Judith Fethney

Background: Pelvic exenteration (PE) is a radical surgery for advanced pelvic malignancies that carries substantial psychosocial impacts. Assessing distress is critical for timely support. Aims: To evaluate the responsiveness‐to‐change and convergent validity of the distress thermometer (DT), and to determine an optimal cutoff score for detecting clinically significant distress in a PE cohort. Methods: Secondary analyses of cohort study data involving adult patients who underwent PE at a quaternary referral hospital. Responsiveness was evaluated by determining whether the DT differentiated cases of decreased emotional well‐being and health‐related quality of life from pre‐ to post‐surgery, using the Functional Assessment of Cancer Therapy‐General (FACT‐G), FACT‐Colorectal, and Emotional Well‐Being (EWB) subscale as external criteria. Convergent validity was evaluated using the correlation between the DT and the EWB subscale scores. Cutoff scores were examined by reviewing the following indices, using an existing EWB cutoff as an external anchor: sensitivity, specificity, positive/negative predictive values, and clinical utility index (CUI). Results: The analysis included 377 patients (mean age: 61 years, 56% male; 41% recurrent rectal cancer). The DT demonstrated responsiveness, with AUCs > 0.7 for detecting emotional and quality‐of‐life decline post‐surgery. Convergent validity was demonstrated through a moderate correlation between the DT and the EWB subscale scores ( r _s = −0.56, p < 0.001). The optimal DT cutoff score was 4: Sensitivity; 87.0%, Specificity; 52.7%, CUI− value; 0.49 (ruling out cases: satisfactory utility), CUI+ value; 0.33 (case finding: poor utility). Conclusion: The DT is a valid and responsive tool for detecting psychological distress in PE patients. Its high sensitivity supports its use in routine screening.

Background: Football (soccer) referees are crucial to contol of football matches. Exposure to emotional stressors may precipitate coronary events. Aims: To characterise emotional stressors, including abuse faced by football (soccer) referees, which may lead to burnout and potential cardiac risk. Methods: The survey was disseminated to referees from eight referee associations ranging from grassroots/amateur to professional competitions in Sydney, Australia. The questionnaire assessed the level and type of emotional stressors that football referees faced in the preceding 12 months and whether they had experienced verbal or physical abuse in the prior 12 months or at any time in their career. Results: One hundred thirty‐four participants undertook the survey, mean age 44.0 years, 117 (87.3%) male and 17 (12.7%) female, 83.6% Caucasian with 62.7% refereeing grassroots football, 23.9% semi‐professional and 13.4% professional football. Most participants had experienced stress (69.8%), anxiety (58.3%), frustration (57.2%) and/or anger (42.9%) during at least one match in the previous 12 months. Younger referees and those refereeing at higher levels reported higher levels of psychological stressors than their colleagues, with age remaining a multivariable predictor. Most participants (93.6%) during their career had experienced verbal abuse while refereeing, while 15.2% reported physical abuse, with younger age being a positive predictor. One in five (21.5%) referees had considered quitting due to the stress they experienced. Conclusions: Findings show a significant emotional stress burden exists with Australian football referees. These findings can guide support and education for referees about stress management techniques and highlight the need to reduce stress and abuse that might contribute to referee burnout and cardiac risk.

Objective: Australia has an ageing population, with an increasing number of older people needing to live in residential aged care facilities (RACFs). There are more Emergency department (ED) presentations by older people living in Australia, including those that are from RACF, and many die in hospital. The aim of this study was to perform a descriptive analysis of hospital deaths, comparing the characteristics of patients from Residential Aged Care Facilities (RACFs) to those from non‐RACF accommodation. Methods: This study examined data from the In‐Hospital Death Database for a major metropolitan tertiary hospital. De‐identified data from 2015 to 2022 were extracted and included in the analysis. Data for patients over the age of 16 were collected. Data were matched on age and sex between the two groups. Results: Compared with non‐RACF patients, patients from RACFs who died in hospital were more likely to have died from a respiratory illness, more likely to die in the ED, no more likely to have been a 28‐day readmission, more likely to have been admitted under Geriatrics, less likely to have been a coroner's case, and had a shorter length of stay. A large proportion of deaths of RACF patients (15%) were in the ED. Approximately 40% of patients from RACFs who died in hospital had Advance Care Plans (ACPs) in place prior to hospitalisation. Conclusions: The relatively large percentage of RACF patients that die in the ED is concerning and raises the question of whether their end‐of‐life care may have been more appropriately delivered within the RACF. The rate of ACP among RACF patients was low but comparable to other studies, and higher than among non‐RACF patients.

Background: Many parents today use digital or mobile health (mHealth) resources for parenting information and support. Thus, interventions or programs to support parenting delivered in this way are a rapidly growing area of innovation and research. Evidence indicates that face-to-face interventions that provide education and support for parents about infant sleep can have positive impacts on both infant sleep and maternal mood. However, there is limited research on the delivery of such interventions via digital or mHealth platforms. SleepWellBaby is an infant sleep mobile app for parents with infants and young children. The app provides parents with a 7-day program that may be repeated according to individual user demand, with information and interactive features aimed at supporting parents to understand infant sleep, and providing advice about strategies to support sleep in a responsive way. Objective: The study objectives were (1) to determine engagement with, and acceptability of, an mHealth-delivered parenting program to support infant sleep and (2) to investigate the impact of the program on parental fatigue, emotional health, and parenting competence, confidence, and self-efficacy. Methods: A multimethod quasi-experimental pre-post study design was used. Participants were parents of infants aged under 6 months, recruited through online advertising. Participants completed baseline questionnaires, then 2 further follow-up questionnaires at 7 days and 30 days post baseline. These questionnaires captured participant demographics (baseline) and perceptions of the program (follow-up), in addition to measuring parental fatigue (Fatigue Severity Scale), parent sense of competence, confidence, and self-efficacy (Me as a Parent Scale), and symptoms of anxiety (Generalized Anxiety Disorder 7-item scale) and depression (Edinburgh Postnatal Depression Scale) at all time points. Open-ended text responses were also collected at the 2 follow-up surveys. Questionnaire data were linked with participants’ engagement with the program (Engagement Index), measured using app analytics. Results: Participants’ (baseline: n=700; 7-d follow-up: n=339; and 30-d follow-up: n=220) engagement with the program varied; however, the majority reported cessation of app use by 1 month. Most participants were broadly satisfied with the program, finding the app easy to use and understand, and reported they could trust the information on the app. Those participants who had higher engagement or found the program most helpful for their sleep and their infant’s sleep showed the greatest improvement in their fatigue. Qualitative feedback from participants noted that while many found the app a lifeline with helpful information and features, others noted unintended negative impacts, such as spending too much time on their phone. Conclusions: Delivery of an infant sleep program via mHealth is effective for and acceptable to many parents. While not preferred by all parents, mHealth is an accessible, low-cost, and high-reach mode of providing information and management strategies for parents experiencing early parenting difficulties.

Purpose: This study aimed to report the incidence, common reasons, and associated risk factors for unplanned hospital presentations during chemotherapy treatment. Methods: A secondary analysis using data from a randomized controlled trial containing hospital data for the first three cycles of chemotherapy of adult oncology patients in two tertiary hospitals in Australia. Descriptive statistics were used to report hospital utilization patterns. Poisson regression explored risk factors for unplanned presentations. Results: Analyses included data from 346 patients; 115 patients (33%) made one/or more presentations during the first three cycles of chemotherapy. Of 144 unplanned presentations, 74 (51%) were made during cycle 1. Predominant reasons were fever with/without neutropenia ( n = 50, 35%) and nausea/vomiting ( n = 30, 21%). Fifty-two percent ( n = 75) of unplanned presentations did not result in hospital admission. Of 346 patients, 70 (20%) had hospital admissions with a median length of stay of 3 days (IQR 2–7). Multivariable analysis identified the following as predictors for unplanned presentations: cancer stage (stage 1 vs stage 4: IRR 2.50, 95% CI, 1.28–4.89; P = 0.01) and cancer type (lung cancer vs breast cancer: IRR 2.25, CI, 1.26–4.01; P = 0.01). Conclusion: Nausea/vomiting management support may be one area warranting improvement, a frequent reason for unplanned presentations that are potentially preventable. Such support will be most beneficial during the first treatment cycle, when most unplanned presentations occurred. A high proportion of unplanned presentations did not result in hospital admission, indicating an opportunity to manage some of the side effects within primary care or outpatient settings, rather than utilizing emergency department services.

Aim(s): To examine the association between caregiving context and the health and well‐being of community‐dwelling people with dementia (functional ability, physical function, depression, quality of life and health‐related quality of life) and their informal carers (health‐related quality of life) at the pre‐rehabilitation stage and the potential mediating role of caregiving context variables. Design: Cross‐sectional study. Methods: Secondary analysis of baseline data from a randomised controlled trial of 130 dementia care dyads—the Interdisciplinary Home‐based Reablement Programme (2018–2022). Bivariate analyses were applied to identify key caregiving context variables—co‐residence, sole carer status, additional caring responsibilities, client‐carer relationship and subjective carer burden (carer burden hereafter)—associated with health outcomes. Subsequently, multivariable linear regression models were developed. To examine carer burden, two models were run for each outcome: one with caregiving context variables and covariates, and the other adding carer burden. The mediating effects of the identified caregiving context variable were examined using post hoc mediation analysis. Results: Spouse/partner carer relationship was significantly associated with better client well‐being, including lower depressive symptoms and higher quality of life scores compared to adult child and other relationships. Higher carer burden was strongly associated with lower functional ability, more depressive symptoms, lower quality of life for clients and lower health‐related quality of life for both clients and carers. Including carer burden in regression models explained the greatest variance across most models. Carer burden fully mediated the association between additional caring responsibilities and client functional ability, and partially mediated the association between other carers and client depression. Conclusion: Carer burden needs to be carefully considered in supporting the health and well‐being of dementia carer dyads. Implications: Addressing carer burden and tailoring support to carers are essential for optimising health impacts for dementia carer dyads. Reporting Method: STROBE checklist. Patient or Public Contribution: None. Trial Registration: ClinicalTrials.gov identifier: ACTRN12618000600246

Background. Chemotherapy can cause a range of side effects including nausea, vomiting, diarrhea, and infection, which can have a significant impact on an individuals quality of life. Survival outcomes can be impacted when side effects are poorly managed, leading to failure to complete the defined dose of treatment. Objective. This study presents clinicians experiences with a shared care model involving home-based community nurse (CN) support to improve side-effect management of individuals receiving chemotherapy as an outpatient. Methods. A qualitative study was conducted with CNs, cancer nurses, medical oncologists, and a general practitioner involved in the CN intervention delivered as part of a randomized controlled trial (RCT) aimed at reducing unplanned presentations to hospital of cancer patients receiving outpatient chemotherapy. Semistructured individual and focus group interviews were conducted. Key themes were identified using thematic analysis. Findings. Twenty-three healthcare professionals were interviewed. Three themes were identified: (1) being able to enhance patient-centered care and clinical practice during chemotherapy; (2) importance of effective communication and collaborative relationships between different care settings; and (3) ways to adapt the intervention for implementation in routine clinical practice. Participants reported that it was feasible for CNs to care for this patient group, and their home visits enabled preemptive symptom management. Suggestions to improve and modify the intervention to implement this care model within existing clinical care included a flexible approach, such as a blended delivery with face-to-face visits and telephone calls; a risk- or needs-based approach to prioritize patient groups more likely to benefit from the intervention; and sharing of electronic medical records for more effective collaboration and communication. Conclusions. A CN-delivered shared care model provided a feasible approach to the provision of individualized support for outpatients receiving chemotherapy. This study suggests ways to adapt this care model into existing clinical workflow and structures. This trial is registered with ACTRN12614001113640.

Purpose: The aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care. Methods: The number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group adult patients with solid tumours starting outpatient chemotherapy. Poisson regression was used to compare the number of presentations between the intervention and control groups. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Linear regression techniques were used to compare quality of life outcomes. Results: The reduction in unplanned presentations in the intervention group relative to the control group was 12% (95% CI, − 25%, 37%; P = 0.48). At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95% CI, − 0.28, 1.22; P = 0.22)), depression (difference = 0.57 (95% CI, − 0.18, 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95% CI, − 2.67, 3.00; P = 0.91)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95% CI, 0.7, 7.9; P = 0.02)). Conclusion: This RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention. Trial registration: Registered at Australian and New Zealand Clinical Trials Registry: ACTRN12614001113640, registered 21/10/2014.

Introduction Chronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD. Methods and analysis This study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes. Ethics and dissemination The trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s). Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12622000329763).