Osborne Park Hospital

Subjective memory complaint is common in later life. Its relationship to future risk of dementia is unclear, although many reports have found a positive association. We designed the present cross-sectional survey to investigate the clinical features associated with subjective memory impairment. One hundred and eight volunteers and 38 non-complainers acting as age-matched controls were recruited. Eleven subjects with memory complaints were excluded because of prior stroke or low MMSE score. The CAMCOG was used to measure cognition; complainers had significantly lower scores (p<0.001). Univariate analysis showed that complainers had greater prevalence of depression, anxiety, insomnia, psychotic phenomenon, difficulties with ADL and word-finding difficulties. The frequency distribution of the apolipoprotein E epsilon4 allele was similar for both groups (p=0.469). Logistic regression analysis indicated that CAMCOG scores (p=0.002) and word-finding difficulty (p=0.002) were independently associated with memory complaints. These results show that memory complainers have worse cognitive performance than non-complainers and support the findings of other studies that suggest that subjective memory loss may be a reliable indicator of cognitive decline.

We measured the concentration of apolipoprotein E (apoE) in plasma from 184 non-fasted subjects in order to determine whether important variations might exist linking plasma apoE levels to clinical phenotypes among early and late onset sporadic Alzheimer's disease (AD) and Down's syndrome (DS). A significant increase in the level of plasma apoE was observed in non-fasted late-onset AD patients (with a mean level of 3.26 +/- 0.08 microgram apoE/mg total protein for n = 84 patients) when compared with the plasma apoE levels of control individuals (mean of 2.32 +/- 0.10 microgram apoE/mg total protein, n = 51 patients; P < 0.001). A similar increase was found for non-fasted early-onset AD patients (mean of 3.69 +/- 0.17 microgram apoE/mg total protein, n = 20) when compared with the plasma apoE levels of control individuals (P < 0.001). Plasma apoE levels for DS patients did not differ significantly from those of controls (P > 0.05). The association of elevated plasma apoE levels in AD may be relevant to clarifying the mechanism(s) whereby apoE isoforms specify differential risk for development of AD.

Clinical symptoms of Parkinson's disease (PD) can make driving hazardous. The removal of the privilege to drive reduces independence; nevertheless, to protect public safety, medical practitioners require reliable screening tools to decide whether a PD driver should be on the road. The aims of this study were to examine whether clinical measures for PD patients and information provided by carers can be employed to predict impairment in driving performance. Fifty three idiopathic PD subjects and 129 age-matched controls were assessed on open roads. Prior to the driving assessment, participants were examined by a geriatrician. Various clinical measures of PD were recorded, and their carers filled out a questionnaire assessing driving ability of the patient. The driving performance of the participants declined with age (r = 0.89, P < 0.001). Drivers with PD were significantly less competent drivers than controls. The commonest errors committed on the road were indecisiveness in T-junctions and reduced usage of rear view and side mirrors. Only two of the clinical measures of PD patients showed links to driving performance. Information provided by carers was significantly related to driving performance of PD patients (F((4,48)) = 3.87, P-value < 0.01, R(2) = 0.557). PD drivers were less competent drivers than the age-matched control group; moreover, standard clinical measures of PD have little value in predicting their driving performance. Carers can provide valuable information to doctors in identifying unsafe PD drivers.

Demented individuals are traditionally investigated for potentially reversible causes. Hypothyroidism is generally accepted as being a condition that, if identified and treated, may be associated with improvement in mental state. A literature search was carried out to determine if data exist to show that this is so. Analysis of 2781 cases from studies of etiology in dementia revealed only one case of reversible dementia due to hypothyroidism. Problems associated with interpretation of previous reports include lack of acceptable criteria for diagnosis of dementia and inadequate follow-up. A randomized controlled trial will be needed to resolve this issue.

Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients' active engagement when making decisions about treatment options.

Background: Communication outcomes following stroke are improved when treatments for aphasia are administered early, within the first 3 months after stroke, and provided for more than 2 hours per week. However, uncertainty remains about the optimal type of aphasia therapy.Aims: We compared constraint-induced aphasia therapy (CIAT) with individual, impairment-based intervention, both administered early and daily after acute stroke.Methods & Procedures: This prospective, single-blinded, randomised, controlled trial recruited participants with mild to severe aphasia within 10 days of an acute stroke from acute/subacute Perth metropolitan hospitals (n = 20). Participants were allocated by computer-generated block randomisation method to either the CIAT (n = 12) or individual, impairment-based intervention group (n = 8) delivered at the same intensity (45–60 min, 5 days a week) for 20 sessions over 5 weeks (15–20 hours total). The primary outcome, measured after completing the intervention, was the Aphasia Quotient (AQ) from the Western Aphasia Battery. Secondary outcomes were the AQ at 12 and 26 weeks post stroke, a Discourse Analysis (DA) score and the Stroke and Aphasia Quality of Life Scale (SAQoL), measured at therapy completion, 12 and 26 weeks post stroke. There was a 10% (n = 2) dropout at the primary end point, both participants were in the CIAT group. The estimates for each treatment group were compared using repeated measures ANOVAs. Data from the 26-week follow-up assessment are presented, however, were not included in the between-group comparisons due to the low number of data points in each group.Outcomes & Results: Within groups analyses comparing performance at baseline, therapy completion, and 12 weeks post stroke revealed a statistically significant treatment effect for the AQ (p < .001), DA (p = .002), and SAQoL (p < .001). Between groups analysis found there was no significant difference between the CIAT and individual therapy groups on any outcome measure.Conclusions: CIAT and individual therapy produced comparable amounts of change in the very early phase of recovery suggesting a standard, intensive daily dose of therapy within this period of recovery is feasible and beneficial. There were no significant differences between the two groups demonstrating that CIAT, which is provided in a group format, may be a viable option in the very early phase of aphasia recovery. The study highlights the need for further research into the impact of therapy type in very early aphasia therapy.

Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners' treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.

Purpose A person with post-stroke lateropulsion actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This study aimed to determine the association of lateropulsion severity with: • Change in function (Functional Independence Measure – FIM) and lateropulsion severity (Four-Point Pusher Score – 4PPS) during inpatient rehabilitation; • Inpatient rehabilitation length of stay (LOS); • Discharge destination from inpatient rehabilitation.Methods Retrospective data for 1,087 participants (aged ≥65 years) admitted to a stroke rehabilitation unit (2005–2018) were analysed using multivariable regression models.Results Complete resolution of lateropulsion was seen in 69.4% of those with mild lateropulsion on admission (n = 160), 49.3% of those with moderate lateropulsion (n = 142), and 18.8% of those with severe lateropulsion (n = 181). Average FIM change was lower in those with severe lateropulsion on admission than those with no lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), (adjusted mean LOS: 35.6 days for those with severe lateropulsion versus 27.0 days for those without), and reduced likelihood of discharge home (p < 0.001).Conclusion Post-stroke lateropulsion is associated with reduced functional improvement and likelihood of discharge home. However, given a longer rehabilitation duration, most stroke survivors with moderate to severe lateropulsion can achieve important functional improvement.Implications for RehabilitationWhile people with post-stroke lateropulsion can be difficult to treat and require more resources than those without lateropulsion, the majority of those affected, even in severe cases, can make meaningful recovery with appropriate rehabilitation.Although those with moderate to severe post-stroke lateropulsion may have poorer outcomes (longer LOS and reduced likelihood of discharge home) it is still important to advocate for access to rehabilitation for this patient group to give them the opportunity for optimal functional recovery.

Background. A geriatric evaluation and management unit (GEM) manages elderly inpatients with functional impairments. There is a paucity of literature on frailty and whether this impacts on rehabilitation outcomes. Objectives. To examine frailty score (FS) as a predictor of functional gain, resource utilisation, and destinations for GEM patients. Methods. A single centre prospective case study design. Participants (n = 136) were ≥65 years old and admitted to a tertiary hospital GEM. Five patients were excluded by the preset exclusion criteria, that is, medically unstable, severe dementia or communication difficulties after stroke. Core data included demographics, frailty score (FS), and functional independence. Results. The mean functional improvement (FIM) from admission to discharge was 11.26 (95% CI 8.87, 13.66; P < 0.001). Discharge FIM was positively correlated with admission FIM (β = 0.748; P < 0.001) and negatively correlated with frailty score (β = -1.151; P = 0.014). The majority of the patients were in the "frail" group. "Frail" and "severely frail" subgroups improved more on mean FIM scores at discharge, relative to that experienced by the "pre-frail" group. Conclusion. All patients experienced functional improvement. Frailer patients improved more on their FIM and improved relatively more than their prefrail counterparts. Higher frailty correlated with reduced independence and greater resource utilisation. This study demonstrates that FS could be a prognostic indicator of physical independence and resource utilisation.

AIM: To assess the effect of age-adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients. METHODS: This prospective cohort study observed 306 older rehabilitation patients admitted to a secondary hospital between February and April 2015. Groups were compared using CCI score cut-offs of ≤4, 5-6 and ≥ 7. RESULTS: Complete FIM data were available for 280 patients. The mean age-adjusted CCI score was 5.59 ± 1.96. An age-adjusted CCI score ≤4 correlated with higher FIM scores at admission P = 0.015, and discharge P = 0.002, but not with a greater gain in FIM score P = 0.067. There were no significant between-group differences in mortality, hospital transfers or length of stay. CONCLUSION: The Charlson age-comorbidity index was not a prognostic marker for FIM gain. Age and comorbidity alone are not barriers to the rehabilitation of older patients.

AIM: The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese individuals with chronic kidney disease (CKD). METHODS: Six statements relating to weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥75% agreement. The recommendations were developed via a mini Delphi process. RESULTS: Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. CONCLUSION: There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian.

Background: Recent reviews conclude that aphasia intervention is effective. However, replication and implementation require detailed reporting of intervention is and a specification of participant profiles. To date, reviews concentrate more on efficacy than on intervention reporting quality.Aims: The aim of this project is to review the descriptions of aphasia interventions and participants appearing in recent systematic reviews of aphasia intervention effectiveness. The relationship between the quality of these descriptions and the robustness of research design is explored, and the replicability of aphasia interventions is evaluated.Methods and Procedures: The scope of our search was an analysis of the aphasia intervention studies included in the and EBRSR 2018 systematic reviews, and in the RCSLT 2014 literature synthesis. Intervention descriptions published separately from the intervention study (i.e. published online, in clinical tools, or a separate trial protocols) were not included. The criteria for inclusion were that participants had aphasia, the intervention involved language and/or communication, and included the following research designs: Randomised Controlled Trial (RCT), comparison or control, crossover design, case series. Exclusion criteria included non-SLT interventions, studies involving fewer than four participants, conference abstracts, studies not available in English. Studies were evaluated for completeness of intervention description using the TIDieR Checklist. Additionally, we rated the quality of patient and intervention description, with particular reference to replicability.Outcomes and Results: Ninety-three studies were included. Only 14 studies (15%) had >50 participants. Fifty-six studies (60%) did not select participants with a specific aphasia profile, and a further 10 studies only described participants as non-fluent. Across the studies, an average of eight (of 12) TIDieR checklist items were given but information on where, tailoring, modification and fidelity items was rarely available. Studies that evaluated general aphasia intervention approaches tended to use RCT designs, whereas more specific intervention studies were more likely to use case series designs.Conclusions: Group studies were generally under-powered and there was a paucity of research looking at specific aphasia interventions for specific aphasia profiles. There was a trade-off between the robustness of the design and the level of specificity of the intervention described. While the TIDieR framework is a useful guide to information which should be included in an intervention study, it is insufficiently sensitive for assessing replicability. We consider possible solutions to the challenges of making large-scale trials more useful for determining effective aphasia intervention.

OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

The paper reviews the issues relevant to the training of Australian clinical psychologists to work with older adults. On the basis of the review, current levels of teaching in clinical masters programs are judged to be inadequate. Possible reasons for this state of affairs are canvassed and suggestions made to address the deficiency. A major recommendation is that courses on older adults should be considered a core area of study for the future: teaching about ageing is the new challenge for Australian clinical psychology.

OBJECTIVES: Amidst the fulfilment of making a positive impact on patients' lives, cancer nurses also contend with high workloads, limited resources, and barriers to career advancement. Understanding the perceptions of cancer nurses is essential in addressing these challenges and fostering an environment that promotes both professional satisfaction and optimal patient care. Our aim was to explore Australian cancer nurses' experiences and perspectives of workforce challenges and their proposed solutions to address them. METHODS: The Cancer Nurses Society Australia workforce cross-sectional survey was distributed online in 2022 through professional networks and social media. Free text responses to open-ended questions were analyzed using qualitative content analysis and inductive processes. RESULTS: Responses from 601 cancer nurses highlight the intricate interplay between rewards and obstacles experienced by the profession and identify key areas for improvement. Positive and negative quotes highlight the passion of cancer nurses which were summarized into themes and subthemes: 1) Finding fulfilment while struggling against the tide. While feeling undervalued and facing workload pressures, burnout and limited opportunities for career progression, nurses express love for their jobs, finding it rewarding yet emotionally challenging. 2) Grassroots solutions versus organizational inertia. Proposed solutions included addressing nurse-to-patient ratios, proactive succession planning, more specific education, dedicated time for learning, and mentorship and career development programs. Perceived barriers to initiatives included lethargic management and resistance to change. Networking opportunities, appropriate remuneration, and interdisciplinary teamwork with an appreciation of individual expertise are desired. CONCLUSIONS: Our findings give a voice to the cancer nurses of Australia. Nurses identified a range of solutions to address workforce challenges. IMPLICATIONS FOR NURSING PRACTICE: Addressing the systemic issues that contribute to high workload and impede nurses' well-being and their recognition, and promoting policies to support professional growth will increase satisfaction, enhance patient care outcomes, and contribute to a sustainable workforce.

BACKGROUND: There is limited evidence on the use of the Snoezelen concept for maternity clients. Snoezelen, a Dutch concept, initiated in the 1970s as a leisure activity for severely disabled people, involves creating an indoor environment using controllable stimuli to enhance comfort and relaxation. These specially designed rooms expose the user to multiple sensory stimulations combining vision, touch, sounds and aromas. The aim of this study was to provide insight into breastfeeding women's experience of using a Snoezelen room during hospitalisation. METHODS: A qualitative exploratory design was chosen to reveal women's perceptions of using the Snoezelen room. Osborne Park Hospital, the study setting is the second largest public provider of obstetric services in Western Australia. A purposive sample was drawn from breastfeeding women who used the Snoezelen room during their postpartum stay from March 2006 to March 2007. Saturation was achieved after eleven breastfeeding women were interviewed six weeks post discharge. Data analysis involved the constant comparison method. RESULTS: Participants entered the room feeling tired and emotional with an unsettled baby and breastfeeding issues aggravated by maternal stress and anxiety. All women indicated they were able to achieve relaxation while in the room and would recommend its use to other breastfeeding mothers. Two key themes revealed how the Snoezelen room facilitated maternal relaxation, which ultimately enhanced the breastfeeding experience. The first theme, "Finding Relaxation for the Breastfeeding Mother" incorporates three subthemes: 'Time out' for mother; Control in own personal space; and a Quiet/calm environment with homelike atmosphere. The second theme, "Enabling Focus on Breastfeeding", occurred after relaxation was achieved and involved four subthemes: Able to get one-on-one attention; Not physically exposed to others; Away from prying, judgemental eyes and Able to safely attempt breastfeeding alone knowing help is nearby. CONCLUSION: Insight into how the Snoezelen room promoted relaxation also highlights what contributes to maternal anxiety during breastfeeding experiences in hospital. The findings offer health professionals the opportunity to consider adopting strategies such as a Snoezelen room in their hospital or being innovative in modifying the postpartum setting to promote relaxation for breastfeeding women.

BACKGROUND: Self-management programs have demonstrated significant health benefits in people with musculoskeletal diseases. AIM: To examine the benefits of a tailored ankylosing spondylitis self-management program (ASSMP) delivered by trained health professionals for people with ankylosing spondylitis (AS) relative to health status, quality of life and disease activity. METHODS: ASSMP was developed within a continuous quality improvement framework following a needs assessment and focus group discussions. Formal feedback from the group after each 6 week program cycle group by questionnaire helped refine the ASSMP. Patient health status, quality of life and disease activity were assessed at multiple time points up to 12 months. RESULTS: Fifty-five percent were female; mean age 48.5 ± 15.2 years. Median time to AS diagnosis was 4 years (interquartile range: 1-10). AS disease activity Bath Ankylosing Spondylitis Global Score scores improved at 3, 6 and 12 months (P < .001). Bath Ankylosing Spondylitis Disease Activity Index improved at 6 weeks and was sustained at 3, 6 and 12 months (P < .001). The Ankylosing Spondylitis Quality of Life improved at 3, 6 and 12 months (P < .001). Bath Ankylosing Spondylitis Functional Index improved by 12 months (P < .001). Participants reported less nocturnal back pain at 6 months and was sustained at 12 months (P < .001). Patients Global Disease Activity improved by 6 months (P = .012), Multi-Dimensional Assessment of Fatigue and a Global Fatigue Index at 6 months (P = .003), Hospital Anxiety and Depression Scale - Anxiety at 12 months (P = .001), Evaluation Ankylosing Spondylitis Quality of Life at 6 months (P = .001) and Pain Self-Efficacy Questionnaire at 12 months (P = .002). CONCLUSION: This ASSMP demonstrated significant and sustained benefit in symptoms, disease activity measures and quality of life in a condition that results in significant impairment, disability and poorer quality of life. The cost effectiveness and benefit of this program should be tested.

We screened 703 Australian subjects for an intronic polymorphism in the presenilin-1 (PS-1) gene. PS-1 intronic allele 1 homozygosity was not associated with individuals with early- or late-onset sporadic Alzheimer's disease (EOAD or LOAD). Carriers for the PS-1 intronic allele 1 were also not associated with significantly increased risk for AD regardless of gender. Our results for the Australian population are consistent with those of recent reports for other populations and do not support the conclusion that the PS-1 intronic polymorphism is associated with AD.

This paper presents a best practice model for psychogeriatric care. Best practice is becoming one of the most common expressions used in the area of health care, and is often referred to in government reports and documents. The definition of 'best practice', however, is still evolving. What then, is best practice? And how can the principles of best practice be applied and integrated into the clinical speciality of psychogeriatrics? The article emphasizes the importance of evidence-based interventions and the need to focus on the pragmatic aspects of providing best practice in the clinical area of psychogeriatrics; that is, what works best in practice? The position taken by the authors of this paper is that the conceptualization of a best practice model in psychogeriatrics is necessary in order to describe and explain the different components involved in the service provided. This conceptualization also communicates and articulates the role of the major stakeholders, and the key players in the achievement of best practice. A psychogeriatric service may become more coherent, more goal-orientated and more efficient if a model is utilized. This paper outlines a proposed model of best practice in psychogeriatrics, and discusses the potential implications for achieving desirable clinical outcomes.

Objective: The purpose of this paper is to examine strategies that may facilitate the successful implementation of service-wide outcome measures in public mental health services. Conclusions: The available evidence suggests that a top-down approach to the introduction of state-wide routine outcome measurement across all public mental health services is likely to have only limited success. A centrally co-ordinated but locally directed bottom-up approach may be a more successful long-term strategy. Such an approach could make optimum use of a small team of “outcome experts”, while the use of strategies such as the development of local clinical guidelines would increase the co-operation and participation of the wider clinical community. An initial collection of clinical and social demographics could provide important contextual information on service populations and would initiate the administrative and communication networks that would need to be developed for later routine, multi-site data collection.