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Background Dementia is a growing challenge to health and aged care worldwide and is the leading cause of disease burden in older Australians. High-quality person-centred care of people with dementia and support for their family caregivers require a trained multidisciplinary health and aged care workforce. Compared with major cities in Australia, rural and remote areas encounter greater challenges in workforce recruitment and retention. Moreover, these areas have distinctive distance-related barriers to workforce training and a higher proportion of aged and First Nations people at elevated risk of developing dementia. We designed and distributed a survey to investigate the perspectives on training among rural and remote health and aged care workers providing dementia care in diverse occupations and settings. Methods After piloting, the online survey was promoted to rural and remote organisations and professional networks nationwide. The instrument included multiple-choice and ordered-scale items on respondents’ dementia care self-rating and appraisal of their current workplace dementia care training, as well as items categorising their demographic characteristics, main work role, main workplace setting, and geographical site. Analysis incorporated description of respondent characteristics and estimation along with graphical presentation of response proportions for ordered-scale items, with differences among key respondent subgroups (i.e., workplace setting, remoteness, and main role) investigated using crude and multivariable robust Poisson regression models. Results There were 558 respondents from residential aged care, community/primary care and hospital settings across all Australian states and territories. The majority (61.7%) were from degree-requiring health professional/management positions, and 27.4% were certificate-requiring workers (predominantly personal care assistants and enrolled nurses). A majority considered that the dementia care provided in their current workplace was inadequate overall and specifically in relation to First Nations and culturally and linguistically diverse clients. Respondents noted organisational resource limitations impeding workers’ participation in training, and insufficient opportunities for input into determining priorities for training content and delivery. Hospital/acute care-based workers had the least favourable self-ratings and represented the highest proportion of respondents reporting shortcomings of training. Conclusions Health and aged care workers in rural and remote Australia perceive substantial shortcomings in the dementia care training provided by their workplace.

Background: Learning Networks are increasingly used to educate clinicians and disseminate information to health professionals. During the height of the second COVID-19 lockdown in Victoria, Australia, COVID+ Learning Network webinars were introduced as a mechanism for disseminating emerging evidence and up-to-date information to health service managers, and primary care and community healthcare clinicians, and for obtaining feedback from the healthcare sector. Methods: A qualitative descriptive study design was used to explore the COVID+ Learning Network webinars from users’ perspectives. Fifteen webinar participants from different professional backgrounds, roles during the COVID-19 pandemic, and geographic locations were individually interviewed. Results: The webinars attracted state-wide engagement and participants described them as an effective way to inform and support health services, and primary care and community healthcare clinicians. However, data analysis revealed important considerations for using Learning Networks to disseminate information in the future. In particular, the importance of tailoring the webinars to address the specific needs of the different participant groups was highlighted. Conclusion: Health service managers, and primary care and community healthcare clinicians, require information pertinent to their specific roles, with consideration of geographic and socio-economic factors important to planning webinar content. Future learning network webinars would benefit from a more targeted approach to address the specific informational needs of the groups participating.

BackgroundChildren with complex medical needs attend the Child Development Center for various reasons and to see different health professionals. This needs lot of commitment from parents and carers and also children have to travel multiple times. They often have to miss school which is vital for their education along with social, cognitive and emotional well-being.ObjectivesMultidisciplinary teams (MDTs) have been shown to be an effective tool to facilitate collaboration between professionals and hence improve care outcomes.Community Paediatric services in Bedford started a pilot project of MDT clinics where a child will see a community paediatrician, physiotherapist, speech and language therapist and dietitian in a single visit. We requested feedback from parents about usefulness of these clinicsMethodsChildren with significant complex needs who require service from all 4 disciplines (paediatrician, speech and language therapist, physiotherapist and dietitian) were offered appointments in MDT clinics.We organised our MDT clinics once every 3 months. We held 4 clinics in between May 2019 to March 2019 (we had to stop because of the COVID-19 Pandemic but we are planning to resume from December 2020). Each child had a 45 minute appointment with Speech and language therapist followed by a 60 minute combined appointment with community paediatrician, dietitian and physiotherapist together. Parents were requested to complete a paper feedback form after the clinic.ResultsWe received 9 feedbacks in total and all of them (100%) found these clinics very useful.Abstract 37 Table 1 Question Parents feedback How did you find the layout of the new multidisciplinary review clinic? • Really useful to see all professionals at the same time.• It was good that different healthcare professionals could collaborate with each other at the same time, preventing duplicate assessments• Helpful and saves time. You don’t have to have the same conversation with different people, you can just say it once• It was really helpful especially as so many of his needs or my questions cross over the different disciplines. It saves a lot of time Are there any recommendations for changes/improvements for the future clinics • Please make sure patients do not have another appointment before or after the joint clinic. It was a long exhausting day otherwise.• For review to be held at schoolConclusionsMDT clinics are held on a regular basis in tertiary centers but they are not so easy to coordinate in secondary care/community settings due to cross organisational working. Our model of multidisciplinary clinics at Bedford Child Development Center was highly appreciated by parents and is more convenient to children who have complex needs. It reduces the need for multiple clinic visits and journey to different clinic/hospitals. For healthcare professionals it brings all relevant people into one clinic which enables faster decision making and encourages discussion amongst professionals. It also reduced the need for internal referrals.Following parent feedback, we will consider taking this MDT clinic to special needs school sites in future to make it more convenient for children with complex needs and enable the specialist nursing service to join the MDT too.

Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care. Conclusions There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.

Objective Public health research is an endeavour that often involves multiple relationships, far-reaching collaborations, divergent expectations and various outcomes. Using the Tall Girls Study as a case study, this paper will present and discuss a number of methodological, ethical and legal challenges that have implications for other public health research. Approach The Tall Girls Study was the first study to examine the long-term health and psychosocial effects of oestrogen treatment for tall stature. Results In undertaking this study the research team overcame many hurdles: in maintaining collaboration with treating clinicians and with the women they had treated as girls - groups with opposing points of view and different expectations; using private practice medical records to trace women who had been patients up to forty years earlier; and exploring potential legal issues arising from the collection of data related to treatment. Conclusion While faced with complex challenges, the Tall Girls Study demonstrated that forward planning, ongoing dialogue between all stakeholders, transparency of processes, and the strict adherence to group-developed protocols were keys to maintaining rigour while undertaking pragmatic research. Implications Public health research often occurs within political and social contexts that need to be considered in the planning and conduct of studies. The quality and acceptability of research findings is enhanced when stakeholders are engaged in all aspects of the research process.

Aim: To describe the process involved in obtaining ethics approval for a study aiming to recruit women from all maternity hospitals in Victoria, Australia. Design: Observational data of the application process involving 85 hospitals throughout Victoria in 2001. Results: Twenty three of the 85 hospitals had a Human Research Ethics Committee (HREC) constituted in accordance with the National Health and Medical Research Council requirements; 27 agreed to accept decisions from other hospitals having HRECs and 27 relied on ethics advisory committees, hospital managers, clinical staff, quality assurance committees or lawyers for ethics decisions. Four of the latter did not approve the study. Eight hospitals no longer provided maternity services in the recruitment period. The process took 16 months, 26 000 sheets of paper, 258 copies of the application and the cost was about $30 000. Approval was eventually obtained for recruitment at 73 hospitals. Discussion: Difficulties exist in obtaining timely ethics approval for multicentre studies due to a complex uncoordinated system. All hospitals should have explicit protocols for dealing with research ethics applications so that they can be processed in a straightforward and timely manner. To facilitate this, those without properly constituted HRECs should be affiliated with one hospital that has an HREC. (author abstract)

In Australia, the proportion of older people living permanently in residential aged care services (RACS) has increased by 8.3% between 2012 and 2022.

Treatment with oestrogen to reduce the adult height of tall girls has been available since the 1950s. We undertook a retrospective cohort study to assess the long-term effects of this treatment on fertility. Eligible participants were identified from the records of Australian paediatric endocrinologists who assessed tall girls from 1959 to 1993, and from self-referrals. Individuals included girls who had received oestrogen treatment (diethylstilboestrol or ethinyl oestradiol) (treated group) and those who were assessed but not treated (untreated group). Information about reproductive history was sought by telephone interview. 1432 eligible individuals were identified, of whom 1243 (87%) could be traced. Of these, 780 (63%) completed interviews: 651 were identified from endocrinologists' records, 129 were self-referred. Treated (n=371) and untreated (n=409) women were similar in socioeconomic and other characteristics. After adjustment for age, treated women were more likely to have ever tried for 12 months or more to become pregnant without success (relative risk [RR] 1·80, 95% CI 1·40–2·30); more likely to have seen a doctor because they were having difficulty becoming pregnant (RR 1·80, 1·39–2·32); and more likely to have ever taken fertility drugs (RR 2·05, 1·39–3·04). Time to first pregnancy analysis showed that the treated group was 40% less likely to conceive in any given menstrual cycle of unprotected intercourse (age-adjusted fecundability ratio 0·59, 95% CI 0·46–0·76). These associations persisted when self-referred women were excluded. High-dose oestrogen treatment in adolescence seems to reduce female fertility in later life. This finding has implications for current treatment practices and for our understanding of reproductive biology.