Does the use of low frequency ultrasonic debridement pose an infection control risk for clinicians, patients and the clinic environment?

Ms Lucia Michailidis1,2, Dr Despina Kotsanas2, Ms Elizabeth Orr2, Ms Georgia Coombes1, Dr Shan Bergin2, Professor Terry Haines3, Dr Cylie Williams1,3

1Peninsula Health, Frankston, Australia, 2Monash Health, Clayton South, Australia, 3Monash University, Frankston, Australia

Abstract:

Aim:
Low Frequency Ultrasonic Debridement (LFUD) is a technology using sound waves conducted through saline to debride wounds.  Whilst this treatment reduces wound healing times, the airborne mist generated is potentially problematic.  This research aims to establish the degree and extent to which there is microbial spread during and following the use of LFUD with and without the suction attachment.

Method:
Testing was performed on ward and in the outpatient setting.  Data was collected before, during and after twenty-four treatments with twelve treatments on ward and twelve treatments in the outpatient setting.  Six of the ‘on ward’ treatments and six of the ‘outpatient room’ treatments were performed without the suction attachment and six with suction.

Results:
There was a higher microbial count during treatment (p<0.001). A higher microbial count was associated with lower amplitude (p=0.028), lower flow (p=0.010), no suction (p>0.001) and larger wounds, (p=0.002).  There was no correlation between handpiece type, wound infection and treatment time or treatment environment.  Even with suction, there was heavy growth noted following some treatments of from microbes such as Staphylococcus aureus, Streptococcus agalactiae and Corynebacterium resistens.

Conclusion:
The results should not dissuade clinicians from using LFUD but it is vital that treatment be performed under the correct conditions to mitigate microorganism aerosolisation.  This research has assisted in developing guidelines for the use.

Biography:

Lucia completed a Bachelor of Podiatry at La Trobe University in 2008.  On completion of the degree she was the recipient of an Award for Excellence in clinical practice by the Australian Podiatry Association (Vic) and attained inclusion on the La Trobe University Dean’s Honours List.

She has worked at three of Victoria’s largest health networks over the past eight years and is well experienced in managing the high-risk foot population in the Melbourne Metropolitan area.

Lucia is currently undertaking her PhD investigating the use of low frequency ultrasonic debridement compared with non-surgical sharps debridement in the management of diabetes-related foot ulcers.

Diabetes education retention: A Systematic Review

Ms Julia Yuncken1

1Monash University, Caulfield North, Australia

Abstract:

Methods:
Databases Medline, CINHAL, Science Direct, EMBASE, Web of Science and Cochrane were searched for articles investigating behaviour change, knowledge, or participant satisfaction in connection with diabetes education. The two reviewers screened articles independently against inclusion criteria and educational methods, and outcomes and timeframes were extracted from qualifying papers. Data were synthesized against Kirkpatrick’s Hierarchy of Learning.

Results:
In total, 849 studies were found using primary search criteria, of those all but 39 studies were disqualified using inclusion criteria. Method of education included verbal, written and visual modes, delivered by both multi-disciplinary teams and single health care practitioners. Topics of education included general diabetes complications, foot complications, diet, physical activity and self-foot care. Outcomes reviewed included diabetes knowledge, foot care knowledge and HbA1C levels post education.

Significance of the findings to Allied Health::
Diabetes education is ubiquitous in diabetes treatment however it remains unclear if patients retain the educational information provided or if the information retained causes behavioural change which in turn results in a decrease to complications.

Biography:

Julia has enjoyed working in both the public and private setting since 2006, predominately with the high risk foot. This has been in conjunction with further study into wound care and diabetes education.

The safety and feasibility of aquatic physiotherapy on falls and balance in people with Parkinson’s Disease: A pilot randomised control trial

Miss Aan Terrens1,2, Dr Sze-Ee Soh2, A/Prof Prue Morgan2

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

Abstract:

Aim:
The primary aim was to determine feasibility of aquatic physiotherapy for clients with Parkinson’s Disease (PD). The secondary aim was to determine whether novel aquatic was more effective than traditional aquatic or land based physiotherapy in improving balance and reducing falls.

Method:
All interventions ran for 60 minutes over 12 weeks. Feasibility outcomes were safety, adherence and attrition. Secondary outcome measures included the Unified Parkinson’s Disease Rating Scale motor subsection (UPDRS-III), Berg Balance Scale (BBS), MiniBESTest and modified Falls Efficacy Scale (mFES).

Results:
Thirty participants with PD were recruited into the single blind pilot randomised control trial. There were no falls during intervention sessions, however ten participants (33%) reported falls during the study period. No other adverse consequences were reported. No significant differences were found in UPDRS-III or BBS scores post intervention for all groups, but the novel aquatic group improved significantly in the MiniBESTest (p=0.011). The traditional aquatic group demonstrated significant improvements in mFES scores post-intervention (p=0.000) and also reported significantly greater confidence than other groups for mFES, (p=0.000).

Significance of the findings to allied health:
Despite people with PD being a vulnerable population, aquatic physiotherapy may be a feasible treatment option. We observed some promising results for balance and fear of falling following aquatic physiotherapy, but due to the small sample size an appropriately powered study is required to increase confidence in these results.

Biography:

Fleur Terrens is the coordinator of the Movement Disorder Program within Peninsula Health. She is also a senior physiotherapist within the Movement Disorder Program at Eastern Health. She has an interest in neurological rehabilitation, in particular Parkinson’s Disease, and has worked in this area since graduating from Monash University in 2009. Currently she is undertaking her PhD through Monash University, where she is examining different aquatic physiotherapy techniques and their influence on postural control and balance in people with Parkinson’s Disease.

A way-finding video to navigate the Barwon Health/Deakin collaborative Health Education Research Building (HERB), to decrease anxiety amongst consumers

Miss Claudia Schlosser1, Mrs  Nikki  Lyons1

1Barwon Health, Horsham , Australia

Abstract:

Aim:
As part of a 4th Year placement project, to create a way-finding video to be used by Barwon Health’s Student Coordinators as part of the orientation information which is provided to consumers (students, guest lecturers, actors who play simulated patients) to help relieve anxiety when accessing HERB.

Method:
A literature review and review of a past way-finding video was completed to highlight the need for further way-finding across Barwon Health sites. A short way-video for the HERB was created in collaboration with Marketing using universal design for learning techniques.  The video was evaluated using a survey, measuring stakeholders’ level of anxiety before and after watching the video.

Results:
Thirty-two participants contributed to the survey answering questions related to anxiety both before and after watching the way-finding video. 93% reported they would watch the video prior to attending the HERB and 83% reported that they would have no anxiety if they were required to access a specific room at HERB after viewing the video, compared with 68.75% who indicated anxiety before watching the video.

Conclusion:
The video provides an accessible and efficient way-finding tool for consumers accessing the HERB. Way-finding to assist navigation decreases anxiety and will therefore contribute to the consumers’ positive experience of the health service. The resource will be a valuable addition to Barwon Health’s orientation tools.

Biography:

My name is Claudia Schlosser, I recently graduated my Occupational Therapy degree from Deakin University. I completed the way-finding project for my final year placement. This project really spoke to me as it allowed me to explore the environment and incorporate my occupational skills into the finished product, while including universal design for learning.

I hope to work within the community setting in the future and look forward to growing my career as an Occupational Therapist.

How does delirium affect allied health therapy after stroke?

Mr Brendan Cutts1,2, A/Prof Anna Wong Shee3,4, A/Prof Chris Barr2

1Barwon Health, Geelong, Australia, 2Flinders University, Adelaide, Australia, 3Deakin University, Ballarat, Australia, 4Ballarat Health Services, Ballarat, Australia

Abstract:

Aim:
Delirium is a common complication post-stroke and increases risk of mortality and admission to residential aged care. This study proposed to evaluate the effect of delirium on patient participation in allied health therapy and determine whether time or length of session improved engagement.

Method:
Observational study conducted in a regional Victorian health service. Patients in the first four weeks post-stroke were assessed for delirium using the Confusion Assessment Method, and physiotherapists, occupational therapists and speech pathologists completed a survey after each therapy session scoring the effect of symptoms of delirium on the therapy session.

Results:
Patients who developed delirium were older (79.3 years, SD 9.9 vs 69.0 years, SD 13.6, p = .024) and had more severe strokes (National Institutes of Health Stroke Scale 12.2, SD 7.8 vs 6.9, SD 4.6, p = .011) compared with patients who didn’t develop delirium. Therapy sessions while a patient was in delirium were shorter and proportion of therapy during therapist contact time was lower. Therapist-rated scores of participation were lower, and both inattention and altered conscious state affected sessions more in the delirious group. Time of day did not alter any outcome.

Significance:
Post-stroke delirium has a significant effect on engagement in allied health therapy. Sessions less than 30 minutes in length reduce the effects of inattention for patients in delirium. There is a need to identify strategies to mitigate the impact of delirium and ensure patients are given optimal therapy.

Biography:

Brendan Cutts is a physiotherapist with an interest in how allied health teams manage acute stroke survivors and is currently working at Barwon Health.

This research was completed as part of Brendan attaining the Master of Clinical Rehabilitation (Neurological Physiotherapy) from Flinders University.

Quality of Life Experiences of Parents of Children with Autism in Scotland

Mrs Deepa Kuriachan1

1Ballarat Health Services, Smythescreek, Australia

Abstract:

Aim:
Based in a Scottish context, the purpose of this study was to enter the world of the parents living with a child with autism, wondering what quality of life means for them and whether their engagement with social work services made any difference to their quality of lives.

Method:
The study adopted a grounded theory methodology informed by a symbolic interactionist theoretical framework. Data were gathered from three study local authorities in Scotland. The participants include an almost equal number of male and female parents (total parent participants = 23); and social workers and operational managers from three study local authorities (total number of social workers =12, total number of operational managers =3).  This study utilized focus groups and semi structured interviews to gather data.

Results:
Using the constant comparison method, three main categories emerged; namely ‘new normal’, ‘on-going burden’ and ‘limited help’ which contextualized the quality of life experiences of parent participants in the study. ‘Oppression’ emerged as the overarching theory.

Significance of the findings to allied health:
The findings offer social workers an ‘autism lens’ to better understand the lived experience of male and female parents of the child with autism. It also support a case for more training, better coordination of services and establishment of an internal register for those with an autism diagnosis for closer monitoring and streamlining of resources.  A few prospective research questions were identified for future allied health research.

Biography:

I was born in India. I have spend approximately 8 years living and working in Scotland prior to relocating to Australia in 2014. I began my social work career  as a support worker in a residential unit in Scotland for young people with complex disabilities.  I completed my Masters in Social Work  from India in 2005.   I have approximately 13 years of post qualifying experience as a social worker. Over the years, I have been fortunate to gain a diverse international work experience, having worked in the United Kingdom , Australia  and India, both in the statutory and non statutory sectors (not for profit or community service organisations). Over the years, I have worked with a heterogeneous client group including children and adults presenting with a a wide range of psycho social issues i.e. learning disability, mental health, exposure to family violence, experiencing abuse and trauma,  substance misuse, juvenile offending, poor educational outcomes and so on.

I recently (July 2018) graduated with a  PhD in Social Work (part time study which I commenced in Scotland and the last leg of the study was completed as a distant/online student) from University of Edinburgh, Scotland.

Identifying methods for quantifying lower limb changes in children with idiopathic toe walking: A systematic review

Mr Antoni Caserta1,2, Dr  Cylie  Williams2,3, A/Prof Prue Morgan2

1Monash Health, Cranbourne, Australia, 2Monash University , Frankston, Australia, 3Peninsula Health, Frankston, Australia

Abstract:

Background:
Idiopathic toe walking (ITW) is a diagnosis of exclusion for children walking on their toes with no medical cause. This systematic review aimed to identify and evaluate the clinical utility, validity and reliability of the outcome measures and tools used to quantify lower limb changes within studies that included children with ITW.

Methods:
The following databases were searched from inception until March 2018: Ovid MEDLINE, EBESCO, Embase, CINAHL Plus, PubMed. Inclusion criteria were studies including children with ITW diagnosis, reporting use of  measurement tools or methods describing lower limb characteristics, published in peer-reviewed journals, and in English. The relevant psychometric properties of measurement tools were extracted, and assessed for reported reliability and validity. Included articles were assessed for risk of bias using McMaster quality assessment tool. Results were descriptively synthesised and logistic regression used to determine associations between common assessments.

Results:
From 3164 retrieved studies, 37 full texts were screened and 27 full texts included. Interventional studies were more likely to report range of motion and gait analysis outcomes, than observational studies. Alvarez classification tool in conjunction with Vicon motion system appeared the contemporary choice for describing ITW gait. There was no significant association between the use of range of motion and gait analysis outcomes and any other outcome tool or assessment in all studies (p>0.05).

Significance:
This review highlighted that a consensus statement should be considered to guide clinicians and researchers in the choice of the most important outcome measures for this population.

Biography:

Antoni works both as a private podiatrist and within a public health multidisciplinary paediatric team. His public health role focuses on assessment and treatment of simple and complex gait disorders.

Antoni is the Chair of the Paediatric Special Interest Group for the Australian Podiatry Association (VIC). He has presented numerous times at Australian Podiatry Association Victorian State Conferences, Special Interest Groups. He was the 2014 winner of the Jennifer O’Meara Memorial Award for outstanding achievement for a young podiatrists. He is currently a PhD candidate at Monash University and undertaking research to better understand the lower limb profile of children with an idiopathic toe-walking gait. He is also leading a Cochrane review on the effectiveness of different treatments for normalising idiopathic toe walking gait. Antoni collaborates with Children’s Podiatry, a education and mentoring platform for paediatrics in podiatry.

Antoni enjoys mentoring undergraduate students during their paediatric rotation paediatrics and this has led him to work with Latrobe University to create learning packages specifically relating to assessment.

Evaluating the uptake of the ‘My Gym’ program and exploring perceptions of physiotherapy and exercise in a neurological rehabilitation population: a mixed methods study

Ms Andrea Grima1,2, Ms Julie Louie1, Mr Chris Barr2, Ms Maayken van den Berg2

1Melbourne Health, Parkville, Australia, 2Flinders University, Tonsley, Australia

Abstract:

Aim:

  1. To evaluate if patients of mixed neurological conditions in inpatient rehabilitation, choose to access a physiotherapy gym space outside of scheduled therapy time independently (‘My Gym’).
  2. To examine the experiences of exercise and physiotherapy in inpatient rehabilitation.

Method:
Patients admitted to subacute rehabilitation with a neurological condition will be assessed by treating therapists for their eligibility to participate in the ‘My Gym’ program. Eligible patients, with or without carer assistance, will be permitted independent access to the physiotherapy gym space as desired outside of scheduled therapy time between 08:30-16:00 to follow an individualised therapist-prescribed exercise program. Semi-structured interviews will be performed to explore the experiences of exercise for neurological inpatients in rehabilitation.

Results:
Data collection is ongoing however preliminary results are promising with 3 patients currently enrolled in the My Gym program. Results presented will include demographic data, ‘My Gym’ use, safety considerations and qualitative analyses from interviews.

Significance of the findings to allied health:
Published research has demonstrated that patients have inadequate opportunities for independent practice within the hospital environment which has traditionally been clinician led and dependent. Existing cultural environments in rehabilitation limit patient independence and practice opportunities due to processes that are risk averse and time efficient.  This study describes a minimal cost method which may provide opportunities for patients with diverse neurological conditions to increase practice time, autonomy and independent self-management. This model challenges the concept of clinician led rehabilitation by exploring patient driven practice.

Biography:

Ms Andrea Grima is a Grade 2 physiotherapist who has worked at the Royal Melbourne Hospital as a physiotherapist for 7 years. She has experience in subacute and community neurological rehabilitation with both new and long-term neurological presentation conditions. She is currently completing her final year of a Masters of Clinical Rehabilitation (Neurological Physiotherapy) through Flinders University in South Australia.

Factors predictive of postoperative clinical outcomes in gastrointestinal surgical patients – A prospective observational study

Miss Karthika Narendra1, Dr Nicole Kiss1, Dr Claire Margerison1, Ms Belinda Johnston2, Ms Brooke Chapman2

1Deakin University, Burwood, Australia, 2Austin Health , Heidelberg, Australia

Abstract:

Aim:
Malnutrition is a highly prevalent condition in gastrointestinal (GI) surgical patients and has been linked to adverse clinical outcomes. The aim of this study is to determine the association between preoperative nutritional status and postoperative nutritional management with clinical outcomes.

Method:
A prospective observational study in GI surgical patients with a minimum three-day postoperative length of stay (PLOS). Data on patient demographics, nutritional status, postoperative nutritional management and clinical outcomes were collected. Four markers of nutritional status were assessed: preoperative weight loss, nutrition risk, nutritional status and handgrip strength (HGS). Multiple linear regression and multivariate logistic regression were used to test for association with PLOS and complications.

Results:
115 patients (55% female, mean age 60.8 ±16.2 years) were included. The median PLOS was 8.0 days with 37% of participants developing at least one complication postoperatively. All four markers of nutritional status independently predicted longer PLOS (all p<0.05). The average time taken to commence feeding (solids, enteral or parenteral nutrition) was 3.3 ± 2.2 days. The mean number of nil-by mouth (NBM) days was 0.7 ± 1.2, though ranged from 0-7 days. No significant association was found between time to commence feeding or number of NBM days, and clinical outcomes.

Significance of the findings to allied health:
All four nutritional markers assessed in this study predicted longer PLOS in patients undergoing GI surgery, facilitating simple identification of patients at high priority for dietetic intervention. This study highlights that delayed and varied feeding practices remain and may exacerbate postoperative nutritional decline.

Biography:

Karthika is a dietetics graduate who completed her honours year at Deakin University in 2018. Following the completion of her studies, she hopes to embark on her career as a clinical dietitian.

Qualitative analysis of a ward-based risk assessment manual handling program

Ms Helen Kugler1,2, Dr Susan Slade2,3, Professor Nicholas Taylor2,4, Dr Natasha Brusco1,2

1Centre for Allied Health Research and Education, Cabrini, Malvern, Australia, 2La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, La Trobe University, Bundoora, Australia, 3Department of Physiotherapy, Monash University, Melbourne, Australia, 4Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia

Abstract:

Aim:
To explore the experiences of ward-based staff who had completed manual handling training and their perceptions of the program.

Methods:
Staff (n=72) across two pilot wards participated in a full-day manual handling education program led by allied health as a part of local mandatory training. Training included two components, Manual Handling Fundamentals and Risk Assessment for Moving Patients (RAMP). The experiences of participant were explored in focus groups 4 months after training. Participants were recruited through purposive sampling and qualitative methods were used to conduct thematic analysis of the data.

Results:
Ten staff participated in the two focus groups. Participants reported they had implemented some of the skills taught in the manual handling training. Three key themes emerged from the data: (1) Manual handling is in everything we do; (2) Individual empowerment and confidence were perceived to result from the RAMP training program; (3) There are factors that influenced the successful implementation of the training program. Visual prompts, refresher training and consistent training of staff across departments were seen as facilitators to implementation while staffing levels, the hospital environmental and provision of equipment were identified as barriers.

Significance of the findings to allied health:
Manual handling is central to the work of ward-based staff. Allied health manual handling training helped participants to feel empowered in helping patients move. However, there are factors to take into account if manual handling training is to be implemented throughout the health service.

Biography:

Helen is a senior physiotherapist working at Cabrini rehabilitation who is currently undertaking further study at La Trobe University. Helen’s interest is neurological physiotherapy and she is passionate about the key role that ward-based staff play in a patient’s rehabilitation from the onset of their admission.