Diabetes clinic attendance improves diabetes management in an urban Aboriginal and Torres Strait Islander population

Background: Optimal diabetes management involves frequent monitoring and achievement of outcome targets. A primary care diabetes clinic that provides a 'one-stop shop' may facilitate more regular review and improve patient care. Methods: A retrospective clinical audit was conducted of adult patients with type 2 diabetes, who attended an urban Aboriginal Community Controlled Health Service (ACCHS) in Canberra during 2012 (n = 65). Diabetes clinic attendees were compared with non-attendees for the proportion meeting guidelines targets from The Royal Australian College of General Practitioners. Results: The average age of the patients was 56 years and 29% were smokers. There was a statistically significant difference between diabetes clinic attendees and non-attendees in meeting diabetes check guidelines, pneumococcal vaccination and use of hypoglycaemic medication. Despite this difference, clinical outcomes between the two groups were not statistically different. Discussion: A comprehensive diabetes clinic may improve management in the ACCHS setting. The clinic promotes regular checks and higher vaccination rates, although insufficient evidence exists to show that this translates to better clinical outcomes. This model may be transferrable to other primary care settings

Girls and economics : An unlikely coupling

While total undergraduate enrolments at Australian universities are increasing, enrolments in Economics are falling--a source of alarm for economists. By appealing to females, economics could effectively tap into the largest sector (58%) of the undergraduate student population. This study suggests that gender is contributing to the falling enrolments. Males need the prospect of money to entice them to study more economics but females require a connection between studying economics and employment opportunities. Providing visible role models may be a practical step to encouraging more females to read economics. More concentration on 'feminising economics' in the undergraduate curricula could help women to believe that they have a contribution to make to the discipline.C

Integrating care: Learning from first generation integrated primary health care centres

Recent Australian health care policies have focused on strategies to increase efficiency, reduce inequalities and improve health outcomes by building a stronger primary health care system.1 At the time this research was commissioned, the establishment of GP Super Clinics was a significant strategic element of primary health care system reform, although this has now transitioned under subsequent governments to a focus on Health Care Homes.2 The research described in this report was funded by the Australian Primary Health Care Research Institute (APHCRI) in 2013 as part of a research program investigating the features of GP Super Clinics that contribute to achieving the objectives of integration. Specifically, this program of research explored co-location as a strategy for promoting service integration within multidisciplinary primary healthcare clinics, to identify developmental and operational characteristics that promote successful integration.3 Key elements of all 'extended general practice models' 4 are a focus on improving integration to drive quality of care, chronic disease management and prevention; coordination between and across services; increased access, and possibly the promotion of workforce development. While such services have been differentiated from broader primary health care centre models' such as Aboriginal Community Controlled Health Services (ACCHSs), both GP Super Clinics and ACCHSs share an integrated, co-located model of service. While we acknowledge there are significant differences (including the Non-Government Organisation (NGO) focus, not-for-profit status and specific Aboriginal employment contexts) for ACCHSs compared to Super Clinics, many of the challenges of establishing and sustaining integrated primary health care are common across both service types.4 Any initiative seeking to understand characteristics of integrated primary healthcare centres (IPHCs) is likely to derive useful lessons from ACCHSs, which predate the GP Super Clinic model by nearly 40 years. The ACCHS sector has established strategies to ensure collaboration across disciplines, to be properly responsive to changing community needs, and to build effective links within and across services. In many cases, these models have benefited from the fine tuning and maturity that accompanies several decades of implementation. Many of the quality innovations in primary health care which are now moving into broader general practice settings, from quality indicators to the Health Care Home, were pioneered in the ACCHS sector.5 Newer models of co-located integrated primary health care are also offered by some community-based refugee health services which provide co-located, integrated psychology, medical, nursing and social care services. These broad-based primary care services for specific populations offer more social service support than the IPHCs which focus on primary medical care for general populations, but both models share the primary care mandate to provide patient-centred, whole person care. This research report describes two case studies exploring characteristics of two different colocated, integrated services: a mature integrated ACCHS, Winnunga Nimmityjah Aboriginal Health Service (Winnunga Nimmityjah AHS); and a rapidly expanding IPHC, Companion House, supporting refugees and asylum seekers. These services are both award-winning organisations that provide primary general practice (GP) medical care as well as more generalised health services to members of their local community. They function as exemplar case models, each highlighting different challenges that IPHCs may have. Both organisations are important community hubs and have had to frequently adapt to shifting needs and priorities of both their communities and of government policies that impact them directly.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy

Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in uniformly well-functioning liver grafts in 11 patients and contributed to a satisfactory success rate for the procedure. Donors were heart-beating. During the donor operation all manipulations of the liver were avoided until after cold preservation, achieved by external cooling at the same time as circulatory interruption, donor exsanguination and perfusion of the liver with cold oxygenated fluid of “extracellular̵ type. The organs were then gently dissected. At transplantation the livers were revascularized with arterial blood shunted from the recipient iliac artery to the graft portal vein after completion of the suprahepatic IVC anastomosis. The infrahepatic IVCs and hepatic arteries were then joined, the iliac artery shunts discontinued and the portal veins joined. Total ischaemic intervals for the allografts were 3½–8 (average 5). Anhepatic intervals were 1–2¼ (average 2). The arterio-portal shunts were operating for 18–85 (mean 46) min. Blood loss and haemodynamic, acid-base and electrolyte abnormalities at revascularization were minimal. All grafts secreted bile immediately and all parameters reflected continuing improvement of liver function thereafter. Nine patients (82%) are alive between 4 and 18 (mean 11) months after transplantation. We conclude that these methods offer effective avoidance of serious organ damage during donor hepatectomy and preservation, reduced allograft ischaemic interval and reduced recipient anhepatic time. They result in avoidance of blood loss at the time of revascularization, together with minimal haemodynamic, acid-base or biochemical changes. In addition, they allow the surgeon to perform and test all anastomoses without time constraints, provide the capability to deal with unexpected complications, and assure good early graft function

Is there a fate worse than debt? : the effects of the Nelson reforms on life long learning

Life long learning, post Nelson reforms, has the potential to further reinforce the divide between the haves and the have-nots. The rise in HECS costs, the greater movement toward a “user pays” system and the movement toward on-line teaching requiring additional resources for the student, all have the potential to impact upon enrolments from equity groups. Education is not an economic commodity with benefits only for the individual…it has benefits for the whole of society, but only if the whole of society is able to access such education. In applying economic rationalism to tertiary education we risk marginalizing the sectors of our society most in need of human and social capital. With the rising cost of tertiary education the present-value calculations don’t add up for the mature learner who does not have the time left in the workforce to reap the income benefits of greater formal qualifications. Is Life Long Learning an agent of change? Can it make a difference to people’s lives for the better? For the low socio-economic who may be unemployed or “trapped” in the secondary labour market, does LLL represent an opportunity or a threat? Life long learning should not mean life long debt! It is becoming apparent that increasing numbers of prospective students are unwilling to shoulder the levels of debt required to obtain tertiary qualifications. This debt aversion has serious implications for the well being of individuals and indeed the benefits to be derived from having more ‘knowledge workers’ in the wider society. We need to ensure that life long learning is open to all, not just the privileged in our society whose access to education reinforces their privilege. Limiting opportunities for certain groups may result in unforseen eventualities that transcend just being in debt

Is there a fate worse than debt? : the effects of the Nelson reforms on life long learning

Bookallil, CM ORCiD: 0000-0003-1820-0070Life long learning, post Nelson reforms, has the potential to further reinforce the divide between the haves and the have-nots. The rise in HECS costs, the greater movement toward a “user pays” system and the movement toward on-line teaching requiring additional resources for the student, all have the potential to impact upon enrolments from equity groups. Education is not an economic commodity with benefits only for the individual…it has benefits for the whole of society, but only if the whole of society is able to access such education. In applying economic rationalism to tertiary education we risk marginalizing the sectors of our society most in need of human and social capital. With the rising cost of tertiary education the present-value calculations don’t add up for the mature learner who does not have the time left in the workforce to reap the income benefits of greater formal qualifications. Is Life Long Learning an agent of change? Can it make a difference to people’s lives for the better? For the low socio-economic who may be unemployed or “trapped” in the secondary labour market, does LLL represent an opportunity or a threat? Life long learning should not mean life long debt! It is becoming apparent that increasing numbers of prospective students are unwilling to shoulder the levels of debt required to obtain tertiary qualifications. This debt aversion has serious implications for the well being of individuals and indeed the benefits to be derived from having more ‘knowledge workers’ in the wider society. We need to ensure that life long learning is open to all, not just the privileged in our society whose access to education reinforces their privilege. Limiting opportunities for certain groups may result in unforseen eventualities that transcend just being in debt

Second-chance education evaluating the outcomes and costs of university-based enabling programs

Despite universities receiving specific Commonwealth Government funding in order to offer Enabling education free to participants, these programs are not part of the Australian Qualifications Framework (AQF) and there has been no systematic evaluation of outcomes. The purpose of this study was to examine Enabling programs offered by Central Queensland University and investigate their cost effectiveness as a conduit to undergraduate programs and university qualifications. Mises (1949) theory of Praxeology formed the basis for examining outcomes from eleven consecutive years of archival data in this case study. Enrolments in Enabling programs, completions, articulations from Enabling to undergraduate study and undergraduate successes have all been quantified and costed in terms of the Commonwealth funding received.Aim one was to quantify the value-added to the university in terms of undergraduate enrolments and to the students in terms of their human capital accumulation according to Becker's (1964) theory. Aim two was to evaluate outcomes in terms of meeting the dual goals of equity and efficiency. Equity was defined by the notion of inclusion, based upon the principle of personal agency as espoused by Sen (2009), and measured by access and completion of a higher education award (Marginson 2011). Efficiency was measured by access to, and completion of, university qualifications consistent with the Australian Government's definition of an Enabling program (Higher Education Support Act 2012 p. 302). This duality of definitions allowed for comparisons between the possible number of successes as indicated by enrolments in Enabling programs and actual outcomes demonstrating a leakage in the public funding bucket (Okun 1975).The provision of specific Commonwealth funding appears to have precipitated an escalation in enrolments but completions and articulations experienced a sustained decline meaning costs of successful outcomes increased. Statistical analysis demonstrated that increasing access by distance education did not increase equity or efficiency as measured in terms of completions and articulations. Logistic regression suggests that it is not student demographics but the program structure and/or mode of study chosen for Enabling that are the strongest predictors of completion, articulation and undergraduate success. </div