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BACKGROUND: Sedation at the end of life is used to relieve distressing symptoms including agitation and delirium. Standard care may include infused benzodiazepines or antipsychotics. These agents often result in deep sedation with loss of interaction with loved ones, which may be distressing. OBJECTIVE: The DREAMS (Dexmedetomidine for the Reduction of End-of-life Agitation and for optiMised Sedation) trial aimed to compare the sedative and antidelirium effects of the alpha-2 agonist dexmedetomidine, a novel palliative care sedative, compared with midazolam, a benzodiazepine when administered by subcutaneous infusion at the end of life, with doses of both agents targeting lighter, or potentially interactive sedation. METHODS: Participants were recruited from adult inpatients admitted for end-of-life care under a palliative care team in regional New South Wales, Australia. Inclusion criteria included patients older than 18 years, with a preference for lighter sedation at the end of life. Exclusion criteria included severe cardiac dysfunction (contraindication to dexmedetomidine). Participants consented and were placed on a treatment-pending list. Upon experiencing terminal deterioration, patients were randomized to either arm 1 (dexmedetomidine) or arm 2 (midazolam) as their treatment arm. These treatments were administered by continuous subcutaneous infusion. The level of consciousness and agitation of the patients were measured by the Richmond Agitation-Sedation Scale-Palliative version and the Memorial Delirium Assessment Score. Richmond Agitation-Sedation Scale-Palliative version assessments were performed by both nursing and medical staff, while Memorial Delirium Assessment Score assessments were carried out by medical staff only. Families and patients were asked to complete, as able, a patient comfort assessment form, to gauge perceptions of distress. Data were collected and matched with the breakthrough medication doses administered, along with qualitative comments in the medical record. In addition, the study tracked symptoms and patient functional status that were recorded as part of the Palliative Care Outcomes Collaborative, a national tracking project for monitoring symptom outcomes in palliative care. RESULTS: The DREAMS trial was funded in May 2020, approved by the ethics committee in November 2020, and started recruiting participants in May 2021. Data collection commenced in May 2021 and is anticipated to continue until December 2024. Publication of results is anticipated from 2024 to 2026. CONCLUSIONS: The evidence base for sedative dosing in palliative care for distress and agitation is not robust, with standard care based primarily on clinical experience and not robust scientific evidence. This study is important because it will compare a standard and a novel sedative used in end-of-life treatment. By assessing the potential efficacy and benefits of both, it seeks to optimize the quality of dying by providing targeted sedation that can improve the communication between dying patients and their loved ones. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Register ACTRN12621000052831; https://uat.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55129.
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Dexmedetomidina , Hipnóticos y Sedantes , Midazolam , Agitación Psicomotora , Cuidado Terminal , Dexmedetomidina/administración & dosificación , Dexmedetomidina/uso terapéutico , Humanos , Hipnóticos y Sedantes/uso terapéutico , Hipnóticos y Sedantes/administración & dosificación , Midazolam/uso terapéutico , Midazolam/administración & dosificación , Agitación Psicomotora/tratamiento farmacológico , Cuidado Terminal/métodos , Masculino , Femenino , Cuidados Paliativos/métodos , Adulto , Persona de Mediana Edad , Anciano , Nueva Gales del SurRESUMEN
Background General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences - whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods Cross-sectional analyses of data (2016-2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation.
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Medicina General , Servicios de Salud Rural , Humanos , Estudios Transversales , Femenino , Masculino , Adulto , Persona de Mediana Edad , Servicios de Salud Rural/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Nueva Gales del Sur , Anciano , Servicios Urbanos de Salud/estadística & datos numéricos , Adolescente , Adulto Joven , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Australia , Población Rural/estadística & datos numéricos , Niño , Territorio de la Capital Australiana , Preescolar , LactanteRESUMEN
BACKGROUND: Many Australian adults are not receiving timely or effective diabetes management to prevent or delay the onset of diabetes related complications. Integrated care, a worldwide trend in healthcare reform, aims to reduce the fragmented delivery of health services and improve outcomes. This study aimed to test whether a specialist-led integrated model of care provided to a small subset of patients in general practices leads to spillover clinical improvements in all patients of the practice with type 2 diabetes. METHODS: Seventy-two general practice sites (clusters) in New South Wales, Australia received the Diabetes Alliance intervention, creating a non-randomised open cohort stepped wedge trial. The intervention comprised of case conferencing, delivered directly to a small proportion of adults with type 2 diabetes (n = 1,072) of the general practice sites; as well as practice feedback, education and training. Spillover clinical improvements were assessed on all adults with type 2 diabetes within the general practice sites (n = 22,706), using practice level data recorded in the MedicineInsight electronic database, compared before and after the intervention. Outcome measures included frequency of diabetes screening tests in line with the Annual Cycle of Care, and clinical results for weight, blood pressure, HbA1c, lipids, and kidney function. RESULTS: Compared to before Diabetes Alliance, the odds of all practice patients receiving screening tests at or above the recommended intervals were significantly higher for all recommended tests after Diabetes Alliance (odds ratio range 1.41-4.45, p < 0.0001). Significant improvements in clinical outcomes were observed for weight (absolute mean difference: -1.38 kg), blood pressure (systolic - 1.12 mmHg, diastolic - 1.18 mmHg), HbA1c (-0.03% at the mean), total cholesterol (-0.11 mmol/L), and triglycerides (-0.02 mmol/L) (p < 0.05). There were small but significant declines in kidney function. CONCLUSIONS: Integrated care delivered to a small subset of patients with type 2 diabetes across a large geographic region has spillover benefits that improve the process measures and clinical outcomes for all practice patients with type 2 diabetes. TRIAL REGISTRATION: ACTRN12622001438741; 10th November 2022, retrospectively registered: https://www.anzctr.org.au/ACTRN12622001438741.aspx .
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Prestación Integrada de Atención de Salud , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/terapia , Masculino , Femenino , Persona de Mediana Edad , Anciano , Australia/epidemiología , Adulto , Estudios de Cohortes , Nueva Gales del Sur/epidemiología , Medicina General , Estudios de Seguimiento , Pueblos de AustralasiaRESUMEN
BACKGROUND: Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities. OBJECTIVE: The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants' acceptability of the chest biosensor. METHODS: The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor's ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study. RESULTS: As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing. CONCLUSIONS: This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor's potential step forward in real-time intervention strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57367.
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Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Sobredosis de Droga/diagnóstico , Sobredosis de Opiáceos/epidemiología , Sobredosis de Opiáceos/diagnóstico , Adulto , Persona de Mediana Edad , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/administración & dosificación , Técnicas Biosensibles/instrumentación , Técnicas Biosensibles/métodos , Estudios Observacionales como Asunto , Nueva Gales del Sur/epidemiología , Insuficiencia Respiratoria/diagnósticoRESUMEN
INTRODUCTION: Patient-reported outcome measures (PROMs) are validated and standardised questionnaires that capture patients' own reports of their symptoms, functioning and well-being. PROMs can facilitate communication between patients and clinicians, reduce symptom burden, enhance quality of life and inform health service re-design. We aim to determine the acceptability of PROMs and the preferred timing of PROM completion in New South Wales (NSW) at the point of care, facilitated by the Health Outcomes and Patient Experiences (HOPE) platform. METHODS AND ANALYSIS: Semi-structured interviews with patients (~50-75, sampling across seven language groups and seven clinical cohorts), carers (~10-20) and clinicians (~18) enrolled in HOPE will be conducted via videoconference, telephone or in person. Participants will be asked questions about (1) what makes PROMs acceptable for use in chronic disease management (2) when patients would prefer to complete PROMs and when clinicians would like to use PROMs for clinical decision-making and (3) factors that impede the acceptability of PROMs for culturally and linguistically diverse patients. Interviews will be analysed using a reflexive thematic approach, guided by Normalisation Process Theory. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Sydney Local Health District Human Research Ethics Committee (SLHD HREC, Study Protocol #X24-0138). Results will be published in appropriate peer-reviewed journals, presented at conferences, disseminated to participants in the form of a plain language summary, and widely disseminated to consumer groups and professional stakeholders.
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Medición de Resultados Informados por el Paciente , Investigación Cualitativa , Humanos , Enfermedad Crónica , Nueva Gales del Sur , Calidad de Vida , Diversidad Cultural , Proyectos de Investigación , Factores de Tiempo , Femenino , Persona de Mediana Edad , Masculino , Lenguaje , Entrevistas como AsuntoRESUMEN
BACKGROUND: Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia. METHODS: This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation. RESULTS: Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness. CONCLUSION: African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.
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Alfabetización en Salud , Accesibilidad a los Servicios de Salud , Atención Primaria de Salud , Investigación Cualitativa , Refugiados , Humanos , Refugiados/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , África/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Nueva Gales del Sur , Adulto Joven , Australia , Anciano , Pueblo AfricanoRESUMEN
BACKGROUND: The effectiveness of the NSW Health "Get Healthy Information and Coaching Service®"(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. METHODS: Men and women aged 40-70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the "Zinc In Preventing the Progression of pre-Diabetes" (ZIPPeD) trial (ACTRN12618001120268). RESULTS: The self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol. CONCLUSIONS: The potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program's effectiveness and cost-effectiveness.
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Medicina General , Humanos , Persona de Mediana Edad , Masculino , Femenino , Adulto , Anciano , Nueva Gales del Sur , Teléfono , Tutoría/métodos , Promoción de la Salud/métodos , Evaluación de Programas y Proyectos de Salud , Pérdida de Peso , Conductas Relacionadas con la Salud , Índice de Masa Corporal , Ejercicio FísicoRESUMEN
This commentary outlines the development of an Inclusion Collaborative in a large health district in Sydney, New South Wales Australia. The Collaborative grew out of ongoing efforts to reduce stigma associated with blood borne viruses while recognising that there are many health conditions and situations where people feel judged when attending services for health care. The formation of the Collaborative drew in health workers in other sectors to create a critical mass of voices calling for stigma reduction, move beyond siloed responses to stigma and to reframe conversations about stigma to a more positive description of "inclusion". The involvement of consumer representatives (paid for their time) was a key principle of the Collaborative. The members of the Collaborative identified the common experience of their clients being 'othered' by the mainstream services and that services can be unwelcoming or not supportive of difference, and therefore create a significant barrier to accessing healthcare. The group considered ways to highlight these issues among colleagues from mainstream services and community members who were not 'othered'. The Collaborative designed and carried out a range of activities including a Festival of Inclusion, a series of seeding grants for staff and consumer-focused initiatives, promotion of diversity days and an audit of compliance with strategic priorities. The Inclusion Collaborative is an example of a structured approach for efforts to reducing stigma that draws on the ambitions of many parts of a large, complex public health service to deliver better outcomes for its staff and consumers.
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Estigma Social , Humanos , Nueva Gales del Sur , Conducta Cooperativa , Accesibilidad a los Servicios de SaludRESUMEN
BACKGROUND: Online food delivery services (OFDS) enable individuals to conveniently access foods from any deliverable location. The increased accessibility to foods may have implications on the consumption of healthful or unhealthful foods. Concerningly, previous research suggests that OFDS offer an abundance of energy-dense and nutrient-poor foods, which are heavily promoted through deals or discounts. OBJECTIVE: In this paper, we describe the development of the DIGIFOOD dashboard to monitor the digitalization of local food environments in New South Wales, Australia, resulting from the proliferation of OFDS. METHODS: Together with a team of data scientists, we designed a purpose-built dashboard using Microsoft Power BI. The development process involved three main stages: (1) data acquisition of food outlets via web scraping, (2) data cleaning and processing, and (3) visualization of food outlets on the dashboard. We also describe the categorization process of food outlets to characterize the healthfulness of local, online, and hybrid food environments. These categories included takeaway franchises, independent takeaways, independent restaurants and cafes, supermarkets or groceries, bakeries, alcohol retailers, convenience stores, and sandwich or salad shops. RESULTS: To date, the DIGIFOOD dashboard has mapped 36,967 unique local food outlets (locally accessible and scraped from Google Maps) and 16,158 unique online food outlets (accessible online and scraped from Uber Eats) across New South Wales, Australia. In 2023, the market-leading OFDS operated in 1061 unique suburbs or localities in New South Wales. The Sydney-Parramatta region, a major urban area in New South Wales accounting for 28 postcodes, recorded the highest number of online food outlets (n=4221). In contrast, the Far West and Orana region, a rural area in New South Wales with only 2 postcodes, recorded the lowest number of food outlets accessible online (n=7). Urban areas appeared to have the greatest increase in total food outlets accessible via online food delivery. In both local and online food environments, it was evident that independent restaurants and cafes comprised the largest proportion of food outlets at 47.2% (17,437/36,967) and 51.8% (8369/16,158), respectively. However, compared to local food environments, the online food environment has relatively more takeaway franchises (2734/16,158, 16.9% compared to 3273/36,967, 8.9%) and independent takeaway outlets (2416/16,158, 14.9% compared to 4026/36,967, 10.9%). CONCLUSIONS: The DIGIFOOD dashboard leverages the current rich data landscape to display and contrast the availability and healthfulness of food outlets that are locally accessible versus accessible online. The DIGIFOOD dashboard can be a useful monitoring tool for the evolving digital food environment at a regional scale and has the potential to be scaled up at a national level. Future iterations of the dashboard, including data from additional prominent OFDS, can be used by policy makers to identify high-priority areas with limited access to healthful foods both online and locally.
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Abastecimiento de Alimentos , Nueva Gales del Sur , Humanos , Abastecimiento de Alimentos/estadística & datos numéricos , Abastecimiento de Alimentos/normas , Abastecimiento de Alimentos/métodos , InternetRESUMEN
OBJECTIVES: The Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures of cognition, in adults at high risk of dementia. DESIGN: A decentralised double-blind, placebo-controlled, randomised feasibility trial with a four-stage screening process. SETTING: Conducted with participants online in the state of New South Wales, Australia. PARTICIPANTS: Participants were aged 50-70 years with moderately elevated BP (systolic >120 and <160 mm Hg or diastolic >80 and <95 mm Hg) and ≥1 additional enrichment risk factor of monotherapy treatment of hypertension, diabetes mellitus, elevated low-density lipoprotein cholesterol, obesity, current smoking or a first degree relative with dementia, which indicated an elevated risk for future cognitive decline. INTERVENTION: Triple Pill (active antihypertensive treatment of telmisartan 20 mg, amlodipine 2.5 mg and indapamide 1.25 mg) or placebo Triple Pill (blinded study capsules). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was feasibility of the study expressed as the percentage of participants randomised from those who were screened. Secondary outcomes were the applicability of videoconference measures of cognition and the overall trial, tolerability of the Triple Pill, safety outcomes and medication adherence. RESULTS: The proportion (95% CI) of patients randomised to those screened was 5% (2%-10%). The applicability of the trial expressed as percentage of those who completed all remote assessments over the number of randomised participants was 67% (95% CI 05 to 22%). There were no serious adverse events or withdrawals from treatment. All participants adhered to study medication, except for one person who had two capsules left at the end of the study period. CONCLUSIONS: The feasibility of this decentralised trial on BP lowering in patients at high risk for dementia is low. However, the applicability of remote assessments of cognitive function is acceptable. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000121864.
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Antihipertensivos , Disfunción Cognitiva , Estudios de Factibilidad , Hipertensión , Humanos , Persona de Mediana Edad , Antihipertensivos/uso terapéutico , Antihipertensivos/administración & dosificación , Masculino , Femenino , Anciano , Hipertensión/tratamiento farmacológico , Método Doble Ciego , Disfunción Cognitiva/tratamiento farmacológico , Telmisartán/uso terapéutico , Telmisartán/administración & dosificación , Nueva Gales del Sur , Amlodipino/administración & dosificación , Amlodipino/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Bencimidazoles/uso terapéutico , Bencimidazoles/administración & dosificación , Demencia/tratamiento farmacológico , Factores de Riesgo , Combinación de Medicamentos , Presión Sanguínea/efectos de los fármacosRESUMEN
OBJECTIVES: To describe and compare the incidence and trends of workers' compensation (WC) claims for psychological injury: (1) between health and social care (HSC) industry and other industries; (2) among specific occupations in the HSC industry; and (3) to determine if psychological injury claim rates differ by age and gender in the HSC industry and among specific occupations. METHODS: A retrospective cohort study was conducted using data from the New South Wales WC system. Workers with accepted psychological injury claims between July 2012 and June 2021 were included. Negative binomial regression models were employed to estimate incidence rate ratios and 95% CIs. RESULTS: The HSC industry had a higher incidence (2.4 per 1000 workers) than all other industries combined (1.1 per 1000 workers). In the HSC industry, the incidence increased from 1.8 in 2013-2015 to 3.4 in 2019-2021. Ambulance officers had the highest incidence (24.9 per 1000 workers) and the highest growth rate. Nurses and midwives, and aged and disability care workers also had fast-growing incidence over the 9 years. Risk of psychological injury claims was highest among female workers and older adults. CONCLUSIONS: The increasing incidence and trend of psychological injury claims among HSC workers in New South Wales signify a growing public health issue. Greater efforts are needed to prevent work-related psychological injury in the HSC industry and support affected workers. The different patterns of psychological injury claims across occupations suggest that interventions should be tailored to each occupational group.
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Personal de Salud , Indemnización para Trabajadores , Humanos , Indemnización para Trabajadores/estadística & datos numéricos , Nueva Gales del Sur/epidemiología , Femenino , Estudios Retrospectivos , Masculino , Incidencia , Adulto , Persona de Mediana Edad , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Trabajadores Sociales/psicología , Factores de Riesgo , Anciano , Adulto Joven , Traumatismos Ocupacionales/epidemiología , Traumatismos Ocupacionales/psicologíaRESUMEN
PURPOSE: There is limited evidence regarding the impact of public health restrictions on hip fracture hospitalization by place of fracture occurrence. This study aimed to examine the impact of COVID-19 public health restrictions on fall-related hip fracture hospitalization rates by place of occurrence. METHODS: This retrospective cohort study was conducted using hospitalization data in New South Wales, Australia, between January 2014 and June 2022. Older adults aged ≥65 years admitted to hospital following a fall-related hip fracture. An interrupted time-series analysis using autoregressive integrated moving average models evaluated the impact of public health restrictions on fall-related hip fracture hospitalization by place of fracture occurrence (home/residence, residential aged care facility (RACF), or away from usual residence). RESULTS: The mean observed fall-related hip fracture hospitalization rate during COVID-19 public health restrictions (36.3 per 100,000 people per month) was 13.4 % lower than the forecasted rate (41.1 per 100,000 people per month). The mean observed hospitalization rates for fall-related hip fractures at home/residence, at a RACF, and away from the usual residence were 3.8 %, 18.5 %, and 40.1 % lower than the forecasted rates, respectively. Level changes in the fall-related hip fracture hospitalization rates at RACFs and away from usual residences were -0.9 per 100,000 people per month (95 % CI -1.6 to -0.2) and -1.7 per 100,000 people per month (95 % CI -2.5 to -0.9), respectively. CONCLUSIONS: There was a decline in fall-related hip fracture hospitalization rates among older adults, where the fracture occurred at RACFs and away from a person's usual residence during COVID-19 public health restrictions.
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Accidentes por Caídas , COVID-19 , Fracturas de Cadera , Hospitalización , Análisis de Series de Tiempo Interrumpido , Salud Pública , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Fracturas de Cadera/epidemiología , Hospitalización/estadística & datos numéricos , Accidentes por Caídas/estadística & datos numéricos , Accidentes por Caídas/prevención & control , Anciano , Femenino , Masculino , Anciano de 80 o más Años , Estudios Retrospectivos , SARS-CoV-2 , Nueva Gales del Sur/epidemiologíaRESUMEN
Anthropogenic noise has been identified as one of the most harmful forms of global pollutants impacting both terrestrial and aquatic ecosystems. As global populations continue to increase, coastlines are seeing substantial increases in the level of urbanisation. Although measures are in place to minimise stress on fauna, they rarely consider the impact of anthropogenic noise. In Australia, New South Wales (NSW) estuaries have seen extensive increases in urbanisation in recent years. Yet, there remains minimal baseline data on their soundscapes to determine if noise pollution is a threat. This research provides a first assessment of baseline sounds across a temporal and seasonal scale. Recreational boating was the primary soundscape contributor in estuaries, and estuaries with higher urbanisation levels contained higher sound levels. This research provides useful information for managers of NSW estuaries and is of global relevance in an era of increasing generation of anthropogenic noise in estuarine and coastal systems.
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Monitoreo del Ambiente , Estuarios , Ruido , Navíos , Urbanización , Nueva Gales del Sur , Ecosistema , SonidoRESUMEN
INTRODUCTION: 20 years ago, health professional student placements in rural areas of Australia were identified as an important rural recruitment strategy and funding priority. Since then, there has been a growing body of research investigating the value, impact, barriers and facilitators of student placements in rural areas of Australia. Charles Sturt University, Three Rivers Department of Rural Health, was recently awarded an Australian Government grant to expand their Rural Health Multidisciplinary Training (RHMT) programme, designed to increase multi-disciplinary student placements in rural areas of New South Wales (NSW), Australia. The aim of this study is to determine if the expanded RHMT has a positive social return on investment (SROI). METHODS AND ANALYSES: The RHMT Programme will expand into the Forbes/Parkes/Lachlan local government areas of NSW where there is a population of 21 004 people, including 3743 First Nations peoples. Data collection includes collecting programme outputs, programme costs and conducting surveys and interviews with students, host organisations, supervisors and community members including First Nations peoples. The SROI will quantify the 'investment' required to implement the RHMT programme, as well as the 'social return' on the RHMT programme from the student, organisational, supervisor and community perspectives. The SROI will compare the combined cost with the combined return, from a societal perspective, including a 3-year time horizon, with cost data presented in $A 2024/25. DISCUSSION: The findings of this SROI study may influence future Australian government investment in RHMT as a mechanism for supporting rural allied health recruitment and for investing in the local rural economy. ETHICS AND DISSEMINATION: This study has been approved by the Charles Sturt University Human Research Ethics Committee (#H23589) and the Aboriginal Health and Medical Research Council of New South Wales (#2130/23). Results will be disseminated via a peer-review journal publication, as well as conference presentations.
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Servicios de Salud Rural , Humanos , Nueva Gales del Sur , Servicios de Salud Rural/economía , Análisis Costo-Beneficio , Técnicos Medios en Salud/educación , Evaluación de Programas y Proyectos de Salud , UniversidadesRESUMEN
The New South Wales Biocontainment Centre is a statewide referral facility for patients with high-consequence infectious disease (HCID). The facility collaborates with researchers to adapt existing HCID procedures such as donning and doffing of personal protective equipment (PPE). However, information on how to respond safely to collapse of a healthcare provider in full PPE within a contaminated zone is scarce. To address this gap, we adapted Nebraska Medicine's "provider down" protocol on paper and then simulated and video recorded the process, iteratively, in the facility. Clinicians analyzed the recordings collaboratively in researcher-facilitated reflexive discussions. Our primary aim was to ascertain how to maintain optimal infection prevention and control while providing urgent care for the healthcare provider. We tested participants' suggested modifications, in repeated video recorded simulations, until consensus on optimal practice was achieved. Our secondary aim was to assess the utility of video-reflexive methods to enhance clinicians' awareness and understanding of infection prevention and control in a rare and complex scenario. Six adaptations and simulations were discussed in video-reflexive sessions before consensus was reached; the final version of the protocol differed considerably from the first. Viewing footage of simulations in situ enabled participants to (1) identify infection and occupational risks not identified on paper or during verbal postsimulation debriefs and (2) test alternative perspectives on safe procedure. Video-reflexivity enables context-sensitive and consensus-building codesign of policies and procedures, critical to protocol development in a new unit. It contributes to a culture of teamwork, preparedness, and confidence before, rather than in the heat of, a crisis.
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Equipo de Protección Personal , Humanos , Nueva Gales del Sur , Grabación en Video , Control de Infecciones/métodos , Personal de Salud , Contención de Riesgos Biológicos/métodosRESUMEN
The platypus (Ornithorhynchus anatinus) is a semi-aquatic monotreme that occupies a high trophic position in the freshwater ecosystems of eastern mainland Australia and Tasmania. Platypuses are continuously exposed to anthropogenic contaminants including perfluorooctane sulfonate (PFOS). This study examined PFOS concentrations in the livers of deceased platypuses (eight wild; one captive) that were opportunistically collected across NSW over a two- and a half-year period. There was a large variation in PFOS concentrations, ranging from < 1 µg/kg to 1200 µg/kg. This study presents the first report of PFOS contamination in platypuses, revealing their PFOS levels are broadly similar to those found in river otters (Lutra canadensis) and lower than those in American mink (Mustela vison), both which occupy similar ecological niches in freshwater systems. This study raises concerns about the impact of PFOS on platypus health.
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Ácidos Alcanesulfónicos , Monitoreo del Ambiente , Fluorocarburos , Contaminantes Químicos del Agua , Animales , Nueva Gales del Sur , OrnitorrincoRESUMEN
Archaea play a crucial role in the global biogeochemical cycling of elements and nutrients, helping to maintain the functional stability of estuarine systems. This study characterised the abundance and diversity of archaeal communities and identified the environmental conditions shaping these microbial communities within six temperate estuaries along approximately 500 km of the New South Wales coastline, Australia. Estuarine sediments were found to exhibit significantly higher species richness than planktonic communities, with representative sequences from the Crenarchaeota phylum characterising each environment. Ordinate analyses revealed catchment characteristics as the strongest drivers of community variability. Our results also provide evidence supporting distance-decay patterns of archaeal biogeography across intermediate scales within and between temperate estuaries, contributing to a growing body of evidence revealing the extent spatial scales play in shaping microbial communities. This study expands our understanding of microbial diversity in temperate estuaries, with a specific focus on archaeal community structure and their role in maintaining ecosystem stability.
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Archaea , Biodiversidad , Estuarios , Archaea/genética , Nueva Gales del Sur , Sedimentos Geológicos/microbiología , Ecosistema , Agua de Mar/microbiología , Agua de Mar/química , FilogeniaRESUMEN
BACKGROUND: Shellfish reef restoration is relatively new in Australia, particularly to intertidal estuarine environments. In late 2019/early 2020 the first large-scale shellfish reef restoration project of the Sydney rock oyster, Saccostrea glomerata was undertaken in the Myall and Karuah Rivers, Port Stephens, on the mid north coast of New South Wales (NSW), Australia. The present study aimed to determine whether locally sourced clean conspecific oyster shells, and/or locally quarried rocks were better for natural recruitment of natural S. glomerata for large-scale oyster reef restoration, and subsequent recruitment of fishes and invertebrates. Over two years, recruitment of S. glomerata spat, and associated fishes and invertebrates were assessed on reefs made of: (1) rock, and (2) rock and shell. RESULTS: The mean (± SE) density of oyster spat on rock reefs (Myall River: 1790 ± 48, Karuah River: 1928 ± 68) was significantly greater (Myall River: ANOVA Si: MS 2, 18 = 31080167, F = 96.05, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 2965449, F = 5.99, P < 0.001) than on rock and shell reefs (Myall River: 840 ± 40, Karuah River: 1505 ± 75). Rock reefs had significantly greater densities (Myall River: ANOVA Si x Ti: MS 18, 270 = 15657, F = 2.71, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 20322, F = 5.25, P < 0.001) of the most abundant invertebrate, Bembicium auratum (Myall River: 85 ± 9, Karuah River: 100 ± 8) than reefs of rock and shell (Myall River: 59 ± 8, Karuah River: 44 ± 5), but there was no significant difference in the diversity and relative abundance of the most abundant species of fish, Acanthopagrus australis. CONCLUSIONS: This study demonstrates that using locally sourced rock is better for S. glomerata recruitment than shells. Although shell might have benefits that were not investigated in the present study, such as elicit greater social licence for oyster reef restoration projects, but as shown here, it may not be beneficial from an ecological perspective. With the global expansion of the range of different native species of reef oysters for restoration, the appropriate material used for reef bases needs to be chosen for a specific species and purpose.
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Arrecifes de Coral , Ostreidae , Animales , Nueva Gales del Sur , Restauración y Remediación Ambiental/métodos , Conservación de los Recursos Naturales/métodos , PecesRESUMEN
BACKGROUND: Addressing Patient Reported Outcomes (PROs) is essential for patient-centred care, shared decision making and improved health outcomes. Value-based health care systems in New South Wales (NSW) have a growing focus on collecting and using PROs that matter most to patients to improve their healthcare outcomes. Developing oral health patient reported outcomes measures (OH-PROM) is a first step towards value-based oral health care. This paper describes the development process of an adult and child OH-PROM tool that can be piloted for NSW public dental patients. METHODS: An expert panel was assembled to undertake a systematic process of developing OH-PROMs for NSW Health. Key methodological considerations included: (1) forming an expert panel to specify the target population and context of implementation, (2) rapid literature review and environmental scan to identify existing validated OH-PROM tools for adults and children. (3) consensus gathering with the expert panel (4) consumer feedback, and (5) finalisation of the tool for electronic oral health record (eOHR) integration to establish a set of questions, that were relevant, context-appropriate, and important to oral healthcare outcomes for patients using public dental services. RESULTS: The panel considered a total of 59 questions from two child (15), and four adult (44) Oral Health Related Quality of Life (OHRQoL) questionnaires used to collect OH-PROMs. These questions were mapped to the four key dimensions of OHRQoL for OH-PROMs: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The consensus resulted in seven questions that aligned with these four dimensions to form two new NSW OH-PROM tools: one for adults and one for children. The tools were tested with consumers for understandability and usefulness before being incorporated into the electronic oral health record system, in readiness for future pilot testing. CONCLUSION: The process for developing new OH-PROMs for NSW public dental services took a pragmatic approach that combined literature appraisal, expert consensus, and consumer consultation. Future work will assess the implementation of the OH-PROM tool and test its validity for broader use as an outcome measure for value-based oral healthcare.
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Salud Bucal , Medición de Resultados Informados por el Paciente , Humanos , Nueva Gales del Sur , Adulto , Niño , Encuestas y Cuestionarios , Servicios de Salud Dental , Calidad de VidaRESUMEN
BACKGROUND: Advance personal planning (APP) involves planning for future periods of incapacity, including making legal decisions and documents. APP ensures that a person's values and preferences are known and respected. This study aimed to examine knowledge of APP, attitudes and confidence towards APP, and participation in APP activities among older people residing in regional and rural areas. METHODS: A cross-sectional survey was conducted with people aged over 65 years residing in and around regional towns in New South Wales, Australia. Participants responded to a social media advertisement or information provided through a community organisation. Data was collected via pen and paper survey or an online survey. The survey was developed for the study and included questions about the participant and their experiences with APP. Poisson regression modelling was conducted to explore the relationship between APP participation and APP knowledge, confidence and attitudes as well as the participant characteristics associated with APP participation. RESULTS: Overall, 216 people completed the survey. Most participants had a will (90%) but only a third (32%) had documented an advance care directive. Knowledge of APP was low with only 2.8% of participants correctly answering all 6 knowledge questions. Participants had a positive attitude towards APP and high level of confidence that they could discuss APP issues with important people in their life. Those with increased knowledge, confidence and attitude towards APP were significantly more likely to participate in APP activities. Older age and having private health insurance were significantly associated with engaging in APP activities. Increased frailty and the presence of health conditions were not associated with increased APP participation. CONCLUSIONS: There is a need to increase engagement with APP particularly among those who may be considered frail or have chronic health conditions. Increasing knowledge of, confidence and attitudes towards, APP could help to increase engagement in APP activities.