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A digital health typology: Navigating the complexity of emerging technologies to negotiate health systems innovation with young people
No full textBackground: A priority across health systems innovation is to develop and apply ethical digital technologies with diverse publics, including young people. Mechanisms to support mutual learning the public involvement of young people in research are emerging. Yet the processes and repercussions of emerging technologies — such as the Internet of Things, Artificial Intelligence, and Big Data — are often complex and opaque to people of diverse ages, backgrounds, and expertise. Aims: This study aims to clarify concepts and explain relationships associated with emerging technologies, focusing on the implications for health systems innovation, by integrating the perspectives of young people guiding an adolescent health research community of practice. Methods: An integrated knowledge translation study spanned: i) a narrative, transdisciplinary literature review exploring the interrelationship between emerging technologies, health systems, and implications for research with young people; ii) a workshop with young people to share review insights and explore digital health innovation; and iii), a synthesis of insights from previous phases. Results: A flexible and adaptable classification tool, the Digital Health Typology, to differentiate and explain emerging technology concepts and interrelationships, perspectives of young people aligned with the typology, plus key insights to inform future research and priority-setting agendas.Conclusions: Findings seek to advance mutual learning between youth and adult stakeholders: by making sense together about the evolving and complex technologies increasingly used across health systems and everyday life in a rapidly changing society
Co-designing a point-of-care Digital Decision Support Tool for GPs to better identify and support people with an eating disorder in primary care.
No full textBackground: Eating Disorders (EDs) are common and can be difficult to identify and treat. General Practitioners (GPs) report feeling out of their depth with this client group and don’t have access to the specialist supports required. Clinical Decision Support Tools (CDST) can synthesise and simplify evidence for busy practitioners at the point of care; evidence is emerging for their use in a range of settings. InsideOut Institute is undertaking an Australian government funded project to develop a CDST for GPs to better identify and treat people with EDs using evidence-based information. Aims: This presentation will outline the agile development process of a CDST that provides evidence-based feedback to GPs and integrates with GP workflows and technology.Methods: Process Analysis included nationwide consultation & participatory human-centred co-design process with GPs and consumers/carers, plus review of GP workflow and practice software systems. Six key elements were identified for development using agile methodology (user testing incorporated at all stages to gain feedback and insight on use/further development of the tool). Results: The CDST is in the final stage of development, due for completion June 2022. Roll-out and evaluation will then be required. The Process Analysis phase identified a clear need for decision support for GPs to better identify, diagnose and manage people with EDs using evidence-based information; and the need for a solution to ensure integration of the CDST with practice software and workflow processes to optimise ease of uptake. Conclusions: Clarification of content and context will help ensure the CDST will be useful, adaptable and fully integrate
Face-to-face physiotherapy compared to a supported home exercise program for the management of musculoskeletal conditions: Protocol of a multicentre, randomised controlled trial - the REFORM trial
No full textBackground: Exercise, support and advice are considered core components of management for most musculoskeletal conditions and are typically provided by physiotherapists through regular face-to-face treatments. However, exercise can be provided remotely as part of a home exercise program while support and advice can be provided over the telephone. There is initial evidence from trials and systematic reviews to suggest that remotely-provided physiotherapy can be used to manage a variety of musculoskeletal conditions safely and effectively.Aims: The aim of this single-blind randomised controlled non-inferiority trial is to determine whether a supported home exercise programme is as good as or better than face-to-face physiotherapy for the treatment of musculoskeletal conditions. A Process Evaluation will be completed alongside the primary trial.Methods: 210 participants will be recruited from four public hospitals in Sydney, Australia. Participants will be randomised to either the Supported Home Exercise Group or the Face-to-face Physiotherapy group. Participants allocated to the Supported Home Exercise Group will initially receive one face-to-face session with the trial physiotherapist and will then be managed remotely for the next 6 weeks. Participants allocated to the Face-to-face Physiotherapy Group will receive a course of physiotherapy as typically provided in Sydney government hospitals. The primary outcome is function measured by the Patient Specific Functional Scale at 6 weeks. There will be 9 secondary outcomes measured at 6 and 26 weeks. Separate analyses will be conducted on each outcome and all analyses will be conducted on an intention-to-treat basis. Two frameworks (REAIM and realist), will be broadly used to guide a process evaluation using a mixed methods approach.Results: It is anticipated that the trial will be completed by Jun 2022 (Delayed due to COVID). Results from the semi structured interview component of the Process Evaluation demonstrate that the underlying assumptions around the intervention have been upheld.Conclusion: This trial will investigate two different models of physiotherapy care for people with musculoskeletal conditions
Dermatologists’ and General Practitioners’ views on the role of patient-led melanoma surveillance using digital technologies
No full textBackground: There is an increasing disparity between the number of dermatologists in Australia and the number of melanoma patients who need ongoing surveillance, particularly outside of metropolitan areas. Digital technologies that enable remote dermatological review of patient performed mobile teledermosopy may be one potential solution. Clinicians’ acceptance of mHealth tools is one of the most influential factors for their adoption and sustainability.Aims: To explore clinicians’ views of mobile teledermoscopy and their experiences of being involved in a pilot trial of patient-led melanoma surveillance, to gain understanding of their acceptability of the digital technologies used and remote care delivery.Methods: Semi-structured interviews and thematic analysis. This qualitative study was nested within a pilot randomised controlled trial (RCT) of 100 patients conducted at specialist and GP-led melanoma clinics in NSW.Results: 8 clinicians were interviewed (1 dermatologist, 1 surgical oncologist, and 3 skin specialist general practitioners). Clinicians identified several benefits such as early detection of skin cancer, reassurance for patients between scheduled visits, facilitation of remote monitoring, and reduction in unnecessary visits. However poor image quality, inability to make an adequate assessment of the imaged lesion, concern that suspicious lesions may be missed, and medico-legal considerations mean mobile teledermatology also has the potential to prompt unnecessary clinic visits and procedures.Conclusions: Clinicians are enthusiastic about the hypothetical and experienced benefits of mobile teledermoscopy however, ways of appropriately managing clinical uncertainty will be key to achieving these benefits in real life, and to minimising potential harms.
Advancing Care Equity and Sepsis Outcomes: ACESO study
No full textBackground: Sepsis is the dysfunctional inflammatory and immunological host response to infection and a major cause of avoidable hospital death in Australia. Aims: The aim of the project is to analyse patient care and improve clinical pratice of patients presenting to Emergency departments (ED), at risk of developing sepsis using routinely collected data under the ACESO collaboration.Methods: Data was extracted from the Western Sydney Local Health District eMR. Multi-disciplinary teams processed and analysed the data to inform current practice, interventions, benchmark care and the development of new clinical decision support tools to provide feedback to the participating hospitals. Results: The study period, 1st of January 2017 till the 30th of November 2019, registered ~480k presentations (aged > 16), originating at any ED within WSLHD.Only 3873 (0.8%) had an ED documented diagnosis of sepsis while 21 % (n = 102,663) were categorised as suspected infection and 6 % (n = 27,408) as suspected sepsis. We aim to share the progress on the aims and the function of the collaboration. We have published on the impact that intravenous fluids have on the risk of in-hospital mortality. Uncovered bias in the provision of care in the elderly population (aged ≥ 65) with respect to a younger population (aged < 65) and developed a sepsis screening algorithm for triage to promote timely interventions. Conclusions: Multiple teams working under a common collaboration have had a positive impact on generating insights associated with patient outcome and clinical practice using a single source of information
Behind the Front Lines: Realities of Racism and Discrimination for IBPOC Social Workers
Get PDFWith the growing initiative to integrate social justice practices into social work praxis, frontline workers need a concrete understanding of what achieving advocacy looks like, particularly in the context of trauma-informed practice. Advocating as a social worker with an intersectional and forced marginalized identity causes further strife between social workers and the societal structures that they operate within, often oppressing Indigenous, Black and other people of colours’ (IBPOC) knowledge systems that challenge colonial and mainstream ideologies. There is a continued recognition amongst the social work profession that there is a lack of knowledge regarding historical and contemporary policies and their current implications, when working with IBPOC, and a lack of support for those who seek to decolonize the social work profession. In this paper, we write from the perspective of a light-skinned, nêhiyaw/métis person and a South Asian settler, working as frontline social workers, to explore the ways in which advocacy work is a key part of a trauma-informed approach.
Antonella Riem. Gesture of Reconciliation: Partnership Studies in Australian Literature
Get PDFAntonella Riem. Gesture of Reconciliation: Partnership Studies in Australian Literatur
