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Melbourne, Australia

Marshall S.D.,Peninsula Health | Marshall S.D.,Monash University | Pandit J.J.,University of Oxford | Pandit J.J.,St Johns College
Anaesthesia | Year: 2016

There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very radical evolution. Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises. All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption. Source

Summary Osteoporosis affects many people and has a large impact on health. As the condition is known to be poorly managed, a project was undertaken to improve treatment results in a hospital setting. The project succeeded in improving management of osteoporosis in patients who are admitted to hospital with broken bones. Purpose Osteoporosis is an inadequately managed condition around the world with high mortality and morbidity resulting from major fractures. Assessment and treatment rates for this condition are low, including hospital settings after minimal trauma fractures. The PRO-OSTEO project was set up to improve assessment and treatment rates of osteoporosis in patients admitted to Frankston Hospital's (Peninsula Health) orthopaedic ward with minimal trauma fractures. Method An osteoporosis assessment and treatment algorithm was introduced into inpatient practice in March 2010. This was accompanied by a multifaceted intervention, which included posters, presentations promoting the project and one on one academic detailing to ward pharmacists, orthopaedic, endocrinology and aged care junior medical staff. Three time periods were retrospectively reviewed to determine assessment and treatment rates, before and after the introduction of the algorithm, as well as 3 months following the introduction of the algorithm, to observe the sustainability of the intervention in a new group of doctors who had not received academic detailing. Results Initially, the introduction of the algorithm increased treatment and assessment rates from 19.7% and 50% at baseline to 71.6% and 87.8%, respectively (p<0.0005), with the results declining in the following period, 3 months after initial intervention and after medical/surgical staff change over, to 47.8% and 54.3%, respectively (p<0.0005). Conclusion An algorithm-based approach linked with academic detailing and education of the multidisciplinary team in acute hospital environment provides a clinically significant and effective strategy to improve osteoporosis management of patients with minimal trauma fractures. © International Osteoporosis Foundation and National Osteoporosis Foundation 2011. Source

Kennedy G.M.,Eastern Health | Brock K.A.,St Vincents Health | Lunt A.W.,Peninsula Health | Black S.J.,St Vincents Health
Archives of Physical Medicine and Rehabilitation | Year: 2012

Objectives: To explore the key factors involved in decision making when selecting patients for rehabilitation after stroke and to examine the level of agreement among physician assessors regarding admission to rehabilitation. Design: Questionnaire. Setting: Health services with rehabilitation units in Victoria, Australia. Participants: Rehabilitation unit physicians. Interventions: Not applicable. Main Outcome Measure: Questionnaire with 2 components: the clinical and nonclinical factors that influence decision making and clinical case scenarios. Results: Responses were received from 17 physicians from 12 of the 18 health services in Victoria. The most influential clinical factors listed by the respondents were prognosis, social supports, anticipated discharge destination, age, and anticipated length of stay. Key nonclinical factors were prioritization of internal health service referrals, patient's residence, and workforce capacity. Analysis of the clinical scenarios of patients with severe stroke showed that there was variability in the responses, with high levels of agreement for some cases and low levels for others. Almost all respondents agreed that prognosis was a key factor, yet, within the case scenarios, the reasons given for accepting or not accepting the patient demonstrated different opinions on the prognosis of the case presented. Conclusions: The decision-making processes in selection for rehabilitation and the factors that influence that decision require further investigation to optimize the use and outcomes from rehabilitation resources. © 2012 American Congress of Rehabilitation Medicine. Source

Hersh D.,Edith Cowan University | Armstrong E.,Edith Cowan University | Bourke N.,Peninsula Health
Disability and Rehabilitation | Year: 2015

Purpose: To explore in detail the narrative of a speech pathologist (SP) working with Indigenous Australian clients with acquired communication disorders following stroke or brain injury. There is some evidence that Indigenous clients do not find speech pathology rehabilitation to be culturally appropriate but, currently, there is very little published on the nature of this service or the experiences of SPs who provide this rehabilitation.Methods: This research uses both thematic and structural narrative analysis of data from a semi-structured, in-depth interview with a SP to examine the adaptations that she made to address the needs of her adult neurological caseload of (mainly) Indigenous Australians from both urban and remote regions.Results: The thematic analysis resulted in a core theme of flexibility and four other sub-themes: awareness of cultural context, client focus/person-centredness, being practical and working ethically. The structural narrative analysis allowed insight into the nature of clinical reasoning in a context lacking predictability and where previous clinical certainties required adaptation.Conclusions: Individual, detailed narratives are useful in exposing the challenges and clinical reasoning behind culturally sensitive practice. © 2015 Informa UK Ltd. Source

Matera J.T.,Peninsula Health | Egerton-Warburton D.,Monash Medical Center | Meek R.,Southern Health
EMA - Emergency Medicine Australasia | Year: 2010

Objectives: To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not.Methods: Descriptive and analytical cross-sectional electronic survey of all FACEMs. Baseline variables including hospital type, US availability, frequency of CVC insertion, US usage and technique are presented descriptively. US practice and opinions on usage are compared between routine and non-routine users.Results: Responses were obtained from 486 (42.4%) of 1146 FACEMs emailed. Whereas 88.5% of respondents had US available and 70% had done an US course, only 37% routinely used US for CVC placement. Completion of an US course and performance of >11 CVC per year were strongly associated with routine US use (odds ratio 10.0 [5.5-18.4] and 2.6 [1.7-3.9], respectively). Common barriers to more frequent US use were not having completed an US course (20%) and US-guided CVC placement taking too long (18%). Eighty-five per cent of FACEMs agreed that there should be ED access to US and US training but only 34% thought its use should be mandatory.Conclusions: We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. Source

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