Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia.

Abstract Background: International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women’s experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer. Methods: Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis. Results: Three themes were identifed: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and benefcial. Participants’ experiences difered in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse. Conclusions: Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients

Time trends, projections, and spatial distribution of low birthweight in Australia, 2009–2030: Evidence from the National Perinatal Data Collection

Introduction: Infants with low birthweight (LBW, birthweight <2500 g) have increased in many high-resource countries over the past two decades. This study aimed to investigate the time trends, projections, and spatial distribution of LBW in Australia, 2009–2030. Methods: We used standard aggregate data on 3 346 808 births from 2009 to 2019 from Australia's National Perinatal Data Collection. Bayesian linear regression model was used to estimate the trends in the prevalence of LBW in Australia. Results: We found that the prevalence of LBW was 6.18% in 2009, which has increased to 6.64% in 2019 (average annual rate of change, AARC = +0.76%). If the national trend remains the same, the projected prevalence of LBW in Australia will increase to 7.34% (95% uncertainty interval, UI = 6.99, 7.68) in 2030. Observing AARC across different subpopulations, the trend of LBW was stable among Indigenous mothers, whereas it increased among non-Indigenous mothers (AARC = +0.81%). There is also an increase among the most disadvantaged mothers (AARC = +1.08%), birthing people in either of two extreme age groups (AARC = +1.99% and +1.53% for <20 years and ≥40 years, respectively), and mothers who smoked during pregnancy (AARC = +1.52%). Spatiotemporal maps showed that some of the Statistical Area level 3 (SA3) in Northern Territory and Queensland had consistently higher prevalence for LBW than the national average from 2014 to 2019. Conclusion: Overall, the prevalence of LBW has increased in Australia during 2009–2019; however, the trends vary across different subpopulations. If trends persist, Australia will not achieve the Sustainable Development Goals (SDGs) target of a 30% reduction in LBW by 2030. Centering and supporting the most vulnerable subpopulations is vital to progress the SDGs and improves perinatal and infant health in Australia

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Future directions for information dissemination: Population health and the primary health care workforce

This report comprises three chapters exploring the capacity of the primary health care (PHC) workforce to undertake and support population health activities. In particular, the report addresses the broader non-General Practitioner PHC workforce, integrating the considerable work undertaken regarding the GP workforce and population health in recent years. The report incorporates insights, examples and recommendations that emerged in five state-based workshops. The input from primary health care workers, and those involved in education, policy and planning for the primary health care workforce, contributed to a clearer picture of both current population health practice and the educational and information needs for future development of the workforce. The first chapter, The Primary Health Care Workforce and Population Health Activities: Scope and Potential defines primary health care and population health, describes the workforce, and explains the complexity and potential of PHC in population health. The second chapter, Future Directions for Information Dissemination: Population Health and the Primary Health Care Workforce, describes dissemination needs and strategies, and proposes future directions for information dissemination. The last of the three chapters, Educational Options to develop Population Health Skills conducts an assessment of the population health educational needs of the PHC workforce, and considers the potential of the Public Health Education for Clinicians program for adaptation for the broader PHC workforce. The project was funded by the Australian Government Public Health Education and Research Program and was a collaborative venture between four universities: Flinders University; La Trobe University; University of New South Wales and University of Queensland

National Mental Health Workforce Strategy - A literature review of existing national and jurisdictional workforce strategies relevant to the mental health workforce and recent findings of mental health reviews and inquiries

This literature review presents an overview of the current policy landscape relating to the Australian mental health workforce and outlines key challenges and best practice approaches for developing an effective mental health workforce. The purpose of the review is to provide relevant information to support the National Mental Health Workforce Strategy Taskforce (the Taskforce) in their role of overseeing the development of the forthcoming National Mental Health Workforce Strategy 2021-2031. A rapid and targeted review was conducted across a six-week period (16 June - 29 July 2020) and involved close consultation with the Australian Government Department of Health project team and the Taskforce members

Clinical practice guideline for care around stillbirth and neonatal death: Section 3 - Respectful and supportive perinatal bereavement care

High quality perinatal bereavement care is critical for women and families following\ua0stillbirth or newborn death. Guidance for health care professionals is essential in this challenging area of practice but the evidence base is sparse and disparate. The\ua0 Clinical Practice Guideline for Respectful and Supportive PerinatalBereavement Care was developed for the Perinatal Society of Australia\ua0and New Zealand (PSANZ) and the Australian Stillbirth Centre of\ua0Research Excellence (Stillbirth CRE). Based on a comprehensive review of published evidence and wide consultation with parent organisations, clinicians, policy makers and researchers, the Guideline presents 49 clear evidence-based recommendations for health care professionals and maternity care facilities

THE DESIGN AND BUILD OF A PORTABLE DEVICE TO MEASURE OCULAR MICROTREMOR (OMT)

ABSTRACT This paper describes the successful design and build of a portable device to record open and closed eye Ocular Microtremor (OMT) signals using an eye contacting piezoelectric crystal. INTRODUCTION The eyes of all normal subjects undergo a continuous, low-amplitude, high frequency, physiological tremor called ocular microtremor (OMT). The tremor occurs at a frequency between 20 and 150 Hz and is of the order of 1µm. It was first described in 1934 by Alder and Fliegelman [1] as one of three fixational eye movements. The first investigation of OMT as a neurological phenomenon was carried out by Shakanovic

Embedding consumer health organisations into the primary care system: The benefits for chronic disease management

Strategies designed to optimise people's capacity to manage chronic illness are at the forefront of health policy; however success hinges on their integration within primary care systems. As part of an larger project funded by the Australian Primary Health Care Research Institute, this study examined the role of consumer health organisations (CHOs) in chronic illness management. It aimed to investigate the benefits of contacting diabetes and arthritis CHOs and whether patterns of use differed depending on the extent to which organisations are embedded in the primary care system. A cross-sectional survey was undertaken with 279 people aged 18 or over who contacted diabetes and arthritis CHOs based in Queensland. Data were collected on health, sociodemographic characteristics, nature of CHO contact and health actions. People contacted CHOs primarily to obtain information about their condition or to access services or products. Most reported gaining useful information about their health and learning better ways to manage health problems. Almost half reported they had started exercising or changed diet following contact. 71% of diabetes contacts had been directed to the organisation by their health professional, compared with 26% for arthritis. Correspondingly, people with diabetes reported shorter periods between diagnosis and contact, more prior contact with the organisation and were less likely to wish they had made contact earlier. The research highlights the potential gains associated with better integration of CHOs into primary care systems. Further attention to the role of these organisations as part of a comprehensive approach to chronic illness management is warranted