Kathryn E Williams

Functional Assessment to Predict Capacity for Work in a Population of School‐leavers with Disabilities

This study reports on an assessment system for school‐leavers with disabilities to identify their capacity for work and the type of transition‐to‐work programme best suited to each person. Participants were 1,556 high school students in four cohorts who left school between 1999 and 2002. Each school‐leaver was assessed by rehabilitation counsellors for functional ability and capacity for work. In a supplementary study, the 2002 cohort was assessed by special transition teachers using a short screening tool. The results demonstrate that there is a predictable hierarchy of functional acquisition among school‐leavers with disabilities and that the single best predictor of future capacity for work and need for transition‐to‐work programmes among this group of young people is the capacity to manage activities of daily living. The results also demonstrate that a short screen used by teachers, together with a behavioural assessment, is sufficient to stream school‐leavers with a disability into a range of transition‐to‐work programmes.

Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study

QUESTION Can primary contact physiotherapists reduce waiting and treatment times and facilitate faster discharge in Australian emergency departments? DESIGN Data on patients treated by primary contact physiotherapists were collected prospectively and compared with historical and concurrent cohorts of patients treated by other clinicians, using diagnosis and urgency. PARTICIPANTS Twenty-nine primary contact physiotherapists, working at 10 sites, treated a total of 14 452 patients with musculoskeletal conditions in triage categories 3, 4 and 5. OUTCOME MEASURES Data were analysed for two time periods: baseline (historical control) and implementation (12 to 15 months). A concurrent control cohort within the implementation period was selected using diagnosis (ICD-10-AM) and urgency of treatment (triage category). Waiting time, treatment time, and time to discharge from the emergency department were compared across periods and between cohorts. RESULTS Significant differences were found in waiting and treatment times. On average, patients treated by primary contact physiotherapists waited 31minutes less than those treated by other practitioners and had an average treatment time of 108minutes compared with 148minutes. Overall, 93% of patients treated by primary contact physiotherapists and 75% treated by other practitioners were discharged from the emergency department within a 4-hour time period. To address concerns that these results could be due to other differences between cohorts, multiple regression models were used and the results were still significantly in favour of the primary contact physiotherapists. CONCLUSION A primary contact physiotherapist model in hospital emergency departments can reduce waiting and treatment times for patients with musculoskeletal presentations, resulting in better performance in achieving discharge within the 4-hour national target. [Bird S, Thompson C, Williams KE (2016) Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study.Journal of Physiotherapy62: 209-214].

Relationships between valued action and well-being across the transition from high school to early adulthood

Well-being promotes positive outcomes, which may include the ability to live according to one’s values, and values-congruent living may be a source of well-being. The current longitudinal study tested bi-directional relationships between subjective well-being and the extent to which values are seen as personally important, pressured by others, activated and successfully enacted. Participants were 468 young people (51.9% female) who responded to questionnaires in the final year of high school (Grade 12) and again approximately one year later. Regression analyses showed that life satisfaction predicted increasing value importance, activity and successful enactment. Valued action did not predict later well-being, when baseline levels of well-being were controlled. Positive changes in well-being over time were correlated with increased value importance, decreased pressure and greater success in enacting values. The findings build on a small body of research exploring the reciprocal interaction of well-being and valued action, and have implications for interventions.

Assessment of need and capacity to benefit for people with a disability requiring aids, appliances and equipment

AIM To develop an equitable system for allocating equipment, aids and appliances to adults with disabilities based on assessment of need and capacity to benefit for use by occupational therapists, who are the main professional group involved in assessing and prioritising applications. METHODS An assessment tool was developed, pilot tested and field tested at four sites in New South Wales. Assessments were undertaken in parallel with existing systems. Feedback on use of the tool was obtained from those conducting the assessments and those making decisions to fund applications for equipment based on the assessments. RESULTS One hundred and six assessments were undertaken. Applications for bed, sleeping and seating equipment and equipment to assist with mobility, toileting, showering and transfers accounted for 94.2% of equipment requested. Provision of equipment was expected to have greatest impact on the physical effort and safety of carers and the safety and quality of life of applicants. Regression analysis identified assessment items that explain variation between applicants and that can avoid unnecessary data collection. CONCLUSIONS The assessment tool provides a standardised method for assessing requests for equipment based on the twin concepts of need and capacity to benefit. The results support the use of both concepts as the foundation of the assessment process. Further development is required, particularly to move to the next stage of using the assessment tool as the basis for prioritising applications for equipment.

Using a logic model to evaluate the Kids Together early education inclusion program for children with disabilities and additional needs

Despite clear evidence that learning and social opportunities for children with disabilities and special needs are more effective in inclusive not segregated settings, there are few known effective inclusion programs available to children with disabilities, their families or teachers in the early years within Australia. The Kids Together program was developed to support children with disabilities/additional needs aged 0-8 years attending mainstream early learning environments. Using a key worker transdisciplinary team model, the program aligns with the individualised package approach of the National Disability Insurance Scheme (NDIS). AIM This paper reports on the use of a logic model to underpin the process, outcomes and impact evaluation of the Kids Together program. METHODS The research team worked across 15 Early Childhood Education and Care (ECEC) centres and in home and community settings. A realist evaluation using mixed methods was undertaken to understand what works, for whom and in what contexts. The development of a logic model provided a structured way to explore how the program was implemented and achieved short, medium and long term outcomes within a complex community setting. DISCUSSION AND CONCLUSION Kids Together was shown to be a highly effective and innovative model for supporting the inclusion of children with disabilities/additional needs in a range of environments central for early childhood learning and development. The use of a logic model provided a visual representation of the Kids Together model and its component parts and enabled a theory of change to be inferred, showing how a coordinated and collaborative approached can work across multiple environments.

A Delphi study to develop indicators of cancer patient experience for quality improvement

PurposeThe purpose of this study was to develop prioritised indicators to measure cancer patient experience and thus guide quality improvement in the delivery of patient care.MethodsA Delphi study, consisting of two surveys and three workshops, was employed to gather expert opinions on the most important indicators to measure. Survey participants were 149 health professionals, academics/technical experts and consumers. The first survey was based on a literature review which identified 105 elements of care within 14 domains of patient experience. These were rated on a 7-point Likert scale, with ‘1’ representing high importance. Elements with mean ratings between 1.0 and 2.0 were retained for the second survey. The 43 least-important elements were omitted, four elements were revised and nine new elements added. Consensus was defined as at least 70% of participants rating an element ‘1’ or ‘2’. Multivariate and cluster analyses were used to develop 20 draft indicators, which were presented to 51 experts to refine and prioritise at the three workshops.ResultsAll elements in the second survey were rated ‘1’ or ‘2’ by 81% of participants. Workshop participants agreed strongly on the four most important indicators: coordinated care, access to care, timeliness of the first treatment, and communication. Other indicators considered highly important were follow-up care for survivors; timeliness of diagnosis; information relating to side effects, pain and medication; comprehensibility of information provided to patients; and needs assessment.ConclusionsExperts identified priorities with a high level of consensus, providing a rigorous foundation for developing prioritised indicators of quality in cancer patient experience.

Assessing the effectiveness of telephoning positive FOBT patients prior to their colonoscopy on quality of the bowel preparation: a randomized controlled trial

Assessing the effectiveness of telephoning positive FOBT patients prior to their colonoscopy on quality of the bowel preparation: a randomized controlled trial N AL-HAJJIRI,* K WILLIAMS,* YH CHIENG,* A GRILLAS,* I VALIOZIS,* C ROGGE,* S ABEY,* D SWARTZ,* J MCDONALD,* O SHARAIHA,* K HOLDING,* M BLANCHARD, R GORDON, T LEE* *Department of Gastroenterology, Wollongong Hospital, and Australian Health Service Research Institute, University of Wollongong, Wollongong, Australia

Shedding the light on men: the Wollongong Men's Shed Project

IntroductionThis paper uses data from My Health @ Age (2008-2010), an EU, Northern Periphery funded project. Its aim is to offer the rapidly ageing population in the northern periphery regions of E ...Age and ageing related humour expressed in birthday cards has been suggested to support negative attitudes towards aged people. Little attention has been paid to how retired people themselves exper ...It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is ...The HPA-1 polymorphism of alphaIIbbeta3 arises from a Leu to Pro exchange at residue 33 of the beta3 subunit resulting in HPA-1a (Leu33) or HPA-1b (Pro33). We have documented that patients with coronary artery disease who are carriers of HPA-1b experience their myocardial infarction 5.2 years earlier than HPA-1a/1a patients (JTH 2005; 3: 1522). Based on these observations, it has been postulated that HPA-1b is a prothrombotic variant of alphaIIbbeta3. To explore the molecular nature of this phenotype, we have now generated a model overexpressing fluorescent proteins fused with alphaIIbbeta3 in transfected HEK293 cells. The yellow (YFP) and the cyan fluorescent protein (CFP) were cloned to the C-termini of the beta3 and alphaIIb subunits prior to transfection of HEK293 cells, subsequently expressing the fusion proteins of both HPA-1 isoforms. Using flow cytometry, Western blotting and specific antibodies directed against alphaIIb or beta3, we identified 12 HPA-1a and 11 HPA-1b positive clones expressing equal amounts of fluorescent fusion proteins, i.e. a 140 kD alphaIIb-CFP and a 113 kD beta3-YFP. Functional integrity of both integrin variants and proper membrane insertion were documented by intact activation through G protein-coupled receptors with organic acid, PMA-induced activation of protein kinase C and by specific binding of Alexa647 fibrinogen to alphaIIbbeta3. In the presencence of pertussis toxin or abciximab, activation or ligand binding of alphaIIbbeta3 were completely (> 98%) inhibited in both isoforms. Analysis of Src, a tyrosine kinase associated with alphaIIbbeta3, revealed that activation of the phosphotyrosine motif at residue 418 was higher in adherent HPA-1b than HPA-1a cells (P < 0.01). Upon activation of alphaIIbbeta3, analysis by FRET showed equal kinetics with signal disappearance of 40 5% in both HPA-1 variants. We therefore conclude that the postulated prothrombotic phenotype of HPA-1b (Pro33) is related to increased outside-in signaling rather than to allosteric changes of the C-terminal cytoplasmic tails of alphaIIbbeta3. Disclosure of interest: none declared.