Ageing with chronic conditions and older persons' experience of social connections: a qualitative descriptive study.

Background Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation.

The contribution of primary care practitioners to interventions reducing loneliness and social isolation in older people-An integrative review.

Background: Social connection is a fundamental human need. Its absence can lead to loneliness and social isolation, adversely impacting health and well-being. Given their regular contact and trusted relationships with older people, practitioners delivering community-based primary care are well-positioned to address this issue.

Practice readiness of new graduate nurses and factors influencing practice readiness: A scoping review of reviews.

Background: For many years there has been concern that new graduate nurses may not have been adequately prepared for the workplace, often framed in terms of whether they are work ready or practice ready and able to deal with the 'reality shock' of transitioning from student to clinician. This has prompted significant research to investigate the practice readiness of new graduate nurses.

Objectives: Identify what is known about the practice readiness of new graduate nurses upon commencement of employment, how practice readiness changes over their first year of employment and explore the factors which influence practice readiness.

Who needs, receives and misses out on palliative and end-of-life care? A population-based study to identify needs and gaps in a regional health service.

Objective The aim of this study was to assess the unmet need for palliative and other end-of-life care, as well as the sociodemographic and diagnostic factors associated with suboptimal access, among residents in an Australian region. Methods A cross-sectional descriptive and analytical study was performed using non-identifiable linked data from four administrative and two clinical datasets. The study population comprised 3175 patients aged ≥15 years who died in hospital in 2016 and 2017.

Application of mixture distributions for identifying thresholds of frequent and high inpatient mental health service use in longitudinal data.

Background: There is a need for greater understanding about frequent and high use of inpatient mental health services, and those with ongoing increased needs. Most studies employ a threshold of frequent use (e.g.

Attributes of innovations and approaches to scalability - lessons from a national program to extend the scope of practice of health professionals.

The context for the paper was the evaluation of a national program in Australia to investigate extended scopes of practice for health professionals (paramedics, physiotherapists, and nurses). The design of the evaluation involved a mixed-methods approach with multiple data sources. Four multidisciplinary models of extended scope of practice were tested over an 18-month period, involving 26 organizations, 224 health professionals, and 36 implementation sites.

Evolution of a multilevel framework for health program evaluation.

A well-conceived evaluation framework increases understanding of a program's goals and objectives, facilitates the identification of outcomes and can be used as a planning tool during program development. Herein we describe the origins and development of an evaluation framework that recognises that implementation is influenced by the setting in which it takes place, the individuals involved and the processes by which implementation is accomplished. The framework includes an evaluation hierarchy that focuses on outcomes for consumers, providers and the care delivery system, and is structured according to six domains: program delivery, impact, sustainability, capacity building, generalisability and dissemination.

Palliative Care Problem Severity Score: Reliability and acceptability in a national study.

Background: The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe).

Aim: To test the reliability and acceptability of the Palliative Care Problem Severity Score.

Design: Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool.

Palliative care health professionals' experiences of caring for patients with advance care directives.

Objective: To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services.

Methods: A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken.

Advance care planning in palliative care: a national survey of health professionals and service managers.

Objective: To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care.

Methods: A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n=105). Seventy-three health professionals (HPs) and 59 service managers completed the survey.

Palliative Care Phase: inter-rater reliability and acceptability in a national study.

Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding.

Aim: To test the reliability and acceptability of revised definitions of Palliative Care Phase.

Design: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.

Emergency department waiting times: Do the raw data tell the whole story?

Objective: To determine whether there are real differences in emergency department (ED) performance between Australian states and territories.

Methods: Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories.

Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: a grounded theory study.

Background: The context for the study was a nation-wide programme in Australia to implement evidence-based practice in residential aged care, in nine areas of practice, using a wide range of implementation strategies and involving 108 facilities. The study drew on the experiences of those involved in the programme to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact?

Methods: The methodology used grounded theory from a critical realist perspective, informed by a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews, resulting in 44 interviews involving 51 people during 2009 and 2010.

Assessment of need and capacity to benefit for people with a disability requiring aids, appliances and equipment.

Aim: To develop an equitable system for allocating equipment, aids and appliances to adults with disabilities based on assessment of need and capacity to benefit for use by occupational therapists, who are the main professional group involved in assessing and prioritising applications.

Methods: An assessment tool was developed, pilot tested and field tested at four sites in New South Wales. Assessments were undertaken in parallel with existing systems.

The Clinical Services Redesign Program in New South Wales: perceptions of senior health managers.

Objective: This study explores the views of senior managers regarding their experience of participating in the Clinical Services Redesign Program (CSRP) in New South Wales and the impact of that Program.

Methods: Semi-structured interviews were conducted in 2007 with 42 senior managers working in the NSW health system.

Results: Managers reported being increasingly oriented towards efficiency, achieving results and using data to support decision-making.

Linkage, coordination and integration: evidence from rural palliative care.

Objective: Review the findings from the evaluations of three rural palliative care programs.

Design: Review by the authors of the original material from each evaluation. The conceptual framework for the review was provided by the work of Leutz, including his distinction between linkage, coordination and full integration.

Literature review to identify factors that support implementation of evidence-based practice in residential aged care.

The aim was to undertake a review of the literature on change management, quality improvement, evidence-based practice and diffusion of innovations to identify key factors that might influence the uptake and continued use of evidence in residential aged care. The key factors will be used to shape and inform the evaluation of the Encouraging Best Practice in Residential Aged Care Program which commenced in Australia in 2007. MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched using combinations of search terms.

Priority rating for community care.

This paper, which is an additional nosokinetics paper to accompany those presented in Aust Health Rev 31(1), reports on priority rating through a standardised community care assessment system, based on screening for functional abilities and incorporating additional indicators of need and risk. Routinely collected measures used to generate a priority rating have proven useful in clinical decision making and active demand management at the service entry point. Priority rating is a step towards a more equitable and efficient assessment system.

Why patients attend emergency departments for conditions potentially appropriate for primary care: reasons given by patients and clinicians differ.

Objectives: To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients.

Methods: Survey of staff and primary care patients in five ED in New South Wales, Australia using questionnaire based on reasons identified in published studies.

Results: Clinicians in the survey identify a broader spectrum of reasons for potential primary care cases presenting to the ED than the patients themselves report.

Policy and practice for preventing skin cancer in children.

This paper identifies what is known and what is not known about the link between sun exposure and skin cancer and what can be done to reduce sun exposure in children. There is evidence for the use of sun protective clothing and of the effectiveness of sunscreens for some, but not all, forms of skin cancer. While there is some evidence to support interventions in schools, there is insufficient evidence to support other interventions aimed at children or their caregivers.

Peer review of adverse events - a perspective on Macarthur.

Recent investigations into the Macarthur Health Service have resulted in multiple reviews of a small number of cases. This article was prompted by a casual observation that these reviews have resulted in differing conclusions about what occurred in each case and what might have been done in response. The reliability of peer review is examined, together with the literature on the scale of adverse events and the issue of problem identification.