Rob Sanson-Fisher

Background: Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. Objective: The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance. Methods: A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate. Results: A total of 106 (100% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9%). ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute. Conclusions: Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics’ overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance.

Background: Social housing tenants have poorer health outcomes than homeowners or those renting privately. Health literacy is associated with access to care and health outcomes. This study aimed to examine the health literacy of Australian adults residing in social housing compared with that of people living in other housing types. Methods: A secondary analysis of the Australian National Health Survey 2017–2018 dataset was undertaken. A total of 5275 respondents were included in the sample and completed the Health Literacy Questionnaire (HLQ). Respondents were categorised according to their housing tenure: 163 (3.1%) respondents were living in social housing, 873 (17%) were living in private rentals, 2085 (40%) were homeowners, and 2154 (41%) were homeowners/mortgages. Mean scores were calculated for each of the nine health literacy domains in the HLQ and compared across housing tenure using linear regression models. Results: Social housing tenants had lower mean domain scores than either homeowners, owner mortgagees, or private renters on six of the nine health literacy domains. This included ‘having sufficient information to manage my health’, ‘social support for health’, ‘ability to engage with healthcare providers’, ‘navigating the healthcare system’ ‘ability to find good health information’, and being able to ‘understand health information enough to know what to do’. However, the differences in mean scores were small. Conclusions: Increasing health literacy may be an important part of multicomponent interventions seeking to improve the health and wellbeing of social housing tenants.

Aim: To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia.Methods: A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment.Results: Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500‐ and 1000‐days follow‐up. At 2000‐days follow‐up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia).Conclusions: Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595–602.

BACKGROUND Emergency medical services attend out-of-hospital cardiac arrest (OHCA) all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. In locations where paramedic exposure to OHCA is low, other avenues for ensuring resuscitation skills are maintained should be put in place. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. OBJECTIVE To examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high quality patient care, as measured by External Cardiac Compression performance (ECC). METHODS A pre-post intervention study without a control group. Data were collected at the start of the manikin training forum (Baseline); immediately following the training forum (Time 2); and 6 to 11 months after the training forum (Time 3). The study was conducted in paramedics from 95 NSW Ambulance locations (75 regional locations, 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (n=95; 100% consent rate). As part of the intervention, paramedics attended a training session on use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measures was an overall compression score was automatically recorded and calculated by the simulator manikin in two-minute cycles. This score was derived from compressions with correct hand position, adequate depth, fully released, and adequate rate. RESULTS ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (p>0.05) were identified for overall ECC performance score. CONCLUSIONS Training and deployment of simulator manikins did not significantly change paramedic’s ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance. CLINICALTRIAL

The objectives of this study were to describe patient-reported adherence to physiotherapist-prescribed self-management strategies; and the perceived barriers and enablers to adherence to each strategy. Patients attending physiotherapy private practices (n = 4) were observed during their consultation. Patients prescribed one or more self-management strategies received a follow-up telephone interview within 10–14 days of the observed consultation and were asked to self-report their level of adherence and their perceived barriers and/or enablers to each prescribed strategy. Results indicated that patients (n = 108) reported receiving 177 strategies and being fully adherent to 36% (95% CI: 29-44%) of these strategies. Patient-reported adherence barriers (n = 113) and enablers (n = 172) were coded using a modified version of the World Health Organisation five dimensions of adherence. Frequently reported barriers included social/economic-related (n = 52; 46%) such as being too busy, and patient-related (n = 29; 26%) including being too tired/lack of motivation. Frequently reported enablers included therapy-related (n = 71; 41%) such as “the strategy was easy to complete”, and condition-related (n = 45; 26%) including “that the strategy helped to manage symptoms”. Thus, patient adherence may be aided by ensuring that: the strategy is less complex; it does not cause pain; it isn’t time consuming; and it leads to an improvement in condition-related symptoms.

Introduction Surgery is the most common treatment for colorectal cancer (CRC) and can cause relative long average length of stay (LOS) and high risks of unplanned readmissions and complications. Enhanced Recovery After Surgery (ERAS) pathways can reduce the LOS and postsurgical complications. Digital health interventions provide a flexible and low-cost way of supporting patients to achieve this. This protocol describes a trial aiming to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention in decreasing the hospital LOS in patients undergoing CRC surgery. Methods and analysis The two-arm randomised controlled trial will assess the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention compared with usual care (control) in patients with CRC. The intervention consists of a website and a series of automatic prompts and alerts to support patients to adhere to the patient-led ERAS recommendations. The primary trial outcome is the length of hospital stay. Secondary outcomes include days alive and out of hospital; emergency department presentations; quality of life; patient knowledge and behaviours related to the ERAS recommendations; health service utilisation; and intervention acceptability and use. Ethics and dissemination The trial has been approved by the Hunter New England Research Ethics Committee (2019/ETH00869) and the University of Newcastle Ethics Committee (H-2015-0364). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team will facilitate its adoption within the Local Health District for widespread adaptation and implementation. Trial registration number ACTRN12621001533886.

Background To examine the delivery of patient-centred care and identify any gaps in care perceived as essential by patients; this study examined outpatients’: 1) views on what characterises essential care and 2) experiences of care received, in relation to cardiac catheterisation and subsequent cardiovascular procedures. Methods A cross-sectional descriptive study was undertaken. Surveys were posted to outpatients who had undergone elective cardiac catheterisation in the prior six months at an Australian tertiary public hospital. Participants completed a 65-item survey to determine: a) aspects of care they perceive as essential for a healthcare team to provide to patients receiving care for a cardiac condition (Important Care Survey); or b) their actual care received (Actual Care Survey). Numbers and percentages were used to calculate the most frequently identified essential care items by patients; and the experiences of care received. Items rated as either ‘Essential’ or ‘Very important’ by at least 80% of participants were determined, reflecting patient endorsement of the importance of the component of care. A gap in patient-centred care was identified as being any item that was endorsed as essential/very important by 80% or more of participants but reported as received by less than 80% of participants. Results Of 582 eligible patients, 264 (45%) returned a completed survey. 43/65 items were endorsed by over 80% of participants as essential/very important. Of those, for 22 items, less than 80% of respondents reported the care as received. Gaps were identified in relation to GP consultation (3 items), preparation (4 items), having the procedure (2 items), follow-up care (1 item), subsequent decision making for treatment (4 items), prognosis (6 items) and post-treatment follow-up (1 item). Conclusions Areas were identified where actual care fell short of patients’ perceptions of essential care, particularly general practitioner involvement, the referral process and information on patient prognosis.

Background: Active patient participation in preparation and recovery from colorectal cancer surgery can be facilitated by timely information and care and may improve patient wellbeing and reduce hospitalizations; Methods: We aimed to identify gaps in perioperative information and care by asking colorectal cancer surgical patients to retrospectively report on their perceptions of care via a cross-sectional survey; Results: Overall, 179 (64% consent rate) patients completed one of two 64-item surveys exploring their views of ‘optimal care’ or their experiences of ‘actual care’. In total, 41 (64%) aspects of care were endorsed as optimal. Of these, almost three-quarters (73%) were received by most patients (80% or more). Gaps in care were identified from discrepancies in the endorsement of optimal versus actual survey items. Of the 41 items identified as representing ‘optimal care’, 11 items were received by fewer than 80% of patients, including the provision of information about the impact of surgical wait-times on cancer cure (69%); pre-habilitation behaviors to improve health (75%); the type of questions to ask the health care team (74%); impact of pain medications on bowel movements (73%); how to obtain medical supplies for self-care at home (67%); dietary or exercise advice after discharge (25–31%); and emotional advice after discharge (44%). Conclusions: These gaps represent patient-centered priorities and targets for supportive interventions.

Sensitive and patient-centred discussion about life expectancy has clear benefits for patients with advanced cancer and their families. Despite their role in providing ongoing care to patients with advanced cancer, the perceptions of oncology nurses about disclosure of life expectancy, and the barriers to disclosure, have rarely been explored. To examine oncology nurses’ perceptions of the: (1) proportion of patients with advanced cancer who want, receive and understand estimates of life expectancy; (2) reasons why doctors may not provide estimates of life expectancy to patients with advanced cancer. Cross-sectional survey. Australian oncology nurses who were members of a professional society or worked at a participating metropolitan cancer centre were emailed a link to an anonymous online survey. Participants provided socio-demographic characteristics and their perceptions about the proportion of patients with advanced cancer who (a) want, (b) are provided with, (c) receive and (d) understand estimates of life expectancy, as well as the reasons estimates of life expectancy may not be provided. A total of 104 nurses participated. While 51% of nurses perceived that most patients (>75%) want to be provided with an estimate of their life expectancy, 63% of nurses reported that <50% of patients were actually provided with an estimate of their life expectancy. Further, 85% of nurses indicated that <50% of patients understand the estimate. The most frequent reason nurses perceived that doctors did not provide an estimate of life expectancy was because the doctor didn’t have an accurate idea of life expectancy (80.8%). Almost one fifth of nurses (18.3%) thought that doctors did not provide estimates because they felt it was not their responsibility to do so. Strategies to ensure a patient centred approach to life expectancy discussions with patients with advanced cancer are urgently needed. Oncology nurses perceive that many patients with advanced cancer are not provided with an accurate estimate of their life expectancy and few understand the information provided to them.