List of Titles

Quality of stroke care within a hospital: Effects of a mobile stroke service

- van der Walt, Anneke, Gilligan, Amanda, Cadilhac, Dominique, Brodtmann, Amy, Pearce, Dora, Donnan, Geoffrey

Authors: van der Walt, Anneke , Gilligan, Amanda , Cadilhac, Dominique , Brodtmann, Amy , Pearce, Dora , Donnan, Geoffrey
Date: 2005
Type: Text , Journal article
Relation: Medical Journal of Australia Vol. 182, no. 4 (2005), p. 160-163
Full Text: false
Reviewed:
Description: Objective: An Australian stroke services study (SCOPES) has developed a framework to compare different forms of acute stroke services, the gold standard being localised stroke units. We aimed to use this framework to assess changes in the quality of stroke care over time as a sequential audit process. Design and setting: A retrospective medical record audit comparing 100 sequential stroke admissions (July 2002 to June 2003) two years after institution of a mobile stroke service (MSS) with 100 historical controls (September 1998 to October 1999) at a 260-bed hospital in Melbourne. The MSS results were also compared with stroke units in SCOPES. Main outcome measures: Adherence to quality indicators and standard measures of outcome (complications, length of stay and discharge disability) after implementing the MSS. Results: Significant improvements were seen in prophylaxis for deep-vein thrombosis, incontinence management, premorbid function documentation, frequent neurological observations and early occupational therapy. The MSS demonstrated fewer severe complications (9% versus 24%; P=0.004), reduced median length of stay (discharged patients: 12.0 days versus 18.5 days; P=0.003) and more patients were independent at discharge (32% versus 9%; P<0.001). Comparison with SCOPES stroke units showed our MSS could improve in incontinence management and appropriate use of antiplatelet therapy. Conclusion: Institution of the MSS was associated with improvements in the quality of stroke care. This study demonstrates application of an audit procedure for quality improvement in hospital stroke management and the potential to improve stroke services in smaller centres.

Predictors of psychosocial distress 12 months after diagnosis with early and advanced prostate cancer

- Couper, Jeremy, Love, Anthony, Duchesne, Gillian, Bloch, Sidney, MacVean, Michelle, Dunai, Judy, Scealy, Marita, Costello, Anthony, Kissane, David

Authors: Couper, Jeremy , Love, Anthony , Duchesne, Gillian , Bloch, Sidney , MacVean, Michelle , Dunai, Judy , Scealy, Marita , Costello, Anthony , Kissane, David
Date: 2010
Type: Text , Journal article
Relation: Medical Journal of Australia Vol. 193, no. 5 (2010), p. S58-S61
Full Text: false
Reviewed:
Description: Objective: To assess psychosocial distress in patients with early (localised) and advanced (metastatic) prostate cancer (PCA) at diagnosis (Time 1) and 12 months later (Time 2), and identify psychosocial factors predictive of later distress. Design, participants and setting: Observational, prospective study of 367 men with early (211) or advanced (156) PCA recruited as consecutive attendees at clinics at seven public hospitals and practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Both groups completed questionnaires at Time 1 and Time 2. Main outcome measures: Health-related quality of life as assessed by the Short Form 36-item Health Survey; psychological distress, including depression and anxiety as assessed by the Brief Symptom Inventory; and coping patterns as assessed by the Mini-Mental Adjustment to Cancer scale. Results: Over the 12 months, both the early and advanced RCA group showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group. Mental health, social functioning and role-emotional functioning also deteriorated in the advanced group. Predictors of depression at Time 2 for the early PCA group were depression, vitality and a fatalistic coping pattern at Time 1; anxiety at Time 2 was predicted by anxiety and vitality at Time 1. In the advanced PCA group, depression at Time 2 was predicted by depression and mental health at Time 1; anxiety at Time 2 was predicted by anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1. Conclusions: Men with early PCA experience decreasing vitality and increasing psychological distress over the 12 months following diagnosis; this trend is accelerated after diagnosis with advanced RCA. A fatalistic coping pattern at diagnosis of early PCA predicts later depression while cognitive avoidance and lower anxious preoccupation at diagnosis of advanced PCA predict later anxiety.

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