Publications by authors named "Rajna Ogrin"

30 Publications

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Loneliness in older age: What is it, why is it happening and what should we do about it in Australia?

Australas J Ageing 2021 Mar 30. Epub 2021 Mar 30.

Bolton Clarke Research Institute, Brisbane, Queensland, Australia.

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.
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http://dx.doi.org/10.1111/ajag.12929DOI Listing
March 2021

Age effects on step adaptation during treadmill walking with continuous step length biofeedback.

Gait Posture 2020 07 4;80:174-177. Epub 2020 May 4.

Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia.

Background: The inability to adjust step length can lead to falls in older people when navigating everyday terrain. Precisely targeted forward placement of the leading foot, constituting step length adjustment, is required for adaptive gait control, but this ability may reduce with ageing. The objective of this study was to investigate ageing effects on step length adaptation using real-time biofeedback.

Research Question: Does ageing affect the ability to adapt step length to match a target using real-time biofeedback?

Methods: Fifteen older adults (67 ± 3 years; 8 females) and 27 young adults (24 ± 4 years; 13 females) completed a step length adaptation test while walking at preferred speed on a treadmill. The test involved walking while viewing a monitor at the front of the treadmill that showed a real-time signal of absolute left-right foot displacement. The task was to match the local maxima of the signal (i.e. step length) to two target conditions, at 10 % longer or 10 % shorter than mean baseline step length. When the target was displayed, it remained unchanged for a set of 10 consecutive step attempts. Three sets of 10 attempts for each target condition were allocated in random order, for a total of 30 step attempts per target. Average absolute error and average error (bias) of step length accuracy was computed for each target condition and compared between groups.

Results: The step adaptation test identified that older adults had greater mean absolute error for both short and long step targets and showed a step length-dependent bias significantly different to the young.

Significance: Real-time foot position feedback could be a useful tool to train and evaluate step adaptation in older people.
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http://dx.doi.org/10.1016/j.gaitpost.2020.04.027DOI Listing
July 2020

Diversity training evaluation for community aged care: Tool development.

Nurse Educ Pract 2020 May 7;45:102796. Epub 2020 May 7.

Bolton Clarke Research Institute, Level 1.01, 973 Nepean Hwy, Bentleigh, Victoria, 3204, Australia; Austin Health Clinical School, University of Melbourne, Victoria, Australia; Biosignals and Affordable Healthcare, RMIT, Victoria, Australia. Electronic address:

Diversity characteristics such as culture, sexual orientation, and social situation potentially impact the participation of older individuals in healthcare. An awareness of diversity characteristics and their potential to impact on older people's access to health and aged care by professionals through training is important. This paper outlines the development and initial validation of a survey using adapted Delphi methodology and distribution to 195 health and aged care professionals pre- and post-diversity training. An initial pool of 31 items were developed with an expert reference group and reduced to 21 through exploratory factor analysis. A two-factor solution was extracted, measuring skills and attitudes of professionals relative to providing services to older people with diverse characteristics. Internal consistency of the items yielded a Cronbach alpha of 0.78. T-tests conducted on the pre- and post-survey data showed significantly higher scores on the domains of skills and attitudes following the training. Knowledge was not effectively captured using this method, with true-false or free-recall questions being a more appropriate approach. This tool fills a gap in the evaluation literature, providing an important first step to assess outcomes of diversity training in community aged care. Further validation is necessary for the tool to be used more widely in the sector.
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http://dx.doi.org/10.1016/j.nepr.2020.102796DOI Listing
May 2020

The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study.

Int J Equity Health 2020 01 28;19(1):16. Epub 2020 Jan 28.

School of Nursing and Healthcare Professions, Federation University, Ballarat, Victoria, 3353, Australia.

Background: The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians.

Methods: Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants' experiences and understanding of diversity concepts and their care needs.

Results: Fifteen older people (seven female, eight male), mean age 76 years (range 71-85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed.

Conclusion: Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.
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http://dx.doi.org/10.1186/s12939-020-1124-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988242PMC
January 2020

Community-Dwelling Older Women: The Association Between Living Alone and Use of a Home Nursing Service.

J Am Med Dir Assoc 2020 09 27;21(9):1273-1281.e2. Epub 2019 Dec 27.

Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia; Institute of Future Environments, Queensland University of Technology, Brisbane, Queensland, Australia.

Objective: To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone.

Design: A retrospective cohort study using routinely collected data.

Setting And Participants: Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015.

Methods: Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode.

Results: A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode.

Conclusions And Implications: Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.
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http://dx.doi.org/10.1016/j.jamda.2019.11.007DOI Listing
September 2020

Implementation and refinement of a community health nurse model of support for people experiencing homelessness in Australia: a collaborative approach.

BMJ Open 2019 11 19;9(11):e030982. Epub 2019 Nov 19.

Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia

Objective: To implement, refine and evaluate an assertive community health nurse (CHN) model of support for people experiencing or at risk of homelessness that aims to improve their access to health and social care services.

Methods: Participants were recruited between 30 August 2013 and 31 October 2015, including clients residing in a Victorian southern Melbourne metropolitan suburb, who registered with the CHN and stakeholders from local service provider organisations engaging with the CHN. A collaborative approach using demographic data collected from client records to identify need and measure the time clients took to engage and access services, qualitative data gathered during Stakeholder Advisory Group meetings and feedback from face-to-face interviews with service organisation representatives informed refinement of the CHN model.

Results: Thirty-nine clients (22 Female, mean age 50±11 years) participated. Clients engaged with services after an average of seven CHN visits. Eighteen clients independently accessed services after approximately 9 weeks, including medical and housing services. Client need and feedback from 20 stakeholders and three community nurses contributed to refining the model to ensure it met local needs and informed the necessary organisational framework, the CHN role and the attributes, knowledge and the skills required.

Conclusion: A collaborative CHN model of support for people at risk of or experiencing homelessness has been articulated. Evaluation of the role demonstrated increased client engagement with health and community services and social activities. Additionally, the CHN assisted other service providers in their delivery of care to this very complex client group.
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http://dx.doi.org/10.1136/bmjopen-2019-030982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887079PMC
November 2019

Co-creation of services to maintain independence and optimise well-being: Learnings from Australia's Older Women Living Alone (OWLA) project.

Health Soc Care Community 2020 03 30;28(2):494-504. Epub 2019 Oct 30.

Bolton Clarke Research Institute, Bentleigh, Vic., Australia.

For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of individuals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.
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http://dx.doi.org/10.1111/hsc.12882DOI Listing
March 2020

Trajectories of home nursing use for older women in Melbourne, Australia: 2006-2015.

Australas J Ageing 2020 Sep 15;39(3):e295-e305. Epub 2019 Oct 15.

Bolton Clarke Research Institute, Melbourne, Vic., Australia.

Objective: To profile changes in older women accessing home nursing between 2006 and 2015, focussing on living circumstances.

Methods: Data pertaining to Australian women aged 55+ who accessed a home nursing service between 2006 and 2015 were analysed, stratified by living status. Comparisons were made between the years 2006 and 2015; rates and relative rates of use per 1000 clients were calculated.

Results: Fewer women lived alone in 2015 compared with 2006. Women were older, less likely to be born in Australia, speak English at home, had more diagnoses and higher average Charlson Comorbidity Index scores in 2015. Relative rates of service use for older women living with others increased slightly over the 10 years, while decreasing by 13% for those living alone.

Conclusion: Women using home nursing services are older than previously, more medically complex, more likely to be born from countries other than Australia and speak a preferred language other than English.
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http://dx.doi.org/10.1111/ajag.12735DOI Listing
September 2020

Feasibility of using a transition diabetes team to commence injectable therapies postdischarge from a tertiary hospital: a pilot, randomised controlled trial.

BMJ Open 2019 09 20;9(9):e023583. Epub 2019 Sep 20.

Endocrinology, Austin Health, Heidelberg, Victoria, Australia.

Objectives: This study aimed to investigate if the use of a transition team was feasible for patients with diabetes being discharged from hospital on injectable diabetes therapies.

Design: Pilot, randomised controlled trial.

Setting: The trial was conducted between 2014 and 2016 conjointly by a tertiary referral hospital and a community healthcare provider.

Participants: Hospital inpatients (n=105) on new injectable diabetes therapies were randomised 1:1 to transition team or standard care. The transition team received in-home diabetes education 24-48 hours postdischarge, with endocrinologist review 2-4 weeks and 16 weeks postdischarge.

Main Outcome Measures: The primary outcome was feasibility, defined by percentage of patients successfully receiving the intervention. Secondary outcomes included safety, defined by hospital readmission and emergency department presentations within 16 weeks postrandomisation, and treatment satisfaction, measured using Diabetes Treatment Satisfaction Questionnaire (DTSQ). Exploratory outcomes included length of stay (LOS) and change in haemoglobin A1c (HbA1c) throughout the study.

Results: The intervention was deemed feasible (85% (95% CI 73% to 94%)). No difference in safety between groups was detected. No difference in change in HbA1c between groups was detected (standard care median HbA1c -1.5% (IQR -3.7% to -0.2%) vs transition team median HbA1c -1.9% (IQR -3.8% to -0.2%), p=0.83). There was a trend towards reduced LOS in the transition team group (per protocol, standard care median LOS 8 (IQR 5.5-12); transition team median LOS 6 (IQR 3-12), p=0.06). There was a significant improvement in patient satisfaction in the transition team (standard care median 10.5 (IQR 8.5-16); transition team DTSQ change version median 15 (IQR 10-17.5), p=0.047), although interpretability is limited by missing data.

Conclusion: This study demonstrated that the use of a novel transition diabetes team is a feasible alternative model of care.
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http://dx.doi.org/10.1136/bmjopen-2018-023583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756454PMC
September 2019

Older People With Type 2 Diabetes-Individualizing Management With a Specialized (OPTIMISE) Community Team: Protocol for a Safety and Feasibility Mixed Methods Study.

JMIR Res Protoc 2019 Jun 7;8(6):e13986. Epub 2019 Jun 7.

Austin Health Clinical School, University of Melbourne, Heidelberg, Australia.

Background: The prevalence of diabetes is rising in older people. In 2018, over 574,000 Australians reported having diabetes. The highest prevalence (19.4%) of diabetes has been observed in people aged 85 years and older. Clinical guidelines recommend that diabetes management should be individualized; however, there is limited information regarding the current management patterns of diabetes in older people, given most clinical trials exclude participants from this age group. Available data identify that few individuals achieve optimal glycemic levels in the general population, potentially leading to adverse health outcomes and impact on quality of life. The data on glycemic profiles of older population are limited.

Objective: The aim of this study is to examine individualized diabetes management intervention for older people through home visits with a credentialed diabetes educator (CDE) and telehealth consultations with an endocrinologist located at a tertiary hospital.

Methods: This paper describes the design and methodology of a mixed methods feasibility and safety study to identify the current management of type 2 diabetes in people aged 65 years or older. We will implement and evaluate a personalized approach to management in the community of an Australian metropolitan city. This management approach will utilize flash glucose monitoring and home visits with the support of a community home nursing service CDE and telehealth consultation with an endocrinologist located at a local tertiary hospital.

Results: The study commenced in February 2017 and has recruited 43 participants, with final data collection to be completed by July 2019. Data analysis will commence after final data collection, with results expected to be published by the end of 2019.

Conclusions: This study is the first of its kind to explore individualized diabetes management for community-dwelling older people, with an aim to achieve optimal glycemic levels (glycated hemoglobin between 53 and 69 mmol/mol [7%-8.5%] depending on the fitness and frailness of the older individual). The data drawn from this study may be used to inform policy makers, service providers, clinicians, and older adults living with diabetes.

International Registered Report Identifier (irrid): DERR1-10.2196/13986.
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http://dx.doi.org/10.2196/13986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592394PMC
June 2019

Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations.

Health Expect 2019 10 11;22(5):1058-1068. Epub 2019 Jun 11.

Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia.

Background: Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems.

Objective: To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action.

Design: Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study.

Setting And Participants: Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations.

Interventions: Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care.

Main Outcome Measures: Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA.

Results: The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples.

Discussion And Conclusions: The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.
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http://dx.doi.org/10.1111/hex.12923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803401PMC
October 2019

Engagement of primary care practice in Australia: learnings from a diabetes care project.

Aust J Prim Health 2019 Mar;25(1):82-89

Bolton Clarke Research Institute, Suite 1.01, 973 Nepean Highway, Bentleigh, Vic. 3204, Australia; and Present address: Latrobe University, Kingsbury Drive, Bundoora, Vic. 3083, Australia.

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.
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http://dx.doi.org/10.1071/PY18057DOI Listing
March 2019

'One size does not fit all': Perspectives on diversity in community aged care.

Australas J Ageing 2018 Dec 13;37(4):268-274. Epub 2018 May 13.

Bolton Clarke Research Institute, Melbourne, Victoria, Australia.

Objectives: Typically, older people are viewed via a single health condition, yet health outcomes are likely impacted by the intersection of many individual characteristics. Promoting inclusive health care is underpinned by reducing bias, respectful communication and supporting individual needs and preferences. This study explores perspectives of community aged care workers on diversity training and implementing training into practice.

Methods: Ninety community aged care workers were telephone-interviewed three months after a one-day diversity training workshop. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results: Five themes emerged: 'raising awareness'; 'reserving judgement'; 'confidence and empowerment to embed diversity into practice'; 'communicating effectively'; and 'thinking about change … but'.

Conclusions: Diversity concepts were positively received, but applying diversity principles into practice is more difficult. Recommendations to promote inclusive health care included raising awareness of bias, communicating with inclusive language and embedding diversity concepts into community aged care practice by addressing individual, organisational and wider system constraints.
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http://dx.doi.org/10.1111/ajag.12534DOI Listing
December 2018

Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool.

Int Wound J 2018 Oct 13;15(5):686-694. Epub 2018 Mar 13.

Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.

The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0.83 (95% CI, 0.76-0.90, P < .001). The prospective study (n = 143) observed that 50.4% (n = 63) of venous leg ulcers recurred within 12 months of healing. Participants were classified using the risk assessment tool as being at low risk (28%), moderate risk (59%), and high risk (13%); the proportion of wounds recurring at 12 months was 15%, 61%, and 67% for each group, respectively. Validation results indicated good discrimination and goodness of fit, with an AUC of 0.73 (95% CI, 0.64-0.82, P < .001). Validation of this risk assessment tool for the recurrence of venous leg ulcers provides clinicians with a resource to identify high-risk patients and to guide decisions on adjunctive, tailored interventions to address the specific risk factors to decrease the risk of recurrence.
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http://dx.doi.org/10.1111/iwj.12911DOI Listing
October 2018

Predicting delayed healing: The diagnostic accuracy of a venous leg ulcer risk assessment tool.

Int Wound J 2018 Apr 26;15(2):258-265. Epub 2017 Dec 26.

Faculty of Health, Queensland University of Technology, Brisbane, Australia.

The aim of this study was to validate a newly developed tool that can predict the risk of failure to heal of a venous leg ulcer in 24 weeks. The risk assessment tool was validated, and performance of the tool was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Retrospective and prospective validation was conducted through multi-site, longitudinal studies. In the retrospective study (n = 318), 30% of ulcers did not heal within 24 weeks, with the tool demonstrating an AUC of 0.80 (95% CI, 0.68-0.93, P < .001) for the total score. In the prospective study across 10 clinical sites (n = 225), 31% (n = 68) of ulcers did not heal within 24 weeks. Participants were classified with the RAT at enrolment as being at low risk (27%), moderate risk (53%) or high risk (20%) of delayed healing; the proportion of wounds unhealed at 24 weeks was 6%, 29% and 59%, respectively. Validation results of the total score indicated good discrimination and goodness of fit with an AUC of 0.78 (95% CI, 0.71-0.85, P < .001). Validation of this risk assessment tool offers assurance that realistic outcomes can be predicted for patients, and scores can guide early decisions on interventions to address specific risk factors for failing to heal, thus promoting timely healing.
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http://dx.doi.org/10.1111/iwj.12859DOI Listing
April 2018

A review of current models for initiating injectable therapy for people with type 2 diabetes in primary care.

J Clin Transl Endocrinol 2017 Jun 22;8:54-61. Epub 2017 May 22.

RDNS Institute, Melbourne, Australia.

Aims: To systematically identify and describe models of injectable therapy initiation for people with type 2 diabetes mellitus (T2DM) in primary care.

Methods: Eight electronic databases and the grey literature were searched. Studies examining models of injectable therapy initiation for adults with T2DM in primary care settings were included.

Results: Successful models included: 1) Nurse-led one-to-one approach; 2) Nurse-led group sessions; and 3) Providing education to GPs and nurses.

Conclusions: Few robust studies were found. Studied models were mainly in general practices, with limited evidence documented about starting people with T2DM on an injectable in the home setting.
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http://dx.doi.org/10.1016/j.jcte.2017.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651335PMC
June 2017

Diversity training for the community aged care workers: A conceptual framework for evaluation.

Eval Program Plann 2017 08 23;63:74-81. Epub 2017 Mar 23.

RDNS Institute, 31 Alma Rd, St Kilda, Victoria, 3182, Australia; Monash University, Wellington Rd & Blackburn Rd, Clayton, Victoria, Australia; International Institute for Primary Health Care Research, Shenzhen, China. Electronic address:

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older people's experience of healthcare.
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http://dx.doi.org/10.1016/j.evalprogplan.2017.03.007DOI Listing
August 2017

Co-creating a Peer Education program to improve skin health in older people from diverse communities: An innovation in health promotion.

Australas J Ageing 2017 Jun 20;36(2):E27-E30. Epub 2017 Mar 20.

Dermal Science and Therapy, Victoria University, Melbourne, Victoria, Australia.

Objective: Chronic wounds, debilitating and costly to manage, are more common in older people. Prevention is possible through improving skin health. We developed, implemented and evaluated an innovative health promotion program to improve skin health of older adults.

Methods: A one-hour, peer education program was co-created and delivered to culturally diverse community-dwelling older people. A mixed-methods evaluation approach comprised objective measures of skin health and barrier function at commencement and six weeks posteducation, and focus groups posteducation.

Results: Seventy-three participants participated in the study (mean age 74.38 ± 11.80 years). Hydration significantly improved at follow-up for English speaking participants (t(27) = -2.90, P = 0.007). The majority of participants reported the education to be informative and useful in supporting behaviour changes.

Conclusion: The peer education program improved skin hydration in older English speaking individuals. Peer education may effectively deliver health promotion information in some groups.
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http://dx.doi.org/10.1111/ajag.12401DOI Listing
June 2017

Clinical leadership and nursing.

Aust Nurs Midwifery J 2015 Aug;23(2):45

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August 2015

A pilot study evaluating protein abundance in pressure ulcer fluid from people with and without spinal cord injury.

J Spinal Cord Med 2015 Jul 26;38(4):456-67. Epub 2014 Jun 26.

Objective: To determine whether the biochemistry of chronic pressure ulcers differs between patients with and without chronic spinal cord injury (SCI) through measurement and comparison of the concentration of wound fluid inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases.

Design: Survey.

Setting: Tertiary spinal cord rehabilitation center and skilled nursing facilities.

Participants: Twenty-nine subjects with SCI and nine subjects without SCI (>18 years) with at least one chronic pressure ulcer Stage II, III, or IV were enrolled.

Outcome Measures: Total protein and 22 target analyte concentrations including inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases were quantified in the wound fluid and blood serum samples. Blood samples were tested for complete blood count, albumin, hemoglobin A1c, total iron binding capacity, iron, percent (%) saturation, C-reactive protein, and erythrocyte sedimentation rate.

Results: Wound fluid concentrations were significantly different between subjects with SCI and subjects without SCI for total protein concentration and nine analytes, MMP-9, S100A12, S100A8, S100A9, FGF2, IL-1b, TIMP-1, TIMP-2, and TGF-b1. Subjects without SCI had higher values for all significantly different analytes measured in wound fluid except FGF2, TGF-b1, and wound fluid total protein. Subject-matched circulating levels of analytes and the standardized local concentration of the same proteins in the wound fluid were weakly or not correlated.

Conclusions: The biochemical profile of chronic pressure ulcers is different between SCI and non-SCI populations. These differences should be considered when selecting treatment options. Systemic blood serum properties may not represent the local wound environment.
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http://dx.doi.org/10.1179/2045772314Y.0000000212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612201PMC
July 2015

The metamorphosis of a collaborative team: from creation to operation.

J Interprof Care 2014 Jul 4;28(4):339-44. Epub 2014 Mar 4.

Department of Sociology, University of Western Ontario , London, Ontario , Canada .

This paper reports on the process of developing a community-based interprofessional team to provide diabetes related foot ulcer care. A new interprofessional team was formed in a local community, and the process of building a successful team was examined by the adoption of an exploratory qualitative case study approach that gathered a series of one-on-one interviews with participants at three points in time - prior to the team's formation, two months into the team's operation, and finally seven months later - shortly before the team and its clinic closed. Interviews were also conducted with a small sample of the team's patients. The factors linked to the successes and challenges of building a care team in a community setting are explored. Informants highlighted the value of regular team meetings, role clarity, and a commitment to patient-centered care. However effective collaboration was not sufficient to maintain the team in the face of poor institutional and government support.
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http://dx.doi.org/10.3109/13561820.2014.891571DOI Listing
July 2014

Development of a Translation Standard to support the improvement of health literacy and provide consistent high-quality information.

Aust Health Rev 2013 Sep;37(4):547-51

Royal District Nursing Service, 31 Alma Road, St. Kilda, Vic. 3182, Australia.

Australia has a high number of people from culturally and linguistically diverse (CALD) backgrounds whose primary language is not English. CALD population groups have comparatively lower levels of education and health literacy, and poorer health outcomes compared with the Australian-born population. The delivery of consumer health information to people from CALD backgrounds usually includes the use of translated resources. Unfortunately, the quality of translated resources available on health issues is highly variable and may impact efforts to address the disparities in health outcomes. Currently applied guides to translation focus on accuracy and literalness of the translation; however, for health translations, conveying meaning and incorporating culturally relevant information is essential. Minimum standards for developing translated resources are needed to provide an indication of quality for end users, including healthcare providers, the client and carer. This paper describes the development of a Translation Standard, led by a community nursing organisation in collaboration and consultation with CALD community members and peak community organisations in Melbourne, Australia. The Translation Standard includes 10 components that have been identified as necessary to ensure a minimum standard of translation that is of high quality and caters to the health literacy levels of the target audience.
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http://dx.doi.org/10.1071/AH13082DOI Listing
September 2013

Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team.

Int Wound J 2015 Aug 9;12(4):377-86. Epub 2013 Jul 9.

Department of Internal Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.
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http://dx.doi.org/10.1111/iwj.12119DOI Listing
August 2015

Oxygen tension assessment: an overlooked tool for prediction of delayed healing in a clinical setting.

Int Wound J 2011 Oct;8(5):437-45

Endocrine Centre of Excellence, Heidelberg Repatriation Hospital, Austin Health Heidelberg, Melbourne, Australia.

Successful wound healing requires adequate transcutaneous oxygen tension (tcpO(2) ). TcpO(2) may not commonly be incorporated in clinical assessments because of variable measurement response at different sensory temperatures. This study aims to assess the relationship between changes in tcpO(2) , measured under basal (39°C) and stimulated (44°C) conditions and healing rate of chronic wounds over 4 weeks, to determine whether tcpO(2) measurement can predict delayed wound healing. TcpO(2) (Radiometer TCM400) measurements at sensor temperatures 39 and 44°C were recorded (twice, 4 weeks apart) adjacent to the ulcer site, and at a mirror image site on the contralateral leg. Ulcer outline was traced on clear acetate and perimeter and area measured (Visitrak™, Smith and Nephew). TcpO(2) measured at 44 and 39°C adjacent to all 13 wounds were lower compared to the contralateral site, significant at 44°C (P = 0·008). Significant correlation (r(2) = 0·8) occurred between wound healing rate and increased tcpO(2) at 44°C over 4 weeks. Importantly, the ratio of 39/44°C tcpO(2) , measured at the initial appointment, appeared to predict normal or delayed healing rate. TcpO(2) may provide clinicians with information regarding anticipated healing ability of wounds at the initial appointment, and hence identify wounds requiring early implementation of adjuvant therapies to accelerate healing.
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http://dx.doi.org/10.1111/j.1742-481X.2011.00784.xDOI Listing
October 2011

The use of sensory nerve stimulation and compression bandaging to improve sensory nerve function and healing of chronic venous leg ulcers.

Curr Aging Sci 2009 Mar;2(1):72-80

Endocrine Centre of Excellence, Heidelberg Repatriation Hospital, Melbourne, Australia.

Unlabelled: Low frequency transcutaneous sensory nerve stimulation (LF-SNS) [International Patent PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z.)] improves sensory nerve function and accelerates wound healing of older animals.

Intervention: Double blind, placebo controlled randomised trial of LF-SNS for 5 minutes, twice daily for up to 12 weeks, on healing of chronic venous leg ulcers in older people. Four layer compression bandaging was the standard therapy. OUTCOME MEASURES (METHODS): Wound healing and the rate of epithelialisation (calculated from serial wound area estimation), microvascular blood flow (measured using LASER Doppler flowmetry), transcutaneous oxygen tension (measured using a transcutaneous oxygen monitor, TCM400 Radiometer). Sensory nerve activity (assessed via measuring electrical cutaneous perception threshold using the Neurometer((R))CPT and the flare response to 5% capsaicin (a selective activator of C fibres).

Participants: 14 older people with chronic venous ulcers randomly allocated to active (mean age 74.8+/-2.3 years) and 15 to Sham nerve stimulation (mean age 76.5+/-2.6 years).

Results: Microvascular blood flow improved in all participants. A high proportion of wounds healed ( approximately 60%). There were trends for better C-fibre function and faster healing rates in the Active group (1.1+/-0.3 cm(2)/wk) compared to the Sham group (0.6+/-0.2 cm(2)/wk) but failed to reach statistical significance due to the small sample size.

Conclusions: The improvement in microvascular blood flow in both groups was an unexpected finding that has not previously been described. Most likely this was due to the four layer compression bandaging provided to all participants. Improved microvascular blood flow may be a significant contributor to wound healing. The observed trends to increased healing rates and improvements in C-fibre function in the actively stimulated group compared to the sham group warrant further studies of LF-SNS as an adjunct therapy for chronic venous leg ulcers. An exploration of the possibility that LF-SNS induced-improvement in C-fibre function could protect against future ulceration is also warranted.
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http://dx.doi.org/10.2174/1874609810902010072DOI Listing
March 2009

The effect of sensory nerve stimulation on sensory nerve function in people with peripheral neuropathy associated with diabetes.

Neurol Res 2007 Oct;29(7):743-8

University of Sharjah, Sharjah, UAE.

Objective: To assess the effect of sensory nerve stimulation in older people with peripheral neuropathy associated with diabetes (DPN).

Materials And Methods: A randomized, placebo controlled, double blind trial was used to assess the effect of 12 weeks of low frequency sensory nerve stimulation (LF-SNS) in the lower limb [International Patent Application No. PCT/AU2004/001079: 'nerve function and tissue healing' (Z. Khalil)]. Response to capsaicin, basal microvascular blood flow, electric cutaneous threshold and oxygen tension were assessed pre- and post-treatment and between limbs.

Participants: People 55 years of age or older diagnosed with DPN: 35 active and 31 placebo participants.

Results: Between groups comparisons: no significant differences occurred between stimulation groups. Within subject comparisons: in the active LF-SNS group, comparing stimulated to contralateral legs, there were significant increases in size of capsaicin flare [t(1,33)=3.65, p<0.05] and capillary blood flow [t(1,34)=-0.33, p<0.05]. There was a trend to improvement in time to initial flare response [t(1,34)=-1.86, p=0.07]. No changes were evident in the placebo group. RESPONDER ANALYSES: In a group of 'responders', the time to initial flare response (p<0.05, r=0.64), size of capsaicin flare (p<0.05 r=1.0) and microvascular blood flow (p<0.05, r=0.60) improved significantly after LF-SNS.

Conclusions: The observed data suggest that LF-SNS improves nerve function in a subset of people with DPN. Targeting toward probably 'responders' may deliver the greatest benefit from short-term therapy. Testing optimal application in others seems warranted.
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http://dx.doi.org/10.1179/016164107X208095DOI Listing
October 2007

Foot assessment in patients with diabetes.

Aust Fam Physician 2006 Jun;35(6):419-21

Repatriation Campus, Austin Health, Heidelberg, Victoria.

Background: Diabetes has long been associated with increased risk of foot ulceration and lower extremity amputation.

Objective: This article briefly describes the risk factors, assessments and management of people with diabetes, to guide physicians to identify and appropriately refer people with diabetes at risk of foot problems.

Discussion: The literature is clear that the presence of peripheral neuropathy associated with diabetes, foot deformity, peripheral arterial disease, and poor glycaemic control increase the risk of foot complications. By annually undertaking foot screening of all people with diabetes, those at risk can be identified and referred for appropriate management. Until screening is undertaken regularly on all patients with diabetes, the currently high rates of foot ulceration and lower extremity amputation will continue.
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June 2006

Use of the sensory nerve stimulator to accelerate healing of a venous leg ulcer with sensory nerve dysfunction: a case study.

Int Wound J 2005 Sep;2(3):242-51

National Ageing Research Institute, The University of Melbourne, PO Box 31, Parkville, Victoria 3052, Australia.

A new therapy using sensory nerve stimulation [International Patent Application Number PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z)] has been developed in our vascular physiology laboratory. This treatment has been found to improve the deficient sensory nerve function and associated deficient wound healing of older persons to levels seen in young people. An 82-year-old man with a small but persistent venous leg ulcer for 18 months, despite apparently appropriate wound dressings and compression therapy, was seen in a specialist wound management service. The patient's sensory and microvascular function was assessed in great detail using the vascular physiology laboratory techniques, and he was provided the sensory nerve stimulation therapy in addition to conventional therapy. His wound healed after 4 weeks. We report the case here. Prior to nerve stimulation therapy, cutaneous sensation, microvascular blood flow and oxygen tension were found to be reduced near the ulcer when compared with the opposite, non ulcerated leg. After therapy, oxygen tension and microvascular blood flow had improved. This case provides further evidence that sensory nerve stimulation therapy at the stipulated parameters improves wound healing. The observation that sensory nerve function improved provides support for the notion that improvement in healing is mediated by improved nerve function.
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http://dx.doi.org/10.1111/j.1742-4801.2005.00122.xDOI Listing
September 2005

Age-related changes in microvascular blood flow and transcutaneous oxygen tension under Basal and stimulated conditions.

J Gerontol A Biol Sci Med Sci 2005 Feb;60(2):200-6

National Ageing Research Institute, The University of Melbourne, Poplar Road Parkville, Melbourne Victoria, 3052.

Background: Adequate cutaneous microvascular blood flow and tissue oxygen tension are important prerequisites for successful tissue repair. The efficacy of tissue repair decreases with age and is linked to the age-related functional decline of unmyelinated sensory neurons that are important for inflammation and tissue repair. However, available information on the effect of these neuronal changes on microvascular blood flow and tissue oxygen tension is limited, particularly under control and injury conditions. The authors had two aims in this study: (a) to assess age-related changes in the relationship between microvascular blood flow and tissue oxygen perfusion under basal and two different stimulated conditions (sensory dependent and sensory independent), and (b) to clarify the biological meaning of transcutaneous partial pressure of oxygen (tcPO2) measurements.

Methods: The effects of a sensory-independent vasodilator (acetylcholine) and a sensory-dependent vasodilator (capsaicin) on microvascular blood flow and oxygen perfusion in persons of different ages were measured. Laser Doppler flowmetry and a commercially available transcutaneous oxygen monitor (with sensors set at 39 degrees C and 44 degrees C) were used. Healthy volunteers were recruited: 11 young, 14 middle aged, and 19 older.

Results: Under basal conditions (skin temperature, 37 degrees C to 39 degrees C), both basal blood flow and tcPO2 increased with increasing age. However, with the sensor set at 44 degrees C, tcPO2 showed a significant decrease with age. Acetylcholine increased blood flow approximately equally in the three age groups. Capsaicin increased blood flow and tcPO2 in all age groups, with the young showing a greater increase compared with the older participants.

Conclusions: The age-associated changes in basal and stimulated microvascular blood flow and tcPO2 could be attributed in part to altered neuronal function. Measuring tcPO2 at 39 degrees C showed a trend toward an increase with age. In contrast, a decrease with age was observed when tcPO2 was measured at 44 degrees C, a temperature sufficient to activate sensory nerve endings. The results may reflect a decline in sensory nerve function with age rather than a decrease in oxygen delivery for vascular reasons. This is supported by the complementary data showing a significant age-related decrease in stimulated blood flow in response to capsaicin, with no change in the response to the sensory-independent vasodilator acetylcholine. Thus, for clinical purposes, data obtained using the tcPO2 monitor should be interpreted with full knowledge of the conditions under which the measurements were made. Furthermore, for scientific purposes, the tcPO2 monitor could be used to assess sensory nerve function when sensors are heated to 44 degrees C.
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http://dx.doi.org/10.1093/gerona/60.2.200DOI Listing
February 2005