This review discusses the achievements of the National Echo Database of Australia (NEDA), a unique Australian resource facilitated by a collaborative nationwide approach and a common purpose to improve understanding of heart diseases through the gathering and analysis of big data. It is a first of its kind world-wide, with >2.1 million echocardiograms on >1.2 million individuals, linked to other national databases reporting outcomes. This article provides an overview of the methodological structure and function of NEDA, and an analysis of NEDA's clinical impact. In the first 10 years of NEDA's existence, it has undergone three large-scale expansions and data linkages and generated 57 high impact studies with a combined citation index >1,100. Beyond its impact on guidelines, NEDA has driven practice change and contributed to changes in global cardiac care. Future directions for NEDA include an emphasis on objectively measuring clinical quality of echocardiography, evaluating its prognostic utility and providing real-world data on Australian cardiac health. Its engagement with digital health and artificial intelligence techniques broaden new avenues of cardiac innovation on a global level.

Background and Aim:Healthcare service disruptions resulting from the COVID-19 pandemic led to substantial changes in surgical pathways across public hospitals in Western Australia (WA). These disruptions, compounded by restrictions and containment measures, influenced the health and lifestyle behaviours of the WA community, including patients awaiting surgery. This study aimed to assess changes in self-reported modifiable lifestyle risk factors among patients during COVID-19. Methods:This observational study analysed hospital patient data across three seasonally matched calendar periods: Period 1 (January-March 2019 vs 2020), Period 2 (March-July 2019 vs 2020), and Period 3 (July-December 2019 vs 2020). Multivariable regression models were used to examine differences between these COVID‑impacted periods and preoperative self‑reported modifiable risk factors. The assessed risk factors included body mass index (BMI), smoking status, alcohol and drug use, malnutrition risk, physical function, and frailty. Results:Data from 2340 patients were analysed. There were no indicated changes between 2019 and 2020 cohorts in relation to body mass index (BMI), current smoking status, alcohol, or drug use, poor function or frailty risk. Change was detected in past smoker, with a higher proportion of individuals in Period 2 (Mar to Jul 2020), (8% more in 2020, 95% CI3% - 14%, p = 0.005) and Period 3 (Jul to Dec 2020) (7% more in 2020, 95% CI: 2% - 12%, p = 0.003). Also, a greater proportion of patients assessed 'at malnutrition' risk in Period 3 (13% more in 2020, 95% CI: 6% - 19%, p = 0.013). Conclusion:This is the first Australian COVID-19 study to report potential pressure on the preadmission pathway for nutrition care during the COVID-19 period, with a higher proportion of patients reported to be at risk of malnutrition in later 2020. An increase in reporting of recent past smoking was observed, potentially attributable to heightened awareness of respiratory vulnerabilities associated with the virus. This study offers valuable insights to inform future pandemic planning, optimise resource allocation, and refine nutritional screening priorities. The COVID-19 pandemic has shaped a new path for innovative preoperative strategies and possible motivations for behaviour change that enhance the development of targeted prehabilitation efforts.

Background: Hospital-acquired complications have detrimental effects on patient outcomes and recovery, with increased morbidity and mortality burdens, and hospital efficiency. The Australian Commission on Safety and Quality in Healthcare has identified 16 high-priority complications, including healthcare-associated infections, as potential targets of clinical risk mitigation strategies. Within the North Metropolitan Health Service in Western Australia, the prevalence of urinary tract infections (UTIs) was recognised as one of the most ubiquitous hospital-acquired complications and thus, there was desire to find new and innovative ways to enhance the existing infection prevention and control practices.Objective: To develop a risk prediction model for early identification of inpatients at risk of acquiring a UTI, to support clinical processes to facilitate targeted intervention strategies.Method: Prognostic modelling techniques were employed using retrospective hospital separation data encompassing patient and local health service factors.Results: The risk prediction model, developed from approximately 350 variables, used just 9 factors: 2 patient characteristics (age, gender), 4 clinical factors (paraplegia, dementia, prostate hyperplasia, neurosurgeon care), and 3 process measures (hospital stay duration, long theatre time, intensive care unit stay). It predicted UTI risk with 91% sensitivity, 86% specificity, and 95% discrimination (area under the curve). Real-time use in ward settings suggested it could help reduce hospital-acquired urinary tract infections (HAUTIs).Conclusion: Predictive modelling techniques can identify patients at risk of developing a HAUTI with high sensitivity and specificity. The resulting model can be used as a real-time clinical decision-making tool to guide proactive interventions and help reduce the prevalence of UTIs among hospital inpatients.Implications for health information management practice: The development and successful validation of a real-time predictive model for HAUTIs demonstrates how health information managers can leverage routinely collected data to support proactive clinical risk mitigation. Integrating such models into electronic health record systems can enhance patient safety, improve clinical workflows, and inform targeted infection control interventions across hospital settings.

12099 Background: The MOST-S26 is a patient-reported outcome measure that complements follow-up after first-line treatment for ovarian cancer (OC). MOST-S26 enables assessment of physical and psychological symptoms, and well-being. A randomized trial was conducted to evaluate nurse-led follow-up for OC via telehealth using the MOST-S26 to structure consultations vs routine hospital follow-up (ACTRN12620000332921). A qualitative sub-study assessed acceptability of the intervention from patient and nurse perspectives. Methods: Semi-structured interviews via video or telephone explored experiences of receiving or delivering nurse-led follow-up. Patients that participated in at least two nurse-led follow-up appointments were eligible. Study nurses delivering the intervention were interviewed at the end of the trial. Interviews were recorded, transcribed and coded using a Framework Approach following five stages: familiarisation, developing a thematic framework, indexing, charting, mapping and interpretation. Results: From June 2021, 38 patients were enrolled at 6 Australian sites. The trial closed to acrual in April 2024. Twenty-one participants were interviewed (15 women with OC and 6 study nurses). Analysis identified 3 overarching themes: (1) key patient-centred benefits (convenience and flexibility; providing a sense of connection and feeling cared for; enabling personalised, holistic care and prompt management of symptoms; providing dedicated space for patients’ to freely express experiences and emotions); (2) challenges to delivery from nurses’ perspectives (emotional impact of patients' cancers recurring; lack of referral pathways; inability to observe physical cues; difficulties establishing rapport; and, lack of suitability for all patients e.g. non-English speaking or patients with low literacy); and, (3) Nurse views on usefulness of MOST-S26 to support consultations (provides a useful tool to guide consultations/referrals, detect recurrence, track symptoms over time, flag symptoms for discussion, and, helps patients’ reflect on their symptoms). Conclusions: Results confirmed acceptability of this type of follow-up for both OC patients and nurses. Both reported several benefits compared with standard hospital-based follow-up. Challenges that should be considered prior to routine implementation of this follow-up model included: the need to provide support to nurses to cope with the emotional impact of patients’ cancers recurring; developing clear referral pathways for symptom management; and considering the characteristics of patients most and least suitable for this type of follow-up. Clinical trial information: ACTRN12620000332921 .

INTRODUCTION:Methamphetamine is a potent stimulant that has been associated with stigma and serious physiological/psychiatric adverse effects. Harms associated with methamphetamine use have increased, placing demand on Australia's hospital services. AIM/QUESTION:This study's aim was to explore the experiences of nurses who work within West Australian hospitals' inpatient mental health service and provide care for individuals presenting with harmful methamphetamine use, while acknowledging that such presentations are often complicated by comorbid psychiatric conditions, trauma and other psychosocial factors. METHOD:Interpretive Phenomenological Analysis was used to structure, implement and analyse interviews with 10 nurses. RESULTS:Three superordinate themes reflected participants' experiences: 'Hit by the Storm', 'Working in the Rain' and 'After the Storm'. DISCUSSION:Participants provided methamphetamine-related nursing care in both an Observation Area of the Emergency department and an acute psychiatric ward. Their contributions helped to identify stigma as a common concern. These nurses described strategies they use to self-regulate while providing care, how they monitor the effects of stigmatisations and preserve their own physical and mental safety. Participants also identified a desire for targeted methamphetamine training. IMPLICATIONS FOR PRACTICE:Stigma associated with methamphetamine use is common among nursing staff, which can result in reduced quality of care. RECOMMENDATIONS:Methamphetamine training is an important factor that improves nurses' confidence while also reducing methamphetamine-related stigma. DESCRIPTION:This study strictly adhered to interpretive phenomenological analysis methodological protocols as recommended by Smith et al. (2009). Trustworthiness standards (Guba and Lincoln 1994; Whittemore et al. 2001) guided this study. For example, credibility was established through member checking between the researchers and participants, ensuring congruency of the results with expert opinions and the participants' contributions. Identified themes were supported by thick descriptions and verbatim quotes (Sundler et al. 2019). Differences of opinion were debated by the research team to reach a singular conclusion. Detailed background of the participants, including their current workplace, age, gender and work history, established transferability (Elo et al. 2014). As recommended by Smith et al. (2009) an internal audit was used to file all data, from initial data collection to final report. The University of Notre Dame Australia's Human Research Ethics Committee and the hospital's HREC and governance provided ethical approval for this study. RELEVANCE STATEMENT:Nursing staff working in Australian Emergency Departments have reported that methamphetamine-related presentations are confronting and resource intensive. Additionally, psychiatric symptoms are a common component of these presentations. Clinicians have reported that individuals who use methamphetamine are often discharged from the emergency department without adequate psychiatric treatment. Exploring nurses' experiences working with this patient cohort in a psychiatric assessment unit attached to the ED, and again in an acute psychiatric ward has resulted in several insights that could help mitigate methamphetamine-related stigma and are relevant for all nursing staff who may work with patients who use methamphetamine.

OBJECTIVE:The aim of this study was to estimate avoidance of hospital bed-days and the resulting cost savings from a wholistic quality improvement program that was implemented to systematically reduce hospital-acquired complications (HACs) in an Australian local health service between 2018 and 2023. METHODS:This was an uncontrolled retrospective observational analysis of prospectively collected data. An association between HAC and length of stay (LOS) was explored through a zero truncated negative binomial regression model for two LOS cohorts, using 21 days as the threshold for long-stay share of bed-days. Bed-day cost avoidance was estimated by applying the adjusted marginal effect of HAC on LOS, multiplied by the estimated number of HAC episodes averted, average weighted average units per bed-day, and the national efficiency price in respective years. RESULTS:HACs were found to increase hospital bed-days by an average of 5.5 days (95% CI: 5.19-5.86) for episodes with LOS of 1-21 days, and by 7.1 days (95% CI: 6.78-7.48) for episodes with LOS exceeding 21 days. The program resulted in an estimated avoidance of HACs in 2991 episodes of care over a 5-year period, averaging 598 episodes per year. This equated to avoidance of a total of 16,751 hospital bed-days, or 3350 annually. Annual cost voidance from bed-days ranged from A$6.4 to A$11.5 million between 2019 and 2023. The budget for program management was A$514,500 per year, resulting in average net benefits of A$7.1 to A$8.2 million, a 14-16-fold return on investment for the health service. CONCLUSION:Findings suggest that financially viable opportunities are available for hospitals to achieve sustained reduction in HACs, which have the potential for wider adoption to tackle the challenges associated with adverse events in hospitals.

BackgroundReducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting resources away from other core patient care activities. While numerous reports are available in the literature for projects that successfully reduce specific HAC, questions remain about the sustainability of this isolated approach and there may be benefits for more wholistic programmes that aim to align prevention strategies across a hospital. This study describes such a programme that uses evidence and theories in the literature to achieve and sustain a reduction in HACs in an Australian local health service between 2019 and 2022.MethodsAn organisation-wide HACs Reduction Programme underpinned by a 3-pillar strategic framework (complete documentation, accurate coding, clinical effectiveness) and a 5-year roadmap to clinical excellence was developed. Priorities were identified through Pareto analysis and aligned at organisational, service and specialty levels. The Institute for Healthcare Improvement (IHI) 90-day cycle was modified to implement contextualised evidence-based interventions supported by the application of the Awareness, Desire, Knowledge, Ability and Reinforcement change management model. Under this wholistic umbrella, specific projects were data-driven, evidence-based and outcome-oriented to promote clinical engagement and a continuous improvement culture.ResultsOverall mean HAC rate per 10 000 episodes of care decreased from a baseline of 459.5 across 2017 and 2018 to 363.1 in 2019 and remained lower through to the end of 2022 indicating sustained improvement in performance.ConclusionA wholistic approach to reduce HACs increased the likelihood of multidisciplinary integration for contextualised strategies and interventions. Improvement work, particularly in relation to patient outcomes, is a dynamic process that needs to be intentionally cultivated, targeted and coordinated. The modified IHI 90-day cycle proved to be an effective tool for implementation that contributed to sustained change.

Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger’s and Begg’s rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs. PROSPERO: CRD42023445294.

INTRODUCTION:Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. METHODS:This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. RESULTS:Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 - 4.5 vs control group - Md = 1.5, IQR 0.6 - 3.8, z = -0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. CONCLUSION:Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.

Background There is minimal data on the number of adolescents in sub-Saharan Africa (SSA) with elevated blood pressure (BP) at increased risk of future cardiovascular events. Combining country -specific population data with data derived from two previously conducted meta -analyses (one African -specific, one based on international cohorts), we sought to address this knowledge deficit. Methods We used meta -analysis data from 37 926 adolescents participating in 36 contemporary SSA studies to generate sex -specific proportions of adolescents aged 10-14 and 15-19 years with elevated BP. The estimates were applied to the 2021 World Bank population data for each country in SSA. We then applied the rate of cardiovascular events attributable to elevated BP levels, derived from a meta -analysis of 17 observational, longitudinal cohort studies comprising 4.5 million young adults (non -African), to determine the excess number of cardiovascular events linked to hypertension among those aged 15-19 years transitioning to adulthood. Results The estimated prevalence of elevated BP among male and female adolescents aged 10-14 years living in SSA was 7.2% (95% confidence interval (CI) = 4.9-9.9) and 6.9% (95% CI = 4.7-9.5), respectively, which increased to 13.0% (95% CI = 10.6-15.6) and 12.5% (95% CI = 10.4-15.3) among male and female adolescents aged 15-19 years, respectively. Consequently, we estimate that 13.6/138.0 million (95% CI = 10.4-17.3) male and 12.9/135.7 million (95% CI = 9.83-16.3) female adolescents living in SSA have elevated BP. Among the estimated 16.1 million adolescents aged 15-19 years with elevated BP approaching adulthood, the projected excess in cardiovascular events attributable to hypertension (vs normotension) is 201 000 (95% CI = 115 000-322 000) to 503 000 (95% CI = 286 000-805 000) over the next 10-25 years. Conclusions Based on the best available data, we estimate that 26.5 million adolescents living in SSA have elevated BP. If left undetected and untreated among those approaching adulthood (those aged 15-19 years), they will experience >0.5 million excess cardiovascular events associated with persistently elevated BP within the next 25 years.

BackgroundPeople with intellectual disabilities living in group homes often have complex health needs, are high health service users and need support from their service provider to access health services. In Australia, little is known about the types and amounts of these supports.MethodsA case study was conducted on a large Western Australian disability provider of group homes to 160 people with intellectual disability. Over an 18-month period, including during the COVID-19 pandemic, the study quantified health service use in hospital- and community-based settings, ways by which the person was supported to access health care and the impact on other people supported by the provider. Economic costs of supporting access to health services were estimated.FindingsOverall, the disability provider supported 160 people in accessing health services an average of 23 times each (n = 3617, median = 20, interquartile range = 10-33) over the 18 months. Support included staff attending with the person (96%), following up with guardian/decision-maker (50%), additional resourcing via overtime or staff backfills (6%) and transport (94%). The average cost of supporting one health visit was estimated at $78.51 AUD (2021). Impact on the person's household included loss of opportunity for housemates (30%), reduced supervision within the home (79%) and longer timeframes to complete care needs (32%). The impact of COVID-19 restrictions saw a reduction in allied and mental health service use that did not return to prepandemic levels following the cessation of restrictions. Primary care, specialist, outpatient, pathology and emergency service use was also lower in the postrestriction period compared to the prepandemic period.ConclusionsFor people living in group homes, the disability provider plays an essential role in supporting health service access, primarily through the provision of support staff and transport. The change in health service utilisation following the COVID-19 restriction period indicates that altered health system priorities can potentially exacerbate access inequality for people with intellectual disability. People with intellectual disability frequently need support to go to a health service. Our study looked at how people in group homes receive this support. We found that after COVID-19 restrictions, people received fewer health services. This is important as we need to make sure that people receive the health services that they need.

IntroductionThis study explored the behavioral profiles of residing Western Australians during a COVID-19 lockdown period and transitions in behavior post-lockdown.MethodsA total of 313 participants (76% female, age: M = 50.1, SD = 15.7 years) completed behavioral and mental health questionnaire items ~2 months after a 3-month COVID-19 lockdown in October 2020, using a retrospective recall to assess their experience during the lockdown period. Latent transition analysis (LTA) was used to identify behavioral profiles and transitions. Indicators were identified by assessing during–post-lockdown group differences (Kruskal–Wallis, chi-square tests) and profiles described using qualitative open-ended questions.ResultsSignificant indicators included changes in physical activity, leisure screen time, alcohol intake, psychological distress, and loneliness, but not fast food consumption. The significant indicators were used to form LTA models. The five latent class model showed the best model fit (Log-likelihood = −1301.66, AIC = 426.12, BIC = 609.68). Approximately one in four participants reported a change in their behavior profiles after the lockdown ceased. Key differences between the profiles were age, household income, education, resilience, sense of control, existing mental health issues, and social relations. Washing hands and social distancing were the most recalled and effective health campaigns across the classes, with health campaigns encompassing physical activity/alcohol consumption, or domestic violence having the least attention.DiscussionOverall, while most participants recovered relatively well after the lockdown period, LTA did identify subgroups such as those who were inactive and lonely experienced more difficulties than other groups, and engagement with public health campaigns differed. The results provide important insights for future public health campaigns on how these campaigns might be diversified to effectively target more people and particular groups to maximize engagement for maintaining people's mental health with additional focus on physical activity, alcohol consumption, and domestic violence.

OBJECTIVE:Dementia affects individuals older than 65 years. Currently, residential aged care facilities (RACF) use psychotropic medications to manage behavioural and neuropsychiatric symptoms of dementia (BPSD), which are recommended for short-term use and have substantial side effects, including increased mortality. Cannabinoid-based medicines (CBM) have some benefits that inhibit BPSD and cause minimal adverse effects (AEs), yet limited research has been considered with this population. The study aimed to determine a tolerable CBM dose (3:2 delta-9-tetrahydrocannabinol:cannabidiol), and assessed its effect on BPSD, quality of life (QoL) and perceived pain.METHODS:An 18-week randomised, double-blinded, crossover trial was conducted. Four surveys, collected on seven occasions, were used to measure changes in BPSD, QoL and pain. Qualitative data helped to understand attitudes towards CBM. General linear mixed models were used in the analysis, and the qualitative data were synthesised.RESULTS:Twenty-one participants (77% female participants, mean age 85) took part in the trial. No significant differences were seen between the placebo and CBM for behaviour, QOL or pain, except a decrease in agitation at the end of treatment in favour of CBM. The qualitative findings suggested improved relaxation and sleep among some individuals. Post hoc estimates on the data collected suggested that 50 cases would draw stronger conclusions on the Neuropsychiatric Inventory.CONCLUSIONS:The study design was robust, rigorous and informed by RACF. The medication appeared safe, with minimal AEs experienced with CBM. Further studies incorporating larger samples when considering CBM would allow researchers to investigate the sensitivity of detecting BPSD changes within the complexity of the disease and concomitant with medications.

Quality activities including quality assurance and quality improvement are an integral part of safety and quality governance for hospitals. Previous studies identified that (i) majority are for quality assurance and knowledge-acquiring purposes and (ii) adherence to the quality cycle as well as impact on patient-related outcomes at the hospital level are unclear, neither associated with costs. This study aims to (i) assess adherence to the quality cycle for quality activities in a large Australian tertiary hospital; (ii) report outcomes of quality activities at the hospital level, including impact on patient-related outcomes measured by the occurrence of hospital-acquired complications; and (iii) estimate time and costs for data collection.This quantitative study utilized three data sources. First is the hospital's electronic quality management system, Governance, Evidence, Knowledge and Outcome that identifies completed quality activities over a 5-year period; second is Tableau dashboards for hospital-acquired complication performance; third is Microsoft Teams Forms used to capture time of data collection for bedside observations and retrospective notes reviews. Median sample size and median hourly rates in 2018 were used for calculations.A total of 1768 quality activities were completed over a 5-year period representing an average of 353 quality activities per year, of which 87.8% were initiated by clinicians and 12.2% planned and coordinated by safety and quality or equivalent. The activity reports indicated that less than a fifth (17.1%) brought about improvement in process measures and only 7.1% improved outcome measures. Two-thirds of the quality activities (66.3%) provided recommendations based on their findings, but evidence of action plan was available in 14.1% of the reports only. No association was found between the number of activities completed and overall hospital-acquired complication performance. Retrospective data collection (64.7%) was common. The estimated time and cost for data collection averaged at 3490 h/year, equivalent to 1.8 full-time employees, for a cost of $171 000 at the nursing rate (A$49.0), $280 000 at the medical rate (A$79.5), and $200 000 at the Health Service Union rate (A$58.9). Most quality activities were clinician-initiated. Implementing change and achieving and sustaining improvement were the two challenging stages in the quality cycle. No clear association was observed between activities completed and improvement in patient-related outcomes although some improvement in processes. A paradigm shift may be needed to engineer quality activities in hospitals to be more outcome-oriented. Opportunities exist for hospitals to consider how quality activities can be organized to maximize returns from investment.

Resistance training (RT) is beneficial for older adults, particularly to support living independently in their home. However, fewer than 25% of older adults in Australia participate in the recommended, twice-weekly sessions. Reasons older adults do not participate in RT include not having anyone to go with or not knowing what to do. Our study linked older adults with a peer (i.e., older person already participating in RT) to help them overcome these barriers. The aim of our study was to determine whether peer support was suitable for older adults participating in RT for the first time in the home or gymnasium setting. Each group (home vs. gymnasium) received a 6 week, twice-weekly program. Twenty-one participants completed the 6 week intervention: 14 in the home group and seven in the gymnasium group. The home group completed significantly more sessions per week (2.7 vs. 1.8) than the gymnasium group. Although both groups significantly improved on many physical assessments, no between-group differences were found. However, it is suitable to link a peer for support with novice older people participating in a RT program for the first time in the home or gymnasium. It is recommended that future studies explore whether peer support improves sustainability.

Background The aim of this study was to examine physical activity and sedentary behaviours during Western Australia’s COVID-19 lockdown and their association with mental well-being. Methods Participants completed activity related questions approximately two months after a three-month lockdown (which formed part of a larger cross-sectional study from August to October 2020) as part of a 25-minute questionnaire adapted from the Western Australia Health and Well-being Surveillance system. Open-ended questions explored key issues relating to physical activity behaviours. Results During the lockdown period, 463 participants (female, n = 347; 75.3%) reported lower number of active days (W = 4.47 p < .001), higher non-work-related screen hours per week (W = 11.8 p < .001), and higher levels of sitting time (χ 2 =28.4 p < .001). Post lockdown body mass index was higher (U = 3.0 p = .003), with obese individuals reporting the highest non-work-related screen hours per week (Wald χ 2 = 8.9 p = .012). Inverse associations were found for mental well-being where higher lockdown scores of Kessler-10 (p = .011), Dass-21 anxiety (p = .027) and Dass-21 depression (p = .011) were associated with lower physical activity levels. A key qualitative message from participants was wanting to know how to stay healthy during lockdown. Conclusions Lockdown was associated with lower physical activity, higher non-work-related screen time and more sitting time compared to post lockdown which also reported higher body mass index. Lower levels of mental well-being were associated with lower physical activity levels during lockdown. Given the known positive affect of physical activity on mental well-being and obesity, and the detrimental associations shown in this study, a key public health message should be considered in an attempt to maintain healthy activity behaviours in future lockdowns and similar emergency situations to promote and maintain positive well-being. Furthermore, consideration should be given to the isolation of a community due to infectious disease outbreaks and to recognise the important role physical activity plays in maintaining weight and supporting good mental health.

Objective: Dementia affects individuals older than 65 years. Currently, residential aged care facilities (RACF) use psychotropic medications to manage behavioural and neuropsychiatric symptoms of dementia (BPSD), which are recommended for short-term use and have substantial side effects, including increased mortality. Cannabinoid-based medicines (CBM) have some benefits that inhibit BPSD and cause minimal adverse effects (AEs), yet limited research has been considered with this population. The study aimed to determine a tolerable CBM dose (3:2 delta-9-tetrahydrocannabinol: cannabidiol), and assessed its effect on BPSD, quality of life (QoL) and perceived pain. Methods: An 18-week randomised, double-blinded, crossover trial was conducted. Four surveys, collected on seven occasions, were used to measure changes in BPSD, QoL and pain. Qualitative data helped to understand attitudes towards CBM. General linear mixed models were used in the analysis, and the qualitative data were synthesised. Results: Twenty-one participants (77% female participants, mean age 85) took part in the trial. No significant differences were seen between the placebo and CBM for behaviour, QOL or pain, except a decrease in agitation at the end of treatment in favour of CBM. The qualitative findings suggested improved relaxation and sleep among some individuals. Post hoc estimates on the data collected suggested that 50 cases would draw stronger conclusions on the Neuropsychiatric Inventory. Conclusions: The study design was robust, rigorous and informed by RACF. The medication appeared safe, with minimal AEs experienced with CBM. Further studies incorporating larger samples when considering CBM would allow researchers to investigate the sensitivity of detecting BPSD changes within the complexity of the disease and concomitant with medications.

Background Community rehabilitation for older people after hospital discharge is necessary to regain functional ability and independence. However, poor adherence to exercise programs continues to hinder achieving positive health outcomes in older people. This study aimed to evaluate the effectiveness of prescribing a tailored video self-modeled DVD-HEP for 6 weeks, on functional mobility, physical activity, exercise self-efficacy, and health-related quality of life, in a sample of frail older adults. Materials and methods A pre- and post-test intervention study design was conducted, with each participant acting as their own control. A convergent, parallel, mixed-methods approach involving quantitative, and qualitative data collection was used. Participants received an individualized assessment at baseline and subsequently were provided with a 30-min tailored 6-week self-modeled DVD-HEP that showed the physiotherapist instructing the participant. The physiotherapist phoned participants fortnightly to encourage engagement in the program and explore responses to it. Outcomes evaluated included functional mobility, balance, gait speed, and exercise self-efficacy. Results Participants ( n = 15) showed clinically meaningful improvements at follow-up compared to baseline in functional mobility (TUG MCID = 3.4–3.5 s, 3-MWT MCID = 0.1–0.2 m/s) and gait speed (3-MWT MCID = 0.1–0.2 m/s). There were also significant improvements in balance and self-efficacy for exercise and a 2.5- and a 1.3-fold increase in moderate and light physical activity participation at follow-up compared to baseline. The deductive themes were: (i) Enjoyment, self-efficacy, and wellbeing; (ii) Achieving life goals; (iii) Background music as a motivator to adherence; and (iv) Enhanced motor performance and learning: Task goal mastery, multimodal feedback, autonomy to self-regulate learning. The new inductive theme was (v) Preference for in-person support for exercise. Conclusion Future studies are warranted to compare a tailored self-modeled video HEP to face-to-face programs and other digital health modalities to evaluate older adults' adherence levels and functional improvement.

BACKGROUND:Use of patient-reported outcome measures in clinical settings facilitate the delivery of better health care to improve patient health outcomes. Previously collected qualitative data indicated themes that could inform items for a health-related quality of life measure. This study investigated the content validity of items for inclusion in a new health-related quality of life measure suitable for patients with ovarian cancer.METHODS:Cognitive interviewing techniques were used with fourteen women diagnosed with ovarian cancer and at different times since diagnosis, to evaluate items derived from the previously collected qualitative dataset. A set of draft items was administered via telephone, Zoom and WhatsApp app together with questions on item meaning and wording. Interviews were transcribed and thematically analysed.RESULTS:Four broad themes emerged in relation to the questionnaire construction and comprehension of items: intent and clarity, wording, relevance and context, and overall questionnaire construct. All draft items were adjusted based on the interview findings. A final set of 38 health-related quality of life items comprised 7 items describing physical health and functioning, 21 describing emotional wellbeing and 10 items describing social wellbeing; each rated on a five-point frequency response scale.CONCLUSION:The items reflected a range of personal experiences associated with the patient clinical journey, creating a health-related quality of life tool specific to women diagnosed with ovarian cancer. The cognitive interviewing process established content validity for the tool, thereby, preparing it for field testing and evaluation of its psychometric properties. This study highlighted the fundamental role of cognitive interviewing during health-related quality of life questionnaire development to ensure that item content is grounded in patient feelings, functioning and meaning.