A randomized multicenter trial of a chronic disease management intervention for decompensated cirrhosis. The A ustra l ian L iver F a i lur e (ALFIE) trial.

Background And Aims: Improving the care of decompensated cirrhosis is a significant clinical challenge. The primary aim of this trial was to assess the efficacy of a chronic disease management (CDM) model to reduce liver-related emergency admissions (LREA). The secondary aims were to assess model effects on quality-of-care and patient-reported outcomes.

Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis: A Qualitative Analysis.

A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic.

Psychometric validation of the Partners in Health scale as a self-management tool in patients with liver cirrhosis.

Background And Aim: Liver cirrhosis is a chronic disease complicated by recurrent hospital admissions. Self-management skills could facilitate optimal disease management. At present there is no validated instrument for measuring self-management in these patients.

The Chronic Liver Disease Nurse Role in Australia: Describing 10 Years of a New Role in Cirrhosis Management.

Cirrhosis of the liver is increasing, with growing patient numbers in hospital outpatient departments, as well as increasing admissions due to decompensated liver disease. Decompensated cirrhosis of the liver is a common and debilitating illness causing disability, readmissions to hospital, and decreased quality of life, and can lead to liver cancer. The advent of the chronic liver disease nurse (CLDN) position in our hospital in 2009 was the first role in Australia dedicated to providing care to patients with cirrhosis.

Validation of Knowledge Questionnaire for Patients With Liver Cirrhosis.

Background & Aims: There is no validated questionnaire to assess disease knowledge and self-management in patients with liver cirrhosis. We developed and validated a Cirrhosis Knowledge Questionnaire (CKQ).

Methods: We created a preliminary CKQ comprising 10 questions relevant to self-management of cirrhosis, based on publications and clinical experiences.

Efficacy of High-Dose, Rapid, Hepatitis A and B Vaccination Schedules in Patients With Cirrhosis.

Patients with cirrhosis have increased morbidity from hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, and vaccination against these infections is an important standard of care. However, vaccination in patients with cirrhosis is hindered by immune dysfunction and there is limited high-quality literature available. The aim of this work therefore was to compare immune responses of standard dose (SD) with high-dose accelerated (HDA) vaccination in cirrhotic patients.

Optimisation of hepatocellular carcinoma surveillance in patients with viral hepatitis: a quality improvement study.

Background: Surveillance for hepatocellular carcinoma (HCC) with 6-monthly ultrasound is a standard of care for higher-risk patients with viral hepatitis. Adherence to screening guidelines is an important quality indicator in hepatology, but multiple studies have demonstrated poor HCC surveillance practices in real-world settings.

Aims: The aim of this project was to audit and then optimise HCC surveillance of viral hepatitis patients, who fulfilled criteria for screening, associated with a large tertiary hospital.

Efficacy of a chronic disease management model for patients with chronic liver failure.

Background & Aims: Despite the economic impacts of chronic liver failure (CLF) and the success of chronic disease management (CDM) programs in routine clinical practice, there have been no randomized controlled trials of CDM for CLF. We investigated the efficacy of CDM programs for CLF patients in a prospective, controlled trial.

Methods: Sixty consecutive patients with cirrhosis and complications from CLF were assigned randomly to groups given intervention (n = 40) or usual care (n = 20), from 2009 to 2010.

Single centre experience with pegylated interferon and ribavirin for hepatitis C: looking back before moving forward.

Background: Hepatitis C treatment is successful in 40-80% of patients in drug sponsored registration trials. However, few studies have examined treatment outcomes in non-trial, routine clinical practice settings.

Aim: The aim of this study was to investigate the treatment outcomes and predictors of a sustained virological response in a routine clinical setting.

Improving management of oesophageal varices in patients with cirrhosis.

Problem: A retrospective audit of management of oesophageal varices in patients with cirrhosis identified the need to improve adherence to guidelines.

Design: Prospective audit of the effect of disseminating guidelines in 2004; prospective audit of the effect of a nurse coordinator for oesophageal variceal screening and surveillance from 2005 to 2008.

Setting: A major public hospital in Australia 2001-2008.

Attitudes to falls and injury prevention: what are the barriers to implementing falls prevention strategies?

Objectives: To ascertain the reasons for not taking up a fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department.

Subjects: As part of another trial, we identified 60 people who attended the emergency department of a public hospital with a fall.

Main Measures: Participants were interviewed to ascertain the reasons for not taking up a falls prevention strategy, their falls-related health state, and the likelihood of them undertaking a falls and injury prevention strategy.

Perspectives of carers on the move from a hospital to a transitional care unit.

The authors describe carers' experiences of the traditional process of moving a relative into residential care from an acute hospital admission and how a transitional care unit affected this experience. Telephone interviews (total 31) confirmed that looking for permanent care was a stressful, time-consuming, and confusing process for all carers. The transitional care unit did not make a great difference to the stress of finding a residential care vacancy, but the overall experience of transitional care was positive, with carers feeling that it gave them time to consider residential care options.

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial.

Objective: To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility.

Design: Randomised controlled trial.

Setting: Three public hospitals in Southern Adelaide.

Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service.

Aims: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention.

Methods: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period were considered for the study.

Accessing residential care from an acute hospital: can we be more efficient?

Hospitalized patients who require admission to residential care are often thought to make prolonged and inappropriate use of hospital resources. There are no Australian data on the factors that contribute to length of hospital stay for such patients. The aim of this study was to determine the timing of critical steps in discharge planning for hospitalized patients who need residential care.

Profile of people referred to an emergency department from residential care.

Background: Elderly people in residential care are among the most infirm in society and are at high risk of developing acute medical problems. There are no Australian data on the use of acute hospital emergency services by this group.

Aim: To determine patterns of use of a major public hospital's Emergency Department (ED) by elderly people living in residential care, their presenting problems and the outcome of attendance.

Use of in-patient hospital beds by people living in residential care.

Background: There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate.

Objective: To determine how and why people living in residential care in Australia use in-patient hospital beds.