Services In NSW Research Articles

An innovative model for delivering culturally safe Mental Health Drug and Alcohol Services in Aboriginal Maternal and Infant Health Services in NSW

In folklore medicine Ananas comosus (pineapple) is reputed to act as an abortifacient and in expectant women as a means of inducing labor.Several reports have claimed abortifacient property of A. comosus fruit (ripe or unripe). Ripe fruit has been used orally as traditional medicine in inducing abortion in Kerala state of India while the juice of unripe fruit was used for abortion in Bangladesh. However, scientific evidence supporting the efficacy of pineapple extracts in inducing uterine contractions is clearly lacking.This study investigated the pharmacological effects of different fractions of pineapple extract with a range of maturities to identify the most potent uterotonic fraction.The ethanolic crude extracts of pineapple (edible part) were prepared and fractionated through a series of liquid-liquid partitions. Fractions were separately tested on isolated uterine muscle from pregnant SD rats and human pregnant myometrium, which were cut into strips along the longitudinal axis of uterus. The strips were mounted vertically in organ baths (37 °C) and exposed to cumulative addition of fractions (0.1–10 mg ml−1), serotonin (0.05–5 µM) and different inhibitors to delineate the mechanism of action of the active ingredients of the extract.Aqueous fraction (F4) possesses uterine stimulant property which was blocked by verapamil but unaffected by indomethacin, prazosin and atosiban. Notably, ketanserin (10 µM) diminished the maximal contractile response induced by both F4 and 5HT by 74.3% and 92.1% respectively.These results may indicate the presence of 5HT or 5HT-like compound(s) and serotonergic pathways may contribute to the uterotonic activity of pineapple extract.

Resettlement as Rebirth: How Effective Are the Midwives?

Resettlement as Rebirth: How Effective Are the Midwives?

The impact of a team-based intervention on the lifestyle risk factor management practices of community nurses: outcomes of the community nursing SNAP trial.

BackgroundLifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs.MethodsThe trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice.ResultsNurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses’ perception of the importance of ‘client and system-related’ barriers to risk factor management diminished over time.ConclusionsThis study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral.Trial registrationACTRN12609001081202

Survey of practices and policies relating to the use of complementary and alternative medicines and therapies in New South Wales cancer services

To examine policies and practices relating to the provision, prescription and monitoring of complementary and alternative medicine and therapies (CAM) in conventional cancer services in NSW. Self-administered questionnaire sent to directors of all 65 eligible cancer services in NSW in 2009. Forty-three services responded to the survey (response rate 66%). Only six (14%) services reported having formal policies about CAM. Most (n = 33, 77%) expected that patients would be asked about CAM use during their initial assessment. Eight services (19%) provided and/or prescribed CAM for patients, and most of these (n = 7) recorded details of CAM use in patients' records. Only four (9%) services permitted CAM practitioners from the community to attend inpatients, whereas 24 (56%) permitted inpatients to bring in their own CAM. Most of these services (n = 17) required medical approval for the use of CAM. Of the latter, most (n = 13) recorded the use of approved CAM, but only seven recorded use of unapproved CAM and only three refused permission to continue use of unapproved CAM. Most cancer services in NSW recognise potential CAM use by patients and expect medical staff to ask patients about their use of CAM. While few cancer services provided or prescribed CAM, over half permitted inpatients to bring their own CAM into hospital. There was little control over the use of CAM, however, and monitoring was lax. Given the wide usage of CAM by patients with cancer, this lack of control may compromise clinical outcomes, with potentially dangerous consequences.

Models of smoking cessation brief interventions in oral health

The links between tobacco smoking, and periodontal disease and oral cancer make the inclusion of smoking cessation interventions at dental visits an important prevention strategy in oral health services. The 5As (Ask, Advise, Assess, Assist, Arrange), which utilises a stages of change model, is the most commonly recognised framework for the provision of smoking cessation brief interventions and is advocated widely. While the popularity of the 5As continues, increasingly evidence suggests that staged-based interventions in smoking cessation may not be the best approach. Lack of time and expertise are also cited by health professionals as barriers to undertaking brief interventions and thus abbreviated forms of the 5As have been advocated. In 2009, NSW Health introduced a mandatory policy for public dental services in NSW to conduct smoking cessation brief interventions at the chairside based on a three-step approach, which is currently being evaluated. Given the debate and the pending evaluation results, this paper reviews models of smoking cessation brief interventions, to contribute to achieving a best practice model for public oral health in NSW.

The information needs of patients with head and neck cancer and their caregivers: A short report of instrument development and testing

PurposeThe study aimed to assess the reliability and scaling assumptions of an information needs questionnaire for patients with head and neck cancer (HNC) and their caregivers. BackgroundPatients with HNC have specific information needs but no tools exist that can simultaneously assess the needs among these patients and their caregivers. MethodsThe Head and Neck Information Needs Questionnaire (HaNiQ) was adapted from a validated information needs questionnaire for breast cancer patients. Participants were recruited from two regionally-defined cancer services in NSW, Australia. Internal consistency reliability was assessed using Cronbach's alpha. Scaling assumptions, specifically item convergent and discriminant validity, were assessed using multi-trait scaling analysis. ResultsThe HaNiQ showed good internal consistency reliability for both patients and caregivers (Cronbach's alpha=0.94 for both) and scaling assumptions were met, with acceptable item convergent and discriminant validity. ConclusionsThe HaNiQ appears reliable, and would benefit from further testing.

S.P.55 Transition and outcomes for young men with Duchenne muscular dystrophy in New South Wales

<h2>Abstract</h2> Duchenne muscular dystrophy (DMD) is a progressive disorder that affects 1 in 3500 males and that typically results in death between 20 and 35years of age from respiratory or cardiac failure. International standards of care have been devised to guide the management of DMD patients. Due to its high incidence in all populations of the world and relatively homogeneous natural history, health outcomes in DMD provide a useful yardstick by which to assess neuromuscular services between regions. There is currently little data available on how males with DMD in NSW, Australia, fare in terms of health outcomes. Such data would provide health service providers important feedback about the effectiveness of neuromuscular services in NSW compared to other populations in Australia and overseas. This study was designed to conduct an audit of all paediatric and adult neuromuscular services in NSW to document the morbidity and mortality of patients with Duchenne muscular dystrophy in NSW in the last 10years, and evaluate their transition experience to adult services. In addition we describe the current range of paediatric and adult neuromuscular services available in NSW and review the literature to identify and evaluate the effectiveness of different transition models that have been developed internationally and within Australia.

Is there scope for community health nurses to address lifestyle risk factors? the community nursing SNAP trial

BackgroundThis paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).MethodsThis was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors.Results804 clients participated (a response rate of 34.1%). Participants had higher rates of obesity (40.5% vs 32.1%) and higher prevalence of multiple risk factors (40.4% vs 29.5%) than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight) risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase) were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition.ConclusionsThere was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice.

Surgical services: shaping future directions

Advances in surgical techniques and anaesthetic practise have facilitated a significant change in the way surgery is currently delivered. In particular, short stay surgery including ambulatory surgery has become the norm for the majority of surgical conditions. However, the planning of surgical services has not always kept pace with nor capitalised on these clinical advances. Like many major urban centres in Australia, the Greater Sydney region is changing, in terms of population growth and configuration of clinical and operational networks. In conjunction with NSW Department of Health, the ministerially appointed Surgical Services Taskforce was tasked with determining the shape and direction of surgery in Greater Sydney over the next 5 to 10 years. Over 400 clinicians either attended hospitals forums or were contacted by the Surgery Futures project team. From the consultations, three models of service delivery were strongly advocated. These were the development of high volume short stay surgery centres, the establishment of specialty centres and the expansion of the streaming of planned and emergency surgery. These three major recommendations will require a significant reorganisation of surgical services in NSW. However, they are also relevant to surgical services planning elsewhere in Australia. It is imperative that these recommendations are incorporated into long term surgical planning in order to improve the efficiency and sustainability of surgical service delivery.

Recruitment and Retention of Community Sector Lawyers: Regional Differences within New South Wales

The Aboriginal Legal Service, Community Legal Centres, Legal Aid NSW and private solicitors undertaking legal aid work all have a role in meeting the legal needs of disadvantaged communities in rural, regional and remote (RRR) parts of NSW. Yet there are reports that staff shortages are affecting the capacity of these services to perform this work — in some areas more than others. In order to gain a ‘snapshot’ of solicitor availability in RRR areas and to assess any regional differences in their availability to undertake community sector legal work in NSW, the Law and Justice Foundation of NSW has undertaken a census of all public legal assistance positions in NSW. The study examined whether the positions were filled or vacant, how they were filled, and the length of time that they were filled (or vacant). The research also drew upon data from the NSW Law Society and the three main public legal services in NSW to map solicitor availability across NSW against a range of indicators, including socio-economic disadvantage. In addition, interviews were conducted with solicitors working in (and who had left) ‘hard to staff’ areas with a view to better understanding differences in the recruitment and retention of solicitors across RRR areas of NSW. The major findings of the Foundation’s full research report are discussed in this paper.&lt;br /&gt;&lt;br /&gt;

Building Consumers in to Service Evaluation: Development of the MH-CoPES Framework in New South Wales

The aim of this paper is to present the Mental Health Consumer Perceptions and Experiences of Services (MH-CoPES) Framework and discuss its development. The Framework was developed to address the need for a consistent approach across New South Wales mental health services for consumer involvement in service evaluation and planning. A four step Framework has been developed for implementation across adult public mental health services in NSW. The Framework focuses not only on collecting consumers' views of mental health services but on ensuring that procedures to report on and make changes based on this information are in place.

The impact of the baby bonus on maternity services in New South Wales

In 2004, the Federal Government introduced the baby bonus, a one-off payment upon the birth of a child. To assess the impact of an increase in the number of births on maternity services in New South Wales following the introduction of the baby bonus payment in July 2004. A population-based study, using NSW birth records, of 965 635 deliveries from 1998 to 2008 was carried out. The difference between the predicted number of births in 2005-2008, estimated from trends in births from 1998 to 2004, and the observed number of births in NSW hospitals in 2005-2008 were calculated. We also estimated the increase in cost to the health system of births in 2008 compared with previous years. Compared with trends prior to the introduction of the baby bonus, there were an estimated 11 283 extra singleton births per year in NSW hospitals by 2008. There were significant increases in the number of deliveries performed in tertiary, urban and rural public hospitals; however, the number of deliveries in private hospitals remained stable. Compared with predicted estimates, in 2008, there were over 8700 more vaginal deliveries, over 1000 more preterm births and over 45 000 extra infant hospital days each year. Compared with 2004, in 2008, the estimated cost of births in NSW hospitals increased by $60 million. The increase in births following the introduction of the baby bonus has significantly impacted maternity services in NSW.

Evaluating paediatric brain injury services in NSW

Rehabilitation professionals strive to provide high-quality evidence-based services for children. Developing systems to measure and monitor the benefits of our services, and health outcomes for children is complex and challenging. The Community Outcome Project aims to introduce systematic outcome measurement across the network of paediatric community-based brain injury services within the New South Wales Brain Injury Rehabilitation Program (BIRP) to support clinical practice and service evaluation. A literature review informed the development of the evaluative framework and identified available paediatric outcome measures which may be appropriate. Extensive consultation with clinicians supported project planning and identified clinical priorities that the outcome measures needed to capture. Outcome measures were shortlisted by matching them to identified clinical priorities, and then trialled in clinical practice. Qualitative feedback regarding clinical utility and feasibility was obtained from clinical staff. The process has utilized change management strategies to ensure the success of the project and keep staff engaged. The process identified the three main clinical priorities for outcome measurement - family functioning, school performance and participation. Three outcome measures were chosen for the pilot project that is currently underway. They are Family Burden of Injury Interview, Academic Competence and Evaluation Scales and Child and Adolescent Scale of Participation. Plans for analyses of outcome data within the paediatric BIRP services are discussed. Extensive preparation is required to optimize staff engagement in a project that systematically introduces outcome measures that are useful to clinicians, clients and service providers. Managing the change required is a key focus of the project. Benefits and costs to clinicians and services will be discussed.

Improvements in hand hygiene across New South Wales public hospitals: Clean hands save lives, Part III

To describe improvements in hand hygiene compliance after a statewide hand hygiene campaign conducted in New South Wales public hospitals. The campaign was conducted in all area health services in NSW (covering all 208 public hospitals). Alcohol-based hand rub (AHR) was introduced into all hospitals between March and June 2006. In each hospital, five overt observation surveys of hand hygiene compliance by health care workers (HCWs) were conducted: one pre-implementation survey and four post-implementation surveys (in August 2006, November 2006, February 2007 and July 2008). Overtly observed hand hygiene compliance rates by HCWs, stratified by before- and after-patient contact, Fulkerson's contact risk categories, and four health care professional groupings. The overall hand hygiene compliance rate improved from 47% before the intervention to an average of 61% over the last three observation periods (P < 0.001). All professional groups sustained improved compliance rates except medical staff, whose practices reverted to pre-intervention rates. Nursing staff maintained significantly improved compliance, with an average rate of 67% after the intervention. Overall hand hygiene compliance before patient contact improved from 39% (pre-campaign) to 52% (July 2008) (P < 0.001). Overall compliance after patient contact improved from 57% to 64% (P < 0.001) over the same period. Compliance associated with medium-risk contacts increased from an average of 51% in the first two observation periods to an average of 62% over the last three observation periods (P < 0.001). The corresponding compliance rates associated with low-risk contacts were 35% and 56%, respectively (P < 0.001). An overall improvement in hand hygiene rates was achieved with the introduction of AHR. Increased adherence to before-patient contact compliance, especially by nursing staff, contributed to the progress made, but an acceptable overall level of hand hygiene practice is yet to be achieved. It is now time to focus on a long-term behavioural change program directed specifically at medical staff.

‘The More Things Change …’: Bail and the Incarceration of Homeless Young People

Homeless young people are being held in remand despite being granted bail because the Department of Community Services cannot or will not find the young person accommodation, and there is no legally enforceable obligation on the Department to so. This practice is not new. Two rounds of amendments to the Bail Act 1978 (NSW) sought to steer young homeless people away from remand yet they have failed to have their intended effect. By failing to provide young homeless people with an alternative to detention the NSW Government is in breach of a number of fundamental principles of the criminal law, juvenile justice and child protection, as recognised in the United Nations Convention on the Rights of the Child, and other international human rights instruments. In its much anticipated report, the Special Commission of Inquiry into Child Protection Services in NSW recommends the establishment of bail support schemes similar to those in Victoria and Queensland, but misses the opportunity to recommend law reform which would squarely place the obligation on the state to provide accommodation for these young people.

Report of the Special Commission of Inquiry into Child Protection Services in New South Wales (the Wood Report): a review and commentary

The Wood Report is the product of a special commission of inquiry into child protection services in NSW that was set up in June 2006 and reported in November 2008. In March 2009, the NSW Government published a response to the report, 'Keep then safe: a shared approach to child wellbeing'. The NSW Parliament in April 2009 also passed the Children Legislation Amendment (Wood Inquiry Recommendations) Act 2009 with little debate. This legislation has introduced many of Justice Wood's recommendations and has enacted other changes that were not included in the Commission of Inquiry report. While many of the amendments are welcome, there is a cause for concern about the likely consequences of some of the new provisions.

Another opportunity for prevention: assessing alcohol use by women attending breast screening services in Lismore, NSW

Substantial epidemiological evidence supports the association between alcohol consumption and the risk of breast cancer; however, information on alcohol consumption is not routinely collected by breast screening services in NSW. This study was conducted to investigate the level of self-reported alcohol use among women accessing North Coast Breast Screen in Lismore, NSW. Two hundred and sixty-four consecutive women were screened using the Alcohol Use Disorders Identification Test. Their drinking status was categorised as low risk, risky or high risk. Two-thirds of the screened women (69.7%) were classified as low-risk drinkers; 9.8% as risky and 0.4% as high-risk drinkers. Although the risk of breast cancer increases with the amount of alcohol consumed, evidence suggests that even low-risk drinking is associated with increased risk of breast cancer. Implications for prevention activities by breast screening services are discussed.

Report of the Special Commission of Inquiry into Child Protection Services in New South Wales (the Wood Report): A review and commentary

The Wood Report is the product of a Special Commission of Inquiry into Child Protection Services in NSW that was set up in June 2006 and reported in November 2008. In March 2009, the NSW Government published a response to the report, ‘Keep them safe: A shared approach to child wellbeing’. The NSW Parliament in April 2009 also passed the Children Legislation Amendment (Wood Inquiry Recommendations) Act 2009 with little debate. This legislation has introduced many of Justice Wood's recommendations and has enacted other changes that were not included in the Commission of Inquiry report. While many of the amendments are welcome, there is cause for concern about the likely consequences of some of the new provisions.

Tracking patient journeys to enhance service development and resource allocation

NSW Health is undertaking the community health and outpatient care information project (CHOCIP), which will develop a patient-level data collection across selected services in NSW. It is the largest project of its type attempted in Australia and will result in the collection of 25 million unit records describing services provided in community health and outpatient care. The business rules of the sub-project are aimed at developing a structure for collecting data on the interactions that a patient has with the public health system in respect of a set of related problems or issues. The rules will allow the resultant patient-level data to be used to analyse patient journeys through the health services system in support of planning, service development and resource allocation processes.

Can short lists facilitate the collection of data on diagnosis, intervention and presenting issue in community health and outpatient care services?

NSW Health is undertaking the community health and outpatient care information project (CHOCIP), which will develop a patient level data collection across all community health and outpatient care services in NSW. It is the largest project of its type ever attempted in Australia and, when complete, will result in the collection of some 25 million unit records describing the services provided in community health and outpatient care settings. A key CHOCIP sub-project is to develop short lists, in consultation with clinicians, that represent the 10–20 most common values in the data domain for the data elements diagnosis, intervention and presenting issue for each of the defined 130 service types in community health and outpatient care. The reason for the development of these short lists is to avoid the use of clinical coders to retrospectively code the three data elements.