Early Childhood Development (ECD) services in the Southern Adelaide Health Service region.

This report documents the findings of a review conducted by the South Australian Community Health Research Unit (SACHRU) at the request of the Southern Adelaide Health Service (SAHS) into the provision of Early Childhood Development services in southern Adelaide. This review was undertaken between June and December 2006 and overseen by a Project Management group consisting of representatives from the SAHS, the primary health services managers, practitioners, an acute service manager and the researchers. The review examined the early childhood services provided by primary health services across the region, the models used, intake procedures and referral pathways. The findings were to be used for future service planning, implementation and resourcing

Families empowered: a strengths based approach. An evaluation of FEAT, Families Empowered to Act Together.

The South Australian Community Health Research Unit undertook an evaluation of the FEAT program to track the progress of a number of families through the Families Empowered to Act Together (FEAT) program and capture the experiences and perspectives of children, families and stakeholders. Interviews were undertaken with carers and children both currently in the program and those recently exited. The evaluation also documents the development of the FEAT model of service and its aims and objectives; relates the operation of FEAT to understandings in the current literature regarding best practice principles and models for family support programs; and identifies other agencies, programs and services that the FEAT program links with in order to meet the needs of referred families. The evaluation adopted an action research framework employing qualitative and quantitative methods, and has encouraged participation by key stakeholders in the research process

Transformational change in health systems: a road strewn with obstacles.

This research study assesses the impact on primary health care of the reform changes in the South Australian health system from 2005 to 2007. The research follows a pilot study conducted in one of the newly created health regions in 2005 to 2006 and reported in: Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care (Baum et al. 2006). Both studies were intended as scoping exercises to contribute towards the development of an evaluation framework for primary health care

The social support and service needs of Australia’s ageing Greek migrants: a pilot project

This article explores the social support and service needs of Greek-speakers in Australia who migrated as young adults mostly in the 1940s and 1950s. The article reports the findings of a pilot research project initiated by the Modern Greek department at Flinders University in conjunction with social, health and ageing researchers. Focus groups and interviews were held in Adelaide and Darwin in 2010 with older Greek-speakers born in Greece and Cyprus; a survey of service organisations was also conducted. All older Greeks chose to be interviewed in Greek. They reported using a range of formal services, although some were confused about how to access services and lacked awareness of services. Interrupted primary education had resulted in low reading proficiency in Greek, while settlement experiences had contributed to low proficiency in reading, writing and speaking English. These were major barriers to accessing services with no Greek-speaking staff. In line with cultural expectations, a key support role was played by adult children, while some Greek-speaking GPs and MPs also mediated information and service access. Many older Greeks appear to be living independently in the community, but this is only possible because of high levels of informal support from close family. Those without children may therefore be more vulnerable to social isolation. The Modern Greek researchers who were integral members of the research team acted as ‘insiders’ who shared the culture and language of interviewees. Since all interviewees chose to be interviewed in Modern Greek, the ability to conduct interviews in Greek clearly enabled their participation, whereas they may have declined to participate had interviews only been available in English. At the same time, the non-Greek researchers provided a critical ‘outsider’ view which strengthened the data analysis and interpretation. We conclude that this project has demonstrated the important role that Modern Greek academics can play in research on social and health issues among the Greek diaspora

The social support and service needs of Australia’s ageing Greek migrants: a literature review.

This paper presents the results of a literature review undertaken to shape an emerging social research program on the service and support needs of Australia’s ageing Greek migrants. In late 2009 a narrative review was conducted of published and ‘grey’ literature to determine the scope of articles, with an emphasis on services and supports which help older people remain independent in the community. The search returned an extensive amount of international literature on ageing populations, but only a very small number of publications on the service use and needs of Australia’s older Greek population. Barriers to service use included low proficiency in English, lack of Greek-speaking service providers, low awareness of services available, and various cultural issues. The review also identified a lack of research carried out in the Greek language by researchers with a Greek background, which suggests that the views of older Greek migrants may be missing from much social research. We conclude that a sustained and culturally appropriate research effort conducted in the first language is needed and is essential if community-based services are to become more appropriate and accessible for the older members of Australia’s Greek communities

Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care.

This report describes a study aiming to assess the impact of the introduction of regional health structures to metropolitan Adelaide. The study was conducted in 2005 in the southern Adelaide region. Major research questions were: What is the most effective way to organise health service governance in order to promote and strengthen primary health care as a key focus of the health system? How does a change in health service governance affect the position of primary health care in relation to acute care services

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment