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At the commencement of 2020 the World Health Organization (WHO) designated this year as the Year of the Nurse and Midwife in recognition of the contribution nurses and midwives make to peoples lives everyday. On the front line there is no doubt that nurses, midwives, medical, allied health and other hospital staff have a massive challenge ahead of them and it is an investment we all need to support. April 7, 2020 was World Health Day and deliberately coincided with the release of the first publication of the WHO The State of the World's Nursing Report to mark The Year of the Nurse and Midwife.

Age standardised skin cancers (melanoma and non-melanoma) continue to increase in Australia, although they are stabilising for those under age 40. People living in regional, rural and remote Australia have higher rates of skin cancer and challenges accessing care. Better targeting of skin protection measures and improved opportunistic screening have been promoted as ways to improve care for these populations as have increased use of information technology and upskilling of primary healthcare nurses. The Australian Government supports that Optimal Cancer Care Pathways for skin cancers be used as a key resource in exploring best practice models of care for skin cancer patients both for the development of digital platforms and face to face multidisciplinary teams (MDTs). Better use of technology has been a core recommendation of national health and skin cancer organisations for improving prevention and early detection of skin cancer. Skin cancers, as a primarily visual diagnosis are considered one of the prime areas for technological health interventions. The harnessing of artificial intelligence (AI) technology as a tool for early detection and disease management of skin cancers has great potential to reduce the burden of healthcare costs to the regional, rural and remote community and improve health outcomes.

Objective: We aimed to develop and test the feasibility of a nurse-led, telehealth transitional care intervention for people with multimorbidity. Design and methods: A feasibility study, using quantitative and qualitative methods was conducted at an 800-bed acute metropolitan hospital from March 2021 to January 2022. Eligible participants were adult in patients with multimorbidity. The intervention involved three stages: (1) baseline risk of readmission assessment and collaborative development of a Transition Action Plan; (2) transitional care coordination following hospital discharge, and (3) handover to the primary healthcare provider. A Transition Coordinator delivered the intervention with the aim of determining the intervention's feasibility in a practice environment. Acceptability to patients was assessed using a feedback survey. Acceptability to staff was noted through recorded interactions, collaboration, and feedback. Results: Twenty-one adults with a mean age of 78 years participated in the intervention. Participants had 3-10 comorbid chronic conditions, and the most common were hypertension (71%), other cardiovascular (66%), renal (52%), and diabetes (47%). Most patients (52%) were at medium risk of readmission and 38% were at high risk, however, only 24% of patients were readmitted. The study identified there is no routine risk of re-admission screening for patients with multimorbidity, and the intervention was found to be acceptable and feasible to patients, ward staff, and the multidisciplinary team. Conclusion: The results indicated feasibility of a transitional care intervention for people with multimorbidity, and the need for routine risk of readmission screening for people with multimorbidity. Further research is required to determine if the intervention is cost-effective and associated with reduced rates of hospital readmission. Keywords: Care coordination, chronic disease, multimorbidity, nursing, telehealth, transitional care model What is already known about the topic? - People with multimorbidity often receive fragmented health services, which May increase their risk of hospital readmission. - Internationally, Transitional Care Model interventions improve the transition experience from acute hospital care to the community and reduce short-term readmission rates, for people with multimorbidity. - Transitional Care Model interventions have shown improved health and economic benefits for older adults. However, these benefits have not been evaluated in Australia. What this paper adds - This study provides evidence regarding the feasibility and acceptability of a low-cost, nurse- led, transitional care intervention to support people with multimorbidity transitioning from acute hospital care to home/community, in the Australian context. - The study identified high support needs of participants upon transition and provides preliminary evidence in favour of a fundamental shift from discharge planning to stratified transition planning for patients with multimorbidity. - Presently, on hospital admission, there is no systematic risk of readmission assessment or transition care planning and implementation for people with multimorbidity. This is a notable service gap requiring redress across South Australian Local Health Networks.

Background: While Parkinson’s disease (PD) is primarily recognized for its motor symptoms, several non‐motor symptoms may also be present. Among these, pain is one of the most common and debilitating, arising from complex neurophysiological mechanisms that often interact with motor symptoms and comorbidities, leading to a diverse range of clinical presentations. Although a variety of pharmacological and nonpharmacological therapies are used to manage pain in PD, the factors influencing treatment practices remain underexplored, particularly within the Australian healthcare context. This study, therefore, aimed to explore, from the patients’ perspective, factors that influence pain management practices among people with PD living in Australia. Methods: A qualitative descriptive research methodology using a maximum variation sampling strategy was used to recruit people with PD, living in Australia. Data were collected using individual, semistructured interviews and thematically analyzed. Results: 18 participants shared their perspectives on the factors that influenced their pain management practices. Thematic analysis of interview data resulted in four themes: (1) recommendations from trusted sources; (2) explorative experimentation and solution seeking; (3) intervention and service provider characteristics; and (4) personal beliefs and abilities; and several subthemes. These findings highlight the complex nature of therapeutic decision‐making from the perspective of people with PD, underscoring the interaction between external and internal influences. Conclusion: There is complexity and nuance in how people with PD make decisions about managing their pain. External and internal factors seem to influence therapeutic decision‐making, while also highlighting notable gaps in the provision of PD pain care services. Understanding these complexities will be critical in developing accessible, effective, and patient‐centered approaches to pain management within this population.

Objective: To collaboratively develop a model of nurse-led care, within a multidisciplinary team and support continuity of care at the primary- secondary interface for people with multimorbidity. Background: Existing models of care are frequently based on a medical model, designed to manage a single disease condition, and thus pose a significant challenge to provide healthcare for people with multimorbidity. Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated, however, these have not been applied to the development of a nurse-led model of care for people with multimorbidity. Study design and methods: This paper, the first in a series of two, is part of a broader action research study and reports on the development of a model which will subsequently be assessed in terms of feasibility to provide a nurse-led care coordination service for people with multi-morbidity. This paper reports on the first action research cycle and methodology including a literature search, stakeholder engagement forums, validation workshop, team meetings, and professional engagement and validation. Results: Data from two stakeholder forums were sorted into 257 'structure, process and outcome' statements and 86 goal related statements. These were cross referenced with design elements on models of care from the literature and finally aggregated into themes. The aggregated themes were then integrated into a model of care for a nurse-led care coordination service. The model consists of an overarching component, 4 domains and 6 operational areas with underpinning criteria. Conclusion: Through stakeholder consultation, consideration of the strengths of previous models and building blocks, a new nurse-led model of care that provides a pathway for transitional healthcare management at the primary-secondary interface has been developed. Inclusion of governance and culture within the model's domains enables the approach to be pragmatic and adaptable, contributing to the potential for successful change management and model implementation in the clinical workplace. Further evaluation and refinement of the model is planned and will be reported on, in part 2 of this two-part series. Implications for research, policy, and practice: These findings provide direction for model implementation and further research required regarding nurse-led models of care. The supporting documents, systems, and processes reported, positions the model to support change and guide clinical practitioners and nursing management working at the primary-secondary healthcare interface. The future success of model implementation could provide evidence for health workforce policy and coordinated healthcare management. What is already known about this topic: - Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated. - Interventions delivered at the primary-secondary care interface, particularly stepped care and models of shared care are effective for the management of depression. - Established model design elements and interventions to improve continuity of care at the primary-secondary interface have not been applied to nurse-led models of care for chronic conditions and still require development within research settings. What this paper adds: - A new person-centred nurse-led model of care coordination, with healthcare management activities intended to support and enable development of the person's agency in their healthcare optimisation. - A model with specific domains and criteria with the potential for application to nurse-led services across primary and secondary settings, for a range of patients. - Inclusion of governance and culture as domains within the model, to enable the best possibility for change, model implementation and continuity of care between the primary-secondary healthcare interface.

Pain is a common, debilitating, and complex non-motor symptom of Parkinson's disease (PD), often requiring input from healthcare providers across various disciplines for effective management. The aims of this study were to explore the perspectives of people with PD on the provision of pain care services. A qualitative descriptive research methodology employing a maximum variation sampling strategy was used to recruit people with PD, living in Australia. Data were collected using individual, semi-structured interviews and analyzed thematically. To ensure trustworthiness, the study was conducted and reported in accordance with the Standards for Reporting Qualitative Research guidelines. Eighteen participants (10 female), with a median age of 71 years (IQR 68-77), shared their perceptions of the provision of PD pain care services. Thematic analysis of interview data resulted in five themes: empathy and understanding (care); acknowledging needs and concerns (listening); explaining diagnoses and treatment options (explaining); expertise in PD (knowledge); and responding to needs with tailored solutions (individualization). Participants' experiences were influenced by the presence, or the lack thereof, of these elements during clinical encounters. Furthermore, participants noted that these features were expressed to varying extents by different types of healthcare providers (neurologists, general practitioners, allied health professionals, and PD nurse specialists), which led to differing perceptions of the quality of pain care services. The findings show that perceptions of pain care are influenced by a healthcare provider's ability to address both the emotional and physical needs of PD patients. The variability observed in participants' experiences highlights the need to ensure that all healthcare providers involved in PD pain care are equipped to deliver empathetic, individualized, patient-centered care that addresses the complex and multifaceted needs of this population.

AimTo determine feasibility and acceptability of completing PROs questionnaires at completion and 1 year after curative cancer treatment.MethodsPatients assessed in a nurse-led end of treatment survivorship clinic, at a tertiary referral centre, recruited between October 2015 and July 2016 were mailed a survey at baseline and at 12-month follow-up. The survey included validated PRO questionnaires. A target response rate for feasibility, defined as the proportion of the eligible population approached that completed the survey, was set at 70%. Qualitative feedback regarding the survey was collected from participants.ResultsOf the 47 eligible patients approached, 34 (72.4%) agreed to participate with 29 (61.9%) completing the survey at baseline, and 21 (44.7%) at follow-up. Respondents lost to follow-up at 12 months had clinically meaningful lower scores on all QLQ-C30 functioning scales and 8 out of 9 symptom scales/items. Qualitative feedback from survey respondents indicated the content was relevant and acceptable. Participants expressed willingness to complete a similar survey approximately once per year and a higher preference for completing the survey in hard copy compared with online.ConclusionsCancer survivors are willing to provide information on a range of PROs, but those with higher needs were the ones less likely to complete surveys. There is scope to improve the response rate and representativeness of the patient cohort captured. Future research should identify strategies to optimise recruitment when collecting PROs data from cancer survivors.

Objectives Issues arising from a lack of outcome standardisation in health research may be addressed by the use of core outcome sets (COS), which represent agreed-upon recommendations regarding what outcomes should be measured as a minimum in studies of a health condition. This review investigated the scope, outcomes, and development methods of consensus-based COS for cancer, and their approaches and criteria for selecting instruments to assess core patient-reported outcomes (PROs). Methods Studies that used a consensus-driven approach to develop a COS containing PROs, for use in research with cancer populations, were sought via MEDLINE, CINAHL, Embase, Cochrane Library, and grey literature. Results Seventeen studies met the inclusion criteria. Most COS (82%) were specific to a cancer type (prostate, esophageal, head and neck, pancreatic, breast, ovarian, lung, or colorectal) and not specific to an intervention or treatment (76%). Conducting a systematic review was the most common approach to identifying outcomes (88%) and administering a Delphi survey was the most common approach to prioritising outcomes (71%). The included COS contained 90 PROs, of which the most common were physical function, sexual (dys) function, pain, fatigue, and emotional function. Most studies (59%) did not address how to assess the core PROs included in a set, while 7 studies (41%) recommended specific instruments. Their approaches to instrument appraisal and selection varied. Conclusion Efforts to standardise outcome assessment via the development of COS may be undermined by a lack of recommendations on how to measure core PROs. To optimise COS usefulness and adoption, valid and reliable instruments for the assessment of core PROs should be recommended with the aid of resources designed to facilitate this process.

Background Australia’s Aboriginal and Torres Strait Islander women have poorer survival and twice the disease burden from breast cancer compared to other Australian women. These disparities are influenced, but not fully explained, by more diagnoses at later stages. Incorporating breast screening, hospital and out of hospital treatment and cancer registry records into a person-linked data system can improve our understanding of breast cancer outcomes. We focussed one such system on a population-based cohort of Aboriginal women in South Australia diagnosed with breast cancer and a matched cohort of non-Aboriginal women with breast cancer. We quantify Aboriginal and non-Aboriginal women’s contact with publicly funded screening mammograms; quantify exposure to a selection of cancer treatment modalities; then assess the relationship between screening, treatment and the subsequent risk of breast cancer death. Methods Breast cancers registered among Aboriginal women in South Australia in 1990–2010 ( N  = 77) were matched with a random selection of non-Aboriginal women by birth and diagnostic year, then linked to screening records, and treatment 2 months before and 13 months after diagnosis. Competing risk regression summarised associations of Aboriginality, breast screening, cancer stage and treatment with risk of breast cancer death. Results Aboriginal women were less likely to have breast screening (OR = 0.37, 95%CIs 0.19–0.73); systemic therapies (OR = 0.49, 95%CIs 0.24–0.97); and, surgical intervention (OR = 0.35, 95%CIs 0.15–0.83). Where surgery occurred, mastectomy was more common among Aboriginal women (OR = 2.58, 1.22–5.46). Each of these factors influenced the risk of cancer death, reported as sub-hazard ratios (SHR). Regional spread disease (SHR = 34.23 95%CIs 6.76–13.40) and distant spread (SHR = 49.67 95%CIs 6.79–363.51) carried more risk than localised disease (Reference SHR = 1). Breast screening reduced the risk (SHR = 0.07 95%CIs 0.01–0.83). So too did receipt of systemic therapy (SHR = 0.06 95%CIs 0.01–0.41) and surgical treatments (SHR = 0.17 95%CIs 0.04–0.74). In the presence of adjustment for these factors, Aboriginality did not further explain the risk of breast cancer death. Conclusion Under-exposure to screening and treatment of Aboriginal women with breast cancers in South Australia contributed to excess cancer deaths. Improved access, utilisation and quality of effective treatments is needed to improve survival after breast cancer diagnosis.

People with multimorbidity have complex health care needs, resulting in high health service use, hospital readmission rates, and support needs. To prevent unnecessary hospital readmissions, effective coordination during the transition from hospital to primary care is essential; the transitional care model (TCM) is an effective approach to achieve this. This study will adapt the TCM, focusing on a nurse-led telehealth-based follow-up transition coordination service to enhance continuity between hospital and primary care, aiming to reduce unnecessary hospital readmissions and improve patient transitions. This study aims to assess the impact of a TCM on 3-month readmission rates in people with multimorbidity after discharge in an Australian context. Other objectives include evaluating the rate of re-presentation to hospital and overall length of hospital stay within 1, 6, and 12 months of discharge from the index admission; conducting a cost analysis of the transitional service model of care; evaluating the patient experience with the transition service; assessing patients' symptom burden before and after transitional support service intervention; and evaluating patients' quality of life, self-efficacy, and symptom management before and after intervention. The study design is a multicenter, pragmatic randomized controlled trial of patients with multimorbidity; therefore, real-world clinical practices, and operations will be the considerations within the research design elements. A mixed methods approach using quantitative and qualitative data collection methods will be used. The study setting incorporates 2 hospitals, initially commencing at the Queen Elizabeth Hospital (a 355-bed acute and subacute teaching hospital) and then at the Royal Adelaide Hospital (an 880-bed acute care teaching hospital), both located within the Central Adelaide Local Health Network, South Australia. We will include 3 to 6 medical units and wards. The intervention will focus on nurse-led transition assessment and care planning and telehealth transition coordination support for people with multimorbidity for 6 to 10 weeks following hospital discharge. This project received ethics approval (17554) on June 29, 2023, and was registered with the Australian New Zealand Clinical Trials Registry on February 15, 2024 (12624000142538). The study commenced on July 1, 2023; data collection started in February 2024 and was completed on March 31, 2025. Finalized results are expected in March 2026. The Central Adelaide Local Health Network currently lacks a process to assess or manage readmission risks for people with multimorbidity, despite evidence linking transitional care to reduced rehospitalizations. Our feasibility study highlighted the effectiveness of a transition coordinator role in supporting patients' return to home and community. Progressing this work, an adapted TCM, with telehealth-based follow-up and home and health care support, will enhance continuity between hospital and primary care, aiming to reduce unnecessary readmissions and improve patient transitions. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12624000142538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383721. DERR1-10.2196/71847.