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Exploring consumer and healthcare professional perspectives on discharge medicine communication and solutions for safer transitions of care
Get PDFBACKGROUND: The period immediately following hospital discharge is a time of heightened vulnerability for patients compounded by poor communication and information transfer between hospital and primary care healthcare professionals. These gaps contribute to medication-related harm, which accounts for a substantial proportion of preventable readmissions and emergency department presentations. This study explored the perspectives of consumers and healthcare professionals on discharge medicine information handover to inform the development of an intervention to improve transitions of care.METHODS: Qualitative methodology was used through focus group discussions in Southeast Queensland, Australia, between March-August 2024. Participants included hospital-based doctors, nurses, and pharmacists; primary care healthcare professionals (general practitioners, community pharmacists, and credentialled pharmacists); and consumers and carers with experience of post-discharge medicine management. Data were audio-recorded, transcribed verbatim, and analysed inductively using thematic analysis. Rigour was enhanced through iterative coding cycles, reflexive team discussions, and triangulation across diverse stakeholder groups.RESULTS: Seventy-five participants contributed to 12 focus groups. Three overarching themes with eight subthemes were identified. First, discharge documentation was frequently delayed, incomplete, or poorly structured, with workforce constraints and fragmented digital systems compounding these issues. Second, primary care providers often received no notification of discharge information, with inaccurate contact details and absent verification processes leading to missed or delayed follow-up. Third, patients reported insufficient or unclear medicine information at discharge, limiting their confidence in post-discharge self-management. Proposed solutions included greater pharmacist involvement in discharge planning, decoupling discharge medicine lists from discharge summaries, automated alerts to confirm receipt of information, improved use of digital health systems, and enhanced patient/carer engagement.CONCLUSION: This study highlights persistent challenges in the transfer of medicine information at hospital discharge at system, healthcare professional, and patient levels. Participants identified practical strategies to address these gaps, including pharmacist-led interventions, digital solutions, and patient-centred discharge practices. These findings will inform the design of a multifaceted intervention to improve medicine handover and reduce 30-day hospital readmissions due to medication-related harm. Broader system investment in workforce capacity, digital integration, and patient engagement will be essential to promote safer transitions of care.TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p, registered 19 April 2024, https://www.anzctr.org.au/ACTRN12624000480583p.aspx.</p
Perceived problems, causes, and solutions of finance research reproducibility and replicability: A pre-registered report
Get PDFIn response to growing concerns about reproducibility and replicability in finance and conflicting findings in the area, we survey finance academics about their perceptions of reproducibility and replicability of finance research. Our survey results will provide evidence of the extent of the perceived problems, the perceived potential causes, and the community's views on possible solutions. To this end, we contribute to the existing conversations in the finance field on the issues of reproducibility and replicability and provide suggestions for how to improve the state of the field concerning these issues
Challenges in management of abnormal thyroid function tests in unwell infants: A tertiary centre real-world experience
No full textAimAbnormal thyroid function tests (TFTs) are found in a wide range of settings in hospitalised infants. This retrospective descriptive study reviewed management decisions and outcomes of these infants, identifying factors influencing clinicians' decision to treat with thyroxine.MethodsData were collected for all infants referred to the on-call endocrinology service at a tertiary Australian centre for thyroid dysfunction between 1 July 2019 and 30 June 2021. Electronic medical records were reviewed for birth and neonatal factors, TFTs, relevant investigations, treatment and disposition.ResultsOf 124 infants referred to the service over a 2-year period, 43% (52 out of 120) were premature, with a high rate of comorbidities, including jaundice, hypoglycaemia, respiratory distress and cardiac anomalies. About 57% (69 out of 121) of referrals to the service were from neonatal intensive care units. Investigations to evaluate hypothyroidism included nuclear thyroid scans in 40% (46 out of 114) and ultrasound in 37% (41 out of 112). Levothyroxine treatment was initiated in 66% (77 out of 117) of infants, with 63% (73 out of 117) assigned a presumptive diagnosis of transient congenital hypothyroidism. At the end of the study period, 70% (54 out of 77) remained on thyroid replacement.ConclusionOur study demonstrates the challenge clinicians face when deciding whether to treat premature and medically unwell infants with abnormal TFTs. Further prospective studies are required to determine predictors of permanent CH in this complex population
Review article: Evaluating the effectiveness of arterial pressure point techniques as a first aid method for external haemorrhage control: A systematic review
Get PDFThe current ANZCOR guidelines for first aid management of life-threatening bleeding from a limb, where bleeding cannot be controlled with direct pressure, recommends the use of an arterial tourniquet. However, tourniquets required specialised training and equipment, which may not be accessible in all emergencies. This systematic review evaluated the effectiveness of arterial pressure point techniques (APPT) as a first aid measure for controlling life-threatening, non-compressible bleeding from limbs and anatomical junctions. A comprehensive literature search was conducted following the PRISMA guidelines. The search was used in five databases: PubMed, CINAHL, SportDiscuss, Proquest Central and Embase. Eligible studies included adult participants in and out of hospital settings, focusing on extremities and junctional areas. Studies assessing APPT alone or compared with other first aid techniques were included. The review included nine quasi-experimental articles, with eight having low levels of evidence. Although most reported high success rates (87.5–100%) for APPT achieving blood flow cessation, its effectiveness compared to alternative methods, such as arterial tourniquets, remains inconclusive because of methodological heterogeneity and differing success benchmarks. APPT shows promise in external haemorrhage control. Additional research with higher levels of evidence, standardised protocols and larger sample sizes is needed. Investigation in real-world scenarios is crucial to compare methods like tourniquets. Future research will determine APPT's effectiveness and its potential role as a bridging technique before tourniquet application or medical assistance
Hunt for the Silver Lining in a Super AI Future
No full textThis article examines the potential impact of artificial superintelligence (ASI) on society, highlighting its capacity to solve complex global challenges and reshape industries. It discusses the promises of ASI, including advancements in problem-solving, scientific discovery, and automation, while also addressing the significant risks, such as ethical dilemmas, social inequalities, and economic disruption. The article provides an overview of key perspectives on the future of ASI, including expert predictions and the urgent need for international collaboration, regulation, and ethical guidelines to ensure its development benefits humanity
Cold water immersion: Exploring the effects on well-being – scoping review
Get PDFBackground. As the prevalence of mental health disorders continues to rise, there is a growing need for effective and accessible holistic approaches to promote well-being. Cold-water immersion (CWI) has gained popularity in recent years due to its potential health benefits. This scoping review aimed to investigate the qualitative benefits of CWI through the experiences of healthy individuals.Methods:A systematic search of seven databases was conducted and included both peer-reviewed and grey literature from the following databases: PubMed, Embase, Psychinfo, SPORTDiscus, Proquest Health and Medical, Proquest Dissertation and Theses Global, and CINAHL. Quantitative studies examining CWI and its effects on well-being, along with the CWI parameters were included to complement the qualitative findings. A qualitative content analysis was conducted through an inductive approach. Results:In the initial search, 419 records were identified, out of which 13 studies were selected for inclusion in this review. A total of 34 unique codes were derived and grouped into eight content categories. Four overarching themes related to the CWI experiences were revealed: 1) physical and psychological health benefits, 2) connection to nature, 3) sense of connectedness, 4) personal growth. Conclusion:The experiences individuals gain from CWI are profound and can exert both direct and indirect influences on the promotion of well-being. However, further research is needed to establish the specific parameters that promote well-being through CWI
Heart rate variability is more sensitive to stress than heart rate in specialist police undergoing selection
Get PDFPolice tactical group (PTG) officers respond to the most demanding and high-risk police situations. As such, PTG personnel require exceptional physical fitness, and selection for employment often evaluates fitness both directly and indirectly. While heart rate (HR) is often used to measure physical effort, heart rate variability (HRV) may be a valuable tool for measuring stress holistically. The primary aim of this research was to investigate whether HRV was more sensitive than HR at monitoring workload during key PTG selection activities. As aerobic fitness is associated with workload during these tasks, a secondary aim was to investigate relationships between HRV, HR and aerobic fitness during the same tasks. The relationships between HRV (percentage of adjacent R-R intervals varying by 50% or more; pRR50%) and HR, as measured by ambulatory electrocardiograms obtained during a specialist police selection course, as well as aerobic fitness, as determined via total shuttles completed on the 20-meter multistage fitness test (MSFT; 'beep test'), were investigated. This study included a cohort of six male PTG candidates (n = 6) undergoing selection. As illustrated by a time-series plot, HR values were generally unremarkable, but HRV values were potentially depressed, and tentatively indicated overstress when count data from consecutive short-term analyses were derived. The MSFT was significantly, positively, correlated with pRR50% (ρ (6) = 0.812, p = 0.050, Fisher's z = 1.132). The MSFT and nonlinear HRV, frequency domain HRV, and HR were not significantly correlated. When assessed by linear regression, neither HRV nor HR were predicted by MSFT score. These findings indicate that HR alone is likely not sufficiently sensitive to provide detail on the stress response of candidates undertaking essential tactical tasks that combine physical stressors with cognitive load in adverse conditions. HRV analysis may provide additional insights regarding candidate suitability, particularly during dynamic and multifaceted assessments, though the causal direction of the relationship between HRV and aerobic fitness remains unclear.</p
Legal Issues When Transferring Health Data Between the EEA and Australia
No full textTaking account of both the laws extraterritorial application (in particular GDPR, Art. 3 and the Privacy Act 1988 (Cth) s. 5B), and the rules on transborder data transfers (in particular GDPR Chap. 5 and the Privacy Act 1988 (Cth) APP 8), this chapter considers and compares how the laws of the European Economic Area (EEA) and Australia regulates the transfer of health data between the EEA and Australia. There has already been a considerable degree of focus on the difficulties of transferring health data from the EEA to the US. But what is the situation when such data are transferred between the EEA and Australia? Using the difficulties associated with EEA-US data transfers as a comparison, do health transfers to Australia face the same obstacles as transfers to the US? And what restrictions, if any, does Australia impose on transfers to the EEA? We identify obstacles to data transfers between the EEA and Australia, both in EU and Australian law
