Does the implementation of an e-learning package to medical and nursing staff improve adherence to dysphagia screening?

Miss Nicole Reyes1, Ms Lillian Krikheli1,2

1Cabrini Health, Malvern, Australia, 2La Trobe University, Bundoora, 3086

Abstract: 

Aim: To implement an e-learning package to medical and nursing staff to improve adherence to dysphagia screening using an acute swallow screening tool within 4 hours of diagnosis.

Method: Speech pathologists developed a dysphagia screening e-learning package, which included a competency assessment by the speech pathologist. Nursing and medical staff from the stroke unit and emergency department were invited to participate. Following successful completion, staff were instructed to implement ASSIST. Data was collected at three time-points via the patient administration system and medical record audit to review adherence to screening, time to screening, accuracy of completion, rate of aspiration-related pneumonia.

Result: 18 doctors and 27 nurses were invited for training; 9 achieved competency. For baseline, immediately and 12 months post-training, the respective findings were 0%, 8%, 53% for adherence to screening; N/A, 5.6 hours, 4.3 hours between diagnosis to screening; 0%, 28%, 47% for accuracy of completion; 0%, 14%, 0% for rate of aspiration-related pneumonia with screening; and 2%, 3%, 0% without screening.

Significance of findings to allied health: Dysphagia is present in 65% of stroke patients. Clinical practice guidelines recommend screening for dysphagia within 4 hours of diagnosis, with a Victorian screening benchmark of 67%. Implementation of an e-learning package did improve adherence to dysphagia screening over time and time taken to complete screening was encouraging, however it fell below the national benchmark and concerns remain over completion correctness.

Biography: 

Nicole Reyes (MA[Comms], USA) is a Speech Pathologist at Cabrini Health working in the acute setting. She has a keen interest in the management of neurological patients and is the primary speech pathologist for the stroke service. Nicole also supervises postgraduate speech pathology students as they enter the workforce. In addition to being a practising member of Speech Pathology Australia, she continues to hold her certificate of clinical competency from the American Speech-Language and Hearing Association.

Lillian Krikheli (BHSc, MSpPath) is a Speech Pathologist at Cabrini Health working in outpatient rehabilitation (progressive neuro, stroke and voice) plus inpatient and community palliative care. She is also a PhD candidate at La Trobe University, where she has taken an active academic role, bridging her passion for clinical speech pathology work with teaching within the School of Psychology and Public Health. Her doctoral research is an international modified Delphi study investigating the role and practice of speech pathologists working in paediatric palliative care settings.

Identifying and prioritizing allied health research priorities in a regional setting: a modified Delphi protocol

Dr Renee Clapham1,2, Dr John  Aitken3, Jaithri Ananthapavan4, Dr Kevin McNamara2, Dr Anna  Ugalde4, Associate Professor Vincent Versace2, Dr Anna Wong Shee1,2

1Ballarat Health Services, Ballarat, Australia, 2Deakin Rural Health, Deakin University, Warrnambool, Australia, 3Rural Northwest Health, Warracknabeal, Australia, 4Deakin University, Burwood, Australia

Abstract: 

AIM: This study links community, allied health professionals (AHPs) and health service managers of the Western Grampians area with academic researchers to identify actionable regional priorities for allied health (AH) research.

METHOD: In Phase 1, surveys and focus groups consisting of community members will be used to understand people’s experiences of AH care and perceived service gaps. In Phase 2, information from Phase 1 will be presented to the priority-setting group consisting of community members, AHPs, service managers and researchers. Using a modified Delphi method, the group will identify and agree on AH research priorities. The Delphi method is an effective approach for collecting opinions from diverse disciplines and it overcomes issues related to peer pressure and power imbalances because it is an anonymous forum.

RESULTS: This study will consult broadly with community, AHPs, health service managers and researchers to reach consensus on regional AH research priorities. It will produce ‘researchable’ topics directly linked to the needs of the people in the Western Grampians region and will inform the development of a strategic regional approach to AH research.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH: There has not been a systematic approach to identifying research priorities for AH practice in rural and regional areas. Transparent priority setting for allocation of research resources requires a robust consultation process. Engaging practitioners, consumers, and researchers to identify research priorities will help ensure the relevance of health research, facilitate the translation of research findings into practice (clinical implementation) and improve patient outcomes (community benefit).

Biography: 

Dr Renee Clapham, qualified Speech Pathologist and early career researcher (PhD November 2017). Currently in a 3-year DHHS-funded role to build research capability and capacity and support research translation in the Grampians region of Victoria.

The Effect of Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients with Multiple Sclerosis

Dr Maryam Zoghi1, Dr Jamie Young2, Professor Mary Galea2, Professor Fary Khan2

1Latrobe University, Bundoora, Australia, 2The University of Melbourne, , Australia

Abstract: 

Aim: The aim of this study was to assess the effect of a five-day application of within-session repeated a-tDCS on neuropathic pain levels in patients with MS.

Method: A total of 30 participants were recruited in the study (n=15 in sham and active groups). A-tDCS was applied via a pair of surface electrodes (5cm x 7cm). The active and return electrodes were placed over primary motor cortex contralateral to the side of pain and the supraorbital area contralateral to the stimulated motor cortex respectively. Participants received 2 sessions of 10 minutes a-tDCS each day, 25 minutes apart for 5 consecutive days. The Visual Analogue Scale and Neuropathic Pain Scale were completed at the beginning and at the end of each treatment session to assess the pain level. The results showed that the pain level decreased significantly in active group compared to the sham group for up to 2 weeks.

Significance of the findings to allied health: patients with MS consider “pain” as one of the most important factors in their overall health-related quality of life and disability.  Pharmacologic interventions are non-specific, and at target doses may cause drowsiness and decreased capacity to carry out activities that require high executive functioning. A-tDCS is a non-invasive technique with no or minimal side effects which can be used to decrease their pain level and eventually improve their mobility level and quality of their lives.

Biography: 

Dr Maryam Zoghi is an academic physiotherapist and neuroscientist with a long-standing interest in brain function particularly aspects relevant to brain excitability, motor control, sensory-motor integration and neuroplasticity. Her area of research expertise is within the field of “neuroscience”. She has one patent, attracted over $800,000 to run her research projects and published 60 peer-reviewed journal articles and 8 book chapters in her area of expertise.

Enhancing healthcare access and support for people with a disability and their carers: Working together to improve hospital experiences

Ms Caitlin Wright1

1Bendigo Health

Abstract:

Aim:
To develop resources and processes which support hospital presentations for people with a disability who have complex needs and behaviours

Method:
This service improvement project has utilised co-design principles with a focus on improving consumer experiences of the service. Two carer representatives participate in the project Advisory Group to monitor, guide and support the development of resources to support hospital access for people with a disability and complex behaviours, particularly those with Autism and/or Intellectual Disability.

Results:
The experiences and advice of carers has informed resource development and staff education regarding caring for patients with a disability and complex needs and behaviours. Key developments have included:
-The Hospital Passport, which details a person’s support needs so that hospital staff know more about the person’s background, abilities and how to approach care;
-Guidelines for assisting patients with a disability who present with complex needs and behaviours, including strategies for communication, environmental modification and managing distress;
-Photo libraries of hospital and dental services to assist with planning and preparation for admissions and appointments; and
-An educational video with carers detailing their perspectives and experiences in accessing healthcare services, which is used in staff training.

Significance of the findings to allied health:
The resources developed emphasise communication access and health equity, which is relevant to all Allied Health clinicians providing care to patients with disability. They also demonstrate the value in co-design and consumer participation for service improvement.

Biography:

Caitlin has worked as a Speech Pathologist with Bendigo Health since 2011. She has worked in a range of clinical areas including acute services, inpatient rehabilitation, outpatient rehabilitation,
transitional care, community services, paediatric outpatient services and residential care. Caitlin has a keen interest in quality improvement and started her role as a Project Officer with Research
and Innovation in 2016 with ‘Enhancing health services access a support for people with a disability and their carers’ project.

Risk factors for medication non-adherence among Victorian patients receiving Home Medicine Reviews (HMRs)

Mr Kyrillos Guirguis1

1PharmaceuCare, Tarneit, Australia

Abstract:

Aim:
To identify risk factors that predict non-adherence among patients receiving HMRs.

Method:
Retrospective study of 109 patients who received HMRs in 2014/2015. Patients’ medication lists and HMR reports were reviewed for comments on non-adherence to medications. Factors considered as possible predictors of non-adherence were age, gender, CALD status, number of drugs, number of medical conditions, number of Over the Counter (OTC) products, number of complimentary & alternative medicines (CAM), availability of carers/family support, the use of pillboxes, patients’ need for education on their medicines, CHF, diabetes, pain, respiratory conditions and dyslipidaemia. Multiple logistic regression analysis was conducted, and a model developed to identify the most significant predictors.

Results:
The regression model (p<0.00001) demonstrated that three factors were related to patients’ non-adherence. Respiratory conditions inferred a five-fold increase in the risk of non-adherence, while the use of OTC products was associated with a two-fold increase. The odds of non-adherence were almost threefold among male patients.

Significance:
Medication non-adherence is a major cause of morbidity and hospitalisation. Outreach allied health clinicians could screen patients with identified risk factors and refer them to receive HMR services, which improve compliance to medications and optimise health outcomes. This supports patients in the community, before medication-related problems worsen and hospital visits become unavoidable. Furthermore, the referral criteria for HMRs should be re-evaluated, to accurately define patient cohorts that would benefit the most from the service and improve its economic sustainability.

Biography:

Kyrillos is a practising consultant pharmacist with extensive clinical experience. He is the Principal Consultant Pharmacist at PharmaceuCare, and Manager, Performance & Quality at MCCC GP Training. He is affiliated with the School of Medicine (UTAS) as a casual academic. Kyrillos has valuable research experience, having managed various research projects that led to publications in international peer-reviewed journals. He is a reviewer for Patient Education & Counselling and the American Journal of Health-System Pharmacy. He has years of experience in education, and has published two books: Successful Online Study and Community to Hospital Pharmacy: making the transition! to support pharmacists’ professional development and career progression. Kyrillos is ultimately passionate about the quality use of medicines, aiming to optimise health outcomes for patients with chronic disease.

 

Comparison of spatiotemporal measures of gait in soft versus hard soled footwear

Ms Simone Cranage1, Dr Luke Perraton2, Dr Kelly-Ann Bowles2, Dr. Cylie Williams2

1Peninsula Health, Frankston, Australia, 2Monash University, Melbourne, Australia

Abstract:

Aim:
There is little evidence to guide recommendations of footwear for young children. The aim of this study was to investigate the difference in spatiotemporal measures of gait in young children during walking and running in soft and hard soled footwear.

Method:
Demographic and lower limb anthropometric data was collected. Participants walked and ran along a GAITrite mat in a randomised order. Conditions of interest were soft and hard soled boots, sandals and runners and a comparison of barefoot to soft soled footwear. Gait spatiotemporal measures were extracted from the GAITrite. Linear regression clustered by participant was used to understand the different gait variables.

Results:
There were 47 typically developing children aged 2-4 years recruited. Soft soled sandals increased stride length significantly greater than hard soled footwear (Coef= -2.07, CI95%=-4.01 to -0.08, p=0.04) during walking only. There were no other differences between walking or running in soft or hard soled sandals, boots or runners. There was a small increase in tripping in soft soled sandals during walking only.

Significance of the findings to allied health:
Current perception is that the sole hardness is an important feature in young children’s shoes. These findings infer that sole hardness has a limited effect on children’s gait. Parents seeking advice from health professionals about footwear can be informed that this feature has limited impact on walking and running in young children which can therefore guide both clinician and industry recommendations.

Biography:

Simone currently works in a multidisciplinary Children’s team at Peninsula Health working in joint podiatry and physiotherapy clinics. She is currently undertaking a Masters by Research degree through Monash University on the impact of different types of footwear on toddler’s gait.

Adherence rates to home exercise programs in older adults following hip fracture: A systematic review and meta-analysis

Ms Lucinda  Yau1, Mr  Brendon  Cook2, Mr  Tony  Nguyen2, Dr Sze-Ee Soh2

1Alfred Health , Caulfield , Australia, 2Monash University , Frankston , Australia

Abstract:

Aim:
To determine the adherence rates to prescribed home exercise programs in older adults following a hip fracture.

Method:
A PRISMA structured literature search was conducted in three databases. Randomised controlled trials were included, and study quality was assessed using the PEDro scale. Random-effects meta-analysis of participant adherence rates was performed using Stata.

Results:
Six studies met the predetermined inclusion criteria. Pooled adherence rates across all included studies was 61% (95% CI 0.53-0.68). In studies where the exercise programs was less than 6 months in duration, adherence rates was 71% (95% CI 0.63-0.79), while studies with exercise programs longer than 6 months had a pooled adherence rate of 55% (95% CI 0.48-0.63).

Significance of the findings to allied health:
The results of this systematic review and meta-analysis indicate that adherence rates to home exercise programs following hip fracture may be lower in programs that last for more than 6 months. This highlights the need for clinicians to consider the length of their interventions and service provision for older adults following a hip fracture, and how this may impact on their ability to make significant functional improvements.

Biography:

Bachelor Health Science and Masters of Physiotherapy Practice 2012

Post Graduate Certificate of Musculoskeletal Physiotherapy 2018

Senior Musculoskeletal/Spinal Cord Injuries/Amputee/ Physiotherapist

Caulfield Hospital Alfred Health

Strictly Come Dancing with Parkinson’s: a regional health service – community research initiative translating evidence into practice

Dr Anna Moran1, Ms Georgina Howard2, Ms Alys Cummings2

1Albury Wodonga Health – University Of Melbourne, Albury, Australia, 2Albury Wodonga Health, WODONGA, Australia

Abstract:

Aim:
o examine the impact of translating evidence-based dance classes for persons with Parkinson’s Disease (PD) into a regional Victorian dance school.

Method:
Pragmatic, multi-methods design. Persons with PD and their carers were invited to participate in a jointly-led rehabilitation staff, dance school initiative in regional Victoria to implement a 6 month evidence-based dance programme for persons with PD. Mirroring Shanahan & Morris’s work: capacity to participate safely in the classes was assessed, dance teachers were trained and baseline and follow-up measures were taken. Focus group interviews were undertaken with participants and dance staff. Data were analysed descriptively and thematically.

Results:
12 people with PD, 4 carers, 4 dance teachers and 2 rehabilitation staff participated in the initiative. The group were extremely varied in their PD presentation (n=11, Hoehn and Yahr range 1-5, median 2). Follow-up outcome measures demonstrated little functional change. The initiative engaged participants who were not currently accessing other rehabilitation services offered. The success of the intervention was perceived as: providing an opportunity for “connectedness” and “enjoyable movement”. This was achieved through a small funding grant and support from rehabilitation professionals alongside the skill of dance staff who used “happy music”, mirroring, repetition and the use of storey lines that were progressively built upon over the 6 month period. The programme has continued beyond the life of the project.

Significance to AH:
This initiative demonstrates the importance of translating low-cost, high impact evidence-based interventions into practice in settings outside traditional rehabilitation environments.

Biography:

Georgie Howard is a Physiotherapist currently working within the Transition Care Program and has a special interest in stroke recovery and Parkinson’s disease. Georgie has extensive clinical experience in geriatric rehabilitation and enjoys supporting patients to bridge the gap between hospital and home after a major health event.

Alys Cummings is a speech pathologist who works within the Rural Allied Health Team and the Transition Care Program. Alys supports the Albury Wodonga, Beechworth and Corryong Parkinson’s peer support groups. She has a clinical interest in improving the quality of life of adults living with disability.

Associations of dietetic intervention and maternal and neonatal outcomes in women with gestational diabetes

Ms Julia Zinga1, Dr Paige  van der Pligt2, Dr Claire Margerison2, Ms Gina Absalom2

1Royal Women’s Hospital, St Helena, Australia, 2School of Exercise and Nutrition Science, Deakin University, Burwood, Australia

Abstract:

Aims:
Dietitians play a pivotal role in gestational diabetes (GDM) management, yet, limited literature has assessed the impact of dietetic intervention in women with GDM. This study aimed to assess the associations between dietetic intervention and aspects of care in women with GDM, and a range of maternal and neonatal outcomes.

Methods:
This was a retrospective cohort study, of 1233 adult women diagnosed with GDM in a singleton pregnancy, who delivered at the Royal Women’s Hospital (RWH) between 2015 and 2017. A medical records audit determined the number of dietetic consultations per patient, and aspects of care: medical nutrition therapy vs added pharmacotherapy; specialist diabetes clinic care vs routine antenatal clinic; and a range of maternal and neonatal outcomes. Adjusted linear and logistic regression was used to analyse associations.

Results:
Women requiring pharmacotherapy had a greater number of dietetic consultations compared to women managed solely with medical nutrition therapy (β-coef (95%CI) =0.28(0.17-0.39)), (p<0.001). Women who received 1 or more dietetic consultations had a decreased likelihood of infant admission to the neonatal intensive care unit (NICU) or special care nursery (SCN) ([OR] 0.41, 95% CI 0.22-0.75; P=0.004), compared to women who didn’t receive dietetic intervention. No associations were noted between number of dietetic consultations and maternal outcomes or other neonatal health outcomes.

Significance:
Dietetic intervention in GDM, within a comprehensive healthcare package, is associated with fewer infant admissions to NICU or SCN. Further research should assess the impact of dietetic intervention on optimising maternal and neonatal health in women with GDM.

Biography:

Julia Zinga is a Diabetes Dietitian and holds a Bachelor of Health Science (Nutrition & Dietetics) from The University of Newcastle. The majority of Julia’s dietetic career has been in the field of diabetes, providing dietary counselling to people of all ages with diabetes. Since 2014, Julia has worked as Diabetes Dietitian at Royal Women’s Hospital, Melbourne, working in the multidisciplinary diabetes unit to support women with Type 1 or Type 2 diabetes who are pregnant or planning pregnancy, and women with gestational diabetes.

“Communicate, communicate, communicate”: Advanced Musculoskeletal Physiotherapy services, enabling factors for multi-site implementation

Ms Bridget Shaw1, Ms Sophie Heywood1, Ms Carolyn Page1, Mr Uyen Phan2, Dr Paula Harding3, Ms Kerrie Walter3, Ms Desiree Terrill4, Dr Catherine  Granger2,5

1Department of Physiotherapy, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia, 3Department of Physiotherapy, The Alfred, Prahran, Australia, 4Health and Wellbeing Workforce Reform, Department of Health and Human Services, Melbourne, Australia, 5Department of Physiotherapy, The University of Melbourne, Parkville, Australia

Abstract:

Aim:
To identify the enablers to implementation of 12 Advanced Musculoskeletal Physiotherapy (AMP) services from the perspective of clinical staff.

Method:
12 participants (physiotherapists) from 12 different healthcare networks in Victoria (seven metropolitan, three regional, two rural) consented to be involved in this qualitative study using a structured survey. The networks implemented AMP services (orthopaedics postoperative joint replacement review n=10, general orthopaedics n=1, emergency n=1 and neurosurgery n=1) over a 12 month period. Thematic analysis was used and mapped to the validated Theoretical Domains Framework.

Results:
Motivation domain enablers included offering a solution to access blocks in specialist clinics; improving patient outcomes; reducing costs and improving efficiency; maximising early and open dialogue with all stakeholders, especially engagement of medical staff; ensuring stakeholders’ knowledge of the AMP clinicians and services; an efficient model of care with clear scope of practice to minimise risk as well as multiple staff willing to further knowledge and skills. Opportunity enablers included regular communication with and support from stakeholders; clear referral processes; time and also the initial restriction of clinic capacity. Capability domain enabling factors included a detailed, relevant, thorough, well-structured learning and assessment framework with a known credentialing standard, supported by senior medical staff; understanding key organisational issues and also having a pool of appropriately skilled, experienced, flexible and dedicated physiotherapists with strong communication skills.

Significance of the finding:
Communication and relationships with stakeholders emerged as critical for successful implementation and should be prioritised along with developing and supporting knowledgeable, adaptable AMP clinicians.

Biography:

Bridget Shaw has been working in Advanced Scope Physiotherapy roles for 10 years and has been the Advanced Scope Physiotherapy Clinical Leader at St Vincent’s Hospital in Melbourne for the last three years. Bridget has a Masters of Manipulative Physiotherapy. Bridget was a member of the team of the DHHS funded Advanced Musculoskeletal Physiotherapy Implementation project from which this research arose.