Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium

This study piloted a hospital-based delirium and falls education program to investigate the impacts on staff knowledge and practice plus patient falls. On a medical ward, staff knowledge was compared before and after education sessions. Other data – collected a day before and after program implementation – addressed documentation of patients' delirium and evidence of compliance with falls risk minimization protocols. These data, and numbers of patient falls, were compared before and after program implementation. Almost all ward staff members participated in education sessions (7 doctors, 7 allied health practitioners, and 45 nurses) and knowledge was significantly improved in the 22 who completed surveys both before and after session attendance. Patients assessed as having delirium (5 before implementation, 4 afterwards) were all documented as either confused or delirious. Small changes eventuated in adherence with falls risk management protocols for confused patients and the number of falls decreased. The program merits a stronger emphasis on staff activities relating to the detection, documentation, and management of delirium to inter-professional roles and communication. Evidence of practice enhancement from program implementation should precede rigorous testing of impacts upon falls

Beyond Chapter 4.7

Chapter 4.7 of the National Statement on Ethical Conduct in Human Research refers specifically to Aboriginal and Torres Strait Islander Peoples. It lays out the points at which researchers working with Aboriginal and Torres Strait Islanders must consider their approach, and the engagement with individuals, communities or groups who are involved in or affected by their research. History, of Australia and of research involving Aboriginal and Torres Strait Islander Australians, has informed this approach. The response to that history has been a rational, institutionalised, systematic demand for a different perception of what should direct research and research processes to ensure engagement with and service to the community with whom the researchers wish to do the work. This paper considers whether these principles could inform the approach to other research work.not applicabl

Exploring ethical issues associated with using online surveys in educational research

Online surveys are increasingly used in educational research, yet little attention has focused on ethical issues associated with their use in educational settings. Here, we draw on the broader literature to discuss 5 key ethical issues in the context of educational survey research: dual teacher/researcher roles; informed consent; use of incentives; privacy, anonymity, and confidentiality; and data quality. We illustrate methods of addressing these issues with our experiences conducing online surveys in educational contexts. Moving beyond the procedural ethics approach commonly adopted in quantitative educational research, we recommend adopting a situated/process ethics approach to identify and respond to ethical issues that may arise during the conduct, analysis, and reporting of online survey research. The benefits of online surveying in comparison to traditional survey methods are highlighted, including the potential for online surveys to provide ethically defensible methods of conducting research that would not be feasible in offline education research settings

The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting

Background: Australian Aboriginal and Torres Strait Islander peoples (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the outcome of a study that aimed to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program. Methods: A randomised controlled trial of Aboriginal researcher delivered tailored smoking cessation counselling during face-to-face visits, aiming for weekly for the first four weeks, monthly to six months and two monthly to12 months. The control (“usual care”) group received routine care relating to smoking cessation at their local primary health care service. Data collection occurred at enrolment, six and 12 months. The primary outcome was self-reported smoking cessation with urinary cotinine confirmation at final follow-up (median 13 (interquartile range 12–15) months after enrolment).Results: Participants in the intervention (n = 55) and usual care (n = 108) groups were similar in baseline characteristics, except the intervention group was slightly older. At final follow-up the smoking cessation rate for participants assigned to the intervention group (n = 6; 11%), while not statistically significant, was double that of usual care (n = 5; 5%; p = 0.131). A meta-analysis of these findings and a similarly underpowered but comparable study of pregnant Indigenous Australian women showed that Indigenous Australian participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care. Conclusions: Culturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12608000604303)

Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): Study protocol for a randomised controlled trial

Background: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. Methods: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. Discussion: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU. Trial registration: Australian New Zealand Clinical Trial Registry (ANZCTR) number: ACTRN12616000436471. Registered on 20 December 2015

Vice chancellors for the 21st century? A study of contemporary recruitment and selection practices in Australian universities

This article is based on recent Ph.D research. The practices for appointing Vice Chancellors (VC\u27s) in Australian Universities were examined, together with the changing role of the VC and new demographic patterns in VC backgrounds. A number of other issues were also examined, including the training and preparation of VC\u27s, mentoring and the changing skill base required to be effective in the role. In addition, the paradox was investigated of appointing academics from the ranks of individuals with non-business backgrounds, to run large enterprises which are being compelled to adopt an increasingly business-oriented focus. The methodology employed involved the use of a survey instrument administered to present and former VC\u27s, Chancellors and members of selection panels, supplemented by interviews. Representatives of the Australian Vice Chancellors Committee (AVCC) and consultants operating in the academic field were also interviewed. In addition, extensive use was made of public domain material. The research was mainly qualitative in nature. However, use was also made of descriptive statistics to provide an insight into how higher education in Australia is changing and to analyse survey findings. Some key results of the research are reported, including the importance of informal processes such as networking in the selection of VC\u27s, the key role played by Chancellors, and the continued practice of appointing VC\u27s from within academia rather than the private sector. This is in spite of evidence that the role of the VC has changed to one of strategic planner and business manager rather than the more traditional role, in the context of a rapidly changing external environment. Suggestions are also made for ongoing research in the area.<br /

Vice chancellors for the 21st century? A study of contemporary recruitment and selection practices in Australian universities

This article is based on recent Ph.D research. The practices for appointing Vice Chancellors (VC\u27s) in Australian Universities were examined, together with the changing role of the VC and new demographic patterns in VC backgrounds. A number of other issues were also examined, including the training and preparation of VC\u27s, mentoring and the changing skill base required to be effective in the role. In addition, the paradox was investigated of appointing academics from the ranks of individuals with non-business backgrounds, to run large enterprises which are being compelled to adopt an increasingly business-oriented focus. The methodology employed involved the use of a survey instrument administered to present and former VC\u27s, Chancellors and members of selection panels, supplemented by interviews. Representatives of the Australian Vice Chancellors Committee (AVCC) and consultants operating in the academic field were also interviewed. In addition, extensive use was made of public domain material. The research was mainly qualitative in nature. However, use was also made of descriptive statistics to provide an insight into how higher education in Australia is changing and to analyse survey findings. Some key results of the research are reported, including the importance of informal processes such as networking in the selection of VC\u27s, the key role played by Chancellors, and the continued practice of appointing VC\u27s from within academia rather than the private sector. This is in spite of evidence that the role of the VC has changed to one of strategic planner and business manager rather than the more traditional role, in the context of a rapidly changing external environment. Suggestions are also made for ongoing research in the area.<br /