Regional Australian Hospital Research Articles

Spinal clearance practices at a regional Australian hospital: A window to major trauma management performance outside metropolitan trauma centres

Background: Prevention of secondary spinal injury via spinal protection measures is a standard component of trauma management, and a high-quality spinal clearance process is imperative in achieving this aim. To evaluate the current practice with a view to achieving best practice, we sought to examine the spinal clearance process and outcomes at a regional Australian referral hospital, which services a large geographical catchment area. Methods: A retrospective review of medical records of all patients with major trauma who presented to an Australian regional hospital during 2014 was conducted. The primary outcome measure was missed or delayed diagnosis of spinal injury. Secondary outcome measures included compliance with internationally accepted spinal clearance process measures, timing and choice of appropriate imaging modalities, rates of spinal injury and documentation of spinal clearance. Results: Of the 112 patients with major trauma who met the study eligibility criteria and were discharged from hospital during the study period from 1 January to 31 December 2014, 11 spinal injuries were missed or delayed in diagnosis. The injuries occurred in 3.6% of patients and all were thoracolumbar spine (TLS) injuries. The predominant reasons for missed or delayed diagnosis were reduced sensitivity of plain X-ray compared with computed tomography for spinal injury screening and incomplete full spinal imaging to detect non-contiguous fractures. Conclusion: Evidence-based clinical decision rules are imperative in ascertaining the need for imaging in the TLS and would be enhanced by an internationally recognised definition of clinical significance based on injury morphology rather than clinician management decision alone. In addition, regional hospitals may have limited capacity to achieve spinal clearance, and other trauma quality assurance standards commensurate with national and international benchmarks without the valuable performance feedback provided by state trauma registries, as is currently the case in Queensland.

Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP.

Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study

Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before–after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Intervention: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Main Measures: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. Results: The enriched environment group (n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in ‘any’ activity (71% vs. 58%, P = 0.005) compared to the usual care group (n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Conclusions: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.

The Master's Apprentice: How do Australian medical interns learn?

Introduction: The 2015 Review of Medical Intern Training Discussion Paper (Australian Health Ministers' Advisory Council, 2015) questions the purpose and effectiveness of the current model of internship. However, there is limited literature describing how the medical internship functioned when first established in Australia, or how the educational model has changed over the years. Methods: A study with the aim of determining how interns currently learn and the degree to which learning still follows an apprenticeship model was conducted over a 2-year period in a large Australian regional hospital. Sixty interns entered learning reflections into a 4-step online survey. A descriptive analysis was undertaken on the extracted data using Microsoft Excel. Results: Results of the study indicate that interns still learn via the apprenticeship relationship they have with their supervisors (registrars and/or consultants) more than they do via self-directed means. Findings from this study suggest that learning in medicine is an iterative process; interns will learn via modelling from their supervisors, on the one hand, but will use self-directed learning when and where necessary. Interns indicated learning more content than they do tasks related to administration or professional identity. There are varying emphases of learning in each of the core terms of medicine, surgery and emergency medicine, which suggests that it is important for interns to continue to have learning opportunities in a variety of settings and disciplines. Conclusions: This study provides some insights into how and what interns learn, which should be considered when decisions are made about future models of medical intern training.

Retrospective audit of antimicrobial prescribing practices for acute exacerbations of chronic obstructive pulmonary diseases in a large regional hospital.

Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and mortality, and frequent exacerbations are associated with an increased risk of death, deterioration in lung function and reduced quality of life. Current Australian guidelines developed by the Lung Foundation of Australia (the COPD-X Plan) recommends the use of a short course of corticosteroids and oral antibiotics (amoxycillin or doxycycline) as part of the treatment of an AECOPD; however, it was noted that clinical practice at the study hospital had deviated from these guidelines. To evaluate the antibiotic prescribing practices in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients, and to compare the differences in clinical outcomes (primarily mean length of stay and the rate of unplanned readmissions) between patients who received broad- vs. narrow-spectrum antibiotics in a large regional hospital. Retrospective audit of medical records for patients admitted with uncomplicated AECOPD during January-September, 2014 in a 224 acute bed regional hospital in Victoria, Australia. Fifty-nine per cent of patients received broad-spectrum antibiotics (ceftriaxone), whereas only 10% of prescriptions were concordant with current Australian guideline recommendations. Patients receiving a broad-spectrum regimen were more likely to be older (74·9 vs. 69·9 years; P = 0·009), have a higher COPD severity score (i.e. BAP-65 score, 1·55 vs. 1·06; P = 0·002) and a higher CRP (59·2 vs. 25·5 mg/L; P = 0·003) on admission. The mean LOS was not significantly different between those who received ceftriaxone and those who did not (5·09 vs. 4·55 days; P = 0·47). There was no significant difference between the groups in rates of readmissions. The antibiotic prescribing patterns for AECOPD in rural and regional Australian hospitals have not previously been examined in the current literature. In the study hospital, the majority of patients received broad-spectrum antibiotics in the initial treatment of AECOPD. No differences in hospital length of stay, or rate of readmission for AECOPD were observed between those who received broad- and narrow-spectrum antibiotics.

Management of Suspected Acute Coronary Syndromes in a Regional Australian Hospital: An Audit of Adherence with Guidelines.

Background: Despite well-established management guidelines for acute coronary syndromes (ACS), including unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI), there are deficiencies in application of evidence based care. Contemporary Australian data has highlighted the discrepancy between metropolitan and rural ACS management and poorer rural outcomes.1 We examined adherence to evidence based guideline recommendations for ACS at the Albany Health Campus (AHC), a rural hospital in southern Western Australia that services an area of 39,000 km2. Methods: A retrospective review of hospital notes for patients with suspected ACS between July and September 2016 at AHC. For those with suspected ACS, we assessed acute medical care according to Australian guideline recommendations. Results: Eighty-two patients met inclusion criteria, including 30 (37%) NSTEMI and 52 (63%) UA. Mean adherence to the guideline recommendations was 75% overall, 80% for NSTEMI and 72% for UA. All patients had a 12-lead ECG performed and baseline troponin, which was repeated for all non-low risk patients if the initial troponin was normal. Management risk stratification was undertaken routinely but bleeding risk was not formally documented prior to therapy. Only 63 patients received aspirin as recommended. 19 (68%) NSTEMI patients received recommended angiographic investigation. 19 (35%) UA patients were referred for outpatient investigation, including 10 (19%) who were referred to an outpatient cardiology clinic. Conclusion: While some aspects of risk assessment were universally practised we observed significant deficiencies relative to guideline recommendations for ACS in this regional hospital. Rates of early invasive management were below optimal for NSTEMI patients.

Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital

Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital

How Does Cholecystectomy Influence Recurrence of Idiopathic Acute Pancreatitis?

BackgroundIdiopathic acute pancreatitis is diagnosed in approximately 10–30 % of cases of acute pancreatitis. While there is evidence to suggest that the cause in many of these patients is microlithiasis, this fact has not been translated into a resource efficient treatment strategy that is proven to reduce recurrence rates. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound. MethodsThis was a retrospective study of 2236 patients who presented to a regional Australian hospital. Patients were included when diagnosed with acute pancreatitis with no confirmed cause. Recurrence of acute pancreatitis was compared between those that did and did not undergo cholecystectomy. ResultsOne hundred ninety-five consecutive patients met the study definition of “idiopathic” acute pancreatitis. 33.8 % (66/195) underwent cholecystectomy. The patients who had cholecystectomy had a recurrence rate of 19.7 % (13/66) whereas, of those managed expectantly, 42.8 % (68/159) had at least one recurrence of acute pancreatitis (P = 0.001). ConclusionsFollowing an episode of acute pancreatitis with no identifiable cause, in patients fit for surgery, cholecystectomy should be considered to reduce the risk of recurrent episodes of pancreatitis.

How are allied health notes used for inpatient care and clinical decision-making? A qualitative exploration of the views of doctors, nurses and allied health professionals.

Inpatient care is dependent upon the effective transfer of clinical information across multiple professions. However, documented patient clinical information generated by different professions is not always successfully transferred between them. One obstacle to successful information transfer may be the reader's perception of the information, which is framed in a particular professional context, rather than the information per se. The aim of this research was to investigate how different health professionals perceive allied health documentation and to investigate how clinicians of all experience levels across medicine, nursing and allied health perceive and use allied health notes to inform their decision-making and treatment of patients. The study used a qualitative approach. A total of 53 speech pathologists, nurses, doctors, occupational therapists, dieticians and social workers (8 males; 43 females) from an Australian regional tertiary hospital participated in eleven single discipline focus groups, conducted over 4 months in 2012. Discussions were recorded and transcribed verbatim and coded into themes by content analysis. Six themes contributing to the efficacy of clinical information transference emerged from the data: day-to-day care, patient function, discharge and discharge planning, impact of busy workloads, format and structure of allied health documentation and a holistic approach to patient care. Other professions read and used allied health notes albeit with differences in focus and need. Readers searched for specific pieces of information to answer their own questions and professional needs, in a process akin to purposive sampling. Staff used allied health notes to explore specific aspects of patient function but did not obtain a holistic picture. Improving both the relationship between the various health professions and interpretation of other professions' documented clinical information may reduce the frequency of communication errors, thereby improving patient care.

A retrospective chart audit of electroconvulsive therapy at a regional Australian hospital

The objective of the current study was to provide a contemporary review of electroconvulsive therapy (ECT) practice in Far North Queensland, Australia. Demographic, diagnostic and treatment characteristics were extracted from the hospital files of people who received ECT between 2011 and 2013. Data were quantitatively analysed and described. Depressive illnesses were the most common indicator for treatment. However, psychotic illnesses also made up a large proportion of treated cases. The technical aspects of treatment were commensurate with previous Australian findings except for the higher incidence of bifrontal ECT and maintenance treatment. Further research is needed across Australia to determine whether the findings of the current study represent changes in Australian ECT practice.

Increasing trend in the frequency of sports injuries treated at an Australian regional hospital.

Australian Journal of Rural HealthVolume 25, Issue 2 p. 125-127 Short Report Increasing trend in the frequency of sports injuries treated at an Australian regional hospital Anna Wong Shee BSc(Hons), BAppSci(Phty), PhD, Corresponding Author Anna Wong Shee BSc(Hons), BAppSci(Phty), PhD [email protected] Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation, University Australia, Ballarat, Victoria, AustraliaCorrespondence: Professor Caroline F. Finch Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, PO Box 663, Ballarat, Victoria 3353, Australia. Email: [email protected]Search for more papers by this authorAngela Clapperton BSc, GradDip(Ed Psych), MC, Angela Clapperton BSc, GradDip(Ed Psych), MC Victorian Injury Surveillance Unit (VISU), Monash Injury Research Institute (MIRI), Monash University, Clayton, Victoria, AustraliaSearch for more papers by this authorCaroline F. Finch BSc(Hons), MSc, PhD, Caroline F. Finch BSc(Hons), MSc, PhD orcid.org/0000-0003-1711-1930 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation, University Australia, Ballarat, Victoria, AustraliaSearch for more papers by this author Anna Wong Shee BSc(Hons), BAppSci(Phty), PhD, Corresponding Author Anna Wong Shee BSc(Hons), BAppSci(Phty), PhD [email protected] Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation, University Australia, Ballarat, Victoria, AustraliaCorrespondence: Professor Caroline F. Finch Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, PO Box 663, Ballarat, Victoria 3353, Australia. Email: [email protected]Search for more papers by this authorAngela Clapperton BSc, GradDip(Ed Psych), MC, Angela Clapperton BSc, GradDip(Ed Psych), MC Victorian Injury Surveillance Unit (VISU), Monash Injury Research Institute (MIRI), Monash University, Clayton, Victoria, AustraliaSearch for more papers by this authorCaroline F. Finch BSc(Hons), MSc, PhD, Caroline F. Finch BSc(Hons), MSc, PhD orcid.org/0000-0003-1711-1930 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation, University Australia, Ballarat, Victoria, AustraliaSearch for more papers by this author First published: 17 April 2016 https://doi.org/10.1111/ajr.12274Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume25, Issue2April 2017Pages 125-127 RelatedInformation

Counting the cost of dementia-related hospital admissions: A regional investigation.

At a time of increasing dementia prevalence, this research explores the cost of treatment and length of stay associated with the syndrome in a large regional hospital. Database analysis of 4332 recorded admissions to a large regional Australian hospital among adults aged 55 years and older during winter 2013 and 2014. Costs of hospital treatment and length of stay for people with a diagnosis of dementia who presented to a regional hospital were significantly greater than people with no diagnosis over two years. Costs were unrelated to age or likelihood of death in hospital. Prevalence of dementia admissions was low, but treated conditions indicate that the syndrome may be an underlying, and potentially unrecognised, factor in many admissions. Dementia imposes a large cost and resource burden on a regional hospital. Improved identification of the syndrome on admission and implementation of best-evidence management of dementia in regional hospitals may improve care efficiency.

Management of community-acquired pneumonia in an Australian regional hospital.

Current management of hospitalised patients with community-acquired pneumonia (CAP) in an Australian regional hospital in accordance with the recommended guidelines is unknown. The prescription rate of inappropriate antibiotic therapy was measured and analysed. A retrospective audit, December 2012 to November 2013. Regional Australian hospital in North East Victoria. Interventions were the average of inpatient and intensive care unit length of stay, time to first antibiotic and to first chest X-ray, days of intravenous antibiotics, and extra intravenous therapy; proportion of intensive care unit admissions, average time to first antibiotic administration, patients with failed outpatient management of CAP, initial microbiological investigations, positive investigations, predominant microbiology, antibiotic choice, and concordance with guidelines; proportion of justifiable deviation from guidelines, ratio of patients switched to oral therapy appropriately, complications during therapy, clinical failure, inpatient mortality, mortality at 30 days, mortality at 6 months, and readmission with CAP in 30 days and in 3 months. To improve the rates of concordance with guidelines by following a specified method to rate severity of CAP, to clearly document reasons for non-concordance with guidelines, and to rationalise investigations. To improve antibiotic stewardship in the management of CAP. In an Australian regional hospital, ceftriaxone and azithromycin were the predominant combination used at 56%, demonstrating that mild CAP was frequently overtreated. Mild CAP was eight times more likely to be treated as severe CAP (odds ratio = 8.2 (95% confidence interval, 1.7-40.3) P < 0.009). There is a need for a simple yet effective strategy to be introduced to rationalise treatment and investigation of CAP in this setting.

Appropriate use of echocardiography in an Australian regional centre.

The 2011 Appropriate Use Criteria (AUC) were developed by the American Society of Echocardiography (ASE) to provide guidance for referring physicians in response to growing concerns about unnecessary transthoracic echocardiogram (TTE) requests. When applied in multiple centres overseas, the rate of inappropriate referrals was as high as 22%. To assess the applicability of, and the level of adherence to the 2011 AUC in an Australian regional hospital where the AUC have not been tested systematically. A retrospective analysis of 1000 inpatient and outpatient TTE referrals was conducted between January 2014 and June 2014 at Bendigo Hospital, a major regional referral hospital. Ninety-eight percent of the TTE referrals were classifiable. The most common indication for ordering TTE was to evaluate symptoms potentially related to a cardiac aetiology. Of the classifiable referrals, 77% were appropriate, 20.3% were inappropriate and 2.7% were uncertain. The most common inappropriate indications were routine surveillance of the left ventricular (LV) function in stable chronic cardiac conditions and routine perioperative evaluation of the LV function with no symptoms or signs of cardiovascular disease. Inappropriate referrals were significantly more frequent in outpatients compared with inpatients (24.4% vs 9.6%, P < 0.001). This study provides a novel insight into the ordering of TTEs in regional Australia. In this study, one in five referrals had an inappropriate indication and could be avoided. This may have significant implications for healthcare resources in regional centres, and strategies to reduce inappropriate echocardiography ordering need to be implemented.

A Cross-Sectional Comparison of Health Literacy Deficits Among Patients With Chronic Kidney Disease

Inadequate health literacy in people with chronic kidney disease (CKD) is associated with poorer disease management and greater complications. There are limited data on the health literacy deficits of people with CKD. The aim of this study was to investigate the types and extent of health literacy deficits in patients with CKD using the multidimensional Health Literacy Management Scale (HeLMS) and to identify associations between patient characteristics and the domains of health literacy measured by the HeLMS. Invitations to participate were sent to patients with CKD attending the renal unit of a regional Australian hospital. These patients included predialysis, dialysis (peritoneal and hemodialysis), and kidney transplant patients. This study identified that inadequate health literacy—especially in the domains relating to attending to one's health needs, understanding health information, social support, and socioeconomic factors—was common. Male gender and education level were significantly associated with inadequate health literacy. The type and extent of health literacy deficits varied among CKD groups, and transplant patients had more deficits than other CKD patient groups. This study provides useful information for health professionals treating patients with CKD, especially with regard to the design of self-management interventions and health information.

A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital

ObjectivesReport the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute...

Ex-vivo Renal Artery Reconstruction with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Late Results of 67 Procedures

s 393 of this study is to determine the true incidence and long term outcome of CIN in the optimised CKD population. Methods: Consecutive patients with stage III-V CKD, undergoing peripheral (group 1) or cardiac (group 2) angiography at a single centre regional Australian hospital between 2005 e2015 were included. Patients concurrently dialysing were excluded. All patients underwent pre procedural medical optimisation by a renal physician (intravenous hydration with normal saline, blood pressure control, withholding ACE Inhibitors, Metformin and Frusemide). Low-osmolality non-ionic contrast diluted to 1/3 strength (group 1) or 1/2 strength (group 2) was used. CIN was defined as creatinine rise of>25% from baseline within 72 hours. Primary outcomewas incidence of CIN. Secondary outcomes were mortality at 6 months, progression to dialysis and long term progression of CKD. Results: 537 patients with CKD stage III-V underwent angiography. 222 patients concurrently dialysing were excluded. Median ages (group 1 n 1⁄4 75, Group 2 n 1⁄4 76, P 1⁄4 0.25) were similar; diabetes was more prevalent in group 1 (70.5%) (group 2 1⁄4 48.4%) (P 1⁄4 0.001) and ischaemic heart disease more prevalent in group 2 (60.0%), (Group 1 1⁄4 44.3%) (P 1⁄4 0.02). Median volume of contrast used was significantly lower for group 1 (n 1⁄4 35 mls, range 2.5 e350 mls) compared to group 2 (n 1⁄4 75 mls, range 20e357) (P < 0.001). Combined incidence of CIN was 3.7%. Incidence of CIN did not differ between groups (group 1 1⁄4 4.1%, group 2 1⁄4 3.2%, P 1⁄4 0.74). No patients with CIN died within 6 months. Follow up ranged from 2e73 months. No patient with CIN progressed to higher CKD stage or dialysis. Conclusion: CIN in CKD population is multifactorial and was not related to volume of contrast used. Pre procedural optimisation of CKD patients and low osmolarity contrast agents may reduce incidence of CIN to a level comparable with the general population. CIN in CKD patients does not lead to death or long term disease progression. Ex-vivo Renal Artery Reconstruction with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Late Results of 67 Procedures B. Chavent, A. Duprey, V. Meyer-Bisch, J.N. Albertini, J.P. Favre, X. Barral, J.B. Ricco University of St Etienne Medical School, France Introduction: The objective of this study was to evaluate the long-term outcome of renal revascularization by ex-vivo renal artery reconstruction and autotransplantation for Renal Artery Branch Aneurysms (RABA) in view of preventing aneurysm rupture. Methods: From 1991 to 2014, 67 ex-vivo renal artery reconstructions with kidney autotransplantation were performed in 58 adults (mean age, 41 years) and in 9 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia. The mean diameter of the RABA was 23.4 mm (12e 45 millimetres). Fifty-seven patients were hypertensive and were given a mean of 1.7 antihypertensive drugs per day, 61 patients had normal renal function and no patient was on haemodialysis, 7 patients (10%) were operated after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 15 patients (22.3%). The hypogastric artery was used in 41 patients, the saphenous vein in 18 patients, the superficial femoral artery in 5 patients and a combination of different materials in 3 patients. Outcomes consisted in primary patency rates, antihypertensive medication requirements, renal function and mortality. Late graft patency, renal size, and cortical thickness were analyzed by yearly renal duplex ultrasound examinations. Results: One in hospital death (1.5%) occurred in a patient having undergone complex emergent aortic and renal reconstruction. Other perioperative complications included 4 bypass occlusions and one reoperation for bleeding. During a mean follow up of 9 years, 4 patients (6%) were lost to follow up. No other bypass occlusion occurred, while two bypasses required a percutaneous angioplasty. Primary patency and primary assisted patency were respectively 90% and 92.5% at 9 years. Survival was 94% at 9 years. Among the 57 hypertensive patients, 20 (35%) were cured and 14 (25%) were improved at 9 years with a significant reduction of antihypertensive medications (p < .05). Late renal function was preserved as measured by no change in all but 2 patients in estimated glomerular filtration rate compared with pre-intervention values. In addition, there was no difference in treated kidney size on follow up compared with pre-operative measurements. Conclusion: Ex-vivo renal artery reconstruction for complex renal artery branch aneurysms suppress the risk of rupture, confers a benefit in blood pressure and preserves renal function. Predicting Post-operative Delirium after Vascular Surgical Procedures.

Achieving eating independence in an acute stroke ward: Developing a collaborative care plan

Aim: This article outlines the development and implementation of a collaborative feeding care plan (FCP) for stroke patients in an acute stroke ward. The aim of this pilot study was to evaluate the impact of an ecological intervention to improve eating independence in an acute stroke ward environment. Methods: An action research approach comprising seven stages—determine the initial problem, develop the care plan, act, reflect and monitor progress, evaluate, reflect, and refine plan—was used to track environmental changes during the development and implementation of the FCP in an acute stroke ward in an Australian regional hospital. During the evaluation phase, six allied health staff completed a survey on the FCP. The staff also completed an observation assessment integrating the Eating Disability Scale, Functional Independence Measure and Canadian Occupational Performance Measure with 12 participants with acute stoke (participants with FCP=6; participants without FCP=6). Results: The FCP group showed significant improvements in upper limb independence (p=0.046), when comparing mean admission scores (3.5±0.97) with discharge scores (4.17±2.14). Clinically significant improvements in levels of collaboration between health professionals were also demonstrated. Conclusions: The changes in team collaboration and the patient's upper limb independence indicate how environmental change can influence acute stroke patient outcomes. It is recommended that this study be expanded to further explore the effect of ecological interventions and change.

The Child Illness and Resilience Program (CHiRP): a study protocol of a stepped care intervention to improve the resilience and wellbeing of families living with childhood chronic illness.

BackgroundFamilies of children living with chronic illness are more vulnerable to mental health problems, however this can be ameliorated by a family’s resilience. The Child Illness and Resilience Program (CHiRP) will develop and evaluate a parent-focussed family intervention designed to increase the resilience and wellbeing of families living with childhood chronic illness.Methods/DesignThe study will be conducted in an Australian regional paediatric hospital and will use a stepped care intervention that increases in intensity according to parental distress. All parents of children discharged from the hospital will receive a family resilience and wellbeing factsheet (Step 1). Parents of children attending selected outpatient clinics will receive a family resilience and wellbeing activity booklet (Step 2). Parents who receive the booklet and report psychological distress at three-month follow-up will be randomised to participate in a family resilience information support group or waitlist control (Step 3). The Step 3 control group will provide data to compare the relative effectiveness of the booklet intervention alone versus the booklet combined with the group intervention for distressed parents. These participants will then receive the information support group intervention. All parents in Step 2 and 3 will complete baseline, post-intervention and six month follow up assessments. The primary outcomes of the study will be changes in scores between baseline and follow-up assessments on measures of constructs of family resilience, including parental wellbeing, family functioning, family beliefs and perceived social support. Qualitative feedback regarding the utility and acceptability of the different intervention components will also be collected.DiscussionIt is hypothesised that participation in the CHiRP intervention will be associated with positive changes in the key outcome measures. If effective, CHiRP will provide an opportunity for the health sector to deliver a standardised stepped care mental health promotion intervention to families living with childhood chronic illness.Trial registrationAustralian clinical Trials Registry ACTRN 12613000844741Universal Trial Number (UTN): 1111-1142-8829

Treatment of distal femur fractures in a regional Australian hospital.

To review our outcomes and compare the results of the Less Invasive Stabilization System (LISS) to other implants for distal femur fracture management at a regional Australian hospital. The LISS is a novel implant for the management of distal femur fractures. It is, however, technically demanding and treatment results have not yet been assessed outside tertiary centres. Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically. Outcomes were union, pain, Lysholm score, knee range of motion, and complication rates. Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants. Analysis of the surgical techniques revealed that 11 fractures managed with the LISS were performed according to the recommended principles (LISS-R) and 9 were not (LISS-N). Union occurred in 67.9% of fractures overall: 9/11 (82%) in the LISS-R group vs 5/9 (56%) in the LISS-N group and 5/8 (62.5%) in the alternative implant group. There was no statistically significant difference between pain, Lysholm score, and complication rates between the groups. However, there was a trend towards the LISS-R group having superior outcomes which were clinically significant. There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group (P = 0.0143) and compared with the alternative implant group (P = 0.0454). The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures, but the correct principle of insertion is important in improving the patient's outcome.