Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian st...Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.
OBJECTIVES: To review and thematically map published research on health-related climate change mitigation or adaptation interventions in Australia. STUDY DESIGN: Systematic mapping of published peer-reviewed research stu...OBJECTIVES: To review and thematically map published research on health-related climate change mitigation or adaptation interventions in Australia. STUDY DESIGN: Systematic mapping of published peer-reviewed research studies and reviews examining outcomes associated with climate change and health interventions in Australia. DATA SOURCES: MEDLINE, Scopus, Google Scholar, published from 1 January 2008 to 1 March 2024, and manual searches of peer-reviewed literature. DATA SYNTHESIS: Eighty-three publications (49 original research, 34 reviews) were included, categorised under four themes: (i) health system decarbonisation (18); (ii) health system adaptation, vulnerability and resilience (24); (iii) health co-benefits of climate change mitigation (9); and (iv) adaptation outside the health system to protect health from climate impacts (26). Six additional studies spanned several of these themes. Ten decarbonisation studies focused on hospital-based clinical care interventions. In comparison, adaptation studies focused on interventions in a wider variety of health services and community settings. Twenty publications focused on heat, with fewer publications on other climate-related hazards (bushfires, floods and droughts). Adaptation interventions largely focused on addressing physical health impacts of climate change, with less attention on psychosocial or mental health impacts. Studies on health co-benefits of mitigation focused on urban greening, shading, cool materials, healthier diets, carbon pricing of food and Indigenous land management. Across all themes, four studies focused on First Nations peoples. Original studies mainly used survey methods, with three studies employing randomised controlled trials and seven using life cycle assessments. Overall, there was limited evidence of stakeholder engagement. CONCLUSIONS: A sustained increase in research on climate change and health interventions will help realise the vision of 'healthy, climate-resilient communities, and a sustainable, resilient, high quality, net zero health system' of the National Health and Climate Strategy. Evidence from local contexts and priority populations, using interdisciplinary methods and stakeholder engagement, will support action on climate change and health in Australia.
Mentoring programmes are increasingly used in the health sector to provide career support and guidance for health professionals. However, a number of mentoring experiences and programmes fall short of their potential, wi...Mentoring programmes are increasingly used in the health sector to provide career support and guidance for health professionals. However, a number of mentoring experiences and programmes fall short of their potential, with variable outcomes reported. This article summarises the mentoring literature, which clearly demonstrates that mentoring is an important evidence-informed component of advancing women in leadership. We provide a perspective on mentoring in the context of promoting gender equity within workplaces and propose a new nuanced and integrated model to consider for the advancement of women in leadership.
OBJECTIVES: To quantify the association between care alignment to the treatment step of the Cancer Council Victoria and Department of Health Victoria Optimal care pathways for people with breast cancer (OCP) (second edit...OBJECTIVES: To quantify the association between care alignment to the treatment step of the Cancer Council Victoria and Department of Health Victoria Optimal care pathways for people with breast cancer (OCP) (second edition) and survival. DESIGN: Retrospective population-based cohort study using the Victorian Cancer Registry and linked administrative health datasets. SETTING, PARTICIPANTS: Adult women diagnosed with invasive, unilateral breast cancer from 1 July 2012 to 31 December 2019 in Victoria, Australia. MAIN OUTCOME MEASURES: Breast cancer-specific and overall survival for women whose care did or did not align to the treatment step of the OCP expressed as adjusted hazard ratios. Interaction between OCP alignment and cancer stage at diagnosis was also assessed. RESULTS: Of 29,591 eligible women, 17,152 (58.0%) were fully aligned, 7086 (23.9%) were partially aligned and 5353 (18.1%) were not aligned to the treatment step of the breast cancer OCP. Median follow-up was 1481 days (interquartile range, 850-2210 days). Adjusting for measured sociodemographic and clinical factors, OCP treatment alignment was associated with 23% (95% confidence interval [CI], 14%-31%) and 34% (95% CI, 29%-40%) lower risk of death from breast cancer and all causes, respectively, compared with non-alignment. By cancer stage, OCP alignment was significantly associated with 40% (95% CI, 27%-50%) and 30% (95% CI, 14%-42%) lower risk of breast cancer death for Stage II and III cancers, respectively, and 39% (95% CI, 26%-49%), 49% (95% CI, 42%-55%) and 33% (21%-44%) lower risk of all-cause death for Stage I, II and III cancers, respectively. CONCLUSIONS: Risk of death was lower for women with breast cancer whose treatment aligned to the OCP compared with women whose treatment did not align. Our findings support the promotion and implementation of the breast cancer OCP.
We performed a 15-year retrospective audit of all cases of malignant otitis externa (MOE) referred to Alice Springs Hospital in Central Australia from 2009 to 2024, the largest Australian series of MOE. Data on demograph...We performed a 15-year retrospective audit of all cases of malignant otitis externa (MOE) referred to Alice Springs Hospital in Central Australia from 2009 to 2024, the largest Australian series of MOE. Data on demographics, risk factors, microbiological culture results, management and outcomes were collected, identifying 64 cases of MOE, with the incidence increasing over time. The incidence of MOE was associated with Indigenous status and the presence of diabetes mellitus and chronic kidney disease. Pseudomonas, Staphylococcus aureus and fungal pathogens predominate as causal agents. Complications and mortality were common.
INTRODUCTION: The Australian Guidelines for the Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder were released in May 2025. These guidelines, updated from the 2016 Australian Guide, were developed through exte...INTRODUCTION: The Australian Guidelines for the Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder were released in May 2025. These guidelines, updated from the 2016 Australian Guide, were developed through extensive stakeholder consultation, a comprehensive review of empirical evidence and the application of a novel Grading of Recommendations, Development and Evaluation (GRADE)-based approach for developing evidence-based diagnostic criteria. RECOMMENDATIONS: The guidelines include 11 GRADE-based recommendations, forming the core of the diagnostic criteria, and 11 lived experience statements, supporting client-centred assessment approaches. The guidelines also feature 40 good practice statements and 18 implementation considerations, tools and tips as practical resources and supports for practitioners. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: Key changes in the new guidelines include: A minimum prenatal alcohol exposure threshold for diagnosis to support more precise identification of fetal alcohol spectrum disorder (FASD); The assessment of neurodevelopmental impairments and functioning has been refined, including detailed advice for practitioners seeking to identify clinically significant impairments; Inclusion/exclusion of neurodevelopmental domains as part of the assessment; and Revisions to some of the content of the included neurodevelopmental domains. Changes have also been made with attention to the needs of First Nations Australians and people from other culturally and linguistically diverse backgrounds. The guidelines advocate for the use of shared decision-making approaches, promoting collaboration between practitioners, individuals attending for assessment and their support network. Importantly, the guidelines will enable an accessible, holistic and flexible assessment process, supporting timely and accurate assessment and diagnosis of FASD in Australia. The rigorous development process also provides practitioners with confidence in the guidelines, promoting increased uptake of assessment and diagnostic practices, and informing international diagnostic criteria and guidelines.
The Bondi Beach terrorist attack has caused widespread community distress resulting in complex psychosocial challenges that require urgent attention to protect population mental health. Acute reactions including shock, f...The Bondi Beach terrorist attack has caused widespread community distress resulting in complex psychosocial challenges that require urgent attention to protect population mental health. Acute reactions including shock, fear and anger are normative, while the psychological responses unfolding over time may vary from adaptive to dysfunctional. A range of mental health and psychosocial services have been mobilised to address acute needs; however, to ensure a sustained and coherent framework of care, interventions should be guided by a set of principles that accurately respond to the unique nature of the event. We provide an overview of the Adaptation and Development After Persecution and Trauma (ADAPT) model as an overarching framework that can guide psychosocial interventions and promote adaptive coping, recovery and resilience.
OBJECTIVE: To explore primary care providers' perspectives on (i) healthcare needs and barriers to care for Aboriginal and Torres Strait Islander children and adolescents; and (ii) enablers and opportunities to strengthe...OBJECTIVE: To explore primary care providers' perspectives on (i) healthcare needs and barriers to care for Aboriginal and Torres Strait Islander children and adolescents; and (ii) enablers and opportunities to strengthen care. STUDY DESIGN: A qualitative study; interviews and open-ended survey responses. SETTING: Primary care providers who work with Aboriginal and Torres Strait Islander children and young people in health and education settings in New South Wales and the Australian Capital Territory. Data were collected between 23 March 2022 and 13 October 2023. MAIN OUTCOME MEASURES: Sixteen interviews and 33 open-ended survey responses were analysed using reflexive thematic analysis with a hybrid inductive/deductive approach. RESULTS: Participants reported that some of the most important health needs for children and young people related to mental health. They recognised that the presenting complaint was not always the underlying or only concern, demonstrated an understanding of trauma-informed care and acknowledged the importance of collaborative services that engaged support networks. Barriers to care included a lack of cultural safety in mainstream services, challenging social circumstances, financial concerns, being unaware of available services and privacy and confidentiality concerns. To improve care, staff identified several areas needing change including having a package of services tailored for young people; additional training for providers in child and adolescent health, particularly for mental healthcare, trauma-informed care and communication with young people; providing a safe and engaging environment; support for staff self-care; and additional resources. CONCLUSIONS: Supporting mental health needs is a key aspect of caring for children and adolescents. To provide optimal primary healthcare, service providers require specialist skills. To support adolescents and children, participants identified a need for ongoing training, professional development and organisational support to ensure best practice care is sustained. This work has informed the development of training and other resources for partner health services.
Giant cell arteritis (GCA) is the most prevalent systemic vasculitis of the elderly and can lead to irreversible vision loss and stroke. We report the case of an 84-year-old woman who presented with a persistent headache...Giant cell arteritis (GCA) is the most prevalent systemic vasculitis of the elderly and can lead to irreversible vision loss and stroke. We report the case of an 84-year-old woman who presented with a persistent headache, prompting investigation for GCA, initially with a temporal artery ultrasound (TAUS) scan. The results were suggestive of GCA and the diagnosis was confirmed on a subsequent temporal artery biopsy (TAB). TAUS is now part of the classification criteria of GCA, and a diagnosis can be made without biopsy. TAB should be reserved for high-risk patients with a negative TAUS result.
Child health inequities remain a persistent challenge, with well-described long-term consequences. Advances in cross-sector administrative data linkage and causal inference methods offer powerful opportunities to transfo...Child health inequities remain a persistent challenge, with well-described long-term consequences. Advances in cross-sector administrative data linkage and causal inference methods offer powerful opportunities to transform data into evidence for addressing inequities. This article explores how linked administrative data support timely, precise, agile and coordinated policy responses and monitor their impact. We outline conditions needed to realise this potential, including sustained cross-sector data infrastructure, analytic capability and increased efforts to translate evidence into action. We argue linked administrative data can inform pathways to more equitable child health and, with investment, help deliver on lasting returns for children, families and society.
OBJECTIVE: To assess the impact of strategies to improve public hospital emergency access using a detailed ward-level simulation modelling approach. DESIGN AND SETTING: Discrete event simulation was used to simulate pati...OBJECTIVE: To assess the impact of strategies to improve public hospital emergency access using a detailed ward-level simulation modelling approach. DESIGN AND SETTING: Discrete event simulation was used to simulate patient flow at three principal referral Australian hospitals from 1 September 2021 to 31 August 2022. Models were developed and validated using every emergency department (ED) presentation, inpatient episode of care and patient ward movement at the study hospitals. MAIN OUTCOME MEASURES: Mean and total ED length of stay, mean waiting time, access block rate, 4-h rule compliance and bed utilisation for patients admitted from the ED. RESULTS: Reducing ED demand via arrangements that accommodate the same proportion and types of admissions from the ED as the existing ED presenting population reduces access block, with larger impacts in winter than in summer. However, reducing 'general practitioner-type patients' in EDs has negligible impact on access block. Tangible impacts on improving patient flow can be achieved by removing maintenance care patients from hospitals (reducing the percentage of access block by up to a third) and reducing elective admissions. Strategies that emphasised morning, midday and early afternoon discharges led to large flow improvements. The strategy already practised by most hospitals of sharing patients among wards greatly improves emergency access, and gains are the same order of magnitude as reducing overall ED demand. CONCLUSIONS: The study provides support to policymakers looking for evidence regarding strategies to improve emergency access to public hospital care.
OBJECTIVES: To evaluate the effect of hospital occupancy levels on inpatient and emergency department (ED) flow rates, ED length of stay (ED) and access block, and identify critical occupancy thresholds above which patie...OBJECTIVES: To evaluate the effect of hospital occupancy levels on inpatient and emergency department (ED) flow rates, ED length of stay (ED) and access block, and identify critical occupancy thresholds above which patient flow deteriorates. DESIGN: Retrospective cohort study using routinely collected administrative data. SETTING: Twenty-five public hospitals in Queensland, Australia, over a 5.5-year period (1 April 2017 to 31 August 2022). MAIN OUTCOME MEASURES: ED presentation and discharge rates, inpatient admission and discharge rates, hospital occupancy levels, length of stay, access block and 4-h rule compliance. RESULTS: The analysis reveals a significant performance shift as hospital occupancy levels increase and identifies site-specific critical 'choke points' where patient flow deteriorates. Notably, as occupancy rises, we observed a growing divergence between ED presentations and discharge rates, and between inpatient admissions and discharges, indicating system congestion. Additionally, when assessing flow across the 25 hospitals, the data demonstrates that a 10% increase in bed occupancy rate correlates with a 0.32-h (19-min) extension in ED length of stay (or 33 min for patients admitted from the ED). Also, significant disparities in hospital operations were observed between weekends and weekdays, with weekday admissions and discharges up to three times higher than weekends, highlighting the increased operational pressure during the work week. CONCLUSIONS: The investigation challenges the traditional 85% occupancy target, demonstrating that optimal occupancy levels vary by hospital. The study also underscores the strong correlation between hospital bed occupancy and ED access performance, with higher hospital occupancy correlating with longer ED stays and decreased adherence to performance indicators. As hospitals approach full capacity, the pressure on ED resources intensifies, resulting in longer wait times and delays in care.