Adventist HealthCare

Importance: CER-001 is a negatively charged, engineered pre-β high-density lipoprotein (HDL) mimetic containing apolipoprotein A-I and sphingomyelin. Preliminary studies demonstrated favorable effects of CER-001 on cholesterol efflux and vascular inflammation. A post hoc reanalysis of a previously completed study of intravenous infusion of CER-001, 3 mg/k, showed that the intravenous infusion in patients with a high coronary plaque burden promoted regression as assessed by intravascular ultrasonography. Objective: To determine the effect of infusing CER-001 on coronary atherosclerosis progression in statin-treated patients. Design, Setting, and Participants: A double-blind, randomized, multicenter trial evaluating the effect of 10 weekly intravenous infusions of CER-001, 3 mg/kg, (n = 135) or placebo (n = 137) in patients with an acute coronary syndrome (ACS) and baseline percent atheroma volume (PAV) greater than 30% in the proximal segment of an epicardial artery by intravascular ultrasonography. The study included 34 academic and community hospitals in Australia, Hungary, the Netherlands, and the United States in patients with ACS presenting for coronary angiography. Patients were enrolled from August 15, 2015, to November 19, 2016. Interventions: Participants were randomized to receive weekly CER-001, 3 mg/kg, or placebo for 10 weeks in addition to statins. Main Outcomes and Measures: The primary efficacy measure was the nominal change in PAV from baseline to day 78 measured by serial intravascular ultrasonography imaging. The secondary efficacy measures were nominal change in normalized total atheroma volume and percentage of patients demonstrating plaque regression. Safety and tolerability were also evaluated. Results: Among 293 patients (mean [SD] age, 59.8 [9.4] years; 217 men [79.8%] and 261 white race/ethnicity [96.0%]), 86 (29%) had statin prior use prior to the index ACS and 272 (92.8%) had evaluable imaging at follow-up. The placebo and CER-001 groups had similar posttreatment median levels of low-density lipoprotein cholesterol (74 mg/dL vs 79 mg/dL; P = .15) and high-density lipoprotein cholesterol (43 mg/dL vs 44 mg/dL; P = .66). The primary efficacy measure, PAV, decreased 0.41% with placebo (P = .005 compared with baseline), but not with CER-001 (-0.09%; P = .67 compared with baseline; between group differences, 0.32%; P = .15). Similar percentages of patients in the placebo and CER-001 groups demonstrated regression of PAV (57.7% vs 53.3%; P = .49). Infusions were well tolerated, with no differences in clinical and laboratory adverse events observed between treatment groups. Conclusions and Relevance: Infusion of CER-001 did not promote regression of coronary atherosclerosis in statin-treated patients with ACS and high plaque burden. Trial Registration: ClinicalTrials.gov Identifier: NCT2484378.

Although people are living longer, well-being and quality of life (QoL) are not guaranteed. The built environment is recognized as influencing health outcomes across lifespans. This narrative review takes a cross-disciplinary approach to understand the current evidence of the relationship between design, healthy ageing and QoL. Diverse methods were used to search for relevant literature, including database, and reference list search. Sixty-five papers were deemed relevant and included in this review. Seven main themes emerged through inductive thematic analysis. The extracted literature suggests there is good evidence for the role of biophilia, and indoor environmental quality; emerging evidence for technology, wayfinding, and opportunities for social interactions; but limited evidence for safety/security and adaptability/fit. One significant consideration for healthy ageing was older adults maintaining agency in their lives, including the ability to exert control over their environment in order to support healthy ageing. Design decisions have a significant impact on the health and well-being of older adults, but these decisions are often made in the absence of strong scientific evidence. This review sets out to assist decision-makers to consider design principles that support healthy ageing.

Organ donation is generally accepted within the medical profession as a beneficial practice with demand continuing to exceed supply. For patients who are dying from cancer opportunities for organ donation are generally limited to eye donation. Between July 1, 2006 and 30 June 2007 over 2000 deaths occurred in nine palliative care units (PCUs) in metropolitan Sydney. Of these deaths only 50 patients became eye donors. Donors came from only four of the nine inpatient PCUs. Of these four, two provided nearly 90% of the eye donations. Only two PCUs in the Sydney metropolitan area provide significant numbers of eye donations. There are likely to be a number of factors contributing to the low rate of eye donation from PCUs and these are discussed in detail.

Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011-14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z=2.62, P=0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.

Information extraction (IE) of unstructured electronic health records is challenging due to the semantic complexity of textual data. Generative large language models (LLMs) offer promising solutions to address this challenge. However, identifying the best training methods to adapt LLMs for IE in residential aged care settings remains underexplored. This research addresses this challenge by evaluating the effects of zero-shot and few-shot learning, both with and without parameter-efficient fine-tuning (PEFT) and retrieval-augmented generation (RAG) using Llama 3.1-8B. The study performed named entity recognition (NER) to nursing notes from Australian aged care facilities (RACFs), focusing on agitation in dementia and malnutrition risk factors. Performance evaluation includes accuracy, macro-averaged precision, recall, and F1 score. We used non-parametric statistical methods to compare if the differences were statistically significant. Results show that zero-shot and few-shot learning, whether combined with PEFT or RAG, achieve comparable performance across the clinical domains when the same prompting template is used. Few-shot learning significantly outperforms zero-shot learning when neither PEFT nor RAG is applied. Notably, PEFT significantly improves model performance in both zero-shot and few-shot learning; however, RAG significantly improves performance only in few-shot learning. After PEFT, the performance of zero-shot learning reaches a comparable level with few-shot learning. However, few-shot learning with RAG significantly outperforms zero-shot learning with RAG. We also found a similar level of performance between few-shot learning with RAG and zero-shot learning with PEFT. These findings provide valuable insights for researchers, practitioners, and stakeholders to optimize the use of generative LLMs in clinical IE. Supplementary Information: The online version contains supplementary material available at 10.1007/s41666-025-00190-z.

BACKGROUND: Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. OBJECTIVE: This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. METHODS: We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. RESULTS: Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. CONCLUSIONS: Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle.

BACKGROUND: Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. OBJECTIVE: This study explored the risk factors for malnutrition in structured and unstructured electronic health data. METHODS: Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. RESULTS: The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. CONCLUSION: This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.

Aim: Curative-intent involved field radiation therapy (IFRT) is a standard treatment for stage I-II follicular lymphoma (FL). It achieves durable local disease control and can produce life-long remissions. However ≥50% of patients relapse, generally outside irradiated volumes. We conducted a randomized controlled trial (RCT) to determine if systemic therapy could improve progression free survival (PFS). Patients and Methods: Patients from Australia, New Zealand and Canada with stage I-II FL of grade 1, 2 or 3a were enrolled after mandatory CT scans and marrow biopsies. PET staging was permitted. Patients were randomized to either; Arm A: 30Gy IFRT alone or Arm B: IFRT followed by 6 cycles of cyclophosphamide 1000 mg/m2 IV D1, vincristine 1.4 mg/m2 D1 and prednisolone 50 mg/m2 D1-5 (CVP), stratified by center, stage, age and PET. A protocol amendment in 2006 added Rituximab 375 mg/m2 D1 to arm B (R-CVP). Results: Between February 2000 and July 2012, 150 patients were recruited: 75 per arm: 44 arm B patients were allocated CVP and 31 R-CVP. Median age was 57 (range 30-79) years, 52% were male, 75% had stage 1 and 48% were PET-staged. Only 8% had an extranodal site (ENS). Median potential follow-up was 9.6 years (range, 3.1-15.8). PFS was significantly superior for arm B (IFRT + systemic therapy) compared to arm A [HR 0.57 (0.34-0.95); p = 0.033]. At 10 years PFS was 58% (95% CI 46-74%) for arm B and 41% (95% CI 30-57%) for arm A. Patients randomized to R-CVP had a substantially superior PFS to those contemporaneously randomized to IFRT alone, [HR 0.26 (0.07-0.97); p = 0.045]. In univariate analysis, patients who had ENS (p = 0.02), fewer involved regions (p = 0.047) and PET staging (p = 0.056) also had improved PFS. Transformation to high-grade lymphoma occurred in 4 patients in arm B compared to 10 in arm A (p = 0.1). Overall survival (OS) is not currently significantly different between arms (HR 0.62, p = 0.4); 10 year rates 95 vs 87% for arms B and A respectively. Only 2 patients had isolated in-field relapses, therefore systemic therapy primarily prevented progression outside RT fields. Only 3 cases with grade 3-4 acute and 1 case with grade 3 late radiation toxicities were observed. Systemic therapy was associated with 29 cases of grade 3 toxicity and one of grade 4 (neuropathy). One treatment-associated death occurred per arm. Keywords: Chemotherapy; follicular lymphoma (FL); rituximab.

Abstract Multi-label classification of unstructured electronic health records (EHR) is challenging due to the semantic complexity of textual data. Identifying the most effective machine learning method for EHR classification is useful in real-world clinical settings. Advances in natural language processing (NLP) using large language models (LLMs) offer promising solutions. Therefore, this experimental research aims to test the effects of zero-shot and few-shot learning prompting, with and without parameter-efficient fine-tuning (PEFT) and retrieval-augmented generation (RAG) of LLMs, on the multi-label classification of unstructured EHR data from residential aged care facilities (RACFs) in Australia. The four clinical tasks examined are agitation in dementia, depression in dementia, frailty index, and malnutrition risk factors, using the Llama 3.1-8B. Performance evaluation includes accuracy, macro-averaged precision, recall, and F1 score, supported by non-parametric statistical analyses. Results indicate that both zero-shot and few-shot learning, regardless of the use of PEFT and RAG, demonstrate equivalent performance across the clinical tasks when using the same prompting template. Few-shot learning consistently outperforms zero-shot learning when neither PEFT nor RAG is applied. Notably, PEFT significantly enhances model performance in both zero-shot and few-shot learning; however, RAG improves performance only in few-shot learning. After PEFT, the performance of zero-shot learning is equal to that of few-shot learning across clinical tasks. Additionally, few-shot learning with RAG surpasses zero-shot learning with RAG, while no significant difference exists between few-shot learning with RAG and zero-shot learning with PEFT. These findings offer crucial insights into LLMs for researchers, practitioners, and stakeholders utilizing LLMs in clinical document analysis.

Objective To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods The Joanna Briggs Institute's scoping review methodology was used. Results The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research.

Nursing staff record observations about older people under their care in free-text nursing notes. These notes contain older people's care needs, disease symptoms, frequency of symptom occurrence, nursing actions, etc. Therefore, it is vital to develop a technique to uncover important data from these notes. This study developed and evaluated a deep learning and transfer learning-based named entity recognition (NER) model for extracting symptoms of agitation in dementia from the nursing notes. We employed a Clinical BioBERT model for word embedding. Then we applied bidirectional long-short-term memory (BiLSTM) and conditional random field (CRF) models for NER on nursing notes from Australian residential aged care facilities. The proposed NER model achieves satisfactory performance in extracting symptoms of agitation in dementia with a 75% F1 score and 78% accuracy. We will further develop machine learning models to recommend the optimal nursing actions to manage agitation.

Natural Language Processing (NLP) is a powerful technique for extracting valuable information from unstructured electronic health records (EHRs). However, a prerequisite for NLP is the availability of high-quality annotated datasets. To date, there is a lack of effective methods to guide the research effort of manually annotating unstructured datasets, which can hinder NLP performance. Therefore, this study develops a five-step workflow for manually annotating unstructured datasets, including (1) annotator training and familiarising with the text corpus, (2) vocabulary identification, (3) annotation schema development, (4) annotation execution, and (5) result validation. This framework was then applied to annotate agitation symptoms from the unstructured EHRs of 40 Australian residential aged care facilities. The annotated corpus achieved an accuracy rate of 96%. This suggests that our proposed annotation workflow can be used in manual data processing to develop annotated training corpus for developing NLP algorithms.

BACKGROUND: The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses' accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)-a tool to assist nurses' assessment, decision-making and care in residential aged care. METHODS: The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses' actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. DISCUSSION: This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. ETHICS AND DISSEMINATION: This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. PROTOCOL VERSION: Version 1.0 6 February 2024.

Central MessageInnovation is advanced and patients benefit when programs leverage congenital heart expertise with minimally invasive skill in adult cardiac surgery.See Article page 262. Innovation is advanced and patients benefit when programs leverage congenital heart expertise with minimally invasive skill in adult cardiac surgery. See Article page 262. In 1998, Alain Carpentier performed the first robotic mitral valve repair using the Da Vinci system. The field of robotic heart surgery has evolved since with other applications such as coronary bypass grafting and procedure for other valves. While robotic and robotic-assisted repairs have previously been applied in the congenital realm to partial anomalous pulmonary venous connections, these reports are admittedly rare. This issue of JTCVS Techniques adds a novel entry to the congenital heart surgery robotic experience with a robotic-assisted 2-patch repair of right partial anomalous pulmonary venous connection and sinus venosus atrial septal defect (ASD).1Sef D. Wei L.M. Rankin J.S. Spear C.R. Gustafson R.A. Badhwar V. Robotic-assisted two-patch repair of right partial anomalous pulmonary venous connection and sinus venosus defect.J Thorac Cardiovasc Surg Tech. 2020; 4: 262-264Google Scholar This report describes a superior sinus venosus ASD with partial anomalous pulmonary venous connection, consisting of right upper and middle lobe veins connected 1.5 cm up the superior vena cava. A robotic-assisted approach was undertaken, using a 4-cm right thoracotomy and 3 robotic ports. A 2-patch repair was chosen to address high insertion of the veins and to avoid superior vena cava obstruction. The authors achieved an excellent result. However, there was a protracted crossclamp time, likely reflecting patient size and a significant learning curve. This particular procedure also raises the question as to whether an additional surgical atrial fibrillation (AF) treatment should have been applied. The evidence surrounding the beneficial effect of surgical treatment for AF is constantly evolving. While there are clear societal recommendations regarding indications for surgical ablation in patients with well-established AF, debate still exists as to the best approach to treat those at greater risk for developing lifelong AF following a procedure. Current evidence suggests that adult patients undergoing surgical closure of an ASD should have a concomitant Cox maze procedure even without a history of AF, due to the high percentage of AF during post-procedure follow-up.2Mavroudis C. Stulak J.M. Ad N. Siegel A. Giamberti A. Harris L. et al.Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations.Ann Thorac Surg. 2015; 99: 352-359Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Probably most telling about this unique case was the manuscript authorship. It is evident the group from West Virginia University leverages their advanced cardiac surgery robotic skills in collaboration with institutional congenital cardiac surgery expertise to benefit this patient. This collaborative approach has been the genesis of many congenital heart surgery advancements in minimally invasive techniques.3Alsarraj M.K. Nellis J.R. Vekstein A.M. Andersen N.D. Turek J.W. Borrowing from adult cardiac surgeons—bringing congenital heart surgery up to speed in the minimally invasive era.Innovations. 2020; 15: 101-105Crossref PubMed Scopus (6) Google Scholar By and large, congenital heart surgeons lack the consistent repetitions needed to be as proficient at robotic surgery (or other minimally invasive techniques) as adult cardiac surgery counterparts. Conversely, adult cardiac surgeons are not exposed to sufficient congenital cases to fully appreciate various subtleties of these procedures and stay current on the state of the art for these repairs. In the microcosm of this commentary, we pursued a similar course of collaboration, in having the congenital surgeon contribute to congenital topics and the minimally invasive and AF expert weigh in on these discussions. We would challenge more heart teams to learn from forward-thinking programs like the one in this case report to develop these strategic collaborations. Clearly, important synergies can be realized by collaborations between adult and congenital heart surgeons on these cases. To accelerate innovation and adoption of minimally invasive congenital heart surgery, we believe a synergy of two is truly better than one. Robotic-assisted two-patch repair of right partial anomalous pulmonary venous connection and sinus venosus defectJTCVS TechniquesVol. 4PreviewPartial anomalous pulmonary venous connection (PAPVC) consists of an abnormal drainage of 1 or more pulmonary veins into the systemic venous system. The incidence of PAPVC has been reported to be between 0.6% and 0.7%, and it is commonly associated with a sinus venosus atrial septal defect (ASD).1,2 Initial presentation in adulthood remains uncommon. Full-Text PDF Open Access

Purpose: The purpose of this study was to evaluate the optimization of fasting blood glucose (FBG) levels in patients with type 2 diabetes mellitus newly initiated on insulin glargine who were enrolled in the Australian Diabetes CoStars Patient Support Program (PSP). Patients and methods: A retrospective analysis of data from 514 patients with type 2 diabetes mellitus who completed the 12-week Diabetes CoStars PSP was performed. All patients were initiated on insulin glargine in primary care and enrolled by their general practitioner, who selected a predefined titration plan and support from a local Credentialled Diabetes Educator. The data collected included initial and final insulin dose, self-reported FBG, and glycated hemoglobin (A 1c ) levels. Results: The insulin dose increased in 81% of patients. Mean FBG was reduced from 208.8 mg/dL (11.6 mmol/L) to 136.8 mg/dL (7.6 mmol/L) after 12 weeks. Initial and final A 1c values were available for 99 patients; mean A 1c was reduced from 9.5% (80 mmol/mol) to 8.1% (65 mmol/mol). The reductions in mean FBG and A 1c were similar irrespective of titration plan. Overall, 27.2% of patients achieved FBG levels within the titration plan target range of 72–108 mg/dL (4–6 mmol/L) and an additional 43.4% of patients achieved FBG within the range recommended by current Australian guidelines (110–144 mg/dL [6.1–8.0 mmol/L]). Overall, 23.3% of patients achieved the A 1c target of ≤7%. Conclusion: These data demonstrate that the majority of patients enrolled in the Diabetes CoStars PSP achieved acceptable FBG levels 12 weeks after starting insulin therapy irrespective of titration plan. Keywords: insulin glargine, titration, type 2 diabetes mellitus, fasting blood glucose

This study aimed to explore the feasibility, acceptability, and clinical outcomes of a best practice–aligned multidisciplinary allied health reablement model of care for older people. A mixed-methods pre-post-intervention study was conducted in two nursing homes and the community. Quantitative measures were collected for frailty, physical function, and quality of life for all participants pre-implementation and 12 weeks post-implementation. Semi-structured interviews were conducted with a sub-group of participants and allied health professionals involved in the intervention. Participants’ ( n = 50) physical function increased (SPPB 4.2 vs. 4.9) while frailty (FRAIL-NH 6.0 vs. 5.5) and quality of life (16 vs. 16) were maintained. There was a high retention (93%) and attendance rate (84%), indicating acceptability. Participants received a daily median of 16 allied health minutes, costing $26AUD. Findings confirm acceptability and feasibility of the model with potential to maintain or improve clinical outcomes. Future work is needed to define long-term outcomes, scalability and sustainability. The study was registered with the ANZCTR [Trial ID: ACTRN12623000915651; Registration Date: 12/1/2024].

PURPOSE: There is evidence goal-setting promotes self-efficacy and maximises outcomes for people living with disability. Effective goal-setting in the disability sector remains challenging due to organisational structure, resource limitations and stakeholder involvement. This study aimed to explore barriers/facilitators and enhance effective goal-setting guided by the Theoretical Domains Framework (TDF) and behaviour change techniques. MATERIALS AND METHODS: = 213 staff). Goal-setting practices were assessed by auditing goals and surveying AH professionals (AHPs) at baseline. TDF guided development of tailored intervention including multimodal training/resources. The audit and survey were repeated post-intervention (6-months) and at follow-up (12-months). RESULTS: Goals set post-intervention had improved across all criteria (measurable/meaningful/time-bound/specific). At follow-up, improvements continued. Goals were more measurable (18%, pre-50%, post-68%), meaningful (23%, pre-54%, post-77%), time-bound (29%, pre-37%, post-66%) and specific (32%, pre-37%, post-69%). AHPs reported their goal-setting to be more collaborative, holistic and multidisciplinary (13%, pre-69%, post-82%) however, goals were less often shared with the person and their support network (-11%, pre-69%, post-58%). CONCLUSION: Multimodal intervention improved goal setting practices in AHPs, with most gains maintained at follow-up. The TDF informed intervention could be adapted for similar organisations seeking to strengthen goal-setting practice.

Currently residential aged care (RAC) provides a solution to address ageing populations in many developed countries. Demand for RAC is predicted to increase as populations continue to age with the recurrent costs posing an increasing burden on society. The contribution the built environment can play to mitigate this potential burden is becoming increasingly important in the design and construction of RAC facilities. The theories of environmental psychology rationalise the relationship between the physical environment and the individual and impacts work stress/satisfaction. Work stress/satisfaction in RAC facilities has a direct influence on quality of care and can directly affect the residents’ quality of life. This paper reports on a two stage study of design influences with the potential to impact upon the care team’s work stress/satisfaction in RAC where the benefits of consultative design are indentified. When compared to other facilities in the study the facility utilising a consultative design approach demonstrated more positive and less negative results for the design influences included. The consultative design approach reduced the potential for designers to copy and adapt a previous design, afforded universal ownership of the facility and optimised the building’s impact on work stress/satisfaction. The approach formed the basis of an overarching process to ensure the necessary elements of the design influences framework can be appropriately incorporated into the built environment.

Clinicians are expected to make use of data to reflect on their practice; this is reflected in its accepted role in mandatory Continuing Professional Development (CPD). One potentially valuable form of relevant data that hospitals routinely collect is clinical indicators (CI), such as readmissions and complications. This paper describes our design and qualitative evaluation of SeeCI, an interface to enable clinicians to use CI data to see, understand, and reflect on their practice. Our think-alouds with ten hospital staff indicate that SeeCI enabled meaningful insights, despite the challenging nature of repurposed data, notably for valuable peer comparisons. Our key contributions: (1) SeeCI, a new interface to support individuals’ reflection on their clinical practice, based on data from a set of repurposed CIs; and (2) demonstration of the value of SeeCI for individuals to gain insights and perspectives, including making use of peer comparison.