pathology, a major pathology practice offering a warfarin care programme in Australia. Patients enrolled in their programme as of September 2014 were included in the study. TTR was calculated using INR test results, and test dates using the Rosendaal method with mean patient TTR were used for analysis and comparison. Exclusions were target therapeutic range outside 2.0-3.0, less than two INR tests and programme treatment time of less than 30 days. The eligible 3692 AF patients had 73.6% of INR tests within the therapeutic range. The mean TTR was 81%, with 97% of patients above a TTR of 60%. TTR was not significantly influenced by age, gender or socioeconomic factors. The observed mean TTR of over 80% is superior to the minimum recommended threshold of 60%. The TTR achieved by the Queensland pathology practice demonstrates that dedicated warfarin programmes can produce high-quality warfarin care, ensuring the full benefit of warfarin for Australian patients.