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Thousands of older Australians live in aged care facilities (Australian Institute of Health and Welfare, 2015). This living arrangement can result in a significant loss of a person’s sense of identity. Professional care staff may not know a resident well, nor appreciate the resident’s individuality. Given the growing trend in Australian health care towards person-centred care in aged care settings, where care practices are tailored to individual needs, there is a need to develop effective methods for helping care staff better understand a resident, in order to promote the delivery of personalised care. Life-stories are narratives about an individual that can communicate to the care staff, the values, and self-image favoured by the resident. Such stories focus on individuals’ achievements, accomplishments, and interests. Although there are several programs worldwide that allow for older adults in residential care to tell their story, no research has been done to examine the impact of such written stories on the attitudes of residential professional care staff. The aims of this research is to examine the impact of life stories written by Swinburne Journalism students, on the attitudes of care staff about the residents. The project examines if care staff show a change in their attitudes, knowledge, and understanding about a resident after reading a 2-4 page story about the resident. In this study such stories are investigated for their impact on attitudes, knowledge and understanding of professional care staff and if positive, it could impact on care practices, and hence be used more widely in Australia for fostering a person-centred care culture in such settings.

Respiratory depression is more likely to be detected during sedation when capnography is used. However, sedation-induced respiratory depression is commonly transient and does not always cause patient harm. Randomised controlled trials have produced conflicting results regarding whether capnography improves patient safety when used during sedation. Further research is required to determine whether applying capnography to the conscious sedation context is warranted. One considerable difficulty in designing a trial to determine whether a specific intervention improves the safety of conscious sedation is that adverse sedation events that pose potential risks to patient safety, such as hypoxaemia, should be so rare that it would not be feasible to recruit the required number of participants. In contrast, the number of participants required to detect a clinically significant difference in ventilation status during conscious sedation, as measured by transcutaneous carbon dioxide concentration (TcCO2), would be feasible to recruit in the context of a clinical trial. However, in order to calculate a sample size for such a trial, the expected control group TcCO2 needs to be identified. In this study, continuous TcCO2 measurements will be recorded from patients undergoing procedures with conscious sedation, starting before conscious sedation is induced (for measurement of baseline TcC02) and ceasing at the end of the procedure.

When patients with diabetes are very unwell (critically ill and admitted to ICU) their blood glucose levels are often higher than previously. This frequently requires the use of insulin which is administered directly into a vein. We are uncertain about how aggressively we should treat these blood glucose levels. Currently, patients with diabetes are treated exactly like all other patients, i.e. persons without diabetes, such that insulin is administered when blood glucose reaches 10 mmol/L and titrated to target a blood glucose less than 10 mmol/L. This approach - called conventional glucose control - may increase the risk of very low blood glucose levels (termed ‘hypoglycaemia’), which is known to be harmful to patients in ICU, and may cause blood glucose levels that are low relative to their normal blood glucose levels before they were sick (termed ‘relative hypoglycaemia’), which may also be harmful. Because intensive care clinicians are uncertain as to which of these approaches is better participants will be randomly assigned, like the flip of a coin, to receive either: Conventional glucose control participants will be treated the same way patients with diabetes usually are, which is exactly like all other patients without diabetes, and insulin will be administered when blood glucose reaches 10 mmol/L with insulin adjusted to target blood concentrations in the range 6-10 mmol/L. OR Liberal glucose control participants will only have insulin administered when their blood glucose is > 14 mmol/L and the insulin will be titrated to target a blood glucose 10-14 mmol/L. We are evaluating whether a more ‘liberal’ approach in patients with diabetes, i.e. insulin in administered when blood glucose is > 14 mmol/L and titrated to target a blood glucose 10-14 mmol/L leads to a reduction in complications that are associated with insulin use and result in better outcomes for patients with diabetes. This approach – called liberal glucose control - isn’t necessarily better, as higher blood glucose levels may increase the risk of developing infections in ICU and could lead to weakness after ICU. This study will include 450 patients who have diabetes and are admitted to ICU. Patients admitted to one of 12 hospitals in Australia or New Zealand will be asked to participate.

The inherent dangers of the aviation environment combined with the potential and unpredictable behaviour of acute psychiatric patients presents a challenge to even the most experienced aeromedical retrieval clinician. An efficacious sedation drug is vital in this environment to ensure crew and patient safety and to minimise patient distress. The incidence of psychiatric patients requiring retrieval from remote areas is increasing. Over a period of two years and nine months, CareFlight Northern Territory Operations has retrieved 660 psychiatric patients (01/02/2012 – 20/11/2014). There is no consensus on the optimal sedative to us in these patients. There has been no research undertaken that compares Ketamine and Propofol sedation in the aeromedical retrieval of acute psychiatric patients. Ketamine and Propofol are currently used within CareFlight Northern Territory Operations to sedate acute psychiatric patients who require aeromedical retrieval from their rural and remote areas. The primary purpose is to compare the safety and efficacy of sedating acute psychiatric patients with either Ketamine or Propofol whilst documenting and treating any potential complications that may arise. This study will also add to the paucity of literature on sedation methods for acute psychiatric patients requiring aeromedical retrieval. Study Hypothesis: Ketamine and Propofol are both as safe and efficacious as each other in sedating acute psychiatric patients who require aeromedical retrieval

Respiratory depression is more likely to be detected during sedation when capnography is used. However, sedation-induced respiratory depression is commonly transient and does not always cause patient harm. Randomised controlled trials have produced conflicting results regarding whether capnography improves patient safety when used during sedation and there is considerable variation in the utilisation of capnography monitoring in clinical practice. This project seeks to optimise the implementation of this technology into clinical practice. AIMS 1. To identify subgroups of patients based on their physiological responses to sedation. 2. To characterise the identified subgroups by determining whether they are associated with particular demographic and clinical characteristics. 3. To examine variation in clinical interventions applied to support respiratory function between subgroups. 4. To determine if there are associations between the subgroups and intra-procedural ventilation status as well as post-procedural outcomes.

Emergency Department (ED) Overcrowding is associated with reduced performance in standard process and flow measures, and worse patient outcomes including mortality. Access block, the situation of patients experiencing prolonged delays in the ED whilst waiting for an inpatient bed, is a particular issue for which the solutions lie outside the ED. There have been several detailed reports on effective hospital-wide interventions in Australia, with demonstrated improvements in process and flow and some evidence of mortality benefit. However, all of the previous reports have been retrospective and thus may suffer from publication bias. The aim of this study is to prospectively document the effects of a multimodal hospital-wide intervention on ED process, flow, and outcomes. In late 2015 and early 2016, The Canberra Hospital is undertaking such an intervention. This study will examine the effects using retrospective controls, Primary outcomes will be the workload caused by excessive inpatients in ED (hours per week with more than 13 inpatients in ED) and ED flow as measured by the standard National Emergency Access Target (4 hours). Secondary outcomes will be standard hospital measures including length of stay, readmission rates, and mortality.

Aims: This study aims to develop the methodology for clinical point of care (POC) sampling to determine the level of exposure to organophosphates (OP’s) by western Victorian farmers. Significance: This methodology will test for cholinesterase activity and provide the basis for future research work by identifying the potential chemical exposure pathways of individuals most at risk in farming communities. Expected outcomes: The study will provide a methodology for cholinesterase activity measurement in farmers and the possible integration of POC sampling in farmer health checks. Importantly it will highlight pesticide contact as a risk for farmers, leading to further research to quantify pesticide exposure both on the farm and in the home of farming families.

Many patients admitted to the intensive care unit (ICU) for on-going clinical management receive mechanical ventilation. Mechanical ventilation is the process by which a patient’s breathing is supported by a machine (ventilator). While receiving mechanical ventilation the patient’s intensive care clinicians make clinical decisions about their patient’s breathing. Beginning in the second half of 2016, and based on emerging evidence, the ICU Consultant group has agreed to implement a practice change in their management of carbon dioxide levels in mechanically ventilated patients. This practice change is termed ‘permissive mild hypercapnia’ and involves clinicians’ targeting of arterial carbon dioxide tension values of 50-55 mmHg instead of the usual value of 35-45 mmHg. This change applies to all adult mechanically ventilated patients, except for those who required extracorporeal membrane oxygen (ECMO) therapy, those in whom death is deemed imminent and those in whom a higher CO2 level is contraindicated for other clinical reasons. We plan to systematically audit biochemical, physiological and patient-centred outcomes and compare such outcomes after the introduction of this practice change with outcomes in patients before the practice change. Importantly, the knowledge generated by this audit may inform future interventional studies aimed at further optimising disease-specific PaCO2strategies for the care of critically ill patients. This audit will take a similar path to the recent conservative oxygen therapy trial, where a practice change allowed slightly lower than usual oxygen levels to be targeted at Austin Hospital and a before and after audit was conducted and showed clear benefits in patient outcomes including an increase in earlier spontaneous ventilation.

The aim of the study is to examine whether young children with early childhood dental decay who are scheduled for treatment under general anaesthesia can be successfully managed in primary care settings by the use of a minimally invasive Atraumatic Restorative Treatment-based approach.

Shoulder impingement syndrome (SIS) represents the most common diagnosis for patients experiencing shoulder pain and is a prevalent condition in overhead athletes. Optimal performance of overhead sporting activities requires overheads athletes to have unrestricted, pain free arm range of motion (ROM). On examination, overhead throwers typically present with an increase in external rotation ROM accompanied by a concomitant decrease in internal rotation ROM. This asymmetrical ROM finding is well documented in the literature. It is postulated that posterior capsule tightness (PST) causes de-centering of the humeral head within the glenohumeral joint with compression of tissues in that joint space and consequent pain and restriction of movement. Clinically, a variety of techniques are implemented to address PST. These include stretching, joint mobilisations and strengthening exercises with varying degrees of success. Outcomes of treatment are commonly measured using pain, disability questionnaires or changes in ROM in order to determine the effectiveness of the treatment program. However, despite studies showing the effects of PST on acromio-humeral distance (AHD) and anterior translation of the humeral head, few studies have focussed on whether or not there is a normalisation of humeral head position, with resolution of PST and reduction in pain with movement following treatment. Therefore this research project will aim to investigate whether a modified sleeper stretch or cross body stretch is most effective at addressing PST, AHD and anterior humeral translation in overhead athletes using diagnostic ultrasound to measure the changes in the subacromial space and humeral head position.