DSpace Collection: Research output collection
http://hdl.handle.net/11054/4
Research output collection2024-03-28T12:57:55ZPracticing inclusive care in the perioperative environment: a personal and professional perspective.
http://hdl.handle.net/11054/2362
Title: Practicing inclusive care in the perioperative environment: a personal and professional perspective.
Abstract: There is an increasing number of people self-reporting as being transgender (trans); 1% of the general population, and higher in younger people. However, there is a lack of hospital, state, federal, and international guidelines in this space, and many perioperative nurses and clinicians may have limited experience caring for trans patients.
“Transition” covers a range of facets for trans people, both social and medical, and trans patients may present with a variety of different appearances and expressions, at different stages of transition. Many of the common operations/procedures trans people undergo have the potential to influence their perioperative care (particularly management of patients’ airways and management of perioperative medications).
Additionally, many trans people have traumatic experiences which can impact care. Trans people in Australia have a much higher rate of being victims of violent crime, abuse, have higher lifetime incidences of depression (73%) and anxiety (67%), overall leading to a lifetime risk of suicide of 43%. Trauma may also be experienced in healthcare settings, including refusal of care, being physically attacked and being sexually assaulted. The literature, however, also shows that having avenues of support improves physical and mental outcomes. Healthcare professionals can be avenues of support.
This leads to recommendations of clinical and non-clinical care, based on literature regarding trans care more generally, perioperative care, and non-clinical care. Particular recommendations include: facilitating a supportive environment through posters, stickers, badges, and similar, diversity officers and training, and individual level efforts to respect names, pronouns, and someone’s gender.2023-01-01T00:00:00ZCo-design, co-production and recovery oriented service transformation initiative – Grampians Mental Health and Wellbeing Service (GMHWS).
http://hdl.handle.net/11054/2361
Title: Co-design, co-production and recovery oriented service transformation initiative – Grampians Mental Health and Wellbeing Service (GMHWS).
Abstract: Our journey began in 2021, GMHWS engaged the consultancy service of Helen Glover, to support the consistent roll out of Recovery oriented practice across the service. Helen facilitated Senior, middle management and the lived and living experience workforce (LLEW) collectively to develop a unique value proposition (UVP) and subsequent practice principles
To support the service and cultural transformation a lived experience role of Director of Co design and Co Production was appointed, recognising LLEW as a unique discipline specialty that is embedded across all teams within the organisation. Multiple workshops were delivered by Helen to over 374 staff within the department to provide the platform for practice change.
At a more strategic level a working group was commissioned to review the design of all governance committees, incorporating the UVP and practice principles. Identifying the need for a LLEW Co-chair for all committees to elevate LLEW and work towards true co production.
To ensure sustainability of the initiative and subsequent practice change a community of practice was developed to facilitate co design opportunities to support systemic change in line with the Royal Commission Recommendations.2023-01-01T00:00:00ZPrediction of no-reflow in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
http://hdl.handle.net/11054/2360
Title: Prediction of no-reflow in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
Abstract: Background: Suboptimal coronary reperfusion (no-reflow) is common in acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate an easy-to-use clinical risk score for no-reflow for use following angiography and prior to PCI to assist in guiding preventative strategies.
Methods: We developed and externally validated a logistic regression model for prediction of no-reflow among adult patients undergoing PCI for ACS using data from the Melbourne Interventional Group (MIG) PCI registry (2005-2015; development cohort) and the British Cardiovascular Intervention Society (BCIS) PCI registry (2006-2020; external validation cohort). A subset of candidate variables was selected based on previous literature and an adaptive least absolute shrinkage and selection operator (LASSO) regression approach used for final variable selection.
Results: 30,561 patients (mean age 64.1 years, 24% women) were included in the MIG development cohort and 440,256 patients (mean age 64.9 years, 27% women) in the BCIS external validation cohort. The primary outcome (no-reflow) occurred in 4.1% (1,249 patients). From 33 variables, 6 were included in the score (cardiogenic shock, STEMI with delayed symptom-to-balloon time, estimated stent length, vessel diameter, pre-PCI TIMI flow, and lesion location). Model discrimination was very good in both development (C-statistic 0.81) and external validation (C-statistic 0.74) cohorts with excellent calibration.
Conclusions: We developed a simple count-based scoring system based on parameters available prior to PCI to predict risk of no-reflow. This score could be useful in guiding patient selection in future preventative treatment trials.2023-01-01T00:00:00ZPrevalence and outcomes of acute coronary syndrome patients with and without standard modifiable risk factors undergoing percutaneous coronary intervention.
http://hdl.handle.net/11054/2359
Title: Prevalence and outcomes of acute coronary syndrome patients with and without standard modifiable risk factors undergoing percutaneous coronary intervention.
Abstract: Background: There is increasing awareness that patients without standard modifiable risk factors (SMuRFs; diabetes, hypercholesterolaemia, hypertension, and smoking) may represent a unique subset of acute coronary syndrome (ACS) patients.
Aim: To investigate prevalence and outcomes of SMuRF-less ACS patients compared to those with ≥1 SMuRF undergoing percutaneous coronary intervention (PCI).
Methods: We analysed data from 2005 to 2020 using the Melbourne Interventional Group PCI Registry. Patients with a history of coronary artery disease were excluded. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital events and cardiac events at 30 days. Long-term mortality was investigated using Cox-proportional hazards regression.
Results: From 1 January 2005 to 31 December 2020, 2,727 of 18,988 (14.4%) patients were SMuRF-less. Mean age was the same for patients with and without SMuRFs (63 years), and fewer females were SMuRF-less (20% vs 25%, p<0.001). SMuRF-less patients were more likely to present with cardiac arrest (6.6% vs 3.9%, p<0.001) and ST-elevation myocardial infarction (59% vs 51%, p<0.001), and were more likely to experience post-procedural cardiogenic shock (4.5% vs 3.6%, p=0.019) and arrhythmia (11.2% vs 9.9%, p=0.029). At 30 days, mortality, myocardial infarction, revascularisation, and major adverse cardiac and cerebrovascular events did not differ between the groups. During follow-up of approximately 7 years, SMuRF-less patients had an adjusted 12% decreased rate of mortality (HR 0.88 [95% CI 0.78, 0.99]).
Conclusions: Despite differences in characteristics, no difference in 30-day outcomes was observed between patients with and without SMuRFs. However, SMuRF-less patients had lower hazard for long-term mortality.2023-01-01T00:00:00Z