8 research outputs found
Cardiac services for care of suspected acute coronary syndromes in Australia and New Zealand hospitals
No full textAbstract 18319Isuru Ranasinghe, Carolyn Astley, Bernadette Aliprandi-Costa, Derek Chew, Christopher J Ellis, Christopher J Hammett, Tom G Briffa, Tegwen E Howell, Karen J Lintern, Hella Parker, Bridie Carr, Greg D Gamble, Rosanna Tavella, Julie Redfern, John French, David Briege
An Exploration of the Terms Educational System Leader and Educational System Leadership
No full textThis thesis explores the concept and practice of system leadership within the context of Welsh education reform. In the context of significant policy change and curriculum transformation, the study investigates how leadership that transcends individual schools can contribute to system-wide improvement. It specifically examines the terms educational system leader and educational system leadership, using an interpretivist approach (Thomas, 2017) to understand how these are perceived by educational leaders, advisers and policy influencers.
Grounded in sociocultural theory (Rogoff, 1990, 1995, 2003), the research is framed by two
central questions:
What is understood by the term educational system leader?
What is understood by the term educational system leadership?
To address these questions, the study employed two qualitative data collection methods: an online questionnaire distributed to a purposive sample of global education professionals and follow-up interviews with four headteachers from across Wales. Reflexive thematic analysis (Braun and Clarke, 2022), supported by Rogoff’s (2003) analytic framework, led to the development of seven themes. These findings culminated in the identification of five core principles of a system leader and eight essential aspects of system leadership, together forming an empirically derived model of system leadership in action.
The study argues that system leadership in Wales is not merely an extension of traditional within-school leadership, but a distinct and necessary form of leadership that supports collaboration, coherence and reform across the education system. It contributes to the field of educational leadership by offering a contextually grounded understanding of system leadership and its role in driving sustainable change. The model developed through this research provides valuable insights for policy, practice and future research, particularly in supporting the ongoing transformation of education in Wales
Availability of highly sensitive troponin assays and acute coronary syndrome care: Insights from the SNAPSHOT registry
No full textFree to read on journal website (may need to create free account first)\ud
\ud
\ud
Summary\ud
\ud
Objectives: To examine differences in care and inhospital course of patients with possible acute coronary syndrome (ACS) in Australia and New Zealand based on whether a highly sensitive (hs) troponin assay was used at the hospital to which they presented.\ud
\ud
Design, setting and patients: A snapshot study of consecutive patients presenting to hospitals in Australia and New Zealand from 14 to 27 May 2012 with possible ACS.\ud
\ud
Main outcome measures: Rates of major adverse cardiac events (inhospital death, new or recurrent myocardial infarction, stroke, cardiac arrest or worsening heart failure); association between assay type and outcome (via propensity score matching and a generalised estimating equation [GEE]; averages of the predicted outcomes among patients who were treated with and without the availability of an hs assay (via inverse probability-weighting [IPW] with regression-adjusted estimators).\ud
\ud
Results: 4371 patients with possible ACS were admitted to 283 hospitals. Over half of the hospitals (156 [55%]) reported using the hs assay and most patients (2624 [60%]) had hs tests (P = 0.004). Use of the hs assay was independent of hospital coronary revascularisation capability. Patients tested with the hs assay had more non-invasive investigations (exercise tests, stress echocardiography, stress nuclear scans, and computed tomography coronary angiography) than those tested with the sensitive assay. However, there were no differences between the groups in rates of angiography or revascularisation. All adjusted analyses showed a consistently lower rate of inhospital events, including recurrent heart failure in patients for whom the hs assay was used (GEE odds ratio, 0.75; 95% CI, 0.60–0.94; P = 0.014); IPW analysis showed a 2.3% absolute reduction in these events with the use of the hs assay (P = 0.018).\ud
\ud
Conclusion: Use of hs troponin testing of patients hospitalised with possible ACS was associated with an increased rate of non-invasive cardiac investigations and fewer inhospital adverse events
Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand
No full textOBJECTIVE: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.Julie Redfern, Karice Hyun, Derek P Chew, Carolyn Astley, Clara Chow, Bernadette Aliprandi-Costa, Tegwen Howell, Bridie Carr, Karen Lintern, Isuru Ranasinghe, Kellie Nallaiah, Fiona Turnbull, Cate Ferry, Chris Hammett, Chris J Ellis, John French, David Brieger, Tom Briff
Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS Study
No full textOBJECTIVES: To characterise management of suspected acute coronary syndrome (ACS) in Australia and New Zealand, and to assess the application of recommended therapies according to published guidelines. DESIGN, SETTING AND PATIENTS: All patients hospitalised with suspected or confirmed ACS between 14 and 27 May 2012 were enrolled from participating sites in Australia and New Zealand, which were identified through public records and health networks. Descriptive and logistic regression analysis was performed. MAIN OUTCOME MEASURES: Rates of guideline-recommended investigations and therapies, and inhospital clinical events (death, new or recurrent myocardial infarction [MI], stroke, cardiac arrest and worsening congestive heart failure). RESULTS: Of 478 sites that gained ethics approval to participate, 286 sites provided data on 4398 patients with suspected or confirmed ACS. Patients’ mean age was 67 years (SD, 15 years), 40% were women, and the median Global Registry of Acute Coronary Events (GRACE) risk score was 119 (interquartile range, 96–144). Most patients (66%) presented to principal referral hospitals. MI was diagnosed in 1436 patients (33%), unstable angina or likely ischaemic chest pain in 929 (21%), unlikely ischaemic chest pain in 1196 (27%), and 837 patients (19%) had other diagnoses not due to ACS. Of the patients with MI, 1019 (71%) were treated with angiography, 610 (43%) with percutaneous coronary intervention and 116 (8%) with coronary artery bypass grafting. Invasive management was less likely with increasing patient risk (GRACE score 200, 36.1%; P < 0.001). The inhospital mortality rate was 4.5% and recurrent MI rate was 5.1%. After adjusting for patient risk and other variables, significant variations in care and outcomes by hospital classification and jurisdiction were evident. CONCLUSION: This first comprehensive combined Australia and New Zealand audit of ACS care identified variations in the application of the ACS evidence base and varying rates of inhospital clinical events. A focus on integrated clinical service delivery may provide greater translation of evidence to practice and improve ACS outcomes in Australia and New Zealand.Derek P Chew, John French, Tom G Briffa, Christopher J Hammett, Christopher J Ellis, Isuru Ranasinghe, Bernadette J Aliprandi-Costa, Carolyn M Astley, Fiona M Turnbull, Jeffrey Lefkovits, Julie Redfern, Bridie Carr, Greg D Gamble, Karen J Lintern, Tegwen E J Howell, Hella Parker, Rosanna Tavella, Stephen G Bloomer, Karice K Hyun and David B Briege
Expertise and infrastructure capacity impacts acute coronary syndrome outcomes
No full textObjective: Effective translation of evidence to practice may depend on systems of care characteristics within the health service. The present study evaluated associations between hospital expertise and infrastructure capacity and acute coronary syndrome (ACS) care as part of the SNAPSHOT ACS registry. Methods: A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured. Results: Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P
Is there inequity amongst patients with acute coronary syndrome who are proficient and not proficient in English language in terms of their in-hospital care: Analysis of the SNAPSHOT ACS Study
No full textPosted in accordance with Publisher's copyright policy.Background: The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care. Objective: The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals. Methods: Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions. Results: The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalenc
The household economic burden for acute coronary syndrome survivors in Australia
No full textOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship.
Methods: Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship.
Results: Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A126.50) per month. The average spending for medical services was A310.35) and medications was A80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18–59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship.
Conclusion: Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended
management for patients
