Medicine & Health

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Now showing 1 - 4 of 4
  • (2012) Olivier, Jake; Walter, Scott; Grzebieta, Raphael
    Journal Article
    Since the 1991 enactment of mandatory helmet legislation (MHL) for cyclists in New South Wales (NSW), Australia, there has been extensive debate as to its effect on head injury rates at a population level. Many previous studies have focused on the impact of MHL around the time of enactment, while little has been done to examine the ongoing effects. We aimed to extend prior work by investigating long-term trends in cyclist head and arm injuries over the period 1991–2010. The counts of cyclists hospitalised with head or arm injuries were jointly modelled with log-linear regression. The simultaneous modelling of related injury mechanisms avoids the need for actual exposure data and accounts for the effects of changes in the cycling environment, cycling behaviour and general safety improvements. Models were run separately with population counts, bicycle imports, the average weekday counts of cyclists in Sydney CBD and cycling estimates from survey data as proxy exposures. Overall, arm injuries were higher than head injuries throughout the study period, consistent with previous post-MHL observations. The trends in the two injury groups also significantly diverged, such that the gap between rates increased with time. The results suggest that the initial observed benefit of MHL has been maintained over the ensuing decades. There is a notable additional safety benefit after 2006 that is associated with an increase in cycling infrastructure spending. This implies that the effect of MHL is ongoing and progress in cycling safety in NSW has and will continue to benefit from focusing on broader issues such as increasing cycling infrastructure.

  • (2012) Georgiou, Andrew; Vecellio, Elia; Toouli, George; Eigenstetter, Alex; Li, Ling; Wilson, Roger; Westbrook, Johanna
    This project aimed to assess the impact of electronic ordering systems, on the quality use of pathology services across six hospital sites and different pathology departments, for the following areas:- the legibility and completeness of laboratory test orders and the impact on Central Specimen Reception work processes (Quality of test orders). - the volume and mix of tests ordered examined by such factors as Diagnosis-related Groups (DRGs), adjusted for clinical activity where appropriate, and the prevalence of add-on and repeat testing (Effectiveness). - the timeliness of the pathology laboratory process (Turnaround time). - the impact of pathology performance (e.g., laboratory test turnaround times) on the duration of patient stay in the emergency department (Patient outcome).The project also produced a benefits realisation framework, made up of performance indicators, that can be used to guide the assessment of electronic ordering in a pathology service and to monitor what works (or doesn’t work), where, and in what circumstances. The project was funded by an Australian Government Department of Health and Ageing, Quality Use of Pathology Program grant.

  • (2012) Low, Lena
    This thesis examines the role of medical clinician surveyors (MC surveyors) working in the hospital-based health care accreditation arena. The thesis examines their motivations for participating in accreditation, the issues that influence them during the survey process, and the ways in which they deal with the influences to facilitate a reliable and credible survey outcome. The study is an evidence-based examination of MC surveyors working for the Australian Council on Healthcare Standards (ACHS), the dominant accreditation agency for public and private hospitals in Australia. There is limited research and empirical evidence as to the benefits of accreditation and improved service quality, despite the significance of accreditation for hospitals and the resources expended on it. The research consisted of three distinct stages: a questionnaire which examined the motivations for MC surveyors participating in accreditation; interviews which looked at the scale and scope of influences on MC surveyors during the accreditation survey process; and a case study approach which assessed how MCs and other surveyors dealt with the influences. The large amount of data generated was analysed utilising a range of social science methods. The findings corroborate and augment past research into the motivations for MC surveyors participating in accreditation, and extend existing knowledge considerably. These motivations included participants perceptions that accreditation facilitated improvement of quality in the health system and within their own organisation, and provided an external perspective and the opportunity to benchmark and share ideas. Furthermore, participants considered accreditation assisted in their professional development, supported professional networking, augmented their prestige, and increased their influence and respect whilst being an enjoyable experience. The research identified fourteen interrelated factors that influence the survey process and potentially, the accreditation outcome. It found that MC surveyors were acutely aware of the need to be objective in their surveying and furthermore were conscious of the difficulty in attaining objectivity. It also provided evidence supporting MC involvement in the accreditation process and reported a positive view of accreditation. In addition, it highlighted the characteristics of the accreditation process that MC surveyors consider benefits health care as well as leading to a more reliable and credible accreditation outcome.

  • (2012) Milne, Jacqueline
    This study explored Junior Medical Officers' (JMOs), particularly international medical graduates' (IMGs) understanding of interprofessional practice (IPP) and its links to patient safety. It investigated their willingness to practise interprofessionally and identified factors inhibiting collaborative IPP. The links between IPP and patient safety are established. Evidence supports the benefits of health professionals working collaboratively for enhanced patient outcomes. Hospital environments are complex with proliferating professional and departmental cultures. Patients are managed by a multiplicity of health professionals. We know that to practise interprofessionally challenges the territorial traditions of health professionals. An understanding of IPP and a preparedness to put patient interests before professional self interests are fundamental to realising improved patient safety. There are difficulties associated with transformation to a collaborative approach to patient care. Paradoxically, overcoming cultural boundaries between interdependent health professionals is one prerequisite for practising interprofessionally. This thesis contributes to our knowledge about junior doctors' perceptions of IPP in teaching hospitals and organisational factors challenging their interprofessional functioning. It reveals compromised intraprofessional practice linked to the hierarchical culture of hospital doctors. A triangulated method comprising semi-structured interviews, a survey questionnaire and ethnographic observations was employed for the research. Thirty two international and Australian medical graduates (IMGs and AMGs) from three Australian teaching hospitals participated. Four themes framed the study: culture, communication, collaboration and competency. The findings highlight diversity in the cultures and medical training of JMOs. Participants' experience of shared learning was minimal, limiting their proclivity to IPP in postgraduate training. JMOs' willingness to embrace IPP is overshadowed by the challenges of adapting to different cultures within hospitals, understanding other health professionals' roles, and working with inadequate support and supervision. Mutual respect and communication are lacking, both intraprofessionally and interprofessionally. Excessive demands, bounded professional cultures and uncompromising hospital organisational cultures impede IPP. The findings can be applied to other comparable settings and individual issues such as supervision, explored in further research.