Evaluation of the Improving Social Connectedness of Older Australians project pilot: Informing future policy considerations

This report draws on findings and lessons learned through the Australian Government funded evaluation of the Improving Social Connectedness of Older Australians (ISCOA) pilot. It summarises what has worked in the context of the evaluation to help inform the Government’s future models of care and interventions for lonely and socially isolated older Australians

Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers' Physical Activity: Qualitative Study.

BackgroundAs mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers.ObjectiveThe aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers' physical activity with both parents and children.MethodsParents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers' mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app.ResultsFive key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families' everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child's mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app.ConclusionsMobile devices are already integrated into most families' daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

Objectives The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies. Methods Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. Results Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p \u3c 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p \u3c 0.001), blood cultures (p \u3c 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p \u3c 0.001 and p = 0.001, respectively), as did the type of surgical approach (p \u3c 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014). Conclusions Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes

Pathways to Community Living Initiative – Final Evaluation Report

The Pathways to Community Living Initiative (PCLI) is a major mental health reform program led by the NSW Ministry of Health (‘the Ministry’) in collaboration with NSW Local Health Districts (LHDs). It is a key component of the whole- of-government enhancement of mental health care under the NSW Mental Health Reform 2014-2024. The PCLI represents a transformational change in the care of people with severe and persistent mental illness (SPMI) and complex needs who are, or are at risk of becoming, long-stay inpatients in NSW hospitals. This is PCLI Evaluation Report 7, the final report of the independent evaluation conducted by the Centre for Health Service Development, University of Wollongong, between January 2017 and October 2021. The report presents the summative findings of the mixed methods evaluation activities and formative information to guide continuing reform within mental health services

Diversity in Party Leadership in State Legislatures

Members of historically underrepresented groups—women, African Americans, Latinos, and workers—are serving in American legislatures in increasing numbers. However, legislators wield substantially greater power in the lawmaking process when they hold leadership positions. Incorporation of these groups into leadership positions could indicate fuller political representation, but scholars to date have not assessed how well these groups are represented in leadership. We analyze original data describing the backgrounds of approximately 2,200 leaders in 30 states between 2003 and 2014. The data show that, on average across states, members of these groups are as well represented in state legislative leadership positions as they are in rank-and-file membership, but there is substantial variation across states and across parties. We then ask what factors might explain this variation and explore institutional characteristics, like the number of leadership positions or leader selection methods. The results show that legislative chambers with a higher number of leadership posts tend to have more women in leadership, and that selection through elections is associated with decreased African American presence in leadership. The findings have implications for minority incorporation and influence in American politics

HWA Expanded Scopes of Practice program evaluation: Extending the Role of Paramedics sub-project: final report

The Extending the Role of Paramedics (ERP) sub-project built on a model developed by the South Australian Ambulance Service (SAAS) which aims to provide a service that is complementary to primary health care, thus reducing emergency department presentations. The core of the model is training Extended Care Paramedics (ECPs) to treat patients in their usual place of residence, with referral to other health professionals if appropriate. ECPs manage patients with a diverse, and often ill-defined, range of signs and symptoms. Although these patients are deemed \u27low acuity\u27, these cases can be complex and require the ECP to apply advanced clinical reasoning. In many cases, the patient may have multiple chronic conditions and present as generally unwell. The published evidence to date generally supports an expansion of the role of paramedics to include the assessment and management of patients with minor illnesses and injuries to avoid transport to hospital. However, the evidence is primarily from overseas, particularly the United Kingdom, and more research is required to establish the effectiveness and safety of the model

HWA Expanded Scopes of Practice program evaluation: Advanced Practice in Endoscopy Nursing sub-project: final report

The Advanced Practice in Endoscopy Nursing (APEN) sub-project was undertaken in response to a national trend of increasing demand for endoscopy services, in part due to the implementation of the National Bowel Cancer Screening Program. The aim was to train nurses to perform endoscopic procedures previously only undertaken in Australia by doctors. Although new to Australia, nurse endoscopists are well established in the United Kingdom. Recently published evidence based on a systematic review of the literature indicates that nurses can achieve similar results for efficacy and safety to those achieved by doctors

Enhancing comfort of resident physicians treating adults with intellectual and developmental disabilities by facilitating meaningful interactions

BackgroundMany physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture content on IDD, few provide structured experiences with individuals with IDD. One strategy for improving comfort is “contact theory:” increasing interactions with “dissimilar” people can lead to decreased negative attitudes toward that population.ObjectiveEvaluate the impact of an interactive session on resident physicians’ comfort with adults with IDD.MethodsSmall groups of resident physicians and artists with IDD collaborated on art projects during the noon conference. A prospective pre-post-intervention survey, including the validated Interaction with Disabled Persons Scale (IDP), evaluated residents’ comfort with patients with IDD before and after the session.Results53 residents completed both pre- and post-conference surveys. Mean IDP scores decreased from 78.7 (10.9) to 75.8 (9.5; p < 0.01), indicating decreasing discomfort. The mean level of comfort interacting with individuals with IDD increased from uncomfortable 3.6 (1.2), before the intervention, to comfortable 4.4 (1.2) after the intervention (p = <0.01). The mean level of comfort treating individuals with IDD increased from uncomfortable 3.5 (1.1) to comfortable 4.1 (1.3) after the intervention (p < 0.01).DiscussionProviding resident physicians with real-life connections with people with IDD was associated with increased comfort. If statistically significant improvements occurred after one session, future studies should evaluate if additional experiences with people with IDD could have more substantial, lasting impacts on future doctors’ comfort with and willingness to care for patients with IDD

Conceptual understanding of screen media parenting: report of a working group

Screen media (television, computers, and videogames) use has been linked to multiple child outcomes, including obesity. Parents can be an important influence on children\u27s screen use. There has been an increase in the number of instruments available to assess parenting in feeding and physical activity contexts, however few measures are available to assess parenting practices regarding children\u27s screen media use. A working group of screen media and parenting researchers convened at the preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity (ISBNPA) annual meeting, “Parenting Measurement: Current Status and Consensus Reports,” to identify and prioritize issues in assessing screen media parenting practices. The group identified that screen media use can pose different risks for children, depending on their age and developmental stage, across physiologic, psychosocial, and development outcomes. With that in mind, a conceptual framework of how parents may influence their child\u27s screen-viewing behaviors was proposed to include the screen media content, context of viewing, and amount viewed. A research agenda was proposed to prioritize a validation of the framework and enhance the ability of researchers to best assess parenting influences across the three domains of content, context and amount of children\u27s screen media use