Department of the Premier and Cabinet

BACKGROUND: Emergency laparoscopy/laparotomy is associated with high levels of mortality. The aim of this study was to determine whether outcomes following emergency laparoscopy/laparotomy in rural and regional South Australian hospitals were comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit. METHODS: A prospective multicentre audit of patients who undergo emergency laparoscopy/laparotomy. Participating hospitals included Mount Gambier and Districts Health Service, Whyalla Hospital and Riverland General Hospital. Inclusion and exclusion criteria were identical to the National Emergency Laparotomy Audit. A modified dataset for patients was collected if patients were up-transferred to another hospital prior to operative management. Data collected included patient demographics, operative management, adherence to processes of care and outcomes. RESULTS: Data were collected for a total of 58 cases. Fifty-one of these had emergency laparoscopy/laparotomy in a rural or regional hospital and seven were transferred in the preoperative period. The median Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity predicted 30-day post-operative mortality was 3.5%. One hundred percent of patients (51 out of 51) had a consultant anaesthetist and surgeon present in the operating theatre. There were no deaths reported within the 30-day post-operative period. CONCLUSION: Outcomes following emergency laparoscopy/laparotomy in rural and regional South Australian hospitals are comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit.

Adaptation to climate change is impacted by a range of interrelated processes operating from local to global levels. There are often significant disconnects between different people's perceptions of responsibilities, capabilities and motivations, and divergent understandings of how the system works across actors, sectors and levels of governance. This results in misalignments of policies and practices, plus ineffective flows of resources and knowledge across the network of climate adaptation actors. As these disconnects are rooted in deep misunderstandings of the grounded realities of different actors, an experiential process of mutual discovery is required to build shared understanding and mutual respect. While it is common in the literature for people to talk about multi-level governance, most existing planning processes involve the production of separate plans at each individual level, based on the often-mistaken assumption that they will aggregate into an effective multi-level approach. This paper presents a new, multi-level integrated planning and implementation (MIPI) process, bringing together diverse actors from community, district, regional and national levels in the same workshop. The MIPI process creates a safe space that allows participants to interact directly in conducting systemic, cross-level analyses, as well as the multi-level integration of policies, plans and programs. The paper describes how the MIPI process was designed and facilitated in Ghana to address climate change, agricultural development and food security. This methodology has potential for much broader applicability to complex, multi-level planning and implementation processes.

Abstract: In November 2016, herpes zoster (HZ) vaccination for older adults, using the live-attenuated zoster vaccine (Zostavax; ZVL) was added to the Australian National Immunisation Program (NIP) with the aim of reducing morbidity from HZ and its complications, particularly for people at increased risk. Prior to the program, there were on average 5.6 cases of HZ per 1,000 persons annually in Australia, with highest risk of disease in older and in immunocompromised people. The burden of complications of HZ, such as post-herpetic neuralgia (PHN), was also highest in older and immunocompromised groups. No formal comprehensive program evaluation has been undertaken since program commencement. This review examined published literature and available vaccine administration data to summarise the evidence and considerations underpinning current use of HZ vaccines and potential future program directions in Australia. There have been modest reductions in the incidence of HZ and its complications since program introduction. However, five years into the program, challenges remain, including suboptimal vaccine coverage and significant safety concerns arising from inadvertent use of ZVL in immunocompromised people, who are contraindicated to receive this vaccine. This reduces opportunities to offset the burden of HZ-related disease. The recombinant subunit zoster vaccine (Shingrix; RZV), first registered in Australia in 2018, became available on the Australian market in June 2021. This vaccine has higher efficacy than ZVL and, as a non-live vaccine, can be used in both immunocompetent and immunocompromised people. RZV has potential to address the unmet needs of at-risk population groups. However, it has not yet demonstrated cost-effectiveness for inclusion as a funded vaccine under the NIP. The Australian HZ vaccination program has had limited effectiveness in meeting its aim in highest risk groups. Future options and challenges anticipated in using vaccination to reduce the burden of HZ and its complications are discussed in this review.

During an influenza pandemic, general practice will inevitably be involved at the front line; however, the nature of the role is likely to vary between jurisdictions and between metropolitan and rural locations. While most of the plans for general practice are still in evolution, measures that general practices can take to prepare for a pandemic include: reviewing the practice's infection control measures; ensuring all at-risk patients are immunised against seasonal influenza and pneumococcus; routinely advising all patients with viral upper respiratory tract infections on infection control techniques; connecting the practice to broadband Internet to aid communication; employing a practice nurse; and appointing a practice pandemic coordinator. General practices should start their preparations now.

We evaluated a diabetic mini-clinic by assessing adherence to American Diabetes Association guidelines and changes in glycosylated haemoglobin levels. Of 1063 patients, 721 were multiple attenders. Single and multiple attenders showed no significant differences in age, sex, time since diagnosis or body mass index. Female and male multiple attenders showed significant declines in glycosylated haemoglobin levels over the first 12 and 18 months respectively. After 2 years, these levels were similar to those at entry to the clinic. The clinic's compliance with standard measurement guidelines was high. The diabetic mini-clinic model, which is effective in industrialized countries, was equally effective in this setting.

Ageing of historical documents often results in changes in the optical properties of the constituent materials. Imaging spectroscopy (IS) can be a valuable tool for monitoring of such changes, if the method fulfils two important conditions. Firstly, compared to natural ageing, the accumulated light dose from repeated measurements of the monitored document must not induce any significant degradation. Secondly, the monitoring instrumentation and procedures should be sensitive enough to detect changes in the materials before they become visible. We present experimental methods to evaluate the suitability of IS instrumentation for monitoring purposes. In the first set of experiments, the impact of repeated monitoring measurements was determined using a set of Blue Wool Standard materials. In the second set of experiments, the capability of the instrument to detect spectral changes was tested using ISO standard materials and several documents representative of European archive collections. It is concluded that the tested hyperspectral instrument is suitable for monitoring of the colour change of documents during display. The described experimental approach can be recommended to test the suitability of other imaging spectroscopy instruments for monitoring applications.

In a recent article Andrew Lokan has suggested that the courts are faced with political choices as they deal with native title. The purpose of this paper is to consider the history of the recognition of Aboriginal customary rights to land in Australia, assess the extent to which policy and political issues have thus far been relevant in those developments and then to consider the extent to which such policy and political issues may be relevant in the future. Possible limitations upon the policies that might be considered by the courts are discussed. The discussion also affords an opportunity to look back over the development of the law of native title and to review how and why we have come to where we now are.

Abstract A party wall is a wall erected along the common boundary of two parcels of land held in different ownership and in which each of the owners has some right or interest. At common law the term “party wall” is capable of different meanings, according to whether— (a) it is situated on both sides of the common boundary or entirely on one side; or (b) it is held by the respective owners as tenants in common, or in severalty subject to easements; or (c) its function is for division or for support, or for both.