Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life.

Background: An advance care plan outlines a patient's wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.

Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?

Objective:  The objective of this study is to measure the impact of a five-step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments.

Design:  Cluster randomised controlled trial.

Setting:   Six rural Victorian emergency departments participated.

How far can systematic reviews inform policy development for "wicked" rural health service problems?

Policy makers and researchers increasingly look to systematic reviews as a means of connecting research and evidence more effectively with policy. Based on Australian research into rural and remote primary health care services, we note some concerns regarding the suitability of systematic review methods when applied to such settings. It suggests that rural and other health services are highly complex and researching them is akin to dealing with "wicked" problems.

A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments.

Background: People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs.

Forecasting emergency department presentations.

Objective: To forecast the number of patients who will present each month at the emergency department of a hospital in regional Victoria.

Methods: The data on which the forecasts are based are the number of presentations in the emergency department for each month from 2000 to 2005. The statistical forecasting methods used are exponential smoothing and Box-Jenkins methods as implemented in the software package SPSS version 14.