Steffen C.M.,James Cook University |
Smith M.,Queensland Health |
McBride W.J.H.,James Cook University
ANZ Journal of Surgery | Year: 2010
Background: As the third most common mycobacterial infection in the world after tuberculosis and leprosy, Mycobacterium ulcerans is a major health and development problem that has become the focus of a World Health Organisation (WHO) initiative seeking to reduce the burden of this disease. The Daintree River catchment in north Queensland is an endemic focus for Mycobacterium ulcerans infection, known locally as the 'Daintree Ulcer'. The aim of this study is to analyse the changing pattern of the disease over the last 44 years in the region. Methods: The study is a descriptive review of all human cases where infection had been acquired in an endemic region of far north Queensland. Demographic information, lesion characteristics, management and outcomes were recorded in a database. Results: Over the period there were 92 cases of M. ulcerans infection. The average age was 41.7 years and 56.7% were male. There was distinct clustering of cases in several defined locations in the area. Most cases (90%) presented with ulcers, and all but three patients were treated surgically. Excision and skin grafting was more commonly used in the period between 1964-1988. Excision alone was the most common treatment used thereafter. Earlier recognition and smaller lesion size is thought to have contributed to the change in surgical practice. Conclusions: Ulcers caused by M. ulcerans infection are a distinct clinical entity in tropical North Queensland. Early recognition, diagnosis and prompt surgical intervention has minimised morbidity associated with this disease. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.
Khanna S.,CSIRO |
Boyle J.,CSIRO |
Good N.,CSIRO |
Lind J.,Queensland Health
EMA - Emergency Medicine Australasia | Year: 2012
Objectives: To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. Methods: Retrospective analysis of hospital inpatient data and ED data from 23 reporting public hospitals in Queensland, Australia, across 30 months. Relationships between outcome measures were explored through the aggregation of the historic data into 21912 hourly intervals. Main outcome measures included admission and discharge rates, occupancy levels, length of stay for admitted and emergency patients, and the occurrence of access block. The impact of shifting discharge timing on occupancy levels was quantified using observed and simulated data. Results: The study identified three stages of system performance decline, or choke points, as hospital occupancy increased. These choke points were found to be dependent on hospital size, and reflect a system change from 'business-as-usual' to 'crisis'. Effecting early discharge of patients was also found to significantly (P<0.001) impact overcrowding levels and improve patient flow. Conclusions: Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system. © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Maier B.J.,Queensland Health
Women and Birth | Year: 2013
The following article describes a midwife's experience in the adaption of the CenteringPregnancy model into her own group practice to provide education and support to the women in her care. Using personal experience and feedback from women and midwifery students the author describes not only the process of group care in her work context but the apparent benefits to women, families', midwifery students and herself. Antenatal group care was so successful for the author that it extended to postnatal group care and student group care, all well attended and sought after groups. This is an exciting and innovative way to provide care for women and families and the author encourages other midwives and group practices to consider how they can adapt and progress similar group care into their own practice. © 2012.
Percival M.,Queensland Health |
Jayasinghe R.,Gold Coast Hospital Southport Campus
International Journal of Clinical Pharmacy | Year: 2012
Aim: To identify Heart Failure patients' beliefs towards their medications and how these beliefs relate to adherence. Method: Patients attending a multi-disciplinary, community based heart failure clinic on the Gold Coast, Australia were interviewed using a questionnaire composed of fours parts: repertory grid technique; Beliefs About Medicines Questionnaire (BMQ); Medicines Adherence Reporting Scale (MARS); demographic details. Patients were divided into those categorised as adherent (MARS score ≥ 23) and those categorised as non-adherent (MARS score < 23). Necessity beliefs scores from BMQ and the frequency of statements generated from the repertory grid portion of the questionnaire were compared between these two groups. Results: Forty-three patients were interviewed with a mean age (±SD) of 64 (±17) years and thirty-six (83.7 %) were male. Thirty-seven (86.0 %) patients were categorised as adherent; the remaining six (14.0 %) as nonadherent. The 43 patients generated a total of 262 statements about their medicines. The three most common themes identified were Related to fluid (36.6 %), Helps the heart (31.7 %) and Related to weight (13.7 %). There was a significantly higher median necessity score in the adherent group compared to the non adherent group (22.0 vs. 19.5, p = 0.0272). Patients with a strong necessity score also had significantly higher self reported adherence compared to patients with a strong concerns score (21.5 vs. 18.0, p = 0.006). Conclusion: This study suggests that patients with heart failure possessing a strong belief in the necessity of their treatment regimen are more likely to demonstrate better adherence. © Springer Science+Business Media B.V. 2012.
Pieper I.,Queensland Health
Monash bioethics review | Year: 2011
The first consideration of any Australian Human Research Ethics Committee should be to satisfy itself that the project before them is worth undertaking. If the project does not add to the body of knowledge, if it does not improve social welfare or individual wellbeing then the use of human participants, their tissue or their data must be questioned. Sometimes, however, committees are criticised for appearing to adopt the role of scientific review committees. The intent of this paper is to provide researchers with an understanding of the ethical importance of demonstrating the merit of their research project and to help them develop protocols that show ethics committees that adequate attention has been paid to this central tenet in dealing ethically with human research participants. Any person proposing human research must be prepared to show that it is worthwhile. This paper will clarify the relationship between research merit and integrity, research ethics and the responsibilities of human research ethics committees.