Attendant care program direct funding pilot evaluation

The Department of Ageing, Disability and Home Care (DADHC) is piloting a direct funding project in conjunction with the Attendant Care Program (ACP). The direct funding pilot aims to complement the objectives of the ACP, which provides support to individuals with physical disabilities with a range of tasks and activities to allow them to live and participate in their communities. The evaluation compares three ACP funding options, which differ in who employs the attendant carers, who receives the funding from DADHC and who is responsible for management and reporting: • Employer model – the service provider is the attendant carers’ employer; in some organisations, clients can chose to participate in some attendant carer management decisions, such as recruitment. DADHC pays the funds to the service provider and the service provider is accountable to DADHC for the management of funds and reporting. Thirty two service providers are registered with DADHC to provide this model. • Cooperative model – the client is the attendant carers’ employer; the service provider supplies administrative and management support. DADHC pays the funds to the service provider and the service provider is accountable to DADHC for the management of funds and reporting. One provider offers this model. • Direct funding – the client is responsible for all attendant carer employment and management. DADHC pays the funds directly to the client, who is accountable to DADHC for the management of funds and reporting. The pilot project is providing funds directly to ten current ACP clients for the direct purchase of personal care services. This is intended to provide clients with greater control over the choice and management of the support they receive as well as to promote more flexible and responsive services for clients

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

The contribution of X-linked coding variation to severe developmental disorders

Abstract: Over 130 X-linked genes have been robustly associated with developmental disorders, and X-linked causes have been hypothesised to underlie the higher developmental disorder rates in males. Here, we evaluate the burden of X-linked coding variation in 11,044 developmental disorder patients, and find a similar rate of X-linked causes in males and females (6.0% and 6.9%, respectively), indicating that such variants do not account for the 1.4-fold male bias. We develop an improved strategy to detect X-linked developmental disorders and identify 23 significant genes, all of which were previously known, consistent with our inference that the vast majority of the X-linked burden is in known developmental disorder-associated genes. Importantly, we estimate that, in male probands, only 13% of inherited rare missense variants in known developmental disorder-associated genes are likely to be pathogenic. Our results demonstrate that statistical analysis of large datasets can refine our understanding of modes of inheritance for individual X-linked disorders

Attendant Care Direct Funding Pilot Project Evaluation: Interim Report

The Department of Ageing, Disability and Home Care (DADHC) is piloting a direct funding project in conjunction with the Attendant Care Program (ACP). The direct funding pilot aims to complement the objectives of the ACP, which provides support to individuals with physical disabilities with a range of tasks and activities to allow them to live and participate in their communities. ACP is funded under the Commonwealth State and Territory Disability Agreement and administered by DADHC. The report compares three types of ACP funding models, which differ in who employs the attendant carers, who receives the funding from DADHC and who is responsible for management and reporting: Cooperative model – the client is the attendant carers’ employer; the service provider provides administrative and management support. Funds are paid to the service provider and the service provider is accountable to DADHC for the management of funds and reporting. Employer model – the service provider is the attendant carers’ employer; in some organisations, clients can chose to participate in some attendant carer management decisions, such as recruitment. Funds are paid to the service provider and the service provider is accountable to DADHC for the management of funds and reporting. Direct funding – the client is responsible for all attendant carer employment and management. Funds are paid directly to the client, who is accountable to DADHC for the management of funds and reporting