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Decentralized Robust Global Prescribed Performance Control of Unknown Interconnected Nonlinear Systems
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Molecular Mechanisms Associated with the Inhibitory Role of Long Chain n-3 PUFA in Colorectal Cancer
Get PDFAcknowledgement and use of advance care directives and goals of care by emergency department staff: a mixed method post intervention study
Get PDFAbstract Introduction Advance Care Planning (ACP) refers to a process that includes Advance Care Directives (ACD) and Goals of Care (GOC), a practice widely used for over three decades. Following the findings of an audit and a cross-sectional study in 2019 and 2021 respectively, we implemented several educational and other interventional strategies aimed at enhancing staff awareness and emphasizing the importance of recognizing and documenting of ACD/GOC. The aim of this study was to evaluate the acknowledgement and use of ACD and GOC by Emergency Department (ED) staff following these interventions.
Method
We used a mixed methods approach, incorporating both observational and cross-sectional designs with reflexive thematic analysis. Data extraction for the observational study took place between 1st April and 30th June 2023 focusing on a target population of randomly sampled adults aged ≥ 65 years. Demographics and other ACD and GOC related patients’ clinical data were collected. Data collection for the cross-sectional study occurred between 19th July and 13th September 2023 targeting all ED staff. Information gathered included demographics, awareness about ACD and GOC, including storage location and implementation, as well as knowledge of Medical Treatment decision Makers (MTDM), a jurisdictional term identifying a person legally appointed to make healthcare decisions on behalf of someone who lacks decision-making capacity and other Victorian State legislative requirements were collected.
Results
In the observational period, 22,335 patients attended the ED and 19% (n=6546) qualifed for inclusion
from which a sample of 308 patients were randomly extracted. We found ACD documents were noted in the medical
records of 6.5% of the sample, fewer than 8% identifed in our previous study. There was no correlation between ACD
record availability and age (p=0.054; CI ranging from −0.065 to 7.768). The response rate for the cross-sectional
survey was 12% (n=340) in contrast to earlier study with 28% (n=476) respondents. Staf knowledge and familiarity
with ACD was 25% and GOC 45%.
Conclusion After implementing interventions in staf education and ACP awareness, we found that ACD documentation did not improve. However, GOC documentation increased in the context of heightened institutional awareness
and integration into the Electronic Medical Records (EMR)
Predicting the web crippling capacity of cold-formed steel lipped channels using hybrid machine learning techniques
Get PDF‘If you are feeling alone and you are not feeling safe, it impacts everything’: a mixed-methods exploration of international students’ accommodation, subjective wellbeing and mental health help-seeking
Get PDFBackground The international education sector is important not only to Australian society, but also to the national
economy. There are growing concerns about the potential wellbeing challenges facing international students in their
host country, owing to acculturative stress; including loneliness, isolation and experiences of racism. Risks include
poor mental health and decreased likelihood to access support due to stigma, language and cultural barriers, not
knowing where to seek help, and poor mental health knowledge.
Methods This study explored students’ perceptions of their accommodation, subjective wellbeing (through the
Personal Wellbeing Index, [‘PWI’]), mental health help-seeking and individual engagement with evidence-based
everyday health promotion actions (informed by the ‘5 Ways to Wellbeing’ model) through an online survey (N=375)
and three online focus groups (N=19). A mixed-methods approach using descriptive statistics, ANOVA, regression
analysis and thematic analysis, were used.
Results The PWI of international students in the survey was observed to be substantially lower (M=60.7) than that
reported for the Australian population (M=77.5). Accommodation impacted on wellbeing (loneliness, belonging,
connectedness) in a number of different ways including through location, safety, and shared accommodation. In
terms of help-seeking, international students noted a number of barriers to accessing support for mental health: cost
of accessing support, language and cultural barriers, lack of information on where to find support and stigma.
Conclusions In the discussion, implications of the findings are considered, including that more could be done to
shape policy and practice in service and facility provision around wellbeing, connectedness, and help-seeking for
mental health support of international students
The impact of critical illness on patients’ physical function and recovery: An explanatory mixed-methods analysis
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