K Butler-Henderson

Intraoperative Assessment of Margins in Breast Conserving Therapy: A Systematic review

Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20-30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.

The development of a classification system for maternity models of care

Background: A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. Objective: As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. Method: The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. Results: The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. Conclusion: The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.

18F-fluorodeoxyglucose positron emission tomography imaging in brain tumours: the Western Australia positron emission tomography/cyclotron service experience.

18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) scans in the first 49 patients referred with either possible brain tumour or brain tumour recurrence were reviewed. FDG‐PET imaging was reported with reference to anatomical imaging. Based on the report the FDG study was classified as either positive or negative for the presence of tumour. Thirty‐eight cases were included in the analysis, 21 having pathological data and 17 with diagnostic clinical follow up. Eleven were excluded, as they had inadequate follow‐up data. Of the 21 cases with pathology, 18 were shown to have tumour. In this group there were five false‐negative scans and two false‐positive PET scans. Seventeen cases were assessed by clinical follow up, nine were considered to have been tumour. There were two false negatives with one false positive. The overall sensitivity, specificity and positive and negative predictive values were 74, 73, 87 and 53% respectively. This is similar to figures previously quoted in published work. Despite relatively limited numbers, the utility of FDG PET imaging in our hands is similar to published reports. With a positive predictive value of 87%, a positive FDG study indicates a high likelihood that there is brain tumour present. A negative study does not exclude the presence of tumour.

Ehealth education for future clinical health professionals: an integrated analysis of Australian expectations and challenges

Australia is experiencing challenges in its health workforce profile to embrace reforms based on ehealth. Although there is much literature on the importance of ehealth education, our study shows that ehealth education for entry-level clinicians is not meeting the demands for a technologically savvy clinical health workforce. This poster reports on a nationally funded project Support for this project has been provided by the Australian Government Office for Learning and Teaching. The views in this project do not necessarily reflect the views of the Australian Government Office for Learning and Teaching. which examines ehealth education for the future clinical workforce in Australia. It discusses 3 key components: the current state of teaching, learning and assessment of ehealth education in health profession degrees in Australia; inclusion of ehealth competencies in accreditation guidelines of health profession degrees and ehealth skills and competencies in job descriptions for the future Australian clinical workforce. It is based on a systems view methodology that these three components are interrelated and influence the development of an ehealth capable health workforce. Results highlight that further research and development across the health workforce is needed before the education of future clinical health professionals can keep pace with the changes that ehealth is bringing to the Australian healthcare system.

Health Informatics and E-health Curriculum for Clinical Health Profession Degrees.

The project reported in this paper models a new approach to making health informatics and e-health education widely available to students in a range of Australian clinical health profession degrees. The development of a Masters level subject uses design-based research to apply educational quality assurance practices which are consistent with university qualification frameworks, and with clinical health profession education standards; at the same time it gives recognition to health informatics as a specialised profession in its own right. The paper presents details of (a) design with reference to the Australian Qualifications Framework and CHIA competencies, (b) peer review within a three-university teaching team, (c) external review by experts from the professions, (d) cross-institutional interprofessional online learning, (e) methods for evaluating student learning experiences and outcomes, and (f) mechanisms for making the curriculum openly available to interested parties. The project has sought and found demand among clinical health professionals for formal health informatics and e-health education that is designed for them. It has helped the educators and organisations involved to understand the need for nuanced and complementary health informatics educational offerings in Australian universities. These insights may aid in further efforts to address substantive and systemic challenges that clinical informatics faces in Australia.

Medical System Choice: Information That Affects the Selection of Healthcare Provider in Australia?

Many complementary and alternative medical practices (CAM) are readily assessable in Australia alongside Allopathic practitioners. Although CAM practices are prevalent, little is known about how patients seek and use information when deciding which system to consult. We report some preliminary findings of a longitudinal study, designed to solicit factors that influence the Australian public when selecting from diverse medical systems. Fifty-four general public participants, willing to provide their confidential and anonymous opinion were included. The magnitudes of importance, critical in influencing factors, were screened. Results indicated a medical system was selected for its effectiveness, safety, credentials and care (p<0.001). Consultation time, convenience, cost, empowerment and rapport were less important factors (p<0.001) influencing selection of a medical system. The level of choices by participants [χ2 (1, N=54) = 53.445, p<0.001] follow similar trends found for those in conventional medical systems. This contrasts with findings in other locations, where cost and time were major contributing factors when selecting medical systems.

A validation study of the Australian Maternity Care Classification System

BACKGROUND The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the models name. AIM To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. METHOD All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemars test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorffs alpha coefficient for a subset of characteristics. RESULTS The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorffs alpha coefficient of 0.4-0.8. CONCLUSION The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.

Health Information Management: Changing with Time

Objective: With the evolution of patient medical records from paper to electronic media and the changes to the way data is sourced, used, and managed, there is an opportunity for health information management (HIM) to learn and facilitate the increasing expanse of available patient data. Methods: This paper discusses the emerging trends and lessons learnt in relation with the following four areas: 1) data and information governance, 2) terminology standards certification, 3) International Classification of Diseases, 11th edition (ICD-11), and 4) data analytics and HIM. Results: The governance of patient data and information increasingly requires the HIM profession to incorporate the roles of data scientists and data stewards into its portfolio to ensure data analytics and digital transformation is appropriately managed. Not only are terminology standards required to facilitate the structure and primary use of this data, developments in Canada in relation with the standards, role descriptions, framework and curricula in the form of certification provide one prime example of ensuring the quality of the secondary use of patient data. The impending introduction of ICD-11 brings with it the need for the HIM profession to manage the transition between ICD versions and country modifications incorporating changes to standards and tools, and the availability and type of patient data available for secondary use. Conclusions: In summary, the health information management profession now requires abilities in leadership, data, and informatics in addition to health information science and coding skills to facilitate the expanding secondary use of patient data.

The development of a national census of the health information workforce: Expert panel recommendations

BACKGROUND There is a need to develop a national census of the health information workforce to inform the planning and forecasting of the workforce and inform education and training needs. Yet, this raises a number of issues that need to be incorporated into the planning stage. This paper discusses the issues and recommendations for the development of a national health information workforce census and an Expert Panels recommendations for how we should proceed. METHODS Nominated participants from Australia and New Zealand participated as Expert Panel members in focus groups to identify and discuss the issues. Recommendations were identified during the focus groups and documented for participant verification. These were then grouped into themes. RESULTS AND DISCUSSION The themes of the issues and considerations identified in the focus groups were: Aim of the census; Census advertisement; Census delivery; Participants; Longitudinal study; Types of data elements; Data development and standards; Data ownership, access and governance; Global census; Dissemination of results.

A visual grid to digitally record an Ayurvedic Prakriti assessment : a first step toward integrated electronic health records

Graphical abstract