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Paterson, Tom, Christopher Seiboth, Barbara Magin, Rajan Nagesh, Cyndy Lloyd et Helena Williams. « An initiative in primary care psychiatry in South Australia ». Australasian Psychiatry 10, no 3 (septembre 2002) : 259–64. http://dx.doi.org/10.1177/103985620201000313.
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Objective: To describe a joint mental health project involving the Adelaide Northern Division of General Practice (ANDGP) and the North West Adelaide Mental Health Service (NWAMHS). Conclusions: This project has been developed to explore alternative strategies to facilitate the identification and management of patients with mental illness in the primary care setting. The project has also endeavoured to explore alternative types of psychiatrist/general practitioner interactions other than the conventional ‘general practitioner referred psychiatrist consultation’. The development of adequate and clinically relevant evaluation methods, both quantitative and qualitative, has also been an explicit objective of the project. While the project provides an exciting stimulus for ongoing development of models of Primary Psychiatric Care, it is evident that such models can only evolve in the context of significant service and systemic change. It is hoped that the experiences in the northern suburbs of Adelaide can stimulate others to explore the ongoing collaborations between psychiatric services and general practitioners in ways that can produce better mental health outcomes in our patients.
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Smith, Judy. « The changing face of community and district nursing ». Australian Health Review 25, no 3 (2002) : 131. http://dx.doi.org/10.1071/ah020131.
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The Royal District Nursing Service (RDNS) of South Australia provides home- and community-based nursing care to people residing in the Adelaide Metropolitan area. The service is funded predominantly by the Home and Community Care Program. It provides community nursing services in the areas of wound management, palliative care, HIV/AIDS care, continence management, disability care, mental health and dementia care, and diabetes management. In 2000-2001, the service made 439,700 visits to people's homes or saw them in a nurse-led nursing centre. In addition, the nursing staff had 84,000 contacts other than face to face that were related to client care. These contacts include the co-ordination of care with other service providers for new and existing clients of RDNS.
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Yadav, Lalit, Tiffany K. Gill, Anita Taylor, Unyime Jasper, Jen De Young, Renuka Visvanathan et Mellick J. Chehade. « Cocreation of a digital patient health hub to enhance education and person-centred integrated care post hip fracture : a mixed-methods study protocol ». BMJ Open 9, no 12 (décembre 2019) : e033128. http://dx.doi.org/10.1136/bmjopen-2019-033128.
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IntroductionOlder people with hip fractures often require long-term care and a crucial aspect is the provision of quality health information to patients and their carers to support continuity of care. If patients are well informed about their health condition and caring needs, particularly posthospital discharge into the community setting, this may support recovery and improve quality of life. As internet and mobile access reach every household, it is possible to deliver a new model of service using a digital education platform as a personal health hub where both patients and their providers of care can establish a more efficient information integration and exchange process. This protocol details proposed research, which aims to develop a ‘model of care’ by using a digital health solution that will allow delivery of high quality and patient-centred information, integrated into the existing process delivered within the community setting.Methods and analysisThis phase of the study uses a pragmatic mixed-methods design and a participatory approach through engagement of patients, their carers and healthcare providers from multiple disciplines to inform the development of a digital health platform. Quantitative methods will explore health literacy and e-health literacy among older people with hip fractures admitted to the two public tertiary care hospitals in Adelaide, South Australia. Qualitative methods will provide an understanding of aspects of content and context required for the digital health platform to be developed in order to deliver quality health information. The study will use appropriate theoretical frameworks and constructs to guide the design, analysis and overall conduct of the research study. The scope of the study intends to ultimately empower patients and their carers to improve self-management and to better use coordinated services at the community level. This could prevent further falls including associated injuries or new fractures; reduce new hospital admissions and improve confidence and engagement by limiting the psychologically restrictive ‘fear of falls’.Ethics and disseminationThe study has been approved by the Human Research Ethics Committee of the Central Adelaide Local Health Network, South Australia (SA) Health, Government of South Australia and the University of Adelaide Human Research Ethics Committee. Findings from the study will be published in suitable peer-reviewed journals and disseminated through workshops or conferences.
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Greaves, Danielle, Peter J. Psaltis, Amit Lampit, Daniel H. J. Davis, Ashleigh E. Smith, Alice Bourke, Michael G. Worthington, Michael J. Valenzuela et Hannah A. D. Keage. « Computerised cognitive training to improve cognition including delirium following coronary artery bypass grafting surgery : protocol for a blinded randomised controlled trial ». BMJ Open 10, no 2 (février 2020) : e034551. http://dx.doi.org/10.1136/bmjopen-2019-034551.
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IntroductionCoronary artery bypass grafting (CABG) surgery is known to improve vascular function and cardiac-related mortality rates; however, it is associated with high rates of postoperative cognitive decline and delirium. Previous attempts to prevent post-CABG cognitive decline using pharmacological and surgical approaches have been largely unsuccessful. Cognitive prehabilitation and rehabilitation are a viable yet untested option for CABG patients. We aim to investigate the effects of preoperative cognitive training on delirium incidence, and preoperative and postoperative cognitive training on cognitive decline at 4 months post-CABG.Methods and analysisThis study is a randomised, single-blinded, controlled trial investigating the use of computerised cognitive training (CCT) both pre-CABG and post-CABG (intervention group) compared with usual care (control group) in older adults undergoing CABG in Adelaide, South Australia. Those in the intervention group will complete 1–2 weeks of CCT preoperatively (45–60 min sessions, 3.5 sessions/week) and 12 weeks of CCT postoperatively (commencing 1 month following surgery, 45–60 min sessions, 3 sessions/week). All participants will undergo cognitive testing preoperatively, over their hospital stay including delirium, and postoperatively for up to 1 year. The primary delirium outcome variable will be delirium incidence (presence vs absence); the primary cognitive decline variable will be at 4 months (significant decline vs no significant decline/improvement from baseline). Logistic regression modelling will be used, with age and gender as covariates. Secondary outcomes include cognitive decline from baseline to discharge, and at 6 months and 1 year post-CABG.Ethics and disseminationEthics approval was obtained from the Central Adelaide Local Health Network Human Research Ethics Committee (South Australia, Australia) and the University of South Australia Human Ethics Committee, with original approval obtained on 13 December 2017. It is anticipated that approximately two to four publications and multiple conference presentations (national and international) will result from this research.Trial registration numberThis clinical trial is registered with the Australian New Zealand Clinical Trials Registry and relates to the pre-results stage. Registration number: ACTRN12618000799257.
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Boord, Monique S., Daniel H. J. Davis, Peter J. Psaltis, Scott W. Coussens, Daniel Feuerriegel, Marta I. Garrido, Alice Bourke et Hannah A. D. Keage. « DelIrium VULnerability in GEriatrics (DIVULGE) study : a protocol for a prospective observational study of electroencephalogram associations with incident postoperative delirium ». BMJ Neurology Open 3, no 2 (décembre 2021) : e000199. http://dx.doi.org/10.1136/bmjno-2021-000199.
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IntroductionDelirium is a neurocognitive disorder common in older adults in acute care settings. Those who develop delirium are at an increased risk of dementia, cognitive decline and death. Electroencephalography (EEG) during delirium in older adults is characterised by slowing and reduced functional connectivity, but markers of vulnerability are poorly described. We aim to identify EEG spectral power and event-related potential (ERP) markers of incident delirium in older adults to understand neural mechanisms of delirium vulnerability. Characterising delirium vulnerability will provide substantial theoretical advances and outcomes have the potential to be translated into delirium risk assessment tools.Methods and analysisWe will record EEG in 90 participants over 65 years of age prior to elective coronary artery bypass grafting (CABG) or transcatheter aortic valve implantation (TAVI). We will record 4-minutes of resting state (eyes open and eyes closed) and a 5-minute frequency auditory oddball paradigm. Outcome measures will include frequency band power, 1/f offset and slope, and ERP amplitude measures. Participants will undergo cognitive and EEG testing before their elective procedures and daily postoperative delirium assessments. Group allocation will be done retrospectively by linking preoperative EEG data according to postoperative delirium status (presence, severity, duration and subtype).Ethics and disseminationThis study is approved by the Human Research Ethics Committee of the Royal Adelaide Hospital, Central Adelaide Local Health Network and the University of South Australia Human Ethics Committee. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.Trial registration numberACTRN12618001114235 and ACTRN12618000799257.
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Wilson, Annabelle, Tamara Mackean, Liz Withall, Eileen Willis, Odette Pearson, Colleen Hayes, Kim O'Donnell et al. « Protocols for an Aboriginal-led, Multi-methods Study of the Role of Aboriginal and Torres Strait Islander Health Workers, Practitioners and Liaison Officers in Quality Acute Health Care ». Journal of the Australian Indigenous HealthInfoNet 3, no 1 (2022) : 1–13. http://dx.doi.org/10.14221/aihjournal.v3n1.2.
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Objectives Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers play an important, often critical role providing advocacy and cultural and emotional support for Aboriginal and Torres Strait Islander patients. The main goals of this research are to explore i) how Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers are integrated in the routine delivery of care for Aboriginal and Torres Strait Islander peoples in hospital, and ii) how the role of Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers facilitates quality health outcomes. Methods This study is being conducted in three different hospitals using a multi-method approach including: yarning and Dadirri, patient journey mapping, survey and semi-structured interviews. Ethics approval has been provided from four ethics committees covering the three project sites in Australia (Adelaide, South Australia; Sydney, New South Wales and Alice Springs, Northern Territory). Significance This study uses innovative methodology founded on the privileging of Aboriginal and Torres Strait Islander knowledges to collect Aboriginal and Torres Strait Islander perspectives and understand patient journeys within acute health care systems. This project is led by Aboriginal and Torres Strait Islander researchers and guided by the Project Steering Committee comprised of stakeholders. Implications There is limited research that explores quality acute care processes and the integration of Aboriginal and Torres Strait Islander Health Workers/Practitioners work within health care teams. This research will make a valuable contribution to understanding how hospital services can achieve quality acute health care experiences for Aboriginal and Torres Strait Islander People.
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Horwood, C. M., P. Hakendorf et C. H. Thompson. « Comparison of specialist and generalist care ». Australian Health Review 42, no 5 (2018) : 579. http://dx.doi.org/10.1071/ah17197.
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Objective The choice of whether to admit under a specialist or a generalist unit is often made with neither clear rationale nor understanding of its consequences. The present study compared the characteristics and outcomes of patients admitted with community-acquired pneumonia to either a general medicine or respiratory unit. Methods This study was a retrospective cross-sectional study using data from public hospitals in Adelaide, South Australia. Over 5 years there were 9775 overnight, unplanned appropriate adult admissions. Patient length of hospital stay, in-patient mortality rate and 30-day unplanned readmission rate were calculated, with and without adjustment for patient age and comorbidity burden. Results Over 80% of these patients were cared for by a general medicine unit rather than a specialist unit. Patients admitted to a general medicine unit were, on average, 4 years older than those admitted to a respiratory unit. Comorbidity burdens were similar between units at the same hospital. Length of in-patient stay was >1 day shorter for those admitted to a general medicine unit, without significant compromise in mortality or readmission rates. Between each hospital, general medicine units showed a range of mortality rates and length of hospital stay, for which there was no obvious explanation. Conclusions Compared with speciality care, general medicine units can safely and efficiently care for patients presenting to hospital with community-acquired pneumonia. What is known about the topic? Within the narrow range of any specific disease, generalist medical services are often cited as inferior in performance compared with a speciality service. This has implications for hospital resourcing, including both staffing and ward allocation. What does this paper add? This paper demonstrates that most patients admitted with a principal diagnosis of community-acquired pneumonia were admitted to a generalist unit and did not apparently fare worse than patients admitted to a specialist service; patients admitted to a generalist unit spent less time in hospital and there was no difference in mortality or readmission rate compared with patients admitted to a specialist service. What are the implications for practitioners? The provision of generalist services at urban hospitals in Australia provides a safe alternative admission option for patients presenting with pneumonia, and possibly for other common acute medical conditions.
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Shin, Hee-Young, Svetla Gadzhanova, Elizabeth E. Roughead, Michael B. Ward et Lisa G. Pont. « The use of antipsychotics among people treated with medications for dementia in residential aged care facilities ». International Psychogeriatrics 28, no 6 (18 janvier 2016) : 977–82. http://dx.doi.org/10.1017/s1041610215002434.
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ABSTRACTBackground:Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities.Methods:Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines.Results:There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months.Conclusions:Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.
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Powell, Kathryn, Nigel Stocks et Caroline Laurence. « A new venture in interdisciplinary student learning in a co-located health service ». Australian Health Review 40, no 2 (2016) : 205. http://dx.doi.org/10.1071/ah14241.
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Learning about interdisciplinary health approaches is important for students of health professions. Yet, interdisciplinary learning programs are sparse within primary health clinics. Larger health care complexes, such as superclinics in Australia, offer interdisciplinary learning opportunities for health, but also pose difficulties. This case study describes the introduction of an interdisciplinary student learning program in Adelaide, South Australia, over a 1-year period. The objectives of the program were for students to: (1) understand the range of patient needs in primary healthcare (PHC); (2) identify circumstances in which the involvement of another professional may benefit patients; and (3) learn more about team work. Despite barriers, the practice environment was found to be suitable for student learning. Program modifications were made in response to the need for scheduled time for clinic staff to work with students, non-simultaneous student placements, a need for a coordinator, the availability of discipline-specific supervision and the need to provide incentives for students to participate, particularly giving course credits or recognition. Embedding interdisciplinary programs in a clinic setting requires time and resources. The present case study demonstrates that larger PHC clinics have the potential to implement interdisciplinary learning programs based on an authentic learning approach.
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Harvey, Peter W., John Petkov, Inge Kowanko, Yvonne Helps et Malcolm Battersby. « Chronic condition management and self-management in Aboriginal communities in South Australia : outcomes of a longitudinal study ». Australian Health Review 37, no 2 (2013) : 246. http://dx.doi.org/10.1071/ah12165.
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Objectives. This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. Methods. The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. Results. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. Conclusions. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. What is known about the topic? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. What does this paper add? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. What are the implications for practitioners? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.
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Oberai, Tarandeep, Maggie Killington, Kate Laver, Maria Crotty et Ruurd Jaarsma. « “Just another piece of paperwork” : perceptions of clinicians on delirium screening following hip fracture repair elicited in focus groups ». International Psychogeriatrics 31, no 06 (15 octobre 2018) : 877–84. http://dx.doi.org/10.1017/s1041610218001369.
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ABSTRACTBackground:Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians’ from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium.Methods:This was a qualitative study using in-depth focus groups discussions with clinical staff of one orthopedic unit within a level 1 trauma center, south of Adelaide, South Australia.Results:A total number of 17 individuals (14 nurses, 1 geriatric registrar, 1 nursing manager, and 1 speech therapist) participated in the focus groups. Four major themes were identified: (1) Delirium is important but can be hard to recognize and validate; (2) ambiguity on the use of delirium screening tool; (3) need of designated delirium care pathway; and (4) vital role of the family. Despite the initial lack of agreement on use of the objective tool to screen delirium, nurses did propose a number of ways that formal delirium screening could be included in routine nursing duties and existing nursing documentation.Conclusion:Although orthopedic nurses aim to provide effective care to patients experiencing delirium symptoms following hip fracture, they are doing so in the absence of structured screening, assessment, and multidisciplinary team approach. This study emphasizes the various barriers which need to be considered before attempting to change practice in this important area.
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Dwyer, Judith, Eileen Willis et Janet Kelly. « Hospitals caring for rural Aboriginal patients : holding response and denial ». Australian Health Review 38, no 5 (2014) : 546. http://dx.doi.org/10.1071/ah14060.
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Objective To investigate how policy requiring cultural respect and attention to health equity is implemented in the care of rural and remote Aboriginal people in city hospitals. Methods Interviews with 26 staff in public hospitals in Adelaide, South Australia, were analysed (using a framework based on cultural competence) to identify their perceptions of the enabling strategies and systemic barriers against the implementation of official policy in the care of rural Aboriginal patients. Results The major underlying barriers were lack of knowledge and skills among staff generally, and the persistent use of ‘business as usual’ approaches in their hospitals, despite the clear need for proactive responses to the complex care journeys these patients undertake. Staff reported a sense that while they are required to provide responsive care, care systems often fail to authorise or guide necessary action to enable equitable care. Conclusions Staff caring for rural Aboriginal patients are required to respond to complex particular needs in the absence of effective authorisation. We suggest that systemic misinterpretation of the principle of equal treatment is an important barrier against the development of culturally competent organisations. What is known about this topic? The care received by Aboriginal patients is less effective than it is for the population generally, and access to care is poorer. Those in rural and remote settings experience both severe access barriers and predictable complexity in their patient care journeys. This situation persists despite high-level policies that require tailored responses to the particular needs of Aboriginal people. What does this paper add? Staff who care for these patients develop skills and modify care delivery to respond to their particular needs, but they do so in the absence of systematic policies, procedures and programs that would ‘build in’ or authorise the required responsiveness. What are the implications for practitioners? Systematic attention, at hospital and clinical unit level, to operationalising high policy goals is needed. The framework of cultural competence offers relevant guidance for efforts (at system, organisation and care delivery levels) to improve care, but requires organisations to address misinterpretation of the principle of equal treatment.
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Ambagtsheer, Rachel C., Renuka Visvanathan, Elsa Dent, Solomon Yu, Timothy J. Schultz et Justin Beilby. « Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting : A Study of Diagnostic Test Accuracy ». Journals of Gerontology : Series A 75, no 6 (5 novembre 2019) : 1134–42. http://dx.doi.org/10.1093/gerona/glz260.
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Abstract Background Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried’s Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. Methods DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility. We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. Results We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2–94.3]; Sp: 73.4% [66.5–79.6]) and REFS (Se: 87.5% [73.2–95.8]; Sp: 75.5% [68.8–81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. Conclusions Two screening instruments—the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.
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Doerr, Christine R., Stephen E. Graves, Graham E. Mercer et Richard H. Osborne. « Implementation of a quality care management system for patients with arthritis of the hip and knee ». Australian Health Review 37, no 1 (2013) : 88. http://dx.doi.org/10.1071/ah11107.
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The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery. What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting. What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative. What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.
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Beard, Matthew, Joseph F. Orlando et Saravana Kumar. « Overcoming the tyranny of distance : An audit of process and outcomes from a pilot telehealth spinal assessment clinic ». Journal of Telemedicine and Telecare 23, no 8 (17 août 2016) : 733–39. http://dx.doi.org/10.1177/1357633x16664851.
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Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with no adverse outcomes reported.
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Chapman-Goetz, Jessica, Nerida Packham, Genevieve Gabb, Cassandra Potts, Kitty Yu, Adaire Prosser, Elizabeth Hotham et Vijayaprakash Suppiah. « Acceptability and feasibility of the NPS MedicineWise mobile phone application in supporting medication adherence in patients with chronic heart failure : Protocol for a pilot study ». PLOS ONE 17, no 2 (4 février 2022) : e0263284. http://dx.doi.org/10.1371/journal.pone.0263284.
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Introduction Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, morbidity and mortality remain high in HF. Medication non-adherence is a crucial factor in optimising clinical outcomes. A growing number of smartphone applications (apps) assist management. While evidence support their use to promote treatment adherence, apps alone may not be the solution. The objective of this pilot study is to assess the acceptability and feasibility of a tiered intervention added to the NPS MedicineWise dose reminder app (MedicineWise app) in supporting medication adherence in HF. Methods and analysis This prospective, single-blinded, randomised controlled trial will recruit 55 Australian patients with HF to be randomly assigned to either intervention (MedicineWise app + usual care) or control (usual care alone) arm. Control participants will remain unaware of the intervention throughout the study. At baseline, intervention participants will be instructed in the MedicineWise app. A reminder will then prompt medication administration at each dosing interval. If non-adherence is suggested from 24 hourly reports (critical medications) or 72 hours (non-critical medications), the individual/s will be escalated through a tiered, pharmacist-led intervention. The primary outcome will be the acceptability and feasibility of this approach in supporting adherence. Between-group comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline, 3 and 6 months will be used to measure the app’s value in supporting adherence. Secondary outcome measures include self-reported medication adherence and knowledge, health-related quality of life, psychological wellbeing, signs and symptoms of HF, and medication and HF knowledge. Ethics and dissemination The protocol received ethics approval from Central Adelaide Clinical Human Research Ethics Committee (Protocol number R20190302) and University of South Australia Human Research Ethics Committee (Protocol number 202450). Findings will be disseminated through peer-reviewed journals. Trial registration number Australian New Zealand Clinical Trials Registry Clinical trial number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx)
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Gesesew, Hailay, Paul Ward, Jonathan Karnon, Richard Woodman et Lillian Mwanri. « Peer-led HIV care and the UNAIDS 90-90-90 treatment targets in Tigrai, Ethiopia : a cluster randomised trial and economic evaluation of teach-test-link-trace model (TTLT) trial protocol ». BMJ Open 11, no 6 (juin 2021) : e043943. http://dx.doi.org/10.1136/bmjopen-2020-043943.
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IntroductionThis study will evaluate the acceptability and effectiveness of a new intervention programme called teach-test-link-trace (TTLT) model in Tigrai, Ethiopia, where peer educators counsel about HIV (teach), perform house-to-house HIV testing (test) through pinprick HIV testing (H2H) or OraQuick HIV self-testing (HIVST), link HIV-positive patients to HIV care (link) and trace lost patients house-to-house (trace).Methods and analysisThe four-arm cluster randomised trial will be conducted in five phases: Phase 1 will assess the acceptability of the TTLT model using a cross-sectional survey among adults aged 18 years irrespective of HIV status in 6909 households from 40 villages (kebeles). Phase 2 will assess effectiveness of the TTLT model through comparing intervention and control groups among HIV negative or unknown HIV status. The intervention groups will receive one of the three home-based interventions provided by peer educators: (1) demonstrate and distribute OraQuick HIV self-testing kits (HIVST), (2) perform pinprick HIV testing (H2H) and (3) offer a choice to either receive HIVST or H2H. The control group will receive the standard care in which nurses counsel and refer eligible household members to nearby health facilities to access existing HIV testing services. The primary outcomes of the interventions are proportion of individuals who know of their HIV status (first 90), link to HIV care and treatment (second 90) and meet virological suppression (third 90). We will perform process evaluation through qualitative interviews in phase 3, economic evaluation for cost-effectiveness analysis in phase 4 and a sustainability exit strategy using nominal group technique in phase 5. We will apply descriptive and inferential statistics for quantitative studies, and thematic framework analysis for qualitative studies.Ethics and disseminationEthics approval was obtained from the Southern Adelaide Clinical Health Research Ethics Committee (SAC HREC), South Australia, and findings will be disseminated through publications, conference presentations, media release and policy briefs.Trial registration numberACTRN12620000570987p.
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Fok, Patrick T., David Teubner, Jeremy Purdell-Lewis et Andrew Pearce. « Predictors of Prehospital On-Scene Time in an Australian Emergency Retrieval Service ». Prehospital and Disaster Medicine 34, no 03 (juin 2019) : 317–21. http://dx.doi.org/10.1017/s1049023x19004394.
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AbstractIntroduction:Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.Hypothesis/Problem:The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.Methods:A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.Results:A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.Conclusion:This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.
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Lautenschlager, Nicola T., et David Ames. « International Psychogeriatricspaper of the year 2014 : a new tradition and the first candidate for a 2024 paper of the decade ? » International Psychogeriatrics 27, no 4 (2 mars 2015) : 527–28. http://dx.doi.org/10.1017/s1041610215000095.
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In 2014, the International Psychogeriatric Association (IPA) celebrated the fact that IPA's flagship scientific journalInternational Psychogeriatrics(IPG) has matured, attaining 25 years of existence since its foundation in 1989. The IPG editorial team introduced several new features in the 2014 issues to celebrate this significant quarter century milestone. One of them was the new “paper of the month” category. Following an internal selection process amongst the editorial team, who ranked available accepted papers focusing on their scientific quality and clinical relevance each month, one paper was selected as paper of the month from the categories “original research articles” and “reviews”. This resulted in 12 papers of the month, of which eight were original research articles and four were reviews or meta-analyses. Each paper of the month was accompanied by a short commentary highlighting its importance, written either by an editorial team member, one of the reviewers of the paper, or an external international expert on the topic of the paper. The editorial team aimed to highlight various psychogeriatric topics, so there are papers covering the wide spectrum of cognitive impairment, from risk factors such a hippocampal atrophy (Ferrariniet al., 2014) and traumatic brain injury (Gilbertet al., 2014), via transition between diagnostic categories on the cognitive continuum (Elliset al., 2014) to variations in symptom expression (Rockwoodet al., 2014) and apathy (Theleritiset al., 2014) to exercise interventions for people with Alzheimer's disease (AD) (Farinaet al., 2014) or antipsychotic use for patients with dementia living in residential care (Kleijeret al., 2014). Other papers reported on topics relevant to the aging process in general, such as neuroplasticity (Valkanovaet al., 2014), loneliness (Yanet al., 2014) or attitudes to aging (Shenkinet al., 2014). Other psychogeriatric topics covered were delirium (Ritchieet al., 2014) and geriatric depression (Steffenset al., 2014). In the international spirit of IPA, authors of the 12 papers come from Australia, Canada China, Greece, Germany, Italy, Mexico, the Netherlands, Switzerland, the UK, and the USA. From those 12 papers an IPG paper of the year 2014 was selected with the help of three independent reviewers: Dr Doh Kwan Kim from South Korea, Dr Gill Livingston from the UK, and Dr Daniel Weintraub from the USA. Our three reviewers ranked all 12 papers of the month independently from each other and the highest ranked paper overall was “The association of traumatic brain injury with rate of progression of cognitive and functional impairment in a population-based cohort of Alzheimer's disease: the Cache County Dementia Progression Study” by Mac Gilbert, Christine Snyder, Chris Corcoran, Maria C. Norton, Constantine G. Lyketsos, and JoAnn T. Tschanz. The reviewers emphasized that traumatic brain injury (TBI) is recognized as an important risk factor for AD which needs more research, and that the study by Gilbertet al.contributes important new knowledge to the area with the specific strength of reporting long-term follow up. In this context, we refer to the excellent commentary on the paper of the year by Dr David Sharp (Sharp, 2014), which was published alongside the paper of the year when it was paper of the month in the October 2014 issue.
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Jamalulhak, Amir Izzat, Cherrie Galletly et Nick Ford. « Improving services for those who serve : A private practice initiative to improve psychiatric care for first responder and military patients ». Australasian Psychiatry, 1 décembre 2021, 103985622110578. http://dx.doi.org/10.1177/10398562211057873.
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Objectives Professional isolation and limited opportunities for multidisciplinary collaborations are well-recognised challenges for psychiatrists in private practice. This narrative paper describes the development of a private practice group to assist first responders (FRs) and military patients located in Adelaide, South Australia. The aims included both peer review, and interdisciplinary communication and collaboration. Relevant personnel in the ambulance, police and fire services, military and veterans’ groups, and the compensation system, participated in monthly meetings. Lack of timely access to psychiatric care for FR and military patients was identified as a problem and an expedited referral service was established. Conclusions The Closing the Gap Group was established in 2017. The terminology refers to the gap between treating psychiatrists and the complex organisations that manage the workplace context for FR/military patients. This initiative provides a template for private practice innovations to improve psychiatrists’ skills and knowledge, along with better engagement and understanding between private psychiatrists and relevant community organisations.
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Cappetta, Kara, Luise Lago, Jan Potter et Lyn Phillipson. « Under-coding of dementia and other conditions indicates scope for improved patient management : A longitudinal retrospective study of dementia patients in Australia ». Health Information Management Journal, 23 janvier 2020, 183335831989792. http://dx.doi.org/10.1177/1833358319897928.
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Background: Under-coding of dementia during hospitalisation results in an inability to identify all patients with dementia using hospital administrative data. Clinical coding can be viewed as a proxy for management; therefore, under-coding indicates dementia was not considered in the patient’s management. While under-coding of dementia is well established, there is sparse evidence on whether dementia is coded in subsequent hospitalisations among patients with a known diagnosis. Objective: (a) To describe patterns of dementia coding over 5 years after a first-coded (i.e. index) admission for dementia; (b) to identify factors associated with clinical coding of dementia; and (c) to identify patient subgroups at risk of not being coded to inform future interventions to improve hospital identification and management of dementia. Method: Retrospective study of longitudinal hospital data from 1 July 2006 to 30 June 2015 for 7919 patients hospitalised during the 5 years’ post-index admission for dementia in a regional local health district of New South Wales, Australia. Results: Dementia was coded in 63.9% of admissions in the 12 months following index admission for dementia; this decreased to 53.7% after 5 years. Patients were 20% more likely to have dementia actively managed when it co-occurred with delirium. Under-coding varied across conditions, with dementia more likely to be coded in admissions for falls and pneumonitis, and less likely for heart failure, pneumonia and urinary tract infection (UTI). Conclusion: The frequency with which dementia was not coded highlights opportunities to improve identification and management of dementia through dementia-specific care, enhanced clinical protocols, and interventions focused around heart failure, pneumonia and UTI admissions.
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Arakawa Martins, B., H. Barrie, J. Dollard, N. Mahajan et R. Visvanathan. « OLDER ADULTS’ PERCEPTIONS OF THE BUILT ENVIRONMENT AND ASSOCIATIONS WITH FRAILTY : A FEASIBILITY AND ACCEPTABILITY STUDY ». Journal of Frailty & ; Aging, 2018, 1–4. http://dx.doi.org/10.14283/jfa.2018.23.
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It is essential to evaluate frail older adults understanding and execution of survey tools to improve data quality and accurate representation in research. The study tested the feasibility and acceptability of a survey that assesses various measures of functional status in frail older people. The study evaluated: 1) recruitment rate; 2) time to complete questionnaires and difficulties encountered; and 3) acceptability by participants. Validated tools including: FRAIL Scale, EuroQoL 5D-5L, Charlson’s Comorbidities Index, Baecke’s Physical Activity Questionnaire, Life-Space Assessment, Katz and Lawton ADL and NEWS Walkability Scale were assessed. Twenty-five older patients (63% recruitment rate) of a post-acute restorative program (residential Transition Care Program) in Adelaide, South Australia were interviewed. Although not statistically different, time to complete the overall questionnaire differed between robust, pre-frail and frail participants. Overall, the survey was considered acceptable and feasible, with consideration with NEWS and Life-Space assessment regarding length, phrasing and layout.
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Duncanson, Emily, Anna Chur-Hansen et Shilpanjali Jesudason. « Patient perspectives of coping with automated peritoneal dialysis ». Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 9 septembre 2021, 089686082110434. http://dx.doi.org/10.1177/08968608211043411.
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Background: Patients receiving peritoneal dialysis (PD) experience poor quality of life, depression, anxiety and lifestyle changes. Insights into how patients adjust to and cope with PD from a psychological perspective will aid care. Methods: Participants were recruited purposively through the Central Northern Adelaide Renal and Transplantation Service in South Australia. Ten patients receiving automated PD (APD) (5 females and 5 males) aged 31 to 77 years (M = 59.3) participated in a semi-structured interview. Interview transcripts were analysed thematically through inductive and deductive methods. Results: Five main themes representing participants’ experiences and perspectives of adjusting to and coping with APD were identified: (1) Resigned Acceptance, (2) A Bridge to Transplant, (3) Navigating Emotions at Milestones and Transitions, (4) Professional Support (Sub-themes: Psychological Support and Education and Information Delivery and (5) Social Enablers (Sub-theme: Hidden from View and Hiding Illness). Conclusions: Patients employ cognitive, emotional and behavioural strategies and rely strongly on social supports to cope with APD. PD at home aids preservation of pre-illness identity, however, also results in feelings of isolation and being misunderstood. Psychological distress and poor coping may be heightened at key disease milestones and transition periods when professional psychological support should be offered. We provide suggestions to address patients’ psychosocial needs and coping in treatment decision-making and dialysis care.
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Oberai, Tarandeep, Kate Laver, Richard Woodman, Maria Crotty, Gino Kerkhoffs et Ruurd Jaarsma. « Does implementation of a tailored intervention increase adherence to a National Safety and Quality Standard ? A study to improve delirium care ». International Journal for Quality in Health Care 33, no 1 (1 janvier 2021). http://dx.doi.org/10.1093/intqhc/mzab006.
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Abstract Background Delirium is commonly detected in older people after hip fracture. Delirium is considered to be a multifactorial disorder that is often seen post-operatively (incidence ranging from 35% to 65%). Hospitals in Australia are required to meet eight standards including the comprehensive care standard to be able to maintain their accreditation. The standard includes actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care. Delirium prevention was identified as an area for improvement in our Orthopaedic unit in a Level 1 University Trauma Centre in Australia. This implementation research project aimed to understand the efficacy of a delirium prevention intervention within an existing orthopaedic speciality care system. Objective Implementation of the tailored intervention will increase adherence to National Safety and Quality Health Service Standards, thereby reducing rate of delirium. Methods In this study, we used an interrupted time series design to examine changes in practice over time in people admitted to hospital with a hip fracture. Clinical staff caring for patients with hip fracture in an acute care setting in Adelaide, South Australia, participated in the project. In brief, intervention included education, environmental restructuring, change champions, infographics and audit feedback reports. The primary outcome of interest was rate of delirium. The secondary outcome was compliance with the use of delirium 4AT screening tool, duration of delirium and hospital length of stay. Results The rate of change per month in patients with delirium decreased significantly by 19.2%. There was no significant change observed in trend for duration of delirium and length of hospital stay between pre-intervention and post-intervention phases. A significant increase in the use of screening tool was observed from 4.7% in the pre-intervention phase to 33.6% in the post-intervention phase. Conclusion Translation of evidence-based intervention model incorporating well-considered implementation strategies had a mixed impact on decreasing the rate of delirium. The scheduled hospital accreditation enhanced the use of validated screening tool to recognize delirium. This project highlights the importance of aligning implementation goals with the wider goals of the organization as well as making clinicians accountable by consistent auditing.
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Ben chmo, Marcelle, Lisa Matricciani, Saravana Kumar et Kristin Graham. « “I was trying to look after myself, but I really wasn’t” : Understanding patient’s perspectives on risk factors for lower extremity amputations ». Journal of Foot and Ankle Research 15, no 1 (12 décembre 2022). http://dx.doi.org/10.1186/s13047-022-00589-6.
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Abstract Background Lower extremity amputations (LEAs) as a result of type 2 diabetes mellitus (T2DM) cause considerable morbidity, mortality, and burden on the healthcare system. LEAs are thought to be preventable, yet the rate of LEAs, particularly in Australia, has risen despite the availability of preventative healthcare services. Understanding patient’s perspectives of risk factors for LEAs may provide valuable insight into why many LEAs occur each year. Objective The aim of this study was to explore patient’s perspectives of risk factors for LEAs as a result of T2DM. Methods A qualitative descriptive methodology involving non-probability purposive sampling was used to recruit inpatients at a tertiary metropolitan hospital in South Australia. Semi-structured interviews were conducted, and data were transcribed verbatim. Data from the interviews were analysed using thematic analysis and the constant comparison approach. Results A total of 15 participants shared their perspectives of risk factors for lower extremity amputations. Most (86%) of participants were male and Caucasian, with a median age of 66.4 years ranging from 44-80 years. The median duration of diabetes was 25.2 years, ranging from 12-40 years. More than half of the participants had undergone a previous amputation with 86% being unemployed or retired and 73% living in metropolitan Adelaide. Two main themes emerged: competing priorities and awareness. Finance and family care were identified as subthemes within competing priorities. While subthemes in the context of awareness related to lack of awareness of risk, experiences with health care professionals and perspectives of disease severity. Conclusions The findings from this research indicate that addressing risk factors for LEAs for patients with T2DM require a holistic and nuanced approach which considers individual patient’s circumstances, and its influence on how risks are viewed and managed.
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Reed, C., M. Happich, J. Raskin, A. Tockhorn-Heidenreich et M. Belger. « UTILIZATION OF OBSERVATIONAL DATA AS A PROXY COHORT FOR COMPARISON PURPOSES WITH OPEN-LABEL STUDY RESULTS : AN EXAMPLE FROM ALZHEIMER’S DISEASE ». Journal Of Prevention of Alzheimer's Disease, 2019, 1–10. http://dx.doi.org/10.14283/jpad.2019.4.
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Background: Randomized placebo-controlled trials in the development of disease-modifying treatments for Alzheimer’s disease are typically of short duration (12–18 months), and health economic modeling requires extrapolation of treatment effects beyond the trial period. OBJECTIVES: To investigate whether observational data can be used to extrapolate data from open-label trials, we compared outcomes (cognition, function, behavior) over 36 months for patients with mild Alzheimer’s disease dementia in the GERAS observational study (proxy for placebo control) with those of the mild Alzheimer’s disease population on active treatment (solanezumab) in two 18-month randomized placebo-controlled trials (EXPEDITION and EXPEDITION2) and the additional 18-month open-label extension study (EXPEDITION-EXT). DESIGN & SETTING: Analysis of longitudinal data from patients with mild Alzheimer’s disease dementia in the GERAS observational study (conducted in France, Germany and the United Kingdom) and the EXPEDITION program (conducted in Europe, North America, South America, Asia and Australia). PARTICIPANTS: European and North American community-living patients, aged ≥55 years, with probable Alzheimer’s disease dementia and their caregivers. Mild Alzheimer’s disease dementia was defined as a Mini-Mental State Examination score of 20–26 in EXPEDITION and 21–26 in GERAS. INTERVENTION: Active treatment in both randomized placebo-controlled trials and the open-label extension study was intravenous solanezumab 400 mg every 4 weeks. Patients in GERAS were receiving treatment as part of standard care. MEASUREMENTS: Between-group differences for changes from baseline over 36 months in cognitive function, ability to perform activities of daily living, and behavioral and psychological symptoms of dementia were assessed using models stratified by propensity score. RESULTS: At baseline, patients and caregivers participating in GERAS were significantly older than those in the EXPEDITION studies, and the GERAS patient cohort had fewer years of education and a shorter time since diagnosis of Alzheimer’s disease. The baseline mean Mini-Mental State Examination score of the GERAS cohort was significantly higher (indicating better cognition) than that of patients receiving placebo or active treatment in the pooled EXPEDITION studies Baseline functional ability scores were significantly lower for the GERAS cohort, indicating poorer functioning. Propensity score stratification achieved a good balance in the baseline variables between GERAS and the two EXPEDITION arms. Over 18 months, least squares mean changes from baseline in outcome measures were similar in the GERAS cohort and the pooled placebo groups from the randomized controlled trials. Also, the 18-month results for the comparison between the GERAS cohort and the pooled active treatment groups from the randomized controlled trials were generally similar to those reported for the comparison with the control group in the randomized trial. Comparison of active treatment (EXPEDITION-EXT) and observational study (GERAS, as proxy control) results over 36 months of the open-label trial showed a significantly smaller decline in activities of daily living (instrumental and basic) in the active treatment group, reflecting better functioning, but no between-group differences at 36 months for cognitive function or behavioral and psychological symptoms of dementia. CONCLUSIONS: Comparing results from clinical trials and observational studies (real-world data) may be a useful methodological approach for informing long-term outcomes in Alzheimer’s disease drug development and could be used to inform health economic modeling. Further research using this methodological approach is needed.
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Thwaites, Simon, Dominic Thewlis, Kelly Hall et Mark Rickman. « Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures : a protocol for a pilot randomised controlled trial ». Pilot and Feasibility Studies 8, no 1 (26 mai 2022). http://dx.doi.org/10.1186/s40814-022-01057-5.
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Abstract Background Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to assess patient outcomes specific to anterior knee pain in this cohort. The central aims of this study are to (1) evaluate the feasibility of a full-scale randomised controlled trial (RCT) investigating the influence of surgical approach on intramedullary nailing of tibial shaft fractures (suprapatellar versus infrapatellar nailing), (2) explore differences in clinical outcomes between the approaches, and (3) explore the development of a biomechanically validated methodology for assessing post-operative anterior knee pain and knee function specific to intramedullary nailing of tibial shaft fractures. Methods This pilot study will follow a prospective randomised controlled design at the Royal Adelaide Hospital and The Queen Elizabeth Hospital (South Australia). This study aims to recruit 60 patients between 18 and 60 years old who will be randomly assigned to either the suprapatellar or infrapatellar approach following a decision for intramedullary surgical fixation by the treating surgeon. All nails in this study will be Stryker T2 Alpha nails. Patients will undergo standard radiograph, magnetic resonance imaging, and clinical assessments in-line with their standard operative care, and complete a number of patient-reported and performance-based outcome measures. Performance-based outcome measures will be assessed utilising three-dimensional motion capture techniques. Follow-up time points are 3, 6, 12, and 18 months. Feasibility outcomes include ability to meet enrolment and retention metrics, compliance with all questionnaires and assessment procedures, and the occurrence of any adverse events. The primary clinical outcome is the incidence of anterior knee pain at 12 months after surgery. Discussion This study will establish the feasibility and inform the design of a large-scale RCT. Evaluation of all clinical data and patient outcomes will lead to the development of a new tool for assessing patient outcomes in this cohort. Limitations of the study include an unpredictable enrolment rate and loss to follow-up, small sample size, and the unknown ability of three-dimensional motion analysis to pick up the effects of anterior knee pain after tibial nailing. Trial registration This trial was prospectively registered on the 7 February 2020 on ANZCTR, ACTRN12620000109909.