المؤلفون: Kristy Fakes, Breanne Hobden, Nick Zwar, Nick Collins, Christopher Oldmeadow, Francesco Paolucci, Allan Davies, Irosh Fernando, Michael McGee, Trent Williams, Cameron Robson, Robert Hungerford, Jia Ying Ooi, Aaron L Sverdlov, Rob Sanson-Fisher, Andrew J Boyle

المصدر: Digital Health, Vol 10 (2024)

مصطلحات موضوعية: Computer applications to medicine. Medical informatics, R858-859.7

الوصف: Objective Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Methods Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: ‘Enhanced HF Care’) or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Results Sixty-five participants enrolled to-date. Co-primary outcomes (‘Minnesota Living with Heart Failure Questionnaire’ Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. Conclusions This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. Trial registration The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2055-2076

URL الوصول: https://doaj.org/article/ce18d4ecd3d7472e9cbbd4db80498207

المؤلفون: Emilie Cameron, Natasha Noble, Jamie Bryant, Grace Norton, Viv Allanson OAM, Rob Sanson-Fisher

المصدر: BMC Health Services Research, Vol 23, Iss 1, Pp 1-8 (2023)

مصطلحات موضوعية: Residential aged care, Job satisfaction, Quality of care, Aged care workforce, Nursing home, Public aspects of medicine, RA1-1270

الوصف: Abstract Background The quality of care provided in residential aged care facilities is largely dependent on the job satisfaction of employees and the organisational framework and systems that they provide care in. This study aimed to explore aged care staff perceptions of job satisfaction, regulation of the sector and the Royal Commission into Aged Care Quality and Safety. Methods A cross-sectional survey conducted in 2019-early 2020 with staff employed in various roles at residential aged care services in Australia. The study specific survey collected views and experiences about working in the aged care sector as well as information about their role. Results A total of 167 aged care staff completed the survey of which 71% worked in a direct care role. Most participants indicated they thought they were doing a worthwhile and important job (98%), were proud to work in the sector (94%) and found the job personally rewarding (94%). However, participants also reported feeling emotionally drained by the work (37%) and fatigued by having to face a day of work (30%). 72% of participants felt the Royal Commission would lead to improvements in the care provided to residents. Conclusion Aged care staff have an overall positive feeling towards their work. Additional support including increasing skills to deliver high-quality care, creating a supportive work environment to reduce job stressors and changes to the way the sector is regulated, are likely to lead to improved care.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1472-6963

URL الوصول: https://doaj.org/article/963d9369ce0f4739aeb36485071c7883

المؤلفون: Phinda G Khumalo, Mariko Carey, Lisa Mackenzie, Rob Sanson-Fisher

المصدر: PLoS ONE, Vol 19, Iss 4, p e0300763 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: BackgroundOver recent years, cervical cancer incidence and related mortality have steadily increased in Eswatini. Low cervical cancer screening uptake partly explains the situation. Cervical cancer screening-related knowledge is positively associated with screening uptake. Little is known about women's cervical cancer screening-related knowledge in Eswatini.ObjectiveThis study aimed to assess cervical cancer screening knowledge and associated factors among Eswatini women eligible for screening.MethodsA cross-sectional study involving three hundred and seventy-seven women aged 25 to 59 selected from four primary healthcare clinics in Eswatini was conducted. A paper and pen survey assessed knowledge about cervical cancer risk factors, benefits of screening, the meaning of screening results, recommended screening intervals, and socio-demographics. Descriptive analyses were performed to assess participants' sociodemographic characteristics. Linear regression was applied to examine associations between cervical cancer screening-related knowledge and participants' sociodemographic characteristics.ResultsTwo hundred and twenty-nine (61%) participants answered 80% or more knowledge questions correctly. Compared to HIV-positive participants, HIV-negative participants had 0.61 times lower cervical cancer screening knowledge scores (β = -0.39, 95% CI: -0.56, -0.19, p = 0.03). Participants who travelled more than 30 minutes to the clinic had 0.3 times lower cervical cancer screening knowledge scores (β = -0.70, 95% CI: -1.15, -0.25, p < 0.01) compared to participants who travelled less than 30 minutes to the clinic.ConclusionsRelatively high overall cervical cancer screening knowledge levels were observed among the study participants. Findings from the current study may inform future educational programs to create and sustain an accurate understanding of cervical cancer screening in Eswatini communities.

وصف الملف: electronic resource

Relation: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0300763&type=printable; https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/44acc830c0ec43798a35e639578af2c3

المؤلفون: Phinda G. Khumalo, Mariko Carey, Lisa Mackenzie, Rob Sanson-Fisher

المصدر: BMC Public Health, Vol 23, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Adherence, Uterine cervical neoplasms, Screening, Guidelines, Eswatini, Public aspects of medicine, RA1-1270

الوصف: Abstract Background In 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women’s risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women’s self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence. Methods A cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations. Results One hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1471-2458

URL الوصول: https://doaj.org/article/407c01b3fa044c3ead00588c1dd6d0ef

المؤلفون: Amy Waller, Kristy Fakes, Mariko Carey, Joshua Dizon, Kim Parrey, Michelle Coad, Rob Sanson-Fisher

المصدر: BMC Psychology, Vol 11, Iss 1, Pp 1-13 (2023)

مصطلحات موضوعية: Stroke, Quality of life, Depression, Anxiety, Psychology, BF1-990

الوصف: Abstract Background Exploring sociodemographic and disease characteristics that contribute to patient-reported outcomes can inform targeting of strategies to support recovery and adaptation to stroke. This study aimed to examine among a sample of stroke survivors at three months post-hospital discharge: (1) self-reported physical and mental health quality of life scores; (2) self-reported depressive and anxiety symptoms; and (3) sociodemographic and clinical predictors of these outcomes. Methods This cross-sectional survey study recruited stroke survivors from eight hospitals in one Australian state. Adult survivors recently discharged from hospital stroke wards (within 3 months) were mailed a study information package and invited to complete a pen-and paper survey. Survey items assessed: quality of life (SF12v2), depression (PHQ-9), anxiety (GAD-7) and sociodemographic and clinical characteristics. Predictors were examined using multiple linear regression analysis. Results Of the 1161 eligible patients who were posted a recruitment pack, 401 (35%) returned a completed survey. Participants reported a mean SF-12v2 Physical Composite Score (PCS) quality of life score of 44.09 (SD = 9.57); and a mean SF-12v2 Mental Composite Score (MCS) quality of life score of 46.84 (SD = 10.0). Approximately one third of participants (34%; n = 132) were classified as depressed (PHQ-9 ≥ 10); and 27% (n = 104) were classified as anxious (GAD-7 ≥ 8). Lower PCS was associated with being female, not employed and having a comorbid diagnosis of diabetes and atrial fibrillation. Lower MCS was associated with a history of transient ischemic attack (TIA). Males and those with higher levels of education, had greater odds of having lower depression severity; those with a history of TIA or diabetes had lower odds of having lower depression severity. Males had greater odds of having lower anxiety severity; those with a history of TIA had lower odds of having lower anxiety severity. Conclusion Sub-groups of stroke survivors may be at-risk of poorer quality of life and psychological morbidity in the early post-discharge phase. These findings support the role of early identification and prioritisation of at-risk survivors at discharge, as they may require modifications to standard hospital discharge processes tailored to their level of risk.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2050-7283

URL الوصول: https://doaj.org/article/d4562393ff8c4a84a29db797ec23070f

المؤلفون: Jamie Bryant, Amy Waller, Alison Bowman, Robert Pickles, Carolyn Hullick, Emma Price, Ben White, Lindy Willmott, Anne Knight, Mary-Ann Ryall, Rob Sanson-Fisher

المصدر: BMC Medical Ethics, Vol 23, Iss 1, Pp 1-7 (2022)

مصطلحات موضوعية: Advance care directives, Advance care planning, Junior doctors, Knowledge, Medical philosophy. Medical ethics, R723-726

الوصف: Abstract Background For the benefits of advance care planning to be realised during a hospital admission, the treating team must have accurate knowledge of the law pertaining to implementation of advance care directives (ACDs) and substitute decision making. Aims To determine in a sample of Junior Medical Officers (JMOs): (1) knowledge of the correct order to approach people as substitute decision makers if a patient does not have capacity to consent to treatment; (2) knowledge of the legal validity of ACDs when making healthcare decisions for persons without capacity to consent to treatment, including the characteristics associated with higher knowledge; and (3) barriers to enacting ACDs. Methods A cross-sectional survey was conducted at five public hospitals in New South Wales, Australia. Interns, residents, registrars, and trainees on clinical rotation during the recruitment period were eligible to participate. Consenting participants completed an anonymous pen-and-paper survey. Results A total of 118 JMOs completed a survey (36% return rate). Fifty-five percent of participants were female and 56.8% were aged 20–29 years. Seventy-five percent of JMOs correctly identified a Guardian as the first person to approach if a patient did not have decision-making capacity, and 74% correctly identified a person’s spouse or partner as the next person to approach. Only 16.5% identified all four persons in the correct order, and 13.5% did not identify any in the correct order. The mean number of correct responses to the questions assessing knowledge of the legal validity of ACDs was 2.6 (SD = 1.1) out of a possible score of 6. Only 28 participants (23.7%) correctly answered four or more knowledge statements correctly. None of the explored variables were significantly associated with higher knowledge of the legal validity of ACDs. Uncertainty about the currency of ACDs and uncertainty about the legal implications of relying on an ACD when a patient’s family or substitute decision maker disagree with it were the main barriers to enacting ACDs. Conclusion JMOs knowledge of the legal validity of ACDs for persons without decision making capacity and the substitute decision making hierarchy is limited. There is a clear need for targeted education and training to improve knowledge in this area for this cohort.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1472-6939

URL الوصول: https://doaj.org/article/dafa055e93bd47a6a0ba14620d4d74b8

المؤلفون: Amy Waller, Jamie Bryant, Alison Bowman, Ben P. White, Lindy Willmott, Robert Pickles, Carolyn Hullick, Emma Price, Anne Knight, Mary-Ann Ryall, Mathew Clapham, Rob Sanson-Fisher

المصدر: BMC Medical Ethics, Vol 23, Iss 1, Pp 1-9 (2022)

مصطلحات موضوعية: Advance care directives, Dementia, Advance care planning, Junior doctors, Knowledge, Law, Medical philosophy. Medical ethics, R723-726

الوصف: Abstract Background Junior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives (ACDs), or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: (1) their legal compliance and decision-making process related to treatment decisions; (2) the factors influencing their clinical decision-making; and (3) the factors associated with accurate responses to one hypothetical vignette. Method A cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: (1) bacterial pneumonia; or (2) suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette. Results Overall, 116 junior doctors responded (35% consent rate). In Vignette 1, 58% of respondents (n = 67/116) selected the legally compliant option (i.e. not commence treatment). Participants who chose the legally compliant option perceived ‘following patient wishes’ (n = 32/67; 48%) and ‘legal requirements to follow ACDs’ (n = 32/67; 48%) as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’ (n = 14/37; 38%). In Vignette 2, 72% of respondents (n = 83/116) indicated they would commence treatment (i.e. not follow the ACD) and 18% (n = 21/116) selected they would not commence treatment. (i.e. follow the ACD). Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario. Conclusions There are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1472-6939

URL الوصول: https://doaj.org/article/4e993b21e9154c118fbeeaba307ea1be

المؤلفون: Elise Mansfield, Jamie Bryant, Balakrishnan R. Nair, Alison Zucca, Ranjeev Chrysanth Pulle, Rob Sanson-Fisher

المصدر: BMC Geriatrics, Vol 22, Iss 1, Pp 1-8 (2022)

مصطلحات موضوعية: Dementia, Alzheimer’s disease, Geriatricians, Health care providers, Diagnosis, Quality of care, Geriatrics, RC952-954.6

الوصف: Abstract Background Providing a timely and accurate diagnosis of dementia and delivering appropriate support following a diagnosis are essential to allow individuals and their families to plan for the future. Recent studies suggest that provision of diagnosis and post-diagnosis support is suboptimal. This study explored geriatricians’ views about strategies to improve quality of care across these domains. Methods An anonymous online survey of geriatricians and advanced trainees in one Australian state was conducted. An Expert Advisory Group of geriatricians, behavioural scientists and consumers proposed strategies to improve quality of care in relation to diagnosis and post-diagnosis support for people with dementia, which formed the survey items. Potential strategies were guided by, but not limited to, dementia and chronic care guidelines. Participants were asked the extent to which they agreed that implementing each of the proposed strategies would improve the quality of dementia care. Results Of 59 participants (response rate 42%), all agreed that improving accessibility of geriatricians would improve the accuracy and timeliness of diagnosis. Over 90% were supportive of strategies to improve capacity of general practitioners to accurately diagnose dementia. Between 97-100% agreed that information provided following diagnosis should encompass symptom progression, treatments, psychological supports, and advance care planning. Just over two-thirds thought that life expectancy should be discussed at this time. There were high levels of support for strategies already included in existing dementia care guidelines, however geriatricians also agreed with a range of possible strategies not currently included in guidelines. Conclusions Geriatricians perceive that timeliness and accuracy of dementia diagnosis may be improved by increasing access to geriatricians and training general practitioners in diagnosing dementia. They also believe it is appropriate to provide information at the time of diagnosis across a comprehensive range of areas, including potentially sensitive topics such as advance care planning. Future studies should explore the views of other groups of health care providers and consumers about these approaches. The strategies proposed should be considered for inclusion in future dementia care guidelines.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1471-2318

URL الوصول: https://doaj.org/article/e9959ca295cb44b888da634a8efa2445

المؤلفون: Jamie Bryant, Elise Mansfield, Emilie Cameron, Rob Sanson-Fisher

المصدر: PLoS ONE, Vol 18, Iss 6, p e0286261 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: BackgroundFuture medical and financial planning is important for persons with dementia given the impact of the disease on capacity for decision making.AimsTo explore from the perspective of carers of persons with dementia: (1) Participation in future medical and financial planning by the person they care for, including when planning was undertaken and the characteristics associated with having an advance care directive completed; (2) The type of healthcare providers who discussed advance care planning following diagnosis; and (3) Preferences for timing of discussions about advance care planning following diagnosis.MethodsRecruitment and data collection took place between July 2018 and June 2020. Carers of persons with dementia aged 18 years and older were mailed a survey. Participants completed questions regarding completion of various future planning documents by the person they support, including time of completion and who discussed advance care planning following diagnosis. Participants were presented with information about the benefits and consequences of early and late discussions of advance care planning and asked when discussions about advance care planning were best initiated.Results198 carers participated. Most participants were female (74%) and had been a carer for more than 2 years (82%). Most participants reported that the person with dementia they support had made a Will (97%) and appointed an Enduring Guardian (93%) and Enduring Power of Attorney (89%). Only 47% had completed an advance care directive. No significant associations were found between characteristics of persons with dementia and completion of an advance care directive. Geriatricians (53%) and GPs (51%) most often discussed advance care planning following diagnosis. Most carers thought that discussions about advance care planning should occur in the first few weeks or months following diagnosis (32%), at the healthcare provider's discretion (31%), or at the time of diagnosis (25%).ConclusionsMore than half of persons with dementia do not have an advance care directive. There is variability in preferences for timing of discussions following dementia diagnosis.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/64cf5c06367d4dfe94dcc991515c69b3

المؤلفون: Mariko Carey, Alison Zucca, Joel Rhee, Rob Sanson‐Fisher, Grace Norton, Christopher Oldmeadow, Tiffany Evans, Kichu Nair

المصدر: Australian and New Zealand Journal of Public Health, Vol 45, Iss 5, Pp 506-511 (2021)

مصطلحات موضوعية: health assessment, ageing, primary care, preventive screening, implementation, Public aspects of medicine, RA1-1270

الوصف: Abstract Objective: To examine general practitioners’ views about how health assessments for older people should be conducted. Methods: General practitioners were randomly sampled from a national database of medical practitioners and invited to complete a survey. Survey items explored general practitioners’ views about essential components of a 75+ Health Assessment and who should assess each component, consultation time, use of standardised templates and tools, and home visits. Results: Overall, 185 (19.2%) general practitioners participated. Of 61 items presented, 24 were rated ‘essential’ by ≥70% of practitioners, with an average estimated consultation time of 65 minutes. Of the 24 essential items, it was perceived that 21 could be assessed by either a general practitioner or clinic nurse. Most practitioners indicated a standardised template (86%) and standardised tools for complex issues (79%) should be used, and home visits conducted (75%). Conclusions: General practitioners agreed on 24 items as essential for every health assessment, with assessments estimated to take more than one hour. Implications for public health: Increases to remuneration for prolonged assessments or mechanisms for improving efficiency and quality of assessments are needed. Acceptable mechanisms may include standardised patient‐reported tools, standardised templates and the use of non‐medical staff to assist with assessments.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1326-0200; https://doaj.org/toc/1753-6405

URL الوصول: https://doaj.org/article/7b253a43d8774ab1bc7d45f43beae83a